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66 Cards in this Set
- Front
- Back
decreased numbers of red blood cells or hemoglobin content caused by blood loss, deficient erythropoiesis, excessive hemolysis, or a combination of these changes.
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anemia
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only occurs when the insult is severe enough to disturb normal homeostatic mechanisms and exceed reserves
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anemia
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Where is 90% of erythopoietin formed
and other 10% is: |
renal system 90%
Hepatic 10% |
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At what GFR level is Erythopoietin supply diminished
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<49
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DNA synthesis is impaired by presence of:
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Chronic inflammation
such as found in: Systemic Lupus, Rheumatoid Arthritis, Chronic infection REVERSABLE when inflammation treated |
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Iron containing oxygen transport protein found in red blood cells
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hemoglobin
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What do you need to make hemoglobin
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iron
b vitamins Vitamin C protein |
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what are reticulocytes
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young blood cells that contain some residual RNA
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What % of RBC count are Reticulocytes
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1-2%
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-osis means
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increase in
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reticulocytes increase or decrease in response to anemia?
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increase
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-penia
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too few cells
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Common causes of anemia
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1. blood loss (uncommon in primary care) must be 1L or more loss although chronic is far more common (erosive gastritis)
2. reduced RBC production 3. premature destruction |
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most likely cause of sudden dangerous drop in Hct and Hgb
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hemorrhage
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Reduced RBC production results from:
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1. nutritional deficiency (B12, folic acid, iron)
2. anemia of chronic disease 3. Bone marrow suppression |
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anemia from Hemolysis is
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shortened RBC lifespan <90 days
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what is normal hemoglobin to hematocrit ratio
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1:3
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which? hemoglobin or hematocrit may be effected by dehydration
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hematocrit
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MCV (mean corpuscle volume)
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red blood cell volume
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microcytic
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MCV <80 small
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Normocytic
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MCV 80-96 (normal)
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Macrocytic
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MCV >96 (abnormally large
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Red blood cell hemoglobin content
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MCH - mean cell hemoglobin
MCHC - mean cell hemoglobin concentration |
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Source of the RBC's color
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hemoglobin
(chromic) |
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Hemoglobin comprises what % of RBC volume
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90%
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Normochromic
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normal color
MCHC 31-37 |
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Hypochromic
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pale color
MCHC <31 |
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RDW
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RBC distribution width
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What is an abnormal value for RDW
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greater than 15%
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What is one of the earliest laboratory indicators of an evolving microcytic or macrocytic anemia?
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Abnormal RDW
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What is the normal RDW?
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11.5-15%
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What is the normal reticulocyte percentage?
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1-2%
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Normal response to anemia is for reticulocytes to increase by ?? %
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>2%
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Most common etiology Normocytic Anemia
(2) |
Acute blood loss
Anemia of chronic disease (most common in primary care) |
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MCV of 80-96
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normocytic anemia
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What is it:
Hgb - 10.1 Hct 32% RBC 3.2 million MCV 82 MCHC 34.8 RDW 12.1% |
Normocytic Anemia
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MCV <80
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Microcytic
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Most common etiology of microcytic, hypochroic anemia with elevated RDW
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Iron Deficiency anemia
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Small RBC are always:
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PALE
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What is it:
Hgb 10.1 Hct 32% RBC 3.2 million MCV 72 MCHC 26.8 RDW 18.1% |
Microcytic
hypochromic IRON DEFICIENCY ANEMIA |
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What etiology presents with anemia that is microcytic hypo chromic with normal RDW
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Alpha and beta Thal minor
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What ethnic group is at risk for alpha thalassemia
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Asian
African A, A, A |
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What ethnic group is at risk for Beta thalassemia
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African
Mediterranean Middle Eastern B, A, M, ME |
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What is it:
Hgb 11.6 Hct 36.7% RBC 6.38 mil MCV 69.6 MCH 22 RDW 13.8% |
Beta Thal Minor
(small pale cells - but lots of them) |
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Etiology of Macrocytic, Normochromic anemia
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1. Dietary induced vit B12 deficiency (uncommon if omnivore)
2. Pernicious anemia (most common) 3. Folate deficiency anemia |
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What is it:
Hgb 8.2 Hct 25% RBC 2.7 million MCV 125.5 MCH 31 RDW 18.8% |
Pernicious anemia
*marked macrocytosis |
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Drug induced macrocytoisis without anemia caused by which meds:
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carbamazepine,
zidovudine, valproic acid, phenytoin, alcohol |
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What is it:
Taking phenytoin Hgb 12 Hct 37% RBC 4.2 mil MCV 105.5 MCH 31 RDW 12.8% |
Drug induced macrocytoisis
Do NOT treat... Leave pt alone |
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Anemia treatment:
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Treat underlying cause
consider multiple causes |
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What medication is helpful in severe anemia, particularly in the presence of advancing renal failure:
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Epoetin alfa (procrit)
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most common type of anemia in childhood
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iron deficiency anemia
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most common type of anemia in pregnancy
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Iron deficiency
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most common type of anemia in women during reproductive years
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iron deficiency anemia
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most common type of anemia in the elderly
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anemia of chronic disease
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Most important source of the body's iron supply
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recycled iron content from aged red blood cells (85%)
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You advise a person who is a vegan to supplement the diet with:
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Vitamin B12
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In evaluating a person with microcytic anemia, the next step in laboratory assessment includes obtaining a serum:
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Ferritin
(iron deficiency status) |
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In providing information about the best way to take oral iron therapy to maximize the drugs absorption you advise the patient to take the medication:
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on an empty stomach
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A 68 /o woman presents with a 6 month hx of increasing severe peripheral numbness and oral irritation. Pale conjunctiva, 2/6 systolic murmur, beefy red tongue - What is it:
Hgb 6.2, Hct 20%, RBC 2.1 mil, MCV 132, MCHC 32.4, RDW 19% |
Vitamin B12 Deficiency
(causes neurologic dysfunction) |
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Per each unit of blood HCt increases by how many points
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3
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Murmur heard in patients with severe dehydration, high fever, profound anemia, thyroid toxicosis:
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hemic murmur
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Iron deficiency anemia presents:
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Microcytic, hypochromic, elevated RDW
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Folate deficiency anemia presents:
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Macrocytic, normochromic, elevated RDW
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Alpha Thalassemia anemia presents with:
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Microcytic, hypocromic, normal RDW
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Anemia of Chronic disease presents with:
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Normocytic, normochromic, reticulocytopenia
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Primary care of the person with alpha thalassemia minor should include:
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offering genetic counseling prior to pregnancy
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