Anemia - MIDTERM

Question 1

How do you determine if anemia is micro, macro, or normocytic

Answer 1

MCV (mean corpuscular volume)

Microcytic = MCV less than 80)

Normocytic = MCV 80-100

macrocytic = MCV greater than 100)

Question 2

What is RDW

Answer 2

= RBC distribution width

is a measure of the size variation of RBC’s

Question 3

Is it important to add Vit C with iron supplementation?

Answer 3

People are often advised to but there’s no actual evidence for it according to RxFiles….it MAY increase iron absorption.

According to MUMs: Acidic foods, such as orange juice, should be recommended to increase absorption of non-heme iron. Ascorbic acid (250-500mg BID) given with the iron preparation may enhance iron absorption

Question 4

What chronic disease commonly leads to iron deficiency anemia?

Answer 4

CKD

Question 5

Serum ferritin of what value indicates iron deficiency anemia?

Answer 5

<20mcg/L

Question 6

Iron supplementation should be continued for how long after correction of anemia?

Answer 6

3 months, to replenish iron stores

Question 7

What dose of iron is recommended for adults with IDA?

Answer 7

Target up to 60-200mg elemental Fe++/day or
2-3mg/kg/day (HD pts may require high dose)

Titrate dose q3-7d as tolerated (start low, go slow)

Question 8

T/F Iron supplements should be taken with food

Answer 8

False - Best to take on
empty stomach to ↑absorption

…but may take
with meals (e.g. crackers, no dairy) to ↓GI AE.

Question 9

B12 deficiency anemia - it mico, macro or normocytic?

Answer 9

Most common MACROcytic

Question 10

What causes B12 deficiency

Answer 10

Can be issue of impaired absorption (as with pernicious anemia or issues such as chrohn’s disease, gastric bypass,)

OR inadequate dietary intake (found in animal products)

Question 11

What happens in pernicious anemia?

Answer 11

autoimmune gastritis that prevents your body from absorbing vitamin B12.

vitamin B12 is unavailable owing to a lack of intrinsic factor (produced by the parietal cells of the stomach), a substance responsible for intestinal absorption of B12

May also have reduced/absent acid production

Question 12

S&S of B12 deficiency

Answer 12

• usual anemia symptoms
• paresthesias of feet and hands
• difficulty walking
• sore tongue (glossitis) - see as smooth red beefy tongue
• Loss of appetite, abdo pain
  Pallor, jaundice
• stroke or ischemic heart disease (d/t increased plaque/clotting)
• If severe, impaired neurologic function (loss of memory, decreased reflexes, psychosis)

Question 13

What populations are at high risk of anemia?

Answer 13

• growing infants/children
• pregnant women, hypogonadal men
• Blood loss (GI, menstrual, regular blood donation)
  -Intestinal parasites (recent travel/immigration)
• Malnutrition (veg diet, alcoholism)
• Elderly

Question 14

T/F You need to stop iron supplements prior to a FIT test

Answer 14

Taking iron products may produce a positive Fecal Occult Blood Test result; if possible, discontinue iron 2 - 3 weeks prior

Question 15

What can a blood peripheral smear show us?

Answer 15

assess number and morphology of red cells, white cells, platelets

Question 16

How long does it take to deplete B12 stores?

Answer 16

2-5 years

Question 17

How is pernicious anemia and IDA linked?

Answer 17

IDA is common complication of patients with longstanding pernicious anemia (so check ferritin too!)

Question 18

How quickly is B12 deficiency improved/fixed with supplementation?

Answer 18

Improvement should be seen within 5 - 7 days, and the deficiency should resolve after 3 - 4 weeks of treatment.

However, 6 months of therapy or longer will be required for signs of improvement in the neurologic manifestations of vitamin B12 deficiency. In cases of chronic B12deficiency, such as pernicious anemia and postsurgical malabsorption states, patients will require lifetime therapy

Question 19

T/F Parenteral admin is typically preferred over oral doses of B12

Answer 19

False - generally oral/SL preferred

There are several drawbacks to parenteral administration including pain, inconvenience and cost. Parenteral administration remains the treatment of choice for hospitalized patients, patients unable to take medication by mouth or with diarrhea or vomiting, severe neurological symptoms or where compliance to a daily dosage regimen is a concern

Question 20

What kind of doses of B12 are given to correct deficinecies?

Answer 20

If pernicious anemia, 1000-2000mcg daily (oral/SL/IM/SC)

If d/t malabsorption or poor nutrition, 100mcg daily

*I’m not sure how we clinically differentiate these things but seems like my preceptor generally does 100mcg daily?

Question 21

In B12 anemia, would you expect the reticulocyte to be high or low?

Answer 21

Low I believe because cells not dividing properly

Question 22

What labs will you order for B12 anemia?

Answer 22

-Hbg and hct to determine severity;

CBC/ diff (including platelet count, RBC count, indices (MCV, MCH, RDW)

serum ferritin
reticulocyte count, peripheral smear.

-B12, folate, TSH (can have macrocytic anemia), LFTs (liver disease can have macrocytic anemia)