Anemia intro, blood loss, hypo/micro Flashcards

(70 cards)

1
Q

anemia (general)

A

decreased oxygen-carrying capacity of the blood leading to tissue hypoxia
-decreased RBC count
-decreased Hb (best value)

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

general anemia s/s

A

fatigue, pallor, dizziness, headache, weakness, dyspnea

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

anemia CBC findings

A

low RBC count, low Hb, low Hct

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

peripheral blood smear

A

most important single test in diagnosis of anemia–color, shape, size

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

RBC indices

A

MCV: size, 80-100, low=microcytic, high=macrocytic
MCH
MCHC: low=hypochromic, high=hyperchromic

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

RDW

A

earliest indicator of anemia, NL 11-15%, only increases

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

etiologic classifications of anemia

A

blood loss, deficient erythropoiesis, excessive RBC destruction

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

what are the two types of anemia due to blood loss?

A

acute post-hemorrhagic anemia
chronic post-hemorrhagic anemia

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

acute post-hemorrhagic anemia etiology

A

traumatic/spontaneous rupture of major blood vessel, erosion of artery by lesion, failure of hemostasis

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

acute post-hemorrhagic anemia lab findings

A

during or immediately following hemorrhage: RBC, Hb, Hct are normal
tissue fluid will enter circulation: drop in RBC count, Hb, and Hct
neutrophilic leukocytosis & thrombocytosis within hours
after several days: polychromatophilia, slight macrocytosis, occasional normoblasts, immature WBCs

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

treatment of acute post-hemorrhagic anemia

A

restoring iron stores (same as iron deficiency anemia)

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

etiology of chronic post-hemorrhagic anemia

A

prolonged moderate blood loss, GI tract lesion, urologic, gynecologic site

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

clinical findings for chronic post-hemorrhagic anemia

A

same as IDA

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

GI tract causes of chronic blood loss anemia

A

peptic ulcers, GERD, gastritis, colorectal cancer, polyps, hemorrhoids, crohn’s

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

GU reasons for chronic blood loss anemia

A

cancer along urinary tract (bladder cancer)

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

reproductive system causes of chronic blood loss anemia

A

heavy menses, hormonal imbalances, PCOS, endometriosis, PID, fibroids, endometrial cancers, hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

hypochromic microcytic anemia DDx

A

iron deficiency anemia, sideroblastic anemia (iron utilization), anemia of chronic disease (iron re-utilization), thalassemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

normocytic normochromic anemia DDx

A

renal disease, endocrine failure, aplastic anemia, myelophthisic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

megaloblastic/macrocytic anemia DDx

A

B12/folate deficiency

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

types of anemia due to deficient erythropoiesis

A

hypo/micro, normo/normo, macro

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

anemia due to excessive RBC destruction

A

anemia due to intrinsic RBC defects
anemia due to extrinsic RBC defects

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

anemia due to intrinsic RBC defects

A

anemia due to red cell membrane alterations (hereditary spherocytosis)
anemia due to disorders of red cell metabolism (G6PD)
anemia due to defective hemoglobin synthesis (sickle cell, thalassemia)

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

anemia due to extrinsic RBC defects

A

traumatic hemolytic anemia, hemolysis due to infectious agent (malaria), anemia due to immunologic abnormalities (autoimmune attack)

