Anemias

Front 1

Anemias are a group of diseases characterized by:
1.
2.

Can result from:
1.
2.
3.

Back 1

Anemias are a group of diseases characterized by:
1. Decrease in Hb or RBC
2. Result in reduced oxygen carrying capacity

Can result from:
1. Inadequate RBC production
2. Increased RBC destruction
3. Blood loss

Front 2

Anemias can be classified based on:
1.
2.
3.

Back 2

1. Morphology of RBC
2. Etiology
3. Pathophysiology

Front 3

Anemias Classification Based on Morphology:'
1.
2.
3.
4.
5.
6.

Back 3

1. Macrocytic
2. Microcytic
3. Normocytic
4. Renal failure
5. Endocrine disorders
6. Myelodisplastic anemias

Front 4

Macrocytic anemias include _____________ anemias caused by:
1.
2.

Back 4

megaloblastic

1. vitamin B12 deficiency
2. folic acid deficiency

Front 5

Microcytic anemias can be caused by:
1.
2.

Back 5

1. iron-deficiency
2. genetic anomaly

Front 6

Normocytic anemias can be caused by:
1.
2.
3.

Back 6

1. recent blood loss
2. hemolysis
3. bone marrow failure

Front 7

Anemias Classification Based on Etiology:
1.
2.
3.

Back 7

1. Deficiency
2. Central, caused by impaired bone marrow function
3. Peripheral

Front 8

Some deficiencies that cause anemias:
1.
2.
3.
4.

Back 8

1. iron
2. vitamin B12
3. folic acid
4. pyrodoxine

Front 9

What are some central causes of anemias (caused by impaired bone marrow function)?
1.
2.
3.

Back 9

1. anemia of chronic disease
2. anemia of elderly
3. malignant bone marrow

Front 10

What are some peripheral causes of anemias?
1.
2.

Back 10

1. Bleeding (hemorrhage)
2. Hemolysis (hemolytic anemias)

Front 11

Anemias Classification Based on Pathophysiology:
1.
2.
3.
4.

Back 11

1. Excessive blood loss
2. Chronic hemorrhage
3. Excessive RBC destruction
4. Inadequate production of mature RBC

Front 12

Patients with anemia can generally present asymtomatically or with vague complaints, but neurologic consequences can result from:

Back 12

Vitamin B12 deficiency

Front 13

What are some signs of anemia?

Back 13

1. Decreased exercise tolerance
2. Fatigue
3. Dizziness
4. Irritability
5. Weakness
6. Palpitations
7. Vertigo
8. SOB

Front 14

What are some symptoms of anemia?

Back 14

1. Tachycardia
2. Pale appearance
3. Decreased mental acuity

Front 15

What are some diagnostic tests for anemia?

Back 15

1. Hemoglobin (Hb)
2. Hematocrit (Hct)
3. Iron level
4. Total Iron Binding Capacity (TIBC)
5. Mean Corpuscular Volume (MCV) = Hct/RBC
6. Vitamin B12 levels
7. Folate level

Front 16

The most common nutritional deficiency in developing and developed countries:

Back 16

Iron

Front 17

Iron-deficiency anemia results from:
1.
2.

Back 17

1. Prolonged negative iron balance
2. Failure to meet increased physiologic iron demand

Front 18

Higher risk for iron deficiency:
1.
2.
3.
4.

Back 18

1. Children < 2YO
2. Adolescent girls
3. Pregnant females
4. Elderly >65 YO

Front 19

Without iron, cells lose capacity for:
1.
2.

Back 19

1. Electron transport
2. Energy metabolism

Front 20

Manifestations of iron-deficiency anemia occur in 3 stages:
1.
2.
3.

Back 20

1. Prelatent
2. Latent
3. Iron deficiency anemia

Front 21

What happens in the prelatent stage of IDA?

Back 21

1. Iron stores are depleted
2. No reduction in serum iron levels
3. Can be assessed with serum ferritin measurement

Front 22

What happens in the latent stage of IDA?

Back 22

1. Iron stores are depleted
2. Hb above the lower limit of normal
3. Can be determined by CBC
(reduced transferritin saturation and increased TIBC)

Front 23

What occurs when anemia progresses to the last stage of IDA?

Back 23

1. Hb below normal
2. Progresses to classic hypochromia and microcytosis

Front 24

In IDA, lab findings include:
1.
2.
3.
4.
5.
6.

Back 24

1. Low serum iron
2. Low ferritin levels
3. High TIBC
4. Increased RDW (not specific)
5. Hb and Hct below normal (later stages)
6. Elevated EPO (in response to low Hct)

LOW: iron, ferritin, Hb, Hct
HIGH: TIBC, RDW, EPO

Front 25

Treatment for IDA depends on ______ & _______ and the main focus of treatment is to:
1.
2.

Back 25

severity; cause

1. replenish iron stores
2. treat underlying disease

Front 26

IDA Treatment - can use:
1.
2.

