Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med- Heme/Oncol > Anemia > Flashcards

Anemia Flashcards

(81 cards)

Start Studying
1
Q

the WHO defines anemia as?

A

♀ Hct < 41% /Hg < 4,000,000/mm3

Different institutions will have slight variations to reference ranges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anemia

A

an indication of an underlying disease process

It is characterized by a decrease in RBC Mass Leading to a Decrease in Oxygen Carrying Capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which organ produces blood cells?

A

The Bone Marrow (BM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

To facilitate adequate RBC production, the BM must be able to Maintain Homeostatic balance of?

A

Macrophages that supply Fe++ for Hgb production
Fibroblasts to support BM integrity
Adipocytes that store energy as fat
Osteoblasts and osteoclasts supporting the boney trabeculae
Precursors of Blood Cell Production
Maintain vascular integrity as a conduit between BM and peripheral circulation
Maintain erythroid stem cells responsive to Erythropoietin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Erythropoietin

A

regulating hormone
Secreted by kidney
Governs day-today RBC production
O2 availability is main EPO stimulus
EPO binds to erythroid precursor receptors
EPO levels should increase in proportion to anemia severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Erythropoietin is inversely related to?

A

HCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does Erythropoietin do?

A

Increases RBC production (4-5x) and speed maturity of RBCs

Iron, B12, folate are needed substrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the lifespan of a RBC in peripheral blood?

A

Lifespan of an RBC in Peripheral Blood is 120 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Epidemiology of Erythropoiesis

A

African Americans have relatively lower RBC mass
Older adults Have a Deceased RBC mass
20% have <12 g/dL
Tissue hypoxia and ↑ cardio output
Increased falls, confusion, frailty, muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Athletes can present with?

A

“Dilutional Pseudoanemia”—increased energy demand, increases O2 demand—with initial Plasma Vol increase followed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Changes in Plasma Volume May Decreases or Increase RBC Concentration Regardless of RBC Mass

A

Acute Bleeding– Decrease Intra-vascular Volume– Normal Hgb and Hct (Concentration)
When Normal Volume is Restored the patient will demonstrate Anemia
Dehydration:
Pregnancy:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does pregnancy cause changes in plasma volume?

A

Plasma volume increases faster that RBC mass, therefore the patient may appear falsely anemic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does dehydration cause changes in plasma volume?

A

presents with normal or elevated Hgb & Hct, but once hydrated the Hgb & Hct may Reveal the Patient to be Anemic ( Decreased RBC Mass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Reticulocyte

A

immature RBC that is Stained with Methylene Blue and reveals residual Ribosomal RNA as beads of tiny deep blue precipitates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does the clinical presentation of anemia depend on? (4)

A

Rapidity of Onset
Severity
Patient’s Physiologic Age & Co-morbidities
Physiologic Responses e.g. increase in 2,3-diphosphoglycerate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some symptoms of anemia?

A 
DOE
Fatigue
Palpitations
Headache
Tinnitus
Chest pain (esp. in patients with CAD)
Esophageal rings: Schatzki’s rings in Chronic Fe Deficiency
Spooning of Nails (Fe Deficiency)
Picas (Fe Deficiency)
Neuropathies (B12 Deficiency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some clinical signs of anemia?

A 
Tachycardia
Orthostatic hypotension
Hypotension if acute
Systolic ejection murmur
Pallor:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where are you going to look for pallor in anemic patients?

A 
Palmar creases 
If lighter than surrounding skin Hg < 8g/dL
Best physical sign indicator
Palpebral conjunctiva
Skin
Oral mucous membranes 
Nail beds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 4 GI signs associated with anemia?

A

Jaundice
Positive stool guaiac
Splenomegaly
Hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 3 MSK signs associated with anemia?

