Lecture 8: Anemia Case Studies Flashcards
What are 3 common symptoms and 4 common signs of anemia?
Symptoms: fatigue, exercise intolerance, rapid heartbeat
Signs: pallor (conjunctiva or muscosa), tachycardia, systolic murmur, edema
What is the earliest and most sensitive sign of Iron Deficiency Anemia?
increased RDW (Red Cell Distribution Width)
- also called Anisocytosis
What are three indications of low iron? What are 2 indications that the body is WAITING for iron?
- low serum iron, low serum ferritin (reflects iron stores), and low transferrin/TIBC (total iron binding capacity)
- increased TIBC and transferrin receptor (TFR)
What do the terms “onychoschizia” and “koilonychia” mean?
O - split nails
K - spooned nails
What are common signs of Iron Deficiency Anemia?
tired, weight loss (cancer/inadequate nutrition), nail problems
- also: conjunctival pallor and cheilosis (angular stomatitis –> around mouth)
PICA –> compulsion to eat substances such as ice, chalk, soil, paper
What should you look for in postmenopausal females or males suspected of iron deficiency anemia?
sources of gastrointestinal blood loss
- do a stool guaiac test (positive for fecal occult blood)
How does anemia of blood loss present? What are 3 common results of anemia from acute blood loss?
- presentation is ACUTE (hypovolemia/heart attack)
FIND THE BLEEDING AND STOP IT
results –> hypovolemia, myocardial ischemia (supply vs demand), renal failure
How much should a single unit of RBC increase Hgb by?
1 g/dL
What blood type is the universal donor and what type is the universal acceptor? How does Rh +/- factor into blood transfusions?
UD: type O blood (has no antigens on it)
- RBCs can be given to anyone
- can receive all types of plasma (no Ags on it)
UR: type AB (produces no antibodies)
- plasma can be given to anyone
- only give Rh+ blood to blood types that are positive, Rh- can give blood to their own type and AB- (O- can be given to anyone regardless of +/-)
What is Sickle Cell Disease?
- autosomal recessive causing predominately HbS hemoglobin (rather than HbA) due to Glutamic Acid –> Valine mutation
- particularly prominent in West Africans (survival against endemic malaria)
African Americans have an 8% prevalence
What is the confirmatory test for Sickle Cell Anemia?
gel electrophoresis
How does sickle cell anemia cause stroke, acute chest pain, and renal manifestations?
S - vaso-occulsion (affects 15% of children)
- TRANSFUSION helps
ACP - common cause of death in adults with SCA
- vaso-occlusion by marrow emboli of necrotic bone
- pulmonary vaso-occlusion dec. oxygen count
RM - urine cannot be concentrated due to damage
- hematuria (even in heterozygous peeps)
What bone manifestation can occur in Sickle Cell Anemia?
Avascular Necrosis
- can lead to long-term disability
What are common therapies for Sickle Cell Anemia?
- start oxygen, give NSAIDS (hydrocodone) for pain
- avoid high altitudes and intense exercise
- Hydroxyurea (dec. HbS, more HbF) and transfusions
- possible stem cell transplant
Who would be the best person to receive a blood transfusion from and why?
- we can potentially generate alloantibodies against transfusions unless we possess that antigen
- chronic transfusions should be received from a donor pool as genetically identical to you as possible
