Lecture 11 - Anemia

Question 1

WHO anemia definition

Answer 1

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

Question 2

Microcytosis (<80) MCV usually….

Answer 2

iron deficiency

Question 3

Normocytosis (80-100) MCV usually….

Answer 3

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

Question 4

Macrocytosis (>100) MCV usually….

Answer 4

Vit B12 deficiency, folate deficiency

Question 5

Low MCH usually….

Answer 5

Microcytosis or hypochromia

Question 6

High MCH usually…..

Answer 6

Macrocytosis (Vit B12, folate deficiency)

Question 7

Low MCHC usually….

Answer 7

Hypochromia (iron deficiency )

Question 8

Normal RDW usually means….

Answer 8

Anemia of inflammation, acute blood loss anemia

Question 9

Higher RDW usually means….

Answer 9

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

Question 10

Low Reticulocyte count usually means….

Answer 10

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

Question 11

Higher Reticulocyte count usually means….

Answer 11

acute blood loss or hemolysis

Question 12

Anemia Diagnosis Process

Answer 12

1. CBC
2. RBC indices
3. Additional diagnostic tests

Question 13

Acute Symptoms of Anemia

Answer 13

Angina
Tachycardia
Palpitations
Hypotension
Orthopnea
Exercise intolerance

Question 14

Chronic Symptoms of Anemia

Answer 14

Fatigue
Vertigo
Headache
Cold sensitivity
Loss of skin tone

Question 15

Indications for blood transfusions

Answer 15

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

Question 16

reasons for iron deficiency

Answer 16

inadequate ingestion
inc requirements
dec absorption
blood loss

Question 17

IDA clinical presentation

Answer 17

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

Question 18

IDA diagnosis

Answer 18

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

Inc = TIBC, RDW

Question 19

Who should be screened for IDA?

Answer 19

all preg women
pre and post weight loss surgery

Question 20

Non-pharm IDA

Answer 20

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

Question 21

How to help with GI upset from Oral iron therapy

Answer 21

convert to iron will lower elemental %%

Question 22

Dosing oral iron

Answer 22

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

Question 23

Iron counseling points

Answer 23

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

Question 24

Causes for “Failure to respond”

Answer 24

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

Question 25

Indications for IV iron therapy

Answer 25

Intolerance to oral iron
Nonadherence to oral iron
in conjunction w/ ESA therapy
Malabsorption
Need for rapid replacement

Question 26

General IV iron dosing

Answer 26

wt (lbs) X Hgb deficit = dose MG

add ~600mg women, ~1000mg men

Question 27

Iron Dextran info

Answer 27

Have to give test dose due to anaphylaxis

IV push or IV infusion (not approved)

Question 28

Feraheme info

Answer 28

can alter MRI images for up to 3 months

Question 29

How often monitoring iron?

Answer 29

~ 4 weeks

caution overload Ferritin > 800, TSAT > 50%

Question 30

Reasons for B12 deficiency

Answer 30

inadequate dietary intake of B12
Impaired absorption of B12
Inadequate utilization of B12

Question 31

B12 Deficiency Presentation

Answer 31

Hyperpigmentation, jaundice, vitiligo

Neurologic symptoms are the big thing, can be permanent

Question 32

B12 Deficiency Labs

Answer 32

Dec: Hgb/Hct, B 12 < 150, Reticulocyte count, milk leukopenia/thrombocytopenia

Inc: MCV, MMA, Homocysteine

Question 33

How to decide if you get IM or Oral B12?

Answer 33

Based if you have neurologic symptoms

if you do, you need it quickly so you get B12 IM

Question 34

Folate deficiency presentation

Answer 34

Depression
Reduced taste
Diarrhea, red/sore tongue
General ssx of anemia

Question 35

Folate deficiency lab values

Answer 35

Dec: Hgb/Hct, Retic count
Serum folate < 3, RBC folate < 150

Inc: MCV > 100, Homocysteine