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Hem/Onc FA2017 > Anemia > Flashcards

Anemia Flashcards

1
Q

Iron Deficiency Anemia

Serum Fe
Transferrin
TIBC
Ferritin
Special Test
Other Cell Lines?
A 
MCV: Small
RDW: Wide
Serum Fe: Low
Transferrin: High
TIBC: High
Ferritin: Low or normal
Special Test:
Other Cell Lines?: Thrombocytosis until Fe is normalized
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2
Q

What are the 5 microcytic anemias?

A 
Fe Deficiency Anemia
Lead Poisoning Anemia - Plumbism
ACD
Sideroblastic Anemia 
Thalassemia
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3
Q

Where is the concentration of iron regulated?

A

Small Intestine

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4
Q

What is remarkable in the CBC regarding other cell lines with Fe deficiency anemia?

A

Thrombocytosis 500k - ish

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5
Q

Who is most at risk for iron deficiency anemia?

A

women of childbearing age, vegetarians, infants, pregnant women, celiacs and IBD

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6
Q

Iron deficiency anemia has common anemia symptoms and 4 other important symptoms that Jill talked about

A

Pica, Restless leg syndrome, leg cramps while climbing stairs, cold intolerance

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7
Q

What are the two broad categories of mechanisms for iron deficiency anemia and examples of each

A

Iron Loss
-Menses
-GI Bleed
Chronic low grade hemolysis

Insufficient absorption

  • Poor dietary intake
  • Malabsoption - celiacs
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8
Q

What test can differentiate iron deficiency anemia and ACD?

A

Soluble transferrin receptor

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9
Q

When testing soluble transferrin receptor and the results are normal what anemia does that signify?

A

Fe deficiency anemia

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10
Q

What is the work up for iron deficiency anemia?

A

Women with heavy menses? –> Fe supp. test in 6 mos

No menses? Ask GI symptoms. –> C-scope, EGD–> if neg
order small scope bowel capsule endoscopy to try and find small intestine bleeding.

If all of those fail you can start eval for celiacs

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11
Q

What is the treatment for Fe deficiency anemia?

A

Ferrous Sulfate with vitamin c at time of consumption

Parenteral iron - Venofer for those who cannot tolorate

Take for 3-4 mos past resolution

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12
Q

When a patient has Fe deficiency anemia and is supplementing with iron when should reticulocytes begin increasing and how should Hgb increase?

A

Reticulocytes - in 5-10days

Hgb - 1/2g every 2 weeks

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13
Q

How much iron is in one unit of PRBC?

A

200mg

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14
Q

Why is alpha thalassemia less severe than beta?

A

Beta chains can form soluble tetramers so there is less effect on erythropoietin , but beta chains cannot off load oxygen

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15
Q

Alpha thalassemia causes what when RBC are exposed to oxidative stress?

A

lysing of RBC and more significant anemia

RBC life is around 40 days with alpha thalassemia

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16
Q

Where do RBC die in beta thalassemia

A

In the bone marrow - intramedullary hemolysis

17
Q 
What are the lab findings for beta thalassemia ?
RBC
HCT
HGB
MCV
RDW
Microscopy?
A 
RBC - increased bc cells are so small
HCT - decreased?
HGB - decreased
MCV - very small <75
RDW- very narrow
Microscopy? - target cells, dacrocytes (tear drop), microcytic, hypochromic
18
Q

What potential protection is offered by alpha and beta thalassemia respectively?

A

malaria, arterial thromboembolic events

19
Q

Beta thalassemia major causes the body to undergo extra medullary erythropoiesis which leads to what complications?

A

iron overload
widening of marrow spaces
abnormal bone growth

20
Q

The severe anemia in beta thalassemia leads to heart failure, why?

A

the heart is working itself to death, literally. Because the body is so low on oxygen it is doing everything because it thinks its to blame

21
Q

What is the work-up of thalassemia?

A

Hgb electrophoresis can be helpful but genetic testing is ideal.

22
Q

How is thalassemia treated with PRBC and why? What is the goal Hgb

A

2u PRBC every 2-4 weeks to suppress extra medullary erythropoiesis

Hgb between 9 and 10

23
Q

What will thalassemia patients need besides PRBC?

A

iron chelation to prevent iron overload

24
Q

Basophilic stippling is associated with what type of anemia?

A

Lead poisoning

25
Q

What is sideroblastic anemia?

A

nucleated RBC that contain iron in cytoplasm and cause microcytic anemia

26
Q

Early stages of nutritional deficiency will have what type of anemia?

A

normocytic

27
Q

What are 5 common normocytic anemias?

A

ACD, Acute Blood Loss Anemia/ Hemolysis, Multiple Myeloma, Anemia of CKD, Myelofibrosis/Myelophthsic anemia

28
Q

What are 3 uncommon normocytic anemias?

A

Aplasic anemia, pure red cell aplasia, thyroid dz

29
Q

What is the lowest a MCV for ACD might be?

A

75

30
Q

Why is iron decreased in patients with ACD?

A

Hepcidin is a antimicrobial peptide released by the liver that decreases iron in the body during infection and inflammation. Also, cytokines play a role in premature RBC destruction

31
Q 
ACD Labs?
MCV:
RDW:
Serum Iron:
TIBC: Low/
Transferrin: 
Ferritin:
A 
ACD Labs
MCV: Normal
RDW: Wide??
Serum Iron: Low
TIBC: Low/normal
Transferrin: >10% low to normal
Ferritin: Elevated
32
Q

With acute blood loss what can be falsely elevated?

A

H&H

Hem/Onc FA2017 (2 decks)

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