Anemia- Module 4

Question 1

What hemoglobin concentration (for adult men & women) suggests anemia?

Answer 1

Men: <12 g/dl

Question 2

What are reticulocytes? What does the reticulocyte count evaluate?

Answer 2

Immature RBCs; The bone marrow production of RBC’s

Question 3

What level indicates a high reticulocyte count? What does this indicate?

Answer 3

> 3%; body is compensating for blood loss

Question 4

What level indicates a low reticulocyte count? What does this indicate?

Answer 4

<1%; RBC production is impaired

Question 5

What lab value differentiates microcytic, normocytic, and macrocytic anemia?

Answer 5

Mean corpuscular volume (MCV)

Question 6

What are the three mechanisms that affect blood volume (and therefore anemia)?

Answer 6

1. Blood loss
2. Decrease in RBC production
3. Increase in RBC destruction

Question 7

What three types of laboratory values are used to discover which mechanism is the cause:

Answer 7

1. CBC (hgb, hct)
2. RBC indices (MCV, reticulocyte count)
3. Iron indices (ferritin, TIBC, serum iron)

Question 8

90% of anemias fit in what three categories?

Answer 8

1. Iron-deficiency
2. Thalassemia
3. Anemia of chronic disease

Question 9

Hemoglobin: normal values (women & men)

Answer 9

Women: 12-16 g/dl
Men: 13.5-17.5 g/dl

Question 10

MCV: normocytic value

Answer 10

80-99 fL

Question 11

MCV: microcytic value

Answer 11

<80 fL

Question 12

MCV: macrocytic value

Answer 12

> 100 fL

Question 13

Serum Iron: Normal value (women & men)

Answer 13

Women: 65-165mg/dl
Men: 75-175 mg/dl

Question 14

What is serum iron?

Answer 14

Iron bound to transferrin (plasma carrier protein), that regulates iron transport in the blood.

Question 15

What is serum ferritin?

Answer 15

Reflects total body iron stores.

Question 16

Serum ferritin: normal values (women & men)

Answer 16

Women: 12-150 mg/L
Men: 15-300 mg/L

Question 17

What is the first value to reflect depleted iron stores?

Answer 17

Serum ferritin

Question 18

What does the Total Iron-Binding Capacity (TIBC) reflect?

Answer 18

The availability of binding sites on the protein for iron transport.

Question 19

How is transferrin level measured?

Answer 19

Indirectly through TIBC.

% calculated by serum iron/TIBC x 100

Question 20

TIBC: normal level

Answer 20

240-450 mg/dl

Question 21

% of transferrin saturation: normal values

Answer 21

20%-50%

Question 22

Early Iron Deficiency lab values:

Answer 22

All normal (earliest to drop is serum ferritin)

Question 23

Intermediate Iron Deficiency values:

Answer 23

Hgb: N; MCV: N; MCHC: N; Serum Iron: low/N; Serum Ferritin: low; TIBC: High N; Transferrin Sat: low

Question 24

Late Iron Deficiency values:

Answer 24

all Low; EXCEPT: TIBC is High

Question 25

Thalassemia minor lab values:

Answer 25

Hgb: Low N/Low; MCV: Low; MCHC: N/Low; Serum Iron: N; Serum Ferritin: N; TIBC: N; Transferrin Sat: N

Question 26

Chronic Disease lab values:

Answer 26

Hgb: Low N; MCV: N/low; MCHC: N/low; Serum Iron: Low; Serum Ferritin: High; TIBC: Low; Transferrin Sat: High

Question 27

Sideroblastic Anemia lab values:

Answer 27

Hgb & RBC indices: LOW; Iron indices: all HIGH except TIBC: N

Question 28

Causes of microcytic anemia

Answer 28

IDA, thalassemia, anemia of chronic disease, sideroblastic anemia, Hgb E disease

Question 29

Causes of macrocytic anemia

Answer 29

Megaloblastic anemia (Vitamin B12 or folate deficiency)

Question 30

Causes of normocytic anemia

Answer 30

Sickle cell disease, anemia of chronic disease, aplastic anemia, hemolytic anemia

Question 31

Conditions that cause increased reticulocyte counts:

Answer 31

1) Hemolytic Anemia: autoimmune hemolysis, RBC enzyme deficiencies, traumatic or angiopathic hemolysis, RBC membrane problems (spherocytosis, elliptocytosis) 2) 3-4 days after acute blood loss 3) Hemoglobinopathies 4) Toxin exposures 5) Hypersplenism 6) After tx of anemias: adequate doses of iron, folate or vitamin B12

Question 32

Causes of decreased reticulocyte counts:

Answer 32

IDA, Aplastic anemia, Untreated megaloblastic anemia, radiotherapy, marrow tumors, myelodysplastic syndromes

Question 33

What is the most common cause of IDA?

