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56 Cards in this Set
- Front
- Back
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What are five things that can cause anemia?
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Nutritional deficiencies
Acute disease Chronic disease Drug-induced Genetic abnormalities |
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Reduction in red cell mass
Reduction in one or more of the major red blood cell measurements |
Anemia
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Hormone that stimulates proliferation and differentiation of erythroid precursors in the bone marrow
Produced by the kidneys Maintains RBC mass |
Erythropoietin
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Delivered by transferrin to the bone marrow
Incorporated into the RBC hemoglobin molecule Necessary part of daily diet |
Iron
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Obtain a careful family history for what things when working up anemia?
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anemia, jaundice, cholelithiasis, splenectomy, bleeding disorders, and abnormal Hbs.
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When you are searching for a history of blood loss in working up an anemia patient what do you look for?
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In women: Document pregnancies, abortions, and menstrual loss.
Women and Men: Change in stools – tarry stools? Melena Change in bowel habits – Colon CA Hemorrhoids |
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What are two important things regarding gastrointestinal and dietary history when working up a patient with possible anemia?
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Ask for history of gastrointestinal complaints that may suggest gastritis, peptic ulcers, hiatal hernias, or diverticula.
A thorough dietary history. Include foods that the patient both eats and avoids Include estimate of their quantity |
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These substances render iron less absorbable. (PICA) Ask the patient if they have ingested either one of them.
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Question patients regarding consumption of either clay or laundry starch.
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What are some unusual presentations of anemia?
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Early graying of the hair, a burning sensation of the tongue, and a loss of proprioception are common.
Paresthesia or unusual sensations frequently described as pain also occur in pernicious anemia. Patients with folate deficiencies may have a sore tongue, cheilosis, and symptoms associated with steatorrhea. |
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What is something that will inhibit production of erythropoietin?
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Renal Failure/Dialysis
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What do you look for in the physical examination of someone who may have anemia?
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Pallor, abnormal pigmentation, icterus, spider nevi, petechiae, purpura, angiomas, ulcerations, palmer erythema, coraseness of hair, puffiness of the face, thinning of the lateral aspects of the eyebrows, nail defects.
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What might be seen in the HEENT examination of a patient with anemia?
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conjunctivae & sclerae can show pallor, icterus, splinter hemorrhages, petechiae, comma signs in the conjunctival vessels.
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What might be seen with anemia in the Lymph nodes?
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palpable enlargement
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What might be seen with anemia in the Cardiac exam?
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murmurs, bradycardia or tachycardia
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What might be seen with anemia in the Abdomen exam?
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hepatomegaly and splenomegaly
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What might be seen with anemia in the Neurologic exam?
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Changes in position sense and vibratory sense, examination of the cranial nerves, and testing for tendon reflexes
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What might be seen with anemia in the Rectal exam?
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Hemorrhoids, rectal bleeding, + hemocult, palpable rectal mass (CA)
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Hypochromic + Microcytic Anemia
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Iron deficiency anemia
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How is iron deficiency anemia initially identified?
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Hematocrit
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This is the actual volume of RBCs in a unit volume of whole blood expressed as a percentage. This value is often about 3X the hemoglobin value.
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Hematocrit
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What can inhibit hematocrit results?
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Hypo/Hyper volemia
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Iron store depletion is caused by?
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Inadequate oral intake
Increased oral demands Blood loss Inadequate absorption ↑ consumption Disease states |
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What are general signs and symptoms of Iron Deficiency Anemia?
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Fatigue
Weakness Dizziness Irritability Headache Rapid heartbeat Chest pain Shortness of breath Skin pallor Spoon-shaped nails |
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What are five symptoms that are signs of severe Fe deficiency?
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Koilonychias (spoon-shaped nails)
Brittle nails Dysphagia Angular stomatitis or glossitis Pica |
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What do the labs look like with iron deficiency anemia?
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↓ Ferritin
↓ Fe level ↑ TIBC ↓ hemoglobin ↓ hematocrit ↓ MCV ↓ MCH ↓ MCHC Blood smear Microcytic, hypochromic cells |
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What are the two main goals of therapy for iron deficiency anemia?
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Normalize Hgb and Hct
Increase Hgb by 2 gm/dL in 3 weeks Increase Hct by 6% in 3 weeks Replete iron stores Iron replacement therapy should continue for 3-6 months |
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What are the ways in which to replenish the iron stores?
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Dietary supplementation
Eggs (yolk) Fish Legumes (peas and beans) Meats (liver is the highest source) Poultry Raisins Whole-grain bread Therapeutic iron preparations 200 mg elemental iron/day in 2-3 divided doses |
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Appropriate indications for this include the following:
Iron malabsorption Oral noncompliance Refusal of blood transfusion Use in chronic renal failure requiring dialysis |
Parenteral Iron Preparations
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What are the adverse drug events associated with iron?
