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Anemia Clinical Care 2 Flashcards

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1
Q

Folic acid deficiency is almost always due to _____.

A

Decreased oral intake

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2
Q

Folate deficiency is common is conditions where the skin turns over often, such as ______ (4).

A
  1. pregnancy
  2. desquamating skin disorders
  3. sickle cell anemia
  4. chemotherapy
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3
Q

Folate is normally absorbed in the ______ part of the intestines.

A
  1. duodenum
  2. proximal jejunum

(wider area than B12 absorption in the ileum)

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4
Q

Diseases that decrease folate absorption

A
  1. celiac
  2. regional enteritis
  3. amyloidosis
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5
Q

Folic acid deficiency will show _____ in the blood smear

A
  1. macrocytosis
  2. hypersegmented neutrophils

(same as B12 deficiency)

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6
Q

In general, thalassemia is ____

A

defect in hemoglobin synthesis (alpha or beta chain)

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7
Q

How is thalassemia dx made?

A

electrophoresis

(these are the other findings in the image)

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8
Q

alpha thalassemia and beta thalassemia are prevalent in the Mediterranean and Asia, which locations are specific to alpha-thalassemia? Beta-thalassemia?

A
  • alpha: Africa & Middle East
  • beta: India & Pakistan
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9
Q

Thalassemias show _____ on blood smear

A
  1. Target cells
  2. Heinz bodies

(microcytic & hypochromic)

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10
Q

Thalassemia tx

A

folate (support cell wall synthesis)

(anemia will remain)

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11
Q

Thalassemia produces a ______ anemia

A
  1. microcytic
  2. hypochromic
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12
Q

How can you tell the difference between a thalassemia & iron deficiency anemia?

A
  1. Thalassemia: ⇣ RDW
  2. Iron deficiency: ⇡ RDW

(both are microcytic; major has an increased RDW)

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13
Q

List the 5 causes of hemolytic anemia, in addition to spherocytosis, trauma, infection and sickle cell.

A
  1. pyruvate kinase deficiency
  2. G6PD deficiency
  3. TTP
  4. HUS
  5. Autoimmune
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14
Q

______ is the MC enzyme defect in RBCs.

A

G6PD Deficiency

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15
Q

G6PD Deficiency is a _____ (genotype) disease that affects which populations?

A
  • X-linked
  • Mediterranean/African
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16
Q

G6PD Deficient patients may experience Brisk Hemolysis when exposed to _____ (3)

A
  1. infections
  2. drugs
  3. toxins

(oxidative stressors)

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17
Q

TTP is a microangiopathic hemolytic anemia that presents with _______ (3 sx).

A
  1. renal insufficiency
  2. neurologic sx (AMS)
  3. fever
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18
Q

Which 3 symptoms do TTP & HUS have in common

A
  1. thrombocytopenia (used in clots)
  2. microangiopathic hemolytic anemia
  3. renal insufficiency (damage to vessels)
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19
Q

2 types of autoimmune hemolytic anemia

A
  1. Warm-antibody mediated
  2. Cold agglutinin disease
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20
Q

Warm-antibody mediated autoimmune hemolytic anemia is due to ______ (IgG/IgM antibodies); while cold-agglutinins is caused by _____ (IgG/IgM antibodies)

A
  • Warm-antibody: IgG
  • Cold-agglutinin: IgM
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21
Q

What is the difference in treatment between warm antibody mediated autoimmune hemolytic anemia and cold agglutinin disease?

A
  • Warm antibody: corticosteroids, splenectomy, immunosuppression
  • Cold-agglutinin: does NOT respond to corticosteroids like warm-ab does.
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22
Q

Hemolytic anemia will show ______ on blood smear

A

schistocytes

(broken up RBCs)

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23
Q

Autoimmune hemolytic anemia is diagnosed by ______

A

direct Comb’s test

(must wait until you know they are hemolyzing already! It’s not part of the workup)

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24
Q

4 Lab findings for hemolytic anemia?

A
  1. indirect bilirubin in urine (urobilinogen)
  2. LDH ⇡ (this is sensitive, not specific)
  3. reticulocyte ⇡ (>3%)
  4. haptoglobin ⇣

(direct = from liver problem)

