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CMN 572 unit 2 > Leik Anemia > Flashcards

Leik Anemia Flashcards

1
Q

Laboratory Norms

Hemoglobin

A

Males: 14.0 to 18.0 g/dL
Females: 12.0 to 16.0 g/dL
Long-term high-altitude (mountain) exposure/chronic hypoxia: Elevated (secondary polycythemia)

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2
Q

Laboratory Norms

Hematocrit

A

The proportion of RBCs in 1 mL of plasma
Males: 42% to 52%
Females: 37% to 47%

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3
Q

Laboratory Norms

Mean Corpuscular Volume (MCV)

A

Normal: 80 to 100 fL (femtoliter)

A measure of the average size of the RBCs in a sample of blood

  • MCV less than 80 fL with microcytic anemia
  • MCV between 80 and 100 fL with normocytic anemia
  • MCV more than 100 fL with macrocytic anemia
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4
Q

Laboratory Norms

Mean Corpuscular Hgb Concentration (MCHC)

A

A measure of the average color of the RBCs in a sample of blood

Decreased in iron-deficiency anemia and thalassemia (hypochromic);

normal in macrocytic and normocytic anemias

Normal: 31.0 to 37.0 g/dL

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5
Q

Laboratory Norms

Mean Corpuscular Hemoglobin (MCH)

A

Indirect measure of the color of RBCs.

Decreased values mean pale or hypochromic
RBCs.

MCH is decreased in iron-deficiency anemia and thalassemia.

Normal with the macrocytic anemias.
Normal: Range is 25.0 to 35.0 pg/cell.

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6
Q

Laboratory Norms

Total Iron-Binding Capacity (TIBC)

A

A measure of available transferrin that is left unbound (to iron). Transferrin is used to transport iron in the body.
Elevated if there is not enough iron to transport (as seen with iron-deficiency anemia).

Normal TIBC is seen with thalassemia, vitamin B12
deficiency, and folate-deficiency anemia (because iron levels are normal).

Normal: Range is 250 to 410 mcg/dL

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7
Q

Laboratory Norms

Serum Ferritin

A

Serum ferritin is the stored form of iron. Produced in the intestines. Stored in body tissue such as the spleen, liver, and bone marrow. Correlates with iron storage status in a healthy adult.

Most sensitive test for iron-deficiency anemia.

Iron-deficiency anemia: Serum ferritin is markedly decreased.

Thalassemia trait: Levels are normal to high. May be high if patient was misdiagnosed with iron-deficiency anemia and erroneously given iron supplementation. Avoid iron supplements before testing serum ferritin level.
Normal: Range is 20 to 400 ng/mL.

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8
Q

Laboratory Norms

Serum Iron

A

Decreased in iron-deficiency anemia. Normal to high in thalassemia and the macrocytic anemias. Not as sensitive as ferritin. Affected by recent blood transfusions.

Normal: Range is 50 to 175 mcg/dL.

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9
Q

Laboratory Norms

Red Cell Distribution Width (RDW)

A

A measure of the variability of the size of RBCs in a given sample.

Elevated in irondeficiency anemia and thalassemia.

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10
Q

Laboratory Norms

Reticulocytes

A

Immature RBCs that still have their nuclei. Reticulocytes are slightly larger in size than
a RBC. After 24 hours in circulation, reticulocytes lose their nuclei and mature into RBCs (no nuclei). The bone marrow normally will release small amounts to replace damaged RBCs.

RBCs survive 120 days before being sequestered by the spleen and broken down by the liver into iron and globulin (recycled) and bilirubin (bile).

Normal: Range is 0.5% to 2.5% (of total RBC count).

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11
Q

Reticulocytosis (More Than 2.5% of Total RBC Count)

A

An elevation of reticulocytes is seen when the bone marrow is stimulated into producing RBCs.

It is elevated with supplementation of iron, folate, or vitamin B12 (after deficiency), after acute bleeding episodes, hemolysis, leukemia, and with erythropoietin
(EPO) treatment.

