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Flashcards in Anemia - CC3 Deck (57):
1

3 components to blood

1. plasma -55%
2. WBC/plateles -

2

3 steps to CBC review

1. review Hb and MCV
2. review WBC and DDx
3. review platelet count

3

what does a marrow problem look like

loss of all cell lines

4

3 ways a single cell line can be low

1. low prod
2. destruction
3. sequestration

5

what is anemia

low RBC
- very common
- abnormalities often found before Sx

6

what is too much RBC

polycythemia/erythrocytosis
- much less common
-

7

sign and Sx of anemia

- faigue
- HA
- lightheaded
- nausea
- chest pain
- SOB
- tachycard.
- HF
- hypotension

8

2 key part to approach to anemia

1. cell size - MCV
2. retic count - underprod vs. destruction/sequestration

9

how to ID retics

- inceased color
- larger
- increased central pallor
- have RNA

10

DDx for microcytic

- Thallasemia
- Anemia of chronic disease
- Iron def
- Lead poisoning
- Sideroblastic

11

how is iron moved in body

- absorbed in duod
- transported by transferritin
- stored by ferritin in heart and liver and in Hb
- no excretion mechanism

12

how is Fe regulated

- taken up by ferrroportin
- ferroportin blocked by hepcidin
- hepcidin produced in liver
-

13

3 measures of Fe in body

1. ferritin - primary storage
2. transferritin
3. serum iron/transferritin - used to assess Fe overload

14

what would be seen in Fe def. (5)

1. low ferritin
2. low MCV

also, but don;t need to measure
3. low retic
4. low serum Fe
5. high transferritin (TIBC)

15

what to do in Fe def.

- in male and non-mens. females, always look for blood loss
- diet, bleeds
- treat Fe def., even if not anemia in women of child bearing age

16

2 types of Fe

1. oral - may not be tolerated well
2. IV

17

def. anemia of chronic disease

- can be micro or normo
- due to acute or chron. inflammation
- caused by cytokines increasing hepcidin

18

5 things seen in anemia of chronic disesase

1. high ferritin
2. retics inapproriately low
3. low serum Fe
4. low TIBC
5. low transferritin sat.
6. low EPO

19

2 treatments of anemia of chronic disease

1. treat underlying cause
2. EPO

20

what is thallasemia and 2 types

- abnormal prod. of Hb
- can be a or B

21

2 types of macrocytic

1. megalobalstic - cells cannot mature
2. non-megaloblastic

22

4 causes of megaloblastic

1. B12 def.
2. folate def.
3. cytotoxic drugs
4. genetics

23

what is B12

- cobalamin
- found in animal products
- absorbed via inrinsic factor
- needed for blood

24

4 causes of B12 def.

1. strict veganism
2. unable to absorb - terminal ileum
3. pernicious anemia - no intrisic factor
4. Gi infection

25

4 nonmegaloblastic causes

1. myelodisplastic syndrome
2. retics bleeding or hemolysis
3. liver disease - target cells
4. hypothyroidism - uncommon

26

what do we need to check in normocytic

retics

27

2 causes of low retics

1. primary or secondary bone marrow failure
2. low EPO

28

what is term when RBC destroyed too soon

hemolysis

29

2 causes

1. extravascular - RBC don't make it full life and destroyed
2. intravascular - lose all the good stuff inside liek FE

30

4 things that happen with hemolysis

1. incr. retics
2. incr. bili
3. incr. LDH
4. dec. haptoglobin

31

2 tests for intra vs. extravascular hemolysis

1. DAT antiglobin tests
2. blood film spertocytes (EV) vs. schistocytes (IV)

32

3 intrinsic RBC factors causing hemolysis

1. hemoglobin - sickle cell
2. enzymes
3. cytoskeleton problem

33

5 external factors causing hemolysis

1. drug!
2. infection
3. ABs against RBC antigens
4. structural probs - mechanical valves ets
5. DIC

34

2 treatments of hemolyssi

1. underlying cause
2. suportive care

35

2 other causes of anemia

1. dilution
2. sequestration in spleen

36

when is transfusion reccomended

HB

37

what is Hct formula

Hb x 3

38

what does retic count indicate

2% excessive destruciton

39

signs of hemolysis

1. signs of anemia
2. signs of underlying disease
3. dark urine
4. jaundice
5. hepatoplenomeg, cholelith, lymphadenopathy

40

test findings in hemolysis

1. HB levels depend on degree
2. elevated retics
3. peripheral smear
- schistocytes - intravasc
- pherocytes or helmet - extravasc.
4. haptoglobin
- low - normally binds to Hb
5. high indirect bili
6. high LDH
7. direct coombs - +ve in autoimmune

41

Tx of hemolysis

1. Tx underlying cause
2. PRBCs
3. folate suppluments

42

patho of sickle cell

HbA replaced by mutant hemoglobin
- under reduced O2 times, they sickle and obstruct

43

4 complications of SCC

1. severe, lifelong hemolytic anemia
2. occlusions Sx
3. infections
- functional asplenia
4. delayed growth and maturation

44

Sx of SCC oclusion

1. bone pain - most common
2. hand-foot syndrome - dactylitis
3. acute chest
- similar to PNA
4. repeated splenic infarcts
5. avasc. joint necrosis
- most common in hip
6. priapism
7. CVAs
8. optho infarcts
9. leg ulcers

45

Dx for SCC

1. anemia
2. sickle smear

46

Tx for sickle

1. avoid low O2
2. early vaccinations
3. prophylactic pen for kids
4. folic acid supplements
5. mgmt of crises
6. hydroxyurea
7. transfusions
8. marrow transplant

47

what is spherocytosis

hereditary
- defect in spherin gene
- loss of RBC membrane area without loss of volume
- get trapped and destroyed by spleen

48

Sx of spherocytosis

1. hemolytic anemia
2. jaundice
3. splenomegaly
4. gallstones
5

49

Tx

splenectomy

50

what is G6PD def.

X-linked - male
- get H2O2 that breaks down RBCs
- preciptated by certain ABx and fava beans

51

Sx of G6PD

- episodic anemia that is drug induced
- dark urine and jaundice on Phx

52

what is seen on smear

1. bite cells
2. heinz bodies

53

what is autoimmune hemolytic anemia (AIHA)

- produce autoantibodies to RBCs
- more fulminant in childs

54

2 types of AIHA

1. warm
- due to IgG which binds at 37
- extravascular hemolysis
2 cold
- due to IgM
- intravasuclar - in liver

55

Sx of AIHA

1. anemia
2. jaundice if sig

56

Dx of AIHA

1. direct coombs
- IgG or cpmplement
2. cold agglutinatin

57

Tx of AIHA

often none
1. warm
- steroids
2. cold
- avoid cold
- transfusions

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