3 PT1 > Anemia > Flashcards

Anemia Flashcards

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1
Q

Which normocytic (MCV 80-100) anemia can be drug induced?
1. Anemia of CKD
2. Aplastic Anemia
3. Hemolysis
4. Leukemias

A
  1. Hemolysis
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2
Q

according to the WHO, anemia is classified as a Hgb less than ___ in men and less than ___ in women

A

13 g/dl, 12g/dl

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3
Q

what are the treatment options for folate defiiciency

A

oral folic acid for 4 months, sometimes IV

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4
Q

Which is the accurate definition for mean corpuscular
volume (MCV)?
1. Volume of RBCs in a unit of whole blood
2. % distribution in the size of the RBCs
3. Protein contained in a RBCs that is responsible for delivery of oxygen to
tissues
4. Average volume (size) of RBCs

A
  1. Average volume (size) of RBCs
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5
Q

What 3 components are hemoglobins broken down into

A

RBCs are broken down into iron, heme, and globin

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6
Q

what is the bone marrow response to RBC destruction, as seen in hemolytic anemia? how do blood cells appear on a peripheral blood smear

A

increased reticulocyte % which indicated increased RBC production. you would see abnormal cells

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7
Q

which OTC oral iron therapy produces less GI SEs with better bioavailability

A

ferrous gluconate

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8
Q

define hemolytic anemia

A

anemia caused by increased RBC turnover due to the abnormal breakdown of RBCs

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9
Q

what is the total iron binding capacity test?

A

an indirect measurement of the iron-binding capacity of serum transferrin

-> how many binding sites are left on transferrin to bind to iron?

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10
Q

T/F: iron deficiency anemia is the most common type of anemia

A

T

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11
Q

why do we see low haptoglobins in hemolytic anemia?

A

they are proteins that irreversibly bind to circulating Hgb, forming a complex that is cleared by the liver.

-> we dont want free circulating Hgb, which is produced as RBCs are lysed

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12
Q

what is the transferrin (iron) saturation test?

A

Extend to which iron-binding sites on transferrin are occupied

-> the amount of iron available for erythropoiesis

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13
Q

How does decreased tissue oxygen affect the production of RBCs?

A

decreased tissue oxygen signals to kidneys -> increased production and release of erythropoietin, which leads to increased production and maturation of RBCs

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14
Q

Which RX oral iron therapy is only intended for use in CKD pts?

A

ferric citrate (auryxia)

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15
Q

what does the patient have if they have low MCV and low ferritin?

A

Iron deficiency anemia

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16
Q

what is the name of the iron transport protein

A

transferrin

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17
Q

what are counseling points that you should go over for a patient starting oral iron therapy?

A

can cause GI upset,
take one hour before meals,
can do qd dosing or every other day,
watch out for DDIs

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18
Q

If the MCV is normal , meaning the anemia is normocytic and the reticulocyte count is low what can you conclude from that and whats the next test?

A

low reticulocyte means there’s a lack of building blocks, poor production of erythropoietin from the kidney, or poor production of RBCs from the bone marrow

next test: WBC and platelets

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19
Q

how are old blood cells cleared from the body?

A

macrophages in the spleen and kupffer cells in the liver

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20
Q

what are some causes of folate deficiency?

A
  1. inadequate diet (vegan, alcoholism)
  2. pregnancy
  3. malabsorption due to medical conditions
  4. drug therapy (methotrexate)
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21
Q

What conditions must be met for healthy RBC production and maturation

A

renal production of EPO (erythropoietin), functioning bone marrow, and enough iron for hemoglobin synthesis

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22
Q

what is the next lab value that should be inspected if the patient has low MCV and normal-high ferritin?

A

serum iron

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23
Q

What is the reticulocyte count?

A

the % of RBCs that are immature; indirect assessment of new RBC production

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24
Q

anemia is a group of diseases characterized by a decrease in either ________ or the ___________, which results in decreased __________ of the blood

