Lecture 11 - Anemia Flashcards
WHO anemia definition
< 13g/dL = men
< 12 g/dL = women
Microcytosis (<80) MCV usually….
iron deficiency
Normocytosis (80-100) MCV usually….
acute blood loss anemia, mixed anemia (Iron/B12)
Macrocytosis (>100) MCV usually….
Vit B12 deficiency, folate deficiency
Low MCH usually….
Microcytosis or hypochromia
High MCH usually…..
Macrocytosis (Vit B12, folate deficiency)
Low MCHC usually….
Hypochromia (iron deficiency )
Normal RDW usually means….
Anemia of inflammation, acute blood loss anemia
Higher RDW usually means….
early IDA, mixed anemia (IDA & B12/Folic acid), hemolysis
Low Reticulocyte count usually means….
IDA, B12 deficiency
Anemia of inflammation, Anemia of renal disease
Higher Reticulocyte count usually means….
acute blood loss or hemolysis
Anemia Diagnosis Process
- CBC
- RBC indices
- Additional diagnostic tests
Acute Symptoms of Anemia
Angina
Tachycardia
Palpitations
Hypotension
Orthopnea
Exercise intolerance
Chronic Symptoms of Anemia
Fatigue
Vertigo
Headache
Cold sensitivity
Loss of skin tone
Indications for blood transfusions
Hgb < 7 = normal, stable pts
Hgb < 8 = CVD, or ortho/cardiac surgery
reasons for iron deficiency
inadequate ingestion
inc requirements
dec absorption
blood loss
IDA clinical presentation
Asymptomatic
Angular stomatitis = cracking edge of lips
Glossitis
Papillary atrophy of tongue
Spoon nails (Koilonychia)
Pica = craving nonfood substances?
IDA diagnosis
Dec: Hgb/Hct, MCV, MCH, Ferritin, Serum iron, Tsat
Inc = TIBC, RDW
Who should be screened for IDA?
all preg women
pre and post weight loss surgery
Non-pharm IDA
inc iron intake form food
OJ/Vit C = inc absorption
Milk/Tea = reduce absorption
How to help with GI upset from Oral iron therapy
convert to iron will lower elemental %%
Dosing oral iron
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
Iron counseling points
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
Causes for “Failure to respond”
non-adherence to therapy
Inability to absorb iron
Continued bleeding
Incorrect diagnosis
Concurent inflammatory conditions impairing response