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Iron Deficiency Anemia(Microcytic) & Macrocytic Anemia (B12, folate def) Flashcards

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5213546592LOWIf RBCs are overhydrated the hematocrit is ______0
5213548189HIGHIf RBCs are dehydrated the hematocrit is _____1
5213551319MCVIf you have clumping of RBCs then CBC may show elevated _____2
5213556533RDWIf RBCs have a HIGH _____ value, it means the cells are NOT homogenous (some very large, some very low)3
5213561514MCHHow much Hb in the cell compared to surface volume of RBC; average concentration of Hb in cell4
5213568232Reticulocytes = immature RBCs-immature, non-nucleated RBCs that contain mRNA and are increased when the marrow responds to stress -Elevation of this count indicates that RBCs are being destroyed or you're losing a lot of blood (causing increased production) -depressed count if marrow is not able to compensate with the anemia -normally 0.5-1.5% in adults5
5213571268nucleus of lymphocytesRBCs should average the size of the _____6
5213578873fatigueMost common symptom of iron deficiency anemia is7
5213598281REMEMBER:Iron deficiency anemia is NOT a diagnosis itself... must identify underlying problem: -GI tract blood loss: H.pylori, peptic ulcer disease -colon polyps -small intestine, tiny BVs that bleed -cancer -GU bleeding (stool, urine)8
5213609674-iron deficiency -anemia of chronic disease/ACD (some) -thalassemias (dysfunction in globin synthesis) -lead poisoning -sideroblastic anemia (dysfunction in heme synthesis)Microcytic Anemias9
5213626216ferritin (indicative of iron storage)With iron deficiency anemia, you continue iron therapy until the ______ is normal10
5219501323anemiainsufficient RBC mass to deliver oxygen to peripheral tissues11
5219549969males = 13 females = 12lower limit of Hb in adult males is ____ g/dl and for females it is ____ g/dl12
5219553557120 daysaverage RBC lifespan13
521955355880-100 flaverage RBC volume (MCV)14
5219585138family history diet travel medications blood loss weight loss, feverrelevant anemia history15
5219591004Microcytosis / Microcytic anemia________ = RBC MCV of <80 fl16
5219596632-iron deficiency -anemia of chronic disease (ACD) -alpha/beta thalassemia trait is important to consider esp in African AmericansMost likely causes of microcytic anemia17
5219609829GI tract = source of blood loss GI malignancy Menstrual blood lossCommon causes of iron deficiency18
5219621740-decreased iron intake (inadequate diet or malabsorption - gastric surgery, celiac disease, increased gastric pH, tannins in tea) -increased loss: GI/GU loss (gastritis, peptic ulcer disease, menstrual loss) -increased requirements: pregnancy, childhoodIron Deficiency Anemia: etiology19
5219648353-symptoms of anemia -pica craving for peculiar food or non-food substances e.g. ices, dirt, chalk -restless legs -Koilonychia-spooning of nails -Dysphagia (difficulty swallowing), esophageal web (plummer- vinson or patterson-kelly Sx)- very rareClinical manifestations of Iron deficiency20
5219708459decrease serum iron & decrease in ferritin (storage iron)Earliest signs of iron deficiency21
5219552599120 daysaverage RBC lifespan22
5219738472iron deficiency anemiaCBC findings of ______ -increase in RDW and platelets -decrease MCV, MCH, MCHC, RBC, Hb, Hct -retic count not increased -serum: low iron, low ferritin high TIBC23
5219818296total iron binding capacity (TIBC)maximum amount of iron needed to saturate plasma or serum transferrin, transferrin receptor24
5219825400Hb and MCV___ and ____ decreased levels can be seen in Stage 3 of iron deficiency anemia25
5219860731hypochromic & microcyticProfound central pallor is found in _____ & ____ RBCs26
52198683231. Treat UNDERLYING CAUSE 2. Oral Ferrous sulfate 200 mg of elemental iron gives maximal Hb regeneration; absorption impaired by milk, tea, cereals side effects- nausea, constipation/diarrhea, abdominal pain; dark stoolTreatment for Iron deficiency anemia27
5219889683parenteral iron if still fail to respond to therapy: question diagnosis, compliance, associated illness, ongoing blood loss and malabsorptionIf intolerant to PO iron, non-compliant, or iron therapy is malabsorbed give ___ for iron deficiency anemia28