A

hemoglobin (Hgb), volume of red blood cells, oxygen-carrying capacity

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25
what is the role of hepcidin in iron regulation?
it degrades of ferroportin, leading to decreased iron absorption from the gut ad decreased release from storage site in the macrophages and liver
26
what are the common causes that we discussed that can cause hemolytic anemia?
G6PD deficiency, drug induced immune hemolytic anemia, drug induced thrombotic microangiopathy
27
What does the patient have if they have low MCV, normal/high ferritin, and low serum iron
anemia of chronic disease/inflammation
28
who is most at risk for iron deficiency anemia
pregnant women menstruating women children elderly vegetarians/vegans ppl with GI diseases like celiac or IBD
29
when should IV iron be used?
in severe iron deficiency, diseases states with poor oral absorption or where it has been shown ineffective (IBD, HF, end-stage kidney disease), patients who cant tolerate oral iron patients with poor response to oral iron
30
How long does it take for anemia of chronic disease/inflammation to develop? what is the root cause?
months to years, underlying chronic "inflammatory" condition (eg. chronic infections, autoimmune disorders, cancer, HF, chronic lung disease)
31
how much folic acid should a women of childbearing should take
400mcg/day
32
vitamin B12 deficiencies can be caused by
1. inadequate diet (vegan, alcoholism) 2. malabsorption due to: -> age (>65) -> medical conditions (that change acid production or surface area for absorption) ->drug therapy (eg. long term PPI use or metformin) -> pernicious anemia (a rare autoimmune condition leads to reduced intrinsic factor)
33
Which populations are at the highest risk of iron deficiency anemia (IDA)? (Select all that apply): 1. Pregnancy women 2. Menstruating women 3. Elderly 4. Vegans/vegetarians 5. Chronic lung disease 6. Children
1. Pregnancy women 2. Menstruating women 3. Elderly 4. Vegans/vegetarians 6. Children
34
what is hemogobin?
the protein in RBCs that is responsible for delivery of O2 to tissues
35
T/F RBCs can be produced and mature independently of erythropoietin
F
36
If the MCV is normal , meaning the anemia is normocytic, the reticulocyte count is low, and **WBC and platelets is normal**, what are the kind of anemia could the patient have.
anemia of chronic kidney disease (there's no erythropoietin production from the kidneys) or anemia of chronic disease/inflammation (there's no iron since its trapped and no building blocks)
37
what kind of foods contain non-heme iron?
dark chocolate, whole grains, nuts, seeds, beans, lentils, leafy greens, fortified foods and veggies
38
What serum ferritin value indicates iron deficiency anemia in MCV <80 (microcytic)? 1. 35 ng/mL 2. 70 ng/mL 3. 25 ng/mL 4. 83 ng/mL
3. 25 ng/mL
39
what is ferroportin?
a protein channel that allows for the export of iron
40
what are the different types of non-megaloblastic anemia?
alcohol induced liver disease hypothyroidism all of these affect the lipid layers, which makes the cells larger (MCV is high)
41
What is the serum iron count
the concentration of iron bound to transferrin value varies thru the day
42
megaloblastic anemia is:
impaired DNA synthesis which inhibits nuclear division... so the RBCs leave the bone marrow early, so they are too big since they have all their organelles and they die quicker
43
non-megaloblastic anemia is:
altered membrane composition (excess lipids) leading to larger cells
44
Which RX oral iron therapy was designed specifically to reduce GI SEs?
ferric maltol (accufer)
45
what happens to heme after hemoglobin is broken down?
heme is broken down by enzymes into biliverdin -> bilirubin -> bilirubin-glucuronide complex bilirubin -> yellow in color bilirubin complex -> water soluble, excreted into the bile
46
what happens to iron after hemoglobin breakdown?
it is either sent to the bone marrow to make RBCs or it stored as ferritin
47
what is the next lab value that should be inspected when the MCV is low?
ferritin levels (the amount of stored iron in the body)
48
low levels of hepcidin leads to what?
increased iron absorption and mobilization from storage sites
49
what is the treatment course for anemia of chronic disease/inflammation
treatment of underlying condition that is causing hepcidin production -> giving iron wont help that much because the body has enough iron, its just trapped in storage
50
what is the red blood cell distribution width (RDW)
% distribution in the size of the RBCs -> the higher the %, the greater the differences in size
51
what happens to globin after hemoglobin breakdown?
globin -> amino acids -> recirculation in the amino acid pool
52
when does hepcidin production increase?
infection, inflammation, iron overload in cases when you don't want excess iron
53
If the MCV is normal , meaning the anemia is normocytic and the **reticulocyte count is high**... what kind of anemia could the patient have?
acute blood loss ** hemolysis ** sickle cell autoimmune **drug induced**
54
When should an RBC transfusion be considered?
if the Hgb is <7 g/dL or if the Hgb is <8 g/dL in a pt with hemodynamic compromise or severe cardiac disease
55
T/F: anemia of chronic disease/ inflammation is the second most common type of anemia, especially in the elderly and hospitalized patients
T
56
What are 2 special populations that warrant different diagnosis and management of Iron deficiency anemia?
HF, CKD
57
which organ produces erythropoietin
