Exam 3 - Anemia

Question 1

List signs/symptoms of anemias?

Answer 1

fatigue/weakness/exercise intolerance, HA/dizziness, angina/tachycardia/ischemia, paleness

Question 2

Explain hemoglobin (Hgb)?

Answer 2

provides an estimate of oxygen-carrying capacity of RBCs

Question 3

Explain hematocrit (Hct)?

Answer 3

provides percentage of RBCs to total volume of blood

Question 4

Explain low, normal, and high mean cell volumes (MVC)?

Answer 4

low = microcytic (<80), normal = normocytic (80-100), high = macrocytic (>100)

Question 5

Explain low and high reticulocyte counts?

Answer 5

low = impaired RBC production (anemias), high = acute blood loss or hemolysis

Question 6

What is the most common macrocytic anemia? List other causes?

Answer 6

pernicious anemia; alcoholism, poor nutrition, GI disorders, pregnancy, drugs (metformin, PPIs/H2RAs)

Question 7

Explain pernicious anemia?

Answer 7

causes B12 deficiency due to lack of intrinsic factor

Question 8

Why does the MCV increase in macrocytic anemia?

Answer 8

B12 is needed for RBCs to mature and condense

Question 9

List changes required for macrocytic anemia diagnosis? (4)

Answer 9

low Hgb, high MCV, low reticulocyte, low serum B12 or folate

Question 10

What is not elevated in folate deficiency and can help in diagnosis?

Answer 10

methylmalonic acid (MMA)

Question 11

What is another laboratory marker that can suggest B12 or folate deficiency?

Answer 11

homocysteine (increase)

Question 12

List clinical manifestations for B12 deficiency? (3)

Answer 12

cutaneous (hyperpigmentation, jaundice), hematologic, neuropsychiatric (dementia-like symptoms)

Question 13

When is injectable B12 preferred?

Answer 13

GI absorption issues

Question 14

What are AEs of folic acid (vitamin B9) supplementation?

Answer 14

well-tolerated, flushing, malaise, pruritus

Question 15

List causes of microcytic anemia? (3)

Answer 15

iron deficiency, sickle cell disease, thalassemia

Question 16

Explain ferritin and its role?

Answer 16

keeps iron bound and is found in abundance in the bone marrow

Question 17

What is considered iron deficiency anemia?

Answer 17

<15 ng/mL (but levels <41 can also manifest disease)

Question 18

What is considered an elevated total iron binding capacity (TIBC)?

Answer 18

> 400 mcg/dL

Question 19

List changes required for microcytic anemia diagnosis? (4)

Answer 19

low Hgb, low MCV, low reticulocyte, low iron/ferritin/TSAT

Question 20

What is treatment for iron deficiency anemia?

Answer 20

100-200 mg elemental Fe per day

Question 21

What decreases iron absorption? What increases?

Answer 21

food, high gastric pH (H2RAs/PPIs); vitamin C

Question 22

What % elemental Fe is ferrous gluconate?

Answer 22

12%

Question 23

What % elemental Fe is ferrous sulfate?

Answer 23

20%

Question 24

What % elemental Fe is ferrous fumarate?

Answer 24

33%

Question 25

Which Fe products are 100% elemental Fe? (2)

Answer 25

ferric citrate, polysaccharide iron complex

Question 26

Which patients is parenteral iron generally reserved for? (4)

Answer 26

CKD, unable to tolerate, GI issues (celiac, bypass), alternative to blood transfusions

Question 27

What is a pearl for sodium ferric gluconate (Ferrlecit)?

Answer 27

benzoyl alcohol toxicity in newborns

Question 28

What is a pearl for iron sucrose (Venofer)?

Answer 28

safe in pregnancy

Question 29

What is a pearl for iron dextran complex (INFeD)?

Answer 29

rarely used due to initial test-dose requirement

Question 30

What do the KDIGO guidelines recommend regarding iron therapy in CKD patients?

Answer 30

TSAT 30% or less and ferritin 500 ng/mL or less

Question 31

What do the KDOQI guidelines recommend regarding iron therapy in CKD patients?

Answer 31

TSAT 20% or less and ferritin 100 ng/mL or less (non-HD) and 200 ng/mL or less (HD)

Question 32

When should an ESA be administered?

Answer 32

Hgb < 10 g/dL

Question 33

List the BBWs for ESAs? (3)

Answer 33

increased risk of death, MI/stroke/VTE, tumor progression (all when Hgb >11 g/dL)