Chronic bleeding does not cause elevation of the reticulocytes due to compensation.

If no reticulocytosis after an acute bleeding episode (after 3 to 4 days), hemolysis, or after appropriate supplementation of deficient mineral (iron, folate, or vitamin B12), or with EPO, rule out bone marrow failure (i.e., aplastic anemia). Diagnosed by bone
marrow biopsy.

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12
Q

Poikilocytosis (Peripheral Smear)

A

Seen with severe iron-deficiency anemia. RBCs abnormal with variable shapes seen in
the peripheral smear.
May be accompanied by anisocytosis (variable sizes of RBCs).

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13
Q

Serum Folate and Vitamin B12

A

Low values if deficiency exists. Deficiency will cause a macrocytic anemia.
Normal folate level: Range is 3.1 to 17.5 ng/mL.
Normal vitamin B12 level: More than 250 pg/mL is normal.

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14
Q

White Blood Cells With Differential

White cell differential: Percentage of each type of leukocyte in a sample of blood. The
differential for each type of WBC should add up to a total of 100%.

A

Normal WBC count (child older than 2 years to adults) is 5.0 to 10.0 × 109 (5,000 to
10,000/10 mm3).
• Neutrophils or segs (segmented neutrophils): 55% to 70%
• Band forms or stabs (immature neutrophils): 0% to 5%
• Lymphocytes: 20% to 40%
• Monocytes: 2% to 8%
• Eosinophils: 1% to 4%
• Basophils: 0.5% to 1%

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15
Q

Secondary Polycythemia

A

Chronic smokers, individuals with long-term chronic obstructive pulmonary disease (COPD), long-term residence at high altitudes, or EPO treatment have a higher incidence of secondary polycythemia (as opposed to primary polycythemia vera).

Polycythemia is defined as:
• Hematocrit in adults of more than 48% (women) and more than 52% (men)
• Hemoglobin in adults of more than 16.5% (women) and more than 18.5% (men)

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16
Q

Iron-Deficiency Anemia

A

Labs:
Decreased Hemoglobin and hematocrit

MCV less than 80 fL

MCHC (paler color)

decreased Ferritin and iron level

Increased TIBC

Peripheral Smear
Anisocytosis (variations in size) and poikilocytosis (variations in shape)

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17
Q

Iron-Deficiency Anemia

A

If the ferritin level is low, the patient has iron-deficiency anemia.

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18
Q

thalassemia minor/trait.

A

If the ferritin level is normal to high, the patient has thalassemia minor/trait.

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19
Q

Best absorbed form of iron supplementation

A

Best absorbed form of iron supplementation (and cheapest) is ferrous sulfate
(available over the counter [OTC]).

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20
Q

If patient took an antacid

A

If patient took an antacid, wait about 4 hours before taking iron pill (minimizes binding).

21
Q

Iron interacts with

A

Iron interacts with tetracycline antibiotics, levothyroxine, and bisphosphonates
(decreases effectiveness).

To avoid, take iron 2 hours before or after antibiotic

22
Q

Failure to respond (if treatment compliant)

A

Failure to respond (if treatment compliant) may be a sign of continuing blood loss,
misdiagnosis (has thalassemia instead of iron-deficiency anemia), malabsorption
(i.e., celiac disease).

23
Q

Iron poisoning in children

A

Iron poisoning in children (especially if age <6 years) may cause death.

Advise patient to store iron supplements in an area that is not accessible to children (or to
grandchildren).

24
Q

Medications reported to lower hemoglobin levels and worsen anemia include

A

Medications reported to lower hemoglobin levels and worsen anemia include:
angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors
(ACEIs) in patients of chronic diseases (CKD, diabetes, chronic HF, hypertension).