Answer 33

Chronic blood loss (GI bleed, menorrhagia)

Question 34

What lab indicates hypochromic anemia?

Answer 34

Low MCHC

Question 35

Mild IDA can be caused by:

Answer 35

Inadequate diet, normal or heavy menses, blood donation, malabsorption, increased requirements (growth, pregnancy), polycythemia tx with phlebootomy

Question 36

Moderate to severe anemia can be caused by:

Answer 36

chronic blood loss, Peptic ulcer disease, varices, malignant dx, diverticulitis, severe menorrhagia, severe malabsorption

Question 37

What products inhibit iron absorption?

Answer 37

Soy protein, bran, dairy, tea, coffee, calcium rich antacids, vegetable sources

Question 38

What products enhance iron absorption?

Answer 38

Ascorbic acid (VIT C), citric acid, meat, poultry, fish, other (low iron stores of individual, low iron content of meal)

Question 39

First line of tx for IDA:

Answer 39

Oral iron preparation; usually 150-200mg daily in divided doses

Question 40

How long should iron therapy continue?

Answer 40

Empirically for 4-6 months or until the serum ferritin level exceeds 50mg/L

Question 41

How should oral iron be taken?

Answer 41

30 min before meals with OJ

Question 42

How long should it take for the Hgb level to rise after oral iron in IDA? MCV level?

Answer 42

Within 1-2 weeks; 1-2 months

Question 43

When to refer IDA pt to hematologist:

Answer 43

non adherance to or intolerance of oral iron, persistent IDA, persistent microcytic anemia despite iron replacement and exclusion of other conditions.

Question 44

What is the mainstay therapy for b-Thalassemia major?

Answer 44

Regular transfusions & Iron chelation therapy

Question 45

What ethnicities are more likely to have a-Thal?

Answer 45

Southeast Asia, India, China, Philipines

Question 46

What ethnicities are more likely to have b-thal?

Answer 46

Mediterranian, middle eastern, African, Asian

Question 47

What is the difference between thalassemia and sickle cell on a blood smear?

Answer 47

Sickle cell - sickle shape | Thalassemia- target cells / aniocytosis (different sizes)

Question 48

Lab values in beta minor:

Answer 48

Hct 28-40; MCV- 55-75; high levels of hgb A2 on hgb electrophoresis

Question 49

Treatment for a or b minor thal?

Answer 49

genetics if planning family; education; Do NOT give Iron!

Question 50

What differentiates Anemia of Chronic Disease (ACD) from IDA in lab values?

Answer 50

ACD: High Serum Ferritin, Low TIBC, High Transferrin sat; low reticulocyte count; more likely to be normocytic, but occasionally microcytic

Question 51

Treatment for ACD?

Answer 51

Optimal control of underlying condition

Question 52

What are the primary causes of macrocytic anemia?

Answer 52

Vitamin B12 deficiency & Folate deficiency (both are essential to normal DNA synthesis-bone marrow is sensitive to deficiencies)

Question 53

Decreased dietary intake, alcoholism, and diseases associated with malabsorption are associated with ______________.

Answer 53

Folate deficiency

Question 54

What is the most prevalent cause of vitamin B12 deficiency?

Answer 54

Pernicious anemia (lack of intrinsic factor)

Question 55

What symptoms are specific to a severe vitamin B12 deficiency?

Answer 55

Marked anemia and neurologic deficits, sore mouth and loss of taste. Neuro sx may not go away with tx.

Question 56

What lab can differentiate vitamin B12 deficiency from folate deficiency?

Answer 56

Methylmalonic acid(N=70-270) is elevated in B12 deficiency, but normal in folate deficiency. Homocysteine (N= 5-16) is elevated in both.

Question 57

What can happen if you treat someone for folate deficiency that actually has B12 deficiency?

Answer 57

Can result in permanent neurologic or psych abnormalities.