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What is the underlying cause of the clinical manifestations of anemia?
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What is used as the primary measurement of the severity of anemia?
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Hemoglobin levels (Hgb) Mild-10-14 Moderate-6-10 Severe-less than 6
What are the three main causes of anemias caused by decreased erythrocyte production?
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-Less hemoglobin is made (iron-deficiency, thalassemia, sideroblastic anemias) -defective DNA synthesis in RBCs (usually nutritional deficiency of B12 or folic acid). Megaloblastic anemias -low numbers of erythrocyte precursors (aplastic anemia, chroni
What is the most common, chronic hematologic disorders in the world?
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Iron-deficiency anemia
Who is most susceptible to iron-deficiency anemia? (3)
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-the very young -those with poor diets -women in their reproductive years
What hematologic disorder can develop from disease or removal of the duodenum?
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Anemia, namely iron-deficiency anemia...this is where dietary iron is absorbed
What is the major cause of iron deficiency anemia in adults?
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GI (ulcers, diverticuli, gastritis, etc.) or GU bleeds (menstruation)
What are the symptoms associated with iron-deficiency anemia?
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Pallor, glossitis, cheilitis (lips inflammation), headache, parathesias, burning tongue
Which type of iron supplements are best for the treatment of iron-deficiency anemia, enteric coated/sustained release or uncoated?
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Uncoated, if it's delayed release it is digested in the wrong place for optimal absorption
What can enhance absorption of an iron supplement?
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Taking one hour before meals, with orange juice
Which type of iron is best absorbed, ferrous sulfate or ferrous gluconate?
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Ferrous sulfate
For a patient who is on iron supplements, what else should they be instructed to take?
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Stool softeners or laxatives
What are the special considerations and instructions for the administration of parenteral iron?
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It can be given IM or IV. Separate needles are used for withdrawing it and injecting it, and 0.5 mL of air should remain in the syringe to clear the iron completely out. No more than 2 mL per injection, use Z track, no massage afterwards. Inject into upper outer quadrant of the buttocks. IV: don't mix or dilute, admin at 1ml/min, saline flush line
How long after hemoglobin levels return to normal should a patient with iron-deficiency anemia continue to take iron?
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2-3 months
When should a patient be administered parenteral iron?
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If they have a malabsorption syndrome, intolerance of oral iron, need beyond oral limits or are non-compliant in oral therapy
_________ is a group of disease that have an autosomal recessive genetic basis involving inadequate production of normal hemoglobin and hemolysis.
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What ethnicities or areas of origin are prone to developing Thalassemia?
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Middle Eastern, Asia, Africa
What is the difference between thalassemia minor and thalassemia major?
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Minor-heterozygous expression, milder form. Major: Homozygous genes, severe
What is the clinical maifestation of Thalassemia major?
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Physical and mental retardation, pallor, hepatomegaly, splenomegaly, jaundice, thickened cranial and maxillary cavities.
What is the clinical manifestation of Thalassemia minor?
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Mild to moderate anemia with microcytosis (small cells) and hypochromia (pale cells)
How is Thalassemia major treated?
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Symptoms are managed with transfusions and IV infusions of a chelating agent that binds to iron (deferoxamine/Desferal), possibly a splenectomy.
____________ are a group of disorders caused by impaired DNA synthesis and is characterized by the presence of large RBCs.
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Megaloblastic anemias
What are the two most common forms of megaloblastic anemia?
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Vitamin B12 (Cobalamin) deficiency and folic acid deficiency.
What is erythroleukemia?
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A malignant blood disorder characterized by a proliferation of erythropoietic cells in bone marrow. It causes megaloblastic anemia.
What is intrinsic factor (IF) and where is it secreted?
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It is a substance needed for the absorption of vitamin B12 (Cobalamin). It is secreted in the gastric mucosa by the parietal cells (distal ileum = duodenum and jejunum)
What is the most common cause of cobalamin deficiency?
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Pernicious anemia
When does pernicious anemia typically develop?
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Between the ages of 40-60, it is usually diagnosed at age 60.
What ethinicities are most likely to develop pernicious anemia?
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People of Scandinavian descent or Africa Americans. The condition is more severe in African Americans, begins earlier, and most often in women.
What types of medications can cause a B12/cobalamin deficiency?
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Long term use of H2-histamine receptor blockers.
What are the symptoms of a B12/cobalamin deficiency?
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Sore tongue, anorexia, n/v, abdominal pain, weakness, paresthesias, reduced vibratory and position senses, ataxia, impaired thought processes ranging from confusion to dementia.

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