25
Q

Pernicious anemia results in:

A

Pernicious anemia results in:
• Vitamin B12-deficiency anemia
• Macrocytic/megaloblastic normochromic anemia
• Neurologic symptoms

26
Q

A cheap screening test for sickle cell

A

A cheap screening test for sickle cell is the Sickledex, but the gold standard is hemoglobin electrophoresis

27
Q

Every state in the United States

A

Every state in the United States, the District of Columbia, and the U.S. territories
requires that every newborn be tested for sickle cell disease as part of the newborn
screening test after birth.

28
Q

pernicious anemia

A

If the parietal antibody test (antiparietal antibody) and/or the intrinsic factor antibody test (anti-IF) are elevated, the patient has pernicious anemia.

29
Q

iron, b12, folate supplementation

A

In a person with normal bone marrow, supplementing the deficient substance (iron, B12, folate) will cause the hemoglobin/hematocrit to increase starting at 1 to 2
weeks; the hemoglogin/hematocrit will be back to normal within 4 to 8 weeks.

30
Q

vitamin b12 deficiency

A

Serum vitamin B12 levels may be normal in up to 5% of patients with vitamin B12 deficiency. Do not rely on vitamin B12 levels alone. Also check antibodies, urine
MMA, etc

31
Q

vitamin b12 deficiency and neurological damage

A

Missing a diagnosis of vitamin B12 deficiency can result in irreversible neurological damage

32
Q

check b12 levels for

A

Any patient complaining of neuropathy or who has dementia should have vitamin B12 levels checked.

33
Q

sickle cell

A

Almost one out of every 500 African Americans in the United States has sickle cell anemia.

34
Q 
3. Which of the following symptoms is associated with B12 deficiency anemia?
A) Spoon-shaped nails and pica
B) Abnormal neurological exam
C) Vegan diet
D) Tingling and numbness of both feet
A
  1. D) Tingling and numbness of both feet Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symptoms of B12 deficiency anemia may
    include tingling or numbness in fingers and toes, difficulty walking, mood changes or
    depression, memory loss, disorientation, and dementia.
    1319
35
Q
  1. Erythromycin 200 mg with sulfisoxazole 600 mg suspension (Pediazole) is
    contraindicated in which of the following conditions?
    A) G6PD deficiency anemia
    B) Lead poisoning
    C) Beta thalassemia minor
    D) B12 deficiency anemia
A

A) G6PD deficiency anemia Glucose-6-phosphate dehydrogenase (G6PD)
deficiency is a hereditary condition that occurs when the red blood cells break down,
causing hemolysis, due to absence or lack of sufficient G6PD, an enzyme that is
needed to help the red blood cells work efficiently. Certain foods and medications
may trigger this reaction. Some of the medications include antimalarial drugs,
aspirin, nitrofurantoin, nonsteroidal anti-inflammatory drugs (NSAIDs), quinidine,
quinine, and sulfa medications.

36
Q
  1. A nurse practitioner is giving dietary counseling to a 30-year-old male alcoholic
    who has recently been diagnosed with folic acid deficiency anemia. Which of the
    following foods should the nurse practitioner recommend to this patient?
    A) Tomatoes, oranges, and bananas
    B) Cheese, yogurt, and milk
    C) Lettuce, beef, and dairy products
    D) Spinach, liver, and beans
A

D) Spinach, liver, and beans Folic acid deficiency is associated with excessive alcohol intake and malnutrition. Folate is a water-soluble B vitamin (vitamin
B9).

Folate is present in the following foods: liver, dark leafy vegetables (spinach, turnip, broccoli), beans (soy, lentils, peas), pasta, breads, and cereals.

37
Q
  1. Physiological anemia of pregnancy is due to:
    A) An increase in the cardiac output at the end of the second trimester
    B) A physiological decrease in the production of red blood cells in pregnant women
    C) An increase of up to 50% of the plasma volume in pregnant women
    D) An increase in the need for dietary iron in pregnancy
A

C) An increase of up to 50% of the plasma volume in pregnant women Physiological anemia of pregnancy is caused by the increased volume of plasma
during pregnancy when compared to the production of red blood cells.

