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22 Cards in this Set
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Spurious anemia
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subnormal hematocrit produced by increased plasma volume=normal numbers of Rbc’s but they are “diluted out by expanded plasma volume. Not a true anemia. Often seen in third trimester, heart and renal failure.
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SYMPTOMS of ANEMIA
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-Fatigue, weakness, decreased work and exercise tolerance, light-headedness, dyspnea, palpitations.
-Differential= sore tongue, ataxia, fever, anorexia, jaundice or unusual bleeding. -Previous anemias or blood transfusion. -Several pregnancies in succession -Changes in bowel habits -Alcohol use -Drug and medication history= aspirin or NSAIDS -Diet deficient in protein, iron, B12 or folate -PICA*** urge to eat things other than food |
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Low Hemoglobin
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<14 gm/dl in males
<12 gm/dl in females |
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Decreased MCV <80
Could be... |
-Iron Deficiency
-THalassemia -Anemia of chronic disease -Lead poisoning |
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Increased MCV >100
Could be ... |
-Megaloblastic Anemia (B12 or Folate Deficiency)
-Alcoholism -Hypothyroidism -Chronic Liver Disease -Hematologic Malignancy |
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If MVC is normal (80-100)
Order ... |
Reticulocyte count
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Low reticulocyte count ...
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-Check WBC and Platelet Count
-If low RBC and Platelet count then… -Leukemia -Metastatic Malignancy -Aplastic Anemia |
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High Reticulocyte
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-Chronic Infection/ Inflammation
-Malignancy -Chronic Renal Disease -Endocrine Dysfunction |
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Reticulocyte is..
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an immature red blood cell containing a network of filaments or granules
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Microcytic Anemia
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= small RBC's
- <80 fl |
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iron deficiency
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- **Most commonly diagnosed anemia in US
- women more than men |
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Iron Deficiency
Causes |
Usually caused by blood loss…not dietary!!!! Common sources of bleeding:
- menstruation - uterine tumors - GI bleeds - angiodysplasia= development of abnormal, dialated blood vessesl within the wall of the bowel often seen in elderly |
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Iron Deficiency
S/S |
-again, remember that iron deficiency develops slowly
-pica -intolerance to cold -cheilosis -Also other common anemia signs |
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LAB DX:
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-earliest indicator is REDUCTION OF SERUM FERRITIN <10-20 ug/L
-variation in RBC size/microsytosis -Hypochromia -Declining hemoglobin and hematocrit |
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CLASSIC PICTURE OF FULL BLOWN IRON DEFICIENCY
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- microcytic hypochromic anemia with decreased serum ferritin, low serum iron, increased TIBC and reduced transferring saturation
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TX of iron deficiency
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-identify and correct underlying cause for iron loss
-replenish iron stores and return RBC production to normal -Ferrous Sulfate 325 mg 3x/day -Iron therapy can be awful -IV injections if necessary (COKE) oHigher risk of anaphylaxis. -RBC transfusion usually reserved for emergency cases |
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Other Causes of Microcytic Anemia
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Thalassemia
Anemia of chronic diseas lead poisoning Sderoblastic anemias |
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Thalassemia
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inherited genetic disorders associated with defects in the synthesis of the globin subunits of hemoglobin
-Alpha and beta forms (depending on which is DECREASED) -Severe forms harm both beta and 3 or 4 of the alpha globins (rare) |
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Thalassemia
TX |
-Can be confused with Iron deficiency
oThal. Tend to have much lower MCV’s often <70 oRed cell width normally normal with Thal. oSerum Ferritin and other iron studies are normal with thal. o***confirm diagnosis= hemoglobin electrophoresis increased levels of hemoglobin A2 and F are see Target cells seen sometimes ONLY THal |
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Anemia of Chronic Disease
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oMay see increased erythrocyte sedimentation rate (ESR) or decreased serum albumin
o*** TIBC is usually decreased= due to a defect in the ability of the body to transfer iron from its storage forms into circulation oTX= directed towards the underlying disease |
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Lead Poisoning
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-Lead interferes with the functioning of an enzyme that is necessary for incorporation of iron into the heme molecule
-RBC’s may show basophilic strippling on stained blood smear -May also see neurologic symptoms -*** Free Erythrocyte Protoporphyrins= easy test used to screen |
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Sideroblastic anemias
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- Very rare heterogeneous group of disorders frequently assosicated with defects in the RBC’s ability to incorporate iron into the heme molecule
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