93 IDA

Question 1

Most common type of anemia

Answer 1

Hypoproliferative anemia

Question 2

Most common hypoproliferative anemia

Answer 2

Iron deficiency anemia

Question 3

Character of anemias related to renal disease, inflammation, cancer and hypometabolic states

Answer 3

Suboptimal Erythropoietin

Question 4

Iron transport protein. It’s two forms. It’s half clearance time

Answer 4

Transferrin
Two forms: monoferric, diferric
Clearance time: 60-90 mins

Question 5

Half clearance time of iron in IDA

Answer 5

10-15 minutes

Question 6

Has the highest affinity for transferrin

Answer 6

Diferric transferrin

Question 7

Cell having the highest number of transferrin receptors

Answer 7

Erythroblast

Question 8

Iron needs of an adult male. Iron needs of a female in childbearing years.

Answer 8

Adult male: 1 mg/day

Adult female: 1.4 mg/day

Question 9

Site of iron absorption

Answer 9

Duodenum and proximal small intestines

Question 10

Transport of iron between membrane is accomplished by what protein

Answer 10

Divalent metal transporter type 1 (DMT 1)

Question 11

Principal iron regulator hormone

Answer 11

Hepcidin

Question 12

What are the stages of iron deficiency

Answer 12

Negative iron balance
Iron deficiency erythropoiesis
Iron deficiency anemia

Question 13

First stage of IDA in which demands for iron exceed body’s ability to absorb iron from diet

Answer 13

Negative iron balance

Question 14

Cardinal rule is that appearance iron deficiency in adult make or post menopausal Female is what until proven otherwise

Answer 14

GI blood loss

Question 15

Signs of advanced anemia. Fissures at corner of mouth. Spooning of fingers

Answer 15

Cheilosis: fissures at corner of mouth
Koilonychia: spooning of fingernails

Question 16

Represent the iron bound to transferrin. What is its normal value?

Answer 16

Serum iron represents iron bound to transferrin

Normal value: 50-150 mcg/dl

Question 17

Indirect measure of transferrin. Normal value

Answer 17

TIBC

Normal: 300-360 mcg/dl

Question 18

How is transferrin saturation computed? What is the normal value? What is the value in iron deficiency states?

Answer 18

Transferrin saturation: serum iron x 100 divided by TIBC
Normal: 20-50
Iron deficiency: less than 20

Question 19

Intermediate in the pathway of heme synthesis and that when heme synthesis is impaired, it accumulates in the blood. That is it normal value and value in iron deficiency states?

Answer 19

Protoporphyrin
Normal: less than 30 mcg/dl
Iron deficiency: more than 100 mcg/dl

Question 20

Most common cause of protoporphyrin levels

Answer 20

Absolute or relative iron deficiency

Lead poisoning

Question 21

Three differential for hypochromic microcytic anemia

Answer 21

Thalassemia: RDW normal compared to IDA
Anemia of inflammation: ferritin is normal or increased, ferritin saturation and TIBC are low
Myelodysplastic syndrome: normal stores despite anemia

Question 22

Most prominent complication of oral iron therapy

Answer 22

GI distress

Question 23

Upon initiation of iron therapy, Reticulocyte count should begin to increase within and peaks when?

Answer 23

Reticulocyte count begins to increase in 4-7 days and peaks at 1 to 1 and half week

Question 24

How is iron tolerance test done

Answer 24

Two iron tablets are give to patient and serum iron is measured 2-3 hours later. Serum iron increases of at least 100 mcg/dl then normal absorption occurred.

Question 25

Iron content. Ferrous sulfate 325 mg. 195 mg

Answer 25

325 - - 65 | 196 - 39

Question 26

Iron content. Ferrous fumarate. 325 mg. 195 mg

Answer 26

325 - -107 | 195- - 64

Question 27

Iron content. Ferrous gluconate. 325 mg.

Answer 27

325 - - 39

Question 28

Iron content. Iron polysaccharide. 150 mg. 50 mg

Answer 28

150 - - 150 | 50 - - 50

Question 29

Which oral iron preparation has the most iron content? Which has the least iron content?

