Pharm 2 Test 2 Part 4

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chronic blood loss

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does not effect blood volume but instead leads to iron deficiency anemia when iron stores are depleted

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acute blood loss

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rbc normal size and color. hypoxia from blood loss stimulates rbc from bone marrow.

Front 3

acute blood loss if bleeding controlled and sufficient iron stores are available

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rbc concentration returns to normal within 3-4 weeks

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what is most common cause of acute blood loss anemia

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GI bleed

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why blood loss anemia (2)

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rbc & hgb & hct low, mcv & mch & mchc normal

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aplastic anemia is what kind of disorder

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life threatening

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aplastic anemia is from

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stem cell in bone marrow

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cause of aplastic anemia

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poorly understood

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mcv and H&H of aplastic anemia

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high mcv, low H&H

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what may induce aplastic anemia

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drugs (chemo)

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iron deficient anemia classified as

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microcytic hypochromic

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4 values seen in iron deficient anemia

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low H&H, low MCV, low MCH, low serum iron level

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3 causes of iron anemia

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increased iron demand while pregnant, inadequate iron intake, chronic blood loss

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inadequate iron intake difficult to achieve because

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need very little

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inadequate iron intake seen in

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infants who get formula only first year of life, breastfeeding is good cause get iron from mom

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4 sns of iron anemia

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tongue, cheilosis, hair and nails, pica

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iron anemia tongue

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shiny smooth beefy-red inflamed sore

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cheilosis

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cracks in corners of mouth

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iron anemia hair and nails

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fine brittle hair, thin nails

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pica

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craving to eat unusual substances such as starch and ice chips

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TIBC

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total serum iron binding capacity

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iron anemia TIBC

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is increased

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serum IBC measures

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iron binding by transferrin

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an increase in TIBC indicates

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transferrin is not carrying any iron which signals reduced iron availability

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iron anemia develops slowly through 3 phases

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1) body's stores of iron used erythropoesis are depleted 2) insufficient iron is transported to the bone marrow and iron deficient erythropoesis begins 3) large amount of hgb deficient cells enter circulation

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iron supplements SE

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nausea, bloating, constipation or diarrhea, aggravate peptic ulcers, black or dark green stool

Front 27

liquid iron supps do what

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stain teeth

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liquid iron supps need to do what

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dilute with juice or water, admin with straw, good oral hygiene

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iron supps NI (7)

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assess lab values, drug better absorbed on empty stomach, give periodically to give bone continuous supply, not with dairy/antacids/tetracyclines, takes few months, IV iron fatal anaphylactic, IM iron causes skin discoloration (Z track)

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B12 anemia classified as

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macrocytic normochromic anemia

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B12 anemia impairs

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cellular division and maturation

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B12 anemia labs show

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increase in MCV and MCHC

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pernicious anemia is body's inability to

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absorb vit B12 due to lack of intrinsic factor

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most common reason fro B12 anemia

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lack of intrinsic factor

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3 other reasons for B12 anemia

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total gastrectomy or intestinal surgery, tape worm, intestinal disease (chrons)

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how to determine if lack intrinsic factor

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antibodies test - antibodies to intrinsic factor means pernicious anemia

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B12 anemia sns

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demyelination of neurons, prioception

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demyelination of neurons causes

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paresthesias and decreased DTR

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prioception is

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difficulty identifying one's position in space which may progress to difficulty with balance and spinal cord damage

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B12 anemia MCV value

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greater than 100

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B12 for anemia given

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SC or IM

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B12 for anemia given oral

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not effective because lack of intrinsic factor and cannot be absorbed

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B12 injections

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q 2 days then q 3 days then q month and is life long

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B12 anemia foods

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eggs, meats, dairy

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Rx routes of B12 anemia

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oral, SL, nasal spray

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oral B12 for

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milder deficiency

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folic acid anemia classified as

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macrocytic anemia

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macrocytic mcv and hgb values

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mcb high, hgb low

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main cause of folic acid anemia

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poor nutrition

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folic acid sns different from B12 by

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lack of neuro symptoms

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folic acid diet

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one veggie or fruit juice q day, good foods inculde - veggies, organ meats, eggs, milk

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folic acid admin

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oral

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folic acid used preventatively in

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pregnancy

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sickle cell anemia

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severe sometimes fatal hereditary disease caused by an abnormal type of hgb ( Hgb S)

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hgb S is result of

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minor changes in the molecular structure

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hgbS causes what

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profound changes in stability and solubility of RBC

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inheriting one defective gene is called

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sickle cell trait

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sickled red cells have a decreased

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survival time - causing anemia

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hgbS causes RBc to

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elongate, become rigid, assume cresent sickled shape

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hgbS causes cells to

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clump together, obstruct capillary blood flow causing ischemia and possible tissue infarction

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with normal oxygenation

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the sickled RBCs resume their normal shape

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repeated episodes of sickling and unsickling

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weaken the cell membrane causing them to hemolyze and be removed

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sickle cell crisis triggers (8)

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hypoxia, low environmental and/or body temp, excessive exercise, high altitudes, inadequate O2 during anesthesia, infection, dehydration, acidosis

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main trigger for sickle cell crisis

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hypoxia

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problem with patients with sickle cell

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noncompliant with O2 use, would rather pain med

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patho sickle cell crisis - what creats logjam effect

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vasospasm

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logjam effect causes what

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blood flow through vessel to stop

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patho of sickle cell crisis - stopped blood flow leads to

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thrombosis and infarction of local tissue

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sickle cell leads to crisis state which is

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extremely painful, lasting 4-6 days

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manage sickle cell crisis how

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pain control

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sickle cell crisis sns (3)

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anemia, large joints and swollen surrounding tissue, pripism if penile veins obstructed

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sickle cell crisis sns - anemia

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sickled cells on smear, pallor, jaundice, fatigue, irritability

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pripism

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abnormal painful continuous erection of penis

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thalassemia

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a hemolytic anemia characterized by microcytic hypochromic and short lived RBC

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thalassemia caused by

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deficient synthesis of hgb polypeptide chains

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thalassemia transmitted by

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autosomal recessive genes

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two types of thalassemia

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major and minor

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thalassemia major evident in

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infancy

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4 thalassemia major sns

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anemia, fever, failure to thrive, splenomegaly

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thalassemia major require frequent cause why

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frequent transfusions because RBCs are rapidly destroyed

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thalassemia major leaves what where from rapid RBC destruction

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leaves large amounts of iron deposited in skin becoming bronze and freckled

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cure for thalassemia major

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none

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tx for thalassemia major

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treat symptoms

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thalassemia minor

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mild anemia and minimal red blood cell changes

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thalassemia minor lacks what

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clinical symptoms although pt show hematological evidence of the disease

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acquired hemolytic anemia characterized by

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chronic premature destruction of red blood cells

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acquired hemolytic anemia associated with

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blood transfusion reactions

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hemolytic reaction (7)

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flushed, HA, urticaria, lumbar pain, chills or fever, dyspnea, hypotension