Exam 3 - Rogers

Question 1

s/sx of anemia

Answer 1

1. exertional dyspnea
2. angina
3. tachycardia
4. fatigue
5. pallor
   *may be asymptomatic if it develops slowly

Question 2

normal Hgb (female)

Answer 2

12-16 g/dL

Question 3

normal Hgb (male)

Answer 3

13.5-18

Question 4

normal MCV

Answer 4

80-100 mm

Question 5

normal RDW

Answer 5

11.5-14.5%

Question 6

microcytic MCV

Answer 6

< 80

Question 7

macrocytic MCV

Answer 7

> 100

Question 8

ferritin normal values

Answer 8

15-200 ng/mL
(iron deficiency is likely for ferritin < 45 ng/mL)

Question 9

normal TSAT percentages

Answer 9

20-50%

Question 10

T/F: drugs are likely to cause iron deficiency anemia

Answer 10

FALSE

Question 11

oral iron exceptions:

Answer 11

1. cannot tolerate (side effects)
2. cannot absorb
3. ESRD
4. HF

Question 12

Why might every other day dosing be better for iron?

Answer 12

Hepcidin, a hormone that decreases dietary iron absorption, is increased after a dose of oral iron for 24 hours and normalizes within 48 hours

Question 13

Oral iron counseling points

Answer 13

1. increased absorption on empty stomach
2. however, causes stomach upset so can take with food or split up doses
3. absorption increased by vitamin C
4. causes constipation - increase fluids, activity, and fiber
5. causes dark stools
6. keep in safe place - children can mistake it for candy

Question 14

IV iron indications

Answer 14

1. ESRD
2. HF
3. failed oral iron
4. malabsorption

Question 15

IV iron side effects

Answer 15

common: hypotension during infusion
rare: skin tattooing

Question 16

causes of vitamin B12 deficiency

Answer 16

1. diet - vegan/vegetarian
2. alcoholism
3. lack of intrinsic factor (pernicious anemia)
4. decreased absorption
5. medications - PPIs, metformin

Question 17

T/F: our bodies can produce vitamin B12

Answer 17

FALSE, must absorb it from diet

Question 18

consequences of vitamin B12 deficiency

Answer 18

neurologic - weakness, numbness, cognitive dysfunction

Question 19

vitamin B12 deficiency treatment options

Answer 19

1. IM or SC: 100-1000 mcg
2. oral: 1000-2000 mcg/day

Question 20

folic acid deficiency causes

Answer 20

1. malabsorption
2. malnutrition - found in greens, orange juice, cereal, flour, milk
3. alcoholism
4. medications: methotrexate, phenytoin, SMZ-TMP, sulfasalazine

Question 21

Never replace folic acid without checking ___________ ______

Answer 21

vitamin B12

Question 22

folic acid deficiency treatments

Answer 22

oral: 1-5 mg daily until Hgb normalizes
(rarely need IV)

Question 23

Which chronic diseases is anemia common in?

Answer 23

1. CKD
2. CHF
3. Cancer
4. HIV/AIDS

Question 24

Mechanism of anemia in CKD

Answer 24

erythropoietin is produced in the kidneys and stimulates production of RBCs, so decreased erythropoietin production -> anemia

Question 25

Treatment of anemia in CKD

Answer 25

**Avoid blood transfusions** 1. correct nutritional deficiencies: folate/B12 iron (oral in stages 3-5, IV in HD) 2. ESAs - only start ESAs after replenishing iron stores

Question 26

T/F: you should target normal Hgb levels when using ESAs for anemia caused by CKD

Answer 26

FALSE - use minimum dose to maintain Hgb > 10, there is an increased risk of CV events if targeting higher Hgb

Question 27

T/F: you should use IV iron in hemodialysis patients

Answer 27

TRUE

Question 28

T/F: you should use oral iron in HF patients

Answer 28

FALSE - oral iron has not showed benefit

Question 29

When are ESAs used in HF?

Answer 29

never

Question 30

Sickle cell anemia treatment options:

Answer 30

1. folic acid 1mg/day 2. blood transfusions 3. hydroxyurea 4. immunizations

Question 31

Which anemic patients may require high doses of opioids?

Answer 31

patients in sickle cell crisis

Question 32

What is aplastic anemia?

Answer 32

Bone marrow failure that causes body to stop producing enough new blood cells

Question 33

What is immune hemolytic anemia?

Answer 33

antibodies form against body's own RBCs and destroy them

Question 34

What is oxidative hemolytic anemia?

Answer 34

Medications trigger premature breakdown of RBCs in patients with genetic deficiency of G6PD enzyme

Question 35

In hemolytic anemia, RBCs are destroyed before _______ days

Answer 35

120 (normal lifespan of RBC)

Question 36

In blood loss anemia, you should transfuse packed red blood cells when Hgb < _______

Answer 36

7

Question 37

When using ESAs for anemia of CKD, you should not titrate the dose up for at least _____ weeks after initiating or increasing dose

Answer 37

4

Question 38

Additional s/sx of iron deficiency anemia

Answer 38

1. spoon-shaped nails 2. inflamed tongue 3. pica

Question 39

Causes of iron deficiency

Answer 39

1. blood loss (menstruation, donation) 2. decreased absorption (celiac) 3. vegetarian diet 4. increased consumption (pregnancy)

Question 40

Which types of anemia are usually macrocytic?

Answer 40

folic acid and B12 deficiency **not always the case!

Question 41

Which types of anemia are usually microcytic?

Answer 41

iron deficiency and sickle cell **not always the case!

Question 42

Which types of anemia are usually normocytic?

Answer 42

1. Blood loss 2. Anemia of chronic disease 3. Hemolytic anemia