-
-
What is MCV?
- Mean Corpuscular Volume
- RBC volume
- allows classification of anemia type
-
__________ is the first level to become abnormal when iron stores are becoming depleted.
Serum ferritin
-
Most common cause of Iron-deficiency anemia (IDA) in adults and kids.
- adults: GI blood loss or menorrhagia
- kids: inadequate intake of dietary iron
-
What should you consider in men and postmenopausal women with IDA?
GI blood loss
-
Substances that inhibit iron absorption.
-
Substances that enhance iron absorption.
- vitamin C
- citric acid
- meat/poultry/fish
-
Severe symptoms specific to IDA.
- paresthesias
- sore tongue
- brittle nails
- spoon-shaped nails
- pica (starch, ice, clay)
-
What labs will be increased and decreased when dx IDA?
- Increased: TIBC
- Decreased: Hgb, ferritin, iron, transferritin saturation
-
In replacing iron for IDA, the goal is ________ of elemental iron/day until anemia is corrected.
150-200mg
-
With IDA oral iron correction, continue until ferritin level is ________.
> 50mcg/L
-
SE of oral iron preparations.
- nausea
- black stools
- diarrhea/constipation
-
With IDA: once ferritin levels have increased, whein will Hgb increase? When will MCV normalize?
-
The goal of ________ mg of elemental iron daily for menstruating women with IDA.
200
-
Ages _______ are at highest risk for IDA.
- 9-18 mos
- adolescent females after starting period
-
Which type of anemia is this? Little or no hematologic effects; mild microcytic hypochromic anemia.
Alpha or beta thalassemia minor
-
Which type of anemia is this? Moderate microcytic hypochromic anemia; not transfusion dependent
Beta thalassemia Intermedia
-
Which type of anemia is this? severe anemia, transfusion dependent
Thalassemia major
-
Short stature; abnormal facies; pallor; jaundice; enlarged spleen, liver, or heart.
beta intermedia and major
-
Management of beta thalassemia minor.
- no tx
- genetic counseling for family planning
-
Management of beta thalassemia intermedia.
- monitor
- can progress to major (if so, --> hematology)
-
Management of beta thalassemia major.
- managed by hematology
- transfusions
- BM transplant is ONLY CURE
-
Most common hemolytic anemia
sickle cell
-
_________ deficiency can result in acute hemolytic anemia.
G6PD
-
Other than inadequate intake (most common), causes of folate deficiency.
- Pregnancy
- chronic inflammatory DO (Crohns, RA)
- CA
- Hyperthyroid
- sickle cell anemia
-
Most common cause of Vitamin B12 deficiency r/t malabsorption.
- pernicious anemia
- Crohns
- Celiac
- s/p gastrectomy, barratric sx
-
Most common cause of Vitamin B12 deficiency r/t meds.
- GERD-Long term use of H2 blockers (decrease release of IF)
- PPIs can decrease absorption of B12
-
Daily requirement of vitamin B12.
- 3-5 mcg/day
- (2 mcg/day RDA)
-
If pernicious anemia is suspected, what should be done?
assay for antiintrinsic factor or anti parietal cell antibodies
-
Pernicious anemia often coexists with what kind of other diseases?
- autoimmune
- GI DO
- Type 1 DM
- Thyroid disease
-
When is the onse of pernicious anemia?
after age 50
-
What is the shilling test?
used to determine if intestinal malabsorption is due to IF deficiency or other malabsorptive states
-
Levels of ________ and ________ will be increased in B12 deficiency b/c the enzymes responsible for their conversion are B12 dependent. What will be increased in folate deficiency?
- Methylmalonic acid (MMA)
- total homocysteine (Hcy)
- total homocysteine (Hcy)
-
In a _____ deficiency, there are rarely any symptoms, even when it is severe.
folate
-
How do you treat macrocytic anemia if the cause is unknown?
Transfuse and treat with B12 and folate until cause is known
-
Tx for perniciuos anemia.
- Vit B12 1000 mcg IM q week x 8 wks
- then monthly for life
-
Tx for folate deficiency.
- 1-2 mg of folic acid po daily
- (treat pregnant and sickle cell prophylactically)
-
How do you treat GI pts (gastrectomy, ileal resection, gastric atrophy, intestinal malabsorption) with B12 & folate?
- prophylactiaclly monthly parenteral B12 &
- daily folic acid
-
What is normocytic anemia?
- aka Anemia of chronic disease
- anemia of underproduction
-
___________ can be confused for IDA.
Normocytic anemia (of chronic disease)
-
Symptoms of normocytic anemia (of chronic disease).
- usually r/t underlying disease
- may have fatigue, tachycardia, pallor
-
Lab results with Anemia of chronic disease.
- Most everything is normal
- Low serum iron (trapped by macrophages)
-
Life threatening condition resulting from bone marrow stem cell failure.
Aplastic anemia
-
Aplastic anemia is _______cytic _______chromic.
-
With aplastic anemia, there is a marked decrease in all hematopoietic precursors, resulting in _________.
pancytopenia
-
Aplastic anemia is usually r/t?
exposure to toxins or meds
-
Management of aplastic anemia.
- REFER!
- BM transplant &/or immunosuppressive therapy
- maybe transfusions
-
Microcytic anemias.
- IDA
- Thalassemia
- Anemia of chronic disease
-
Normocytic anemias & causes.
- Leukemias
- Aplastic anemia
- hemorrage
- hemolytic anemias
-
Macrocytic anemias and diseases.
- pernicious
- vit B12 & folate deficiency
- drug-induced
- alcohol abuse, liver disease
- congenital BM failure syndromes
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