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anemia Flashcards

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1
Q

what is a red blood cell called

A

erythrocyte

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2
Q

what is the survival time of an erythrocyte

A

120 days

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3
Q

how are erythrocytes produced?

A

they are produced in the bone marrow and eventually released into the circulation.
erythropoietin is an important stimulus for the production.
hemoglobin & iron are incorporated into maturing erythrocytes prior to their release into the circulation.

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4
Q

______ delivers iron to the bone marrow for incorporation into Hgb

A

transferrin

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5
Q

excess iron is stored as _____

A

ferritin

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6
Q

what is anemia?

A

an objective sign of a disease
a decrease in proportion of RBCs (reduced oxygen carrying capacity of blood)
WHO defines as Hgb <13 (men) or <12 (women) or <11 (children)

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7
Q

in whom is anemia more common?

A

females of reproductive age, pregnancy, elderly (in elderly vastly due to nutritional deficiency or CKD)

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8
Q

GENERAL causes of anemia

A

blood loss
decreased RBC production
increased RBC destruction

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9
Q

classifications of anemia based on MORPHOLOGY?

A

macrocytic (large RBCs): B12/folate deficiency
microcytic (small RBCs): iron deficiency, genetic anomaly
normocytic: blood loss or hemolysis, chronic disease

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10
Q

classifications of anemia based on ETIOLOGY?

A

deficiency: iron, B12, folate, pyridoxine
impaired bone marrow function: chronic disease
peripheral cause: bleeding, hemolysis

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11
Q

classifications of anemia based on PATHOPHYSIOLOGY?

A

blood loss/hemorrhage
RBC production: RBC antibodies, medications, genetics, deficiency in Hgb synthesis
Inadequate production: deficiency of nutrients, endocrine abnormalities, renal disease, inflammation, hepatic disease

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12
Q

what are the mechanisms of anemia

A

increased destruction: blood loss, surgery, trauma, hemorrhage, menses
hemolytic anemia: autoimmune, infectious, sickle cell, G6PD
deficient or defective erythropoiesis

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13
Q

what are some pieces of a patient’s history that may indicate anemia

A

bleeding, diet including alcohol, eating of non foods like ice, stools fatty, hemorrhoids, surgical history, family history, meds

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14
Q

what are some symptoms of anemia

A

skin cool to touch
tachypnea & hypotension
pale
jaundice
glossitis, cheilitis
splenomegaly, hepatomegaly
tachycardia, murmur
decreased perception of vibration
rectal bleeding

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15
Q

what are some objective signs of anemia

A

CBC with differential
Hgb <13 (male), <12 (female)
hematocrit (normal is 41-53% male, 36% female)
absolute reticulocyte count >2% suggests hemolysis or acute blood loss
mean corpuscular volume (normal 80-100)

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16
Q

what is mean corpuscular volume

A

the average volume of RBCs

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17
Q

in microcytic anemia, mean corpuscular volume is ____, and this can mean ______

A

low
iron deficiency, lead poisoning

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18
Q

in normocytic anemia, mean corpuscular volume is ____, and this can mean _____

A

normal
renal failure

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19
Q

in macrocytic anemia, mean corpuscular volume is _____, and this can mean _____

A

high
B12 and folate deficiency

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20
Q

normal content of iron in the body?

A

~3-4 g (2.5 exists in hemoglobin)
~400 mg iron containing proteins (myoglobin)
3-7 mg bound to transferrin
remaining is stored in form of ferritin

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21
Q

iron is absorbed in which form?

A

the ferrous (Fe2+) form
normally it is in the diet as ferric (3+) form and ionized by the stomach acid

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22
Q

how is iron absorption correlated to iron intake?

A

it is not a direct correlation
as physiologic iron levels decrease, GI absorption of iron increases

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23
Q

which type of anemia is the most common nutritional deficiency

A

iron deficiency anemia

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24
Q

who is at highest risk for iron deficiency anemia

A

children <2, adolescent girls, pregnant females, elderly >65, malabsorptive syndromes, diet, blood loss

