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Maternal Medicine > Anemia > Flashcards

Anemia Flashcards

EB MFM, Creasy

1
Q

Normal plasma iron level

A

40-175 mcg/dL

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2
Q

Normal plasma TIBC

A

216-400 mcg/dL

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3
Q

Normal transferrin saturation

A

16-60%

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4
Q

Normal serum ferritin level

A

> 10 mcg/dL

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5
Q

Definition of anemia in 1st or 3rd trimester

A

Hgb < 11 g/dL

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6
Q

Definition of anemia in 2nd trimester

A

Hgb < 10.5 g/dL

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7
Q

Physiologic changes in RBC mass and plasma in pregnancy

A

RBC mass and plasma both increase, but the plasma increase (50%) is proportionally greater than the RBC increase (15-30%)

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8
Q

Initial workup of anemia

A

CBC with Hgb and mean corpuscular volume

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9
Q

Workup if Hgb < 11 g/dL and MCV < 80 um3

A

Microcytic anemia

Obtain Hgb electophoresis and serum ferritin

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10
Q

Workup if Hgb < 11 g/dL and MCV > 80 um3

A

Retic count, history - active bleeding, med exposure, chronic dz, G6PD deficiency, fam hx of RBC disorders

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11
Q

Workup if high reticulocyte counts

A

Anemia may be due to hemolysis or blood loss
Consider:
Peripheral blood smear
Haptoglobin
Direct coombs for autoimmune hemolytic anemia
Electrophoresis
Hemoccult

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12
Q

Most common cause of anemia in pregnancy

A

Iron deficiency

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13
Q

Diagnosis of iron deficiency anemia

A

MCV < 80
Decreased serum iron
Increased TIBC (>400 mcg/dL)
Decreased serum ferritin (<30 mcg/L)

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14
Q

Complications of iron deficiency in anemia in pregnancy

A 
Low birth weight
Preterm birth
Maternal CV compromise
Need for transfusion
Postpartum depression
Poor mental and psychomotor performance testing in offspring
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15
Q

Dosing of IV iron sucrose

A

Weight before pregnancy (kg) x (110g/L - actual hemoglobin g/L) x 0.24 + 500 mg

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16
Q

Is anemia of chronic disease normocytic or microcytic?

A

Usually normocytic (20% microcytic)

17
Q

Diagnosis of anemia of chronic disease

A

Decreased serum iron
Normal or increased serum ferritin
Decreased TIBC

18
Q

Causes of anemia of chronic disease

A 
Chronic liver disease
Thyroid disease
Uremia
Chronic infections
Malignancies
19
Q

Workup of anemia of chronic disease

A

LFTs
BUN/Cr
TSH
Tests for malignancy or chronic infxn as indicated by hx/phys
Iron, B12, folate to rule out combine deficiencies

20
Q

Iron studies in thalassemia

A

Normal or increased serum iron

Normal or increased TIBC

21
Q

Common ancestries for alpha-thalassemia

A

Southeast Asian

22
Q

Diagnosis of alpha-thalassemia

A 
Probable alpha thal:
MCV < 80
Nl Fe studies
Hgb A2 on electrophoresis < 3.5% 
Confirm with DNA probe, consider testing of father/prenatal dx
23
Q

Common ancestries for beta-thalassemia

A 
Mediterranean
Asian
Middle Eastern
Hispanic
West Indian
24
Q

Diagnosis of beta-thalassemia

A

MCV < 80
Nl Fe studies
Hgb A2 on electrophoresis >3.5%
Consider testing of father, prenatal dx if +, Hb electrophoresis at one year of age if negative

25
Q

Recommended dietary allowance of ferrous iron during pregnancy

A

27 mg, present in most prenatal vitamins

26
Q

Definition of macrocytic anemia

A

MCV > 100 fL

27
Q

Causes of macrocytic anemia

A

Levels greater than 115 fL are almost exclusively seen in patients with folic acid or vitamin B12 deficiencies

28
Q

Diagnosis of B12 deficiency

A

<100 pg/mL

29
Q

Diagnosis of folate deficiency

A

RBC folate < 150 ng/mL

30
Q

Causes of folate deficiency

A

Diets deficient in fresh leafy vegetables, legumes, or animal proteins.

31
Q

Folic acid requirements in pregnancy

A

Increase from 50 mcg to 400 mcg per day

32
Q

Treatment of pregnancy-induced folic acid deficiency

A

Nutritious diet, folic acid and iron supplementation

1 mg folic acid/day

33
Q

Causes of vitamin B12 (cyanocobalamin) deficiency

A

Partial or total gastric resection, Crohn’s disease

34
Q

Treatment of B12 deficiency

A

Monthly IM injections of 1000 mcg B12

Maternal Medicine (20 decks)

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