Anemia & Management PDF

4 Sgramsironpresentinthebody T RBCcontainmaxamount highestis 2nd P 2 medications deficiency of erythrocytes 24 30myturnoverin24hours I Recycled through body Ithantoneed I reduction in the concentration of hemoglobin (Hgb) results in reduced oxygen-carrying capacity of the blood. Introduct...

4 Sgramsironpresentinthebody T RBCcontainmaxamount highestis 2nd P 2 medications deficiency of erythrocytes 24 30myturnoverin24hours I Recycled through body Ithantoneed I reduction in the concentration of hemoglobin (Hgb) results in reduced oxygen-carrying capacity of the blood. Introduction Fatigue , lethargy, shortness of breath, headache, edema, and tachycardia. The lack of oxygen to tissues results: millionRBCproducedsecond Common causes: 3enterbloodstream • Acute or chronic blood loss • Decreased functional RBC production, and • Increased RBC destruction. Pernicious EEEErnst Macrocytic-Normochromic anemias: Iron deficiency Microcytic-Hypochromic anemias: size teenb Common forms ⬇ Vit b12 & folate or folate - Thalassemia Sickle cell Aplastic Normocytic-Normochromic anemias: Hemolytic Post-hemorrhage Chronic disease IKE north pore I 43% of young children (< 5 years old) Hangin tanen place more high men o stainX Prevalence based on age, gender, race/ethnicity, and geographic location. p eople south 40% of pregnant women. High rates with cancer and chronic kidney disease ano humanneed Reason - malignancy and myelosuppressive antineoplastic therapy Cancer (30% to 90%): 15% to 20% in stages 1 through 3 and up to 70% in stage 5. Chronic kidney disease: Epidemiology & Etiology Fe, Vitamin B12, and folic acid – 1/3rd Elderly patients. Most common cause: Nutritional deficiencies high risk of iron deficiency anemia (IDA), poor dietary intake, iron loss through monthly menses. Childbearing woman: Dysregulations in iron and erythropoietin (EPO) hemostasis. Cancer or CKD - Rheumatoid arthritis and systemic lupus erythematosus. Chronic immune-related diseases - Anemia related to chronic inflammatory conditions is termed anemia of chronic disease (ACD). ⁉ A Prevalence Erythropoietin Iron Vitamins: • Vitamin B12 (Cyanocobalamin) • Folic Acid (Folate) • Ascorbic acid (Vitamin C) • Pyridoxine (Vitamin B6) Erythropoiesis necessary factors Amino acids " Pernicious Anemia Iron: " IDA: needed for nucleus formation of the iron-porphyrin heme ring, along with globin chains. inadequate absorption of iron or excessive blood loss. Congenital. Iron : Normal Homeostasis Inadequate absorption: such as inflammatory bowel disease, celiac disease, or bowel resection. Acquired intestinal conditions excessive menstruation, ulcers, neoplastic lesions Excessive blood loss Anemia & Management Chronic diseases associated with ACD (anemia of chronic disease) include: infection, autoimmune disease, CKD, and cancer. Cytokines impair the proliferation and differentiation of erythroid precursors. ⬇ Immune activation: upregulates cytokines RBC ↑ due to the upregulation of inflammatory cytokines. Dysregulation of Iron Homeostasis and Impaired Marrow Production Hepcidin - an acute-phase protein It ↓ iron absorption and ↓ iron release from macrophages. Released by kidney EPO (erythropoietin): Decreased production and responsiveness of EPO M: 14 -18 g/dL Hgb: F: 12 -15 g/dL CBC:M: 40% -50% " T RBC indices :- Laboratory Tests in the Evaluation of Anemia F: 36% - 44% MCV: 88 ±8 i Serum iron:- M: 45 -160 mcg/dL Serum iron: Iron studies :RBC indices :- F: 30 - 160 mcg/dL TIBC: 220 - 420 mcg/dL M: 0.5% - 1.5% Reticulocyte count (erythrocyte pre-c): F: 0.5% - 2.5% Other Tests :- I Act HCT: know Alice Folic acid (RBC): 125 - 600 ng/mL Vitamins B12: 200 -1000 pg/mL know reict Fatigue, lethargy, dizziness, Pallor & yellowish Shortness of breath Headache Signs and Symptoms: Generally nonspecific Edema Tachycardia Clinical presentation Dry skin, chapped lips I Nail brittleness or spoon-shaped nails (koilonychia) Other findings that may be present: Hunger for ice, starch, or clay (termed pica) Cognitive impairment, gait abnormalities, irritability, peripheral neuropathy (vitamin B12 anemia) Blood loss, such as hemorrhoids, melena, or menorrhagia (IDA) Dietary habits (vegan/vegetarian), malnourishment, or recent weight loss (vitamin B12 or folate deficiency) Medical History GI surgeries (gastric bypass) (vitamin B12 or folate deficiency) Alcoholism (folate deficiency) Cancer or CKD Medical history Chronic autoimmune disorders or infections, such as HIV infection or rheumatoid arthritis Orthostatic hypotension and tachycardia secondary to volume depletion Physical Examination: determining the severity of the anemia A CBC is a necessary first step Laboratory Evaluation Cutaneous changes such as pallor, jaundice, and nail brittleness Hgb and Hct – low RBC indices and the peripheral smear Mean corpuscular volume (MCV) is the next step classified: microcytic, normocytic, or macrocytic 77 volume corpuscular mean ee mamma IoT mint of to amount ironbound yay Tat Grancranton disease transfer CIDA IDA gnomonic ppm feritireshenocidine Far sansenant lowTIBC