Anemia part 1 and 2

Question 1

anemia

Answer 1

• Decrease in hemoglobin (Hb) level or decreased red blood cells (RBC)
• Hb < 13 mg/dL in men
• Hb < 12 mg/dL in women
May lead to psychomotor and cognitive dysfunction

Question 2

rbc transport what? from where to where

Answer 2

• RBC transport oxygen from lungs to the rest of the body

* RBCs are formed in bone marrow released into bloodstream and survive ~ 120 days.

Question 3

Erythropoietin EPO

Answer 3

• Erythropoietin (EPO)- regulatory hormone produced in kidney
• EPO released when tissue oxygen levels decrease

Question 4

• Classification by size and hemoglobin content of RBC

mean corpuscular volume-

Answer 4

size of the red blood cells

Question 5

MCV < 80fL = Microcytic

Answer 5

Defects in Hb synthesis
• Iron deficiency
• Thalassemia
• Chronic inflammation

Question 6

MCV 80 -100 fL= Normocytic

Answer 6

• Acute bleed
• Hemolysis
• Chronic inflammation
• Chronic kidney disease

Question 7

MCV > 100 fL= Macrocytic

Answer 7

• DNA synthesis defects
• Vitamin B12/folate deficiency
• Drugs
• Alcohol
• Liver/thyroid disease

Question 8

Pathophysiologic Classifications of
Anemia
• Classifies based on the mechanism of

Answer 8

anemia development like blood loss, Inadequate RBC

production, or excessive rbc desctruction

Question 9

blood loss

Answer 9

• Acute: trauma

* Chronic: ulcer, vaginal bleeding, aspirin ingestion

Question 10

Inadequate RBC production

Answer 10

• Nutritional deficiency:
• Bone marrow failure
• Lack of EPO
• Chronic diseases

Question 11

Excessive RBC destruction

Answer 11

• Intrinsic factors: hereditary (G6PD deficiency)

* Extrinsic factors: autoimmune rxn, drug rxn, infections

Question 12

• S/sx are unreliable in predicting the degree

Answer 12

of anemia.

Question 13

gradual onset of anemia

Answer 13

• can tolerate lower Hb

Question 14

acute onset of anemia

Answer 14

• Tachycardia
• Shortness of breath (SOB)
• Lightheadedness
• Irritability
• Decreased mental acuity

Question 15

chronic onset of anemia

Answer 15

• Weakness/Fatigue
• Decreased exercise tolerance
• Paleness of the mucous membranes

Question 16

diagnosis of anemia

Answer 16

CBC with differentials

Question 17

Mean Corpuscular Hemoglobin (MCH)

Answer 17

Average amount of Hb per RBC
• ↓ MCH: microcytosis and hypochromia (i.e IDA)
• ↑ MCH: macrocytosis (i.e vitamin B12 deficiency)

Question 18

• Mean Corpuscular Hemoglobin Concentration

MCHC

Answer 18

• Average mount of Hb per unit volume • Concentration of Hb inside a single RBC

Question 19

Reticulocytes

Answer 19

• Immature RBC
• Indicator of ability of bone marrow to produce
new RBC
• Has lifespan of 1 day before becoming mature
RBCs

Question 20

positive occult blood

Answer 20

gi bleeding

Question 21

Transferrin

Answer 21

transport protein that delivers iron to the bone marrow where it’s incorporated into Hb

Question 22

Ferritin

Answer 22

Stored form of iron
• Reflects total body iron storage
• Low ferritin = iron deficiency anemia (IDA)

Question 23

• 2 categories of IDA

* Absolute iron deficiency:

Answer 23

lack of total body iron

• Low Tsat and ferritin

Question 24

• 2 categories of IDA

Functional iron deficiency:

Answer 24

iron availability is not sufficient for intended use

• Low Tsat but normal ferritin

Question 25

Causes of IDA | • Blood loss

Answer 25

* Acute | * Chronic loss: peptic ulcer disease, hemorrhoids, menstruation

Question 26

Causes of IDA | • Malabsorption

Answer 26

* Gastric bypass surgery, celiac disease | * Heme iron vs. plant iron

Question 27

Causes of IDA | • Poor nutrition

Answer 27

• Children/vegan/vegetarian diet

Question 28

Causes of IDA | • Increased requirement

Answer 28

• Infancy, pregnant/lactating women

Question 29

signs and symptoms

Answer 29

* smooth tongue * Brittle or spoon-shaped nails * Pica- craving for non-food items * Pagophagia- craving for ice

Question 30

most sensitive indicator of iron | deficiency?

Answer 30

ferritin levels | < 30 ng/mL indicate IDA

Question 31

low iron levels results in

Answer 31

high Total Iron-Binding Capacity (TIBC)

Question 32

Transferrin saturation (Tsat):

Answer 32

Iron immediately available for use bone marrow for erythropoiesis • < 20% indicate IDA

Question 33

severe IDA

Answer 33

Hb, Hct and RBC: • May remain at normal values until iron levels significantly fall Low MCV, low MCHC • Typically maintain normal values until Hb < 10 g/dL Low reticulocyte count

Question 34

iron deficiency anemia | ups and downs

Answer 34

``` ↓ Hgb ↓ Hct ↓ MCHC ↓ Fe ↑ TIBC TSat: < 20% ```

Question 35

Which of the following lab values is | NOT specific to PK’s diagnosis?

Answer 35

hemoglobin, because it is low in all types of anemia

Question 36

Which of the following signs/symptoms | is/are consistent with your diagnosis?

Answer 36

pallor and lack of energy

Question 37

What is the most likely cause of his | anemia?

Answer 37

GI bleed | PPI could contribute

Question 38

Ferrous | fumarate

Answer 38

most elemental iron per tablet | • 2 tabs~ 200 mg Fe2+

Question 39

ferrous sulfate

Answer 39

• 3 tabs~ 200 mg Fe2+

Question 40

ferrous gluconate

Answer 40

5 tabs~ 200 mg Fe2+

Question 41

how do you take iron

Answer 41

``` on empty stomach • Separate from food, especially diary • Separate from antacids Dose: 65-200 mg elemental iron per daily in divided doses start at lower dose and titrate up ```

Question 42

iron dextran

Answer 42

``` • IVP: 100 mg undiluted at ≤ 50 mg/min • IVPB : 500-1000 mg in 250 mL of NS infused over 3-4 hours (for a larger dose) Adverse effects • Anaphylaxis • 25 mg test dose required • Monitor for 1 hour ```

Question 43

Sodium ferric | gluconate

Answer 43

``` • 125 mg IV over 1 hour • Off label: 250 mg but associated with higher incidence of adverse effects Adverse effects • Cramps • Nausea/vomiting • Hypotension ```

Question 44

blackbox warning for ferumoxytol (feraheme)

Answer 44

serious hypersensitivity/anaphylaxis reactions

Question 45

total iron deficit in mg

Answer 45

= [total body weight in kg X (target Hb-actual Hb in g/dL) x 2.4] +500

Question 46

blood transfusions

Answer 46

Patients with active bleeding unstable hemodynamics • Hb < 7 g/dL temporary solution