1 Anemia Part I

Question 1

What is the normal Hb to Hct ratio? What are anemic Hb levels in men and women?

Answer 1

1:3 (hb:Hct)
<14 Hb Men
<12 Hb Women

Question 2

Normal retic count?

Answer 2

0.5-2%

Question 3

Normal ranges of MVC?

MCH? MCHC?

Answer 3

78-100fL -MCV
27-34 pg - MCH
31-37 g/dL- MCHC

Question 4

What is RDW and it’s normal ranges?

Answer 4

(red cell distribution width) = measure of degree of variation in RBC size.
Normal RDW= 11-15%.

Question 5

Causes of microcytic hypochromic anemia?

Answer 5

Iron def, thalassemia, sideroblastic anemia.

Question 6

Causes of Normocytic normochronic anemia?

Answer 6

Hypothyroidism, liver disease, chronic disease

Question 7

Causes of macrocytic (megaloblastic) anemia?

Answer 7

Folate def, vitamin B12 def (d

Question 8

Causes of iron def anemia?

Answer 8

• Blood loss (most common)
• decreased dietary intake
• decreased iron absorption (celiac disease, bariatric surgery, H. pylori infection

Question 9

Labs of iron def anemia?

Answer 9

-Low Fe/ Ferritin (these 2 go hand in hand)
-High TIBC
-Increased RDW
-Low RBC/Hg/Hct
(note MCV can be normal early in IDA)

Question 10

Clinical signs of iron def anemia?

Answer 10

Atrophic glossitis, angular cheilitis, koilonychia.

-Pica, RLS

Question 11

What is the syndrome associated with dysphagia for iron def anemia?

Answer 11

Dysphagia (plummer-vinson syndrome difficulty swallowing 2/2 to anemia

Question 12

If a patient is Dx with iron def anemia? Do you given iron supplements and stop there?

Answer 12

NO! Always find underlying cause.. worried about occult malignancy!

Question 13

Tx for iron def anemia?

Answer 13

• oral Ferrous sulfate 325mg daily-TID, on empty stomach
• should increase Hg 2-4g/dL every 3 weeks
• continue 3-6 months after anemia has corrected to replenish stores.

Question 14

What is Thalassemia? Inherited or congenital?

Answer 14

Inherited hemoglobinopathy. Reduction in synthesis of globin chains (alpha or beta).

Question 15

How many alphas and beta’s does a normal Hg chain have?

Answer 15

Normal hemoglobin A= 4 alphas 2 betas (alpha2beta2)

Question 16

What does thalassemia lead to/ cause?

Answer 16

• *Can lead to ineffective erythropoiesis and hemolysis!
• Extrameduallary hematopoiesis
• iron overload, bone changes, impaired growth

Question 17

Explain the severity if 1 alpha chain is lost compared to all 4 chains?

Answer 17

No replacement for alpha, so 1 deletion is mild (silent carrier), 3 is moderate microcytic anemia, and 4/4 deletions, fetus will die

Question 18

If Blake were a member of the Spice Girls who would she be?

Answer 18

Scary Spice aka Mel B duh

Question 19

Explain the difference between beta thalassemia minor, intermedia, and major?

Answer 19

• If loss of 1–> minor, asymptomatic, mild microcytic anemia.
• Thalassemia intermedia–> chronic hemolytic anemia.
• Thalassemia major–>Dysfunction of both chains, severe hemolytic anemia, if untreated will die by 5.

Question 20

Labs of Thalassemia anemia?

Answer 20

• Normal to high Fe/Ferritin
• Any TIBC
• Normal to increased RBC
• MCV often low
• RDW normal

Question 21

What will you see on the Blood smear of thalassemia anemia?

Answer 21

Target cells

Question 22

Physiological condition of thalassemia anemia?

Answer 22

Splenomegaly

+ family hx! (is inherited)

Question 23

What supports the dx of thalassemia anemia?

Answer 23

Hemoglobin electrophoresis! Detects type of Hg present.

Question 24

Tx for thalassemia anemia?

Answer 24

• Folic acid supplementation if chronic hemolysis.
• Avoid iron supplementation!!
• If severe thalassemia= regular transfusion schedule.
• If severe beta thalassemia= hematopoietic cell transplantation.
• Genetic counseling.

Question 25

What is Sideroblastic anemia?

Answer 25

• Hereditary or acquired RBC disorder.

- Abnormal RBC iron metabolism–> diminished heme(iron) synthesis –>iron accumulates in the cells

Question 26

What conditions is sideroblastic anemia typically seen with?

Answer 26

Myelodysplastic syndrome (MDS), or chronic alcoholism, meds, copper def.

Question 27

Labs for sideroblastic anemia?

Answer 27

• Normal to high Fe/Ferritin
• Any TIBC
• MCV low, normal, or slightly increased
• elevated RDW
• Normal to low restock count

Question 28

What will you see on peripheral and bone marrow smear of sideroblastic anemia?

Answer 28

• Siderocytes w/ pappenheimer bodies on peripheral smear

- Ring Sideroblasts on bone marrow

Question 29

Tx of sideroblastic anemia?

Answer 29

• Patient education/ ref to hematology.
• Treat underlying cause. D/c offending drugs. Remove toxic agents
• Pyridoxine (Vit B6)
• Transfusion/management of iron overload.

Question 30

What are some examples of chronic diseases associated w/ anemia of chronic disease?

Answer 30

Inflammatory diseases, Rheum disorders, Malignancy, chronic infection, organ failure.

Question 31

What happens in anemia of chronic disease? (pathogenesis)

Answer 31

Reduction in RBC production by BM, w/ component due to mild shortening of RBC survival

Question 32

3 things that contribute to the pathogenesis of anemia of chronic disease?

Answer 32

1. Hepcidin-induced alteration in iron metabolism
2. Inability to increase erythropoiesis
3. Decrease in erythropoietin production

Question 33

What is Hepcidin?

Answer 33

Key regulator of entry of iron into circulation. Traps iron in macrophages and decreased gut iron absorption.

Question 34

Labs for anemia of chronic disease?

Answer 34

• Low Fe and TIBC
• Normal- increased serum ferritin
• Retic count decreased-normal
• Mild anemia

Question 35

Treatment for anemia of chronic disease?

Answer 35

Treat underlying disease. Erythropoietin may be beneficial.