TEST 2- Anemia

Question 1

Anemia definition

Answer 1

Anemia is defined as a reduction in the number of red blood cells (RBCs), hemoglobin concentration, or hematocrit. In general, a hemoglobin concentration in adults below 13.6 g/dL for men or below 12 g/dL for women suggests anemia.

Question 2

Symptoms of anemia

Answer 2

Asymptomatic generally until hgb <7.5= Fatigue, malaise, headache, dyspnea, irritability, and mild decrease in exercise tolerance

Question 3

Normal RBC

Answer 3

male: 4.7-6.1
Female: 4.2-5.4

Question 4

Normal hemoglobin

Answer 4

13. 8-17.2

female: 12.1-15.1

Question 5

Hematocrit

Answer 5

male: 41-50%
Female: 36-44%
rule of thumb: 1 hgb for every 3 hct

Question 6

MCV

Answer 6

normal: 80-100

volume of RBC: tells you how big the RBC is. allows for classification of anemia:

Question 7

MCHC

Answer 7

normal: 32-36

concentration of hgb in RBC’s: tells you how colorful RBC’s are (Pale, dark, normal).

Question 8

Reticulocyte count

Answer 8

normal 0.5-2%. baby RBC’s. marrow production of RBC’s differentiate if anemia is related to decreased production or increased loss.

Question 9

hgb electrophoresis

Answer 9

shows percentage of subclass of hgb
helps identify thalassemias

Question 10

Rdw

Answer 10

12.2-16.1 in females
11.8-14.5 in males
rbc distribution. tells you variance in size of RBC (lets you know if there are a lot of reticulocytes or not)

Question 11

TIBC

Answer 11

transferrin iron binding capacity
normal: 250-420
indirectly measures amount of transferrin
indicates the availability of binding sites on the protein for iront ransport

Question 12

Serum ferritin

Answer 12

10-120 ng/ml in females
20-250 in males
total body iron stores
first level to become abnormal when iron stores are becoming depleted.

Question 13

Serum iron

Answer 13

50-170 females
65-175 males
amount of iron bound to transferrin

Question 14

Transferrin saturation percentage

Answer 14

20-50%

Question 15

Types of anemia

Answer 15

Microcytic hypochromic- MCV <80, decreased MCHC
Macrocytic, normochromic: MCV >100 normal MCHC
Normocytic, normochromic: MCV: 80-100, normal MCHC

Question 16

IDA is most common in..

Answer 16

Young children and pregnant women.

most common anemia in the world- usually nutrient deficiency

Question 17

What diagnostic test when considering anemia..

Answer 17

number 1: CBC
peripheral smear
reticulocyte count
ferritin
TIBC
serum iron
transferrin
stool for occult blood x3
electrophoresis
Iron studies- to differentiate between microcytic d/t IDA versus ACD, thalassemia, etc.

Question 18

What leads to mild IDA

Answer 18

inadequate diet, normal/heavy menses, blood donation, malabsorption, periods of rapid growth, pregnancy

Question 19

what leads to moderate to severe IDA (symptomatic)

Answer 19

chronic blood loss, PUD, varices, malignancy, diverticulitis, severe menorrhagia, severe malabsorption.

Question 20

Labs for IDA

Answer 20

CBC w diff, ferritin, iron, TIBC,

HGB will be low, ferritin will be low, iron can be low, tibc high, transferrin saturation low.

Question 21

Management for IDA

Answer 21

1st line: treat underlying cause!!
If severe, or malabsorption syndrome/unable to tolerate PO- consider IV iron AND REFER to hematologist.
replace iron: oral: 150-200mg daily until anemia corrected. Continue empirically until ferritin level is over 50.
side effects: nausea, constipation, upper gi discomfort, black stools, diarrhea.
iron absorption is optimum when taken 30 minutes before meals with vit. C. No dairy or calcium 1-2 hours after taking iron.
start on a low dose and increase slowly. Once ferritin levels have increased, hgb should follow in 1-2 weeks. MCV in 1-2 months.
ferrous sulfate 325mg= 65mg of elemental iron for ida give 750-1500mg/day divided BID-QID
for kids: 1mg/kg/day
pregnancy: supplementation almost always required. best indicator is serum ferritin.
older adults: if IDA throughoughy evlauate for GI cancers.
incrase iron rich foods, screen for nsaid overuse, strict vegetarians need supplementation.

Question 22

symptoms specific to IDA

Answer 22

if severe: paresthesia, sore tongue, brittle nails, spoon shaped nails, pica

(other symptoms if severe (general anemia symptoms): fatigue, exercise intolerance, weak, palpitations, irritability headaches)

Question 23

What is Thalassemia?

Answer 23

Inherited blood disorder that affects how the body makes hemoglobin. Microcytic, hypochromic (MCV<80, decreased MCHC).

Question 24

Thalassemia Alpha types

Answer 24

Alpha: 4 genes (two from each parent)
Silent carrier: 1 gene affected, asymptomatic, normal hgb and rbc.
Alpha thalassemia minor (trait): two genes affected, carrier, mild anemia, asymptomatic
Hemoglobin H disease: three genes affected, moderately to severely anemic
Alpha thalassemia major (hydrops fetalis): four genes affected, leads to premature births that are either stillborn or die shortly after birth → incompatible with life

Question 25

Beta

Answer 25

Autosomal recessive Affected people: Mediterranean, Middle Eastern, African, Asian 2 genes (one from each parent) involved Beta thalassemia minor (trait): one gene affected Beta thalassemia intermedia: two genes affected, moderate anemia Beta thalassemia major (Cooley’s anemia): two genes affected, severe anemia

Question 26

CM of Beta Thalassemia intermedia/major

Answer 26

``` Short stature Abnormal facies Cranial marrow expansion - trying to make more RBCs Pallor, jaundice, enlarged spleen, liver, or heart Beta thalassemia intermedia Moderate microcytic, hypochromic anemia Not transfusion dependent Beta thalassemia major Severe anemia Transfusion dependent ```

Question 27

Thalassemia Alpha Major

Answer 27

Alpha → incompatible with life

Question 28

Labs for Thalassemia

Answer 28

Anemia ⬇ MCV ✔ iron studies Hemoglobin electrophoresis (⬆ levels of hemoglobin A2) >3.5%- p.751 (primary diagnostic) Alpha globin DNA mutation (REFER for this if thalassemia is suspected, test not readily available) Mentzer index <13