Geriatric Anemia

Question 1

WHO definition of anemia

Answer 1

men: HgB

Question 2

Highest and lowest rates of anemia (race)

Answer 2

nonhispanic blacks - highest

non hispanic whites - lowest

Question 3

Commonly reported symptoms of anemia in elderly

Answer 3

fatigue, weakness, dyspnea

can worsen symptoms of other comorbid conditions (dyspnea from CHF)

Question 4

What physical exam sign is a reliable sign of anemia in the elderly and noted in patients with Hgb

Answer 4

conjuntival pallor

Question 5

glossitis, decreased vibratory sense, ataxia, paresthesia, confusion, dementia, pearly gray hair

Answer 5

vitamin b12 deficiency

Question 6

Difference between vitamin b12 and folate deficiency

Answer 6

both present similarly but folate deficiency doesn’t have neurologic deficits…folate usually seen in alcoholics

Question 7

koilomychias (spoon nails), glossitis, dysphagia

Answer 7

severe iron deficiency

Question 8

anemia with jaundice

Answer 8

hemolysis

Question 9

anemia with splenomegaly

Answer 9

thalassemia/neoplasm?

Question 10

What is the initial workup for suspected anemia?

Answer 10

CBC with measurement of RBC indices, peripheral smear, and reticulocyte count

Question 11

Most common cause of anemia with low MCV

Answer 11

iron deficiency

in elderly this is due to chronic GI blood loss, poor nutrition, or bleeding disorder

Question 12

What lab results would you expect to see in iron deficiency?

Answer 12

low serum iron, low ferritin, high TIBC

Question 13

Iron deficiency can be initial presentation of what kind of malignancy

Answer 13

GI (so get those upper and lower GI endoscopies done!)

Question 14

Anemias with high MCV

Answer 14

folate or vitb12 deficiency (most common)

drug effects, liver dx, or hypothyroidism (less common)

Question 15

What labs indicate vitb12 and folate deficiency

Answer 15

vitb12 - elevated MMA (methylmalonic acid)

folate - elevated homocysteine

Question 16

Most common cause of normocytic anemia in elderly

Answer 16

anemia of chronic inflammation (aka chronic disease)

Question 17

How to differentiate between iron deficiency and anemia of chronic inflammation

Answer 17

iron deficiency - high TIBC, low ferritin
chronic disease- low TIBC, normal/high ferritin

can also use bone marrow iron store

Question 18

Threshold for RBC transfusion

Answer 18

Hgb

Question 19

treatment for iron deficiency anemia

Answer 19

oral iron (ferrous sulfate TID) plus correction of any source of blood loss…may need up to 6-8 weeks for treatment,

may need to give parental administration in patients with malabsorption, malignancy, or CKD and heart failure

Question 20

how to treat vitb12 deficiency or folate

Answer 20

IM b12 or folate…duh

Question 21

treatment for anemia of chronic inflammation

Answer 21

treat underlyin condition
if anemia severe enough…RBC transufsion or erythropoesis stimulating agents
goal in CKD patients - between 10-12 hgb

Question 22

Most common cause of vitb12 deficiency

Answer 22

pernicious anemia (lack of intrinsic factor)