Anemia 1

Question 1

primary driver of red cells

Answer 1

erythropoietin

Question 2

where is epo produced

Answer 2

kidneys

Question 3

stimulants for epo production

Answer 3

decreased o2 tension

kidney, lung, heart problems

Question 4

other things used in rbc production

Answer 4

iron, folate, b12

Question 5

t/f anemia is a decrease in red cells

Answer 5

false, decrease in hemoglobin causing decreased oxygen carrying capacity of blood

Question 6

who standard for anemia

Answer 6

< 13.0 g/dl in males

< 12.0 g/dl in females

Question 7

first step in classification of anemia

Answer 7

get cbc and reticulocyte count

Question 8

indexes in anemia

Answer 8

index < 2.5: red cell morphology, hypoproliferative

index >/= 2.5: hemolysis/hemorrhage

Question 9

types of morphology pathologies

Answer 9

normocytic normochromic = marrow damage (aplasia, aplastic anemia), iron deficiency in early stages, decreased stimulation (kidney disease)

microcytic = cytoplasmic defects

macrocytic = nuclear defects

Question 10

causes for hemolysis or hemorrhage

Answer 10

blood loss, intravascular hemolysis or destruction of red cells, membrane abnormality or hemoglobinopathy

Question 11

causes for microcytic, hypochromic anemia (hypoproliferative anemia)

Answer 11

iron deficiency anemia
thalassemia (not always)
myelodysplastic syndromes (sideroblastic anemia)

Question 12

causes for macrocytic anemia (hypoproliferative anemia)

Answer 12

vitamin b12, folate deficiency
drug toxicity
myelodysplastic syndrome (refractory anemia)

Question 13

causes for normocytic, normochromic anemia

Answer 13

myelopthisis (marrow infiltration/fibrosis)
anemia of inflammation
anemia of chronic renal disease
aplastic anemia

Question 14

causes of proliferative anemias

Answer 14

acute blood loss

hemolysis (toxin-induced, autoimmune, paroxysmal nocturnal hemoglobinuria)

Question 15

most common form of anemia worldwide

Answer 15

iron deficiency anemia

Question 16

who are at risk for iron deficiency anemia

Answer 16

pregnant women

growing children and teenage girls

Question 17

normal values for checking iron deficiency

Answer 17

serum ferritin 60 mcg/l
transferrin saturation 35%
hemoglobin >120 g/l in females, >130 g/l in males

Question 18

stage of iron depletion

Answer 18

• depleted iron in ferritin, hemosiderin, or reticuloendothelial cells
• decreased serum ferritin (<15 mcg/l)
• normal hemoglobin

Question 19

stage of iron deficient erythropoiesis

Answer 19

• low serum ferritin (<15) and transferrin saturation (<15)

- normal hemoglobin (can still make rbc)

Question 20

stage of iron deficiency anemia

Answer 20

• no more stores, and no more in transport

- hemoglobin, transferrin, and ferritin are low

Question 21

best test used to detect iron deficiency

Answer 21

serum ferritin

Question 22

t/f the daily diet has 10-20mg of iron, and we absorb only 1-2 mg of iron

Answer 22

true

Question 23

___ mg of iron is lost in a day because of desquamation of epithelium

Answer 23

1-2 mg

Question 24

iron is obtained from _____ to make new red cells

Answer 24

old senescent red cells

Question 25

breakdown of iron use

Answer 25

75: erythropoiesis 10-20% in liver and heart via ferritin 5-15% others

Question 26

t/f iron has no physiologic excretion mechanism

Answer 26

true

Question 27

causes of iron deficiency

Answer 27

increased demand for iron increased iron loss decreased iron intake or absorption

Question 28

causes of increased demand for iron

Answer 28

rapid growth in infancy or adolescence pregnancy epo therapy

Question 29

causes for increased iron loss

Answer 29

chronic blood loss (females: gyne conditions, males: occult bleeding) menses acute blood loss blood donation phlebotomy as treatment for polycythemia vera

Question 30

common cause of iron deficiency in males and post-menopausal females

Answer 30

gi bleed unless proven otherwise (common ulcer or bleeding mass)

