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.
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
Severe symptoms specific to IDA.
- 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.
With IDA oral iron correction, continue until ferritin level is ________.
SE of oral iron preparations.
- black stools
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.
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
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.
- can progress to major (if so, --> hematology)
Management of beta thalassemia major.
- managed by hematology
- BM transplant is ONLY CURE
Most common hemolytic anemia
_________ deficiency can result in acute hemolytic anemia.
Other than inadequate intake (most common), causes of folate deficiency.
- chronic inflammatory DO (Crohns, RA)
- sickle cell anemia
Most common cause of Vitamin B12 deficiency r/t malabsorption.
- pernicious anemia
- 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?
- 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.
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 is _______cytic _______chromic.
With aplastic anemia, there is a marked decrease in all hematopoietic precursors, resulting in _________.
Aplastic anemia is usually r/t?
exposure to toxins or meds
Management of aplastic anemia.
- BM transplant &/or immunosuppressive therapy
- maybe transfusions
- Anemia of chronic disease
Normocytic anemias & causes.
- Aplastic anemia
- hemolytic anemias
Macrocytic anemias and diseases.
- vit B12 & folate deficiency
- alcohol abuse, liver disease
- congenital BM failure syndromes