38
Q 
164. Koilonychia is associated with which of the following conditions?
A) Lead poisoning
B) Beta thalassemia trait
C) B12 deficiency anemia
D) Iron-deficiency anemia
A

D) Iron-deficiency anemia Koilonychia is also known as spoon-shaped nails. The finger nails are thin and have a concave shape. Koilonychia is associated with severe
iron-deficiency anemia

39
Q 
172. The red blood cells in pernicious anemia will show:
A) Microcytic and hypochromic cells
B) Microcytic and normochromic cells
C) Macrocytic and normochromic cells
D) Macrocytic and hypochromic cells
A

C) Macrocytic and normochromic cells Anemias resulting from vitamin B12 or folate deficiency are sometimes referred to as macrocytic or megaloblastic anemia because red blood cells are larger than normal.

A diagnosis of pernicious anemia first
requires demonstration of megaloblastic anemia with a complete blood count (CBC) with differential that evaluates the mean corpuscular volume (MCV), as well the mean corpuscular hemoglobin concentration (MCHC).

Pernicious anemia is identified with a high MCV (macrocytic) and a normal MCHC (normochromic).

40
Q 
198. Beta thalassemia minor is considered a:
A) Macrocytic anemia
B) Normocytic anemia
C) Microcytic anemia
D) Hemolytic anemia
A

C) Microcytic anemia Beta thalassemia minor is a genetic disorder in which the
bone marrow produces small, pale, red blood cells in which mild hypochromic,
microcytic anemia occurs.

41
Q 
210. Lead poisoning can cause which type of anemia?
A) Mild macrocytic anemia
B) Normocytic anemia
C) Microcytic anemia
D) Mild hemolytic anemia
A

C) Microcytic anemia Anemias can be classified according to the mean corpuscular volume (MCV) into microcytic, normocytic, and macrocytic anemias. A
microcytic anemia is defined by an MCV of less than 80 fL.

The differential diagnosis of a microcytic anemia includes iron-deficiency anemia (IDA),
thalassemias; anemia of chronic disease (ACD); and sideroblastic anemias, including
lead poisoning. Lead causes anemia by mimicking healthful minerals such as calcium, iron, and zinc.

It is absorbed by the bones, where it interferes with the production of red blood cells. This absorption can also interfere with calcium absorption, which is
needed to keep the bones healthy.

42
Q 
238. All of the following conditions are associated with an increased risk of normocytic anemia except:
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Polymyalgia rheumatica
D) Pregnancy
A

D) Pregnancy Mild normocytic anemia is associated with chronic autoimmune
or inflammatory disorders and chronic infection. Its exact mechanism is unknown.
Pregnancy does not cause normocytic anemia, but it may cause several other types of
anemia: iron-deficiency anemia (microcytic anemia, which can develop in some
women who have very low ferritin levels), folate-deficiency anemia (macrocytic
anemia), and vitamin B12 deficiency (also a macrocytic anemia).

43
Q
  1. Which of the following tests would you recommend to patients to confirm the
    diagnosis of beta thalassemia or sickle cell anemia?
    A) Hemoglobin electrophoresis
    B) Bone morrow biopsy
    C) Peripheral smear
    D) Reticulocyte count
A
  1. A) Hemoglobin electrophoresis Patients with the diagnosis of beta thalassemia
    and/or sickle cell anemia would be screened using hemoglobin electrophoresis to
    identify the blood disorder
44
Q 
365. You would recommend the pneumococcal vaccine (Pneumovax) to patients with
all of the following conditions except:
A) Sickle cell anemia
B) Splenectomy
C) HIV infection
D) G6PD-deficiency anemia
A
  1. D) G6PD-deficiency anemia Pneumococcal vaccine is not indicated for glucose-6-phosphate dehydrogenase (G6PD)-deficiency anemia.

