Anemia

Question 1

How are blood oxygen levels managed?

Answer 1

Negative feedback loops

Question 2

What is the sequence of events when blood oxygen levels are low?

Answer 2

1. Stimulus - hypoxia (due to low RBC count, low amount of hemoglobin, or decreased availability of O2)
2. Tissues in the kidney sense low O2 and release Erythropoietin (EPO)
3. EPO stimulates bone marrow to produce more RBCs
   * B12 and folate are necessary in order to produce blood iron

Question 3

What is the factory for the production of RBC’s?

Answer 3

Bone marrow

Question 4

What detects low O2 and releases EPO to stimulate bone marrow?

Answer 4

Healthy kidneys

Question 5

What “ingredients” are necessary for RBC’s to be built?

Answer 5

B12 and folate in the gut

Question 6

What are some causes of anemia?

Answer 6

• Bone marrow disfunction –> cancer, chemo, radiation, aplastic anemia
• Renal disease –> often tx with exogenous EPO
• Malabsorption/malnutrition –> B12, folate deficiency from diet
• Consumption –> bleeding, hemolysis

Question 7

Anemia is a ______ not a _______

Answer 7

Symptom, Disease

Question 8

If a pt has Hgb <12 and MCV <80 what test should you order? (MCH <26)

Answer 8

Iron panel

Microcytic hypochromic

Question 9

What are the two most important values on an iron panel in terms of diagnosing anemia?

Answer 9

Ferritin and TIBC (total iron binding capacity)

Question 10

What are abnormal values of ferritin and TIBC that would cause you to diagnosis someone with iron deficiency anemia?

Answer 10

LOW ferritin and HIGH TIBC

Question 11

If an iron panel comes back normal for a pt with Hbg <12 and MCV <80 what test should you now order?

Answer 11

Gel electrophoresis

Question 12

Once you’ve ordered gel electrophoresis, what is the most likely diagnosis?

Answer 12

Thalassemia

Question 13

What do RBC’s look like in microcytic hypochromic anemia?

Answer 13

Target cells (think the target logo)

Question 14

What does total iron binding capacity (TIBC) measure?

Answer 14

The amount of proteins available for binding iron (in healthy individuals, you want to see low TIBC because it means you have enough iron to bind to all the proteins)

Question 15

What are long term iron stores called?

Answer 15

Ferritin (want high long term stores)

Question 16

What is treatment for iron deficiency anemia?

Answer 16

Start with iron supplementation (oral or IV) which searching for a cause

Question 17

What is the number one cause of iron deficiency anemia in the world?

Answer 17

Parasitic disease

Question 18

What is the intense craving for nonfood items?

Answer 18

Pica

Question 19

What is the craving for ice and when is it commonly seen?

Answer 19

Pagophagia. Commonly seen in the iron-deficient state

Question 20

If a pt has Hgb <12 and MCV 80-100 what lab should you order?

Answer 20

Reticulocyte count

Question 21

What does a high reticulocyte count indicate in a patient with normocytic anemia?

Answer 21

There is a bleed somewhere internally and you need to find it, next step = peripheral blood smear

Question 22

What does a low reticulocyte count indicate in a patient with normocytic anemia?

Answer 22

Abnormally functioning bone marrow, next step = bone marrow biopsy

Question 23

What are schistocytes?

Answer 23

Helmet shaped cells or fragments of RBCs that have been lysed

Question 24

What should you order if schistocytes are present?

Answer 24

Haptoglobin (decreased in times of lysis <50) and LDH (elevated >200)

Question 25

If a pt has Hgb <12 and MCV >100 what lab should you order?

Answer 25

B12 and folate

Question 26

What can cause macrocytic anemia?

Answer 26

ETOH, diet/gut health, bowel conditions, certain drugs (folate antagonists)

Question 27

How do certain drugs cause macrocytic anemia?

Answer 27

Folic acid is a building block for many things and certain drugs inhibit folic acid production which leads to macrocytic anemia

Question 28

How do you treat anemia?

Answer 28

Follow the flow chart and treat accordingly. Remember anemia is a SYMPTOM of an underlying DISEASE (so you need to treat the disease)