Anemias

Question 1

What is the general rule for blood transfusion in patients with anemia?

Answer 1

Hb concentration below 7g/dL
or
patient requires increased O2 carrying capacity like in patients with CAD or other cardiopulmonary disease

Question 2

best place to look for pallor in a patient with anemia

Answer 2

conjunctiva

Question 3

What are the next two tests needed once an H/H reveals anemia?

Answer 3

MCV

Reticulocyte count

Question 4

How much does a unit of packed RBCs increase Hb and Hct?

Answer 4

Hb increases by 1g/dL
Hot increases by 3%
(Hct is Hb x 3)

Question 5

What is contained in the following transfusion products?

1. PRBCs
2. FFP
3. Cryoprecipitate
4. Platelets
5. Whole Blood

Answer 5

1. Only RBCs and plasma (give with normal saline only)
   administer over 90 minutes to 2 hrs
2. All clotting factors (no RBCs/WBCs/platelets)
3. Factor VIII and fibrinogen (hemophilia A, DIC, vWD)
4. Platelets (1 unit raises platelets by 10,000)
5. All blood components (given for massive blood loss)

Question 6

What does the reticulocyte index indicate?

Answer 6

How effective erythropoiesis is in the bone marrow. Index greater than 2% means excessive RBC destruction or blood loss is occurring.

Question 7

What is treatment for a Hemolytic reaction causing massive hemolytic blood cell lysis such as ABO mismatch transfusion?

Answer 7

Fluids to prevent shock and renal failure

Epinephrine for anaphylaxis, dopamine or NorE to maintain blood pressure

Question 8

What is the algorithm if the reticulocyte index is normal? (less than 2%)

Answer 8

Check the MCV

Question 9

What can the 3 different MCV scenarios tell you about anemias with a normal reticulocyte index?

Answer 9

Microcytic (MCV less than 80):
check Fe and TIBC
-if both decreased it is anemia of chronic disease
-if Fe is low and TIBC is high it is iron deficiency anemia
-if both are normal it’s lead poisoning or Thalassemia

If normocytic (MCV between 80 and 99):
-aplastic anemia, fibrosis of bone marrow, tumor, renal failure

If microcytic (MCV above 100:
check vit. B12 and folate

Question 10

How does anemia of chronic disease occur?

Answer 10

Usually in some chronic disease there is a high amount of macrophages in the blood that consume iron. So plenty of iron is still in the body just not available for Hb synthesis

Question 11

Top two causes of Iron deficiency anemia in the US

Answer 11

Menstrual Bleeding and GI blood loss

Question 12

What are the two major treatment modalities of Iron deficiency anemia?

Answer 12

Iron supplementation and/or find the source of a bleed if suspected

Question 13

When is splenectomy needed for Thalassemias?

Answer 13

Beta thalassemia major
Hb H (3 mutations in alpha) thalassemia

Question 14

What is characteristic on blood smear for Thalassemia major

Answer 14

Target Cells

Question 15

What is Sideroblastic anemia?

Answer 15

Mutation in iron metabolism in RBCs. Drugs or inheritance can lead to it. Ringed sideroblasts occur in bone marrow

Question 16

Why is it important to determine B12 vs folate deficiency?

Answer 16

Even B12 deficiency anemia can be corrected by folate supplements but the neurologic components cannot be corrected. So patients may have a masked problem that leads to permanent neurological issues.

Question 17

How long can the liver store B12

Answer 17

3 years

Question 18

Micro bug that can cause B12 def.

Answer 18

Diphyllobothrium latum (fish tapeworm)

Question 19

What occurs in B12 deficiency and NOT in folate def.

Answer 19

Neuropathies: demyelination of posterior columns, lateral corticospinal tracts, spinocerebellar tracts

So the results are ataxia, UMN signs, urinary and fecal incontinence, dementia

Question 20

How long can folate last in the body?

Answer 20

3 months

Question 21

How can labs distinguish B12 from folate deficiency?

Answer 21

B12: both homocysteine and methylmalonic acid levels increased

Folate: only homocysteine increased