Exam 3 Anemia

Question 1

General cell count

Answer 1

Men: RBC 4.5-6.2, Hgb 13.5-18, Hct 40-54
Women: RBC 3.5-5, Hgb 12-15, HCT 37-47

Question 2

anemia r/t VB12 etiology

Answer 2

VB12 deficiency usually from deficiency in hydrochloric acid or pancreatic enzymes which causes an inability to break down

Question 3

General Classifications

Answer 3

Classification:
Macrocytic: V B12 def, pernicious, folate def
Normocytic: mild forms of macro, mirco anemias, kidney disease
Mircocytic: Iron def, Anemia of chronic disease

Question 4

General Sxs

Answer 4

SXS: SOB, palpitations, fatigue, alt concentration, anorexia, tachycardia, pallor

Question 5

Reticulocyte count

Answer 5

Elevated: probable blood loss or hemolysis

Low: anemia of marrow failure

Question 6

causes of anemia of VB12 deficiency

Answer 6

Lack of dietary intake: strict vegetarian and vegans (B12 comes from animal)

Gastrectomy: Eliminate sit of intrinsic factor production

Competition:
Blind Loop Syndrome: Competition for VB12 by bacterial overgrowth in the lumen
Tapeworm:

Decreased ileal B12 Absorption:
Surgical Resection: eliminate the site of VB12 absorption
Crohn’s:

Question 7

Dx of anemia of VB12 deficiency

Answer 7

1) Macrocytic
2) megaloblastic Blood Smear:
Maro-ovalocyte: megaloblastic
Anisocytosis: increased variation of RBC size
Poikilocytosis: hypersegmented neutrophils
3) Low VB12 levels ( <170….symptomatic <100)

****takes 3 years to deplete stores of VB12

Question 8

Lab of anemia of VB12 deficiency

Answer 8

MCV >100 (but can be normal if co-existing Iron deficiency anemia or Thalassemia).

VB12 <100

Megaloblasitc blood smear:

 1) Anisocytosis: increased variation if RBC size (RDW >14.4)
 2) Poikilocytosis: hypersegmented neutrophils
 2) Macro-Ovalocytes

Serum folate: Increased (> 20)

Serum Ferritin: Increased (>50)