Term
| Whether or not a patient becomes symptomatic from anemia will depend in part on these three factors. |
|
Definition
1. acuity of onset
2. etiology of anemia
3. presence of other comorbidities (pulmonary and cv especially) |
|
|
Term
| most patients will experience some symptoms related to anemia (no matter how slow the onset) when the hemoglobin level reaches . . . |
|
Definition
|
|
Term
| Once produced, the average life expectancy of an RBC is . . . |
|
Definition
|
|
Term
| If the WBC and platelet counts are low in the patient with anemia, a . . . |
|
Definition
| bone marrow process is more likely. |
|
|
Term
| The RBC count is low in most cases of anemia, but if elevated is a useful diagnostic clue to the presence of _________ |
|
Definition
|
|
Term
| since the MCV is the result of the average of RBC sizes, a normal MCV may represent the average of ___________. Therefore, a normal MCV does not exclude _____________. |
|
Definition
small and large cells
microcytic or macrocytic cells |
|
|
Term
| The red cell distribution width (RDW) is a measure of the __________ |
|
Definition
| variation in red cell size (anisocytosis). |
|
|
Term
| What must be done when evaluating a reticulocyte count? |
|
Definition
| calculate the correct reticulocyte response |
|
|
Term
| How do you calculate a corrected reticulocyte response? |
|
Definition
corrected retic =
(%retics)/(pts HCT/nl HCT) |
|
|
Term
| What is the normal HCT in men? |
|
Definition
|
|
Term
| What is the normal HCT in women? |
|
Definition
|
|
Term
| Polychromasia indicates that many of the red cells are ____________ |
|
Definition
|
|
Term
| What is the mneumonic for MIRCOcytic anemias? |
|
Definition
|
|
Term
| What does FLAT stand for? |
|
Definition
Fe (iron deficiency
Lead poisoning
Anemia of chronic disease
Thalassemia
Sideroblastic anemia |
|
|
Term
| What percentage of pts with gastrectomy will develop iron deficiency anemia? |
|
Definition
|
|
Term
| What are the five tests ordered in iron deficiency anemia? |
|
Definition
1. Serum iron
2. Transferrin level
3. TIBC
4. Transferrin Saturation
5. Ferritin |
|
|
Term
| In iron deficiency anemia, what will happen to TRANSFERRIN LEVELS? |
|
Definition
|
|
Term
| In iron deficiency anemia, what will happen to TIBC? |
|
Definition
|
|
Term
| In iron deficiency anemia, what will happen to FERRITIN LEVELS? |
|
Definition
|
|
Term
| What relatively new test is used to distinguish between iron deficiency anemia and anemia of chronic disease? |
|
Definition
SOLUBLE TRANSFERRIN RECEPTOR
(elevated in iron deficiency anemia) |
|
|
Term
| Standard evaluation of iron deficiency anemia involves ________ to look for a source of blood loss |
|
Definition
| endoscopy or colonoscopy depending on which symptoms manifest first |
|
|
Term
| If colonoscopy and EGD do not reveal a source of blood loss, what can be considered next? |
|
Definition
| wireless capsule endoscopy |
|
|
Term
| If endoscopy is undertaken and no cause is found, further investigation into a ____________ should be considered, and a __________ and _____________ |
|
Definition
malabsorption syndrome
small bowel biopsy
serum antibody tests |
|
|
Term
| Treat with oral iron therapy, reticulocytosis should be seen within how many days? |
|
Definition
|
|
Term
| With oral iron therapy, correction of iron deficiency anemia should be seen in . . . |
|
Definition
|
|
Term
| What is given to pts on oral iron therapy to help with iron absorption? |
|
Definition
| Vitamin C, given 30 min prior to taking the Fe tablet |
|
|
Term
| If three alpha genes are deleted in alpha thalassemia then produces an abnormality defined as ___________ |
|
Definition
|
|
Term
| Many patients with thalassemia trait will have ____________ red blood cell counts on the CBC. |
|
Definition
|
|
Term
| With thalassemias the MCV will be very _______, yet the hematocrit will be only ___________. |
