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IBI Test 3 > B3-083 Big Case: Anemia > Flashcards

B3-083 Big Case: Anemia Flashcards

1
Q

anemia is defined as

A

decreased RBC mass

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2
Q

anemia is associated with decreased

A

hematocrit
hemoglobin
RBCs

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3
Q

Two exceptions to the definition of anemia

A
  1. acute blood loss
  2. hemodilution
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4
Q

leading cause of anemia worldwide

A

iron deficiency

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5
Q

symptoms of anemia

A

pale conjunctiva
fatigue
pale palms

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6
Q

severe anemia can lead to

A

cardiac insufficiency

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7
Q

3 causes of anemia

A
  1. decreased RBC production
  2. increased RBC destruction
  3. bleeding
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8
Q

what is the best indicator of RBC production?

A

reticulocyte count

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9
Q

RBC lifespan

A

120 days

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10
Q

RBCs are identifiable as reticulocytes for

A

about 1 day

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11
Q

a normal reticulocyte count should be approx.

A

1% of circulating RBCs

about 50,000

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12
Q

an anemia patient’s reticulocyte count would be

A

about 200,000 recticulocytes

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13
Q

a reticulocyte count _______________ indicates a problem with RBC destruction

A

over 200,000

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14
Q

a reticulocyte count _________ indicates a problem with RBC production

A

less than 100,000

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15
Q

in a patient with normal Hct, an absolute reticulocyte count greater than 100,000 suggests

A

ongoing hemolysis or blood loss

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16
Q

RPI

A

reticulocyte production index
corrects for the crit and reticulocyte lifespan

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17
Q

MCV > 100

A

macrolytic

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18
Q

MCV <80

A

microcytic

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19
Q

MCV 80-100

A

normocytic

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20
Q

variation in RBC shape

A

poikilocytosis

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21
Q

variation in RBC size

A

anisocytosis

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22
Q

cells with large, pale centers

A

hyprochromia

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23
Q

iron from [plant or animal sources] is absorbed best

A

animal

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24
Q

most iron comes from

A

diet

5-10% absorbed in proximal intestine

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25
Q

iron is absorbed and oxidized to

A

Fe3+ form

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26
Q

Fe3+ is bound tightly to __________ in blood

A

transferrin

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27
Q

iron is transferred to cells and reduced to Fe2+ form, then inserted into

A

heme or stored

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28
Q

stored iron (Fe3+) is bound to

A

ferritin

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29
Q

is ferritin in plasma?

A

yes some, mostly intracellular

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30
Q

hemosiderin

A

insoluble form of ferritin

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31
Q

peptide produced in the liver

A

hepcidin

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32
Q

hepcidin interacts with _________ to inhibit iron release for villus enterocytes and macrophages

A

ferroportin

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33
Q

hepcidin is upregulated by [high/low] plasma iron levels or inflammation

A

high

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34
Q

low iron levels [decrease/increase] hepcidin, which stimulates iron absorption and release into the blood

A

decrease

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35
Q

mutations in HFE can cause diminished hepcidin release, leading to

A

hereditary hemochromatosis

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36
Q

bound iron is transported in the blood by what?

A

transferrin

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37
Q

the total amount of transferrin in blood

A

total iron binding capacity (TIBC)

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38
Q

reflects body iron stores

A

serum ferritin

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39
Q

serum ferrtin is ________in iron deficiency, and _________ in inflammation

A

low; increases

40
Q

TIBC is _______ in iron deficiency and ________ in inflammation

A

high; normal/low

41
Q

serum iron is ________ in iron deficiency and inflammation

A

low

42
Q

circulating protein derived from the cleavage of the membrane transferrin receptor on erythroid precursor cells

A

sTfR

43
Q

what is the advantage of sTfR?

