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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
In Alpha-Thalassemia, how many deletions causes a silent carrier? How many deletions causes hydrops fetalis?
1 deletion = Silent carrier 4 deletions = hydrops fetalis
26
How many dysfuntional beta chains are in Thalassemia Minor? What about in Thalassemia Major?
Minor: One Major: Both
27
In Thalassemia, are the following labs normal, low, or high? - RBC - MCV - RDW - Retic count - Ferritin - Serum Fe - TIBC
``` 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
What tool helps in the diagnosis of Thalassemia and can help determine what type of hemoglobin is present?
Hemoglobin electrophoresis
29
What is the treatment for Thalassemia?
- Folic acid supplementation - AVOID iron supplementation - Regular transfusion (severe) - Hematopoietic cell transplantation (severe beta) - Genetic counseling
30
What is the pathogenesis of Sideroblastic Anemia?
Abnormal RBC iron metabolism --> Diminished heme synthesis --> Iron accumulates in the cells
31
In Sideroblastic Anemia, what will be found in bone marrow aspirate? What about in peripheral smear?
Bone Marrow Aspirate = Ring sideroblasts (diagnostic hallmark) Peripheral smear = Pappenheimer bodies
32
While Sideroblastic Anemia is either genetic or acquired, what are three other causes?
- Chronic alcoholism - Medications - Copper deficiency
33
In Sideroblastic Anemia, will the following labs be normal, high, or low? - MCV - RDW - Retic count - Ferritin
MCV = Low, normal, or slightly increased RDW = high Retic count = normal to low Ferritin = normal to high
34
What other condition may Sideroblastic Anemia be indistinguishable from due to its systemic iron overload?
Hereditary hemochromatosis
35
What is the treatment for Sideroblastic Anemia?
- Hematology referral - Treat underlying cause - Discontinue offending drugs - Pyridoxine (vitamin B6) - Transfusion/management of iron overload
36
What is anemia of chronic disease?
Reduction in RBC production by the bone marrow
37
What factors can contribute to anemia of chronic disease?
Factors: - Hepcidin-induced alterations in iron metabolism - Inability to increase erythropoiesis in response to anemia - A relative decreased in erythropoietin production
38
What is Hepcidin?
A key regulator of the entry of iron into circulation (high level seen with inflammation)
39
In anemia of chronic disease, are the following labs normal, low, or high? - Hb - MCV - Retic count - Ferritin - Serum Fe - TIBC
``` Hb = low (mild anemia) MCV = Normal (normocytic) Retic count = normal to mildly low Ferritin = normal to high Serum Fe = low TIBC = low ```
40
What is the reference range for RBC?
RBC = 3.7-5.4
41
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?
- Microcytic hypochromic anemia - Iron deficiency anemia - Serum Ferritin, Serum Fe - Menses
42
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?
- Microcytic hypochromic - Thalassemia - Hemoglobin electrophoresis - Iron supplements
43
What happens to RDW in thalassemia? What about in Iron deficiency anemia and sideroblastic anemia?
It is normal in thalassemia and elevated in both iron deficiency and sideroblastic
44
What is the reference range for MCV?
MCV = 78-100
45
What is the reference range for MCH?
MCH = 27-34
46
What is the reference range for MCHC?
MCHC = 31-37
47
What is the reference range for RDW?
RDW = 11.5-14.5%

Clinical Med I (24 decks)

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