10: Anemia

Question 1

Three H and three nutrients essential to avoid anemia

Answer 1

1. EPO, thyroid H, testosterone

2. Fe, B12, Folate

Question 2

Anemia sx**

Answer 2

Fatigue, weakness, dyspnea, pre-syncope, pale conjunctiva, pale skin

Question 3

Reticulocyte index >2 means what?

Answer 3

Adequate BM response to anemia

Question 4

Microcytic, normocytic, and macrocytic values of MCV

Answer 4

Micro: <80
Normo: 80-100
Macro: >100

Question 5

The earliest and most sensitive index that will change in IDA

Answer 5

RDW

Question 6

IDA in males/post-menopausal females should prompt an evaluation for what?

Answer 6

GI bleed (esp w weight loss)

Question 7

3 ways to tx anemia of chronic disease

Answer 7

1. Tx underlying disease, dont just give Fe without knowing the cause
2. ESA: erythrocytes stimulating factors
3. Blood transfusion (for severe anemia, Hb <7

Question 8

Four ways to tx hemorrhagic shock

Answer 8

1. Apply pressure/compression as possible
2. Obtain large IV access
3. Rapid infusion of 1L NS
4. Blood transfusion

Question 9

A single unit oF RBCs should increase Hb how much?**

Answer 9

1g/dL

Question 10

Two times to screen gravid woman for Rh Abs

Answer 10

1st prenatal visit + 28 weeks

Question 11

Two ways to confirm sickle cell dx

Answer 11

1. Peripheral smear

2. Hb electrophoresis

Question 12

Sx and CXR in ACS (acute chest syndrome)

Answer 12

1. Sx: CP, dyspnea, cough, hypoxemia, fever

2. CXR: pulmonary infiltrates

Question 13

Common cause of death in adults with sickle cell

Answer 13

Acute chest syndrome

Question 14

Cons of autosplenectomy in sickle cell pts

Answer 14

Increased infection with encapsulated organisms - need to be immunized

Question 15

Fiveways to tx sickle cell

Answer 15

1. O2 and breathing exercise with incentive spirometer
2. Control pain w NSAIDs, Tylenol, opiates
3. Hydroxyurea: increases HbF, so less HbS
4. Exchange transfusions
5. Stem cell transplant - can be curative but 10% mortality rate

Question 16

Two ways to treat aplastic anemia

Answer 16

1. Transfusions

2. Growth factors

Question 17

Platelet counts for if you can give transfusion or not - three levels

Answer 17

1. 50: if having a procedure
2. 20: if have a fever
3. 10: in all cases

Question 18

Sources of B12 vs folate

Answer 18

B12: meat, eggs, dairy, seafood, fortified foods
Folate: green leafy veggies, fruit, fortified foods

Question 19

Dx of B12 vs folate deficiency**

Answer 19

B12: low B12, increased methylmalonic acid + homocysteine
Folate: low folate, increased homocysteine (nl MMA)

Question 20

3 ways to tx vitamin B12 or folate deficiency

Answer 20

1. Prevention is key
2. Supplements
3. Treat underlying dz