Anemias Flashcards
(113 cards)
1
Q
Hgb and hematocrit in anemic men
A
Hgb < 13.5 g/dl
Hct <41%
2
Q
Hgb and hematocrit in anemic women
A
Hgb <12
Hct<36%
3
Q
Decreased RBC production causes of anemia
A
lack of nutrients, bone marrow disorders, and hypothyroidism
4
Q
Increased rbc production causes of anemia
A
Inherited/ acquired hemolytic anemias
5
Q
Blood loss causes of anemia
A
Obvious, occult and induced
6
Q
Normal MCV
A
80 to 100 fl
7
Q
Norm MCH
A
26-34 p/ cell
8
Q
Normal Mean corpuscular hemoglobin concentration
A
32-36 g/dl
9
Q
Symptoms of anemia
A
Sob, headache, tinnitus, syncope, dizziness, fatigue, sleep and mood disturbances, impaired concentration, neuro manifestations, chest pain, dementia, anorexia, skin pallor, tachycardia, increased pulse pressure, peripheral edema, flame like retinal hemorrhages, jaundice, arrhythmias
10
Q
Anemia labs
A
Cbc with diff, reticulocyte (absolute), platelet count, Wright stained blood smear, serum ferritin, iron and total binding capacity
11
Q
What does it mean if absolute retic count isn’t elevated?
A
Marrow failure (most common cause of anemia )
12
Q
What does it mean if absolute retic count is elevated?
A
Blood loss or hemolysis
13
Q
Microcytosis
A
MCV less than 80
14
Q
Normocytosis
A
MCV 80 to 100
15
Q
Macrocytosis
A
MCV greater than 100
16
Q
Pernicious anemia: type
A
Megaloblastic, autoimmune
17
Q
Pernicious anemia caused by?
A
Caused by lack of intrinsic factor produced by parietal cells of the gastric mucosa.
This prevents vitamin b12 absorption, resulting in vitamin b12 deficiency
18
Q
Incidence/ predisposing factors for pernicious anemia
A
- most common in northern European
- rare in Asians and AAs
- may be caused by atrophic gastritis, antibodies to parietal cells, or autoimmune histamine fast achlorhydria
19
Q
pernicious anemia S&S
A
pale, icteric, abnormal reflexes, babinski and romberg positive, vibratory sensation decreased in lower extremeties, paresthesia and numbness, ataxia, decreased sense of smell, smooth tongue with tenderness, depression, dementia, splenomegaly, tinnitus, hepatomegaly, tachy, CHF, weakness, asthenia, bleeding gums, nausea, weight loss, decreases appetite, sore tongue, yellowish tinge to eyes and skin, sob, headache, palpitations, chest pain
20
Q
pernicious anemia MCV
A
macrocytic, 110-140 fl, but can be in normal range if concurrent with iron deficiency or thalassemia.
21
Q
pernicious anemia RDW
A
increased
22
Q
HCT in pernicious anemia
A
10-15 ml/dl or lower
23
Q
blood smear in pernicious anemia
A
macro-ovalocytes, anisocytosis, poikilocytosis, hyper-segmented neutrophils (4 to six lobes)
24
Q
retic count in pernicious anemia
A
reduced
25
serum folate in pernicious anemia
increased
26
chance of deficiency based on serum vitamin b12 in pernicious anemia
>300- normal
200-300-borderline, deficiency possible
<200- deficiency likely
27
serum ferritin in pernicious anemia
increased
28
lactic dehydrogenase in pernicious anemia
elevated, mistaken for hemolytic anemia b/c of this
29
Major lab to affirm b12 deficiency
anti IF and anti-parietal cell antibodies. Presence affirms deficiency.
30
pernicious anemia tx
B12 sub q (1mg daily for 7 days then once a week then once a month) for rest of life
OR
or B12 with 2000 u load then 1000 u daily.
31
Giving folic acid in pernicious anemia
don't give folic acid without B12 b/c of potential for neuro change
32
electrolyte changes during tx of pernicious anemia
HYPOkalemia
33
Are central nervous changes reversible in pernicous anemia?
