CMN 572 EXAM 2 QUESTIONS WITH
CORRECT ANSWERS
What is anemia? - Correct Answers -A broad high yield diagnosis usually suspected by
physical findings & the lab parameters of low hemoglobin and/or hematocrit. Can be
thought of as "symptom."
What is the most common presenting symptom/chief complaint? - Correct Answers -
FATIGUE is the most common presenting symptom.
-Other c/o can be CC but an incidental lab finding presents.
What do you look for w/ anemia? - Correct Answers --Excess loss (acute hemorrhage,
chronic loss)-- ex: trauma (MVC accident -still blood loss-get CBC- sometimes just
acute & repair on own but can be chronic (GI blood less from colon cancer)
-Excess destruction-- ex: sickle cell destroyed d/t hereditary
-Decreased/impaired production of Fe --ex: sometimes bone marrow or something else
like iron deficient like dietary (seen a lot in clinic)
What kind of history do you look at w/ anemia? - Correct Answers -Medical hx:
-Injuries/trauma/abnormal bleeding (recent trauma involving blood loss, decreased
clotting, DUB in females)
-Liver/thyroid disease
-Bleeding disorders
-GI (black tarry stools indicate PUD; chronic loss even if not seeing bright red stool)
-Anorexia Nervosa (Vegetarians- poor intake)
-Inherited diseases
-Malignancies
-Frequent blood donations (acutely being taken from system)
Social Hx
-Alcohol/drug use (alcohol causes liver damage)
-Dietary habits
-Activity level changes (fatigue)
-CO detector (CO takes place of oxygen on RBCs & cause anemia)
-Medication use (Zinc) (Ppl taking zinc to prevent COVID; Zinc causes decreased
copper which causes a decrease in absorption of iron aka sideroblastic anemias)
-ASA NSAIDs (don't cause anemia but can blood loss w/ PUD)
*History/physical necessary on everyone*
What are the physical symptoms r/t to impaired O2 delivery (anemia)? - Correct
Answers --CV
,-respiratory
-nervous system
-GI
-others
**Any patient in distress w/ fever or acute blood loss shouldn't be evaluated based upon
the anemia algorithm*
ex: Pallor, tachycardia, increased workload on the hert, dizziness, SOB,
numbness/tingling, n/v, smooth tongue, Hematachezia.
-If H/H severely low & blood loss, whether acute or chronic should be emergently
treated.
-We don't treat acute, treat chronic, if it's urgent REFER
What are the 3 RBC indices? - Correct Answers -MCV, MCH, MCHC (Reticulocytes)
Wha is RBC indices — MCV? - Correct Answers -(Size)
High value = macrocytosis
Low value = microcytosis
Wha is RBC indices — MCH? - Correct Answers -(color)
High value = hyperchromic
Low value = hypochromic
Wha is RBC indices — reticulocytes? - Correct Answers -Immature RBCs
Increased value = body tries to replenish when loss occurs
Decreased value = bone marrow failure or nutritional deficiency
What is Mentzer index? - Correct Answers -described in 1973 by William C. Mentzer, is
the MCV divided by the RBC count. It is said to be helpful in differentiating iron
deficiency anemia from beta thalassemia. The index is calculated from the results of a
complete blood count.
-Sometimes thalassemia with a low ferritin level will have a normal RBC count. The
Mentzer Index is <13 in Thalassemia and the RBC number is not decreased.
What is other lab work up of anemia? - Correct Answers --Serum ferritin, serum iron,
transferrin, and TSAT (iron studies next slide)
-Folate level
-B12 level
-Reticulocytes
-Serum bilirubin- hereditary
-Copper
-----Erythropoietin produced by kidney must be present for synthesis of RBCs - renal
disease (look at this for lack of these) - can replace but expensive - dialysis patients =
chronic
----Serum bilirubin- hereditary
---Hemoccult - specific
,---Electrophoresis - sick cell Diane
----Thyroid- hypo causes anemia (untreated)
----Renal panel -
What do transferrin saturation & TIBC (Total iron binding capacity) measure? - Correct
Answers -2 different tests but measure the same thing --> how much transferrin is
available for iron to attach to.
