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NM703 Primary Care of the Woman > Anemia- Module 4 > Flashcards

Anemia- Module 4 Flashcards

1
Q

What hemoglobin concentration (for adult men & women) suggests anemia?

A

Men: <12 g/dl

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2
Q

What are reticulocytes? What does the reticulocyte count evaluate?

A

Immature RBCs; The bone marrow production of RBC’s

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3
Q

What level indicates a high reticulocyte count? What does this indicate?

A

> 3%; body is compensating for blood loss

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4
Q

What level indicates a low reticulocyte count? What does this indicate?

A

<1%; RBC production is impaired

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5
Q

What lab value differentiates microcytic, normocytic, and macrocytic anemia?

A

Mean corpuscular volume (MCV)

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6
Q

What are the three mechanisms that affect blood volume (and therefore anemia)?

A
  1. Blood loss
  2. Decrease in RBC production
  3. Increase in RBC destruction
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7
Q

What three types of laboratory values are used to discover which mechanism is the cause:

A
  1. CBC (hgb, hct)
  2. RBC indices (MCV, reticulocyte count)
  3. Iron indices (ferritin, TIBC, serum iron)
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8
Q

90% of anemias fit in what three categories?

A
  1. Iron-deficiency
  2. Thalassemia
  3. Anemia of chronic disease
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9
Q

Hemoglobin: normal values (women & men)

A

Women: 12-16 g/dl
Men: 13.5-17.5 g/dl

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10
Q

MCV: normocytic value

A

80-99 fL

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11
Q

MCV: microcytic value

A

<80 fL

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12
Q

MCV: macrocytic value

A

> 100 fL

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13
Q

Serum Iron: Normal value (women & men)

A

Women: 65-165mg/dl
Men: 75-175 mg/dl

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14
Q

What is serum iron?

A

Iron bound to transferrin (plasma carrier protein), that regulates iron transport in the blood.

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15
Q

What is serum ferritin?

A

Reflects total body iron stores.

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16
Q

Serum ferritin: normal values (women & men)

A

Women: 12-150 mg/L
Men: 15-300 mg/L

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17
Q

What is the first value to reflect depleted iron stores?

A

Serum ferritin

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18
Q

What does the Total Iron-Binding Capacity (TIBC) reflect?

A

The availability of binding sites on the protein for iron transport.

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19
Q

How is transferrin level measured?

A

Indirectly through TIBC.

% calculated by serum iron/TIBC x 100

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20
Q

TIBC: normal level

A

240-450 mg/dl

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21
Q

% of transferrin saturation: normal values

A

20%-50%

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22
Q

Early Iron Deficiency lab values:

A

All normal (earliest to drop is serum ferritin)

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23
Q

Intermediate Iron Deficiency values:

A

Hgb: N; MCV: N; MCHC: N; Serum Iron: low/N; Serum Ferritin: low; TIBC: High N; Transferrin Sat: low

24
Q

Late Iron Deficiency values:

A

all Low; EXCEPT: TIBC is High

25
Q

Thalassemia minor lab values:

A

Hgb: Low N/Low; MCV: Low; MCHC: N/Low; Serum Iron: N; Serum Ferritin: N; TIBC: N; Transferrin Sat: N

26
Q

Chronic Disease lab values:

A

Hgb: Low N; MCV: N/low; MCHC: N/low; Serum Iron: Low; Serum Ferritin: High; TIBC: Low; Transferrin Sat: High

27
Q

Sideroblastic Anemia lab values:

A

Hgb & RBC indices: LOW; Iron indices: all HIGH except TIBC: N

28
Q

Causes of microcytic anemia

A

IDA, thalassemia, anemia of chronic disease, sideroblastic anemia, Hgb E disease

29
Q

Causes of macrocytic anemia

A

Megaloblastic anemia (Vitamin B12 or folate deficiency)

30
Q

Causes of normocytic anemia

A

Sickle cell disease, anemia of chronic disease, aplastic anemia, hemolytic anemia

31
Q

Conditions that cause increased reticulocyte counts:

A

1) Hemolytic Anemia: autoimmune hemolysis, RBC enzyme deficiencies, traumatic or angiopathic hemolysis, RBC membrane problems (spherocytosis, elliptocytosis)
2) 3-4 days after acute blood loss
3) Hemoglobinopathies
4) Toxin exposures
5) Hypersplenism
6) After tx of anemias: adequate doses of iron, folate or vitamin B12

32
Q

Causes of decreased reticulocyte counts:

A

IDA, Aplastic anemia, Untreated megaloblastic anemia, radiotherapy, marrow tumors, myelodysplastic syndromes

33
Q

What is the most common cause of IDA?

