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52 Cards in this Set
- Front
- Back
name some of the sx's of anemia
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pallor, fatigue, dec'd stamina, rapid pulse, chest pain, cold hands and feet, SOB, orthostatic hypoTN, HA, problems with mental concentration
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what are all of the sx's of anemia due to?
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dec O2 content to tissues
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when evaluating anemia, what is the significance of the MCV?
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mean cell volume: is used to separate macro- and microcytic anemias
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what 2 vitamin def's can cause megaloblastic anemia?
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B12 and Folate (B9)
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what do def's in B12 or B9 impair that causes megaloblastic anemias
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impairs conversion of U (RNA) to T (DNA) [B12 and B9 are cofactors for this rxn] so that the cytoplasm matures, Hb is made, but nucleus remains large
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what type of NP is absolutely characteristic of megaloblastic anemia due to vitamin def?
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Hypersegmented NP's
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besides hypersegmented NP's what other cellular abnormalities are seen with megaloblastic anemia?
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oval macrocytes
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Vitamin B12 absorption: where is B12 absorbed?
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Ileum
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Vitamin B12 absorption: what is B12 found in?
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meats, milk, eggs (NOT fruits and veggies)
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Vitamin B12 absorption: what role does Transcobalamin play (types I&III and type II)?
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Transcobalamin I and III in saliva bind to B12; transcobalamin 2 transports VitB12-Intrinsic factor into intestinal epithelial cells
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Vitamin B12 absorption: what role dies intrinsic factor play in absorption and where does it come from?
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Intrinsic factor is secreted for the parietal cells of the stomach; it binds B12 after pancreatic enzymes have stripped off TC 1 &3
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which factor of B12 absorption probably contributes to why 3-5% of the elderly population is B12 deficient?
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gastric atrophy may occur in the elderly such that they cannot secrete intrinsic factor which must bind to B12 to be absorbed
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what is the daily requirement of B12? Of folate?
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B12 = 2 micrograms; folate = 0.2mg
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_____________ anemia is when autoantibodies attack the pariental cells of the stomach so that intrinsic factor is not produced
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pernicious anemia
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what conditions is pernicious anemia associated with?
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vitiligo (MJ); Graves disease (thyroid); Addisons disease (adrenal insufficiency); other autoimmune phenomena
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besides old age, vitiligo, Graves, and Addison's disease, what are other causes of B12 deficiency?
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dietary def in vegans, gastric resection, small bowel bacterial overgrowth that compete for the utilization of B12; ileal damage with Crohn's disease, sprue, and lymphoma
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how long does it take to deplete the body of B12 stores? Folate stores?
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B12 - 4 years, Folate - a few months
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name some of the sx's of anemia
|
pallor, fatigue, dec'd stamina, rapid pulse, chest pain, cold hands and feet, SOB, orthostatic hypoTN, HA, problems with mental concentration
|
|
what are all of the sx's of anemia due to?
|
dec O2 content to tissues
|
|
when evaluating anemia, what is the significance of the MCV?
|
mean cell volume: is used to separate macro- and microcytic anemias
|
|
what 2 vitamin def's can cause megaloblastic anemia?
|
B12 and Folate (B9)
|
|
what do def's in B12 or B9 impair that causes megaloblastic anemias
|
impairs conversion of U (RNA) to T (DNA) [B12 and B9 are cofactors for this rxn] so that the cytoplasm matures, Hb is made, but nucleus remains large
|
|
what type of NP is absolutely characteristic of megaloblastic anemia due to vitamin def?
|
Hypersegmented NP's
|
|
besides hypersegmented NP's what other cellular abnormalities are seen with megaloblastic anemia?
|
oval macrocytes
|
|
Vitamin B12 absorption: where is B12 absorbed?
|
Ileum
|
|
Vitamin B12 absorption: what is B12 found in?
|
meats, milk, eggs (NOT fruits and veggies)
|
|
Vitamin B12 absorption: what role does Transcobalamin play (types I&III and type II)?
