Anemias

Question 1

According to WHO, an Hb level of <___ g/L in men and <___ g/L in nonpregnant women can be used to diagnose anemia

Answer 1

<130 men

<120 women

Question 2

Blood is made up of 3 components:
1.
2. Buffy coat
3.

Answer 2

1. plasma
2. hematocrit

Question 3

What are erythrocytes?

Answer 3

Red blood cells

Question 4

Hemoglobin is part of red blood cell that?

Answer 4

Carries oxygen

Question 5

Anemia results from decreased level of _______ or RBCs

Answer 5

Hemoglobin

Question 6

Clinical presentation of someone with anemia:
1.
2.
3.

Answer 6

1. Weakness
2. Fatigue
3. Pale

Short of breath, dizzy, edema, tachycardia

Question 7

What is hematopoiesis?

Answer 7

Maturation of blood components

Question 8

What is erythropoiesis?

Answer 8

Development of red blood cells

Question 9

____ is the regulatory hormone required for RBC production. Kidney’s produce it in response to reduced oxygen levels

Answer 9

EPO, it stimulates the bone marrow

Question 10

Normal development of RBCs require adequate ____, vitamin ___ and ____

Answer 10

folate vitamin b12 iron

Question 11

An immature red blood cell is called a:

Answer 11

Reticulocyte, just before a red blood cell is formed (Erythrocyte)

Question 12

The ratio (%) of total volume RBC to the total volume of blood is called _________

Answer 12

hematocit

Question 13

Reticulocyte count is the % of ____________ produced and circulating compared to circulating _______

Answer 13

Reticulocytes compared to erythrocytes

Question 14

The amount of iron bound to transferrin is known as

Answer 14

Serum Iron

Question 15

_________ is the main protein in the blood that binds to iron and transports it throughout the body.

Answer 15

Transferrin

Question 16

Transferrin SAT (TSAT) is the ?

Answer 16

% iron-binding sites used on transferrin (aka. how much of your stored iron can be used to make new RBC)

A reduced level (<20%) reflects iron deficiency while an elevated level (>50%) indicates iron overload.

Question 17

TIBC is the amount of iron that could bind to ________

Answer 17

transferrin

High TIBC + low serum iron = iron deficiency anemia

Question 18

_____ and _____ are required in erythropoiesis to generate RBC

Answer 18

Vitamin b12 and folate

Question 19

______ is an iron-storage protein

Answer 19

Ferritin (how much iron stored in the body)

Question 20

The 3 types of anemia are:
1.
2.
3.

Answer 20

1. Microcytic
2. Normocytic
3. Macrocytic

Question 21

______________ typically presents as a microcytic anemia with a low MCV

Answer 21

Iron Deficiency anemia (IDA)

Question 22

A patient with iron deficiency anemia will present with:
1. ______ serum ferritin
2. ______ hemoglobin
3. ______ serum iron
3._______ TIBC
4. Microcytic RBC

Answer 22

Low
Low
Low
Increased (high binding capacity, just not enough iron to bind)

Question 23

Microcytic anemia occurs as a result of impaired hemoglobin synthesis. It can be caused by:
1. IDA
2.

Answer 23

Thalassemia

Question 24

Common causes of iron deficient anemia:
1.
2.

Answer 24

1. Chronic blood loss
2. inadequate intake

pregnancy, poor absorption, chronic renal failure

Question 25

Symptoms specific to iron deficiency anemia: 1. 2 3. atrophic glossitis (inflammation of the tongue) 4. inflammation around mouth

Answer 25

1. Koilonychia (concave nails) 2. PICA (cravings for non-nutritive substances such as clay, ice, cornstarch)

Question 26

Dietary Iron: Average all males/females: Menstruating females: Pregnant females:

Answer 26

10 15 30 elemental

Question 27

Iron from plant sources (non-heme) is more or less absorbable?