Answer 29

Most content: iron polysaccharide | Least content: ferrous gluconate

Question 30

How much elemental iron are given per day for iron replacement therapy?

Answer 30

200 mg elemental iron

Question 31

Iron content. Ferumoxytol? Ferruc gluconate? Ferric carnoxymaltose? LMW iron? Iron sucrose

Answer 31

``` Ferumoxytol: 510 mg Ferric gluconate complex: 125 Ferric carnoxymaltose:750 LMW iron dextran : 1500 Irom sucrose: 200 ```

Question 32

Two ways to administer IV iron

Answer 32

1. Total dose +500 iron stores given in 1 infusion | 2. Small repeated doses in protected time

Question 33

Usual approach of IV iron in dialysis patients

Answer 33

100 mg iron weekly for 10 weeks

Question 34

How is IV iron computed

Answer 34

Weight x 2.3 x (15- Hgb) +500 or 1000 for stores

Question 35

Concern regarding IV iron

Answer 35

Anaphylaxis

Question 36

Most distinguishing feature between IDA and AI

Answer 36

Serum ferritin increases 3x in the face of inflammation

Question 37

Directly increases EPO production

Answer 37

Interluekin 1

Question 38

What is the iron study profile to Anemia sec CKD

Answer 38

Normal serum iron, TIBC and ferritin levels

Question 39

Hormones that augment erythropoiesis

Answer 39

Testosterone and anabolic steroids

Question 40

When is blood transfusion needed?

Answer 40

Below 7 - 8 mg/dl

Question 41

Usual dose of EPO in CKD patient. When is effect usually seen?

Answer 41

50 - 150 U/Kg 3x per week | Target hemoglobin of 10-12 mg/dl is achieved by 4-6 weeks

Question 42

Dose of EPO in chemotherapy induced anemia

Answer 42

EPO 300 U/Kg 3x per week

Question 43

Long acting preparation of EPO with additional carbohydrate and half life is M 3x - 4x longer then recombinant human EPO

Answer 43

Darbepoeitin

Question 44

In CBC, how to differentiate IDA from thalassemia?

Answer 44

In thalassemia, RBC is normal or high as hemoglobin is normal

Question 45

Blood loss leading to iron deficiency

Answer 45

10-20 ml/ day

Question 46

Max elemental iron to be given per day

Answer 46

200 mg/day

Question 47

True or false. EPO is not part of IDA regimen

Answer 47

True.

Question 48

Which form of iron preparation is given?

Answer 48

Based on patients tolerance. At least 105 mg elemental iron

Question 49

When is blood transfusion warranted in IDA? In cardiac patient with anemia what's the target Hgb?

Answer 49

General population: Hgb less than 7 mg/dl Stable cardiac patient: Hgb 8 mg/dl Unstable cardiac patient: Hgb 10 mg/dl

Question 50

What's the hemoglobin level for pallor to manifest?

Answer 50

Hgb less than 8 mg/dl

Question 51

What uncommon cause of IDA base on EGD finding?

Answer 51

Hiatal hernia, the rubbing of the herniated stomach causes intermittent blood loss leading to IDA

Question 52

Cause of IDA in vegetarians? Where is this substance found also?

Answer 52

Phytates inferred with iron absorption. | Phytate is also found in tea and coffee

Question 53

When is iron supplement given? What can enhance iron absorption?

Answer 53

Oral supplements are to be taken on empty stomach | Vitamin C can enhance iron absorption

Question 54

Iron requirement in 2nd and 3rd trimester of pregnancy

Answer 54

5-6 mg iron

Question 55

Causes of IDA due to increased demand for iron

Answer 55

Rapid growth in infancy and adolescence Pregnancy Erythropoietin therapy

Question 56

Causes of IDA due to increased iron loss

Answer 56

``` Chronic blood loss Menses Acute blood loss Blood donation Phlebotomy as treatment for PV ```

Question 57

Causes of IDA due to decreased iron intake or absorption

Answer 57

Inadequate diet Malabsorption from disease Malabsorption from surgery Acute or chronic inflammation