Exam 3 - Anemia Rogers Flashcards
male normal hemoglobin range
13.5-18 g/dL
female normal hemoglobin range
12-16 g/dL
normal MCV range
80-100 mm^3
Which of the following patients have anemia?
a. 45 year old female with Hgb 12.5g/dL
b. 28 year old vegetarian diet female with fatigue and MCV 72 mm3
c. 74 year old male with Hgb 12.5g/dL
d. 33 year old male with Hct 36% and RDW of 11.5%
c. 74 year old male with Hgb 12.5g/dL
MCV < 80
a. microcytic
b. normocytic
c. macrocytic
a. microcytic
MCV 80-100
a. microcytic
b. normocytic
c. macrocytic
b. normocytic
MCV > 100
a. microcytic
b. normocytic
c. macrocytic
c. macrocytic
iron deficency, sickle cell, thalassemia
a. microcytic
b. normocytic
c. macrocytic
a. microcytic
anemia of chronic disease, blood loss, hemolysis
a. microcytic
b. normocytic
c. macrocytic
b. normocytic
folic acid and B12 deficiency
a. microcytic
b. normocytic
c. macrocytic
c. macrocytic
CKD, cancer, CHF, and deficiencies in iron, folic acid, and B12 lead to
a. dec RBC production
b. inc RBC destruction
c. inc RBC loss
a. dec RBC production
drugs and sickle cell/thalassemia lead to
a. dec RBC production
b. inc RBC destruction
c. inc RBC loss
b. inc RBC destruction
acute blood loss and chronic NSAIDs/ASA lead to
a. dec RBC production
b. inc RBC destruction
c. inc RBC loss
c. inc RBC loss
most common type of anemia
iron-deficiency anemia
iron deficiency is likely in pts with ferritin < ___ ng/mL
a. 5
b. 30
c. 45
d. 200
c. 45
normal TSAT value range
a. 5-10%
b. 20-50%
c. 50-75%
d. 95-100%
b. 20-50%
iron is best absorbed in which part of the SI?
duodenum
two examples of diseases/surgeries that dec absorption of iron
celiac disease; gastric bypass
heme iron source
a. meat
b. plants or dairy
a. meat
non-heme iron source
a. meat
b. plants or dairy
b. plants or dairy
T or F: vegetarians are more likely to require supplements even if they have adequate iron intake
T (due to iron from diet)
s/sx of iron deficiency anemia (3 of them; slides 31-33)
-spoon-shaped nails (koilonychias)
-inflamed tongue (glossitis)
-pica (craving things with no nutritional value)
two different types of pica
pagophagia -> ice
geophagia -> dirt, soil, clay
which is generally preferred, oral or IV iron?
oral
oral iron for anemia:
-___ mg of elemental iron every other day
-___-___ mg of elemental iron per day (BID or TID)
65; 120-200
exceptions to oral iron (4 of them; slide 35)
Cannot tolerate (side effects)
Cannot absorb
End stage renal disease (ESRD)
Heart failure
it often takes ___-___ months to replete iron stores
3-6
which is FALSE about hepcidin?
a. Iron-regulating peptide hormone produced in the liver
b. Decreases dietary iron absorption and iron transfer to the plasma
c. Hepcidin is increased after a dose of oral iron for ~24 hours and normalizes within 48 hours
d. Hepcidin is decreased during inflammation
d. Hepcidin is decreased during inflammation
(increased)
what % elemental iron is in ferrous fumarate, sulfate, and gluconate?
fumarate -> 33%
sulfate -> 20%
gluconate -> 10%
which has the MOST elemental iron?
a. ferrous fumarate
b. ferrous sulfate
c. ferrous gluconate
a. ferrous fumarate
rare SE of IV iron
skin tattooing
vitamin B12 < ____ pg/mL indicates vitamin B12 deficiency anemia
a. 5
b. 30
c. 200
c. 200
vitamin B12 is aka ?
a. cyanocobalamin
b. cobalamin
c. ferrous sulfate
b. cobalamin
lack of intrinsic factor leads to which kind of anemia?
