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Flashcards in anemia Deck (39):
1

acute anemia

is a rapid loss of blood (RBC and Hgb)

2

acute hemmorhagic anemia: severity depends on

site, rate and volume lost

3

Chronic hemmorhagic anemia: is?

etiology

gradual ongoing loss of blood
(it may not be very noticeabe)

Et:
-prolonged or heavy menses
-bleeding peptic ulcers
-cancerous lesions in GI tract
-hemmorhoids

4

Tx of hemmorhagic anemia

eliminate cause

5

what is it: sickle cell anemia

it is a genetic problem.
Recessive homozygous trait
If heterozygous it is sickle cell trait

6

what are the three types of HB

fetal hemoglobin has a higher affiity for oxygen
adult hemoblogin also exists
sickle cell hemoglobin (in his notes HB S)

It is the globin that varies (the amino acid)

7

how is HB S differe;nt than HB A

Hb S is 50x less soluble

HB S has valine instead of glutamic acid in the beta chain

8

what is the problem with HB S

no problem binding to oxygen in lungs
dissociation nthe tissues is normal
the problem occurs after the oxygen dissociation. The HB crystallizes.

9

How does the HB S change to sickle

the HB S crystallizes on dissociation at low P02->RBC deforms and sickles->chronic hemollysis->vessel occlusion->ischemia->infarction->obstructed capillaries->hypoxia->more sickling

10

how is SCA lead to a vicious cycle

inc viscosity->impaired circulation->occlusion and further hypoxia->more RBCs sickle->vicious cycle

11

once the Hb has changed shape and sickled what happens to it

it will have difficulty moving through the capillaries. Because the cells are abnormal the will be destroyed by hemolysis. All problems from hemolytic anemia will apply

12

in SCA is there a problem in the marrow? how is RBC production affected

no problem there. RBC production wont increase

13

mnfts of SCA

hemolysis
thrombosis and infarction (nonloacalized)
inc bilirubin

14

SCA Tx

-supportive (rest, oxygen, analgesics, IV fluids and electrolytes)
-hypertransfusion when pt is at inc risk (eg during surgery, pregnancy) give until pt has 75% donor blood in circulation
-hydroxyurea. Ths is hepatotoxic and toxic to marrow. It is used for cancer but it is also known to cause leukemia. When used in SCA
1. it facilitates the transformation of HB
2. it prevents hemolysis and sickling
-marrow or stem cell transplant

15

what is the most common blood disorder

anemia

16

whats anemia

hgb or RBC deficiency

17

etiology of anemia

-defective erythropoiesis
-high hemolysis
-high loss

18

patho of anemia

abnormal Rbc number, structure or fx which causes dec oxygen carrying capacity and leads to hypoxia

19

mnfts of anemia

-hypoxia (underying problem that is systemic)
-moderate:
dyspnea (whenver youve hypoxia you will end up with dyspnea which is beneficial, you will also have tachycardia which is beneficial but may cause
palpitations
chronic fatigue

-severe: chronic exhaustion, more palpitations, profound weakness, dizziness & headache (rt the hypoxia), sensitivity to cold (this is because of the lack of energy that would normally be produced in 3 or 4 steps of aerobic cellular respn. 70% of the metabolic heat produced is used to heat the body. the other 30% are for ATP produced

20

what complications could arise from anemia

potential acidosis

21

iron deficiency anemia what would you test in the blood

ferritin levels

22

why does a lack of iron cause anemia

iron is part of the Hb molecule

23

why is CBC not a useful test for iron def anemia

it will tell you the number of cells and the difffeerential but it doesnt have info abt iron

24

tx for iron deficiency anemia

underlying cause
iron PO for 4-6 months

25

folic acid and vitamin b12 deficiency how does this lead to anemia?
-tx?

B12 and folic acid are nec for DNA synthesis and cell division
->abnormal DNA synthesis and cell division-> impaired RBC, WBC and platelets

Tx: vitamin B12 and folic acid

26

where are erythrocytes produced
how long do they survive

they are produced int he red bone marrow of long bones

survive 120 days

27

how many RBCs do we produce

180x10^6 per minute (million)

28

what do RBCs transport and not transport

they transport 02 which is not a nutrient. they dont transport nutrients

29

Pernicious anemia
what is it

damaged gastric mucosa->no intrinsic factor->poor or no vitamin B12 absorption->RBC rpoduction is impaired

30

what is intrinsic factor

its a glycoprotein prod by parietal cells of stomach nec for absorption of B12 in the ileum (sm intestine)

31

what might cause P.anemia

stomach ulcers, infection in stomach,

32

P. anemia Tx

they used to give small doses and? or? parenterally
now they give high dose of vitamin B12 by mouth

its given IM only if there are neurologic symptoms present

33

aplastic anemia

all the nec components are present but there is a marrow failure which affects all blood cells
1/3 of the itme it is dt autoimmune issues, radiation, toxic chemicals
2/3 are idiopathic

34

aplatic anemia tx

mgmt is difficult

underlying cause
transfusions? (cant continuously transfuse)
marrow transplant in severe cases (they would remove the existing marrow and completely replace)

35

hemolytic anemia is...
Et

premature or excessive hemolysis
1/2 acquired (eg autoimmunity, drugs)
1/2 genetic (eg in thalassemia)

36

thalassemia

-is an autosomal recessive blood disorder
-affects either the alpha or beta globin chains-> hgb isnt formed properly. There is an enzyme missing

37

hemolysis process

older RBCs make less ATp and cant maint membrane->fragile->get trapped in narrow vessels of spleen->engulfed by macrophages then get broken into iron, heme, globin.
The globin is reused but the heme and iron are taken to liver and transformed there.
The heme which as transformed into bilirubin can deposit in tissues if theres excess hemolysis.

38

how does hemolysis present clinically

presents in sclera, skin may be yellow

spleenomegaly and liver inc in size

39

how do yu Tx hemolyti anemia

underlyiing cause
give oxygen if hypoxic
transfuse
steroids-inhibits hemolysis
renal fx (precipitation in renal tubule dt hemolysis)
splenectomy???-if hemolysis is occurring here