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25
which foods contain dietary iron
leafy greens, tofu, red meat, raisins, dates
26
what is the recommended iron dietary allowance for the following groups: Males, postmenopausal females, menstruating females, pregnant females, lactating females, children
adult males, postmenopausal females: 8 mg menstruating females: 18 mg pregnant females: 27 mg lactating females: 9 mg children: 1-2 mg/kg/day (up to 20 mg/day)
27
what is a normal range of serum iron
male ~ 50-160 female ~ 40-150
28
treatment of iron deficiency anemia?
if life threatening blood loss: PRBC transfusion is indicated if not life threatening: oral or IV iron
29
how to dose PO iron??
65 mg every other day (or MWF) (all products are equally effective, avoid enteric coated) ferrous sulfate, gluconate, fumarate, maltol
30
why is PO iron not recommended to be dosed TID?
as iron levels increase, absorption decreases, so less frequent dosing is just as effective and reduces ADEs
31
notable counseling for iron
GI effects: constipation, n/v, diarrhea metallic taste administer 1 hour before meals
32
drugs interactions that decrease iron absorption
antacids (Al, Mg, Ca) tetracyclines H2RAs PPIs cholestryramine
33
drugs that are affected by iron
tetracyclines quinolones synthroid methyldopa, levodopa penicillamine mycophenolate
34
when is IV iron replacement preferred over PO?
poor GI absorption failed PO iron (didn't respond, poor tolerability) CKD IBD chronic, excessive blood loss gastric bypass
35
IV iron products: efficacy and safety?
all equally effective but differ by concentration of iron, administration details. ex: iron sucrose (Venofer) infusion reactions usually self limiting: fever, arthralgias, muscle spasms, anaphylaxis (rare)
36
how to calculate total iron replacement dose?
mg of iron= 0.6 x wt (kg) x [100-(actual hemoglobin/12 x 100)]
37
when does full repletion of iron stores occur after administration of iron therapy?
~6-8 weeks
38
what is megaloblastic anemia?
macrocytosis caused by abnormal DNA metabolism resulting from vitamin B12 or folate deficiency
39
what kind of drugs can cause megaloblastic anemia?
chemo phenytoin methotrexate
40
_______ is required for vitamin B12 absorption
intrinsic factor
41
what are risk factors for vitamin B12 deficiency?
inadequate absorption (vegan, alcoholics, elderly) pernicious anemia (absence of intrinsic factor- gastric bypass surgery) cobalamin malabsorption (prolonged use of PPIs, H2RAs, metformin)
42
signs & symptoms of B12 deficiency anemia
neuro findings: numb, paresthesias, peripheral neuropathy, ataxia, diminished vibratory sense, decreased proprioception, imbalance, vision changes, psychiatric glossitis (inflamed tongue) muscle weakness
43
source & storage of B12?
NOT synthesized: have to obtain it through dietary sources. best sources are organs, beef, chicken, pork, fish, dairy, seafood, yeast, fortified cereal liver stores B12 for a 3 year supply
44
RDA of B12 in children, adults, pregnant
children- 0.2 mcg/d adults- 1 mcg/d pregnant- 1.5 mcg/d
45
how long does vit B12 deficiency take to develop
YEARS
46
treatment of vitamin B12 deficiency anemia??
1. dietary modifications 2. oral 1-2 mg daily if marginally low 3. IM B12 if severe, symptomatic, or neuro findings: 1000 mcg daily x 1 week, then 1000 mcg weekly x 1 month, then monthly thereafter.
47
lab tests for B12
a normal serum B12 level is 100-900 but elders can have neurological sx with low normal levels and no anemia
48
monitoring for B12 treatment?
resolution of anemia: Hgb, Hct, reticulocyte, B12, MCV neurological symptom improvement
49
normal folic acid in the body?
5-10 mg, primarily in the liver
50
folic acid is necessary for _____ is destroyed by ____
necessary for production of nucleic acids, proteins, amino acids, purine-- and hence RNA and DNA water soluble vitamin destroyed by cooking/processing
51
sources of folic acid?
humans unable to synthesize depends on dietary sources mandated fortification of grain products with folic acid
52
daily recommended allowance of folic acid for the following groups: general population, non-pregnant females, pregnant females, lactating females
general population: 50-100 non-pregnant females: 400 mcg pregnant females: 600 mcg lactating females: 500 mcg
53
a congenital abnormality caused by folic acid deficiency
neutral tube defects
54
how to prevent neural tube defects
all women take 0.4 mg folic acid daily beginning 1 month pre-conception. increase to 4 mg/day if previous NTD pregnancy
55
which drugs are associated with risk of NTD?
anti-epileptics such as valproic acid
56
risk factors for folic acid deficiency anemia
eating habits, malabsorptive syndromes, pregnancy, hemolytic anemia, chronic inflammatory disorders (RA), long-term dialysis, drugs
57
which drugs can cause folic acid deficiency anemia
azathioprine, 6MP, 5FU MTX, pentamidine, TMP phenytoin, phenobarbital, primidone
58
signs & symptoms of folic acid deficiency anemia
decr exercise tolerance, fatigue, dizziness, irritable, weak, palpitations, vertigo, SOB, chest pain, tachypnea sensitivity to cold, decreased mental acuity, pale, glossitis, muscle weakness, dysphagia, anorexia
59
lab tests for folic acid deficiency anemia?
folic acid: reference range 3-20 MCV>100 (macrocytic) absolute reticulocyte count
60
treatment of folic acid deficiency anemia
dietary modifications oral folic acid: 1 mg daily in most cases, 1-5 mg daily in malabsorption, 500 mcg with anticonvulsant drugs
61
duration of treatment for folic acid deficiency
~4 months if underlying cause can be corrected long term in chronic conditions
62
which anemia causes a decreased perception of vibration
B12
63
menstruating females need ____ iron
18 mg
64
pregnant females need ____ iron
27 mg
65
what is pernicious anemia
body can't absorb B12 because it lacks intrinsic factor (gastric bypass)

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