Anemia I

Question 1

What is anemia?

Answer 1

A decrease in the circulating RBC mass

Question 2

What are the major RBC measurements that when reduced indicate anemia?

Answer 2

RBC count (number of RBCs in a specified vol of whole blood)
Hemoglobin (conc of Hb in whole blood)
Hematocrit (vol of packed RBCs)

Question 3

What Hb and Hct level indicates anemia?

Answer 3

<14 g/dL for men and <12 g/dL for women

<40% for men and <35% for women

Question 4

What do RBCs originate from?

Answer 4

Myeloid stem cell

Question 5

What are reticulocytes and what is their life span?

Answer 5

Immature RBCs

3 days in bone marrow and 1 day in circulation

Question 6

What is the life span of RBCs?

Answer 6

120 days (then removed by spleen primarily)

Question 7

What does retic count indicate?

Answer 7

Bone marrow production of RBCs to see if it is working well

Normal: .5-2%

Question 8

What do reticulocytes look like on a peripheral smear?

Answer 8

“Lots of blue means lots of new”- bigger than normal RBCs and have a hint of blue because lack central pallor that indicated mature RBC

Question 9

3 causes of anemia

Answer 9

Decreased RBC production (nutritional deficiencies, chronic disease, ineffective erythropoesis)
Increased RBC desctruction (hemolysis)
Blood loss (menstrual, GI, trauma)

Question 10

What are the RBC indices?

Answer 10

MCV, MCH and MCHC

Question 11

How do you classify RBCs by size?

Answer 11

Normocytic, microcytic or macrocytic

Question 12

Mean corpuscular volume (MCV)

Answer 12

Calculated value to determine avg vol (size) or RBCs

Normocytic is 80-100

Question 13

Mean corpuscular hemoglobin (MCH)

Answer 13

Average Hb content in a RBC

Question 14

Mean corpuscular hemoglobin concentration (MCHC)

Answer 14

Average Hb concentration per RBC

Question 15

How do you talk about MCH and MCHC?

Answer 15

Usually follow MCV so “microcytic hypochromic”

Question 16

Red cell distribution width (RDW)

Answer 16

Measure of variation in RBC size

Normal: 11-15%

Question 17

What is anisocytosis?

Answer 17

Variation in size of RBCs

Question 18

Signs and symptoms of anemia

Answer 18

Fatigue/weakness, HA, dizzy, dyspnea, palpitations

Pallor, heme + stool, orthostatic chances, tachycardia

Question 19

3 categories of anemia and their probable causes

Answer 19

Microcytic hypochromic (iron deficiency, thalassemia, sideroblastic anemia)
Normocytic normochromic (hypothyroidism, liver disease, chronic disease)
Macrocytic/megaloblastic (folate or B12 deficiency)

Question 20

What are the major causes of iron deficiency anemia?

Answer 20

Blood loss (most common), decreased dietary intake, decreased iron absorption (Celiac, bariatric surgery, H pylori)

Question 21

Diagnostic studies for iron deficiency anemia

Answer 21

Decreased RBC, H/H
MCV can be normal early on but will be microcytic later
Iron: decreased ferritin and serum Fe, increased TIBC
Increased RDW
Retic count probably low (but may be inappropriately normal)

Question 22

What do you see on a peripheral smear of iron deficiency anemia?

Answer 22

RBCs that are microcytic and hypochromic, anisocytosis and poikilocytosis (varies in shape)

Question 23

Other manifestations of iron deficiency anemia

Answer 23

Glossitis, angular cheilitis, koilonychia (spoon nails)
Pica (crave ice)
Dysphagia (esophageal webs- Plummer Vinson syndrome)
Restless legs syndrome

Question 24

What is the most important part of treating iron deficiency anemia?

Answer 24

Determine the underlying cause!

Question 25

Treatments for iron deficiency anemia

Answer 25

Replace iron stores: Orally ferrous sulfate 325 mg BID-TID and should see return of HCT 1/2 way to normal in 3 weeks and full return to baseline at 2 months (continue for 3-6 mos to replenish stores) Parenteral iron used in some people Blood transfusions in ppl not recommended for iron replacement

Question 26

What are the thalassemias?