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25
sickle cell anemia (SS, SC, Sickle thalassemia)
26
Sickle cell disease is characterized by chronic \_\_\_\_\_
hemolytic anemia from mutant hemoglobin → clog vessels
27
4 major presentations of sickle cell crisis complications
1. Hyper hemolytic crisis/ acute hemolytic anemia 2. Vaso-occlusive crisis 3. Splenic sequestration crisis 4. Aplastic crisis
28
What is acute chest syndrome?
1. Second most common complication of sickle cell (25% of deaths) 2. vaso-occlusive crisis of lungs
29
Why is it important to ask patients with sickle cell anemia about difficulty breathing?
* acute chest syndrome (25% of sickle cell deaths) * CP, fever, pulmonary infiltrate & hypoxemia
30
What is splenic sequestration crisis and sickle cell crisis?
Splenic sequestration of defective and ruptured cells (schistocytes lead to infection)
31
aplastic crisis is due to \_\_\_\_\_\_
parvovirus 19 in sickle cell patients
32
Sickle-cell precipitants
1. Physical or emotional stress 2. Hypoxia 3. Infection 4. Dehydration (retic count may reach 25%)
33
***_Acute_*** Sickle cell crisis tx (4)
1. morphine (opens vessels→prevent infarct) 2. O2 3. ABX 4. IV fluids (folic acid & stop infarction)
34
Why is it important to use caution with transfusion in Sickle Cell crisis and thalassemia patients?
They absorb iron better than the average patient → iron overload (hemochromotosis)
35
***_Maintenance_*** Sickle Cell tx
1. Hydroxyurea 2. Folic acid 3. Hydration 4. Avoid high altitude
36
Cure for sickle cell anemia
children can be cured with bone marrow transplant in childhood
37
spherocytosis
38
TTP/HUS - microangiopathic hemolysis w/schistocytes (little pacwomen)
39
Malaria
40
Malaria
41
babesiosis
42
Hemoglobin and hematocrit values to dx anemia
* female = Hgb \< 12 or Hct \< 36 * male = Hgb \< 13.5 or Hct \< 41
43
4 medical conditions that can lead to anemia?
1. sickle cell disease 2. thalassemia 3. renal disease 4. hereditary spherocytosis
44
If white count and platelets are both low it is _____ until proven otherwise!
aplastic anemia
45
If you have a patient with anemia and low platelets, consider _____ (2 diseases)
1. TTP 2. HUS (check for schistocytes; sign of microangiopathic hemolytic anemia)
46
If a patient has low platelets, renal failure, and E coli exposure, the diagnosis is \_\_\_\_\_
* HUS * toxin attaches to WBC → carried to glomerular vessels → toxins cause apoptosis (may have fever; may look like TTP)
47
If a patient has low platelets, renal failure, **neurologic changes**, the diagnosis is \_\_\_\_\_\_\_.
TTP (may have fever; looks like HUS)
48
If an anemic patient has high platelets consider _____ (dx)
iron deficiency (especially in microcytic anemia)
49
Anemic patient with low hemoglobin and hematocrit but RBC count is normal or high, it is ______ (dx).
thalassemia (they make normal amount of cells, but they are small - normal count)
50
Hematochezia is \_\_\_\_\_; while melena is \_\_\_\_\_.
* bright red blood per rectum * black tarry stool (either way - consider colonoscopy)
51
If a patient is anemic and has abdominal pain or recent femoral vein/artery manipulation (stent placement) or trauma, the cause may be \_\_\_\_\_.
bleeding into the retroperitoneal or thigh compartment hematoma
52
If other cell lines are ok, and MCV \< 80 check _______ (3)
1. serum iron 2. ferritin 3. TIBC
53
In iron-deficiency anemia, look for \_\_\_\_\_
sources of chronic bleeding: menstrual (consider colonoscopy)
54
In iron-deficiency anemia consider ________ 3 causes in addition to chronic bleeding.
1. lead poisoning 2. copper deficiency 3. thalassemia
55
If a patient has normocytic anemia (MCV 80-100), check ______ (4 lab values)
1. indirect bili 2. LDH 3. haptoglobin 4. retic
56
Iatrogenic causes of macrocytic anemia (3)
1. Hydroxyurea 2. AZT 3. Methotrexate
57
\_\_\_\_\_\_ is the MC enzyme defect in RBCs.
G6PD Deficiency
58
G6PD Deficiency is a _____ (genotype) disease that affects which populations?
* X-linked * Mediterranean/African
59
2 types of autoimmune hemolytic anemia
1. Warm-antibody mediated 2. Cold agglutinin disease
60
Warm-antibody mediated autoimmune hemolytic anemia is due to ______ (IgG/IgM antibodies); while cold-agglutinins is caused by _____ (IgG/IgM antibodies)
* Warm-antibody: IgG * Cold-agglutinin: IgM
61
What is the difference in treatment between warm antibody mediated autoimmune hemolytic anemia and cold agglutinin disease?
Warm antibody: corticosteroids, splenectomy, immunosuppression Cold-agglutinin: does NOT respond to corticosteroids like warm-ab does.
62
If a patient has a normal Hgb electrophoresis and iron levels, but microcytosis, what is the dx? Why?
* alpha-thalassemia trait * there is no increase in Hgb A2 (DNA testing to confirm absence of alpha chain gene deletion)

Blood & Lymph (29 decks)

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