Anemias

Question 1

What are some symptoms of anemia?

Answer 1

red eyes, fainting, angina

Question 2

What are ranges for hemoglobin, hct, RBC count

Answer 2

hemglobin male: 13.6-17.2, female = 12-15
hct male: 39-49, female = 33-43
RBCs male 4.3-5.9 female = 3.5-5

Question 3

What are ranges for reticulocyte % and RBC distribution width

Answer 3

reticulocyte% = 0.5-1.5
width = 11.5-14.5

Question 4

Whole blood (red blood cells, plasma, white blood cells, and platelets) are all being lost in same ratio. Caused by laceration

Answer 4

normocytic/chromic

Question 5

What are examples of antibody mediated RBC destruction?

Answer 5

Hemolytic disease of the newborn
Transfusion reactions
Drug-induced
Autoimmune

Question 6

What deficiencies cause dec in RBC production?

Answer 6

1. Nutritional deficiencies of DNA synthesis: B12 deficiency, Folate deficiency
2. Deficiencies of hemoglobin synthesis: Iron deficiency
3. Erythropoietin deficiency: Renal disease, Anemia of chronic disease
4. Inflammation does iron sequester which can cause anemia
5. Infection via parvovirus B19

Question 7

What are inherited anemia diseases?

Answer 7

Sickle cell - 2 or 1 abnormal beta globin genes
Thalassemia - reduced synthesis of a/B chains, microcytic, RBCs usually elevated.

Question 8

where are alpha and beta thalassemia most prevalent?

Answer 8

alpha in asia and far east
beta in mediterranean

Question 9

pts have vaso-occlusive crises that lead to chronic pain, bone deformities, acute chest syndrome, and strokes. Chronic hemolysis so need frequent transfusions, pain management, hydration, and possible red cell exchange

Answer 9

sickle cell anemia

Question 10

What are treatments for sickle cell anemia?

Answer 10

A level of anemia is actually protective in sickle cell anemia. Generally, do not want hemoglobin > 10 g/dL or hematocrit >30%
Hydroxyurea – increases production of HbF
Folic acid supplementation
Simple transfusion
Exchange transfusion
Vaccinations & antibiotic due to autosplenectomy
Allogeneic stem cell transplant for cure

Question 11

What are treatments for thalassemia?

Answer 11

Regular RBC transfusions to keep hemoglobin over 7 g/dL
Folic acid supplement
Iron chelation therapy
Splenectomy to decrease extravascular hemolysis
Endocrine therapy
Immunizations to compensate for splenectomy
Allogeneic stem cell transplant for cure

Question 12

What are mechanical causes of anemia?

Answer 12

Microangiopathic hemolytic anemia (schistocytes)
Hemolytic uremic syndrome, Defective or mechanical valves or ventricular assist devices, Repetitive physical trauma “march” hemolysis, infections (malaria, babeosis), chemicals, membrane lipid abnormalities

Question 13

a laboratory value that measures the average size and volume of a red blood cell

Answer 13

MCV

Question 14

is a calculation of the average amount of hemoglobin contained in each of a person’s red blood cells

Answer 14

MCH

Question 15

What are MCV values of micro, normo, and macrocytic

Answer 15

micro - <80fL, normo (80-100fL), macro >100fL

Question 16

test measures the differences in the volume and size of your red blood cells

Answer 16

RDW

Question 17

If a cell is microcytic (small in size/volume), but have normal RDW

Answer 17

minor thalassemia, chronic anemia

Question 18

If a cell is microcytic (small in size/volume), but have high RDW

Answer 18

Fe deficiency, thalassemia, Hb H

Question 19

if a cell is normocytic with normal RDW

Answer 19

acute bleeding

Question 20

if cell is normocytic with high rdw

Answer 20

fe/vitamin deficiency, sickle cell disease

Question 21

if cell is macrocytic with normal rdw

Answer 21

aplastic anemia

Question 22

if cell is macrocytic and high rdw

Answer 22

vitamin B12/folate deficiency

Question 23

loss of RBCs increase production of

Answer 23

reticulocytes

Question 24

Is there an increase or decrease of reticulocytes in: Anemia of chronic disease, Renal disease, Endocrine disorders, Liver disease, Stem cell disease, Bone marrow replacement

Answer 24

decrease in reticulocytes

Question 25

What are causes of microcytic anemia?

Answer 25

Disorders of Fe metabolism, disorders of heme/globin synthesis, or chronic inflammation

Question 26

Symptoms of iron deficiency

Answer 26

Fatigue, tachycardia, Pica, Spooned fingernails, Glossitis, Angular chelatitis

Question 27

where is iron in chronic anemia

Answer 27

sequestered in macrophages

Question 28

measure of the ferric (Fe3+) ions bound to serum transferrin, variation due to multiple factors (not best measure of iron status)

Answer 28

serum iron

Question 29

percentage of transferrin that is bound to iron, more accurate measure of total body iron than the serum iron concentration

Answer 29

Total iron binding capacity

Question 30

transport protein that binds to iron in plasma, proportional to the total iron binding capacity saturation

Answer 30

transferrin

Question 31

intracellular iron storage protein correlates to body’s total iron stores

Answer 31

serum ferritin

Question 32

rarely performed in clinical practice. Its main utility is in differentiating iron deficiency from anemia of chronic disease

Answer 32

soluble serum transferrin

Question 33

what are causes of macrocytic anemia

Answer 33

Alcoholic and nonalcoholic liver disease
Drug effect
Nutrient deficiency (folate and B12)
Reticulocytosis/accelerated erythropoiesis

Question 34

What are causes of folate deficiency?

Answer 34

Nutritional,, Malabsorption – celiac, Crohn’s,
Physiologic (pregnancy, lactation, prematurity),
Pathologic (hematologic diseases, hemolytic anemias (inc. sickle cell dz), malignancy, inflammatory disease)
Excess urinary folate loss
Drugs – anticonvulsants
Mixed – Liver disease, alcoholism, intensive care

Question 35

symptoms of B12 deficiency

Answer 35

Megaloblastic anemia
Angular stomatis
Macrocytosis of epithelial surfaces
glossitis
Neuropathy (B12 only)

Question 36

If large doses of folic acid are given in B12 deficiency …

Answer 36

hematologic response with aggravation of neuropathy
but need to give in pregnancy