Anemia/thyroid

Question 1

Iron

Answer 1

Necessary for production of hemoglobin and proliferation of RBCs.

Critical values: >800 mcg/dL fatal poisoning

Not a sole measure of anemia use in conjunction with other measure

Question 2

Increased iron

Answer 2

Thalssemia,
acute iron poisoning,
iron-overload syndrome,
lead poisoning,
multiple transfusions

Question 3

Decreased iron

Answer 3

iron-deficiency anemia,
chronic blood loss,
chronic disease,
third-trimester of pregnancy,
inadequate iron absorption

Question 4

Transferrin Saturation & values

Answer 4

Transferrin saturation is an index of iron saturation

Protein that carries iron through the blood and into parts of the body

Question 5

Increased Transferrin Saturation

Answer 5

increased iron intake
acute liver disease

Question 6

Decreased Transferrin Saturation

Answer 6

iron deficiency anemia, malignant, anemia of chronic disease

Question 7

Ferritin

Answer 7

Measure of iron stores. Reliable and sensitive assessment of body stores
– determine your body’s total iron storage capacity.

Critical: <10 complete exhaustion of stores / iron deficiency

Question 8

Total Iron Binding Capacity (TIBC)

Answer 8

• correlates with serum transferrin.
  Evaluates how much iron is available for tissues of the body to use / bound to blood

Question 9

Reticulocyte Count

Answer 9

Immature RBCs that circulate in blood for 24 hours before they mature
The body’s response to anemia

Question 10

Increased Reticulocyte Count

Answer 10

hemolytic anemia,
3-4 days after hemorrhage, after treatment for anemia

Question 11

Decreased Reticulocyte Count

Answer 11

untreated iron deficiency anemia,
aplastic anemia,
anemia of chronic disease,
alcoholism

Question 12

Vitamin B12

Answer 12

• Necessary for production of RBCs. It is obtained only from ingestion of animal protein and requires intrinsic factor for absorption.

Question 13

Increased Vitamin B12

Answer 13

liver disease, diabetes, obesity

Question 14

Decreased Vitamin B12

Answer 14

pernicious anemia,
malabsorption,
zollinger-Ellison syndrome (pancreatic or intestinal tumors),
insufficient dietary intake

Question 15

Folate

Answer 15

• Formed by bacteria in the intestine, stored in the liver, and required for DNA production. Needed for normal RBC and WBC function

Question 16

Increased Folate

Answer 16

vegetarian diet

Question 17

Order thyroid profile if:

Answer 17

• Heart palpitations or irregular beat
• New onset A-fib
• Rapid unexplained weight loss or weight gain, nervousness, insomnia
• Unexplained menstrual disorders, myalgia, fatigue, weakness, constipation, hyperlipidemia, anemia
• Family history; DM, high triglycerides, autoimmune disorders
• Medications: lithium or amiodarone

Question 18

Thyroid stimulating hormone (TSH)

Answer 18

Single MOST SENSITIVE test for primary hypothyroidism, hyperthyroidism
- The best way to initially test thyroid function is to measure TSH level in a blood sample.

Question 19

TSH critical value

Answer 19

< 0.1 mlU/L > primary hyperthyroidism or exogenous thyrotoxicosis increases risk of A fib> CVA

Question 20

Increased TSH

Answer 20

primary hypothyroidism,
Hashimoto’s disease (most common form of hypothyroidism)

Question 21

Decreased TSH

Answer 21

hyperthyroidism, over replacement of hypothyroidism

Question 22

Thyroxine T4 (Free T4)

Answer 22

T4 circulates in the blood in two forms:
T4 & free T4
- Combining the TSH test with the FT4 or FTI accurately determines how the thyroid gland is functioning.

Question 23

T4

Answer 23

bound to proteins that prevent the T4 from entering the various tissues that need thyroid hormone

Question 24

Free T4:

Answer 24

• enter the various target tissues to exert its effects
• most important to determine how the thyroid is functioning.

Question 25

Increased Thyroxine T4 (Free T4)

Answer 25

Grave’s disease,
hypothyroidism with over treatment,
Hyperthyroidism

Question 26

Decreased Thyroxine T4 (Free T4)

Answer 26

hypothyroidism

Question 27

A low TSH and low FT4 or FTI indicates

Answer 27

hypothyroidism due to a problem involving the pituitary gland

Question 28

A low TSH with an elevated FT4 or FTI

Answer 28

hyperthyroidism.

Question 29

Total Triiodothyronine (T3)

Answer 29

Useful to diagnose hyperthyroidism or the severity of hyperthyroidism
- Rarely helpful in hypothyroidism since its the last test to become abnormal

Critical value: <50 ng/dL

Question 30

Increased T3

Answer 30

hyperthyroidism,
graves disease,
iodine deficiency goiter,
Estrogen (OCP or pregnancy)

Question 31

Decreased T3

Answer 31

hypothyroidism, starvation

Question 32

during pregnancy or while taking birth control pills, high levels of total T4 and T3 can exist:

Answer 32

because the estrogens increase the level of the binding proteins. In these situations, it is better to ask both for TSH and free T4 for thyroid evaluation.

Question 33

Primary hypothyroidism

Answer 33

High serum TSH
Low serum free T4 & T3

Question 34

Subclinical hypothyroidism

Answer 34

High TSH
Normal serum free T4 & T3

Question 35

Primary hyperthyroidism

Answer 35

Low serum TSH
- High serum free T4 & T3

Question 36

Subclinical hyperthyroidism

Answer 36

Low serum TSH
Normal Serum free T4 & T3

TSH <0.1 = RED FLAG for hyperthyroidism

Question 37

Hemoglobin A1C

Answer 37

Represents average glucose for 90-120 days (the life of the RBC)

Critical Value: >8.1%

Question 38

Increased HgB A1C

Answer 38

diabetes
In nondiabetic conditions:
- iron deficiency anemia,
- alcohol toxicity, lead toxicity

Question 39

Decreased Hgb A1C

Answer 39

hemolytic anemia,
chronic blood loss,
chronic renal failure,
pregnancy