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78 Cards in this Set

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Anemias are a group of diseases characterized by:
1.
2.

Can result from:
1.
2.
3.
Anemias are a group of diseases characterized by:
1. Decrease in Hb or RBC
2. Result in reduced oxygen carrying capacity

Can result from:
1. Inadequate RBC production
2. Increased RBC destruction
3. Blood loss
Anemias can be classified based on:
1.
2.
3.
1. Morphology of RBC
2. Etiology
3. Pathophysiology
Anemias Classification Based on Morphology:'
1.
2.
3.
4.
5.
6.
1. Macrocytic
2. Microcytic
3. Normocytic
4. Renal failure
5. Endocrine disorders
6. Myelodisplastic anemias
Macrocytic anemias include _____________ anemias caused by:
1.
2.
megaloblastic

1. vitamin B12 deficiency
2. folic acid deficiency
Microcytic anemias can be caused by:
1.
2.
1. iron-deficiency
2. genetic anomaly
Normocytic anemias can be caused by:
1.
2.
3.
1. recent blood loss
2. hemolysis
3. bone marrow failure
Anemias Classification Based on Etiology:
1.
2.
3.
1. Deficiency
2. Central, caused by impaired bone marrow function
3. Peripheral
Some deficiencies that cause anemias:
1.
2.
3.
4.
1. iron
2. vitamin B12
3. folic acid
4. pyrodoxine
What are some central causes of anemias (caused by impaired bone marrow function)?
1.
2.
3.
1. anemia of chronic disease
2. anemia of elderly
3. malignant bone marrow
What are some peripheral causes of anemias?
1.
2.
1. Bleeding (hemorrhage)
2. Hemolysis (hemolytic anemias)
Anemias Classification Based on Pathophysiology:
1.
2.
3.
4.
1. Excessive blood loss
2. Chronic hemorrhage
3. Excessive RBC destruction
4. Inadequate production of mature RBC
Patients with anemia can generally present asymtomatically or with vague complaints, but neurologic consequences can result from:
Vitamin B12 deficiency
What are some signs of anemia?
1. Decreased exercise tolerance
2. Fatigue
3. Dizziness
4. Irritability
5. Weakness
6. Palpitations
7. Vertigo
8. SOB
What are some symptoms of anemia?
1. Tachycardia
2. Pale appearance
3. Decreased mental acuity
What are some diagnostic tests for anemia?
1. Hemoglobin (Hb)
2. Hematocrit (Hct)
3. Iron level
4. Total Iron Binding Capacity (TIBC)
5. Mean Corpuscular Volume (MCV) = Hct/RBC
6. Vitamin B12 levels
7. Folate level
The most common nutritional deficiency in developing and developed countries:
Iron
Iron-deficiency anemia results from:
1.
2.
1. Prolonged negative iron balance
2. Failure to meet increased physiologic iron demand
Higher risk for iron deficiency:
1.
2.
3.
4.
1. Children < 2YO
2. Adolescent girls
3. Pregnant females
4. Elderly >65 YO
Without iron, cells lose capacity for:
1.
2.
1. Electron transport
2. Energy metabolism
Manifestations of iron-deficiency anemia occur in 3 stages:
1.
2.
3.
1. Prelatent
2. Latent
3. Iron deficiency anemia
What happens in the prelatent stage of IDA?
1. Iron stores are depleted
2. No reduction in serum iron levels
3. Can be assessed with serum ferritin measurement
What happens in the latent stage of IDA?
1. Iron stores are depleted
2. Hb above the lower limit of normal
3. Can be determined by CBC
(reduced transferritin saturation and increased TIBC)
What occurs when anemia progresses to the last stage of IDA?
1. Hb below normal
2. Progresses to classic hypochromia and microcytosis
In IDA, lab findings include:
1.
2.
3.
4.
5.
6.
1. Low serum iron
2. Low ferritin levels
3. High TIBC
4. Increased RDW (not specific)
5. Hb and Hct below normal (later stages)
6. Elevated EPO (in response to low Hct)

LOW: iron, ferritin, Hb, Hct
HIGH: TIBC, RDW, EPO
Treatment for IDA depends on ______ & _______ and the main focus of treatment is to:
1.
2.
severity; cause