Studies interpretation - Correct Answers -
What is TIBC (Total Iron Binding Capacity) - Correct Answers -Measurement of
transferrin iron binding capability (1/3 of transferrin is typically bound with iron).
ex: Take pic of blood how much capacity is there; if iron is there, why isn't it being used
to capacity? Not w/ iron deficiency - not enough iron there-high capacity. A lot of places
for iron to bind since iron not present.
What is ACD/AID? - Correct Answers -ACD: anemia of chronic disease
AID: anemia of inflammation- usually work the same
Low serum ferritin + TIBC = - Correct Answers -iron deficient anemia
Microcytic -- what are diagnosis help w/ MCV? - Correct Answers --Fe Deficiency
-Thalassemia
Normocytic -- what are diagnosis help w/ MCV? - Correct Answers --Anemia of Chronic
Disease
-Anemia of Inflammation
Macrocytic -- what are diagnosis help w/ MCV? - Correct Answers --B12 Deficiency
-Folate Deficiency
-Vegetarians
-ETOH/drug abuse
What is Fe deficiency anemia? - Correct Answers --The most common cause of anemia
in adults & children
-----BLEEDING is the most common cause in adults
-Older men presume colon cancer; occult blood in stool
-Young female past menarche, DUB (dysfunctional uterine bleeding/AUB abnormal
uterine bleeding; off cycle, on OCP, how bad bleeding it is, etc.)
-Older female near menopause, menorrhagia
---- Nutritional deficiency is the most common cause in children (MUST replace needed
iron)
-Lead poisoning (replace hbg molecule; usually associated just w/ kids; does matter
where they live - 1970s lead paint in house by ingesting & causing anemia. Community
health centers screen kids routinely_
, -High doses of Zinc (leads to low dose of copper in gut - iron deficient bc copper must
be present in gut for iron to be absorbed)
What is Fe deficiency anemia treatment? - Correct Answers --Increase in iron rich foods
in diet
-Iron supplements ferrous sulfate/gluconate
-Vitamin C to increase absorption
-Hct should return to normal in 2 months; continue on for 3-6 months
-If response is unacceptable, refer to hematologist
-CHILDREN: elemental iron 3-6 mg/kg/day
-ADOLESCENTS: elemental iron 65 mg daily
-ADULTS: Ferrous sultate 325 mg/day, divide this daily dose to TID
What is thalassemia? - Correct Answers --Hereditary in the Mediterranian ancesty
-Defective synthesis or production of hgb
-Major or minor
-Alpha or beta chains- missing one or more chains (what the chain is missing is what it's
called. If missing alpha chain, alpha is the type)
-Alpha chain: 1 deletion, asymptomatic, 2 deletions mild anemia, 3 deletions severe
anemia, 4 deletions hydrops fetalis
-Beta chain: 1 deletion asymptomatic called beta thalassemia minor, 2 deletions beta
thalasemmia major can cause severe skull deformity
-Microcytic but may have normal or elevated RBC count (large number of small pale
cells)
-Ferritin is normal
What is thalassemia treatment? - Correct Answers --May need no treatment at all
-Transfusions
-Bone stem cell transplants
-No iron replacement (can cause iron overload!!)
*generally refer to hematology; eval by hematologist can prevent repeated work ups &
inappropriate fe replacement treatment
What is B12 deficiency or pernicious anemia? - Correct Answers --Glossitis, spleen
enlargement, icterus
-Rarely caused by nutritional deficiency, but loss of appetite may be a symptom
-Can produce neuro-psychiatric s&s
-Autoimmune factors in pernicuous anemia. Antibody binds to intrinsic factor
disallowingB12 to bind.
-Can be caused by chronic use of PPIs, H2 blockers, Metformin
-Increased MMA and homocysteine in B12 deficiency
(Methylmalonic acid is a functional elevation in B12 deficiency. Homocysteine an amino
acid that is broken down by B12, an elevation may indicate a B12 def. Homocysteine
elevated can be a risk fx for dementia, heart disease & stroke
------B12 bind in gut/intrinsic factor
CORRECT ANSWERS
What is anemia? - Correct Answers -A broad high yield diagnosis usually suspected by
physical findings & the lab parameters of low hemoglobin and/or hematocrit. Can be
thought of as "symptom."