|
Transcobalamin I and III in saliva bind to B12; transcobalamin 2 transports VitB12-Intrinsic factor into intestinal epithelial cells
|
|
Vitamin B12 absorption: what role dies intrinsic factor play in absorption and where does it come from?
|
Intrinsic factor is secreted for the parietal cells of the stomach; it binds B12 after pancreatic enzymes have stripped off TC 1 &3
|
|
which factor of B12 absorption probably contributes to why 3-5% of the elderly population is B12 deficient?
|
gastric atrophy may occur in the elderly such that they cannot secrete intrinsic factor which must bind to B12 to be absorbed
|
|
what is the daily requirement of B12? Of folate?
|
B12 = 2 micrograms; folate = 0.2mg
|
|
_____________ anemia is when autoantibodies attack the pariental cells of the stomach so that intrinsic factor is not produced
|
pernicious anemia
|
|
what conditions is pernicious anemia associated with?
|
vitiligo (MJ); Graves disease (thyroid); Addisons disease (adrenal insufficiency); other autoimmune phenomena
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besides old age, vitiligo, Graves, and Addison's disease, what are other causes of B12 deficiency?
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dietary def in vegans, gastric resection, small bowel bacterial overgrowth that compete for the utilization of B12; ileal damage with Crohn's disease, sprue, and lymphoma
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how long does it take to deplete the body of B12 stores? Folate stores?
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B12 - 4 years, Folate - a few months
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what is the source of folic acid in our diet?
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green, leafy veggies (boiling removes); also enriched flour in US
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what 2 main things can cause a folic acid deficiency?
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alcoholism and hemolytic anemia
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who has inc'd requirements?
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preggers and infants
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what types of things are seen in the peripheral blood (or not seen)?
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leukopenia, macrocytic RBCs, anemia, thrombocytopenia, hypersegmented NPs, low reticulocyte count
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pallor, glossitis, and angular chelitis are signs of A) B12 def, B) folate def, C) both, D) neither
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C) both
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which vit def causes neurologic signs?
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B12 - caused by damage to posterior columns of the spinal cord - loss of vib & pos sense, gait disturbance, megaloblastic madness (indistinguishable from psychosis)
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T/F: with B12 def, neurological disturbances may occur prior to anemia
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TRUE
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with vit def's, folic acid **__does/does not__** correct the neurologic disease; does it correct the anemia?
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folic acid corrects the anemia, but DOES NOT correct the neuro disease - it makes it worse
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name some other causes of macrocytic anemia besides vit defs.
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EtOH, liver disease, excess bile salts --> cholesterol buildup in RBC mem; drugs that impair DNA syn (chemo, AIDs,etc); hypothyroidism, myelodysplastic syndrome, increased reticulocytes (younger are larger than RBCs)
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Do you give metabolites to confirm deficiency dx if: B12 is dec'd and folate is normal?
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no, dec'd B12 is consistent with B12 def, therefore no need to confirm dx
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Do you give metabolites to confirm deficiency dx if: B12 is low to normal and folate is normal?
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YES b/c B12 def is suspected and you must rule it out!
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Do you give metabolites to confirm deficiency dx if: B12 is normal and folate is dec'd?
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no, dec'd folate alone is consistent with folate deficiency
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Do you give metabolites to confirm deficiency dx if: B12 is dec'd and folate is dec'd?
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YES!! b/c can't really tell what's going on
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Do you give metabolites to confirm deficiency dx if: B12 is normal and folate is either almost too low or almost too high?
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YES b/c this is consistent with folate deficiency OR with an anemia unrelated to vitamin def
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if you give metobolties (methylmalonic acid and homocysteine) to a pt with suspected vit def, and their conc inc's, then what is confirmed?
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B12 = confirmed, folate def still possible
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if you give metobolties (methylmalonic acid and homocysteine) to a pt with suspected vit def, MMA is normal but HC inc's, then what is confirmed?
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FOLATE DEF
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if you give metobolties (methylmalonic acid and homocysteine) to a pt with suspected vit def, and both conc's are normal, then what is confirmed?
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B12 and folate are excluded!!
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Shillings test - review it!!
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review Shillings test!
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