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FALL15 N757 Primary Care Adults 2 > Anemia > Flashcards

Anemia Flashcards

1
Q

Components of CBC

A

RBC, Hgb, Hct, MCV, MCH, MCHC, RDW, WBC, Diff, PLT count, MPV

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2
Q

Total RBCs: normal values

A

male 4.5-6.0 x 10^12/L

female 3.8-5.2 x 10^12/L

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3
Q

Hgb: values

A

Normal ranges: male 13-18 g/dL; female 12-16 g/dL

• Hgb below normal = anemia

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4
Q

Hct: values

A

male 40-52%

female 35-47%

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5
Q

MCV

A
  • Avg volume (size) of RBC
  • Normal range: 80-100 fL
  • Differentiates between microcytic (MCV < 80), normocytic (MCV 80-100)
  • and macrocytic (MCV > 100) anemias
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6
Q

MCH

A

Weight of Hgb in the average red blood cell

  • Normal range: 26-34 pg
  • Not a frequently used parameter
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7
Q

MCHC

A
  • Concentration of hb (color)
  • Normal range: 32-36 g/dL
  • Differentiates between hypochromic (MCHC < 32) and normochromic (MCHC 32-36) anemias
  • There is no such thing as a hyperchromic red cell (you can’t put excess hemoglobin into a cell, or it would burst!)
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8
Q

RDW

A
  • Range of variation in RBC volume
  • Tells you how much the red blood cells differ from each other in size. If they
  • are all pretty similar in size, the RDW is low. If some cells are little and some are big, the RDW is high.
  • Normal range = 12-13.5%
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9
Q

Anisocytosis

A

Elevated RDW

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10
Q

Poikilocytosis

A

Abnormal blood cell shape that makes up >10% of population

Typically d/t nutrient or B12 deficiencies

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11
Q

TIBC

A

Blood’s capacity to bind iron to transferrin

increased in IDA

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12
Q

WBC

A
  • Normal ranges: adult: 4.5-11 x 109/L, newborn: 9-30, child over 1: 5.0-17.0
  • A high WBC is seen in many conditions. Some are benign, such as infection and inflammation. Others are malignant, such as leukemia.
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13
Q

PLTs

A
  • Normal range = 150-450 x 109/L
  • Causes of a low platelet count are numerous and include splenomegaly, idiopathic thrombocytopenic purpura, disseminated intravascular coagulation, and bone marrow failure.
  • Causes of a high platelet count are also numerous, and include reactive thrombocytosis (as seen in iron-deficiency anemia) and essential thrombocythemia.
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14
Q

MPV

A
  • Mean plt volume
  • Average size of platelets
  • Normal range depends on the platelet count! (Normally, if the platelet count falls, the body compensates a little by trying to make bigger platelets.)
  • Not used all that often.
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15
Q

IDA: pathogenesis

A

Bleed or bad diet/malabsorption

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16
Q

Iron deficiency: order of change in labs

A
  • Low Ferritin, low iron, increased RDW, increased TIBC, changes in H/H, decreased indices (small, pale)
  • other changes:
    • PLT increased (erythropoiesis can increase PLT counts)
  • *serum ferritin is most sensitive!
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17
Q

Anemia of chronic disease labwork

A
  • Typically normochromic, normocytic, minimal anisocytosis and poikilocytosis. Sometimes microcytic, rarely <72 MCV
  • Iron studies: Low iron, Low TIBC, normal or increased ferritin
  • Low retic count
18
Q

Treatment for anemia of chronic disease

A

Usually too mild to treat – focus on underlying cause

19
Q

Vitamin B12 replacement: when, route

A
  • R/O causative factors before supplementing
  • Traditionally: Daily IM injection 1mg cobalamin x 1 wk, 1mg weekly x 4 weeks, 1 mg monthly for life
  • Reasonable to begin 1000-2000 mcg PO QD if MMA <400 pg/mL
  • Parenteral, nasal, oral: PO is found to be sufficient now d/t passive absorption rate 1% in small bowel – will get more than RDA of 2.4 mcg/day
20
Q

