Anemia Flashcards
3 types of Anemia
Microcytic
Macrocytic
Normocytic
Microcytic
MCV<80
Iron Deficiancy Anemia
Thalassemia
Normocytic
Anemia of Chronic Disease
Acute blood loss
Early IDA
Macrocytic
MCV>100
Vitamin B12 deficiency
Folate deficiency
Microcytic
Men and postmenopausal women
Menstrual loss
children-nutritional
Microcytic
Low H&H Low MCV and MCHC ****Low Serum ferritin High TIBC Low serum iron
Iron Deficiency Anemia Tx
Identify cause 3x stool cards elemental iron 50-100 mg 3x/day pregnancy 60-120 mg then reduce to 30 elderly 15 mg If after 3 weeks consider something wrong normal hemoglobin in 2 months Continue for 6 mos if it was severe
IDA
Keep away from children
take 2 hours apart from meals, antacides, calcium or medications
Take with Vitamin C (orange juice)
Retic count up in 2 weeks
Thalassemia-Alpha minor
reduction in synthesis of hemoglobin
Seen in more Asian, African and Mediterranean descent
Alpha minor-mild anemia MVC 60-75
Retic count and iron parameters are normal
Hemoglobin electrophoresis is normal
Thalassemia-Beta Minor
May see basophilic stippling(small dots)
retic count is normal or slightly elevated
Electrophosesis may show abnormal elevations
Important to differenciated Thalassemia from IDA
They do not respond to iron therapy
May need genetic counseling
Macrocytic Anemia
Vitamin B12 deficiency
In older population
Autoimmune disorder resulting in B12 absorption-lack of Intrinsic Factor (IF)
Malabsorption from:
alcohol, H. Pylori, long term use of antacids
Long term use of Metformin
Macrocytic Anemia
Smooth red beefy tongue
Macrocytic Symptoms
irritable memory impairment neurological complaints Chronic vegetarians alcoholics
Macrocytic Dx
MCV=elevated serum B121 of elevated serum methylmalonic acid elevated serum homocysteine level serum holotranscobalamin <35 absence of renal failutre, folate deficiency, or vitamin B6 def.
Macrocytic
Retic count is low
peripheral smear abnormal
folate level is normal
IF or anti parietal cell antibodies can confirm
Macrocytic B12
B12 supplementation
orally at 1,000-2,000mcg/day
IM once daily or every other day for 1-2 weeks, then 100-1000 mcg every 1-3 months
intranalsal spray once weekly after normalized
Treat underlying contributing factors
Macrocytic B12 severe
Refer
Significant reticulocytosis should be seen in 1-2 weeks
For mild-repeat serum B12, homocystein, and Methylmalonic acid levels in 2-3 months
Folate Deficiency
Reduced folate levels Most common cause is inadequate dietary intake Alcoholic, and anorectic clients Drugs may interfere with absorption -Phenytoin -sulfa drugs Supplements before and during pregnancy 0.4mg/day
Folate symptoms
fatique
anorexia
gastritis
low-grade fever, dyspnea, palpitations
Drugs that interfere with folate absorption
methotrexate, pyrmethamine, trimethorprin, triamterene, sulfa drugs (phenobarb, dilantin,)
oral contraceptives
Folate deficiency
Ask about diet. May see pallor, glossitis, mild icterus
Folate Diagnostics
serum folate<305
serum methymalonic acid (MMA) and total homocysteine can differenciate folate from B12
NORMAL MMA with elevated homocysteine indicates likely Folate Def,
Folate Def Tx
folate rich foods
folic acid 1 mg per day (will replenish in weeks)
reduce alcohol
CBC in 10-14 days show increase hemoglobin and decreased MCV Good response in 8 weeks
