Anemia Clinical Care Flashcards
normal RDW
11-15%
(elevation = variability in RBC size)
Reticulocyte normal value
0.5-1.5%
Hgb count in anemia
- women < 12.0 g/dL
- men< 13.5 g/dL
Hct % in anemia
- women < 36%
- men < 41%
RBC count in anemia
- women < 4.2 mil cells/microL
- men < 4.7 mil cells/microL
Pitfalls of determining anemia
- acute bleed: hct & red cells lost together
- pregnancy: plasma vol increases (looks like anemia)
- dehydration doesn’t look anemic
MCV > 100 fL/cell = ____ anemia
MCV < 80 fL/cell = _____ anemia
- macrocytic
- microcytic
MCH < _____ or
MCHC < _____ =
hypochromic anemia
- 27 picograms/cell
- 33 g/dL
(MCHC preferred)
chronic anemias are typically _______
normocytic
List the major causes of microcytic anemia (7)
- iron deficiency
- thalassemia
- sideroblastic
- lead poisoning
- sickle cell
- anemia in chronic disease
- spherocytosis
List the types of sideroblastic anemia
- congenital (microcytic)
- acquired clonal
- acquired reversible
(bottom 2 are normocytic or macrocytic)
List the most common normocytic anemias
- pregnancy
- dehydration
(think blood loss or change in plasma volume)
Macrocytic anemias as typically caused by ______
vitamin deficiencies
Causes of erythrocyte loss: bleeding
- trauma
- chronic: GI, menstrual
- acut: GI, retroperitoneal
anemia due to low EPO is caused by _____
kidney disease
Target Hgb in patients on dialysis
10 g/dL
Echinocytes “burr cells” which retain their central pallor (acanthocytes do not)
(normocytic, seen in kidney disease → anemia)
anemia due to decreased response to EPO
- iron deficiency
- vit B12 deficiency
- folate deficiency
- anemia of chronic disease
Describe the peripheral smear of iron deficiency anemia (3)
- microcytic
- hypochromic
- red cells w/marked anisopoikilocytosis
Iron deficiency anemia s/sx
- pallor
- koilonychia
- beeturia (red urine; not blood)
koilonychia
Iron deficiency anemia lab findings (6)
- HIGH iron binding capacity (open seats)
- elevated platelet
- low serum iron
- low serum ferritin
- low MCHC
- low transferrin saturation (serum Fe/TIBC)
Gold standard for diagnosing iron deficiency anemia
bone marrow biopsy → low stainable iron
Good sources of dietary iron to maintain stores
- red meat
- spinach
- cast iron skillet cooking
(not enough to correct deficiency)
Hemochromatosis
toxicity of iron overload
(the reason why you must check iron stores before giving iron supplement)
Iron therapy route of admin
- oral
- IM
- IV
How do H2 antagonists and PPIs interfere with oral iron therapy?
iron is best absorbed in an acidic environment (stays Fe2+)
(taking w/orange juice helps)
Oral iron tablets are most efficiently absorbed as _____
ferrous sulfate
side effects of oral iron (3)
- constipation
- black stools
- nausea
(may cause positive hemoccult test)
parenteral (IV or IM) iron therapy indications
cannot tolerate or absorb oral iron
parenteral iron therapy adverse reaction
anaphylaxis
Reasons patient may not be responding to iron therapy
- incorrect dx
- continued bleeding
- non-compliance (pt not taking meds)
- lack of absorption (PPIs)
middle aged - elderly patients with iron deficiency anemia have a ______ until proven otherwise
GI bleed from tumor
Cobalamin levels in macrocytic anemia
<200 pg/mL
How do you confirm cobalamin deficiency → anemia
- elevated serum methylmalonic acid
- elevated serum homocysteine
Pernicious anemia is specifically ______.
ab to intrinsic factor → B12 deficiency
Schilling test
give patient B12 → check urine → give IF + B12 → measure again
(checks for pernicious anemia; positive test = increased B12 in urine after given IF + B12)
Neuropsychiatric s/sx of B12 deficiency anemia
- spastic ataxia
- psychosis
- loss of vibratory sense
- dementia
(may not be reversible if caught too late)
Blood smear of B12 deficiency anemia
macrocytosis w/hypersegmentation of PMN w/ possible basophilic stippling (granulations)
B12 deficiency anemia tx
- Pernicious: B12 shots (oral won’t work; they don’t have IF) 1000 mg
- Absorption issue: treat underlying condition (Crohn’s or Celiac)
