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Questions and Answers
What is a common non-dietary cause of iron deficiency anemia?
What is a common non-dietary cause of iron deficiency anemia?
Which clinical manifestation is NOT typically associated with iron deficiency anemia?
Which clinical manifestation is NOT typically associated with iron deficiency anemia?
What dietary recommendation aids iron absorption when taking supplements?
What dietary recommendation aids iron absorption when taking supplements?
What characterizes a sickle cell crisis?
What characterizes a sickle cell crisis?
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Which test is utilized to diagnose iron deficiency anemia?
Which test is utilized to diagnose iron deficiency anemia?
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Which oral iron supplement is commonly used despite potential gastrointestinal distress?
Which oral iron supplement is commonly used despite potential gastrointestinal distress?
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What is the primary reason for administering a small test dose before parenteral iron administration?
What is the primary reason for administering a small test dose before parenteral iron administration?
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In the context of sickle cell anemia, what does the term 'plastic crisis' refer to?
In the context of sickle cell anemia, what does the term 'plastic crisis' refer to?
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Which symptom is considered a classic manifestation of sickle cell disease?
Which symptom is considered a classic manifestation of sickle cell disease?
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Which of the following dietary choices may hinder iron absorption when taking supplements?
Which of the following dietary choices may hinder iron absorption when taking supplements?
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What primarily indicates the presence of anemia?
What primarily indicates the presence of anemia?
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Which of the following is a cause of hypo-proliferative anemia?
Which of the following is a cause of hypo-proliferative anemia?
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What is the result of increased erythrocyte destruction in hemolytic anemia?
What is the result of increased erythrocyte destruction in hemolytic anemia?
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Which factor is NOT associated with inadequate erythrocyte production?
Which factor is NOT associated with inadequate erythrocyte production?
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Which disorder is characterized by an abnormality within the erythrocyte itself and can lead to hemolytic anemia?
Which disorder is characterized by an abnormality within the erythrocyte itself and can lead to hemolytic anemia?
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What happens to erythropoietin production in response to tissue hypoxia caused by increased red blood cell destruction?
What happens to erythropoietin production in response to tissue hypoxia caused by increased red blood cell destruction?
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Which of the following is NOT a mechanism for hemolysis?
Which of the following is NOT a mechanism for hemolysis?
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What condition may arise from a deficiency in vitamin B12 or folic acid?
What condition may arise from a deficiency in vitamin B12 or folic acid?
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Which type of anemia involves the loss of red blood cells resulting from bleeding?
Which type of anemia involves the loss of red blood cells resulting from bleeding?
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In which anemia type is a high reticulocyte count typically observed?
In which anemia type is a high reticulocyte count typically observed?
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What is the most common organ affected by sickled cells in children during a sequestration crisis?
What is the most common organ affected by sickled cells in children during a sequestration crisis?
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Which of the following is NOT a risk factor for sickle cell crisis?
Which of the following is NOT a risk factor for sickle cell crisis?
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Which symptom is commonly associated with Acute Chest Syndrome?
Which symptom is commonly associated with Acute Chest Syndrome?
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What is the primary goal of treatment with hydroxyurea for sickle cell disease?
What is the primary goal of treatment with hydroxyurea for sickle cell disease?
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Which of the following is a common complication of sickle cell disease that may lead to death?
Which of the following is a common complication of sickle cell disease that may lead to death?
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What is the significance of Doppler echocardiography in patients with SCD?
What is the significance of Doppler echocardiography in patients with SCD?
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Which of the following statements about RBC transfusions in sickle cell disease is false?
Which of the following statements about RBC transfusions in sickle cell disease is false?
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In patients with sickle cell trait, which laboratory findings would typically be observed?
In patients with sickle cell trait, which laboratory findings would typically be observed?
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What is a key medical management approach to reduce the risk of acute chest syndrome?
What is a key medical management approach to reduce the risk of acute chest syndrome?
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Which of the following is an important component of supportive therapy in managing sickle cell disease?
Which of the following is an important component of supportive therapy in managing sickle cell disease?
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What is a potential complication of untreated severe beta thalassemia?
What is a potential complication of untreated severe beta thalassemia?
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Which intervention is crucial for managing complications in patients with beta thalassemia?
Which intervention is crucial for managing complications in patients with beta thalassemia?
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What is the purpose of iron chelation therapy in patients with thalassemia?
What is the purpose of iron chelation therapy in patients with thalassemia?
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Which of the following teaching points is essential for preventing sickle cell crisis?
Which of the following teaching points is essential for preventing sickle cell crisis?
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In thalassemia, what describes the abnormality seen in erythrocytes?
In thalassemia, what describes the abnormality seen in erythrocytes?
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What is the primary risk associated with the agglutination of sickled cells in patients with sickle cell disease?
What is the primary risk associated with the agglutination of sickled cells in patients with sickle cell disease?
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Which of the following is NOT a common nursing intervention for managing patients in sickle cell crisis?
Which of the following is NOT a common nursing intervention for managing patients in sickle cell crisis?
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What is a key characteristic of alpha thalassemia compared to beta thalassemia?
What is a key characteristic of alpha thalassemia compared to beta thalassemia?
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Which symptom indicates the most severe form of beta thalassemia?
Which symptom indicates the most severe form of beta thalassemia?
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What is an important preventative measure to decrease infection risk in patients with sickle cell disease?
What is an important preventative measure to decrease infection risk in patients with sickle cell disease?