Question 31

needed diagnostic test for elderly patients with blood loss

Answer 31

gastroesophagealduodenoscopy | or colonoscopy

Question 32

___ are also at risk for iron deficiency

Answer 32

patients who regularly donate blood

Question 33

causes for decreased iron intake or absorption

Answer 33

inadequate diet malabsorption from disease (sprue, crohn's disease) malabsorption from surgery (gastrectomy and bariatric surgery) acute or chronic inflammation

Question 34

wounds at the angle of the mouth

Answer 34

angular cheilitis

Question 35

spooning of the nails

Answer 35

koilonychia

Question 36

eating disorder where patient craves for unusual things

Answer 36

pica

Question 37

common lab pattern in iron deficiency anemia

Answer 37

low serum ferritin (<20) low serum iron elevated tibc (>400)

Question 38

gold standard for iron deficiency anemia diagnosis

Answer 38

demonstrating that bone marrow no longer has iron | - bone marrow exams are not required for all patients

Question 39

t/f serum iron is initially low in negative iron balance and decreases as disease progresses

Answer 39

false, initially normal in negative iron balance

Question 40

t/f total iron binding capacity is low in iron deficiency anemia

Answer 40

false, it's elevated because transferrin still has a large capacity for iron to be transported

Question 41

best treatment for very symptomatic patients of iron deficiency anemia

Answer 41

transfusion to immediately correct the symptoms

Question 42

iron deficiency anemia treatment with patients without or with bearable symptoms

Answer 42

tablets of ferrous sulfate, ferrous gluconate, or ferrous fumarate at least 300 mg of elemental iron per day best taken without food and with something acidic, once a day

Question 43

side effects of iron tablets

Answer 43

bloatedness, abdominal pain, nausea, vomiting, constipation, black tarry stools

Question 44

iron deficiency anemia treatment for patients with ckd or unbearable side effects

Answer 44

``` iv iron (iron dextran/sucrose/ carboxylase) - adverse effects: anaphylaxis, tattoo ```

Question 45

dietary advise for patients with iron deficiency anemia

Answer 45

intake of food rich in iron (red meat, liver, vegetables, limit intake of tea)

Question 46

composition of hemoglobin

Answer 46

2 alpha subunits, 2 beta subunits

Question 47

consequences of malformed hemoglobin

Answer 47

inefficient in transporting oxygen -> hold on to oxygen -> negatively affects tissue perfusion

Question 48

alpha vs beta thalassemia

Answer 48

``` alpha = dont make enough adult hemoglobin with a chains beta = dont make enough adult hemoglobin with b chains ```

Question 49

product when only producing a and gamma chains

Answer 49

hgbf

Question 50

what happens to pure a chains

Answer 50

precipitation --> destruction of rbc precursors or hemolysis causing splenomegaly

Question 51

effects of anemia (thalassemia)

Answer 51

- more epo produced - bone marrow produces more blood - marrow expansion - bone deformity, increased metabolic rate, wasting, gout, folate deficiency

Question 52

effects of transfusions

Answer 52

iron overload = endocrine deficiencies, cirrhosis, cardiac failure, death

Question 53

clinical manifestations of thalassemia

Answer 53

``` frontal bossing chipmunk facies hydrops fetalis (stillborn with hg barts, bloated) splenomegaly hair on end appearance on xray ```

Question 54

required to diagnose thalassemia

Answer 54

hemoglobin electrophoresis

Question 55

treatments for thalassemia

Answer 55

rbc transfusion iron chelating agents bone marrow transplant (best) other advice

Question 56

indication and problem with rbc transfusion

Answer 56

indication: symptomatic problem: iron overload

Question 57

t/f 1 L of blood = 1 g of Fe

Answer 57

false, 1 mL blood = 1 g of Fe

Question 58

example of iron chelating agent

Answer 58

deferasirox | binds to excess iron

Question 59

best treatment for thalassemia major

Answer 59

bone marrow transplant: hematopoietic stem cell transplant | allogenic stem cell transplant for thalassemia major