Answer 27

3x less than from animal (heme) sources

Question 28

First line treatment for IDA? 1.

Answer 28

1. Oral Iron supplementation

Question 29

Second line treatment for IDA ? 2.

Answer 29

2. Parenteral iron therapy reserved for patients who are unresponsive to oral, CKD, malabsorption, need rapid iron, chronic blood loss, gastric resection careful it can cause anaphylaxis or hypotension

Question 30

Common side effects of oral iron?

Answer 30

GI, constipation, dyspepsia

Question 31

These two forms of iron may be better tolerated than iron salts but are less efficacious? 1. 2.

Answer 31

Polysaccharide iron complex (FeraMAX) Heme iron polypeptide (Proferrin) (bovine source)

Question 32

Elemental iron in each product: Ferrous fumarate: Ferrous sulfate: Ferrous gluconate: FeraMax

Answer 32

100 60 35 150

Question 33

Oral iron therapy is best absorbed on ______, absorption can be increased with ______, and calcium antacids tea coffee red wine ______ absorption

Answer 33

empty stomach (can take with food if unable to tolerate) vitamin c decrease Treatment may continue for 3-6 months once Hb normalizes, sometimes life long

Question 34

Normocytic anemia is typically due to the following: 1. 2. 3.

Answer 34

1. Anemia of chronic disease 2. Acute blood loss 3. Hemolytic anemias (spherocytosis, sickle cell anemia)

Question 35

In normocytic anemia, A ___ reticulocyte count is indicative of anemia of chronic disease

Answer 35

LOW

Question 36

In normocytic anemia, A ____ reticulocyte count is indicative of: 1. Acute blood loss 2. Hemolytic anemias

Answer 36

HIGH (body is pumping out lots of reticulocytes instead of RBC) Acute blood loss or Hemolytic anemias

Question 37

The following are examples of hemolytic anemias: 1. 2.

Answer 37

Spherocytosis (blood disorder, sphere shaped RBC) Sickle cell anemia (constant RBC shortage due to abnormal C shape RBC which die early)

Question 38

Anemia of chronic disease common presentation: MCV: CRP: Ferritin: Serum Iron: TIBC:

Answer 38

MCV: normocytic CRP: HIGH Ferritin: normal or high Serum iron: low TIBC: low > During inflammation your CRP is elevated, and this causes INC in Hepicidin, it acts to sequester iron from invading bacteria by removing iron from circulation. DEC SERUM iron, INC iron stores. TIBC is low since already lots stored

Question 39

Medications that interact with iron include: 1. 2. 3. 4. cholestyramine 5. levodopa 6. sodium bicarbonate

Answer 39

1. fq 2. tetracyclines 3. PPI

Question 40

Megaloblastic anemias arise because of impaired DNA synthesis of the RBC caused by deficiencies of vitamin ___ or ______

Answer 40

B12 or Folate

Question 41

Megaloblastic anemia lab values: MCV: Folate: B12:

Answer 41

INC Dec Dec

Question 42

Folate deficiency anemia specific symptoms include: 1. 2.

Answer 42

Decreased weight due to loss of appetite swollen red tongue

Question 43

Duration of folate therapy in folate deficiency anemia is typically up to __ months

Answer 43

4 months (sometimes life long) whereas B12 is usually life long

Question 44

Vitamin ___ deficiency must be ruled out before starting folic acid

Answer 44

B12 - folic acid supplementation can mask b12 deficiencies which allows the underlying neuropathy to persist

Question 45

Vitamin b12 deficiency anemia is typically due to alcoholics, vegans and elderly. However it may also be caused by this medication:

Answer 45

Metformin

Question 46

Vitamin b12 deficiency anemia may present with symptoms like: 1 2

Answer 46

1 fatigue 2 headache palpitations SOB ataxia vision loss

Question 47

Vitamin b12 deficiency anemia must be treated ASAP due to:

Answer 47

possible neurological damage