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

CBC and RBC indices findings for hypochromic/microcytic anemia

A

Decreased Hb, Hct, RBC count
Decreased MCV, MCH, MCHC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Components of an iron panel
Serum ferritin: storage form of iron Serum Iron: total iron in blood, bound to transferrin Transferrin/total iron binding capacity (TIBC) Iron saturation %: how much iron occupies transferrin
26
Iron metabolism
-Absorption of iron occurs in duodenum and proximal jejunum -To be reabsorbed iron must be in ferrous state or bound to heme -Iron from plants is in ferric state and must be converted to ferrous iron -Bone marrow RBC precursors utilize portion of available iron -The remainder is stored as ferritin or hemosiderin
27
What is hemosiderin?
Coagulation of ferritin
28
What is the most common type of anemia?
Iron deficiency anemia
29
General info about IDA
60% of anemias in people >65 Populations to watch: infants whose major source of nutrition is cow’s milk and juices, adolescent females, pregnancy, elderly
30
Etiology of IDA
Iron intake not sufficient to replace normal losses Iron not available for erythropoiesis adequate intake Increased loss of body iron not adequately replaced by normal intake
31
Risk factors for iron intake not sufficient to replace normal iron losses (either decrease in intake or increase in demand)
6mo-1yr: growth Adolescent females: 1st period, growth, diet Pregnancy: growth, peak in 3rd trimester Elderly: insufficient dietary intake, dental issues, decreased stomach acid Pica: cause & symptom; weird cravings (clay, dirt), vegetarians
32
Risk factors for iron not available for erythropoiesis despite adequate intake (decrease absorption)
Malabsorption diseases: celiac, gastroectomy, chronic diarrhea Achlorhydria: gastric bypass, antacids
33
Risk factors for increased loss of body iron not adequately replaced by normal intake (blood loss)
Excessive blood loss: GI, carcinoma, hemorrhoids, vaginal Excessive blood donation
34
Step 1 in pathophysiology of IDA
Iron depletion; iron deficient, not anemic Decrease in ferritin, NL Hb, NL RBC indices
35
Step 2 in pathophysiology of IDA
Iron deficient erythropoiesis Iron panel abnormalities present, changes in RBC indices—1st increase in RDW, decrease in MCV
36
3rd step in pathophysiology of IDA
Iron deficiency anemia Decrease in Hb, Hct, RBC count S/s of anemia present
37
What is pagophagia?
Craving for ice
38
Clinical findings in IDA
Pallor, koilonychia, cheilosis Neurological, restless leg syndrome, s/s of underlying condition
39
What labs to order when suspecting hypo/micro anemia
CBC with differential blood smear, iron panel Possibly: colonoscopy, endoscopy, fecal blood occult
40
CBC findings in IDA
Decreased RBC count/Hb/Hct Decreased MCV/MCH/MCHC Increased RDW
41
Iron panel findings in IDA
Decreased ferritin Decreased serum iron Increased transferrin/TIBC Decreased iron saturation
42
Special tests for IDA
Stainable iron in bone marrow aspiration, occult blood in stool, UA
43
Management for IDA
Search for the cause and correct it Heme vs non-heme iron
44
Heme iron
Bound to myoglobin/hemoglobin from animal sources
45
Non-heme iron
Less effective, most common supplement, plants
46
Typical approach to management with non-heme iron salts
150-200 mg of elemental iron/day, doses split throughout the day Ferrous sulphate: 325 mg 3x/day Ferrous fumerate, ferrous gluconate, ferrous biscuit-glycinate all have differential elemental iron content, so dosage will vary
47
Alternative approach to management with non-heme iron salts
Double dose, every other day Can decrease side effects, but slow hemoglobin response
48
Side effects of non-heme iron salts
Epigastric pain, nausea, darkened stool, diarrhea or constipation Lead to non-compliance
49
Risks/benefits of heme iron
More expensive, easier to absorb, not for vegetarians or vegans, complications with long term use that may lead to stroke or heart attack, not common 30/40 mg/day
50
Other factors impacting iron treatment
Empty stomach: take 30 min before or 2 hrs after meal Vitamin C enhances absorption Calcium, manganese, copper, zinc, coffee, tea, antacids, PPIs, H2 blockers all interfere with iron absorption
51
Food sources for iron
Red meat, liver, fish (heme) Beans, green leafy vegetables, dried fruits, whole-grain and enriched breads (non-heme form that needs to be converted)
52
Response to care for IDA
Reticulocyte count: 7-10 days after treatment Hemoglobin should rise: 2 weeks Continue treatment for 3-6 months to replenish iron stores
53
General info on sideroblastic (iron utilization) anemia
Due to inadequate or abnormal utilization of Intracellular iron for hemoglobin synthesis, iron levels within mitochondria of RBC precursors are adequate or elevated Rare
54
Etiology of sideroblastic anemia
Hereditary Acquired: primary—idiopathic, secondary—alcoholism, toxin induced (lead poisoning), nutritional deficiency (B6)
55
Clinical findings for iron utilization anemia
Moderate to severe anemia, hepatosplenomegaly
56
CBC findings for iron utilization anemia
Hypochromic, microcytic anemia, high RDW
57
Iron panel findings for iron utilization anemia
Increase ferritin Increase serum iron NL/decrease TIBC Increase iron saturation
58
Peripheral blood smear findings of sideroblastic anemia
Ringed sideroblasts
59
Chem panel findings for sideroblastic anemia
Liver enzymes elevated
60
Special tests for sideroblastic anemia
Low reticulocyte count, bone marrow examination to confirm diagnosis (sideroblasts)
61
Treatment of iron utilization anemia
Specific to cause, alcohol use Supplementation of B6 in addition to treating the cause
62
General info on iron re-utilization anemia (anemia of chronic disease)
Second most common anemia in the world Can also be normocytic normochromic
63
Etiology of ACD
Chronic infections, inflammatory diseases (RA, lupus), certain malignancies (liver, lung, breast cancer, lymphoma, multiple myeloma)
64
Clinical findings for ACD
Anemia symptoms Underlying disease symptoms
65
CBC findings for ACD
Anemia, NL or slight elevation in RDW
66
Iron panel findings for ACD (hypo/micro)
Increase ferritin Decrease serum iron Decrease transferrin Decrease iron saturation
67
Iron panel findings for ACD (normo/normo)
Increase ferritin NL serum iron, transferrin, iron saturation
68
Additional tests for ACD
CRP, ESR, other tests associated with primary condition
69
Management of ACD
Treat underlying disease, decrease inflammation (longer process)
70
Combined IDA and ACD
Difficult to identify due to acute phase reactants, serum transferrin receptor (elevated in IDA, NL in ACD), ferritin After treatment of underlying inflammatory condition, if s/s and iron panel still indicate IDA, then go through treatment of IDA and follow-up accordingly