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Flashcards in Anemia - Krafts Deck (32):
1

What is anemia?

A reduction below normal in hemoglobin OR RBC number

2

What are symptoms of anemia?

-Pale skin (not a great judgment)
-Mucous membranes
-Jaundice (if hemolytic)

3

What does heme break into if hemolytic?

Bilirubin --> causes Jaundice

4

What are symptoms of anemia?

-Pale skin (not a great judgment)
-Mucous membranes
-Jaundice (if hemolytic)
-Tachycardia
-Breathlessness
-Dizziness
-Fatigue
-Atrophic glossitis (papillae in tongue shrink/atriphy, and become shiny, angular cheilitis- cracks at edge of mouth)
-Koilonychia (spoon nails) in iron-deficiency anemia

5

What are three ways to "get anemic"?

1. Lose blood
2. Destroy too much blood
-Intracorpuscular reasons
-Extracorpuscular reasons
3. Make too little blood
-Too few building blocks
-Too few erythroblasts
-Not enough room

6

What is important about Iron-deficiency anemia?

MOST IMP. TO LEARN/CATCH: Microcytic
-Most imp cause = GI bleeding
-Microcytic, hypochromic anemia
-Increased anisocytosis (patients RBCs of unequal size) and poikilocytosis (funny shaped red blood cell)
-Abnormal iron studies

7

Basics of Iron:

-Most Iron is in hemoglobin
-Iron absorption: In duodenum/proximal jejunum, binds to transferrin
-Iron circulation: transferrin carries iron, iron goes to red cell precursors, organs

8

Hemoglobin review:

-4 globin chains, 4 heme molecules
-Globin: polypeptide chains (2 alpha, 2 beta)
-Heme: Iron molecule in protoporphyrin ring
-Iron only binds O2 in ferrous (Fe2+) state
-In ferric (Fe3+) state, "methemoglobin"

9

How is iron metabolized?

-Most goes to RBCs
-Rest goes to macrophages

10

Where is iron stored?

-Ferritin: quick in, quick out
-Hemosiderin: more stable

11

Where is iron stored?

-Ferritin: quick in, quick out
-Hemosiderin: more stable (looks blue-ish in bone marrow)

12

What causes iron deficiency?

-Decreased iron intake
---bad diet
---bad absorption
-Increased iron loss
---GI bleed
---menses
---hemorrhage
-Increased iron requirement
---pregnancy

13

Bottom line in iron-deficiency anemia:

Premenopausal women:
-think MENORRHAGIA
Everyone else:
-think GI BLOOD LOSS

14

Why shouldn't elderly people take iron supplements?

-Supplements will hide iron deficiency in labs/hide colon cancer

15

Clinical Picture of Iron-Deficiency Anemia:

-Symptoms: asymptomatic, or fatigue, dizziness
-Signs: pale, spoon nails, smooth tongue
-Pica: craving for dirt, windex, household cleaners
-Cause of symptom?

16

What does the blood look like in Iron-Deficiency Anemia?

-Hypochromic, microcytic anemia
-Anisocytosis
-Poikilocytosis(red cells looks like elipses/cigars)

17

What does the bone marrow look like in Iron-Devificiency Anemia?

-Erythroid hypoplasia (underdevelopment of red cells)
-Dyserythropoiesis (funny looking RBCs - not malignant)
-Decreased Iron stores

18

What does the bone marrow look like in Iron-Devificiency Anemia?

-Erythroid hypoplasia
-Dyserythropoiesis
-Decreased Iron stores (no blue, hemosiderin)

19

What do the labs look like in Iron-Deficiency Anemia?

Start by testing ferritin!!
Low serum iron
High total binding capacity
Low ferritin (if low, you have your diagnosis, if normal you need to keep looking!)

20

What should you do when treating iron-deficiency anemia?

Find out WHY the patient is iron-deficient.
-Then give oral iron!

21

What is the only macrocytic anemia you need to know?

Megaloblastic anemia!

22

Megaloblastic anemia - TO KNOW:

-Defective DNA synthesis
-Nuclear/cytoplasmic asynchrony
-Dec. B12/folate
-Macrocytic anemia with oval microcytes and hypersegmented neutrophils

23

Megaloblastic anemia - TO KNOW:

-Defective DNA synthesis
-Nuclear/cytoplasmic asynchrony
-Dec. B12/folate
-Macrocytic anemia with oval macrocytes and hypersegmented neutrophils

24

What do Megaloblasts look like?

Dark nucleus in center of cytoplasm

25

What causes megaloblastic anemia?

1. Retarded DNA synthesis
2. Unimpaired RNA synthesis
3. BIG CELLS
4. Immature nucleus
5. Mature cytoplasm

26

What are sources of B12?

-Meat, dairy, cereal
-Not veggies

27

B12 absorption, transport:

1. Binds to IF (from parietal cells)
2. Absorbed in distal ileum
3. Carried in blood by transcobalamin II

28

Causes of B12 Deficiency:

-Diet (rare)
-lack of IF
-Pancreatic damage
-Ileal damage
-Tapeworm!

29

What is atrophic glossitis seen in?

Megaloblastic anemia - B12 deficiency

30

Bottom line regarding B12: In a patient with macrocytosis. . .

ALWAYS check for B12 deficiency (Even if folate is low!)

31

What else is B12 good for?

Converts Homocystine to methionine!
-Inc. homocytstin causes atherosclerosis and thrombosis
-Dec. methionine causes subacute combined degeneration

32

What are hyperhsegmented neutrophils associated with??

MEGALOBLASTIC ANEMIA!!