There two types of pneumonia vaccine for adults: PPSV23 (Pneumovax 23) and PCV13
(Prevnar 13). Pneumococcal vaccine is recommended for individuals beginning at age 65 years, but the two types should not be given together. The Centers for Disease Control and Prevention (CDC) recommends administering Prevnar 13 first, then waiting at least 1 year (12 months) and giving the Pneumovax.

The immunogenic response is better using this method. Prevnar 13 is recommended for all infants and
children younger than 2 years of age, all adults aged 65 years or older, and people (2 to 64 years old) with certain medical conditions that increase risk of pneumococcal disease, such as functional or anatomic asplenia (sickle cell), HIV infection, chronic
renal failure, leukemia, heart failure, cyanotic congenital heart disease, chronic lung
disease (asthma, chronic obstructive pulmonary disease [COPD]), diabetes, and
others.

45
Q 
540. Which of the following individuals is more likely to be affected by alpha
thalassemia anemia?
A) 53-year-old Greek patient
B) 25-year-old Chinese patient
C) 62-year-old Russian patient
D) 38-year-old African American patient
A

B) 25-year-old Chinese patient

Alpha thalassemia minor/trait or disease is more prevalent among Asians such as Chinese and Filipinos.

Beta thalassemia minor/trait or disease is more common in the countries in the Mediterranean area, such as Greece and Italy.

46
Q
  1. A new patient is being interviewed by the nurse practitioner. The patient reports
    that she had a gastrectomy procedure 5 years ago to treat severe obesity. Currently,
    her body mass index (BMI) is 25 and the patient denies complications from the
    procedure. The nurse practitioner is aware that the patient is at higher risk for which
    of the following disorders?
    A) Folate deficiency anemia
    B) B12-deficiency anemia
    C) Iron-deficiency anemia
    D) Normocytic anemia
A
  1. B) B12-deficiency anemia Intrinsic factor is made by the parietal cells, which are
    located on the fundus of the stomach. Intrinsic factor is needed to effectively absorb
    vitamin B12 (found in dairy and meat). Because the gastric fundus is damaged in
    patients who have undergone gastrectomy, they are at higher risk of B12-deficiency
    anemia (mean corpuscular volume [MCV] >100).
47
Q 
694. What is the gold-standard test for alpha thalassemia minor and sickle cell anemia?
A) Ferritin
B) Hemoglobin electrophoresis
C) Total iron-binding capacity (TIBC)
D) Folate level
A
  1. B) Hemoglobin electrophoresis Alpha thalassemia and sickle cell anemia are both conditions that affect the hemoglobin molecule.

The gold-standard test for
these types of diseases (hemoglobinopathies) is the hemoglobin electrophoresis.

48
Q
  1. Which of the following findings are seen in a patient with folate-deficiency
    anemia?
    A) Microcytic and hypochromic red blood cells
    B) Microcytic and normochromic red blood cells
    C) Normal size and color of the red blood cells
    D) Macrocytic and normocytic red blood cells
A
  1. D) Macrocytic and normocytic red blood cells

Vitamin B12-deficiency
adversely affects myelin, leading to neuropathy. The most common cause of B12-
deficiency anemia is pernicious anemia. Anemia resulting from vitamin B12 or folate
deficiency is referred to as macrocytic or megaloblastic anemia because the red blood
cells (RBCs) are larger than normal. Deficiency in folate and B12 does not affect the
color of RBCs (normochromic). The RBCs have large cytoplasm because folate and
B12 are necessary for normal DNA synthesis and cytoplasmic maturation. The mean
corpuscular volume (MCV) measures the size of the RBCs. An MCV greater than
100 is seen in macrocytic anemias (folate or B12-deficiency anemia). The mean
corpuscular hemoglobin concentration (MCHC) is a measure of color, but number
values are not used on the exam. Instead, color is described as normochromic or
hypochromic.

CMN 572 unit 2 (8 decks)

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