kidney
58
What are the treatment options for B12 deficiency
IM or Oral cyanocobalamin -> IM is for neurological sx (need more aggressive tx)
59
what are the unique manifestations of severe iron deficiency anemia?
tongue pain, smooth tongue, reduced saliva, compulsive eating of non food items (pica), and restless leg syndrome
60
what is the name of the iron storage protein
ferritin
61
what are the unique symptoms of vitamin B12 deficiency?
neurological: early on numbness and paraesthesia, later- loss of balance, spasticity, bad vibratory sense, bad proprioception vision changes psychiatric: irritability, personality change, memory impairment, depression ,psychosis
62
What is the hematocrit
the volume if RBCs in a unit of whole blood
63
what is the advantage of heme iron? what kinda food is it found in?
3x more absorbable than non heme meat, fish, poultry
64
when does hepcidin production decrease?
when iron levels are low or when iron needs to increase (low oxygen)
65
what are some side effects associated with IV iron
they are rare but serious: hypotension, hypersensitivity rxns
66
what is the serum ferritin test?
iron storage protein ... the best indicator of iron in the body low levels is indicative of iron deficiency could increase with infection/inflammation (because we want storage in these cases)
67
what is the mean corpuscular volume?
the average volume (size) of RBCs
68
what are the acute and chronic symptoms of anemia
acute: tachycardia, lightheadedness, chest pain, dyspnea chronic symptoms: weakness, fatigue, headache, sensitivity to cold, vertigo, and pallor (paleness)
69
how does severity of symptoms of iron deficiency anemia present?
worse in older patients and those with underlying cardiac or pulmonary disease and if anemia develops acutely
70
T/F: for B12 or folate deficiency anemia , the MCV is high (macrocytic) and the reticulocyte % is normal
T
71
What are 4 things that can decrease dietary iron absorption?
1. reduced gastric acid 2. phytates in diet --> forms complexes with nonheme iron 3. polyphenols in tea/coffee 4. calcium
72
What happens to hepcidin in low iron? 1. Hepcidin increases to increase iron absorption and export 2. Hepcidin increases to decrease iron absorption and export 3. Hepcidin decreases to increase iron absorption and export 4. Hepcidin decreases to decrease iron absorption and export
3. Hepcidin decreases to increase iron absorption and export
73
Which are oral iron therapy options? (Select all that apply): 1. Ferumoxytol (Feraheme) 2. Iron Sucrose (Venofer) 3. Ferric Maltol (Accufer) 4. Ferrous Sulfate 5. Ferrous Gluconate 6. Ferrous Fumarate 7. Ferric Citrate (Auryxia)
3. Ferric Maltol (Accufer) 4. Ferrous Sulfate 5. Ferrous Gluconate 6. Ferrous Fumarate 7. Ferric Citrate (Auryxia)
74
why do we see an increase in lactate dehydrogenase and bilirubin for hemolytic anemia
LDH and heme are converted into bilirubin -> LDH and heme are released when RBCs are destroyed
75
what is serum methylmalonic acid (MMA) level? what does elevated MMA mean?
this is a substance that is converted into succinyl CoA, but it **requires B12** to do this -> high levels of MMA means there's not enough B12 to convert it into succinyl CoA -> high levels =functional B12 deficiency
76
what is serum homocysteine level? what does elevated levels of this mean?
this is a substance that is converted into methionine, but it ** requires B12 AND Folate** to do this ->high levels of serum homocysteine means there is not enough B12 or folate -> high levels means patient has a functional deficiency (usually this is ordered when folate is low so it is used to diagnose folate deficiency)
77
when should oral iron be considered for treatment?
for acute iron deficiency anemia
78
which OTC oral iron therapy has more GI SEs and dark green stools
ferrous fumarate
79
T/F Heme iron is 3x less absorbable than nonheme iron
F; heme iron is 3x more absorbable than nonheme iron and is found in meat, fish, and poultry
80
what type of anemias are microcytic... meaning the MCV is low
thalassemia, anemia of chronic disease/inflammation, and iron deficiency anemia
81
what are 3 markers of RBC breakdown?
1. Increased lactate dehydrogenase (LDH) 2. indirect increase in bilirubin 3. low haptoglobins
82
if MCV is high (macrocytic), the reticulocyte % is normal, and **folate levels are normal but B12 is low/normal** what should you do?
check serum MMA (methylmalonic acid) level -> if its high then treat for B12 deficiency -> normal means no deficiency
83
When the MCV is higher than normal meaning that the anemia is macrocytic, what is the next test to look at? what will this value tell us?
reticulocyte count; if its high, there is hemolysis happening -> MCV is high because the RBCs still have all their organelles if it is normal, the anemia can be megaloblastic or non-megaloblastic
84
if MCV is high (macrocytic), the reticulocyte % is normal, and **B12 levels are normal but folate is low/normal** what should you do?
check serum homocysteine level -> if high, treat for folate deficiency -> normal means no deficiency
85
what are the types of megaloblastic anemias?
drug induced, Vitamin B12 or folate deficiency (these are needed for DNA synthesis so it makes sense its megaloblastic since megaloblastic = impaired DNA synthesis)
86
If the MCV value is normal, the anemia is normocytic. what is the next lab value you look at?
reticulocyte count (is the body making new blood cells?)
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