Anemia

Question 1

Anemia

How do we diagnose anemia in pregnancy?

Answer 1

Hct <32 in the second trimester

Question 2

Anemia

What’s the Ddx for microcytic anemia?

Answer 2

Iron deficiency, thalassemia, lead/copper

Question 3

Anemia

What causes normocytic anemia?

Answer 3

Iron deficiency
Hemorrhage
Chronic disease
Renal insufficiency
Autoimmune hemolytic anemia

Question 4

Anemia

What are the causes of macrocytic anemia?

Answer 4

B12 or folate deficiency
Liver disease (alcohol)
Acute myelodysplastic syndrome
Hypothyroidism
Drugs (zidovudine)

Question 5

Anemia

Hoe much does our blood volume increase in pregnancy? How about our RBC mass?

Answer 5

Blood volume increases by 50%

RBC mass increases by 25%

Question 6

Anemia

What ferritin and TIBC levels are consistent with iron deficiency anemia?

Answer 6

Ferritin < 15

TIBC >400

Question 7

Anemia

How much iron should a pregnant women take daily?

Answer 7

27mg (compared to 15mg outside of pregnancy)

Question 8

Anemia

How common is iron deficiency in pregnancy, by trimester?

Answer 8

First trimester: 2%
Second trimester: 8%
Third trimester: 27%

Question 9

Anemia

What foods are rich in iron?

Answer 9

Beef, shrimp, turkey, enriched cereals, beans

Question 10

Anemia

What foods enhance and diminish iron absorption?

Answer 10

Enhance: vitamin C (citrus, peppers)
Diminish: soy, spinach, coffee, dairy

Question 11

Anemia

What pregnancy complications are associated with iron deficiency?

Answer 11

Low birth weight, preterm delivery, perinatal morbidity

Question 12

Anemia

Hgb below what level is associated with HR abnormalities, oligohydramnios, and IUFD?

Answer 12

Hgb <6

Question 13

Anemia

What patients are most likely to have B12 deficiency?

Answer 13

Vegetarians, HIV +, gastric bypass, Crohn’s, EtOH use

Question 14

Anemia

How is B12 deficiency treated?

Answer 14

B12 1000mcg IM monthly

Question 15

Anemia

You have a patient with mild asymptomatic microcytic anemia. What should you do?

Answer 15

Treat empirically with iron

Recheck CBC in one month - if no improvement, do further workup.

Question 16

Anemia

How will iron studies appear in pt with chronic disease?

Answer 16

Ferritin: high
TIBC: low

Question 17

Anemia

When should parenteral iron be considered?

Answer 17

Iron deficiency anemia with intolerance or unwillingness to take iron
Malabsorption

Question 18

Anemia

If you have a seriously iron deficient patient receiving IV iron, what else can be done to improve the Hct?

Answer 18

Epo (erythropoeitin)