Antianemics

Question 1

What is a microcytic anemia?

Answer 1

MCV (mean corpuscular volume)

Question 2

What is a macrocytic anemia?

Answer 2

MCV >99= large RBCs due to accumulation of precursors for DNA synthesis (which require B12 or folate to carry them through maturation).
*So you will treat a macrocytic anemia with either B12 or folic acid.

Question 3

How much total iron is in the body?

Answer 3

4 grams

Question 4

Is iron essential to all cells?

Answer 4

YES and 90% is recycled.

Question 5

Is iron ever free?

Answer 5

RARELY. It is usually bound to specific proteins bc it is toxic otherwise.

Question 6

How is iron lost?

Answer 6

It doesn’t have a good mechanism for loss, so it is only lost by exfoliation in the skin or bleeding.

Question 7

What are the major causes of iron deficiency anemia?

Answer 7

In men due to peptic ulcer and menorrhagia in women.

Also malnutrition, malabsorption, and gastrectomy.

Question 8

What is the major storage site for iron?

Answer 8

the liver as apoferritin.

Question 9

What happens if you need more iron?

Answer 9

your body will absorb more.

Question 10

What happens if you have enough of iron?

Answer 10

your body will not absorb anymore and will be passed along.

Question 11

How is iron transported in the blood?

Answer 11

via transferrin.

Question 12

What is the total iron binding capacity?

Answer 12

really synonymous with the amount of transferrin available in the blood.

Question 13

What are the iron binding proteins in the body?

Answer 13

• hemoglobin= 50-66%
• reticuloendothelial cells (macrophages)= 27% (ferritin and hemosiderin).
• myoglobin= 3-13%
• cytochromes= 2%
• transferrin= 1%

Question 14

What is the normal saturation % of transferrin?

Answer 14

20-35%

Question 15

What will the TIBC be if you have an iron deficiency?

Answer 15

High, because there is little iron around, you have many open sites on transferrin.

Question 16

Will your hematocrit and hemoglobin be normal in slight iron deficiency?

Answer 16

YES

Question 17

What are the symptoms of iron deficiency?

Answer 17

tired and fatigued

Question 18

Will your hematocrit (%RBCs) be decreased if you have an iron deficiency ERYTHROPOIESIS?

Answer 18

YES, TIBC saturation will be low and TIBC will be high

Question 19

**Will your hematocrit be decrease if you have an iron deficiency ANEMIA?

Answer 19

YES along with microcytosis, hypochromia, irregular cell shapes, and sizes.
TIBC saturatoin= low
TIBC= high
You will also have sever fatigue, dizziness, increased HR, dyspnea, CHF and palpitations.

Question 20

What is the treatment for microcytic anemia?

Answer 20

Restore hemoglobin and RBC production via FERROUS SULFATE, thus increasing iron stores.

Question 21

** What is iron dextran?

Answer 21

iron supplement administered IM or IV as a large bolus.

Question 22

** What will acute iron toxicity do to you?

Answer 22

shock, hypovolemia, heart/liver/renal failure due to free iron, also acidosis, coma, or even death.
TIBC>100%

Question 23

** How do you treat iron toxicity?

test question

Answer 23

deferoxamine= an iron chelator that binds to iron.
Also use emesis, lavage, and sodium-bicarb.
*contraindicated in pregnancy and renal dysfunction.

Question 24

** What is folic acid?

Answer 24

essential for 1-carbon metabolism of DNA and it is needed in pregnancy to inhibit neural tube disorders in fetus.

Question 25

What will a deficiency in folic acid lead to?

Answer 25

a deficiency in DNA synthesis.

Question 26

What is a MEGALOblastic anemia?

Answer 26

any deficiency that involves lack of folic acid or B12, and thus a megaloblastic change in all rapidly dividing cells (i.e. these cells look large).

Question 27

How does a macrocytic anemia differ from a megaloblastic anemia?

Answer 27

macrocytic does not involve folic acid or vitamin B12 deficiency. Rather alcohol, liver disease, and the drug 5-FU can cause this.

Question 28

What does methotrexate and trimethoprim do?

Answer 28

inhibit dihydrofolate reductase, thus leading to a folate deficiency

Question 29

Will methylmalonic acid change in a folate deficiency?

Answer 29

NO it will be normal.

Question 30

Will methylmalonic acid change in a B12 deficiency?

Answer 30

YES it will go up because it requires B12 to convert it to succinyl-CoA

Question 31

How do you treat folate deficiency?

Answer 31

Eat leafy green veggies :)

Question 32

** What would happen if you treat a vitamin B12 deficiency with folate; aka you thought you had a folate deficiency, so you treated with folate? (BOARD QUESTION)

Answer 32

you will correct the NONneurologic symptoms of B12 deficiency and treat the anemia, but you will still have the neurologic symptoms!!!

Question 33

***Why do we need vitamin B12 (hydroxocobalamin)?

Answer 33

it is needed for FH4 (TH4) production and used to generate deoxythymidylate (dTMP) for DNA synthesis and also needed for methionine/myelin synthesis (hence neurological).

Question 34

What will pernicious anemia do?

Answer 34

inhibits the parietal cells of the stomach from secreting intrinsic factor, which is needed for B12 absorption in the ileum. Hence, you will get a B12 deficiency.

Question 35

Will B12 deficiency cause myelin degeneration and memory loss?

Answer 35

YES. Folate deficiency will NOT though.

Question 36

How do you test for B12 deficiency/pernicious anemia?

Answer 36

Schilling test

Question 37

Will oral supplements of vitamin B12 often help if you have a deficiency?

Answer 37

NO, because it is mostly due to a malabsorption issue, so even if you take more, you won't be able to absorb it. So you must get it IM or IV. *Remember, this takes a LONG time to develop because the liver has at least a year's worth of B12 stores.

Question 38

What important condition will lead to a decrease in erythropoietin (EPO)?

Answer 38

anemia of chronic disease (renal failure) because the kidneys are what produce EPO. Be careful when giving EPO though because too much can cause thrombosis :(

Question 39

**What is Filgrastim (G-CSF)? | board question

Answer 39

- increases production of neutrophils and enhances mobilization of hematopoietic stem cells into the blood. - used in recovery from chemo/AIDS/transplantation immunosuppression.

Question 40

What is Sargramostim?

Answer 40

stimulates growth of stem cells into granulocytes and macrophages.

Question 41

What is Oprelvekin (IL-11)?

Answer 41

stimulates growth of megakaryocytes and increases number of platelets.