Answer 26

Inherited hemoglobinopathy with reduction in the synthesis of globin chains Leads to ineffective erythropoiesis and hemolysis

Question 27

What is the result of the thalassemias?

Answer 27

Varying anemia and extramedullary hematopoiesis (produce RBCs outside of bone marrow) Bone changes, impaired growth and iron overload

Question 28

What is alpha-thalassemia?

Answer 28

Deletion of one or more of the four alpha-globin chains

Question 29

4 types of alpha-thalassemia

Answer 29

1 deletion: silent carrier 2 deletions: alpha-thal minor or mild microcytic anemia 3 deletions: Hb H disease or mod microcytic anemia-chronic hemolytic anemia 4 deletions: hydrops fetalis (fatal in utero)

Question 30

What is beta-thalassemia?

Answer 30

Reduced or absent beta-globin chain synthesis (usually due to pt mutation)

Question 31

3 types of beta-thalassemia

Answer 31

``` Thalassemia minor (trait)- 1 chain, asymptomatic and mild microcytic anemia Thalassemia intermedia- less sever than major, non-transfusion dependent, chronic hemolytic anemia Thalassemia major- both chains, transfusion-dependent, sever hemolytic anemia ```

Question 32

Labs seen in the thalassemias

Answer 32

``` Normal to increased RBC MCV super low (<75) RDW is normal Retic count: variably increased Normal to increased ferritin and iron Normal to decreased TIBC ```

Question 33

What is hemoglobin electrophoresis?

Answer 33

Used in the diagnosis of the thalassemias to detect the type of Hb present

Question 34

Treatments for thalassemia

Answer 34

Tailored to severity obvi Folic acid supplementation (for chronic hemolysis) AVOID IRON SUPPLEMENTS Severe: regular transfusion schedule, hematopoietic cell transplant or genetic counseling

Question 35

What is the process of sideroblastic anemia?

Answer 35

Hereditary or acquired RBC disorder | Abnormal RBC iron metabolism- diminished heme synthesis- iron accumulates in cells

Question 36

What do you use to seesideroblastic anemia?

Answer 36

Bone marrow aspirate: ring sideroblasts (blue-stained iron) *hallmark Peripheral smear: siderocytes with pappenheimer bodies

Question 37

Causes of sideroblastic anemia

Answer 37

Acquired is most common in adults Often a variant of myelodysplastic syndrome Chronic alcoholism, meds, copper deficiency

Question 38

What is the highest prevalence of thalassemias?

Answer 38

Africa, Asia and the Mediterranean region

Question 39

Diagnostics of sideroblastic anemia

Answer 39

Elevated RDW Normal to low retic count Normal or elevated ferritin (leads to systemic volume overload- may look just like hereditary hemochromatosis)

Question 40

Treatments for sideroblastic anemia

Answer 40

Treat the underlying cause duh Discontinue offending drugs/toxic agents Pyridoxine (vitamin B6) to help with Hb synthesis Transfusion/manage iron overload

Question 41

What is the second most common cause of anemia worldwide?

Answer 41

Anemia of chronic disease

Question 42

What causes anemia of chronic disease?

Answer 42

Hepcidin-induced alterations in iron metabolism Inability to increase erythropoiesis Impaired to erythropoietin production

Question 43

What is hepcidin?

Answer 43

Key regulator of the entry of iron into circulation | High levels are seen in inflammation (because of iron trapping in macrophages and decreased gut iron absorption)

Question 44

Labs seen in anemia of chronic disease

Answer 44

Mild anemia: Hb or 10-11 g/dL Normocytic, normochromic Retic count may be low Normal or increased serum ferritin (acute phase reactant) Serum Fe and TIBC low (inflammation setting)

Question 45

Treatment for anemia of chronic disease

Answer 45

Obvi treat the underlying cause | Erythropoietin may help