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Clinical Med I > Exam 4 - Anemia > Flashcards

Exam 4 - Anemia Flashcards

1
Q

What range of Hb is classified as anemia in men and women?

What is the normal hematocrit range?

A

Men: Hb < 14
Women: Hb < 12

Men: Hematocrit of 40-50%
Women: Hematocrit of 35-45%

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2
Q

What is a reticulocyte?

What does a Reticulocyte count indicate and what is the normal range?

A

Immature RBC

Indicates bone marrow production of RBC; Normal is 0.5-2%

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3
Q

What indicates new reticulocytes on a peripheral smear?

A

Blue staining

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4
Q

What are three causes of anemia?

A
  • Decreased RBC production (nutritional deficiencies, disease, ineffective erythropoiesis)
  • Increased RBC destruction (hemolysis)
  • Blood loss (menstrual, GI, trauma)
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5
Q

What does normocytic, microcytic, and macrocytic mean?

A
  • Normocytic = normal size RBCs
  • Microcytic = small than normal RBCs
    Macrocytic = larger than normal RBCs
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6
Q

What is Mean Corpuscular Volume (MCV)?

A

Calculated value to determine average size of RBCs

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7
Q

What MCV value correlates to microcytic, normocytic, and macrocytic anemia?

A
  • Microcytic is < 80
  • Normocytic is 80-100
  • Macrocytic is > 100
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8
Q

What is MCH?

A

The average hemoglobin content in a RBC

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9
Q

What is MCHC?

A

The average hemoglobin concentration per RBC

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10
Q

How are MCH and MCHC related to MCV?

A

MCH and MCHC typically “follow” MCV

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11
Q

What is Red Cell Distribution Width (RDW)?

What is a normal RDW?

A

A measure of the degree of variation in RBC size.

Normal RDW is 11-15%.

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12
Q

What does anisocytosis on a peripheral smear mean?

A

Variation in size of RBCs

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13
Q

What are signs and symptoms of anemia?

A

Signs:

  • Pallor
  • Orthostatic changes
  • Tachycardia
  • Heme + stool

Symptoms:

  • Fatigue, weakness
  • Headache
  • Dizziness
  • Palpitations
  • Dyspnea
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14
Q

What are the three main categories of anemia?

A
  • Microcytic hypochromic
  • Normocytic normochromic
  • Macrocytic (megaloblastic)
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15
Q

What are the three types of microcytic hypochromic anemia?

A
  • Iron deficiency anemia
  • Thalassemias
  • Sideroblastic anemia
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16
Q

What population is most commonly affected by iron deficiency anemia?

A

Women of childbearing age

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17
Q

What are major causes of iron deficiency anemia?

A
  • Blood loss (most common cause in adults)
  • Decreased dietary intake
  • Decreased iron absorption
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18
Q

You are given the following labs:

  • RBC, H/H: Decreased
  • MCV: Decreased
  • MCH: Decreased
  • Ferritin: Decreased
  • Serum Fe: Decreased
  • TIBC: Increased
  • RDW: Increased
  • Retic count: Low to normal

What is the likely diagnosis?

A

Iron deficiency anemia

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19
Q

Other than known signs and symptoms, what are other clinical manifestations that can be associated with iron deficiency anemia?

A
  • Atrophic glossitis
  • Koilonychia (spoon nails)
  • Pica (craving for non-nutritional sources/ice)
  • Dysphagia
  • Restless legs syndrome
20
Q

What is the treatment for iron deficiency anemia?

A
  • Treat underlying cause
  • Replace iron stores
  • Blood transfusions (select patients)
21
Q

When replacing iron store in iron deficiency anemia, what would you prescribe?

What is the appropriate response to this medication and how long should it be continued for?

A

Oral Ferrous Sulfate 325mg (daily-TID)

Appropriate response: Increased in Hb at a rate of 2-4 grams every three weeks until return to baseline

Continue 3-6 months after anemia has corrected to replenish stores

22
Q

What is Thalassemias?

A

Inherited hemoglobinopathy in which there is a reduction in the synthesis of globin chains (alpha or beta)

23
Q

What can Thalassemias lead to and eventually cause?

A

Can lead to ineffective erythropoiesis and hemolysis.

In turn, can cause bone changes, impaired growth, and iron overload.

24
Q

What is Alpha-Thalassemia?

What is Beta-Thalassemia?

A

Alpha = Deletion of one or more of the four alpha globin chains.

Beta = Reduced or absent beta-globin chain synthesis

25
Q

In Alpha-Thalassemia, how many deletions causes a silent carrier? How many deletions causes hydrops fetalis?