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Study Notes
Anemia
- Anemia is a condition where hemoglobin levels are lower than normal, resulting in fewer red blood cells (RBCs) and reduced oxygen delivery to tissues.
- It's not a disease but a symptom of an underlying issue, and it's the most common hematologic condition.
Classification of Anemia
- Hypo-proliferative: Anemia caused by inadequate RBC production. Bone marrow doesn't produce enough RBCs due to factors like medication, chemical damage, or insufficient production factors (e.g., iron, vitamin B12).
- Bleeding: Anemia resulting from blood loss. RBCs are lost, leading to reduced RBC counts.
- Hemolytic: Anemia resulting from RBC destruction. RBCs are destroyed prematurely, releasing hemoglobin into the plasma. This leads to elevated bilirubin levels and tissue hypoxia, stimulating erythropoietin production and increasing reticulocyte count (as the bone marrow responds). Hemolysis can be caused by issues within the RBCs themselves (like sickle cell disease), issues within the plasma, or direct trauma to the RBCs in the circulation.
Iron Deficiency Anemia
- Occurs due to insufficient dietary iron for hemoglobin production.
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Causes:
- Bleeding (ulcers, gastritis, inflammatory bowel disease, GI tumors, heavy periods, pregnancy without iron supplementation)
- Chronic alcoholism
- Iron malabsorption (after surgery, with celiac/inflammatory bowel disease, or from medications like proton pump inhibitors/H2 blockers)
- Inadequate iron intake (vegetarian diets), or blood loss (like hookworm).
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Clinical Manifestations:
- Weakness, fatigue, pallor, tachycardia, palpitations, dyspnea, dizziness, nausea, vomiting, melena, diarrhea, anorexia, glossitis
- Pica (cravings for unusual substances like ice, starch or dirt)
- Severe/prolonged deficiency can lead to a smooth red tongue, brittle/ridged nails, angular cheilosis
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Assessment & Diagnostics:
- Bone marrow aspiration
- Low levels of hematocrit, RBCs, hemoglobin, and ferritin.
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Medical Management:
- Identify the cause of deficiency.
- Oral iron supplements (ferrous sulfate, ferrous gluconate) taken 1-2 hours before meals to improve absorption OR slowly increased doses.
- Vitamin C enhances iron absorption.
- Dietary changes to include high-iron foods (organ meats, beans, leafy greens).
- IV or IM iron dextran if oral is poor absorbed/tolerated.
- Possible longer treatment (6-12 months) needed to replenish iron stores
Sickle Cell Anemia
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A hereditary disease, often inherited through consanguineous marriages.
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Characterized by a defective hemoglobin (HbS) gene, which causes abnormal hemoglobin formation.
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HbS crystallizes at low oxygen tension, deforming RBCs into rigid, sickle shapes.
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Sickle Cell Crisis: Intermittent episodes related to micro-circulation blockade. Types include:
- Acute vaso-occlusive crisis: Micro-circulation blockages causing tissue hypoxia, inflammation, and necrosis.
- Plastic crisis: Occurs from viral (parvovirus) infections when the bone marrow can't compensate for the rapid fall in hemoglobin leading to no reticulocytes.
- Sequestration crisis: Sickled cells pool in organs (spleen in children; liver /lungs in adults, which causes organ damage.)
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Acute Chest Syndrome: A serious complication of SCD, marked by fever, respiratory distress (tachycardia, cough, wheezing). Often caused by infections or pulmonary issues.
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Complications: Infection, stroke, kidney injury, impotence, heart failure, and pulmonary hypertension.
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Risk factors for crisis: Dehydration, cold, stress, strenuous activity, infection, low oxygen.
Thalassemia
- A group of inherited anemias characterized by:
- Hypochromia (low hemoglobin content)
- Microcytosis (small RBCs)
- Hemolysis
- Variable degrees of anemia
- Defective hemoglobin synthesis (reduced production of globulin chains). This leads to increased rigidity and premature destruction of RBCs.
- Classified as Alpha and Beta Thalassemia, based on the diminished globulin chain.
- Thalassemia Major: Severe anemia and ineffective erythropoiesis, often fatal before adulthood if untreated. Requires early and regular blood transfusion therapy to facilitate growth and development.
- Management: Blood transfusions and iron chelation therapy. Preconception counseling is important for couples.
Other Medical Management
- Peripheral Blood Stem Cell Transplant (PBSCT): A possible cure for SCD, but limited availability due to lack of compatible donors or existing organ damage.
- Hydroxyurea: Chemotherapy agent which increases fetal hemoglobin levels, reducing sickling and painful crises.
- Folic Acid: Daily supplementation is often needed to support erythropoiesis.
- Transfusion Therapy: Effective in reducing/treating sickle cell crisis and preventing complications like strokes and heart failure but with associated risks (e.g., infection, iron overload).
- Pain Management: Aspirin, NSAIDs, and parenteral opioids are used for pain relief.
- Hydration: Maintained through oral hydration or IV fluids as part of supportive therapy during a crisis.
- Treatment of infections is critical.
Nursing Management
- Managing Pain, Fatigue, Infection and Deficient Knowledge: Assessing patients for symptoms, administering meds, managing fluids, infection control measures, and patient education.
- Potential Complications: Close monitoring and treatment of possible complications from anemia(e.g., infection, stroke, heart failure).
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Description
This quiz covers the essential aspects of anemia, a condition characterized by low hemoglobin levels and reduced red blood cells. Learn about the different classifications of anemia, including hypo-proliferative, bleeding, and hemolytic types, and their underlying causes.
