FNP2 - Quiz4- Anemia

  1. Normal MCV
    80-100 fL
  2. What is MCV?
    • Mean Corpuscular Volume
    • RBC volume
    • allows classification of anemia type
  3. __________ is the first level to become abnormal when iron stores are becoming depleted.
    Serum ferritin
  4. Most common cause of Iron-deficiency anemia (IDA) in adults and kids.
    • adults:  GI blood loss or menorrhagia
    • kids: inadequate intake of dietary iron
  5. What should you consider in men and postmenopausal women with IDA?
    GI blood loss
  6. Substances that inhibit iron absorption.
    • soy
    • bran
    • dairy
  7. Substances that enhance iron absorption.
    • vitamin C
    • citric acid
    • meat/poultry/fish
  8. Severe symptoms specific to IDA.
    • paresthesias
    • sore tongue
    • brittle nails
    • spoon-shaped nails
    • pica (starch, ice, clay)
  9. What labs will be increased and decreased when dx IDA?
    • Increased: TIBC
    • Decreased: Hgb, ferritin, iron, transferritin saturation
  10. In replacing iron for IDA, the goal is ________ of elemental iron/day until anemia is corrected.
  11. With IDA oral iron correction, continue until ferritin level is ________.
    > 50mcg/L
  12. SE of oral iron preparations.
    • nausea
    • black stools
    • diarrhea/constipation
  13. With IDA: once ferritin levels have increased, whein will Hgb increase?  When will MCV normalize?
    • 1-2 weeks
    • 1-2 months
  14. The goal of ________ mg of elemental iron daily for menstruating women with IDA.
  15. Ages _______ are at highest risk for IDA.
    • 9-18 mos
    • adolescent females after starting period
  16. Which type of anemia is this? Little or no hematologic effects; mild microcytic hypochromic anemia.
    Alpha or beta thalassemia minor
  17. Which type of anemia is this? Moderate microcytic hypochromic anemia; not transfusion dependent
    Beta thalassemia Intermedia
  18. Which type of anemia is this? severe anemia, transfusion dependent
    Thalassemia major
  19. Short stature; abnormal facies; pallor; jaundice; enlarged spleen, liver, or heart.
    beta intermedia and major
  20. Management of beta thalassemia minor.
    • no tx
    • genetic counseling for family planning
  21. Management of beta thalassemia intermedia.
    • monitor
    • can progress to major (if so, --> hematology)
  22. Management of beta thalassemia major.
    • managed by hematology
    • transfusions
    • BM transplant is ONLY CURE
  23. Most common hemolytic anemia
    sickle cell
  24. _________ deficiency can result in acute hemolytic anemia.
  25. Other than inadequate intake (most common), causes of folate deficiency.
    • Pregnancy
    • chronic inflammatory DO (Crohns, RA)
    • CA
    • Hyperthyroid
    • sickle cell anemia
  26. Most common cause of Vitamin B12 deficiency r/t malabsorption.
    • pernicious anemia
    • Crohns 
    • Celiac
    • s/p gastrectomy, barratric sx
  27. 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
  28. Daily requirement of vitamin B12.
    • 3-5 mcg/day
    • (2 mcg/day RDA)
  29. If pernicious anemia is suspected, what should be done?
    assay for antiintrinsic factor or anti parietal cell antibodies
  30. Pernicious anemia often coexists with what kind of other diseases?
    • autoimmune
    • GI DO
    • Type 1 DM
    • Thyroid disease
  31. When is the onse of pernicious anemia?
    after age 50
  32. What is the shilling test?
    used to determine if intestinal malabsorption is due to IF deficiency or other malabsorptive states
  33. 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)
  34. In a _____ deficiency, there are rarely any symptoms, even when it is severe.
  35. How do you treat macrocytic anemia if the cause is unknown?
    Transfuse and treat with B12 and folate until cause is known
  36. Tx for perniciuos anemia.
    • Vit B12 1000 mcg IM q week x 8 wks
    • then monthly for life
  37. Tx for folate deficiency.
    • 1-2 mg of folic acid po daily
    • (treat pregnant and sickle cell prophylactically)
  38. How do you treat GI pts (gastrectomy, ileal resection, gastric atrophy, intestinal malabsorption) with B12 & folate?
    • prophylactiaclly monthly parenteral B12 & 
    • daily folic acid
  39. What is normocytic anemia?
    • aka Anemia of chronic disease
    • anemia of underproduction
  40. ___________ can be confused for IDA.
    Normocytic anemia (of chronic disease)
  41. Symptoms of normocytic anemia (of chronic disease).
    • usually r/t underlying disease
    • may have fatigue, tachycardia, pallor
  42. Lab results with Anemia of chronic disease.
    • Most everything is normal
    • Low serum iron (trapped by macrophages)
  43. Life threatening condition resulting from bone marrow stem cell failure.
    Aplastic anemia
  44. Aplastic anemia is _______cytic  _______chromic.
    • normo
    • normo
  45. With aplastic anemia, there is a marked decrease in all hematopoietic precursors, resulting in _________.
  46. Aplastic anemia is usually r/t?
    exposure to toxins or meds
  47. Management of aplastic anemia.
    • REFER!
    • BM transplant &/or immunosuppressive therapy
    • maybe transfusions
  48. Microcytic anemias.
    • IDA
    • Thalassemia
    • Anemia of chronic disease
  49. Normocytic anemias & causes.
    • Leukemias
    • Aplastic anemia
    • hemorrage
    • hemolytic anemias
  50. Macrocytic anemias and diseases.
    • pernicious
    • vit B12 & folate deficiency
    • drug-induced
    • alcohol abuse, liver disease
    • congenital BM failure syndromes
Card Set
FNP2 - Quiz4- Anemia