#95 Anemia In Pregnancy

Question 1

Does the numerical cut off for anemia vary by trimester?

Answer 1

Yes

Question 2

What are the H&H cut offs for anemia in pregnancy?

Answer 2

First trimester: 11/33
Second: 10.5/32
Third: 11/33

Question 3

By what percentage does the blood volume expand? How about total red cell mass?

Answer 3

50%. 25%

Question 4

How can you define iron deficiency anemia? (3 ways)

Answer 4

Abnormal values on biochemical tests.
Increase in hemoglobin by at least 1g/dL after iron treatment.
Absent bone marrow iron stores on bone marrow iron smear

Question 5

What lab results are characteristic of iron deficiency anemia?

Answer 5

microcytic, hypochromic anemia, low plasma iron levels, high total iron-binding capacity, low serum ferritin levels, and increased levels of free erythrocyte protoporphyrin.

Question 6

What lab measurement had the highest specificity for diagnosing iron deficiency anemia in anemic patients?

Answer 6

Ferritin level (level <10-15 micrograms/L)

Question 7

What is the recommended daily dietary allowance of ferrous iron?

Answer 7

27mg

Question 8

What are causes of megaloblastic anemia?

Answer 8

Vitamin B12 deficiency, folate deficiency, pernicious anemia

Question 9

Causes of nonmegaloblastic macrocytic anemia?

Answer 9

Alcoholism, liver disease, myelodysplasia, aplastic anemia, hypothyroid, increased reticulocyte count

Question 10

What is the daily folic acid requirement in pregnancy?

Answer 10

400mcg. (50mcg when not pregnant)

Question 11

How much B12 do women with a complete gastrectomy require?

Answer 11

1000mcg B12 IM q month

Question 12

MCV > what is nearly always associated with B12 deficiency?

Answer 12

115

Question 13

What is the most likely cause of anemia with an MCV of 117?

Answer 13

B12 deficiency

Question 14

What vitamin deficiency is associated with Crohn’s disease?

Answer 14

Vitamin B12

Question 15

Are African Americans more likely to have higher or lower H&H than their Caucasian counterparts? By how much?

Answer 15

Less by 0.8g/dL and 2%

Question 16

Which patients are candidates for IV iron therapy?

Answer 16

Severe IDA, unable to tolerate/adhere to oral regimen, malabsorptive syndrome

Question 17

Does iron dextran or iron sucrose IV have lower rates of allergic reaction?

Answer 17

Iron sucrose

Question 18

Is IV iron better at improving hemoglobin values compared to oral supplementation short term? Long term?

Answer 18

Better short term (studied days 5 and 14)

Same values on day 40