Most common cause B12 deficiency

A

Pernicious anemia

21
Q

Typical sx and PE findings of B12 def

A
  • Typical Symptoms
    • weakness, fatigue, lightheadedness, tachycardia, palpitations, angina, sx CHF
  • Neuro sx – late, typically BL, LE, leading to late cerebral involvement
  • PE findings
    • Pale, icteric skin, atrophic glossitis, rarely -purpuric lesions s/t thrombocytopenia
22
Q

Lab findings in B12 def

A
  • macro-ovalocytic erythrocytes, megaloblasts, hypersegmented neutrophils
  • Absolute retic, leukocyte, PLT counts: nl to low
  • MMA! Very important as FA supplementation may = no macrocytes. MMA rises when B12 <400.
23
Q

Who to screen for B12 def

A
  • Any pt w/normocytic anemia! FA supp is screwing us up!
  • All elderly pts
  • T2D on metformin
  • Prolonged PPI
  • Excessive physical stress
  • c/o imbalance, decreased sensation in LE
  • Celiac/Crohn’s
  • Oral ulcers
  • tongue complaints
  • persistent mild diarrhea
  • memory loss
  • ?persistent irritability
  • autoimmune DO
24
Q

PICA associated with…

A

IDA – ice

No clear reason

25
Q

RLS associated with

A

IDA

26
Q

Etiology of anemia of chronic disease

A

immune driven: cytokines and cells of the reticuloendothelial system induce changes in iron homeostasis, the proliferation of erythroid progenitor cells, the production of erythropoietin, and the life span of red cells

27
Q

Target for Procrit success in patients w/CDK / undergoing hemodialysis

A
  • Hb 11-12
  • Hct: 33-36, but not in target range (was found to be associated w/greater mortality)
  • Much controversy on the right targets
28
Q

Iron absorption in anemia of chronic dz

A
  • Iron is absorbed in duodenum.
  • Absorption is downregulated in acd – hard to get iron to a place where it can be used.
  • If combined w/EPAs, can work well as EPAs able to use it – however, only if low ferritin, as can be harmful if ferritin is nl or high.
29
Q

Macrocytic anemia: expected lab values

A

MCV: >100 fL

MCHC: normal

Serum Folic Acid: <4 ng/mL

Serum cobalamin: <150pmol/L

Homocysteine: >13 micromol/L

Serum methylmalonic acid: >0.4 micromol/L

Urine methylmalonic acid: >3.6 micromol/mol creatinine

30
Q

Describe vit B12 absorption

A

Gastric acid and pancreatic proteases release dietary vitB12 → Free Vit B12 binds w/intrinsic factor (IF) → Vit B12-IF complex absorbed in ileum

31
Q

Where is FA absorbed?

A

proximal jejunum

32
Q

Why is FA important?

A

Essential for DNA synthesis – major impact on cells w/rapid turnover

33
Q

How long does Vit B12 deficiency continue?

A

Typically lifelong

34
Q

What is microcytic anemia?

A

Deficiency in oxygen carrying erythrocytes Microcytic & hypochromic → small erythrocytes w/insufficient Hb (hence pale)

35
Q

Expected lab values w/microcytic anemia

A

Mean Cell Volume (MCV): <80fL
Mean Cell Hemoglobin Concentration (MCHC): <30%
Serum Iron (SI): <30 mcg/dL
Transferrin saturation: <10%
Serum ferritin: <20 mcg/

36
Q

Types of PO iron

A

Ferrous sulfate (Feosol) Ferrous gluconate (Fergon) Ferrous fumarate (Feostat)

37
Q

When is iron best absorbed?

A

on empty stomach but may take w/food to minimize GI effects

38
Q

How long should iron supplementation continue in IDA?

A

3-6mths after correcting IDA cause

39
Q

What are the indications for the different types of IV iron?

A

INFeD: IDA

Ferrlecit & Venofer: CKD pts on hemodialysis

40
Q

Special consideration for INFed?

A

requires test dose prior to 1st admin

FALL15 N757 Primary Care Adults 2 (13 decks)

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