pernicious anemia
Which of the following patients are NOT at risk of vitamin B12 deficiency anemia?
a. A 22 year old female with a vegan diet
b. A 22 year old female with asthma
c. A 65 year old male who drinks 5 beer per day
d. A 39 year old male taking metformin for type 2 diabetes
b. A 22 year old female with asthma
serum folate < _____ ng/mL typically indicates folic acid deficiency
a. 5
b. 30
c. 200
a. 5
medications that can cause folic acid deficiency (4 of them; slide 53)
methotrexate
phenytoin
sulfasalazine
Bactrim
folic acid deficiency tx
1-5 mg oral folic acid supplement, until hgb normalizes
never replace folic acid without checking ___
B12
which chronic diseases can cause anemia? (4 of them)
CKD
CHF
Cancer
HIV/AIDS
erythropoietin is produced in the _____ and stimulates production of RBCs
a. spleen
b. kidneys
c. liver
d. lungs
b. kidneys
two ways to treat anemia of chronic kidney disease
-avoid blood transfusions
-correct nutritional deficiencies
use oral iron in stage ___-___ CKD for pts with anemia of chronic disease
3-5
should we use oral or IV iron in hemodialysis pts?
IV
when treating anemia of CKD, we should target TSAT > ___%
a. 5
b. 10
c. 30
d. 50
c. 30
which of the following is FALSE about using ESAs for anemia of CKD?
a. they help prevent blood transfusions
b. they target normal Hgb levels
c. lead to increased risk of CV events, stroke, and death
d. only start ESA after replenishing iron stores
e. do not titrate dose up for at least 4 wks after starting or increasing dose
b. they target normal Hgb levels
which HF pts may benefit from IV iron? (2 criteria)
-NYHA class II and III HF
-iron deficiency (ferritin < 100 or 100-300 if TSAT < 20%)
T or F: oral iron has shown benefit for HF pts
F
Pt is a 68 YOM with stage 4 CKD. His most recent lab work shows Hgb 11.7g/dL, MCV 82, TSAT 15%. He is currently taking ferrous sulfate 325mg daily for anemia, which he started 6 months ago. Which of the following recommendations would you make? (2 options)
a. Increase ferrous sulfate to 325mg bid
b. Stop ferrous sulfate because Hgb >11.5g/dL
c. Change ferrous sulfate to 325mg every other day
d. Increase ferrous sulfate to 325mg bid and add ESA
a, c
Patient is a 59 year old female with heart failure. Her ejection fraction is 30%. Her physician asks you if she would benefit from iron. Which response is most appropriate?
a. Patients with heart failure benefit from oral iron supplementation
b. All patients with heart failure benefit from IV iron
c. IV iron decreases hospitalization in certain patient with heart failure, but there is no evidence that it will improve survival
d. IV iron improves survival in patients with heart failure
c. IV iron decreases hospitalization in certain patient with heart failure, but there is no evidence that it will improve survival
for blood loss anemia, we should transfuse blood when Hgb < ___
< 7
in hemolytic anemia, RBCs are destroyed before ____ days
120
types of hemolytic anemia (2 types, 3 examples)
intertied -> sickle cell anemia; G6PD deficiency
acquired -> drug induced
to have sickle cell anemia, does the sickle cell gene need to be heterozygous or homozygous?
homozygous
(if heterozygous, this is asymptomatic, sickle cell trait)
drug tx for sickle cell anemia (2 of them)
-folic acid 1 mg/day
-hydroxyurea 10-15 mg/kg/day (titrated to max 35 mg/kg/day)
which drug is a fetal hemoglobin inducer?
a. folic acid
b. hydroxyurea
c. IV iron
b. hydroxyurea
which anemia pts usually have the highest dose of opioids/patient controlled analgesia?
sickle cell anemia pts
which vaccines are recommended for sickle cell pts? (3 of them)
-influenza
-pneumococcal
-meningococcal
what drugs can cause folic acid deficiency? (4 of them; slide 80)
methotrexate
phenytoin
sulfasalazine
Bactrim
what 2 drugs/drug classes cause B12 deficiency? (slide 80)
metformin
PPI’s
