Lecture 11 - Anemia Flashcards

1
Q

WHO anemia definition

A

< 13g/dL = men
< 12 g/dL = women

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2
Q

Microcytosis (<80) MCV usually….

A

iron deficiency

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3
Q

Normocytosis (80-100) MCV usually….

A

acute blood loss anemia, mixed anemia (Iron/B12)

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4
Q

Macrocytosis (>100) MCV usually….

A

Vit B12 deficiency, folate deficiency

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5
Q

Low MCH usually….

A

Microcytosis or hypochromia

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6
Q

High MCH usually…..

A

Macrocytosis (Vit B12, folate deficiency)

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7
Q

Low MCHC usually….

A

Hypochromia (iron deficiency )

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8
Q

Normal RDW usually means….

A

Anemia of inflammation, acute blood loss anemia

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9
Q

Higher RDW usually means….

A

early IDA, mixed anemia (IDA & B12/Folic acid), hemolysis

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10
Q

Low Reticulocyte count usually means….

A

IDA, B12 deficiency
Anemia of inflammation, Anemia of renal disease

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11
Q

Higher Reticulocyte count usually means….

A

acute blood loss or hemolysis

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12
Q

Anemia Diagnosis Process

A
  1. CBC
  2. RBC indices
  3. Additional diagnostic tests
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13
Q

Acute Symptoms of Anemia

A

Angina
Tachycardia
Palpitations
Hypotension
Orthopnea
Exercise intolerance

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14
Q

Chronic Symptoms of Anemia

A

Fatigue
Vertigo
Headache
Cold sensitivity
Loss of skin tone

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15
Q

Indications for blood transfusions

A

Hgb < 7 = normal, stable pts
Hgb < 8 = CVD, or ortho/cardiac surgery

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16
Q

reasons for iron deficiency

A

inadequate ingestion
inc requirements
dec absorption
blood loss

17
Q

IDA clinical presentation

A

Asymptomatic
Angular stomatitis = cracking edge of lips
Glossitis
Papillary atrophy of tongue
Spoon nails (Koilonychia)
Pica = craving nonfood substances?

18
Q

IDA diagnosis

A

Dec: Hgb/Hct, MCV, MCH, Ferritin, Serum iron, Tsat

Inc = TIBC, RDW

19
Q

Who should be screened for IDA?

A

all preg women
pre and post weight loss surgery

20
Q

Non-pharm IDA

A

inc iron intake form food
OJ/Vit C = inc absorption
Milk/Tea = reduce absorption

21
Q

How to help with GI upset from Oral iron therapy

A

convert to iron will lower elemental %%

22
Q

Dosing oral iron

A

Traditional = 150-200mg elemental/day in 2-3 doses

Novel = 40-80 elemental every other day

Duration ~3-6 months after anemia resolves to get ferritin > 100

23
Q

Iron counseling points

A

Take on empty stomach to inc absorption (1hr before or 2hr after meal)
Keep iron away from children

GI side effects, admin with food or lower dose can help

24
Q

Causes for “Failure to respond”

A

non-adherence to therapy
Inability to absorb iron
Continued bleeding
Incorrect diagnosis
Concurent inflammatory conditions impairing response

25
Indications for IV iron therapy
Intolerance to oral iron Nonadherence to oral iron in conjunction w/ ESA therapy Malabsorption Need for rapid replacement
26
General IV iron dosing
wt (lbs) X Hgb deficit = dose MG add ~600mg women, ~1000mg men
27
Iron Dextran info
Have to give test dose due to anaphylaxis IV push or IV infusion (not approved)
28
Feraheme info
can alter MRI images for up to 3 months
29
How often monitoring iron?
~ 4 weeks caution overload Ferritin > 800, TSAT > 50%
30
Reasons for B12 deficiency
inadequate dietary intake of B12 Impaired absorption of B12 Inadequate utilization of B12
31
B12 Deficiency Presentation
Hyperpigmentation, jaundice, vitiligo **Neurologic symptoms are the big thing, can be permanent**
32
B12 Deficiency Labs
Dec: Hgb/Hct, B 12 < 150, Reticulocyte count, milk leukopenia/thrombocytopenia Inc: MCV, MMA, Homocysteine
33
How to decide if you get IM or Oral B12?
Based if you have neurologic symptoms if you do, you need it quickly so you get B12 IM
34
Folate deficiency presentation
Depression Reduced taste Diarrhea, red/sore tongue General ssx of anemia
35
Folate deficiency lab values
Dec: Hgb/Hct, Retic count Serum folate < 3, RBC folate < 150 Inc: MCV > 100, Homocysteine