Microcytic and Normocytic anemias

Question 1

anemia of chronic disease (ACD) is a result of

Answer 1

underlying systemic dx causing:

release of IL-6 and TNF

increased hepcidin that inhibits iron transport into the intestine

stops iron release in macrophages resulting in decreased RBC production in bone marrow from abnormal iron metabolism.

Decreases EPO production and decreased RBC survival

Question 2

bone marrow aspiration of anemia of chronic dx

Answer 2

abundant iron in macrophages and no iron in RBC precursors

Question 3

bone marrow aspiration in iron deficency anemia

Answer 3

absent iron in macrophages and abscent iron in RBCs

Question 4

TIBC in iron deficiency anemia

Answer 4

TIBC - will be high because there’s more spaces for iron to bind to because there’s more “seats” or iron receptors available because there’s low iron

****most specific test to determine if IDA is there****

Question 5

TIBC in anemia of chronic dx

Answer 5

normal to low

because there’s no extra transferrin receptors available to bind to iron because of acute phase reactants will cause hepcidin to internalize ferritoportin and transferrin receptors so there’s less receptors available for iron to bind .

Question 6

ferritin represents what in iron metabolism?

Answer 6

amount of stored iron but also is an acute phase reactant that can be high in anemia of chronic disease and low in iron deficiency anemia.

<15% ferritin is highly suggestive of IDA

Question 7

test to check for concerns over hemochromatosis

Answer 7

check transferrin level because that will be high. It has the most seats full.

Question 8

transferrin saturation levels represent

in Fe deficiency anemia

in anemia of chronic dx

in hemochromatosis

Answer 8

the number of seats that are full with iron or receptors bound to iron.

in iron deficiency anemia- there’s low transferrin saturation because low iron.

In anemia of chronic dx, there ls also low to normal because of either less iron available to

In hemochromatosis - there’s high transferrin saturation because there’s a lot of iron bound to these receptors.

Question 9

alpha and beta thalassemia traits have

Answer 9

normal to increased total iron and ferritin due to high cell turnover. But total iron binding capacity is normal

Question 10

Thalassemia trait will have a MCV that is ???

Answer 10

MCV<70

Question 11

Iron deficiency will have

Answer 11

low iron, low ferritin and increased total iron binding capacity and MCV<80 and elevated MCV

Question 12

hemoglobin analysis in alpha thalassemia trait

Answer 12

no therapy and normal Hgb analysis

Question 13

chart for thalassemias

Answer 13

Question 14

Fe deficiency anemia vs. thalassemia chart

Answer 14

Question 15

What does this peripheral smear show?

Answer 15

See microcytic, hypochromatic RBCs - microcytic anemia includes Fe deficiency, thalassemia, anemia of chronic dx. Likely Fe because high RDW

Question 16

Chart comparing all the microcytic anemia parameters.

Answer 16

Question 17

What causes Fe deficiency?

Answer 17

blood loss (Gi or menstral bleeding).

Decreased GI absorption of iron (celiac dx or inflammatory bowel dx, or bariatric surgery)

Question 18

Can give EPO for anemia if

Answer 18

undergoing chemotherapy and has Hgb <10 and are asympotmatic.

But use cautiously because increases risk for VTE and cardiovascular complications.

Question 19

Cancer related anemia and management

Answer 19

since anemia could be result of Fe deficiency, chemo induced myelosuppression or increased RBC destruction from tumor induced hemolysis (mAHA or autoimmune)

Best to recheck CBC at next visit as long not symptoatmic and Hgb >10

Question 20

Chart of common RBC abnormalities seen on peripheral smear

Answer 20

Question 21

Iron deficiency is defined as

What is the goal iron replacement for pts who are on dialysis or ESRD?

Answer 21

transferrin saturation<20%, ferritin <100 and (<200 in dialysis pts), and needs to be treated prior to starting EPO

Goal is to reach 20-50% transferrin saturation and 200-500 for ferritin

Question 22

Goal iron replacement for FE defiiciency anemia in CKD and ESRD pt

Answer 22

Goal is to reach 20-50% transferrin saturation and 200-500 for ferritin

Question 23

target level for EPO is to increase Hemoglobin to

Answer 23

10-11

helps improve physiological parameters and improves quality of life.

>12 adds little benefit and increases mortality and morbidity with stroke, hypertension and vascular access thrombosis.

Question 24

spherocytes can occur in

Answer 24

autoimmune hemolytic anemia, clostridial sepsis, snake bites, G6PD dehydrogenase deficiency, MAHA and hereditary spherocytosis

Question 25

if you see spherocytosis, what lab test do you have to order?

Answer 25

direct antiglobulin test (DAT)

helps to differentiate between two conditiosn of hereditary spherocytosis and AIHA

Question 26

hereditary spherocytosis is seen with:

Answer 26

due to atlered genes for encoding RBC membrane proteins which leads to instability and phagocytosis by spleen.

Autosomal dominant.

See chronic hemolytic anemia, jaundice and splenomegaly and can see increased folate requirement and see bilirubin gallstone formation.

Question 27

hereditary spherocytosis labs:

how is it diagnosed?

Answer 27

elevated MCV and increased RDW

can show spherocytosis in varying degrees depending on disease severity

Diagnosis is confirmed by flow cytometery with eosin5 maleimide binding or acidified glycerol lysis test.

Question 28

Treatment of hereditary spherocytosis

Answer 28

folic acid supplmentaion

transfusion for symptomatic anemia

splenectomy for severe cases.

Question 29

what is transferrin saturation?

Answer 29

iron / TIBC x 100

Question 30

CKD levels of goal iron replacement

Answer 30

transferrin saturation level >30%

serum ferritin >500 ng/ml

replace with IV or oral iron

transferrin saturation level is (Fe/TIBC x100)