ACNP EXAM (AACN) | QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | LATEST EXAM UPDATE
Types of microcytic anemias
Iron deficiency
Thalassemia
Sideroblastic
Can be anemia of chronic disease
Types of anemia in cancer
Anemia of chronic disease
Normocytic, normochromic anemia
Why do men have higher hemoglobin levels
Testosterone stimulates erythropoietin
What does total iron binding capacity signify
The higher the TIBC, the high the need for iron
MCV ranges
80-100
<80 = microcytic
>100 = macrocytic
MHCH ranges
32-26
<32 = microchromic
>36 = macrochromic
Macrocytic anemia types
B12/folate deficiency
-ie. megaloblastic anemias
Most common cause anemia worldwide
Iron deficiency anemia
Causes of iron deficiency anemia
,Blood loss
Inadequate iron intake
Inadequate iron absorption
Signs/symptoms of iron deficiency anemia
Slow onset, will have few symptoms with HCT >30
As HCT falls
-PICA/unusual food cravings (ice/clay/metals)
-dyspnea/mild fatigue
-headaches
-palpitations
-tachycardia
-postural hypotension
-pallor
Labs findings in iron deficiency anemia
Low hgb/hct
Low MCV/MCHC
Low RBC
High RDW
Low serum iron
Low serum ferritin
**HIGH total iron binding capacity**
Iron deficiency anemia management
Oral ferrous sulfate
-300-325mg 1-2 hours after meals
**should not be taken with antacids**
-taking with vit C containing juice INCREASES absorption
Intake of foods high in iron
-raisins, meat, green leafy vegetables, citrus
Foods high in iron
Raisins
Meat (red)
Green leafy vegetables
Citrus
Thalassemia incidence/prevalence
,Mainly found in
-Mediteranean
-Asian
-middle eastern
-indian
-african
Asians with anemia
Think thalassemia
Thalassemia signs/symptoms
Generally asymptomatic UNLESS thalassemia is severe
Most familial type of thalassemia
Beta thalassemia
-decreased production of normal adult hgb B chains
-ie. 4 hgb chains: 2 hgb A, 2 hgb B
Types of thalassemia
Minor
-Heterozygous for beta thalassemia
Major
-Homozygous for beta thalassemia
**normal presentation at birth, anemia within a few months before
becoming severe**
Thalassemia lab findings
Decreased hgb
Microcytic
Hypochromic
NORMAL total iron binding capacity
NORMAL ferritin
Decreased hgb A or B chains
Management of thalassemia
No treatment for mild-moderate thalassemia
For severe thalassemia
-transfusions
, -splenectomy
**iron is contraindicated**
Causes of folic acid deficiency
Inadequate intake
Inadequate absorption
RBC findings in folic acid deficiency
Macrocytic
Normochromic
Folic acid deficiency signs/symptoms
Fatigue
Dyspnea on exertion
Pallor
Headaches
Tachycardia
Anorexia
Glossitis
Aphthous ulcers
Folic acid deficiency lab findings
Decreased hgb/hct
Macrocytic, normochromic
Decreased serum folate
RBC folate <100
Folate deficiency management
1mg PO daily
What patients are most likely to have a folic acid deficiency
Homeless
Alcohol/drug abuse
Eating disorders
Foods high in folic acid
Bananas
Peanut butter
Fish
Green leafy vegetables
WELL DETAILED ANSWERS | LATEST EXAM UPDATE
Types of microcytic anemias
Iron deficiency
Thalassemia
Sideroblastic
Can be anemia of chronic disease
Types of anemia in cancer
Anemia of chronic disease
Normocytic, normochromic anemia
Why do men have higher hemoglobin levels
Testosterone stimulates erythropoietin
What does total iron binding capacity signify
The higher the TIBC, the high the need for iron
MCV ranges
80-100
<80 = microcytic
>100 = macrocytic
MHCH ranges
32-26
<32 = microchromic
>36 = macrochromic
Macrocytic anemia types
B12/folate deficiency
-ie. megaloblastic anemias
Most common cause anemia worldwide
Iron deficiency anemia
Causes of iron deficiency anemia
,Blood loss
Inadequate iron intake
Inadequate iron absorption
Signs/symptoms of iron deficiency anemia
Slow onset, will have few symptoms with HCT >30
As HCT falls
-PICA/unusual food cravings (ice/clay/metals)
-dyspnea/mild fatigue
-headaches
-palpitations
-tachycardia
-postural hypotension
-pallor
Labs findings in iron deficiency anemia
Low hgb/hct
Low MCV/MCHC
Low RBC
High RDW
Low serum iron
Low serum ferritin
**HIGH total iron binding capacity**
Iron deficiency anemia management
Oral ferrous sulfate
-300-325mg 1-2 hours after meals
**should not be taken with antacids**
-taking with vit C containing juice INCREASES absorption
Intake of foods high in iron
-raisins, meat, green leafy vegetables, citrus
Foods high in iron
Raisins
Meat (red)
Green leafy vegetables
Citrus
Thalassemia incidence/prevalence
,Mainly found in
-Mediteranean
-Asian
-middle eastern
-indian
-african
Asians with anemia
Think thalassemia
Thalassemia signs/symptoms
Generally asymptomatic UNLESS thalassemia is severe
Most familial type of thalassemia
Beta thalassemia
-decreased production of normal adult hgb B chains
-ie. 4 hgb chains: 2 hgb A, 2 hgb B
Types of thalassemia
Minor
-Heterozygous for beta thalassemia
Major
-Homozygous for beta thalassemia
**normal presentation at birth, anemia within a few months before
becoming severe**
Thalassemia lab findings
Decreased hgb
Microcytic
Hypochromic
NORMAL total iron binding capacity
NORMAL ferritin
Decreased hgb A or B chains
Management of thalassemia
No treatment for mild-moderate thalassemia
For severe thalassemia
-transfusions
, -splenectomy
**iron is contraindicated**
Causes of folic acid deficiency
Inadequate intake
Inadequate absorption
RBC findings in folic acid deficiency
Macrocytic
Normochromic
Folic acid deficiency signs/symptoms
Fatigue
Dyspnea on exertion
Pallor
Headaches
Tachycardia
Anorexia
Glossitis
Aphthous ulcers
Folic acid deficiency lab findings
Decreased hgb/hct
Macrocytic, normochromic
Decreased serum folate
RBC folate <100
Folate deficiency management
1mg PO daily
What patients are most likely to have a folic acid deficiency
Homeless
Alcohol/drug abuse
Eating disorders
Foods high in folic acid
Bananas
Peanut butter
Fish
Green leafy vegetables
