Wk 1 Anemia Flashcards
(199 cards)
1
Q
What is the center of all hemoglobin molecules?
A
Iron
2
Q
Hemoglobin reversibly binds to __ and __ for transport
A
oxygen and CO2
3
Q
CO2 is a waste product and is usually in the form of
A
sodium bicarbonate in the plasma
4
Q
What does hemoglobin bind to more readily than oxygen?
A
carbon monoxide
5
Q
How is carbon monoxide poisoning treated?
A
100% oxygen and maybe ventilation
6
Q
What permanently binds to hemoglobin?
A
Glucose
7
Q
What is the lifespan of a RBC?
A
120 days / three months
8
Q
Oxygen binds to __ on the hemoglobin molecule
A
heme
9
Q
The more saturated with oxygen an RBC, the more
A
red it appears
10
Q
Pulse oximetry looks at how __ the blood is
A
red
11
Q
What is an absolute decrease in red blood cells?
A
Do not have enough number of red blood cells
12
Q
What is a relative decrease in red blood cells?
A
Dilutional
13
Q
Why does a pregnant woman have a relative decrease in red blood cells?
A
Plasma volume increases by 50%, but RBC count increases only 30%
14
Q
What are two examples of relative decrease in RBCs?
A
Fluid volume overload and athletes
15
Q
If someone is very dehydrated the could have a relative __ in RBCs
A
increase
16
Q
Normal hematocrit = about
A
45%
17
Q
Anemia hematocrit = about
A
30%
18
Q
Polycythemia hematocrit = about
A
70%
19
Q
8 causes of anemia
A
1) Inflammation
2) Neoplasia
3) Chronic disease
4) Marrow damage
5) Acute bleeding
6) Hemolytic anemia
7) Maturation disorders
8) Iron deficiency
20
Q
What is the main cause in western culture of anemia?
A
Iron deficiency
21
Q
What are hemolytic anemias?
A
Autoimmune diseases where our bodies attack our own RBCs and destroy them
22
Q
What are maturation disorders?
A
Cells can’t carry oxygen effectively
23
Q
With bone marrow damage you would also see a decrease in….
A
WBCs and platelets
24
Q
Why does chronic kidney disease lead to anemia?
A
Kidneys are not secreting erythropoietin
25
What does erythropoietin do to red bone marrow?
Stimulates it to make red blood cells
26
What would someone with anemia look like?
```
Pale
Fatigue quickly
Hypotensive
Tachycardia, especially with exertion
Tachypnea
```
27
Why is someone with anemia tired?
Their muscles go into anaerobic metabolism due to the lack of oxygen, and create lactic acid and muscle fatigue
28
What are the symptoms of severe anemia?
Chest pain, angina, heart attack, worsening CHF, syncope
29
Anemia also has these neuro symptoms
Memory, cognition, insomnia
30
Moderate anemia symptoms
fatigue
weakness
tachycardia
dyspnea
31
Severe anemia symptoms
tachypnea
tachycardia
hypotension, pallor, faintness
cardiovascular symptoms, especially with exertion
32
What causes bone pain in a person with anemia?
Increased production of erythropoietin
33
Where is erythropoietin secreted?
Kidneys
34
An example of abnormal hemoglobin
sickle cell disease
35
Normal hematocrit for females
37-48
36
Normal hematocrit for males
45-52
37
With abnormal hemoglobin, the count of red blood cells would be __
normal
38
How do they test for abnormal shapes of red blood cells?
hemogram
39
Two examples of abnormal hemoglobin pathologies
Sickle cell anemia and Thalassemia
40
Misshapen RBCs have a __ life span
shorter
41
With sickle cell anemia, hemoglobin tend to become distorted and this occurs under __
stress
42
What are examples of stressors that can cause someone with sickle cell anemia to have misshapen hemoglobin
Infection, dehydration, hypoxia, anything that can cause stress on the body
43
RBCs can go back to their normal shape, so...
they can sickle and then return to the round shape
44
What is thalassemia?
A genetic disorder that causes defective hemoglobin, and hemolysis
45
Where are defective cells destroyed (in thalassemia)?
bone marrow or spleen
46
When RBCs are sickled they tend too...
Clump together and can block blood flow
47
If RBCs are clumped together and blocking off blood flow, what can this lead to?
Pain and ischemia distal to the clot
48
What are common sites for blockages in a patient with sickle cell anemia?
Liver, spleen, heart, kidneys, and retina
49
What nutrient deficiencies can cause anemia? (3)
Iron, folate, b12
50
Iron is essential to...
normal hemoglobin production
51
B12 and folate are required for normal __ __
DNA synthesis
52
How are anemias classified?
