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42 Cards in this Set

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What is the definition of anemia?
hemoglobin concentration or hematocrit two or more standard deviations below the mean value for age, sex

not a disease but sympmtom of another disorder
How does the hemoglobin concetration change in a newborn? to adulthood?
Relativel high in newborn
Declines reaching a nadir known as physiologic anemia of infancy

Thereafter hemoglobin concetration rises gradually during childhood, reach adult values after puberty
When does the nadir of physiologic anemia come in infants?
6 weeks in the premature infant
2-3 months in term infant
What are the causes of anemia?
decreased red cell production
increased red cell destruction
blood loss
What are the reasons for decreased red cell production?
deficiency of hematopoietic precursors of bone marrow failure
What are the reasons for increased red cell destruction?
Hemolytic disease, due to extracorpuscular or intracorpuscular defects
For what is adjustred reticulocyte count used for and how is it calculated?
used to determine whether there has been an adequate erythropoietic response to the given anemia

ARC calculated= measured hematocrit/ expected hematocrit x reticulocyte count
What are the readings for ARC?
ARC <2 signifies ineffective erythropoeisis

ARC>2 signifies effective erythropoeisis, suggesting hemolysis or chronic blood loss
What are causes of anemia in an infant?
perinatal hx of twin-twin fetomaternal transfusion
What are causes of anemia in a child?
dietary history may suggest factors for iron, Vitamin B12, or folate deficiency anemia
How can iron deficiency anemia and lead poisoning manifest?
both are microcytic anemias that have pica
What are signs of overt or occult bleeding?
melena, hematochezia, hematuiria, hematemesis, abnormal menses, or epistaxis
What are symptoms indicate an inherited hemolytic anemia as?
patient's race/ethnicity and family history of splenectomy or cholecystomy suggest an inherited hemolytic anemia
What medications can cause either bone marrow suprresion or hemolysis? What are the signs of anemia?
history of fever, weight loss, fatigue, rash, bruising, jaundice and cough
What are important findings on PE that indicate the presence of anemia?
pallor (skin, conjunctiva, mucosa) and loss of palmar crease pigmentation, comparing complextion of patient to parent useful
tachycardia and postural change in heart rate and blood pressure are seen with acute blood loss

congestive heart failure (hepatosplenomegaly, lower extremity edema, tachycardia)
pancytopenia (petechiae, purpura)

blood loss (positive stool guiac, or gastroccult, gross hematuria)

hemolysis (scleral icterus, jaundice, urobilinogen in the urine)
or infiltrative disorders (lympadenopathy, hepatosplenoegaly)
What are the ways to notice decreased pallor?
pallor (skin, conjunctiva, mucosa) and loss of palmar crease pigmentation, comparing complextion of patient to parent useful
What are the physical signs of acute blood loss?
tachycardia and postural change in heart rate and blood pressure are seen with acute blood loss
What are the physical signs that can be seen with CHF secondary to anemia?
congestive heart failure (hepatosplenomegaly, lower extremity edema, tachycardia)
What are the physical signs that can been with pancytopenia secondary to anemia?
pancytopenia (petechiae, purpura)
What are the ways for assesing blood loss?
blood loss (positive stool guiac, or gastroccult, gross hematuria)
What are the physical signs of anemia due to hemolysis?
hemolysis (scleral icterus, jaundice, urobilinogen in the urine)
What are the physical signs of anemia due to infiltrative disoders?
infiltrative disorders (lympadenopathy, hepatosplenoegaly)
What are the goals of testing and diagnostic evaluation in anemia?
To determine whether the anemia results from decreased production, increased destruction or blood loss
What are the initial lab tests needed to evaluate anemia?
CBC with man diff and RBC indices, reticulocyte count, and peripheral blood smear
What two parameters can be used to classify the anemia into a microcytic, normocytic, or macrocytic anemia with adequate, inadequate red blood cell production?
mean corpuscular volume (MCV) and adjusted reticulocyte count
What is peripheral blood smear used to assess?
Red and white blood cell morphology and the platelet number and size
What diagnostic tests should be considered for hemolytic anemia?
electrolytes, lactate dehyfrogenase, bilirubin, Coomb's test (indirect and direct) and serum haptoglobin
How can urinobilinogen be dected?
detected on urinalysis
What cause of anemia should be considered in all African Americans and Mediterranean populations who present with hemolytic anemia?
glucose-6- phosphate dehydrogenase
What test is should be ordered to diagnose suspected hemoglobinopathies?
hemoglobin electrophoresis
How can iron deficiency anemia be evaluated?
serium iron level, total iron binding capacity, and serum ferritin level are needed for analysis
When is a lead level indicated?
If lead posioning is contemplated
How can Free erythrocyte protoporphyrin (FEP) levels be obtained and what do elevated FEP leverl suggest?
FEP levels can be obtained quickly and with a small amount of blood

elevated FEP levels suggest disordered heme incorporation seen with iron deficiency and lead poisoning
What diagnostic test should be ordered for anemia of chronic disease?
elevated erythrocyte sedimentation rate
What tests indicate GI Bleeding?
positive heme tests of stool or gastric contents
What is the treatment for macrocytic anemia?
VB12 and RBC folate levels
What are the causes of microcytic anemias?
iron deficiency
severe lead posioning
thalassemia syndrome
sideroblastic anemia
What are some causes of megaloblastic macrocytic anemia?
vitamin B12 deficiency, folate deficiceny, orotic aciduria
What are some causes of nonmeaglbloastic macrocytic anemia?
aplastic anemia, diamond blackfan anemia, bone marrow infiltration, hypothyroidism, liver disease
What are some causes of normocytic inheritedhemolyic anemieas?
anl Sickel Cell Disease
RBC enzyme disorders
G6PD deficiency
Pyruvate Kinase Deficiency
RBC membrane disoders
Hereditary spherocytosis, elliptocytosis
Paroxysml nocturnal hemoglobinuria
What are some causes of causes of acquired hemolytic anemias?
antibody-mediated anemias
autoimmune hemoyltic anemiase
isoimmune hemolytic anemias
microangiopathic hemolytic anemias
hemolytic uremic syndrome
disseminated intravascular coagulation
What is the differential diagnosis for anemia?
Microcytic, macrocytic (megaloblastic vs nonmegaloblasti), inherited hemolytic normocytic anemias, acquired hemolytic normocytic anemias, chronic inflammation, acute blood loss, splenic sequestration, chronic renal disease