1. replenish iron stores
2. treat underlying disease
IDA Treatment - can use:
1.
2.
1. Dietary supplements
2. Therapeutic iron preparations
Dietary supplements for IDA are BEST absorbed from:
meat, fish and poultry
Dietary supplements for IDA are POORLY absorbed from:
vegetables, grains, eggs, and dairy products
True or False: Iron supplements should be dosed based on patient tolerance and can be started at low dose and gradually increased to full dose.
TRUE
The general recommendation for iron supplementation for IDA is:
200mg of elemental iron daily in 2-3 divided doses
What iron products contain the highest amounts of elemental iron?
Polysaccharide iron capsule and carbonyl iron
The major adverse reactions to therapeutic doses of elemental iron are ______________ in nature and include:
1.
2.
3.
4.
gastrointestinal

1. dark discoloration of feces
2. constipation/diarrhea
3. nausea
4. vomiting
True or False: Meals have no effect on iron absorption.
FALSE - reduce absorption by more than half
What are the 3 therapeutic iron interventions that can be used to treat IDA?
1. Therapeutic supplements
2. Parenteral iron therapy
3. Blood transfusion
When is parenteral iron therapy used in IDA tmt and what products are available?
Used when PO iron is not absorbed or patient cannot tolerate - does NOT lead to quicker hematologic response

Products:
1. Iron dextran (can lead to anaphylactic reaction and death)
2. Sodium ferric gluconate
3. Iron sucrose
Megaloblastic anemia is a type of __________ anemia and involves abnormal DNA metabolism which results from:
1.
2.
macrocytic

1. Vitamin B12 deficiency
2. Folate deficiency
What are the major causes of vitamin B12 deficiency?
1. Inadequate intake
2. Malabsorption syndromes
3. Inadequate utilization
Vitamin B12 is (water/fat) soluble and can be obtained through ingestion of:
water-soluble; meat, fish, poultry, dairy products, fortified cereals
The recommended daily allowance for vitamin B12 is:
2mcg for adults

2.6mcg for pregnant or breastfeeding women
Vitamin B12

1. Works with _____ in synthesis of building blocks for ___ & ___.
2. Essential for maintaining integrity of ________ system.
3. Plays role in _____ ____ _________ and _______ production.
1. folate; DNA & RNA
2. neurological
3. fatty acid biosynthesis; energy
What are the lab findings associated with vitamin B12 deficiency?
1. MCV elevated
(some patients may have normal levels)
2. Mild leukopenia and thrombocytopenia
3. Macrocytosis and hypersegmented polymorphonuclear leukocytes
(earliest and most specific indications)
4. Pancytopenia in advanced cases
What are the goals associated with vitamin B12 deficiency treatment?
1. reversal of hematologic manifestations
2. replacement of body stores
3. prevention or resolution of neurologic manifestations
How can replacement of vitamin B12 stores be achieved?
1. Food
2. Vitamin B12 PO
(1-2 mg daily)
3. Vitamin B12 IM
(usually start with 1,000mcg daily for 1 week then weekly for 1 month then monthly)
4. Nasal spray
(once weekly)
Potential adverse effects of vitamin B12 are rare and may include:
1. hyperuricemia
2. hypokalemia
3. rebound thrombocytosis
4. fluid retention
What is the best dietary source of B12?
liver
What are the most common causes of folic acid deficiency anemia?
1. excessive alochol intake
2. pregnancy
What are some drugs that may cause folic acid deficiency anemia?
1. azathioprine
2. 6-MP
3. 5-FU
4. hydroxyurea
5. zidovudine
6. MTX
Lab findings associated with folic acid deficiency anemia:
1. rule out B12 deficiency - levels should be normal
2. serum folate levels decreases to <3ng/mL within few days of reduced folate intake
3. RBC folate level (<150ng/mL) declines
Treatment of folic acid deficiency anemia:
1. exogenous folic acid
-usually 1mg/day sufficient
(1-5mg can be used if malabsorption)

