Anemia Clinical Care

Question 1

normal RDW

Answer 1

11-15%

(elevation = variability in RBC size)

Question 2

Reticulocyte normal value

Answer 2

0.5-1.5%

Question 3

Hgb count in anemia

Answer 3

• women < 12.0 g/dL
• men< 13.5 g/dL

Question 4

Hct % in anemia

Answer 4

• women < 36%
• men < 41%

Question 5

RBC count in anemia

Answer 5

• women < 4.2 mil cells/microL
• men < 4.7 mil cells/microL

Question 6

Pitfalls of determining anemia

Answer 6

1. acute bleed: hct & red cells lost together
2. pregnancy: plasma vol increases (looks like anemia)
3. dehydration doesn’t look anemic

Question 7

Answer 7

Question 8

MCV > 100 fL/cell = ____ anemia

MCV < 80 fL/cell = _____ anemia

Answer 8

• macrocytic
• microcytic

Question 9

MCH < _____ or

MCHC < _____ =

hypochromic anemia

Answer 9

• 27 picograms/cell
• 33 g/dL

(MCHC preferred)

Question 10

chronic anemias are typically _______

Answer 10

normocytic

Question 11

List the major causes of microcytic anemia (7)

Answer 11

1. iron deficiency
2. thalassemia
3. sideroblastic
4. lead poisoning
5. sickle cell
6. anemia in chronic disease
7. spherocytosis

Question 12

List the types of sideroblastic anemia

Answer 12

1. congenital (microcytic)
2. acquired clonal
3. acquired reversible

(bottom 2 are normocytic or macrocytic)

Question 13

List the most common normocytic anemias

Answer 13

• pregnancy
• dehydration

(think blood loss or change in plasma volume)

Question 14

Macrocytic anemias as typically caused by ______

Answer 14

vitamin deficiencies

Question 15

Causes of erythrocyte loss: bleeding

Answer 15

1. trauma
2. chronic: GI, menstrual
3. acut: GI, retroperitoneal

Question 16

anemia due to low EPO is caused by _____

Answer 16

kidney disease

Question 17

Target Hgb in patients on dialysis

Answer 17

10 g/dL

Question 18

Answer 18

Echinocytes “burr cells” which retain their central pallor (acanthocytes do not)

(normocytic, seen in kidney disease → anemia)

Question 19

anemia due to decreased response to EPO

Answer 19

1. iron deficiency
2. vit B12 deficiency
3. folate deficiency
4. anemia of chronic disease

Question 20

Describe the peripheral smear of iron deficiency anemia (3)

Answer 20

1. microcytic
2. hypochromic
3. red cells w/marked anisopoikilocytosis

Question 21

Iron deficiency anemia s/sx

Answer 21

1. pallor
2. koilonychia
3. beeturia (red urine; not blood)

Question 22

Answer 22

koilonychia

Question 23

Iron deficiency anemia lab findings (6)

Answer 23

1. HIGH iron binding capacity (open seats)
2. elevated platelet
3. low serum iron
4. low serum ferritin
5. low MCHC
6. low transferrin saturation (serum Fe/TIBC)

Question 24

Gold standard for diagnosing iron deficiency anemia

Answer 24

bone marrow biopsy → low stainable iron

Question 25

Good sources of dietary iron to maintain stores

Answer 25

1. red meat 2. spinach 3. cast iron skillet cooking (not enough to correct deficiency)

Question 26

Hemochromatosis

Answer 26

toxicity of iron overload (the reason why you must check iron stores before giving iron supplement)

Question 27

Iron therapy route of admin

Answer 27

1. oral 2. IM 3. IV

Question 28

How do H2 antagonists and PPIs interfere with oral iron therapy?

Answer 28

iron is best absorbed in an acidic environment (stays Fe²⁺) (taking w/orange juice helps)

Question 29

Oral iron tablets are most efficiently absorbed as \_\_\_\_\_

Answer 29

ferrous sulfate

Question 30

side effects of oral iron (3)

Answer 30

1. constipation 2. black stools 3. nausea (may cause positive hemoccult test)

Question 31

parenteral (IV or IM) iron therapy indications

Answer 31

cannot tolerate or absorb oral iron

Question 32

parenteral iron therapy adverse reaction

Answer 32

anaphylaxis

Question 33

Reasons patient may not be responding to iron therapy

Answer 33

1. incorrect dx 2. continued bleeding 3. non-compliance (pt not taking meds) 4. lack of absorption (PPIs)

Question 34

middle aged - elderly patients with iron deficiency anemia have a ______ until proven otherwise

Answer 34

GI bleed from tumor

Question 35

Cobalamin levels in macrocytic anemia

Answer 35

\<200 pg/mL

Question 36

How do you confirm cobalamin deficiency → anemia

Answer 36

1. elevated serum methylmalonic acid 2. elevated serum homocysteine

Question 37

Pernicious anemia is specifically \_\_\_\_\_\_.

Answer 37

ab to intrinsic factor → B12 deficiency

Question 38

Schilling test

Answer 38

give patient B12 → check urine → give IF + B12 → measure again (checks for pernicious anemia; positive test = increased B12 in urine after given IF + B12)

Question 39

Neuropsychiatric s/sx of B12 deficiency anemia

Answer 39

1. spastic ataxia 2. psychosis 3. loss of vibratory sense 4. dementia (may not be reversible if caught too late)

Question 40

Blood smear of B12 deficiency anemia

Answer 40

macrocytosis w/hypersegmentation of PMN w/ possible basophilic stippling (granulations)

Question 41

B12 deficiency anemia tx

Answer 41

* Pernicious: B12 shots (oral won't work; they don't have IF) 1000 mg * Absorption issue: treat underlying condition (Crohn's or Celiac)