Anemia Diagnosis/Management

Question 1

Anemia =

Answer 1

Decreased RBC mass

Question 2

Anemia for males is Hgb < ___

Answer 2

14

Question 3

Anemia for females is Hgb < ____

Answer 3

12

Question 4

What are common symptoms of Anemia?

Answer 4

Fatigue
Weakness
Dizziness
PALE skin and PALE conjunctiva
Dyspnea

Question 5

If the Reticulocyte Index is greater than 2, that means?

Answer 5

There is an adequate bone marrow response

Question 6

Normocytic MCV range?

Answer 6

78-98

Question 7

3 clues to hemolysis?

Answer 7

1. Lactate Dehydrogenase
2. Indirect Bilirubin
3. Haptoglobin

Question 8

Ferritin =

Answer 8

Iron storage protein

- It is proportional to iron levels

Question 9

Transferrin =

Answer 9

Iron transport protein

- synonymous to TIBC (total iron binding capacity)

Question 10

___ RDW indicates Anemia

Answer 10

Increased

Question 11

What is the earliest and most sensitive index that will change in Iron Deficiency Anemia?

Answer 11

RDW

Question 12

With Iron Deficient Anemia, what will the levels be for:

Iron, Ferritin, TIBC and MCV

Answer 12

Iron = LOW
Ferritin = LOW
TIBC = HIGH
MCV = LOW

Question 13

In older patients with Iron Deficient Anemia, what should you check for?

Answer 13

GI BLEED

Question 14

Anemia of Chronic Disease is caused by?

Answer 14

Inflammation (inflammatory cytokines)

Question 15

With Anemia of Chronic Disease, what will the levels be for:

Iron, Ferritin, TIBC and MCV

Answer 15

Iron = LOW
Ferritin = HIGH**
TIBC = LOW
MCV = Normal to low

Question 16

What do Inflammatory cytokines activate with Anemia of Chronic Disease?

Answer 16

Hepcidin

Question 17

If Hepcidin is activated, what are its effects on Ferritin and Transferrin and Ferroportin?

Answer 17

Ferritin = HIGH
Transferrin = LOW
Ferroportin = LOW

Question 18

In patients with Anemia of Chronic Disease, how should you treat them?

Answer 18

TREAT THE UNDERLYING DISEASE

Question 19

Inflammatory cytokines also decrease _____ production (seen with Anemia of Chronic Disease)

Answer 19

Decreased Erythropoietin production

Question 20

What are signs of hypovolemic shock (acute blood loss)?

Answer 20

Pulse - INCREASED
BP - DECREASED
PALLOR
Cool extremities

Question 21

What are signs of hypovolemic shock (acute blood loss)?

Answer 21

Pulse - INCREASED
BP - DECREASED
PALLOR
Cool extremities

Question 22

Levels of MCV and reticulocytes with UNcompensated acute blood loss

Answer 22

MCV - normal

Reticulocytes - normal

Question 23

What are 2 things that can result from hemorrhagic shock?

Answer 23

Myocardial ischemia

Renal failure

Question 24

Treatment for Hypovolemic shock due to acute blood loss?

Answer 24

RECOGNIZE

** BLOOD TRANSFUSION!!!!!

Question 25

Treatment for Hypovolemic shock due to acute blood loss?

Answer 25

Recognize it | = BLOOD TRANSFUSION!!!!

Question 26

A single unit of RBCs can increase Hgb by ___

Answer 26

1

Question 27

How is Sickle Cell Anemia inherited?

Answer 27

Autosomal Recessive

Question 28

Sickle cell Anemia is more common in what populations?

Answer 28

African Americans

Question 29

Describe the cycle that is Sickle cell anemia

Answer 29

- HbS will polymerize when de-oxygenated - Creates Sickled cells - Sickled cells occlude vasculature = de-oxygenation - More HbS polymerizes

Question 30

Chronic hemolysis, tissue damage and vascular occlusion point towards?

Answer 30

Sickle cell anemia

Question 31

Who is at risk for stroke with sickle cell anemia?

Answer 31

Children

Question 32

Low O2 saturation, anemia, avascular necrosis of bone can point towards?

Answer 32

Sickle cell anemia

Question 33

What is Acute Chest Syndrome and what is it seen with?

Answer 33

- Seen with Sickle cell anemia = Vaso-occlusion in the lungs that leads to hypoxia -- This worsens the vaso-occlusion and causes chest pain, dyspnea and pneumonia -- Pulmonary infiltrates in the lungs can be fatal

Question 34

What organ is usually enlarged with sickle cell anemia and what can occur? - Also what are they at risk for?

Answer 34

Splenomegaly - Autosplenectomy can occur due to infarcts in the blood supply - - increased risk for infections

Question 35

How is sickle cell anemia diagnosed?

Answer 35

Hemoglobin electrophoresis | = Increased HbS and HbF

Question 36

Initial treatment for Sickle cell anemia?

Answer 36

Give oxygen to decrease cell sickling and control pain

Question 37

What drug can be given for sickle cell anemia?

Answer 37

Hydroxyurea (increased HbF)

Question 38

What is Aplastic Anemia?

Answer 38

PANCYTOPENIA

Question 39

With Aplastic Anemia, what are the levels for: | MCV, RDW, and reticulocytes

Answer 39

``` MCV = HIGH RDW = normal Reticulocytes = LOW ```

Question 40

High MCV, normal RDW and low reticulocytes could indicate?

Answer 40

Aplastic Anemia | - Pancytopenia

Question 41

What is the first sign of Aplastic Anemia?

Answer 41

Bleeding

Question 42

What does the bone marrow biopsy show with Aplastic Anemia?

Answer 42

Adipose tissue and hypocellularity

Question 43

What will be increased if there is a B12 deficiency causing megaloblastic anemia?

Answer 43

INCREASED MMA and Homocysteine

Question 44

What will be increased if there is a folate deficiency causing megaloblastic anemia?

Answer 44

INCREASED Homocysteine only

Question 45

Where is folate normally absorbed and what diseases can impair this?

Answer 45

Normally absorbed in the jejunum and ileum | - Impaired by celiac and crohn's diseases

Question 46

What medication can cause a folate deficiency?

Answer 46

Methotrexate

Question 47

Methotrexate commonly causes a deficiency in?

Answer 47

Folate