A

Pale, cold extremities
Bone tenderness
Frontal Bossing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Microcytic (and hypochromic) Anemia

A

Mean Corpuscular Volume (MCV) < 80 mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Main Causes of microcytic anemia

A

Thalassemia minor/major

Iron Deficiency Anemia
Most common cause anemia

Anemia of Chronic Diseases/Inflammatory Diseases
Sideroblastic Anemias and Pb Poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Iron deficiency anemia epidemiology

A

Accounts for 50% of Anemias Worldwide
Accounts for > 800,000 Deaths/year Worldwide
> 70% of Iron Deficiency Anemia Deaths are in Africa & Asia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lab evaluations for iron deficiency anemia

A

Serum Iron, Fe: Iron Bound to Transferrin in the Serum

Total Iron Binding Capacity, TIBC: Total Transferrin in the Serum

Fe/TIBC is the % Saturation of Iron to Iron Binding Capacity (Transferrin)

Serum Ferritin: A Rough Estimate of Iron Stored in the Reticuloendothelial System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Causes (DDX) of Iron Deficiency Anemia
``` GI Bleeding*** Excessive Menstruation Malnutrition & Dietary Insufficiency Celiac sprue Crohn’s Disease Subtotal gastrectomy Pregnancy Growth Spurts in Childhood Blood Donation, Blood Loss in Dialysis & Factious Auto-phlebotomy ```
26
Specific Clinical Manifestations of Iron Deficiency Anemia
``` Angular Cheilosis PICA Koilonychia (spoon nails) Plummer-Vinson Syndrome Fe++ def anemia, esophageal webs, dysphagia and atrophic glossitis ```
27
inital eval of someone you suspect is anemic?
``` CBC Ferritin level Wright-stained Peripheral Smear Degree of Anisocytosis and Poikilocytosis (Increased RDW) decreased Fe increased TIBC Saturation < 10% Ferritin < 20 ng/dL ```
28
Treatment of Iron deficiency
oral iron supplement -ferrous sulfate = MC can also be given IV or IM
29
Why would iron be given IM or IV?
Patients Intolerant to Oral Preparation If More Rapid Correction of Fe Deficiency Anemia is Needed If Patient Cannot Absorb Oral Iron If Chronic Blood Loss  Fe Loss > Oral Repletion is Possible Patients on Dialysis
30
Why can the treatment fail?
``` Unidentified blood loss Non-adherence Incorrect diagnosis GI malabsorption Achlorhydria PPIs Crohn’s etc. S/P Gastrectomy ```
31
Side effects of iron supplements?
Constipation, black stools, nausea, bloating abdominal pain, & diarrhea
32
What increases iron absorption?
vit c--> orange juice
33
Alpha-Thalassemia:
↑prevalence in Malaria Regions: | Southeast Asia & China
34
Beta-Thalassemia:
↑ prevalence in Mediterranean populations (Southern Italy, Greece & North Africa)
35
Thalassemia Syndromes
Genetic disorder characterized by inadequate production of either the Alpha or Beta-globin chain of hemoglobin
36
What are Heinz bodies?
Are precipitants of excess Alpha chains in Beta-Thalassemia Are precipitants of excess Beta chains in Alpha-Thalassemia They Impair DNA synthesis   RBC Production They Damage RBC Membrane   RBC Destruction
37
Thalassemia Clinical features
Positive family history History of life-long hypochromic, microcytic anemia not responsive to Fe++ From silent carrier status to profound anemia: Depends on genetic defects
38
Complications of Beta-Thalassemia Major (Cooley’s Anemia)
``` Growth retardation Severe anemia Abnormal facial structure Pathologic fractures & Osteopenia Hepatosplenomegaly Jaundice and bilirubin gall stones High out put CHF Short life span (< 30 years) ```
39
What lab findings confirm the diagnosis of Cooley's anemia?
Hg electrophoresis increase Hgb F (in both Thalassemias) Hgb A decrease Beta Thal, but ↑ Hgb A2 Hgb H in severe Alpha Thalassemia
40
What would be seen on peripheral smear for Cooley's anemia?
Small, pale RBCs Target cells Nucleated erythroblasts Basophilic stippling
41
Thalassemia Treatment
Transfusions + deferoxamine (to prevent iron overload) Keep Hgb >12 g/dL Splenectomy Experimental Allogeneic Hematopoietic Stem Cell Transplantation (BM transplant) in severe cases Avoid Iron containing Supplements
