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58 Cards in this Set
- Front
- Back
What IS anemia?
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-reduction below normal Hgb quantity
-reduction in PCV per 100 ml of blood. |
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Based on Hgb, what is an anemia
-moderate -severe |
Mod = < 10 g/dl
Severe = < 7 g/dl |
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What are the two most important pieces of info for diagnosing anemia?
-Then? |
Hgb and Hct
Then: RBC indicies, Retic count, iron studies. |
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What is the effect of anemia?
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reduced oxygen delivery to tissues and organs.
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What are some clinical symptoms of a significant anemia?
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rapid pulse
sob pallor difficulty breathing |
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what are two ways to classify anemias, which is used more?
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1. Pathophysiologic - cause
2. Morphologic - used more |
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what are the 2 pathophysiologic classifications of anemia?
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1. Relative
2. Absolute |
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What is a relative anemia?
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an anemia that isn't real - something is making it LOOK like anemia, like increased plasma volume in a pregnant woman.
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What are the 2 types of Absolute anemias?
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1. Anemia due to decr. RBC production
2. Anemia due to incr. RBC destruction |
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What are 5 things that decrease RBC production, causing an anemia?
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1. Defective pluripotent cell
2. Defective unipotent cell 3. Disturbed DNA synthesis 4. Disturbed Hgb synthesis 5. Unknown idiopathic |
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what are 2 abnormalities that cause Anemia due to incr. destruction?
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1. Intrinsic abnormalities - spherocytosis or sickle cells
2. Extrinsic abnormalities - mechanical harm like burn, artificial heart valve, thrombopurpura. |
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what are the 3 types of morphological classification?
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1. Microcytic
2. Normocytic 3. Macrocytic |
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what are 4 mechanisms for alleviating tissue hypoxia?
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1. O2 diss. curve shift
2. Redistribution of blood 3. Increase cardiac output 4. Increase erythropoeisis |
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what are the 3 types of Micro/Hypo anemias?
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1. Fe deficiency
2. Sideroblastic 3. Anemia of chronic disease |
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what is the most common micro hypo anemia?
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iron deficiency
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what is the 2nd most common micro hypo anemia?
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chronic disease.
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what are 4 causes of iron defic. anemia?
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-inadequate source of Fe
-increased demand -excessive loss -maldistribution |
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what are the clinical features (patient symptoms) of fe defic. anemia?
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-fatigue/irritable/headache
-pica syndrome -glossitis/stomatitis -achlorhydria -inability to maintain normal body temp |
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what is pica syndrome?
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the urge to eat all one thing, and that thing is often very strange.
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what is koilonychia?
-glossitis? -stomatitis? -achlorhydria? |
flat fingernails
glossitis = sore tongue stomatitis = sores/cracks around the mouth. achlor = lack of stomach acid |
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What does the b.marrow "QC" do to hemoglobin production in Fe defic. anemia?
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decreases Hgb production - b/c abnormal cells due to lack of Fe can't release into circulation.
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what are three states of Fe defic. anemia that show different sets of lab findings?
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1. Fe depletion state
2. Fe deficient state 3. Fe deficiency anemia |
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What are the lab findings in Fe depletion state?
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Mostly normal - except for Ferritin, which shows the body Fe stores decreasing.
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What are the lab findings in Fe Deficient state?
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Normal CBC still
Decr serum iron Incr TIBC Decr. %Transferrin saturation |
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What are the three stages of Fe deficiency anemia?
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Early
Intermediate Severe |
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What are Lab characteristics of Early Fe defic. anemia?
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MCV may be normal, RDW only slightly incr., a Few Targets,
Iron studies indicating lack of iron stores. Hgb = 9-12 g/dl |
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What are Lab characteristics of Intermed. Fe defic. anemia?
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Same Fe studies as early;
RBCs: poik, targets, hypo b/c the body's less picky now. -Hgb about 8 g/dl -RDW is high and MCV is low |
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What are Lab characteristics of Severe Fe defic. anemia?
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Hgb is very very low.
RBCs tailed, elliptos, burrs, targets, high RDW. |
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What are the classic indices seen with an Fe defic. anemia?
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MCV 53-79
MCH 14-29 MCHC 22-30% |
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What 3 other factors will contribute to anemia and compound the problems?
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-Incr. blood flow, shear stress damages.
-Destruction of cells with MCH less than 20 during release (natural QC) -Bmarrow detainment of hypochromic cells in case they might develop |
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what are 3 types of treatment for iron def. anemia
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-oral iron
-IV -transfusions for very severe |
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what are 3 indications of a responseto therapy?
