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38 Cards in this Set
- Front
- Back
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Define anemia
What are the criteria for anemia |
any condition resulting from a significant decrease in the total erythrocyte mass
Hgb <12(F) <14(M) Hct <36%(F) <42%(M) |
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What is erythropoiesis
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a series of events during which the hematopoeitic cells mature into functional blood cells
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What factors is erythropoiesis controlled by
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erythropoietin, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor and cytokines such as interleukin-3 and 5
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What does a normal RBC look like
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biconcave disk with a life span of about 120 days
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What is a reticulocyte and what does it contain
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It is a cell that remains after the nucleus is lost from an orthochromic normoblast ... It contains RNA and other cellular remnants that stain blue with methylene blue stain
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What is the reticulocyte count/index
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a formula used to correct for anemia
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What is the formula for reticulocyte count
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Observed retic count (%) X (Pt Hct/Norm Hct) = Reticulocyte index
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What are the normal values for reticulocyte count
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1-2% or absolute count 50,000-60,000
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Describe what an elevated vs decreased reticulocyte count means
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Inc. = anemia due to DESTRUCTION of RBC's
Dec. = anemia due to decreased PRODUCTION of RBC's |
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What are symptoms of anemia (by category - ex: dec. O2transport)
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DECREASED O2 TRANSPORT
Fatigue, Dyspnea, Angina DECREASED BLOOD VOLUME Pallor, postural hypotension, syncope, HA, tinnitus INCREASED CARDIAC OUTPUT tachycardia, systolic ejection murmur, lightheaded HEMOLYSIS OF RBC'S Jaundice, Splenomegaly |
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What are the cytochromic classifications in anemia
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Microcytic
Normocytic Macrocytic |
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What anemias present with microcytic (MCV<80)
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Iron deficiency anemia
Thalassemia Anemia of Chronic Dz Lead Poisoning Sideroblastic anemia |
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What anemias present with normocytic (80-100) anemia
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Anemia of Chronic disease
hemolytic anemia anemia of acute hemorrhage aplastic anemia |
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What disease present with Macrocytic anemia (MCV>100)
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Vit. B12 deficiency
Folate Deficiency |
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Where does iron absorption occur
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duodenum and upper jejunum
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How is iron transported and stored
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Transported by Transferrin
Stored by Ferritin |
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What are the 5 main causes of iron deficiency anemia
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1. Blood loss (GI,menses,pulm,urine)
2. Increased demand (preg, lactate,growth) 3. Malabsorption (gastsrectomy, pancreatic insufficiency, sprue, short bowel syndrome) 4. Poor dietary intake 5. Hemolysis |
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Other than the common anemia symptoms, what symptoms are specific to iron deficiency anemia
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Pica
Angular stomatitis and atrophy of tongue mucosa secondary to impaired epithelial function Koilonychia (spooning or curling of nails) |
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What is the typical cell morphology of iron deficiency anemia
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microcytic, hypochromic (varies w/degree of anemia)
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If suspected iron deficiency anemia, what test should be done
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ferritin
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What will be the typical lab findings in a patient with iron deficiency anemia
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Total Serum Iron <30
TIBC >360 Percent saturation <10% Ferritin <15******* |
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What is the primary tx for iron deficiency anemia
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correct underlying cause
(transfusion with CV instability, blood loss, or need for immediate intervention) |
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How do you treat iron deficiency anemia with no underlying cause
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300mg of elemental iron per day
-Ferrous sulfate 325mg PO tid |
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What are complications of oral iron replacement in iron deficiency anemia
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GI distress, abdominal pain, nausea, vomiting or constipation
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How can you monitor a patient with iron deficiency anemia on iron replacement
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note increase in reticulocyte count in 7 to 10 days and increase in hgb/hct in 2-3 weeks
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If a patient with iron deficiency anemia fails treatment what should be suspected
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noncompliance, incorrect diagnosis (thalassemia), poor absorption, erythropoietin deficiency or other concurrent anemia
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What is thalassemia
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a group of hereditary disorders in which there is a defect in the synthesis of one or more of the globin polypeptide chains in hemoglobin --> leading to absent or decreased synthesis of the affected globin chain and development of nonfunctioning hemoglobin
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What does a mature adult hemoglobin consist of
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2 alpha chains
2 beta chains |
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What happens if the ratio of alpha to beta chains in thalassemia are not right
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hemoglobin may precipitate out in the red blood cell
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What population is primarily affected by thalassemia
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Mediterranean, African or Asian ancestry (specifically where malaria endemic
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What is alpha-thalassemia
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defect in alpha chain -- excess beta chains
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What are the 4 types of alpha-thalassemia (what does each mean)
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1. Silent Carrier : deletion of alpha gene
2. A-thalassemia trait: deletion of 2 alpha genes - mild anemia 3. Hemoglobin H: deletion of 3 alpha genes - severe anemia with signs of hemolysis 4. Hydrops Fetalis: deletion of all 4 alpha genes - death in utero |
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What is beta-thalassemia
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defect in beta-chain -- excess alpha chains
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What are the 2 types of beta thalassemia and describe them
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Minor: microcytic anemia
Major (Cooley's anemia): severe anemia w/bone changes, copper-colored skin, jaundice and hepatosplenomegaly |
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What does a thalassemia blood cell look like
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***Target and teardrop cells
Microcytic, hypochromic blood cells |
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What is the MCV and iron level going to be like in a pt with thalassemia
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MCV is low (typically less than 75fl)
Normal iron studies |
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What is diagnostic for thalassemia
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hemoglobin electrophoresis
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What is the treatment for thalassemia
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transfusions & misdiagnosis - iron overload
possible splenectomy |