Size and shape of the red blood cell
53
What does mcv blood test stand for?
Mean corpuscular volume
54
What will the MCV be of someone with iron deficiency anemia?
Less than 80, so the RBC will be smaller
55
Iron deficiency anemia is a __ anemia
microlytic
56
If someone has a folate or vitamin b12 deficiency anemia, what will the MCV be?
Greater than 100, so the RBC will be larger
57
Folate and vitamin b12 deficiency anemias are __ anemias
macrolytic
58
What is a normal MCV?
80-100
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What is a reticulocyte count?
Immature red blood cell count
60
If someone has a high reticulocyte count, what does that mean?
They have high immature RBCs, which means they are anemic or experiencing blood loss
61
What is the most prevalent type of anemia?
Iron-deficiency anemia
62
Only 10% of iron deficiency anemia is in where?
developed countries
63
What vitamin deficiency can cause an iron deficiency anemia?
Vitamin C
64
What two drinks decrease absorption of iron?
Tea and coffee
65
What is an example of an increased demand for iron, that can lead to iron deficiency anemia?
Pregnancy
66
What are two examples where excessive blood loss can lead to iron deficiency anemia?
Heavy mentsruation and GI bleeding (occult)
67
What is visible blood called?
frank blood
68
4 GI disorders that can cause iron deficiency anemia
Ulcerations
Inflammation
Hemorrhoids
Colon cancer
69
Why does iron deficiency lead to anemia?
Your body can't make hemoglobin without iron
70
5 demographic factors that put someone at higher risk for iron deficiency anemia
```
Elderly
Teenager
Female
Immigrant
Widower
```
71
5 dietary factors that put someone at higher risk for iron deficiency anemia
```
Low iron intake
Low vitamin C
Excess phytate (phosphorous) intake
Excess tea/coffee
Fad diets
```
72
5 social factors that put someone at higher risk for iron deficiency anemia
```
Poverty
Poor detention
Alcohol abuse
GIT disease
depression
```
73
__ is needed to synthesize hemoglobin
Iron
74
Where is iron absorbed?
Duodenum
75
Why does it take a long time to become anemic from an iron deficiency?
Iron is reused when erythrocytes die
76
All anemias lead to... (3 things)
Fatigue
Weakness
Exercise intolerance
77
__ __ is a symptom specific to iron deficiency anemia
Epithelial atrophy
78
What is a sign of epithelial atrophy?
Brittle hair and nails
79
What are spoon shaped nails called?
Koilonychia
80
Why does iron-deficiency anemia cause epithelial atrophy?
It's secondary to the tissues having a lack of oxygen
81
What are 3 GI symptoms of iron-deficiency anemia
Smooth tongue
Mouth sores
Dysphagia
82
What is a unique symptom of iron deficiency anemia related to appetite?
PICA
83
What is pagophasia?
Chewing or eating ice
84
What is cobalamin?
Vitamin b12
85
What does vitamin b12 do to folic acid?
It turns inactive folic acid to active folic acid
86
Why is active folic acid important?
It's needed for normal maturation of erythrocytes
87
What is the problem with administering folic acid?
It can mask vitamin b12 deficiency because it bypasses the step of vitamin b12 converting inactive folic acid to active folic acid
88
Folic acid deficiency is a problem with...
red blood cell production
89
Folic acid deficiency is a __ anemia
megaloblastic
90
In megaloblastic anemias, the MCV is...
High
91
Inflammation of the __ is common with folic acid deficiency
tongue
92
Vitamin b12 is important in the synthesis of RBCs but also the...
synthesis of myelin sheath of neurons
93
B12 deficiency can lead to what 3 manifestations
Anemia
Glossitis
Neurologic disease/ subacute combined degeneration
94
What is glossitis?
Inflammation of the tongue
95
What are symptoms of a vitamin b12 deficiency
Balance/gait problems
Numbness and tingling in hands/feet
Memory loss
irritability
96
Folate deficiency is not a problem with __
absorption
97
The body can store a few __ worth of folate
months
98
3 reasons you might see decreased intake of folate in the diet
Alcoholism
Dieting
Cirrhosis
99
Who has an increased need of folate?