|
Definition
|
|
Term
| In thalassemia, the RDW tends to be _______ |
|
Definition
|
|
Term
| How will the RDW be affected in thalassemia? |
|
Definition
| normal (high in Fe deficiency anemia) |
|
|
Term
| How will ferritin look in thalassemia? |
|
Definition
|
|
Term
| How will the RDW look in iron deficiency anemia? |
|
Definition
|
|
Term
| What will bone marrow biopsy show in thalassemia? |
|
Definition
|
|
Term
| What will bone marrow biopsy show in iron deficiency anemia? |
|
Definition
|
|
Term
| Which thalassemia will not show up on Hgb electrophoresis? |
|
Definition
|
|
Term
| What is typically given for sideroblastic anemia? |
|
Definition
|
|
Term
| Besides microcytic anemia, individuals with lead poisoning develop a ____________ and ____________ |
|
Definition
motor neuropathy
abdominal pain |
|
|
Term
| What is really going on with a normocytic anemia with an elevated RDW? |
|
Definition
| a mixed microcytic and macrocytic anemia (the MCV is an average of all the RBCs the detector encounters - suspect a mixed anemia if you see an elevated RDW) |
|
|
Term
| What are two serum markers help differentiate anemia of chronic disease and iron deficiency anemia? |
|
Definition
ferritin
soluble transferrin receptor |
|
|
Term
| In anemia of chronic disease, the soluble transferrin receptor level will be . . . |
|
Definition
|
|
Term
| In cases where there is both anemia of chronic disease and iron deficiency, the sTfR would be expected to be. . . |
|
Definition
|
|
Term
| Anemia due to CKD is multifactorial. What are the potential causes of anemia in CKD? |
|
Definition
1. reduced EPO production
2. decreased serum folate due to dialysis
3. Aluminum overload interferes with heme production
4. hyperparathyroidism can result in osteodystrophy of the bone marrow |
|
|
Term
| With anemia of CKD, and tx with EPO, at what level of ferritin is iron therapy indicated? |
|
Definition
|
|
Term
| What is the most common CONGENITAL aplastic anemia? |
|
Definition
|
|
Term
| What is Fanconi's Anemia? |
|
Definition
| a syndrome that includes aplastic anemia plus short stature, cafe-au-lait spots, genitourinary abnormalities, microphthalmia, mental retardation, and skeletal abnormalities |
|
|
Term
| What are two major categories of normocytic macrocytic anemia? |
|
Definition
| megaloblastic and non-megaloblastic |
|
|
Term
| What is megaloblastic anemia? |
|
Definition
| characterized by abnormal nuclear maturation of RBC precursors in the bone marrow, known as megaloblasts |
|
|
Term
| What are the seven causes of of hypoproliferative macrocytic anemia? |
|
Definition
•Vitamin B12 deficiency*
•Folate deficiency*
•Myelodysplastic syndrome
•Hypothyroidism
•Liver disease* (cirrhosis can be a cause of folate deficiency)
•Alcohol*
•Drugs (some chemotherapeutic agents may cause megaloblastic anemia) |
|
|
Term
| What are the potential causes of hypoproliferative megaloblastic anemia? |
|
Definition
•Vitamin B12 deficiency*
•Folate deficiency*
•Liver disease* (cirrhosis can be a cause of folate deficiency)
•Alcohol* |
|
|
Term
| How does liver disease cause a megaloblastic anemia? |
|
Definition
| cirrhosis can cause of folate deficiency |
|
|
Term
| Hemolytic anemia with an inadequate bone marrow response can result in a . . . |
|
Definition
| hypoproliferative macrocytic anemia |
|
|
Term
| What are MACROOVALOCYTES? |
|
Definition
|
|
Term
| What are MACROOVALOCYTES suggestive of? |
|
Definition
| vitamin B12 or folate deficiency |
|
|
Term
| Hypersegmented neutrophils (>6 lobes, Figure 16) have a high sensitivity and specificity for . . . |
|
Definition
|
|
Term
| The most common cause of vitamin B12 deficiency in the elderly is presently thought to be . . . |
|
Definition
| food-cobalamin malabsorption |
|
|
Term
| What is food-cobalamin malabsorption? |
|
Definition
