Fitzgerald Leik FNP Hematology exam questions and answers

Chronic Low Volume Blood Loss: Mechanism -Erosive Gastritis, menorrhagia, GI malignancym & others, resulting in iron deficiency anemia -Iron from RBCs wasted via blood loss cannot be recycled. Clinically significant blood loss can be as little as a few mL/day Reduced RBC Production: Mechanism -Nutritional deficit (Vitamin B12, folic acid, iron deficiency), anemia of chronic disease, bone marrow suppression, reduced erythropoietin production (chronic renal failure) -Also associated with the use of select medications that prevent micronutrient absorption including chronic PPI use (vitamin B12 and iron malabsorption), metformin (vitamin B12 malabsorption) Which drugs can result in micronutrient malabsorption? PPIs and metformin Premature destruction of RBCs: Mechanism -Hemolysis, shortened RBC lifespan (90-120 days) -This is part of the mechanism in anemia of chronic disease, but hemoylsis is UNCOMMON etiology in primary care Normal RBC Lifespan 90-120 days -aka the time it would take to see a change in CBC after attempting to correct the anemia Acute Blood Loss: Mechanism In an adult, >1L acute blood loss is needed before that is a clinically significant drop in hemoglobin (UNCOMMON in primary care) -if there is acute blood loss (hemorrhage), patient typically presents w/ dizziness, tachycardia, and low BP Microcytic MCV <80 Normocytic MCV 80-96 Macrocytic MCV >96 MCHC Reflect the color of the RBCs -lower number (<31) = pale -If pale, always smaller too RDW RBC distribution width (11-15%) -value only increases, not decreases -Increased value means varying sizes of RBCs Reticulocyte percentage -Body's normal response to anemia=correction of anemia via increasing the number of young RBCs (reticulocytes) -1-2% What is the type of anemia below: Hgb: low Hct: low RBC: low MCV: WNL MCHC: WNL RDW: WNL Normocytic, normochromic anemia w/ WNL RDW -Most common causes: anemia of chronic disease, chronic kidney disease, acute blood loss -Examples: 72yo male w/ acute GI bleed, 32yo female w/ newly diagnosed SLE What is the type of anemia below: Hgb: low Hct: low RBC: low MCV: low MCHC: low RDW: high Microcytic hypochromic anemia with elevated RDW -Most common causes: Iron deficiency, plumbism (lead toxicity) -Examples: 68yo M w/ erosive gastritis, 48yo F w/ menorrhagia, 3yo w/ plumbism Plumbism Lead Toxicity Next step test for microcytic hypochromic anemia w/ elevated RDW -Ferritin level -Lead for young children/suspected industrial exposure in adult What is the type of anemia below: Hgb: low Hct: low RBC: high MCV: low MCHC: low RDW: WNL Microcytic hypochromic anemia w/ WNL RDW -Most common causes: Alpha or beta thalassemia minor -Next steps: Alpha Thalassemia Minor: At risk groups Asians and African descent (AAA) Beta Thalassemia Minor: At risk groups African, mediterranean, middle eastern ancestry (BAMME) Next step test for microcytic hypochromic anemia w/ NL RDW Hemoglobin electrophoresis for evaluation of hemoglobin variants What is the type of anemia below: Hgb: low Hct: low RBC: low MCV: high MCHC: WNL RDW: high Macrocytic normochromic anemia with elevated RDW -Most common causes: Vitamin B12 deficiency, folate deficiency anemia Which vitamin deficiency is pernicious anemia? Vitamin B12 Next step test for macrocytic normochromic anemia w/ elevated RDW Serum Vitamin B12 and RBC folate What is reflected through the values below? Hgb: WNL Hct: WNL RBC: WNL MCV: high MCHC: WNL RDW: WNL Drug-induced macrocytosis w/o anemia -Most common causes: excessive alcohol use or antiepileptic drugs (carbamazapine, phenytoin, methotrexate)... more commonly excessive alcohol Excessive alcohol use in male >5 drinks per day Excessive alcohol use in female >3 drinks per day Alcohol content of 12fl oz of beer 5% Alcohol content of 8-9 fl oz of malt liquor 7% Alcohol content of 5fl oz of table wine 12% Alcohol content of 1.5 fl oz shot of 80-proof spirits 40% Most common anemia in childhood Iron deficiency anemia Most common anemia in pregnancy Iron deficiency anemia Most common anemia in women of reproductive years Iron deficiency anemia Most common anemia in the elderly 1. Anemia of chronic disease 2. Iron deficiency anemia 3. Pernicious anemia (typically older women) What vitamin should vegans supplement with? Vitamin B12 How to take iron supplements -1 hour before or 2 hour after meal (empty stomach) -antacids and dairy products interfere with iron absorption -Vitamin C may help, but minimally Hemic mumur Found on assessment when an individual is profoundly dehydrated, febrile, anemic, etc. -Resolves w/ treatment of the underlying illness