42
Iron Overload can cause what?
``` Heart Failure Liver Failure Pancreatic Failure with DM & Malabsorption Other Endocrine Abnormalities Skin Pigmentation ```
43
How do you treat iron overload?
``` Iron chelation therapy extends life expectancy by reducing iron overload IV Desferal (deferoxamine) ```
44
Thalassemia Patient Education
Genetic counseling Testing of parents Prenatal diagnosis for severe forms of Thalassemia
45
Normochromic Normocytic Anemias causes?
``` Causes: Anemia of Chronic Disease Early Fe++ deficiency Myelodysplasia or Marrow Failure Acute Blood Loss Anemia Associated with Renal Failure ```
46
Normochromic Normocytic Anemias
Definition: | MCV 80-100 mm3
47
Anemia of Chronic/Inflammatory Disease
Reticulocyte Production Index is Low Normal or Increased Ferritin “Normal” Fe/TIBC (Transferrin Saturation) BUT…. Low Levels of Transferrin ( Low TIBC) & Low serum iron decreased Fe++ release to BM from storage sites Iron Remains Sequestered in the RE System:
48
Treatment of Anemia of Chronic Disease
Treatment of the Underlying condition is Most Important Fe++ supplements +/- help Erythropoietin There is decreased response to Erythropoietin
49
Anemia of Renal Failure: a Normocytic Normochromic Anemia
Erythropoietin deficiency Uremic toxins interfere with RBC production and survival Hemodialysis (causes hemolysis and blood loss) Responds well to Erythropoietin & Iron
50
Hemolytic Anemias intrinsic causes?
RBC defects) G6PD deficiency Sickle Cell Hereditary spherocytosis
51
Hemolytic Anemias extrinsic causes?
``` Immune hemolytic anemia** Drug-induced hemolytic anemia** Thrombotic thrombocytopenic purpura Hemolytic Uremic Syndrome Disseminated intravascular coagulation Mechanical hemolysis d/t cardiac valve difunction Hypersplenism ```
52
Hemolytic anemia clinical features?
May Be Associated with Jaundice, Gallstones or Splenomegaly | May Have Symptoms Consistent with Tissue Hypoxia, similar to other anemia related syndromes: Pallor, SOB, Tachycardia
53
Sickle Cell Anemias?
Point mutation of the Beta-globin chain of Hb A molecule—with abnormal replacement of glutamine (hydrophilic) with valine (hydrophobic)  HbS Short arm of chromosome 11 mutation
54
Pathophys of sickle cell anemia?
HbS becomes sickled when deoxygenated—producing structural cellular damage Sickled Hgb can return to Its Normal Configuration when re-oxygenated
55
Sickle Cell disease vs sickle cell trait?
Sickle Cell Disease Homozygous Hemoglobin S Sickle Cell Trait: Heterozygous for Hgb A & Hgb S Little tendency to sickle unless there’s severe hypoxia—usually asymptomatic
56
Sickle cell anemia complications?
``` hemolysis splenic sequestration microvascular occlusion bone infarcts osteomyelitis priaprism blindness ```
57
How do you diagnose sickle cell anemia?
Hg Electrophoresis Will detect Hb S Trait will have 40% Hb S Disease >95% Hb S Smear Sickled cells, hemolysis, reduced RBC count Reticulocytosis Nucleated RBCs Target Cells Holly Jolly Bodies due to Autosplenectomy
58
Treatment of sickle cell anemia?
Prevent Sickle Cell crises by monitoring for conditions that demand O2 from RBCs Infection Exercise Climate extremes Dehydration during periods of physiologic/emotional distress Bone marrow transplant**
59
Treatment for sickle cell crisis?
IV Hydration Supplemental oxygen Analgesics—Morphine Transfusion for Hct < 30% ( Hgb < 10 g/dL) R/O Occult Infections, MI or Pulmonary Emboli
60
Supportive care for sickle cell anemia?
Folic acid qd Pneumococcal and H. flu vaccination Penicillin prophylaxis Ophthalmological monitoring against retinopathy Orthopedic Care Careful Monitoring of Renal, Pulmonary and Cardiac Function Pain Management
61
Autoimmune Hemolytic Anemias
occurs when antibodies directed against the person's own red blood cells (RBCs) cause them to burst (lyse), leading to insufficient plasma concentration
62
2 types of Autoimmune Hemolytic Anemias
IgG or IgM mediated have different disease courses
63