| the stomach is unable to cleave vitamin B12 from food |
|
|
Term
| The neurologic defects caused by B12 deficiency are referred to as . . . |
|
Definition
| subacute combined degeneration |
|
|
Term
| What is subacute combined degeneration? |
|
Definition
| impact of vitamin B12 deficiency on the posterior and lateral columns of the spinal cord |
|
|
Term
| In B12 deficiency which will develop first - neurologic symtpoms or anemia? |
|
Definition
| NEUROLIGIC SYMPTOMS develop first |
|
|
Term
| an elevated methylmalonic acid level is not specific for vitamin B12 deficiency in the setting of _________ |
|
Definition
|
|
Term
| When ordering a folate level, which test do you order for evaluating a true measure of folate tissue status; RBC folate or serum folate? |
|
Definition
|
|
Term
| What is the problem with ordering a serum folate level as opposed to a RBC folate level? |
|
Definition
| serum folate levels are a reflection of short-term intake, and may be normal despite total body folate deficiency |
|
|
Term
| In folate deficiency, methylmalonic acid levels are _________ |
|
Definition
|
|
Term
| What is the dose for treating folate deficiency? |
|
Definition
|
|
Term
| What kind of cells are seen with MYELODYSPLASTIC SYNDROME? |
|
Definition
|
|
Term
| What are pseudo-Pelger-Huet cells? |
|
Definition
| macrocytic, with varying degrees of aniso- and poikilocytosis, and dysplastic, hypogranular and hyposegmented neutrophils |
|
|
Term
| What are the five premalignant hematologic disorders that result in myelodysplastic syndrome? |
|
Definition
1. refractory anemia
2. refractory anemia with ringed
sideroblasts,
3. refractory anemia with excess blasts,
4. refractory anemia with excess blasts in transformation
5. chronic myelomonocytic leukemia |
|
|
Term
| What are the five tests to consider when evaluating the patient with hypoproliferative macrocytic anemia? |
|
Definition
•Vitamin B12 level
•Red cell folate
•TSH
•Liver function panel
•Peripheral blood smear and white cell differential |
|
|
Term
| What is the order of operations of working up hemolytic anemia? |
|
Definition
1. Confirm hemolysis with LDH, indirect bili, haptoglobin
2. Perhipheral smear (directs which test to order next)
3. order DAT |
|
|
Term
| What is the next test to order in you see SPEHROCYTES on peripheral smear? |
|
Definition
|
|
Term
| What is the next test to order in you see SICKLED CELLS on peripheral smear? |
|
Definition
|
|
Term
| What is the next test to order in you see BITE CELLS on peripheral smear? |
|
Definition
|
|
Term
| What is the next test to order in you see TARGET CELLS on peripheral smear? |
|
Definition
Hgb electropheresis
Liver enzymes |
|
|
Term
| What is the next test to order in you see SCHISTOCYTES on peripheral smear? |
|
Definition
PT/aPTT
CREATININE
PLATELETS |
|
|
Term
| What is the next test to order in you see PARASITE INCLUSIONS on peripheral smear? |
|
Definition
|
|
Term
| What is the next test to order in you see ACANTHOCYTES on peripheral smear? |
|
Definition
|
|
Term
| When working up hemolytic anemia, if spherocytes are absent and the direct antiglobulin test is negative, what should be worked up next? |
|
Definition
| non-immune hemolytic causes should be sought |
|
|
Term
|
Definition
| Pts RBC are mixed with COOMB's reagent (anti-human globulin). If agglutination occurs the test is positive, and further testing is done to evaluate if IgG or C3 are coating the RBCs. |
|
|
Term
|
Definition
| solution that contains anti-IgG and anti-C3 |
|
|
Term
| What is the Indirect aggluntination test? |
|
Definition
| Tests the patient's serum for antibodies that are not coating the patient's RBC's. |
|
|
Term
| When is indirect aggluntination test helpful? |
|
Definition
| It is helpful for detecting alloantibodies that were introduced by PRIOR TRANSFUSION or by FETAL TRANSFER of red blood cells TO THE MOTHER. |
|
|
