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70 Cards in this Set
- Front
- Back
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What is the definition of Anemia?
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Deficiency in the oxygen carrying capacity of the blood
due to a diminished erythrocyte mass |
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What can cause Anemia?
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Erythrocyte loss (bleeding)
Decreased Erythrocyte production • low erythropoietin • Altered erythrocyte differentiation Increased Erythrocyte destruction (hemolysis) |
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What is Normocytic Anemia?
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normal size, just fewer cells
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What is Microcytic Anemia?
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smaller size, from decreased hemoglobin content
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What is Macrocytic Anemia
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large, retain some immature precursor characteristics
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What are the microcytic anemias that are associated with decreased production?
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Iron deficiency
Thalassemia Anemia of Chronic Disease |
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What are the macrocytic anemias that are associated with decreased production?
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Megaloblastic:
- Vit. B12 def. - Folic Acid Def. Non-megaloblastic: - myeoldysplasia - chemotherapy - Hepatitis |
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What are the normocytic anemias that are associated with decreased production?
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Aplastic Anemia
Bone Marrow Infiltration Carcinoma Lymphoma |
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What are the normocytic anemias that are associated with increased production?
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Intrinsic hemolysis
extrinsic hemolysis |
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What are the normocytic anemias that are associated with blood loss?
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Acute hemorrhage
Chronic Hemorrhage |
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What is the measurement of Hemoglobin?
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G of hemoglobin per 100 mL of whole blood (g/dL)
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What is the measurement of Hematocrit?
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% of a sample of whole blood occupied by intact RBC's
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What is the measurement of RBC?
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Millions of red blood cells per microL of whole blood
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What is MCV ?
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Mean corpuscular volume
– If > 100 → Macrocytic anemia – If 80 – 100 → Normocytic anemia – If < 80 → Microcytic anemia |
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What is RDW?
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Red blood cell distribution width
– = (Standard deviation of red cell volume ÷ mean cell volume) × 100 – Normal value is 11‐15% – If elevated, suggests large variability in sizes of RBCs |
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What is the laboratory def. of Hgb in men and women?
What about Hct? |
Hgb:
- Men: <13.5 - Women: <12 Hct: - Men: <41 - Women: <36 |
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What are the symptoms of Anemia associated with decreased oxygenation?
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– Exertional dyspnea
– Dyspnea at rest – Fatigue – Bounding pulses – Lethargy, confusion |
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What are the symptoms of Anemia associated with decreased volume (essentially hypotension)?
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– Fatigue
– Muscle cramps – Postural dizziness – syncope |
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What are some special considerations in determining Anemia?
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Acute bleeding
Pregnancy Volume Depletion |
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Drop in Hgb or Hct may not be shown until _____ hours acer acute bleed (even though patient may be hypotensive)
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36 to 48
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In _____ trimester, RBC and plasma volume are expanded by_____ , respectively.
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Third
25 and 50% |
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Patientʼs who are severely volume depleted may not show anemia until after _____.
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rehydrated
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What is a major cause of Anemia?
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Erythrocyte loss - bleeding
• Chronic (gastrointes)nal, menstrual) • Acute/Hemodynamically significant: – Gastrointes)nal – Retroperitoneal |
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Other than bleeding some other causes of anemia are...
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Iron‐Deficiency
Vitamin B12 Deficiency Folate Deficiency Anemia of Chronic Disease |
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In Iron deficiency Anemia what are the
Serum Iron? Total Iron Binding Capacity (TIBC)? Serum Ferritin? |
Low <60 micrograms/dl
High >360 micrograms/dl Low<20 nanograms/ml - can be falsely normal in inflammatory states |
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What are the best foods used to treat iron deficiency anemia?
What is the percentage absorbed in these foods? |
– Liver, heart
– Oysters – Eggs – Yeast – Veggies less so, despite Popeye 10% |
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What are the classes of Oral iron Salts used in the treatment of iron deficiency anemia?
What is the percentage absorbed in these foods? |
Sulfate, gluconate, fumerate
10% |
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What is the most common oral iron salt used for iron deficiency anemia?
What can help to facilitate iron absorption? |
Ferrous Sulfate - 325mg PO a day
Vitamin C |
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What are the adverse effects to taking Ferrous Sulfate?
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Gastric distress
Constipation Black stools Positive hemmocrit test Taken w/ meals to decrease side effects, but lowers absorption |
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Patients taking iron supplements show decreased absorption to what types of drugs?
How do you handle this? |
Quinolones
Tetracyclines Hormones Stagger doses by two hours |
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Describe Porphyria and why it is considered a non-iron deficient anemia?
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–Assoc. w/ altered production of porphyrin ring structure.
–Usu. genetic/ sometimes meds. (Madness of King George) –Usu. not confined to Hgb also enzymes (Cytochrome P450s) |
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What is the most common genetic Porphyria cause?
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Acute Intermipent Porphyria
Porphyrin synthesis diminished not lost Highly variable symptoms or asymptomatic |
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How does genetic Porphyria usually occur?
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In "Attacks" of:
Mental changes Seizures Neuropathies – Chest, neck, back pain Gastrointestinal |
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What is Thalassemia?
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Defects in either the alpha or beta chains of hemoglobin, leading to ineffective erythropoiesis and hemolysis
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What are the anemias that are due to the destruction of red blood cells?
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Hemoglobinopathies
Aplastic Anemia Hemolytic Anemia |
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What are the forms of Hemoglobinopathies?