Warm AIHA—IgG mediated | Autoimmune Hemolytic Anemias
More common than cold AIHA IgG binds to RBC at > 37⁰C Results in extravascular hemolysis—especially in spleen or liver
64
Cold AIHA—IgM mediated | Autoimmune Hemolytic Anemias
IgM binds to RBC in temperatures < 37⁰C | Produces complement fixation & activation leading to intravascular hemolysis—within blood vessels
65
Causes of Warm AIHA- IgG mediated?
Primary or Idiopathic | Secondary to lymphoid malignancies, collagen vascular disease (SLE), viral infections, or drugs
66
Causes of Cold AIHA- IgM mediated?
Idiopathic Lymphoproliferative diseases, e.g. Waldenstrom’s Macroglobulinemia Mycoplasma pneumoniae Infectious mononucleosis (EBV infection)
67
Clinical signs of Autoimmune Hemolytic Anemia
Jaundice Splenomegaly Fatigue Pallor
68
Diagnosis of Autoimmune Hemolytic Anemias (6)
``` Positive Direct Coombs Test Elevated reticulocyte count Blood smear reveals immature RBCs Free serum hemoglobin (hemoglobinemia) and hemoglobinuria—indicates intravascular hemolysis Unconjugated (indirect) bilirubin is high Total bilirubin can rise to 4 mg/dL Elevated serum LDH indicates hemolysis Low or Absent Haptoglobin ```
69
Treatment of AIHA (6)
``` Treat Underlying Disease Lymphoma, Mycoplasma pneumonia, EBV Immunosuppressive medications Steroids: Prednisone Cyclophosphamide Rituximab (Anti-CD 20 Ab) RBC transfusions Folate Splenectomy ```
70
Vitamin B12 deficiency
Most common cause is of B12 deficiency is impaired GI absorption due to lack of intrinsic factor produced by gastric parietal cells
71
Pernicious Anemia
is lack of Intrinsic Factor (IF) due to auto-antibody destruction of Gastric Parietal Cell
72
Clinical Presentation of Vitamin B12 deficiency
``` Can take >3 years to show up Macrocytic Hypoproliferative Anemia Weakness, faintness, pallor of skin and mucous membranes Dyspnea after slight exertion Atrophic Glossitis and stomatitis Neuropathy ```
73
Lab Findings for Vitamin B12 deficiency anemia
Blood smear shows marked macrocytic RBCs (MCV >100 mm3) Low serum B12 (< 250 pg/mL) High methylmalonic acid (high only in B12 def.) High homocysteine (elevated in both B12 and folate def.) levels Anisocytosis, poikilocytosis, macro ovalocytes and hypersegmented PMNs Low Reticulocyte Count Elevated LDH and indirect bilirubin
74
Deficiency in Erythropoiesis will result in
Ineffective RBC Production Defective and fragile RBCs Asynchronous maturation between cytoplasm and nucleus
75
Treatment for B12 deficiency anemia
1mg B12 (cyanocobalamin) IM qd x 7 days then q wk x 4-8 weeks then monthly for life—for pernicious anemia If treatment is delayed greater than 6 months neurological problems may not respond to treatment Folate can reverse hematologic abnormalities of B12 deficiency, but not neurologic symptoms It is therefore Essential to obtain BOTH B12 & Folate Levels in Macrocytic Anemias.
76
Causes of Folate def anemia?
``` Inadequate Folate intake Alcoholics anorectic persons elderly diet low in meat, fruit and vegetables (leafy green vegetables—do not over cook veggies) ```
77
Folate deficiency anemia?
Body stores sufficient for 2-3 months | Decrease folic acid causes impaired RBC maturation and early destruction
78
when are times the body requires an increase in folate?
``` Pregnancy Chronic Hemolytic Anemias Malignancy Dialysis infants and children ```
79
Clinical Presentation of Folate def anemia?
Symptoms from dietary deficiency can be seen in a few months—quicker than B12 deficiency Atrophic Glossitis and Angular cheilosis anemia symptoms related to poor tissue oxygenation
80
Lab findings for folate def anemia?
Macro-ovalocytes Hypersegmented PMNs B12 levels are normal Low Levels of Serum folate ( < 5.4 ng/ml)
81
Treatment for folate definciency anemia?
1-5 mg/day Folic Acid usually PO Avoidance of alcohol and folic acid antagonists Treat causes of malabsorption Must rule out B12 deficiency Deficiency can cause spontaneous abortion or fetal neurologic defects

Clin Med- Heme/Oncol (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions