Anemias

Question 1

Microcytic Anemias

Answer 1

Low MCV.

• Thalassemia
• Iron Deficiency
• Chronic Disease
• Sideroblastic Anemia

Question 2

Whats the most common cause of iron deficiency anemia in the US?

Answer 2

Blood loss: either occult or acute.

- Generally GI

Question 3

Average iron storage in adult man?

Answer 3

10mg/kg

Question 4

Usual anemia presenting symptoms

Answer 4

Weakness, HA, Irritability, fatigue, exercise intolerance.

Many patients are asymptomatic

Question 5

Pica

Answer 5

Cravings for food not fit for consumption. Dirt, paper, ice.

Question 6

Pagophagia

Answer 6

Pica for ice. Considered quite specific for the iron deficiency state.

Question 7

Gold standard for diagnosing iron deficiency.

Answer 7

Low serum ferritin (iron stores).
Serum iron: reduced
Total iron binding capacity: increased
Transferrin sat: low

Question 8

RDW

Answer 8

Measures anesiocytosis

Test measuring the variation of size in red blood cells.

Question 9

Microcytic anemia with low or normal RDW = ?

Answer 9

Chronic disease or thalassemia

Question 10

Microcytic anemia with high RDW = ?

Answer 10

Iron deficiency anemia.

Question 11

Anemia of chronic disease

Answer 11

Occurs in the setting of chronic inflammatory diseases.
EPO is low, serum iron is reduced.
ferritin is high(ddx from IDA)
usually normocytic, can be micro

Question 12

Diseases than are commonly associated with ACD?

Answer 12

RA, SLE
HIV, TB
Carcinomas, lymphomas, leukemias

Question 13

Megaloblastic Macrocytic Anemias

Answer 13

Abnormalities in DNA metabolism.

• B12 and Folate deficiency
• Drug side-effects

Question 14

Absorption of B12 depends on these 5 things.

Answer 14

Adequate dietary intake
Acid-pepsin in stomach
Intrinsic factor
Pancreatic proteases
Functional ileum

Question 15

Total body stores of cobalamin

Answer 15

The average stores of B12 are 2 - 5 milligrams

Question 16

Pernicious Anemia

Answer 16

Autoimmune disease where parietal cells fail to release intrinsic factor in the stomach.

Question 17

Lab results that ddx B12 from folate deficiency?

Answer 17

Elevated homocysteine (HC) AND Methylmalonic acid (MMA).
Folate is just elevated HC

Question 18

B12 deficiency tx

Answer 18

1000 mg B12 daily for a week, weekly for a month, monthly for life.

Question 19

Most common cause of folate deficiency?

Answer 19

Nutritional due to poor diet and or alcoholism.

Question 20

Non-megaloblastic macrocytic anemias?

Answer 20

Alcoholism
Liver disease
Aplastic anemia
drug-induced
pregnancy
myeloma
hypothyroidism

Question 21

DDx for normocytic anemia

Answer 21

NORMAL SIZE HEM

Question 22

Anemia of chronic renal failure.

Answer 22

different from chronic disease anemia. Much more severe.

Give EPO!

Question 23

Mixed anemia

Answer 23

Order peripheral smear because many different cells.
High RDW (many different sized cells), but MCV may be normal because the AVERAGE is in the normal range.

Question 24

Reticulocyte count

Answer 24

Usually make up about 1% (stain blue)
Usually reticulocytes circulate in blood for one day before maturing.
Elevated count shows that bone marrow is responding to anemia and producing more cells.

Question 25

3 areas where reticulocyte count is appreciated

Answer 25

Acute blood loss Hemolytic anemia Response to iron, B12, folate replacement

Question 26

Anemia of acute blood loss

Answer 26

Source is usually quite clear Generally takes 24 hours for Hgb to drop. Reticulocytosis may result in mild macrocytic anemia.

Question 27

Which test cal determine of a hemolytic anemia is immune?

Answer 27

Direct Coomb's Test. Perform once you know the anemia is hemolytic.

Question 28

Lab tests for hemolysis

Answer 28

Decreased Haptoglobin: bound with damages cells Elevated D.Bili: porphyrin concerted to Bili Elevated Lactate dehydrogenase (LDH): released from hemolysed RBC's

Question 29

HUS

Answer 29

Hemolytic urea syndrome. Cause by E-coli. Generally happens in kids and causes kidney failure.

Question 30

Heriditary Hemochromatosis

Answer 30

Excess Iron. Harrison's disease. Iron is deposited in many tissues and damages them.

Question 31

What cells go with lead?

Answer 31

Stippling.

Question 32

What does iron in tissues produce?

Answer 32

Hydrogen peroxide is converted to free radical ions. Can cause cancers, cardiac toxicity and many other factors

Question 33

Hemochromatosis liver pathology

Answer 33

Usually first organ affected Hepatomegaly present in 95% Most common cause of death in treated pt's.

Question 34

Hemochromatosis Cardiac Pathology

Answer 34

Presenting in 15% of patients. | Mostly CHF and arrhythmias.

Question 35

Hemochromatosis Pancreatic Pathology

Answer 35

Causes diabetes in 65% of patients | Generally have family hx of diabetes

Question 36

Hemochromatosis Skin Pathology

Answer 36

Excessive skin pigmentation present in 90% of symptomatic pt's. Metallic hue

Question 37

Hemochromatosis Pituitary pathology

Answer 37

Hypogonadism | Decreased libido, no period, manboobs

Question 38

Hemochromatosis Joint pathology

Answer 38

Arthritic changes in 25 - 50% of pts Often starts in hands Pseudogout can occur

Question 39

Hemochromatosis Lab Dx

Answer 39

Transferrin > 50% Elevated serum ferritin DNA testing

Question 40

Hemochromatosis Tx

Answer 40

Phlebotomy | Take off blood volume, removes iron as well.