What is the most common presenting symptom/chief complaint? - Correct Answers -
FATIGUE is the most common presenting symptom.
-Other c/o can be CC but an incidental lab finding presents.
What do you look for w/ anemia? - Correct Answers --Excess loss (acute hemorrhage,
chronic loss)-- ex: trauma (MVC accident -still blood loss-get CBC- sometimes just
acute & repair on own but can be chronic (GI blood less from colon cancer)
-Excess destruction-- ex: sickle cell destroyed d/t hereditary
-Decreased/impaired production of Fe --ex: sometimes bone marrow or something else
like iron deficient like dietary (seen a lot in clinic)
What kind of history do you look at w/ anemia? - Correct Answers -Medical hx:
-Injuries/trauma/abnormal bleeding (recent trauma involving blood loss, decreased
clotting, DUB in females)
-Liver/thyroid disease
-Bleeding disorders
-GI (black tarry stools indicate PUD; chronic loss even if not seeing bright red stool)
-Anorexia Nervosa (Vegetarians- poor intake)
-Inherited diseases
-Malignancies
-Frequent blood donations (acutely being taken from system)
Social Hx
-Alcohol/drug use (alcohol causes liver damage)
-Dietary habits
-Activity level changes (fatigue)
-CO detector (CO takes place of oxygen on RBCs & cause anemia)
-Medication use (Zinc) (Ppl taking zinc to prevent COVID; Zinc causes decreased
copper which causes a decrease in absorption of iron aka sideroblastic anemias)
-ASA NSAIDs (don't cause anemia but can blood loss w/ PUD)
*History/physical necessary on everyone*
What are the physical symptoms r/t to impaired O2 delivery (anemia)? - Correct
Answers --CV
,-respiratory
-nervous system
-GI
-others
**Any patient in distress w/ fever or acute blood loss shouldn't be evaluated based upon
the anemia algorithm*
ex: Pallor, tachycardia, increased workload on the hert, dizziness, SOB,
numbness/tingling, n/v, smooth tongue, Hematachezia.
-If H/H severely low & blood loss, whether acute or chronic should be emergently
treated.
-We don't treat acute, treat chronic, if it's urgent REFER
What are the 3 RBC indices? - Correct Answers -MCV, MCH, MCHC (Reticulocytes)
Wha is RBC indices — MCV? - Correct Answers -(Size)
High value = macrocytosis
Low value = microcytosis
Wha is RBC indices — MCH? - Correct Answers -(color)
High value = hyperchromic
Low value = hypochromic
Wha is RBC indices — reticulocytes? - Correct Answers -Immature RBCs
Increased value = body tries to replenish when loss occurs
Decreased value = bone marrow failure or nutritional deficiency
What is Mentzer index? - Correct Answers -described in 1973 by William C. Mentzer, is
the MCV divided by the RBC count. It is said to be helpful in differentiating iron
deficiency anemia from beta thalassemia. The index is calculated from the results of a
complete blood count.
-Sometimes thalassemia with a low ferritin level will have a normal RBC count. The
Mentzer Index is <13 in Thalassemia and the RBC number is not decreased.
What is other lab work up of anemia? - Correct Answers --Serum ferritin, serum iron,
transferrin, and TSAT (iron studies next slide)
-Folate level
-B12 level
-Reticulocytes
-Serum bilirubin- hereditary
-Copper
-----Erythropoietin produced by kidney must be present for synthesis of RBCs - renal
disease (look at this for lack of these) - can replace but expensive - dialysis patients =
chronic
----Serum bilirubin- hereditary
---Hemoccult - specific
,---Electrophoresis - sick cell Diane
----Thyroid- hypo causes anemia (untreated)
----Renal panel -
What do transferrin saturation & TIBC (Total iron binding capacity) measure? - Correct
Answers -2 different tests but measure the same thing --> how much transferrin is
available for iron to attach to.