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-increased retics
-dual RBC population -RDW increase |
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what are 5 causes of iron deficiency?
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inadequete Fe intake
inadequate Fe absorption Increased Fe demand Maldistribution Excessive blood loss |
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what are 2 things that cause inadequate Fe absorption?
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-achlorhydria - low stomach acid
-gastrectomy |
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what may cause
-incr. demand for Fe -maldistribution |
Increased demand: pregnancy and growth spurts
Maldist: congenital atransferrinemia |
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what is the main feature of sideroblastic anemia?
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a problem with heme synthesis so there is excess iron - overload
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what is the typical Hgb seen in sideroblastic anemia?
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3-10 g/dl
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SIDEROBLASTIC ANEMIA - what does the peripheral blood look like?
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-Very low hemoglobin, HYPOCHROMIC
-Dimorphic population - Macro/micro -Elliptocytes/Dacrocytes -More than 10% Basophilic stippling and Pappenheimer bodies - abnormal heme synth. -Very high RDW -normal Platelet/WBC |
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What is seen in the bone marrow during sideroblastic anemia?
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-Erythroid yperplasia
-Over 15% ringed sideroblasts -may see megaloblastic changes |
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what are the 3 categories of sideroblastic anemia?
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1. Primary
2. Secondary 3. Toxic exposure |
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what are the three types of primary siderobl. anemia?
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1. Sex-linked
2. Autosomal recessive 3. Idiopathic (refractory anemia w/ ringed sideroblasts |
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what characterizes sex-linked siderobl. anemia?
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-usually have enzyme abnormalities like reduced ALA synthetase
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what characterizes autosomal recessive siderobl. anemia?
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other enzyme deficiencies
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what characterizes refractory anemia w/ ringed sideroblasts?
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CLONAL abnormality of pluripotent stem cell
-myelodysplastic disease |
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what are two types of secondary sideroblastic anemias?
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1. Due to medication/treatment
2. Due to infections and neoplasms |
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Name 4 medications/treatments that can cause iatrogenic sideroblastic anemia.
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1. Anti-parkinson meds
2. Anti-tubercular meds 3. Chloramphenical 4. Long-term blood transfusions |
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what are 3 causes of toxic sideroblastic anemia?
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1. Excessive vit/mineral intake
2. chronic alcohol abuse 3. lead poisoning |
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what are 3 important points re: lead poisoning pathology?
-Fe storage -Heme synth -Erythropoeisis |
-abnormal Fe storage in mitochon
-abnormal heme synthesis by interfering with enzymes. -ineffective erythropoeisis. |
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what are features of RBCs seen in toxic exposure sidero anemia?
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Hypo/micro
Basoph. stippling, pappenheimers 30% decr. MCV and MCH decreased lifespan of RBC dual cell population |
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how does toxic siderobl. anemia affect:
-Retic index -Bone marrow -Fe studies -Blood lead -Prophyrins |
Retic index is decr.
Bone marrow: erythroid hyperplasia and ringed sideroblasts -Fe studies normal-increased Blood lead: >80ug/dl is BAD Porph: ALA in urine |
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What is anemia of chronic disorcer sometimes called?
Describe cell morphology in - Advanced cases - Less severe cases |
Aka, Anemia of inflammation
Advanced: hypo/micro Less sev: Normo/normo |
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what are 6 causes of anemia of chronic disorder?
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-chronic inflammatory disease
-lymphoma -regional enteritis -ulcerative colitis -liver disease -chronic infection |
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What 4 changes occur in anemia of chronic disease?
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1. Fe supply gets decreased.
2. Erythropoeitin level doesn't increase though it needs to. 3. Erythropoeisis actually gets SUPPRESSED by cytokines. 4. Cell destruction is increased |
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what causes the decreased iron supply in anemia of chronic disease, and what results?
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Release and reutilization of iron is blocked, resulting in decreased Hgb synthesis.
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What suppresses erythropoeisis in chronic disease anemia?
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cytokines, produced by macrophages and lymphs - they are doing their inflammation thing.
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What are lab findings in anemia of chronic disease?
-Hgb, MCH, MCV, Retic |
Hgb is about 7-11 g/dl
MCH is 31, MCV is 80, Retic is normal. Not a hugely hypo/micro disease, can be normo/normo. |
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what are iron study results in anemia of chronic disease?
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Increased ferritin, FEP, BM Fe
Decreased serum Fe, TIBC |
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How is anemia of chronic disease treated?
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Well if it were treatable it wouldn't be chronic would it.
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