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Sickle Cell Anemia
Essentially a form of β‐thalassemia |
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What is the cause of Aplastic Anemias?
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Decrease in all lines of cells – Hgb, Hct,
WBC, platelets • Parvovirus B19, EBV, CMV • Acquired aplas)c anemia |
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What causes Hemolytic Anemia?
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Drug Toxicities
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What are the attacks of Sickle Cell Anemia brought on by?
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• Hypoxic stress
• Odontogenic infec)ons |
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What anemia is essentially considered drug allergy? And is not considered
an antigen as free drug but is bound |
Anemia from Hemolysis
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What is the diagnostic test for Penicillin drug Allergy?
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Penicilloyl Polylysine [Pre-Pen®]
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What does Penicillin do to Bacteria?
What does it do to RBC's? |
Binds to bacterial transpeptidases and inactivates it
Modifys proteins on RBC's creating foreign epitopes |
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After Penicillin binds to RBC's what happens?
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1. Complement coated RBC's phagocytosed by macrophages
2. Macrophages present peptides to CD4 T cells to make TH2 Cells 3. B Cells activated by Antigen and TH2 Cells 4. B cells cause plasma cells to produce penicillin specific IgG 5. IgG binds to complement coated RBC's (antigen) 6. IgG activates C1-C9 cascade to lyse RBC's 7. IgG activates C1-C3 cascade to Covalently bind RBC's to macrophages for phagocytosis |
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What Macrocytic Anemia is characterized by
- Elevated serum methylmalonic acid - Elevated serum homocysteine |
Cobalamin Vitamin B12 Deficiency
Cobalamin Levels are <200 pg/ml |
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What vitamin is needed for DNA synthesis?
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Vitamin B12
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Binds to _____ in the small bowel inorder to be absorbed
_____ anemia: antibodies to intrinsic factor |
Intrinsic factor
Pernicious |
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A deficiency in Vitamin B12 results in what kind of symptoms?
Are these symptoms reversible? |
Neuropsychiatric
No not even with Cobalamin replacement |
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What is the treatment of Vitamin B12 deficiency?
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Vitamin B12 either intramuscularly or PO
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What deficiency has ...
Increased serum homocystine NORMAL methylmalonic acid |
Folic Acid Deficiency
Low Folate |
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-Folate is normally absorbed in _____ and proximal jejunum
-Deficiency found in _____ disease, regional _____, _____ |
duodenum
celiac, enteritis, amyloidosis |
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– Deficiency frequently in _____, because enzyme required for deglutamation of folate
is inhibited by _____. |
alcoholics, alcohol
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– Deficiency often found in _____ women, persons with _____ skin disorders, parents with _____ anemia
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pregnant
desquamating sickle cell |
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What can the treatment of Folate deficiency due for Vit. B12 deficiency?
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Improves the Anemia of Vit. B12 but not the neurologic symptoms
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What is a historically fatal anemia that does not respond well to iron therapy?
What other types is it related to? |
Pernicious Anemia
Vit B12 and Folic acid deficiency pernicious anemias |
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Long term exposure to _____ induces a megablastic anemia
What is this similar to? |
nitrous oxide
B12 Deficiency |
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What does megablastic anemia from NO Inhibit?
How? What kind of enzyme does this make? |
methionine synthase
Irreversibly oxidizes cobalt atom of methylcobalbumin cofactor Permanently inactivating enzyme |
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What are hematopoetic growth factors?
What do they do? What are their problems? |
Recombinant human proteins
Augment normal processes biologic nature causes: • Degradation • Allergy • Neutralization |
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What was the first growth factor to be cloned?
What does it affect? Where is it normally found? |
Erythropoietin/ Darbepoetin
Erythrocyte differentiation Normally formed in the kidney |
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What is a blood doping drug used to augment erythrocyte production?
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Erythropoietin EPO
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What are the two forms of EPO?
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Epoetin alfa
Darbopoetin alfa |
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G‐CSF
GM‐CSF M‐CSF |
granulocyte colony stimulating factor
granulocyte macrophage stimulating factor macrophage stimulating factor |
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What does G-CSF Do?
What are the agents? |
Stimulates granulocyte/neutrophil lineage
• Filgras)m (Neupogen) Amgen • PegFilgras)m (Neulasta) Amgen |
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What are the uses of G-CSF?
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- Bone marrow transplant
- Neutropenia - Leukapheresis |
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What are the effects of G-CSF toxicity?
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• Can cause ARDS
• From neutrophil influx into lungs • Hypersensi)vity • Sickle cells disease crisis |
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What is GM-CSF?
What is its agent? |
Recombinant, yeast derived 127aa
Also s)mulates monocyte/mac lineage Sargramos)m (Leukine) Amgen |
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What is GM-CSF used for?
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– Bone marrow transplantation
– AML – Autologous peripheral blood progenitor transplanta)on |
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What are the toxic effects of GM-CSF?
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Can stimulate tumor growth
Watch for allergic reactions |
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What does IL-11 (Neumega) do?
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• Thrombopoietic
Megakaryocyte maturation Platelet production • Similar to: Hgh, GSFʼs • Also anti‐inflammatory |
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What are synthetic plasma extenders?
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Dextran
Hetastarch |
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Anemic dental patients may have what?
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• Oral mucositis
• Viral disease • Fungal infections • Odontogenic infections Dentists may be the first to see symptoms |
