anemia

Question 1

what is anemia

Answer 1

group of diseases characterized by a decrease in hemoglobin or RBCs
-females: hemoglobin <11.9 or hematocrit <35%
-males: hemoglobin<12.6 or hematocrit <40%

associated with increased risk of hospitalization and mortality, reduced quality of life and decreased physical functioning in elderly

Question 2

blood function

Answer 2

transport
-oxygen, hormones, waste, nutrients, ions/electrolytes
protection
-white blood cells, antibodies, platelets
regulation
-pH, temperature, water balance

Question 3

symptoms

Answer 3

fatigue, lightheadedness, weakness, exercise intolerance, headache, angina/palpitations/tachycardia, pale mucous membranes, ischemia

Question 4

RBC count

Answer 4

indirect estimate of hemoglobin content of the blood

Question 5

hemoglobin

Answer 5

provides an estimate of oxygen carrying capacity of RBC
can decrease because:
-low number of RBCs
-low amount of Hgb per RBC

Question 6

hematocrit

Answer 6

percentage of RBCs to total volume of blood
low Hct indicates:
-reduction in either the number or size of RBC
-increase in plasma volume

Question 7

mean cell volume

Answer 7

represents average volume of RBC
normal MCV: 80-100fL

Question 8

total reticulocyte cound

Answer 8

indirect assessment of new RBC production (immature RBCs)
low retic count in anemia: indicates impaired RBC production (b12 def, anemia of inflammation, anemia of renal disease)
high retic count: acute blood loss or hemolysis
corrected reticulocyte count: calculated based on normal Hct

Question 9

macrocytic anemia

Answer 9

caused by vitamin B12 or folate deficiency or both
Causes- pernicious anemia:
-b12 deficiency occurs due to lack of intrinsic factor which is required for adequate vitamin B12 absorption in the small intestine
-requires lifelong parenteral vitamin b12 replacement

other causes: alcoholism, poor nutrition, GI disorders, pregnancy, metformin, acid reducers
build up of MMA
-also elevated in renal disease and hypovolemia

Question 10

homocysteine

Answer 10

b12 and folate required to convert to methionine
increased serum homocysteine may suggest vitamin B12 or folate deficiency
also elevated in renal failure and hypothyroidism

Question 11

treatment of macrocytic anemia

Answer 11

b12 def
-injections to bypass absorption followed by oral supplements
folic def
-0.4-1mg daily
-should be continued for 4 months
-ades: flushing, malaise, rash/pruritus

Question 12

microcystic anemia

Answer 12

causes: iron deficiency
ferritin: keep iron bound (non-toxic form)
IDA: <15ng/mL but level below 41 ng/dL do not eliminate the possibility of IDA
ferritin level elevated in acute phase reactant

Question 13

serum total iron binding capacity

Answer 13

transferrin that carries Fe in blood
inverse relationship between ferritin and transferrin
elevated in IDA: >400 mcg/dL (because many iron binding sites available)

Question 14

transferrin saturation

Answer 14

ratio of the serum iron level to the TIBC

Question 15

microcytic treatment

Answer 15

oral iron therapy:100-200 mg elemental iron/day
absorption is decreased with: food + high gastric pH
enhanced absorption: vitamin C

goal: increase serum hemoglobin by 1g/dL every 2-3 weeks; continue treatment for 3-6 months after iron stores return normal

Question 16

parenteral iron

Answer 16

more effective
more adverse reactions and more expensive
indications:
-CKD on hemodialysis
-CKD receiving erythropoiesis stim agents
-unable to tolerate oral iron or failure of oral therapy
-alternative if pt refuse blood transfusion

Question 17

normocytic anemia

Answer 17

deficiency in erythropoietin
iron therapy and ESA are the mainstay treatments for anemia of CKD