Anemia

Question 1

Hemoglobin concentration in adult male (anemia)

Answer 1

Less than 13.6 g/dL

Question 2

Hemoglobin concentration in adult female (anemia)

Answer 2

Less than 12.0 g/dL

Question 3

Most common etiology of anemia in young children and pregnant women

Answer 3

Iron deficiency anemia (IDA)

Question 4

Anemia is more common in individuals older than ___ years

Answer 4

65

Question 5

Most common type of anemia in elderly

Answer 5

Anemia of chronic disease (ACD)

Followed by nutritional deficiencies (iron, B12, folate) and decreased marrow response to erythropoietin

Question 6

Sickle cell anemia most common in which ethnicity

Answer 6

African ancestry

Question 7

Thalassemia most common in which ethnicity

Answer 7

People from the geographic regions of the Mediterranean, the Middle East, Southeast Asia, and parts of India and Pakistan

Question 8

Hemoglobin’s major function

Answer 8

Transport O2 to tissues

(Anemia is a condition that results in too little O2 being transported to the tissues)

Question 9

Anemia is defined as a reduction in the number of _________, __________ concentration, or ____________.

Answer 9

Red blood cells
Hemoglobin
Hematocrit

Question 10

Three major etiologies of anemia

Answer 10

1. RBC production disorder
2. RBC destruction disorder
3. Blood loss (acute or chronic)

Question 11

The production of erythrocytes (RBCs)

Answer 11

Erythropoiesis

Limited to axial skeleton and proximal ends of the long bones in the adult. Any condition that interferes with bone marrow function can cause anemia.

Question 12

Most important factor in the body’s ability to increase RBC production is ______

Answer 12

Iron

Without adequate iron stores, the marrow cannot increase erythropoiesis.

Question 13

Chronic kidney disease can result in the ____ production and ____ of erythropoietin.

Answer 13

Under (production)
secretion (of)

Suppressing an essential signal trippering RBC production

Question 14

RBC destruction disorders

Mechanisms involved in the increased hemolysis or destruction of RBCs resulting in anemia

Answer 14

Sickle cell trait
Hereditary spherocytosis
Hereditary elliptocytosis

Question 15

RBC destruction disorders

RBC enzyme defects

Answer 15

G6PD deficiency

Question 16

RBC destruction disorders

Autoimmune antibody production

Answer 16

Autoimmune hemolytic anemia

Question 17

Blood loss from trauma or hemorrhage which may result in life-threatening anemia with significan syptoms of hemodynamic cardiovascular compromise

Sudden and profound drop in hemoglobin level

Answer 17

Acute blood loss

Question 18

Occurs slowly, over time, and from as little as a few teaspoons of blood loss per day, especially from the GI tract

Also mild to moderate menorrhagia, chronic microscopic hematuria, or chr

Body compensates for this type of slowly evolving anemia

Answer 18

Chronic blood loss

Question 19

Healthy patient with gradual anemia onset - when do signs or symptoms generally appear

Answer 19

When hemoglobin falls below 7.5 g/dL

Initial symptoms: fatigue, malaise, HA, dyspnea, irritability, mild decrease in exercise tolerance

Question 20

Nonspecific findings that accompany long-term, moderate to severe anemia

Answer 20

Wide pulse pressure, midsystolic or pansystolic murmur, confusion, lethargy, brittle nails, glossitis, angular chelitis, and spoon shaped nails.

Question 21

Common signs of anemia

Answer 21

Pallor of mucous membranes, lips, conjunctivae, nail beds, and palmar creases

Question 22

When palmar creases are as pale as the surrounding skin, the patient usually has a hemoglobin value of:

Answer 22

<7 g/dL

Question 23

What diagnostic should be obtained initially when evaluating for anemia

Answer 23

CBC with differential

Question 24

RBC index that quantifies RBC cell size

Answer 24

Mean corpuscular volume (MCV)

Question 25

RBC indices that quantify RBC hemoglobin concentration

Answer 25

Mean corpuscular hemoglobin (MCH) Mean corpuscular hemoglobin concentration (MCHC)

Question 26

RBC index that quantifies variation of cell size across the specimen

Answer 26

RBC distribution width (RDW)

Question 27

RBC index that reflects the average RBC size ## Footnote Referred to as microcytic, normocytic, or macrocytic

Answer 27

MCV ## Footnote Most useful of the RBC indices

Question 28

Immature RBCs ## Footnote Have nucleus when they enter circulation (larger in size than mature RBC)

Answer 28

Reticulocyte ## Footnote Extrude their nucleus within a few days and decrease in size (assume the classic concave disc shape of the mature RBC)

Question 29

Most easily accessible method of evaluating bone marrow production of RBCs ## Footnote Marrow biopsy requires an invasive procedure

Answer 29

Reticulocyte count ## Footnote Provides an assessment of whether the causative factor of anemia is related to either decreased production or increased loss

Question 30

# Reticulocyte count Normal absolute reticulocyte count (ARC) ____ Above ____ is considered a marrow that is responding normally to anemic conditions. ## Footnote Low ARC is considered consistent with impaired RBC production.

Answer 30

25,000-75,000/ul (normal) >100,000/ul

Question 31

What lab testing should be obtained if concerned for hemolysis as a source of anemia?

Answer 31

Serum bilirubin levels (marker of hemoglobin cataboslism) Serum lactate dehydrogenase (LDH) (indicative of direct cellular injury) Serum haptoglobin (low with intravascular hemolysis) ## Footnote Hemolytic anemias are complex to evaluate and diagnose - if suspected, immediate hematology referral is indicated

Question 32

Variations in RBC size and shape as well as abnormal cell populations too small to change the indices can be directly visualized with which diagnostic?