Back 26

1. Dietary supplements
2. Therapeutic iron preparations

Front 27

Dietary supplements for IDA are BEST absorbed from:

Back 27

meat, fish and poultry

Front 28

Dietary supplements for IDA are POORLY absorbed from:

Back 28

vegetables, grains, eggs, and dairy products

Front 29

True or False: Iron supplements should be dosed based on patient tolerance and can be started at low dose and gradually increased to full dose.

Back 29

TRUE

Front 30

The general recommendation for iron supplementation for IDA is:

Back 30

200mg of elemental iron daily in 2-3 divided doses

Front 31

What iron products contain the highest amounts of elemental iron?

Back 31

Polysaccharide iron capsule and carbonyl iron

Front 32

The major adverse reactions to therapeutic doses of elemental iron are ______________ in nature and include:
1.
2.
3.
4.

Back 32

gastrointestinal

1. dark discoloration of feces
2. constipation/diarrhea
3. nausea
4. vomiting

Front 33

True or False: Meals have no effect on iron absorption.

Back 33

FALSE - reduce absorption by more than half

Front 34

What are the 3 therapeutic iron interventions that can be used to treat IDA?

Back 34

1. Therapeutic supplements
2. Parenteral iron therapy
3. Blood transfusion

Front 35

When is parenteral iron therapy used in IDA tmt and what products are available?

Back 35

Used when PO iron is not absorbed or patient cannot tolerate - does NOT lead to quicker hematologic response

Products:
1. Iron dextran (can lead to anaphylactic reaction and death)
2. Sodium ferric gluconate
3. Iron sucrose

Front 36

Megaloblastic anemia is a type of __________ anemia and involves abnormal DNA metabolism which results from:
1.
2.

Back 36

macrocytic

1. Vitamin B12 deficiency
2. Folate deficiency

Front 37

What are the major causes of vitamin B12 deficiency?

Back 37

1. Inadequate intake
2. Malabsorption syndromes
3. Inadequate utilization

Front 38

Vitamin B12 is (water/fat) soluble and can be obtained through ingestion of:

Back 38

water-soluble; meat, fish, poultry, dairy products, fortified cereals

Front 39

The recommended daily allowance for vitamin B12 is:

Back 39

2mcg for adults

2.6mcg for pregnant or breastfeeding women

Front 40

Vitamin B12

1. Works with _____ in synthesis of building blocks for ___ & ___.
2. Essential for maintaining integrity of ________ system.
3. Plays role in _____ ____ _________ and _______ production.

Back 40

1. folate; DNA & RNA
2. neurological
3. fatty acid biosynthesis; energy

Front 41

What are the lab findings associated with vitamin B12 deficiency?

Back 41

1. MCV elevated
(some patients may have normal levels)
2. Mild leukopenia and thrombocytopenia
3. Macrocytosis and hypersegmented polymorphonuclear leukocytes
(earliest and most specific indications)
4. Pancytopenia in advanced cases

Front 42

What are the goals associated with vitamin B12 deficiency treatment?

Back 42

1. reversal of hematologic manifestations
2. replacement of body stores
3. prevention or resolution of neurologic manifestations

Front 43

How can replacement of vitamin B12 stores be achieved?

Back 43

1. Food
2. Vitamin B12 PO
(1-2 mg daily)
3. Vitamin B12 IM
(usually start with 1,000mcg daily for 1 week then weekly for 1 month then monthly)
4. Nasal spray
(once weekly)

Front 44

Potential adverse effects of vitamin B12 are rare and may include:

Back 44

1. hyperuricemia
2. hypokalemia
3. rebound thrombocytosis
4. fluid retention

Front 45

What is the best dietary source of B12?

Back 45

liver

Front 46

What are the most common causes of folic acid deficiency anemia?

Back 46

1. excessive alochol intake
2. pregnancy

Front 47

What are some drugs that may cause folic acid deficiency anemia?

Back 47

1. azathioprine
2. 6-MP
3. 5-FU
4. hydroxyurea
5. zidovudine
6. MTX

Front 48

Lab findings associated with folic acid deficiency anemia:

Back 48

1. rule out B12 deficiency - levels should be normal
2. serum folate levels decreases to <3ng/mL within few days of reduced folate intake
3. RBC folate level (<150ng/mL) declines

Front 49

Treatment of folic acid deficiency anemia:

Back 49

1. exogenous folic acid
-usually 1mg/day sufficient
(1-5mg can be used if malabsorption)

2. parental available - rarely used

Front 50

True or False: Anemia of chronic disease is usually diagnosed by exclusion of other causes.

Back 50

TRUE - usually overlooked due to other prominent disease

Front 51

What are the most common causes of anemia of chronic disease?

Back 51

1. chronic infection
2. chronic inflammation
3. malignancies

Front 52

True or False: There is no definitive test to confirm dx of anemia of chronic disease.