Pregnant women
100
The body can store __ worth of vitamin b12
years
101
What is vitamin b12 deficiency anemia called?
pernicious anemia
102
Where is vitamin b12 absorbed?
terminal ileum
103
What does vitamin b12 need to be able to be absorbed?
intrinsic factor
104
Where is intrinsic factor secreted?
in the gastric parietal cells
105
3 conditions that reduce the production of intrinsic factor
Gastric bypass
Gastrectomy
Bowel resection, especially if the terminal ileum
106
Pernicious anemia normal symptoms (6)
```
Fatigue
Exercise intolerance
Weakness
Tachycardia
Dyspnea
Glossitis
```
107
Neurological symptoms of vitamin b12 deficiency (8)
```
Depression
Paranoia
Confusion
Irritability
Anxiety
Balance issues
Gait issues
Memory loss
```
108
What 3 things lead to anemia
Abnormal hemoglobin
Decreased hemoglobin content on RBC
Decreased number of circulating erythrocytes
109
What is an example of abnormal hemoglobin cause of anemia?
Sickle cell disease
110
What are two example of causes of decreased hemoglobin content on RBC?
Loss or iron
| Loss of key nutrients
111
What are three causes of decreased number in circulating erythrocytes?
Decreased production
Increased destruction
Blood loss
112
Why does chronic kidney disease lead to anemia?
In a healthy kidney, erythropoietin is secreted to stimulate bone marrow to create RBCs
113
A patient with chronic kidney disease may have very little symptoms despite having a very low h&h. Why?
Because kidney disease progresses so slowly that their body has time to compensate
114
It's not uncommon to see a patient with chronic kidney disease have a hemoglobin of __-__
5-6
115
What is the treatment for patients with anemia who have chronic kidney disease?
Treat them with recombinant erythropoietin
116
Aplastic anemia is a __ cell disorder
stem
117
What is aplastic anemia characterized by?
pancytopenia
118
What is pancytopenia?
Reduction in RBCs, WBCs, AND platelets
119
What are the two classifications of aplastic anemia?
Congenital or acquired
120
Acquired aplastic anemia is often __
idiopathic
121
Acquired aplastic anemia can also be an __ __.
Autoimmune disorder
122
What is a possible trigger of acquired aplastic anemia?
Radiation/chemo treatment
123
A patient with aplastic anemia will be at high risk for __ and __
infection and bleeding
124
What are some autoimmune triggers for aplastic anemia?
Complications of infection such as hepatitis or mononucleosis
125
Absent or decreased production of hemoglobin is what type of anemia?
Thalassemia
126
Abnormal hemoglobin and decreased lifespan of RBC is what type of anemia?
Sickle cell
127
What are two types of thalassemia?
Alpha and beta
128
What is acquired hemolytic anemia?
Premature destruction of RBCs by some external agent
129
What are common causes of acquired hemolytic anemia? (4)
Blood incompatibilities
Drug reactions
Severe burns
Microangiopathy
130
Acquired hemolytic anemia is an __ attack
Autoimmune
131
What are examples of blood incompatibilities that can lead to acquired hemolytic anemia? (2)
Blood transfusion with wrong type
| Rh factor issues with pregnancy
132
What 3 drug classes have been linked to hemolytic anemia?
Penicillins
Cephalosporins
NSAIDs
133
What happens in hemolytic anemia?
We get these immune complexes that amount a direct attack on the cell and cause lysis
134
Why is low hemoglobin a symptom of hemolytic anemia?
Because of the destruction of RBCs
135
What are specific signs/symptoms to look for in a patient with hemolytic anemia? (5)
```
Low hemoglobin
Increased reticulocyte count
Mild jaundice
Hemoglobinuria
Decreased haptoglobin
```
136
Why does a patient with hemolytic anemia have mild jaundice?
Some bilirubin escapes when RBCs are destroyed
137
Why does a patient with hemolytic anemia have increased reticulocyte count?
Bone marrow increases production to compensate for RBC destruction/low count
138
Where is haptoglobin made?
The liver
139
What does haptoglobin do?
It attaches to hemoglobin and helps carry it to the reticuloendothelial system
140
Blood loss anemia results from __ and __ blood loss
Gross and occult
141
What is a normal person's normal blood volume?
About 5000 mL
142
If someone loses 10% (500ml) of their blood volume, what are their s/s?
Usually none, but maybe syncope or dizziness
143
If someone loses 20% (1000ml) of BV, what are their s/s?
No symptoms at rest but tachycardia with exercise
144
If someone loses 30% (1500ml) of BV, what are their s/s? (3)
Flat neck veins when supine
Tachycardia with exertion
Orthostatic hypotension
145
If someone loses 40% (2000ml) of BV, what is their s/s? (4)
Tachycardia
Hypotension when supine
Air hunger
Cool, clammy skin
146
If someone loses 50% (2500ml) of BC, what is their s/s?
Shock and death
147
What organs are important to watch with someone who is experiencing blood loss?
Heart
Brain
Lungs
Kidneys
148
A patient with chronic blood loss may be asymptotic until their hemoglobin reaches...?