A

reflects overall erythropoiesis, which is increased in iron deficiency

distinguishes from ACD

44
Q

________mg of iron per day is required for erythropoiesis

A

20

45
Q

most iron is recycled from

A

old RBCs after they are eaten by macrophages

46
Q

excess iron is stored in the

A

liver

47
Q

3 causes of iron deficiency

A
  1. blood loss
  2. failure to meet increased requirements (pregnancy, infancy, etc.)
  3. inadequate absorption
48
Q

symptoms of iron deficiency

A

koilonychia: spoon shaped nails
angular cheilosis: fissuring at corners of mouth
Pummer-Vinson: narrowing of esophagus

49
Q

treatment of iron deficient anemia

A

dietary iron supplement

last resort: transplant

50
Q

most common cause for noncompliance of iron supplements

A

constipation/GI distress

51
Q

indications for IV iron

A

severe symptomatic anemia
failure of oral iron d/t GI intolerance or absorption issues
cancer/chemo
anemia with chronic renal disease
heavy ongoing GI or menstrual blood loss

52
Q

response to oral iron therapy: peak reticulocyte count

A

7-10 days

53
Q

response to oral iron therapy: increased Hb and Hct

A

14-21 days

54
Q

response to oral iron therapy: normal Hb and Hct

A

2 months

55
Q

response to oral iron therapy: normal iron stores

A

4-5 months

56
Q

most common cause of anemia in hospitalized patients

A

anemia of inflammation/chronic disease

57
Q

sfTF Ferritin in ACD

A

decreased

58
Q

transferritin in ACD

A

decreased

59
Q

ferritin in ACD

A

increased

60
Q

marrow iron in ACD

A

no changes

61
Q

ferritin in IDA

A

decreased

62
Q

serum iron in IDA

A

decreased

63
Q

transferrin sat in IDA

A

decreased

64
Q

sfTF in IDA

A

increased

65
Q

marrow iron in IDA

A

decreased

66
Q

thalassemeia is an ________ disorder of hemoglobin production

A

inherited

67
Q

thalassemia is caused by a defect in

A

alpha or beta proteins

68
Q

thalassemia major causes

A

severe microcytic anemia requiring transfusions

69
Q

thalassemia minor causes

A

mild or moderated anemia

70
Q

most important part of diagnosing iron deficient anemia

A

find the etiology

71
Q

preferred site of bone marrow aspiration and biopsy in adults

A

iliac crest

72
Q

can a bone marrow biopsy be taken at the sternum?

A

no, too close to vital organs

only aspiration

73
Q

can a bone marrow biopsy be taken at the sternum?

A

no, too close to vital organs

only aspiration

74
Q

contain RNA in cytoplasm

A

reticulocytes

75
Q

low MCV, low MCHC, high RDW

A

iron deficiency

76
Q

amount of iron absorbed by a normal adult male per day

A

1 mg

77
Q

iron bioavailibilty ranked

A

attached to hemoglobin> Fe2>Fe3

78
Q

inflammatory anemia typically results in a Hgb of

A

.>8 g/dL
mild to moderate anemia

79
Q

in ACD, reticulocyte count is

A

low

80
Q

result of elevated hepcidin levels that develop in response to IL-1, IL-6, INF-a

A

ACD

81
Q

hepcidin decreases iron absorption by causing

A

internalization and proteolysis of ferroportin

82
Q

normal/low serum iron levels

A

ACD

83
Q

low TIBC

A

ACD

84
Q

elevated serum ferritin

A

ACD

85
Q

ACD is initially normocytic, normochromic but can progress to

A

hypochromic, microcytic

86
Q

blood smear for Warm AIHA would show

A

spherocytes

87
Q

blood smear for MAHA would show

A

shistocytes

88
Q

high TIBC

A

IDA

89
Q

high serum transferrin

A

IDA

90
Q

low transferrin saturation

A

IDA

91
Q

normal transferrin saturation

A

25-45%

92
Q

transferrin saturation below 16%

A

IDA

93
Q

low hepcidin

A

IDA

94
Q

high hepcidin

A

ACD

95
Q

iron excretion cannot be

A

physiologically modulated

96
Q

iron absorption takes places in

A

first part of small intestine

97
Q

Hgb should improve within

A

30 days of starting iron replacement therapy

IBI Test 3 (20 decks)

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