Exam 3 - Anemia Rogers Flashcards by Rehman Hameed

Q

male normal hemoglobin range

A

13.5-18 g/dL

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Q

female normal hemoglobin range

A

12-16 g/dL

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Q

normal MCV range

A

80-100 mm^3

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Q

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%

A

c. 74 year old male with Hgb 12.5g/dL

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Q

MCV < 80

a. microcytic
b. normocytic
c. macrocytic

A

a. microcytic

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Q

MCV 80-100

a. microcytic
b. normocytic
c. macrocytic

A

b. normocytic

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Q

MCV > 100

a. microcytic
b. normocytic
c. macrocytic

A

c. macrocytic

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Q

iron deficency, sickle cell, thalassemia

a. microcytic
b. normocytic
c. macrocytic

A

a. microcytic

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Q

anemia of chronic disease, blood loss, hemolysis

a. microcytic
b. normocytic
c. macrocytic

A

b. normocytic

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Q

folic acid and B12 deficiency

a. microcytic
b. normocytic
c. macrocytic

A

c. macrocytic

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Q

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

a. dec RBC production

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Q

drugs and sickle cell/thalassemia lead to

a. dec RBC production
b. inc RBC destruction
c. inc RBC loss

A

b. inc RBC destruction

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Q

acute blood loss and chronic NSAIDs/ASA lead to

a. dec RBC production
b. inc RBC destruction
c. inc RBC loss

A

c. inc RBC loss

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Q

most common type of anemia

A

iron-deficiency anemia

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Q

iron deficiency is likely in pts with ferritin < ___ ng/mL

a. 5
b. 30
c. 45
d. 200

A

c. 45

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Q

normal TSAT value range

a. 5-10%
b. 20-50%
c. 50-75%
d. 95-100%

A

b. 20-50%

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Q

iron is best absorbed in which part of the SI?

A

duodenum

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Q

two examples of diseases/surgeries that dec absorption of iron

A

celiac disease; gastric bypass

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Q

heme iron source

a. meat
b. plants or dairy

A

a. meat

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Q

non-heme iron source

a. meat
b. plants or dairy

A

b. plants or dairy

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Q

T or F: vegetarians are more likely to require supplements even if they have adequate iron intake

A

T (due to iron from diet)

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Q

s/sx of iron deficiency anemia (3 of them; slides 31-33)

A

-spoon-shaped nails (koilonychias)
-inflamed tongue (glossitis)
-pica (craving things with no nutritional value)

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Q

two different types of pica

A

pagophagia -> ice
geophagia -> dirt, soil, clay

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Q

which is generally preferred, oral or IV iron?

A

oral

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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