Anemias

Question 1

Anemia signs

Answer 1

Pallor
tachycardia to move oxygen around

Men Hgb below 13
Women Hgb below 12

Question 2

Causes of decreased RBC (anemia)

Answer 2

Iron
vitB12, folate
Copper

Thalassemia
Erythropoietin deficiency, hypothyroid
Sickle cell
Sideroblastic

Question 3

Iron deficient

Answer 3

Cells are pale, Hypochromic
small - iron lacking in the center of the cell

High total iron binding capacity b/c empty mitt
Low ferritin stores

Shrunken
Low MCV
Low MCH

Question 4

VitB12, Folate deficiency

Answer 4

B stands for big

High MCV
High MCH

Question 5

B12 deficiency symptoms

Answer 5

Anemia, pancytopenia

Neurological symptoms due to lack of methionine formation (neuron integrity)

Hypersegmented poly

Question 6

Anemia symptoms

Answer 6

Fatigue, shortness of breath
Angina - lack of O2 to heart
Tachycardia
Dizziness

Question 7

Folate deficiency

Answer 7

no neuropathy symptoms

Question 8

High reticulocyte count

Answer 8

Sign of hemolysis, increased destruction

Also G6PD deficiency

Question 9

Low reticulocyte count

Answer 9

Sign of hypoproliferation, decreased production of RBC

Question 10

Functional iron deficiency

Answer 10

Adequate iron stores, but insufficient use to erythroid precursors

Lab values High TIBC, low MCV, low MCH

Give IV iron to be better utilized

Question 11

Risk factors for iron deficiency anemia

Answer 11

Vegetarian diet
Menstruating, pregnant
Children 
Excessive exercise athlete
Low stomach acid 
Ulcers, Crohn's, 
NSAIDs

Question 12

Drugs that decrease iron absorption

Answer 12

PPI, H2RA
Cholestyramine
Doxycycline

Question 13

IDA treatment

Answer 13

120mg/day x 3 months

Question 14

Sources of folic acid (vitB9)

Folic foliage

Answer 14

Vegetables fruits, fortified breads cereal

Treatment: 1mg/day

Question 15

Vitamin B12 sources

Answer 15

Treatment 1-2mg/day PO/IM

Diet: meat, fish, poultry, fortified cereal

Question 16

Chronic kidney disease anemia: hemoglobin goals

Answer 16

Hgb goal is 11-12g/dL

Treat ESA if less than 10 until over 11

CHOIR: 11.3 is ideal goal
CREATE: start less than 10.5, until 11.5

Question 17

Aplastic anemia

Aplastic transfusion

Answer 17

Chemotherapy, radiation
Toxins, autoimmune
Aspirin, lisinopril, captopril, chlorpromazine

1) cyclosporine immunosuppression

Transfusion (CIA)
Risk: reaction, infection, CHF, iron overload
Benefit: rapid Hgb increase of 1 and improved fatigue, possible survival benefit

Question 18

Inherited anemias : sickle cell disease infection preventative care

Answer 18

Annual retinal examination
PCV13, PPSV23
Pen VK 125mg prophylaxis until age 3
Erythromycin if penicillin allergy
Folic acid Vit B

Question 19

Recurrent SCD pain

Answer 19

Hydroxyurea

Question 20

Medications to avoid in hemolytic G6PD deficient anemia

Answer 20

Antimalarial drugs- hydroxychloroquine
Aspirin, NSAIDs
Nitrofurantoin
Sulfa drugs 
Quinidine, quinine

Question 21

Inflammatory anemia

Infection

Answer 21

Inflammatory occurrence, poor utilization
Hepcidin blocks iron release from stores

High ferritin, low TIBC

Question 22

Pernicious anemia

Answer 22

Treat with IM B12 1-2mg

Question 23

Erythropoietin stimulating agent goal

Answer 23

Avoid transfusion