Back 52

TRUE - can coexist with IDA and folic acid deficiency

Front 53

What are the goals associated with treatment of anemia of chronic disease?

Back 53

1. treat underlying disease
2. correct reversible causes

Front 54

2 treatment options for anemia of chronic disease:

Back 54

1. RBC transfusions
2. Erythropoeitic agents

Front 55

True or False: RBC transfusions are an effective treatment for anemia of chronic disease.

Back 55

TRUE - should be limited to situations when oxygen transport is inadequate due to concomitant disease.
Transfusion threshold when Hb 8-10g/dL

Front 56

What are the 2 erythropoietic stimulating agents available to treat anemia of chronic disease?

Back 56

1. Recombinant Epoetin alfa
2. Recombinant Dabropoetin alfa (has longer half-life)

Front 57

Causes of anemia of critical illness include:

Back 57

1. sepsis
2. taking frequent blood samples
3. hemodilution
4. surgical blood loss
5. active bleeding

Front 58

In anemia of critical illness, mechanisms of ___ __________ and _________ are altered.

Back 58

RBC replenishment; homeostasis

Front 59

Laboratory findings in anemia of critical illness:

Back 59

1. low Hb
2. low serum iron
3. low TIBC
4. low iron/TIBC ratio
5. serum ferritin normal to high
6. low EPO

(ferritin only thing not low)

Front 60

Treatment options for anemia of critical illness:

Back 60

1. Require substrates for RBC production
(iron, folic acid, vitamin B12)
2. EPO
3. RBC transfusions

Front 61

Anemia in the elderly is associated with adverse outcomes including:

Back 61

1. all-cause hospitalization
2. hospitalization secondary to CV disease
3. all-cause mortality

Front 62

Anemia in the elderly is associated with a progressive reduction in:

Back 62

hematopoietic reserve

Front 63

Most common causes of anemia in the elderly:

Back 63

1. Chronic disease
2. Unexplained cause
3. Iron deficiency

Front 64

Anemia in the elderly is usually _______ & ____ with Hb levels __-__ g/dL.

Back 64

normocytic and mild; 10-12 g/dL

Front 65

Treatment options for anemia in the elderly:

Back 65

1. Treat underlying cause
2. Give iron supplement
3. Vitamin B12
4. Folic acid

Front 66

What iron supplement should be given to the elderly?

Back 66

ferrous sulfate 325mg once daily

(usually lower doses to decrease GI effects)

Front 67

What is the leading cause of infant morbidity and mortality around the world?

Back 67

pediatric anemia

Front 68

A lack of normal Hb at birth:
1.
2.

Back 68

1. Affects nonstorage of iron
2. Increases risk of IDA in first 3-6 months

Front 69

Pediatric anemia is usually due to primary hematologic abnormalities:
1.
2.
3.
4.

Back 69

1. Erythopoiesis decreases after birth
2. Decrease in EPO production
3. Iron stores are depleted by age of 6 months
4. Blood volume doubled from 4-12 months

Front 70

True or False: The primary goal of pediatric anemia is prevention.

Back 70

TRUE

Front 71

Treatment options in pediatric anemia:
1.
2.
3.

Back 71

1. RBC transfusions
2. EPO use controversial
3. Iron

Front 72

Hemolytic anemia results from:

Back 72

decreased survival time of RBCs secondary to destruction in spleen or circulation
(severity depends on mechanism)

Front 73

Hemolytic anemia can be:
1.
2.
3.
4.
5.
6.

Back 73

1. Mild
2. Chronic
3. Compensated
4. Acute
5. Severe
6. Life-threatening

Front 74

True or False: Hemolytic anemia is defined as RBC lifespan < 120 days.

Back 74

TRUE (normal lifespan 120 days)

Front 75

Hemolytic anemia can be the result of 3 primary defects that are intrinsic or extrinsic in origin:
1.
2.
3.

Back 75

1. membrane defects
2. alterations in Hb solubility or stability
3. change in intracellular metabolic processes

Front 76

Laboratory findings in hemolytic anemia:
1.
2.
3.
4.
5.
6.
7.
8.

Back 76

1. Normocytic
2. Normochromic
3. Increased reticulocyte count
(attempt to maintain RBC mass)
4. Peripheral blood smear
(sickle cell, target cell, spherocytes, elliptocytes, fragmented RBCs)
5. Decreased haptoglobin
6. Lactate dehydrogenase elevated
7. Hemoglobinuria
8. Increase in indirect bilirubin often occurs

Front 77

Treatment of hemolytic anemia involves:
1. Treatment of ________ _____
2. ________ and ______________ for autoimmune hemolytic anemias
3. ___________ - reduces RBC destruction

Back 77

1. underlying cause
2. steroids and immunosuppressants
3. splenectomy

Front 78

Patients with G6PD deficiency should avoid use of:

Back 78

precipitating oxidant medications and chemicals