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PO formulations
Dark colored stools Constipation Diarrhea Nausea/vomiting IM or IV formulations (Dextran) Injection site reactions Diarrhea Nausea Hypotension Allergic reactions anaphylaxis |
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Iron decreases the absorption of the following medications:
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Tetracyclines
Quinolones ACE inhibitors Carbidopa and Levodopa Levothyroxine |
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Iron may increase the absorption of the following medications:
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Birth control medications
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How should you counsel a patient when they are taking iron?
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Take 1 to 2 hours prior to meal
Small snack if GI intolerance Avoid dairy products and tea Keep out of reach of children Take 1 hour before or 3 hours after antacids Many drugs interact with iron Use OTC docusate if constipation occurs |
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It appears when a person does not produce enough alpha chains for hemoglobin.
It is mainly prevalent in the Africa, the Middle East , India, and occasionally in Mediterranean region countries. |
Alpha Thalassemia
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mutation of 1 or more of the 4 alpha globin genes on chromosome 16
severity of disease depends on number of genes affected results in an excess of beta globins |
Alpha Thalassemia
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no functional globin genes
death before birth (embryonic lethality) |
Alpha Thalassemia Major
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3 functional alpha globin genes
No symptoms, but thalassemia could potentially appear in offspring |
Alpha Thalassemia Silent Carriers (heterozygotes +/-)
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It appears when a person does not produce enough beta chains for hemoglobin. It is mainly prevalent in the mediterranean region countries.
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Beta Thalassemia
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Caused by the reduced availability of beta chains in hemoglobin and can lead to moderate to severe anemia and an array of complications including bone deformities and splenomegaly.
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Thalassemia Intermedia
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Caused by the unavailability of beta chains in hemoglobin leading to a very severe and fata if left untreated anemia. It requires regular blood transfusions leading to iron-overload which is treated with chelation therapy to prevent death from organ failure.
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Thalassemia Major (Cooley's Anemia)
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Thalassemic RBCs offer protection against this, which is caused by Plasmodium falciparum.
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Severe malaria
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Signs such as paleness and growth retardation, are readily detectable since the first year of life.
These signs are mainly due to severe anemia. Later bone deformities and hepato-splenomegaly develops. |
Thalassemia Major
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There are usually no signs of this with these carriers?
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Thalassemia carrier state
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What does thalassemia minor show in the blood smear?
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Blood smear shows hypochromia and microcytosis (similar to Iron Deficiency Anemia).
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-Blood smear shows profound microcytic anemia, with extreme hypochromia, tear drop, target cells and nucleated RBCs.
-Hemoglobin may be very low at 3-4 g/dl. |
Thalassemia Major
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No need for any treatment, since the carriers are usually symptomless.
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Thalassemia minor (trait)
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The severe life-threatening anemia, requires regular life long blood transfusion, to compensate for damaged red blood cells.
The continuous blood transfusion will eventually lead to iron overload, which must be treated with chelation therapy to avoid organ failure. |
Thalassemia major
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What are the four major prevention efforts to consider for Thalassemia?
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Pre marital screening to make sure that the couple are not both carriers.
Provision of counseling and health education for the thalassemics, their families and the public . Provision of prenatal testing for thalassemia. Reduction of marriages between relatives. |
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What are three major problems facing patients in developing countries and thalassemia major?
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Reduced availability of blood for transfusion.
Reduced availability of Desferal pumps, less than third of the patients have access to pumps. High cost of treatment. |
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Hypoproliferative anemia
Normocytic cells Associated with the following types of diseases lasting for > 1-2 months: Infectious diseases Inflammatory diseases Hepatic diseases Renal diseases Neoplastic diseases |
Anemia of Chronic Disease
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Causes:
Impaired release of iron from reticuloendothelial stores Decreased erythropoeitin life span Inadequate bone marrow response to a decreased erythrocyte life span |
Anemia of Chronic Disease
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What do the diagnostics look like with anemia associated with chronic disease?
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Diagnosis of Exclusion
↓ Serum iron ↑ iron in bone marrow Normal ferritin ↓ TIBC Symptoms are usually nonspecific |
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What is the TX for anemia of chronic disease?
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More non-specific than other types of anemia
Vitamin supplementation should only be used if concurrent deficiency exists Blood transfusions may be required for symptomatic anemia Human Recombinant Erythropoietin Therapy |
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Growth factor used to induce erythropoiesis
Stimulates division and differentiation of progenitor cells Induces release of reticulocytes from bone marrow into the blood stream Available in 2 formulations: Erythropoietin (Epogen®) Darbepoetin (Arenesp®) |
Human Recombinant Erythropoietin Therapy (rHuEPO)
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What are the indications for use of Human Recombinant Erythropoietin Therapy (rHuEPO)?
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Indications for use:
End-stage renal disease AIDS Cancer Drug-induced anemia Low endogenous EPO levels Autologous blood transfusions for elective surgery |
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Indication: Fe deficiency anemia in chronic hemodialysis patients
Concurrent use with rHuEPO Fewer anaphylactic reactions than iron dextran Requires test dose |
Sodium ferric gluconate
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Indication: Fe deficiency anemia in chronic hemodialysis patients
Concurrent use with rHuEPO Anaphylactic reactions rare Does not require test dose |
Iron Sucrose
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