Nutritional Anemia's

Question 1

Pernicious anemia- Etiology of B12 Deficiency

Answer 1

Usually seen in older adults, primary in African Americans & Caucasians/not Hispanics and Asians
Autoimmune attack on gastric IF
One type of anti-IF antibodies blocks the attachment of Cbl to IF
Other type blocks attachment of the Cbl-IF complex to ileal receptors

Question 2

Chronic Atrophic Gastritis- Etiology of B12 Deficiency

Answer 2

Leads to a decline in IF production
Associated w/ autoantibodies directed against gastric parietal cells
Resulting in less acidic pH in the stomach
Also associated with increase risk of gastric cancer and gastric carcinoid tumor

Question 3

Macrocytic anemia

Answer 3

Often—elevated iron levels, indirect bilirubin & LDH: indicating increased RBC breakdown due to both peripheral destruction & ineffective erythropoiesis

Peripheral smear—megaloblasts, hypersegmented neutrophils & macrocytosis

Question 4

Neurologic changes

Answer 4

only seen in B12 deficiency… NOT with folate deficiency

Question 5

Drugs that interfere w/ folate metabolism

Answer 5

Trimethoprim, methotrexate, phenytoin

Question 6

B12/Folate deficiency Special Populations

Answer 6

Older adults
Alcoholics
Patients w/ malnutrition
Strict vegans
Patients who have undergone bariatric surgery and are not being compliant w/ their vitamins

Question 7

Iron Deficiency Anemia

Answer 7

MCV<80 FL

Question 8

MACROCYTIC ANEMIA

Answer 8

MCV > 100 FL

Question 9

Iron deficiency anemia Etiologies

Answer 9

Decreased dietary intake: most common

Reduced iron absorption (gastric bypass)

Increased blood loss—Western world safest to assume cause is blood loss and search for that cause
Overt blood loss—obvious, surgery, menometrorrhagia, pregnancy
**Occult bleeding—assume GI cancer until proven otherwise!, peptic ulcer disease

Intravascular hemolysis

Congenital

Question 10

CBC Results-Results in IDA

Answer 10

Low MCV
Low MCHC
Elevated platelet count > 450,000
Normal/ elevated WBC count

Question 11

Peripheral smear-Results in IDA

Answer 11

Microcytic hypochronic

Increased platelet counts

Question 12

Iron Studies-Results in IDA

Answer 12

Low serum iron & ferritin levels with elevated TIBC = IDA dx.
Normal serum ferritin in coexisting hepatitis / ACD

Question 13

IRON STUDIES—NORMAL VALUES

Answer 13

Serum Iron (Fe) mcg/dL – 60 – 170 : shows how much iron is in your blood

Serum Ferritin ng/mL – 12 – 150 (females)/12 – 300 (males): reveals the amount of iron stored in your body

Transferrin/Total iron binding capacity (TIBC) microgm/dL –240 – 360: measure the ability of transferrin protein to carry iron in the blood

Transferrin saturation (Fe/TIBC) % –15– 50

Question 14

There are conditions where oral iron therapy is either poorly tolerated or ineffective

Answer 14

GI side effects are VERY common and can lead to poor compliance—70% of some populations who are prescribed oral iron do NOT take it

IBD

Dialysis Patients

Malabsorptive States (Celiac)