5219906994Hb (usually returns to normal after 2 months) reticSymptomatic response to iron therapy treatment precedes increase in _____; ____ count increased after 5-10 days of Rx29
5219939357Macrocytic anemiasencompasses both megaloblastic and non-megaloblastic anemias MCV > 100 fl30
5219956038megaloblast-refers to characteristic bone marrow RBC precursors with specific chromatin changes; impaired DNA synthesis -in macrocytic anemia31
5219963068Non-megaloblastic anemias_______ anemias do NOT have impaired DNA synthesis and RBC precursors are normal -common causes: ETOH, liver disease, alcoholism,32
5219970207Megaloblastic anemiaAnemias caused by -folate deficiency OR -B12 deficiency characteristics: -pancytopenia (may be seen with B12 def.)33
5219984905PancytopeniaWhen anemia, leukopenia and thrombocytopenia occur together34
5220004223folate def = occurs rapidly B12 def = takes years to developIn megaloblastic anemia, _____ deficiency occurs rapidly; _____ deficiency takes years to develop35
5220022042Neurological changes Ineffective erythropoeisis_______ changes in B12 deficiency may occur without anemia; reversal of changes with treatment is variable Ineffective _____ (destruction of red cells within the marrow may be seen in B12 def) = labs may be suggestive of hemolytic anemia... but....LOW retic count, because hemolysis is occuring within the bone barrow ..36
52200469863-4 lobesNeutrophils normally have _____ lobes37
5220053476megaloblastic anemia; typically B12 deficiencyHypersegmented neutrophils (ex. 8 lobes) & macro-ovalocytes are characteristic of ...38
52200585941- pernicious anemia 2- surgical (several years after total gastrectomy or resection of terminal ileum - site of B12 absorption - acid blocking drugs in the stomach) 3- Zollinger-Ellison syndrome (gastric acid inactivates pancreatic proteases which impairs B12 binding to IF in the ileum) 4-pancreatic exocrine deficiency 5- blind loop syndrome (stasis, colonizing bacteria bind cobalamin-B12) 6- Diphyllobothrium latum infestation (bind B12 and prevent absorption) 7-Dietary deficiency (very rare, vegans)Causes of B12 (Cobalamin) Deficiency39
5220119116pernicious anemiaautoimmune disorder -associated with vitiligo, hypotheyroidism -failure of secretion of intrinsic factor (IF) - Antibody directed against IF or parietal cells) leading to B12 deficiency40
5220167218B12 deficiencyIf see macrocytic anemia with MYELOPATHY & the following symptoms (neuropsychiatric features - subacute combined degeneration-affects posterior and lateral parts of spinal cord) think..... -->Posterior columns (ascending fibers) -sensory disturbances -incoordination (legs)/ ataxia -diminished vibration, position sense -->Lateral columns (descending fibers) -weakness, spasticity41
5220189233Blood test B12 deficient if .... elevated levels of homocysteine AND methyl-malonic acid (MMA) And possibly Anti-IF antibodies in cases of pernicious anemiaIf B12 = <200 deficient >400 NOT deficient between 200-400.. do not know so order ___?42
5220197647Folate____ deficiency will show elevated levels of homocysteine but NOT MMA43
5220226217B12Prophylactic _____ therapy is given in patients with gastric bypass or ileal resection44
5220236374hypokalemia_____ may occur early on in B12 deficiency Treatment in severe cases bc potassium is an intracellular ion - taken out as maturation proceeds- can occur when you're replacing cells45
5220254393FOLATE/ folic acid (only 3-4 month supply) main food source = plant & animal cooking = easily destroyedTest results characteristic of ______ deficiency 1- low serum folate concentration (<2ng; reflects recent intake)- cheaper screening test 2- low serum RBC folate concentration (less sensitive to dietary effects) 3-elevated serum homocysteine level (ONLY)46
52202651391- inadequate diet (MAJOR cause) - elderly, poverty, alcoholism 2- impaired absorption - non-/tropical sprue, other diseases of small intestine 3- increased requirements - pregnancy, chronic hemolytic anemias, exofiliative dermatitis (ex. psoriasis)Folate deficiency causes47
5220281743folate prophylactic folate oral treatment given during pregnancy, prematurity, severe hemolytic anemia, dialysis____ deficiency can lead to neural tube defects of fetus in pregnant women; but a lot of food is fortified with folate to avoid this (ex. cereals)48

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