Anemia: Overview of Approach to Patient

Question 1

Define anemia.

Answer 1

Insufficient red cell mass to deliver oxygen to peripheral tissues

Question 2

What is the first question you ask in response to patient anemia?

Answer 2

Are there other hematologic abnormalities? If yes, test bone marrow.

Question 3

What should you ask if there are no other hematologic abnormalities in an anemic patient?

Answer 3

Is there a normal reticulocyte response? If yes, is there evidence of hemolysis. If no, test MCV.

Question 4

If there is no evidence of hemolysis in an anemic patient without other hematologic abnormalities and with a normal reticulocyte response, what should you be thinking?

Answer 4

Hemorrhage!

Question 5

Iron is absorbed through the ______.

Answer 5

duodenum (because it is solubilized by the low pH and protein gastroferrin in the stomach)

Question 6

_____ is on the apical surface of duodenal cells and converts iron from ___ to ___.

Answer 6

DCYTB; Fe3+; Fe2+

Question 7

______ imports iron from the duodenal lumen through the apical membrane.

Answer 7

DMT1

Question 8

______ exports Fe2+ through the basolateral membrane, where it then is converted back to Fe3+ by _____.

Answer 8

Ferroportin; hephaestin

Question 9

_____ is an intracellular iron-storage protein.

Answer 9

Ferritin

Question 10

Transferrin is a plasma protein (produced by the liver) that can bind up to ____ of iron.

Answer 10

two moles

Question 11

During infection or inflammation, _____ can lead to anemia.

Answer 11

inhibition of ferroportin (which releases iron through the basolateral membrane)

Question 12

Iron overload is also called _____ and can be caused by ____ deficiency.

Answer 12

hemochromotosis; hepcidin (which is a negative regulator of iron absorption)

Question 13

List the characteristics of iron deficiency.

Answer 13

Decreased Hgb synthesis
Decreased cell proliferation
Hemolysis
Anemia
Immune deficiency 
Pica

Question 14

Normal hemoglobin levels (g/dL) range from _____ in menstruating women to ______ in infants.

Answer 14

12; 17

Question 15

Normal hematocrit levels (%) range from ____ in children ages 3 months to five years to ____ in infants.

Answer 15

36; 52

Question 16

______ stains are used to study red cell morphology.

Answer 16

Wright’s

Question 17

The normal reticulocyte count is ____.

Answer 17

0.4 - 1.7%

Question 18

Hepcidin is a polypeptide, produced by the _____, that ________.

Answer 18

liver; negatively regulates iron absorption (even degrading ferroportin)

Question 19

Transferrin gets __________.

Answer 19

ingested in clathrin-coated pits that acidify (endosomes), thus releasing iron into the cell

Question 20

Hereditary hemochromatosis results from ________.

Answer 20

autosomal recessive defects in the HFE gene