Anemia

Question 1

Tests to order for suspected anemia

Answer 1

Hemoglobin
MCV
Serum Ferritin 
Peripheral blood smear 
Retic count 
Direct and total bilirubin 
LDH 
ALT
ESR
CRB
HGB electrophoresis 
B12
Folate
SPEP
Serum Iron (if under 18 according to TOP)
Total iron binding (if under 18 according to TOP) 
Transferrin saturation (if under 18 according to TOP) 
Colonoscopy 
Beta HCG

Question 2

So you found a Microcytic anemia. But your go to of the ferritin is over 100! Can’t call that iron deficiency! What do you order next to check for three other possibilities

Answer 2

HGB electrophoresis (Thalasemia)
ESR, CRP (Inflamatory disease)
Smear (sideroblastic

Question 3

You find microcytic anemia with a ferritin og 50. What do you do

Answer 3

Trial of iron. If ineffective look for other causes of microcytic

Question 4

Improtant history for Thalassemai

Answer 4

Are you Pregnant or trying to get pregnant
Does your partner have thalassemia
Where are you from

Question 5

Which regions of the world carry a high risk of thalassemia?

Answer 5

Africa 
Middle East 
South America 
South East Asia 
Caribbean 
Mediterranean 
(All coffee producing areas)

Question 6

Risks for Low B12

Answer 6

Gastric surgery (Because lack of gastric parietal cells so you don’t have intrisic factor)
Vegan diet
Breastfeeding from a mon on a vegan diet
Elderly
Psychiatric

Question 7

What to order if you suspect pernicious anaemia

Answer 7

B12 and if low confirm with anti-intrinsic factor antibody (Not schillings test)

Question 8

Red flags for anaemia

Answer 8

Tachycardia
LOC
Hypotensive
Hypothermia

Question 9

Important history of Anaemia

Answer 9

B symptoms 
Bleeding 
Diet 
Medications (NSAIDS, ASA, anticoags) 
Alcohol intake

Question 10

Treatment for Anaemia

Answer 10

ABCS
Depends on cause
If HB <70 AND symptomatic, can transfuse
1 unit at a time (10 g/L)
Consider iron infusions even for general blood loss

Question 11

Treatment for iron deficiency

Answer 11

Replace even if Hb normal
All orals have the same evidence
Some say ferrous furmurate is best (has highest iron content)
Take every second day
Don’t give polysaccharide
IV iron dextran if oral ineffective (Well tolerated 0.01% hypersensitivity)

Question 12

What iron and how to take

Answer 12

Take Ferrous Furmurate 
Every second day 
Ferrous Sulfate for children 
Don't need to take with Vt C (disproven) but don't take it with tea 
ALWAYS FIND CUASE

Question 13

Causes of normocytic anemia

Answer 13

Bone marrow (MM)—CKD, Hypercalcemia, bone pain
(MGUS) (Myelodysblastic)
Hemolysis
Hemorrhage

Question 14

What to do if the ferritin is high

Answer 14

Get a transferrin saturation and refer if >45% twice

Question 15

When to worry about MM

Answer 15

CKD
Bone pain
Hypercalcemia

Question 16

What to do for MGUS

Answer 16

Follow anually with CBC, Creat, SPEP and SFLC

Refer if Crab symptoms or abnormal labs

Question 17

Things that cuase hemolysis

Answer 17

Thalassemia
Sickle Cell
Shunts 
MAHA 
Infection

Question 18

Tests for hemolysis

Answer 18

LDH
Billi
Haptoglobin

Question 19

When could you see physiologic anemia

Answer 19

6-9 weeks old due to decreased EPO

Question 20

Common cause at 0-3 months

Answer 20

Hemolysis, infection, Congenital hemolytis anemia (G6Pd deficiency

Question 21

Common causes at 3-6 months

Answer 21

Sickle cell

Thalassemia

Question 22

Common causes at 9-12 months

Answer 22

Poor diet

Question 23

Risk for anemia at 1 year old

Answer 23

Poverty\
poor weight gain
Obesity, 
Malabsorption, 
Excessive milk intake

Question 24

If someone has anemia and they are on a blood thinner, name two situations where you would stop the anticoagulant and two where you would not

Answer 24

1. Don’t stop if mechanical valve
2. VTE less than three months ago
3. AF with mitral stenosis
4. AF CHADS 1-4
5. VTE more than 3 months ago