A

Chronic blood loss (GI bleed, menorrhagia)

34
Q

What lab indicates hypochromic anemia?

A

Low MCHC

35
Q

Mild IDA can be caused by:

A

Inadequate diet, normal or heavy menses, blood donation, malabsorption, increased requirements (growth, pregnancy), polycythemia tx with phlebootomy

36
Q

Moderate to severe anemia can be caused by:

A

chronic blood loss, Peptic ulcer disease, varices, malignant dx, diverticulitis, severe menorrhagia, severe malabsorption

37
Q

What products inhibit iron absorption?

A

Soy protein, bran, dairy, tea, coffee, calcium rich antacids, vegetable sources

38
Q

What products enhance iron absorption?

A

Ascorbic acid (VIT C), citric acid, meat, poultry, fish, other (low iron stores of individual, low iron content of meal)

39
Q

First line of tx for IDA:

A

Oral iron preparation; usually 150-200mg daily in divided doses

40
Q

How long should iron therapy continue?

A

Empirically for 4-6 months or until the serum ferritin level exceeds 50mg/L

41
Q

How should oral iron be taken?

A

30 min before meals with OJ

42
Q

How long should it take for the Hgb level to rise after oral iron in IDA? MCV level?

A

Within 1-2 weeks; 1-2 months

43
Q

When to refer IDA pt to hematologist:

A

non adherance to or intolerance of oral iron, persistent IDA, persistent microcytic anemia despite iron replacement and exclusion of other conditions.

44
Q

What is the mainstay therapy for b-Thalassemia major?

A

Regular transfusions & Iron chelation therapy

45
Q

What ethnicities are more likely to have a-Thal?

A

Southeast Asia, India, China, Philipines

46
Q

What ethnicities are more likely to have b-thal?

A

Mediterranian, middle eastern, African, Asian

47
Q

What is the difference between thalassemia and sickle cell on a blood smear?

A

Sickle cell - sickle shape

Thalassemia- target cells / aniocytosis (different sizes)

48
Q

Lab values in beta minor:

A

Hct 28-40; MCV- 55-75; high levels of hgb A2 on hgb electrophoresis

49
Q

Treatment for a or b minor thal?

A

genetics if planning family; education; Do NOT give Iron!

50
Q

What differentiates Anemia of Chronic Disease (ACD) from IDA in lab values?

A

ACD: High Serum Ferritin, Low TIBC, High Transferrin sat; low reticulocyte count; more likely to be normocytic, but occasionally microcytic

51
Q

Treatment for ACD?

A

Optimal control of underlying condition

52
Q

What are the primary causes of macrocytic anemia?

A

Vitamin B12 deficiency & Folate deficiency (both are essential to normal DNA synthesis-bone marrow is sensitive to deficiencies)

53
Q

Decreased dietary intake, alcoholism, and diseases associated with malabsorption are associated with ______________.

A

Folate deficiency

54
Q

What is the most prevalent cause of vitamin B12 deficiency?

A

Pernicious anemia (lack of intrinsic factor)

55
Q

What symptoms are specific to a severe vitamin B12 deficiency?

A

Marked anemia and neurologic deficits, sore mouth and loss of taste. Neuro sx may not go away with tx.

56
Q

What lab can differentiate vitamin B12 deficiency from folate deficiency?

A

Methylmalonic acid(N=70-270) is elevated in B12 deficiency, but normal in folate deficiency. Homocysteine (N= 5-16) is elevated in both.

57
Q

What can happen if you treat someone for folate deficiency that actually has B12 deficiency?

A

Can result in permanent neurologic or psych abnormalities.

NM703 Primary Care of the Woman (5 decks)

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