Studies interpretation - Correct Answers -
What is TIBC (Total Iron Binding Capacity) - Correct Answers -Measurement of
transferrin iron binding capability (1/3 of transferrin is typically bound with iron).
ex: Take pic of blood how much capacity is there; if iron is there, why isn't it being used
to capacity? Not w/ iron deficiency - not enough iron there-high capacity. A lot of places
for iron to bind since iron not present.
What is ACD/AID? - Correct Answers -ACD: anemia of chronic disease
AID: anemia of inflammation- usually work the same
Low serum ferritin + TIBC = - Correct Answers -iron deficient anemia
Microcytic -- what are diagnosis help w/ MCV? - Correct Answers --Fe Deficiency
-Thalassemia
Normocytic -- what are diagnosis help w/ MCV? - Correct Answers --Anemia of Chronic
Disease
-Anemia of Inflammation
Macrocytic -- what are diagnosis help w/ MCV? - Correct Answers --B12 Deficiency
-Folate Deficiency
-Vegetarians
-ETOH/drug abuse
What is Fe deficiency anemia? - Correct Answers --The most common cause of anemia
in adults & children
-----BLEEDING is the most common cause in adults
-Older men presume colon cancer; occult blood in stool
-Young female past menarche, DUB (dysfunctional uterine bleeding/AUB abnormal
uterine bleeding; off cycle, on OCP, how bad bleeding it is, etc.)
-Older female near menopause, menorrhagia
---- Nutritional deficiency is the most common cause in children (MUST replace needed
iron)
-Lead poisoning (replace hbg molecule; usually associated just w/ kids; does matter
where they live - 1970s lead paint in house by ingesting & causing anemia. Community
health centers screen kids routinely_
, -High doses of Zinc (leads to low dose of copper in gut - iron deficient bc copper must
be present in gut for iron to be absorbed)
What is Fe deficiency anemia treatment? - Correct Answers --Increase in iron rich foods
in diet
-Iron supplements ferrous sulfate/gluconate
-Vitamin C to increase absorption
-Hct should return to normal in 2 months; continue on for 3-6 months
-If response is unacceptable, refer to hematologist
-CHILDREN: elemental iron 3-6 mg/kg/day
-ADOLESCENTS: elemental iron 65 mg daily
-ADULTS: Ferrous sultate 325 mg/day, divide this daily dose to TID
What is thalassemia? - Correct Answers --Hereditary in the Mediterranian ancesty
-Defective synthesis or production of hgb
-Major or minor
-Alpha or beta chains- missing one or more chains (what the chain is missing is what it's
called. If missing alpha chain, alpha is the type)
-Alpha chain: 1 deletion, asymptomatic, 2 deletions mild anemia, 3 deletions severe
anemia, 4 deletions hydrops fetalis
-Beta chain: 1 deletion asymptomatic called beta thalassemia minor, 2 deletions beta
thalasemmia major can cause severe skull deformity
-Microcytic but may have normal or elevated RBC count (large number of small pale
cells)
-Ferritin is normal
What is thalassemia treatment? - Correct Answers --May need no treatment at all
-Transfusions
-Bone stem cell transplants
-No iron replacement (can cause iron overload!!)
*generally refer to hematology; eval by hematologist can prevent repeated work ups &
inappropriate fe replacement treatment
What is B12 deficiency or pernicious anemia? - Correct Answers --Glossitis, spleen
enlargement, icterus
-Rarely caused by nutritional deficiency, but loss of appetite may be a symptom
-Can produce neuro-psychiatric s&s
-Autoimmune factors in pernicuous anemia. Antibody binds to intrinsic factor
disallowingB12 to bind.
-Can be caused by chronic use of PPIs, H2 blockers, Metformin
-Increased MMA and homocysteine in B12 deficiency
(Methylmalonic acid is a functional elevation in B12 deficiency. Homocysteine an amino
acid that is broken down by B12, an elevation may indicate a B12 def. Homocysteine
elevated can be a risk fx for dementia, heart disease & stroke
------B12 bind in gut/intrinsic factor