2. parental available - rarely used
True or False: Anemia of chronic disease is usually diagnosed by exclusion of other causes.
TRUE - usually overlooked due to other prominent disease
What are the most common causes of anemia of chronic disease?
1. chronic infection
2. chronic inflammation
3. malignancies
True or False: There is no definitive test to confirm dx of anemia of chronic disease.
TRUE - can coexist with IDA and folic acid deficiency
What are the goals associated with treatment of anemia of chronic disease?
1. treat underlying disease
2. correct reversible causes
2 treatment options for anemia of chronic disease:
1. RBC transfusions
2. Erythropoeitic agents
True or False: RBC transfusions are an effective treatment for anemia of chronic disease.
TRUE - should be limited to situations when oxygen transport is inadequate due to concomitant disease.
Transfusion threshold when Hb 8-10g/dL
What are the 2 erythropoietic stimulating agents available to treat anemia of chronic disease?
1. Recombinant Epoetin alfa
2. Recombinant Dabropoetin alfa (has longer half-life)
Causes of anemia of critical illness include:
1. sepsis
2. taking frequent blood samples
3. hemodilution
4. surgical blood loss
5. active bleeding
In anemia of critical illness, mechanisms of ___ __________ and _________ are altered.
RBC replenishment; homeostasis
Laboratory findings in anemia of critical illness:
1. low Hb
2. low serum iron
3. low TIBC
4. low iron/TIBC ratio
5. serum ferritin normal to high
6. low EPO

(ferritin only thing not low)
Treatment options for anemia of critical illness:
1. Require substrates for RBC production
(iron, folic acid, vitamin B12)
2. EPO
3. RBC transfusions
Anemia in the elderly is associated with adverse outcomes including:
1. all-cause hospitalization
2. hospitalization secondary to CV disease
3. all-cause mortality
Anemia in the elderly is associated with a progressive reduction in:
hematopoietic reserve
Most common causes of anemia in the elderly:
1. Chronic disease
2. Unexplained cause
3. Iron deficiency
Anemia in the elderly is usually _______ & ____ with Hb levels __-__ g/dL.
normocytic and mild; 10-12 g/dL
Treatment options for anemia in the elderly:
1. Treat underlying cause
2. Give iron supplement
3. Vitamin B12
4. Folic acid
What iron supplement should be given to the elderly?
ferrous sulfate 325mg once daily

(usually lower doses to decrease GI effects)
What is the leading cause of infant morbidity and mortality around the world?
pediatric anemia
A lack of normal Hb at birth:
1.
2.
1. Affects nonstorage of iron
2. Increases risk of IDA in first 3-6 months
Pediatric anemia is usually due to primary hematologic abnormalities:
1.
2.
3.
4.
1. Erythopoiesis decreases after birth
2. Decrease in EPO production
3. Iron stores are depleted by age of 6 months
4. Blood volume doubled from 4-12 months
True or False: The primary goal of pediatric anemia is prevention.
TRUE
Treatment options in pediatric anemia:
1.
2.
3.
1. RBC transfusions
2. EPO use controversial
3. Iron
Hemolytic anemia results from:
decreased survival time of RBCs secondary to destruction in spleen or circulation
(severity depends on mechanism)
Hemolytic anemia can be:
1.
2.
3.
4.
5.
6.
1. Mild
2. Chronic
3. Compensated
4. Acute
5. Severe
6. Life-threatening
True or False: Hemolytic anemia is defined as RBC lifespan < 120 days.
TRUE (normal lifespan 120 days)
Hemolytic anemia can be the result of 3 primary defects that are intrinsic or extrinsic in origin:
1.
2.
3.
1. membrane defects
2. alterations in Hb solubility or stability
3. change in intracellular metabolic processes
Laboratory findings in hemolytic anemia:
1.
2.
3.
4.
5.
6.
7.
8.
1. Normocytic
2. Normochromic
3. Increased reticulocyte count
(attempt to maintain RBC mass)
4. Peripheral blood smear
(sickle cell, target cell, spherocytes, elliptocytes, fragmented RBCs)
5. Decreased haptoglobin
6. Lactate dehydrogenase elevated
7. Hemoglobinuria
8. Increase in indirect bilirubin often occurs
Treatment of hemolytic anemia involves:
1. Treatment of ________ _____
2. ________ and ______________ for autoimmune hemolytic anemias
3. ___________ - reduces RBC destruction
1. underlying cause
2. steroids and immunosuppressants
3. splenectomy
Patients with G6PD deficiency should avoid use of:
precipitating oxidant medications and chemicals