Yes if tx is aggressive and symptoms lasted less than 6 months
34
Endoscopy for pernicious anemia
every 5 years, even if asymptomatic
35
What is vitamin b12 deficient anemia
Macrocytic, megaloblastic
results from deficiency of hydrochloric acid or pancreatic enzymes that cause inability to metabolize vitamin b12
36
who is more likely to have vitamin b12 deficient anemia
vegans, strict vegetarians, those with dz of ilieum and enteritis, blind loop syndrome, hemodialysis, gastric bypass, fish tapeworm,
37
drugs that make vitamin b12 deficient anemia more likely
alcohol, metformin, anesthetics, nitrous oxide, para-aminosalicyclic acid (anti TB med)
38
S&S of vitamin b12 deficient anemia
same as pernicious anemia; pale, icteric, abnormal reflexes, babinski and romberg positive, vibratory sensation decreased in lower extremeties, paresthesia and numbness, ataxia, decreased sense of smell, smooth tongue with tenderness, depression, dementia, splenomegaly, tinnitus, hepatomegaly, tachy, CHF, weakness, asthenia, bleeding gums, nausea, weight loss, decreases appetite, sore tongue, yellowish tinge to eyes and skin, sob, headache, palpitations, chest pain
39
labs for vitamin b12 deficient anemia
same as pernicious EXCEPT you won't find anti IF and anti parietal cell antibodies
Serum b12 <100 when symptomatic
40
normal vitamin b12 deficient anemia tx
B12 IM or sub q (100 mcg daily for 7 days then once a week then once a month) for rest of life
OR
or B12 with 2000 u load then 1000 u daily.
41
vitamin b12 deficient anemia tx when patient has blind loop syndrome
also give antimicrobial coverage for 7-10 days
| rifaximin, amoxicillin-clavulanate, flagyl, norfloxacin
42
vitamin b12 deficient anemia tx when patient has fish tapweorm
give IF and vitamin B12
| common in scandanavian countries
43
iron deficient anemia type and definition
microcytic
iron stores in body inadequate to preserve homeostasis, less than 12 mcg/l
most common anemia worldwide
44
causes of iron deficient anemia
**most important is chronic blood loss: gi bleed, menstruation, repeated blood dontaions
blood loss, decreased iron absorption, celiac dz, certain meds, gastric/small bowel sx, blood donations, pregnancy, long term aspirin use, menstrual bleeding, chronic hemoglobinuria (traumatic hemolysis from abnormal cardiac valve function), repeated pregnancies with breastfeeding, diet deficient
45
S&S iron deficient anemia
pallor, red smooth tongue, spoon shape brittle nails (koilonychia), cracking corners of mouth (cheilosis), tachy, palpitations, peripheral parasthesia, apical systolic hemic murmur, fatigue, sob on exertion, dizzines, HA, exercise intolerance, pica
46
staging of iron deficient anemia using peripheral smear
stage 1: body stores depleted but labs normal
stage 2: hgb normal but iron stores depleted on labs
stage 3: iron depletion, slight anemia, normal MCV
stage 4: severe iron deficiency, hypochromic RBCs, low MCV with marked anemia
47
RDW in iron deficient anemia
elevated with absence of any other RBC abnormality
48
retic count in iron deficient anemia
decreased
49
ferritin level indicating low iron stores
less than 12
50
TIBC in iron deficient anemia
increased by > 300 mcg/dl
51
serum iron in iron deficient anemia
< 50
iron to TIBC ratio < 15%
52
platelet count in iron deficient anemia
elevated up to 1.5 million/mm
53
Gold standard for diagnosing iron deficient anemia when labs not conclusive
bone marrow iron stain, look for decreased or absent iron stores. Reported as "prussian blue negative"
54
iron deficient anemia tx
tx underlying cause- may need blood transfusion
oral ferrous sulfate (300-325 mg tid, 1 hr before meals for 6 months)
Uncomplicated cases can use polysaccharide iron complex for less adverse affects ( hytinic, niferex, nuiron
55
iron deficient anemia tx followup
repeat CBC in 3 weeks
| hgb should be normal in 2 months
56
iron amount in PRBCs
1 ml of PRBCs has 1 mg iron
| 1 unit contains 200 mg iron
57
precautions for sodium ferric gluconate
can cause anaphylaxis,
rapid infusion can cause hypotension and flushing
keep epi and resuscitation equipment readily available
58
IV and IM iron, when to give and special precautions
only for noncompliance and intolernce with oral supplements
watch for anaphylaxis and keep benadryl and epi close by
painful- give in buttock
can cause plebitis when given IV
59
formula for IV/IM iron
{(normal hgb-patients hbg) x weight in kg} x 2.21 /1000