Answer 32

Peripheral blood smear ## Footnote Sickle cell shape or sperocytes Evidence of hemolysis

Question 33

Significant variations in size of cells in a specimen is described as ____ on a peripheral blood smear.

Answer 33

Anisocytosis

Question 34

Significant variations in cell shapes in a specimen is described as ____ on a peripheral blood smear.

Answer 34

Poikilocytosis

Question 35

What is the first lab value to become abnormal when iron stores are becoming depleted?

Answer 35

Serum ferritin ## Footnote Even before IDA is reflected in RBC morphology <12ng/mL indicates absence of iron stores

Question 36

____ is an acute phase reactant and may be elevated due to inflammation

Answer 36

Serum ferritin ## Footnote Inflammation causes the release of tissue ferritins resulting from damage to the liver and other ferritin-rich tissues. ESR and/or CRP can establish the presence of general inflammation.

Question 37

Condition with low serum ferritin

Answer 37

IDA

Question 38

Condition with normal to elevated serum ferritin

Answer 38

ACD | Anemia of chonic disease

Question 39

Conditions with elevated serum ferritin | Aside from ACD

Answer 39

Iron overload (transfusion dependent or hereditary hemochromatosis) Inflammatory disorders Alcoholism

Question 40

Normal values for serum iron concentration

Answer 40

65-165 mcg/dL

Question 41

Indicates the availability of binding sites on the protein for iron transport. | Normal values are ____

Answer 41

Total iron-binding capacity (TIBC) | 300-360mcg/dL

Question 42

What are the priority differentials for anemia?

Answer 42

Blood loss (acute hemorrhage, hemolysis; chronic - GI/GYN causes) Bone marrow failure or disease Malignancy Renal failure

Question 43

MCV <80 fL | Classification of anemia

Answer 43

Microcytic ## Footnote IDA most common but may be associated with ACD, thalassemia, and sideroblastic anemia

Question 44

Most common type of anemia in the world and most common nutrient deficiency

Answer 44

IDA ## Footnote Predominantly affects women of reproductive age and older adults

Question 45

Most common cause of IDA?

Answer 45

Chronic blood loss | GI blood loss or menorrhagia ## Footnote Chronic GI blood loss should be suspected as a cause of IDA in adult men and postmenopausal womeny.

Question 46

Most common cause of IDA in children and pregnant women?

Answer 46

Inadequate nutrition and increased iron requirements | Anemia prevalence in pregnant women = 38%; >50% is a result of iron def ## Footnote Preterm infants are at greater risk for IDA during infancy as fetal iron stores are established in the last trimester of pregnancy.

Question 47

Normal adult male has a total body iron content of ____ Woman of childbearing age has a total body iron content of ____

Answer 47

4000mg (male) 2000mg (woman of childbearing age) ## Footnote Average adult loses ~1mg iron each day through natural losses (adult woman loses an additional 1mg through normal menstruation)

Question 48

As body iron stores are depleted, the transerrin saturation decreases, leading to a reduced supply of iron to the RBC precursors, resulting in ____?

Answer 48

Impaired (iron-deficient) erythropoiesis ## Footnote Once iron stores are truly depleted and no iron is available for erythropoiesis, an overt microcytic, hypochromic anemia is present.

Question 49

In IDA, MCV, MCH, and MCHC are the last to change; however the ____ may be elevated well before the MCV decreases as it reflects the newer, smaller RBCs entering the circulation.

Answer 49

RDW

Question 50

Early IDA | Lab values in microcytic anemias ## Footnote Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

Answer 50

Hemoglobin: Normal MCV: Normal MCHC: Normal RDW: Increased Serum Iron: Normal Serum Ferritin: Normal TIBC: Normal Transferrin saturation: Normal

Question 51

Intermmediate IDA | Lab values in microcytic anemias ## Footnote Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

Answer 51

Hemoglobin: Normal MCV: Normal MCHC: Normal RDW: Increased Serum Iron: Decreased/Normal Serum Ferritin: Decreased TIBC: High normal Transferrin saturation: Decreased

Question 52

Late IDA | Lab values in microcytic anemias ## Footnote Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

Answer 52

Hemoglobin: Decreased MCV: Decreased MCHC: Decreased RDW: Increased Serum Iron: Decreased Serum Ferritin: Decreased TIBC: Increased Transferrin saturation: Decreased

Question 53

Thalassemia minor | Lab values in microcytic anemias ## Footnote Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

Answer 53

Hemoglobin: Low normal/Decreased MCV: Decreased MCHC: Normal/Decreased RDW: Normal Serum Iron: Normal Serum Ferritin: Normal TIBC: Normal Transferrin saturation: Normal

Question 54

Chonic Disease | Lab values in microcytic anemias ## Footnote Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

Answer 54

Hemoglobin: Low normal MCV: Normal/Decreased MCHC: Normal/Decreased RDW: Normal Serum Iron: Decreased Serum Ferritin: Increased TIBC: Decreased Transferrin saturation: Increased

Question 55

Sideroblastic anemia | Lab values in microcytic anemias ## Footnote Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

Answer 55

Hemoglobin: Decreased MCV: Decreased MCHC: Decreased RDW: Variable Serum Iron: Increased Serum Ferritin: Increased TIBC: Normal Transferrin saturation: Increased

Question 56

Clinical presentation of IDA: Mild to moderate Severe

Answer 56

Mild to moderate: no clinical symptoms Severe: fatigue, decreased exercise tolerance, weakness, palpitations, irritability, and HA. Systolic flow murmur, forceful apical pulse, tachycardia with exertion. May also see paresthesias, sore tongue, brittle nails, spoon-shaped nails, and pika for starch, clay, ice. Older adult may present with signs of CHF.