A

1 deletion = Silent carrier

4 deletions = hydrops fetalis

26
Q

How many dysfuntional beta chains are in Thalassemia Minor? What about in Thalassemia Major?

A

Minor: One

Major: Both

27
Q

In Thalassemia, are the following labs normal, low, or high?

  • RBC
  • MCV
  • RDW
  • Retic count
  • Ferritin
  • Serum Fe
  • TIBC
A 
RBC = Normal to high
MCV = Low
RDW = Normal
Retic count = High
Ferritin = normal to high
Serum Fe = normal to high
TIBC = normal to low
28
Q

What tool helps in the diagnosis of Thalassemia and can help determine what type of hemoglobin is present?

A

Hemoglobin electrophoresis

29
Q

What is the treatment for Thalassemia?

A
  • Folic acid supplementation
  • AVOID iron supplementation
  • Regular transfusion (severe)
  • Hematopoietic cell transplantation (severe beta)
  • Genetic counseling
30
Q

What is the pathogenesis of Sideroblastic Anemia?

A

Abnormal RBC iron metabolism –> Diminished heme synthesis –> Iron accumulates in the cells

31
Q

In Sideroblastic Anemia, what will be found in bone marrow aspirate? What about in peripheral smear?

A

Bone Marrow Aspirate = Ring sideroblasts (diagnostic hallmark)

Peripheral smear = Pappenheimer bodies

32
Q

While Sideroblastic Anemia is either genetic or acquired, what are three other causes?

A
  • Chronic alcoholism
  • Medications
  • Copper deficiency
33
Q

In Sideroblastic Anemia, will the following labs be normal, high, or low?

  • MCV
  • RDW
  • Retic count
  • Ferritin
A

MCV = Low, normal, or slightly increased
RDW = high
Retic count = normal to low
Ferritin = normal to high

34
Q

What other condition may Sideroblastic Anemia be indistinguishable from due to its systemic iron overload?

A

Hereditary hemochromatosis

35
Q

What is the treatment for Sideroblastic Anemia?

A
  • Hematology referral
  • Treat underlying cause
  • Discontinue offending drugs
  • Pyridoxine (vitamin B6)
  • Transfusion/management of iron overload
36
Q

What is anemia of chronic disease?

A

Reduction in RBC production by the bone marrow

37
Q

What factors can contribute to anemia of chronic disease?

A

Factors:

  • Hepcidin-induced alterations in iron metabolism
  • Inability to increase erythropoiesis in response to anemia
  • A relative decreased in erythropoietin production
38
Q

What is Hepcidin?

A

A key regulator of the entry of iron into circulation (high level seen with inflammation)

39
Q

In anemia of chronic disease, are the following labs normal, low, or high?

  • Hb
  • MCV
  • Retic count
  • Ferritin
  • Serum Fe
  • TIBC
A 
Hb = low (mild anemia)
MCV = Normal (normocytic)
Retic count = normal to mildly low
Ferritin = normal to high
Serum Fe = low
TIBC = low
40
Q

What is the reference range for RBC?

A

RBC = 3.7-5.4

41
Q

Ann K is a 37 year old teacher who presents with 4 day history of worsening fatigue and occasional dizziness when standing. Exam is normal. LMP: current.

CBC showed: 
Hb: 8.3, Hct: 25%
MCV 75, MCH 22
Plt count normal
RDW 18%

What type of anemia is this?
What is the suspected diagnosis?
What other labs should be done to confirm this?
What could be the cause?

A
  • Microcytic hypochromic anemia
  • Iron deficiency anemia
  • Serum Ferritin, Serum Fe
  • Menses
42
Q

K. Smith is a 28 year old engineer who has a long history of “mild” anemia. He wonders what can be done for this problem. His exam is unremarkable. He reports a family history of “iron deficiency anemia.”

CBC showed: 
RBC: 6.5, Hb: 11.7, Hct: 35%
MCV 65, MCH 22
Plt count normal
RDW 12%

What type of anemia is this?
What is the suspected diagnosis?
What other labs should be done to confirm this?
What should be avoided in this patient?

A
  • Microcytic hypochromic
  • Thalassemia
  • Hemoglobin electrophoresis
  • Iron supplements
43
Q

What happens to RDW in thalassemia? What about in Iron deficiency anemia and sideroblastic anemia?

A

It is normal in thalassemia and elevated in both iron deficiency and sideroblastic

44
Q

What is the reference range for MCV?

A

MCV = 78-100

45
Q

What is the reference range for MCH?

A

MCH = 27-34

46
Q

What is the reference range for MCHC?

A

MCHC = 31-37

47
Q

What is the reference range for RDW?

A

RDW = 11.5-14.5%

Clinical Med I (24 decks)

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