60
folic acid deficiency anemia type/definition
megaloblastic, macrocytic
| decreased RBC and hemoglobin content caused by impaired production related to decreased serum folate
61
folic acid deficiency anemia causes
inadequate intake (alcoholism, anorexia special diet, older age), lack of absorption (celiac dz, tropical sprue,gluten sensitve enteropathy), inadequate conversion of folate to tetrahydrofolate, increased utiliztion during pregnancy, cancer and hemolysis
62
drug induced folic acid deficiency anemia caused by
methotrexate, pyrimethamine, phenytoin, alcohol, isoniazid, oral contraceptive
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normal body store of folate
5000 to 20000
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S&S of folic acid deficiency anemia
fatigue, pallor, mouth/tongue pain, signs of malnutrition, GI issues
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serum folate in folic acid deficiency anemia
>4- rule out folate deficiency
| <2- diagnostic of folate deficiency in absence of anorexia or fasting
66
RBC folate in folic acid deficiency anemia
less than 150, indicative of folate deficiency
67
MCV in folic acid deficiency anemia
>115 gl, macrocytic
68
homocysteine in folic acid deficiency anemia
elevated
69
folic acid deficiency anemia tx
make sure you have diagnosed correctly because giving folate to someone with b12 deficiency can make neuro symptoms worse
give oral folate 1-5 mg daily for 3-4 months
Total correction should be seen in 2 months
70
anemia of chronic dz definition
- gradual onset, 2nd most common anemia
- can be normochromic and normocytic, OR hypochromic and microcytic
- accompanies chronic dz (infection, inflammation,immune activation {rheumatoid}, CKD,malignancies, diabetes, MI, burns, liver dz, and hypo endocrine dzs) and is resolved when underlying dz fixed
71
subjective findings of anemia of chronic dz
usually no symptoms until severe, then fatigue, SOB, weight loss, light headedness, loss of appetite
Physical findings will be related to underlying dz
72
RBCs in anemia of chronic dz
can be normochromic and normocytic, OR hypochromic and microcytic
RDW normal
73
iron storage in anemia of chronic dz
normal or increased, sideroblasts absent in bone marrow
74
retic count in anemia of chronic dz
less than 1% or low absolute number
75
serum ferritin in anemia of chronic dz
normal or high. >100
76
TIBC in anemia of chronic dz
lowered, <250
77
anemia of chronic dz tx
tx underlying dz,
- may try oral iron in premenopausal women
- Recombinant human erythropoietin (epogen, procrit) to promote hematopoiesis
78
risk for fast HCT rise
hct should not be raised more than 4 points during any 2 week period b/c this could cause htn or seizures.
79
Thalassemia definition/type
group of inherited disorders that are the result of defective production of the globin portion of hemoglobin
-hypochromic and microcytic
80
Name for severe Thalassemia
Cooley's anemia
81
Thalassemia incidence
most common in Mediterranean people (italian, greek)
82
alpha Thalassemia 4 types
1: silent carrier, asymptomatic, alpha Thalassemia-2 trait
2: mild microcytic , hypochromic, alpha Thalassemia 1 trait
3: moderately severe hemolytic anemia, usually don't need transfusions, 3 genes affected
4: nonfunctional: all four genes affected, hydrops fetalis and bart's hemoglobin
83
Who is most affected by beta Thalassemia in US
mediterranean, asian and african descent
84
Who is most affected by alpha Thalassemia in US
asian descent
85
S&S and physical findings of Thalassemia
Hepatosplenomegaly, cardiac failure/dilatation, jaundice, cooley's anemia, growth retardation, delayed or absent adolescent growth (late menarche, oligomenorrhea or amenorrhea, delayed sexual characteristics, hypogonadism) pallor, fatigue, dark urine, poor growth
86
Cooley's anemia findings
marked osteoporosis and cortical thining, erythroid overgrowth of the marow may distort bones of head, face, rib cage, and pelvis, predisposed to fxs
87
CBC for Thalassemia
Decreased Hgb, hct, MCV, and MCH, increased RBCs
88
Wright stain for homozygous beta Thalassemia and double heterozygous non alpha Thalassemia
extreme anisocytosis and poikilocytosis with bizarre shapes, target cells, and ovaloctyes and large number of nucleated RBCs
89
Wright stain for heterozygous beta Thalassemia
hypochromic and microcytic cells with mild to moderate anisocytosis and poikilocytosis.
