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Hematology > 93 IDA > Flashcards

93 IDA Flashcards

1
Q

Most common type of anemia

A

Hypoproliferative anemia

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2
Q

Most common hypoproliferative anemia

A

Iron deficiency anemia

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3
Q

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

A

Suboptimal Erythropoietin

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4
Q

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

A

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

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5
Q

Half clearance time of iron in IDA

A

10-15 minutes

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6
Q

Has the highest affinity for transferrin

A

Diferric transferrin

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7
Q

Cell having the highest number of transferrin receptors

A

Erythroblast

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8
Q

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

A

Adult male: 1 mg/day

Adult female: 1.4 mg/day

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9
Q

Site of iron absorption

A

Duodenum and proximal small intestines

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10
Q

Transport of iron between membrane is accomplished by what protein

A

Divalent metal transporter type 1 (DMT 1)

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11
Q

Principal iron regulator hormone

A

Hepcidin

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12
Q

What are the stages of iron deficiency

A

Negative iron balance
Iron deficiency erythropoiesis
Iron deficiency anemia

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13
Q

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

A

Negative iron balance

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14
Q

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

A

GI blood loss

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15
Q

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

A

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

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16
Q

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

A

Serum iron represents iron bound to transferrin

Normal value: 50-150 mcg/dl

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17
Q

Indirect measure of transferrin. Normal value

A

TIBC

Normal: 300-360 mcg/dl

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18
Q

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

A

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

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19
Q

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?

A

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

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20
Q

Most common cause of protoporphyrin levels

A

Absolute or relative iron deficiency

Lead poisoning

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21
Q

Three differential for hypochromic microcytic anemia

A

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

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22
Q

Most prominent complication of oral iron therapy

A

GI distress

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23
Q

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

A

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

24
Q

How is iron tolerance test done

A

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.

25
Q

Iron content. Ferrous sulfate 325 mg. 195 mg

A

325 - - 65

196 - 39

26
Q

Iron content. Ferrous fumarate. 325 mg. 195 mg

A

325 - -107

195- - 64

27
Q

Iron content. Ferrous gluconate. 325 mg.

A

325 - - 39

28
Q

Iron content. Iron polysaccharide. 150 mg. 50 mg

A

150 - - 150

50 - - 50

29
Q

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

A

Most content: iron polysaccharide

Least content: ferrous gluconate

30
Q

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

A

200 mg elemental iron

31
Q

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

A 
Ferumoxytol: 510 mg
Ferric gluconate complex: 125
Ferric carnoxymaltose:750
LMW iron dextran : 1500
Irom sucrose: 200
32
Q

Two ways to administer IV iron

A
  1. Total dose +500 iron stores given in 1 infusion

2. Small repeated doses in protected time

33
Q

Usual approach of IV iron in dialysis patients

A

100 mg iron weekly for 10 weeks

34
Q

How is IV iron computed

A

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

35
Q

Concern regarding IV iron

A

Anaphylaxis

36
Q

Most distinguishing feature between IDA and AI

A

Serum ferritin increases 3x in the face of inflammation

37
Q

Directly increases EPO production

A

Interluekin 1

38
Q

What is the iron study profile to Anemia sec CKD

A

Normal serum iron, TIBC and ferritin levels

39
Q

Hormones that augment erythropoiesis

A

Testosterone and anabolic steroids

40
Q

When is blood transfusion needed?

A

Below 7 - 8 mg/dl

41
Q

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

A

50 - 150 U/Kg 3x per week

Target hemoglobin of 10-12 mg/dl is achieved by 4-6 weeks

42
Q

Dose of EPO in chemotherapy induced anemia

A

EPO 300 U/Kg 3x per week

43
Q

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

A

Darbepoeitin

44
Q

In CBC, how to differentiate IDA from thalassemia?

A

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

45
Q

Blood loss leading to iron deficiency

A

10-20 ml/ day

46
Q

Max elemental iron to be given per day

A

200 mg/day

47
Q

True or false. EPO is not part of IDA regimen

A

True.

48
Q

Which form of iron preparation is given?

A

Based on patients tolerance. At least 105 mg elemental iron

49
Q

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

A

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

50
Q

What’s the hemoglobin level for pallor to manifest?

A

Hgb less than 8 mg/dl

51
Q

What uncommon cause of IDA base on EGD finding?

A

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

52
Q

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

A

Phytates inferred with iron absorption.

Phytate is also found in tea and coffee

53
Q

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

A

Oral supplements are to be taken on empty stomach

Vitamin C can enhance iron absorption

54
Q

Iron requirement in 2nd and 3rd trimester of pregnancy

A

5-6 mg iron

55
Q

Causes of IDA due to increased demand for iron

A

Rapid growth in infancy and adolescence
Pregnancy
Erythropoietin therapy

56
Q

Causes of IDA due to increased iron loss

A 
Chronic blood loss
Menses
Acute blood loss
Blood donation
Phlebotomy as treatment for PV
57
Q

Causes of IDA due to decreased iron intake or absorption

A

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

Hematology (11 decks)

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