8 or less
149
Someone with chronic blood loss will have the __ __ __ but less cells in it
same blood volume
150
What symptoms might someone have if their hemoglobin is 8 or less?
Pallor
Tachycardia
Tachypnea
151
What are potential issues a person may have that is causing their chronic blood loss?
GI erosion
| Diverticulitis
152
Chronic blood loss can lead to what type of anemia?
iron deficiency anemia
153
What type of drug is epoetin alfa?
Erythropoietin stimulating agent
154
What are brand names for epoetin alfa?
Epogen and procrit
155
What is the MOA of epoetin alfa?
Mimics the function of human erythropoietin
156
What are some indications of epoetin alfa?
Maintains RBCs in patients with chronic kidney failure, HIV infection on drug therapy, preop for patients with anemia, anemia secondary to chemo
157
What routes if epoetin alfa given?
SQ
158
If you give a patient with chronic kidney disease epoetin alfa, what are the risks?
Puts them at increased risk for increased mortality and serious cardiovascular events
159
If you give a patient with cancer epoetin alfa, what are the risks?
Increased mortality and tumor progression
160
If you give a patient who is undergoing surgery epoetin alfa, what are the risks?
Puts them at risk for thromboembolic events and mortality
161
What does the CDC recommend for epoetin alfa? (3)
Weigh risks versus benefits
Do not administer if hgb about 10 or higher
Use lowest dose possible to reduce need for transfusion
162
What are nursing implications for epoetin alfa? (3)
Administer BP before and during therapy
Monitor Hgb levels
Teach patient to take iron supplements
163
When should you hold epoetin alfa?
Someone with uncontrolled hypertension
| Hgb level of 10 or higher
164
What can happen concerning blood pressure when administering epoetin alfa?
Patient can become hypotensive
165
What are the two forms of dietary iron?
heme and non-heme iron
166
Heme iron makes up 40% of the iron in...
meat, fish, poultry
167
Heme iron is __ __
well absorbed
168
Non-heme iron is 60% of __ __
animal tissue
169
What type of iron is in plants?
Non-heme iron
170
Non-heme iron is what compared to heme iron?
not as well absorbed
171
What are iron rich vegetables?
Green leafy vegetables, broccoli, tomatoes, green beans
172
What is recommended for pregnant women so they don't become iron deficient?
ferrous sulfate
173
What is the MOA of ferrous sulfate?
Taken up by bone marrow cells to make hgb
174
What are the adverse effects of ferrous sulfate? (3)
GI disturbances
teeth staining
tarry stools
175
What type of drug is ferrous sulfate?
iron replacement therapy
176
Ferrous sulfate only contains __% of elemental iron
20%
177
If a patient needs a 100mg dose of elemental iron, how much ferrous sulfate will they need to take?
500mg
178
__ reduce absorption of iron
Antacids
179
Food can help decrease the GI side effects of iron, but what adverse effect does this have?
Decreases the absorption of the iron
180
Food decreases absorption of iron by __-__%
50-70%
181
Recommend patients take iron on an __ __ if they can tolerate it
empty stomach
182
What is the leading cause of death in children concerning iron?
Iron toxicity, overdose
183
What is the parenteral iron therapy drug called?
Iron dextran
184
What is the brand name of iron dextran?
DexFerrum
185
What are the indications for iron dextran?
Iron deficiency or
| Oral iron is intolerable or ineffective
186
Why is there a black box warning for iron dextran?
Potentially fatal anaphylaxis
187
What are three safety considerations for administering iron dextran?
Only use when absolutely necessary
Have epi and CPR equipment close by
Do a small "test" dose before each administration
188
What are the routes of iron dextran?
IV or IM
189
What are three adverse effects of iron dextran?
Persistent pain
Discoloration at the site
Tumors
190
When giving iron dextran IM, what is important to do?
Use the z track method
191
The discoloration on the skin caused by iron dextran is __
permanent
192
What is the drug called used for vitamin b12 replacement?
Cyanocobalamin
193
What is the preferred route for cyanocobalamin?
PO
194
What is an adverse effect of cyanocobalamin?
hypokalemia
195
Why use caution when administering cyanocobalamin with __ __ because it may mask b12 deficiency
folic acid
196
With oral cyanocobalamin, the doses need to be __
larger
197
What is the MOA of folic acid administration?
Converts to the active form of folic acid after administering
198
What are the 3 indications for folic acid admin?
Folic acid deficiency anemia
Prophylaxis to folic acid anemia
Initial treatment of severe anemia due to vitamin b12 deficiency
199
When taking folic acid a patient may report they feel...
flushed