Target cells with basophilic stippling
90
Indirect bilirubin level in Thalassemia
increased, 1-6 mg/dl, higher in Thalassemia intermedia
91
test to confirm diagnosis
Hgb electrophoresis
- If HbA2 is elevated= heterozygous beta Thalassemia
- if HbF and HbA2 levels are normal, microcytosis with minimal or no anemia= alpha Thalassemia
92
skull xray with Thalassemia
beta Thalassemia skull xray may show "hair on end" appearance
93
Severe beta Thalassemia tx
- blood transfusions- multiple transfusions pt patient at risk for hemochromatosis
- Iron chelation therapy: deferoxamine IM or sub q pump or hickman cath. Done to prevent organ damage from iron overload
- hgb goal 9-10
- concurrent admin of vitamin c to enhance iron excretion
94
Tx of choice for beta thalassemia major
allogeneic bone marrow transplant
this is the only cure
95
what to watch for to indicate spleen issues in Thalassemia
look for leukopenia and thrombocytopenia as indicator of splenic enlargement and possible need for spleenectomy
96
Which anemias are microcytic? (5)
```
Iron deficiency
Thalassemia
anemia of chronic dz
lead toxicity
zinc deficiency
```
97
Which anemias are macrocytic and megaloblastic (3)
Vitamin b12 deficiency
Folate Deficiency
DNA synthesis inhibitors
98
Which anemias are macrocytic and nonmegaloblastic (7)
```
Aplastic anemia
myelodysplasia
liver disease
Reticulocytosis
Hypothyroidism
Bone marrow failure
Copper Deficiency
```
99
Which anemias are normocytic
Kidney disease
Non thyroid endocrine gland failure
copper deficiency
the mild forms of most anemias start as normoctic
100
Ferritin levels indicating iron deficiency anemia
less than 30
101
What happens to transferrin levels when serum iron values drop
Transferrin (iron transport protein) increases to compensate leading to transferrin saturation of less than 15%
102
Medication for CKD patients with iron deficiency anemia
Ferric pyrophosphate citrate (triferic) is added to diasylate
Maintains hemoglobin without increasing iron stores
103
transferrin levels in iron anemia of chronic dz
normal or increased, Saturation may be low
104
Hematocrit in anemia of chronic dz
rarely falls <60% of baseline
105
Lab findings in alpha thalassemia trait
```
mild anemia
hct: 28%-40%
MCV is really low though (60-75)
RBC normal or increased
Blood smear: microcytes, hypochromia, some target cells, acanrhocytes
Normal retic count and iron
```
106
Hemoglobin H disease labs
Hct: 22-32%
MCV: 60-70
Blood smear: hypochromia, microcytosis, target cells, poikilocytosis
Elevated retic count
RBC norm or elevated
-Fast migrating hemoglobin (hemoglobin H) which compromises 10-40% of hemoglobin
Blood smear will show hemoglobin H
107
Beta Thalassemia minor
HCT: 28-40%
MCV: 55-75
Retic counr norm or elevated
Blood smear: hypochromia, microcytosis, target cells
***Basophilic stippling present
-Elevation of HEmoglobin A2 to 4-8%, and hemoglobin F elevations to 1-5%
108
Beta thalassemia intermedia
Hct: 17-33%
MCV: 55-75
RBC norm or elevated
Elevated retic count
Blood smear: hypochromia, microcytosis, basophilic stippling, target cells
-30% Hemoglobin A1, increase in Hemoglobin A2 up to 10% and elevation of hemoglobin F from 6-10%
109
Beta thalssemia major
severe anemia, without transfusion, hct can drop to < 10%
blood smear bizarre: severe poikilocytosis, hypochromia, microcytosis, target cells, basophilic stippling, nucleated RBCs
Little or no hemoglobin A2, predominant hemoglobin seen is hemoglobin F
110
tx for hemoglobin H disease
folic acid supplement
AVOID medicinal iron and oxidative drugs such as sulfonamides
111
Normal serum b12
> 210
112
red blood cell folic acid level in folic acid deficiency
<150 ng/mL
113
Hemolytic anemias
RBC survival is reduced, and bone marrow will increase production to compensate until it is impaired
