Flashcards in Anemia (slides only) Deck (48):
1
How many people does iron deficiency anemia effect?
1 billion
2
What hallmark symptoms do we see in severe anemia?
fainting, chest pain, angina heart attack
3
Do we see in or decreased size of spleen in anemia?
enlarged
4
What are the 3 major types of anemia?
1. Dilutional
2. Decreased RBC production
3. Increased RBC breakdown
5
What type of anemia does anemia of prematurity fall under?
Dilutional
- reduced EPO, overzealous laboratory testing
6
How do we get apparent dilution anemia? 3
1. excessive sodium or fluid intake
2. sodium or water retention, fluid shift intravascular
3. pregnancy
7
How many days does it take for erythrocyte development?
5.5 days (lasts for 3 months)
8
How long do reticulocytes stay before becoming erythrocytes?
3 days
9
Pure red blood cell aplasia is also known as what?
erythroblastopenia
10
Review the following things that can cause pure red blood cell aplasia.
autoimmune
thymoma
viral infections (eg HIV, herpes, parvovirus B19)
lymphoproliferative
congenital
11
What are the 3 main causes of aplastic anemia?
-Fanconi anemia- problem with DNA repair
-Anemia of Renal failure- insufficient EPO
-Anemia of endocrine disorders
12
What cell cyle point is megaloblastic anemia stuck in?
G2
13
what is addisons anemia or biermers anemia?
pernicious anemia- intrinsic factor loss
14
What is the best indicator of iron deficiency anemia?
Ferritin
15
What is iron deficiency anemia almost always due to?
insufficient dietary intake of anyone with chronic blood loss (preg women, toddlers, GI bleeds)
16
What is the most common cause of iron deficiency in the US? in the world?
GI bleed
parasitic infection
17
True or false- the total iron amount in the body is 3.5 grams in it doesn't take long to deplete stores?
False- it is 3.5 g but it takes a while to deplete
18
If I have ferritin of 20 and normal erythrocytes what might I think? what about ferritin of 10 and normal erythrocytes? what about ferritin <10 and microcytic/hypochromatic erythrocytes?
1. Iron depletion
2. Iron deficient erythropoiesis
3. Iron deficiency anemia
19
Is the oral bioavailability of iron high or low?
Very low
20
What happens to lactate dehydrogenase, haptoglobin, reticulocyte count and bilirubin in hemolytic anemia?
1. increase
2.decreae
3. increase
4. increase
21
Does warm or cold hemolytic anemia occur by IgM?
Cold excessive rite permits binding in the cold [think viruses or cancer], Warm is IgG [think autoimmune]
22
If we have anemia with small cells, what should we think about the environment and the genetics?
too little iron
too much lead
thalessemias
23
If we have anemia with large cells, what should we think about the environment?
too little B12 or B9 or a drug side effect
24
If we have anemia with normal cells but decreased survival, what should we think about the environment and the genetics?
acute hemorrhage
sickle cells
25
If we have anemia with normal cells but bad cell development, what should we think about the environment and the genetics?
chronic disease or aplastic anemia
G6PD enzyme
cell shape (spherical)
leukemia
26
What helps absorption of oral iron?
Vitamin C
27
Are ferrous salts or ferric salts much better?
ferrous Fe2+
28
Where is iron absorbed?
duodenum and proximal jéjunum
Sustained release pills don't work well
29
Are oral iron supplement pH dependent?
yes! don't take things that kill the acid
30
Do we dose by salt weight or iron content?
salt weight
31
What is the iron RDA does for men and postmenopausal women? pre menopause?
1. 8 mg/d
2. 18 mg/d
32
is heme iron or non-heme iron absorbed better?
heme iron from animal source
33
What does fiber, dairy, phosphates and tea do to iron absorption?
decreases it
34
When do we use parenteral iron?
Speed--deficit would take forever to treat orally
35
What is a big risk to iron injections with erythropoietin?
hypersensitivity and anaphylaxis
36
Should patients stay on Iron for a long time?
No- chronic iron overload is not good
37
What are the key points to acute iron toxicity?
1. rare except for young children
2. can be fatal
3. abdominal pain and blood diarrhea in 30 min
4. hepatic failure and acidosis, coma,
5. necrotizing gastorenteritis
38
What are the key points to chronic iron toxicity or hemochromatosis?
1. excess iron is deposited in heart, liver, pancreas-->organ death
2. can happen to patients with excess ability to absorb or those with parenteral iron on multiple transfusions
3. do phlebotomy
39
How do we treat iron overdose?
1. gastric aspiration or induced vomiting
2. Lavage with iron precipitating salts
3. deferoxamine- iron chelator
40
what is deferoxamine used for?
acute iron poisoning or inherited/acquired hemochromatosis
41
rapid IV deferoxamine causes what? long term use?
hypotension
neurotoxicity and increased infection
42
What does B12 deficiency cause? B9
1. neurotoxicity and anemia
2. just anemia
43
Can folate compensate for B12?
yes for anemia no for neurotoxicity
44
Is blood transfusion recommended for very low Hgb <60 status and no CV instability?
No- need to have instability
45
Why don't we use whole blood transfusion?
potassium from lysis is bad
46
Erythropoiesis stim agent ESA should be used in mild and moderate anemia? what about in chronic kidney disease? what does treatment with ESA require?
1. No just to get to lowest acceptable range
2. No unless extreme anemia of <10g
3. iron delivery
47
What is used for hemoglobin independent transport to increase oxygen content of plasma?
hyperbaric oxygen
48