CMN 572 Exam 2: Questions With In-Depth
Solutions
What is anemia? Correct Answer - 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 Answer - 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 Answer - -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 Answer -
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 Answer - -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 Answer - MCV, MCH,
MCHC (Reticulocytes)
Wha is RBC indices — MCV? Correct Answer - (Size)
High value = macrocytosis
Low value = microcytosis
Wha is RBC indices — MCH? Correct Answer - (color)
,High value = hyperchromic
Low value = hypochromic
Wha is RBC indices — reticulocytes? Correct Answer -
Immature RBCs
Increased value = body tries to replenish when loss occurs
Decreased value = bone marrow failure or nutritional deficiency
What is Mentzer index? Correct Answer - 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 Answer - -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 Answer - 2 different tests but measure the
same thing --> how much transferrin is available for iron to attach
to.
Studies interpretation Correct Answer -
What is TIBC (Total Iron Binding Capacity) Correct Answer -
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 Answer - ACD: anemia of chronic
disease
AID: anemia of inflammation- usually work the same
Low serum ferritin + TIBC = Correct Answer - iron deficient
anemia
Microcytic -- what are diagnosis help w/ MCV? Correct Answer -
-Fe Deficiency
-Thalassemia
Normocytic -- what are diagnosis help w/ MCV? Correct Answer -
-Anemia of Chronic Disease
-Anemia of Inflammation
Macrocytic -- what are diagnosis help w/ MCV? Correct Answer -
-B12 Deficiency
-Folate Deficiency
Solutions
What is anemia? Correct Answer - 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 Answer - 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 Answer - -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 Answer -
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 Answer - -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 Answer - MCV, MCH,
MCHC (Reticulocytes)
Wha is RBC indices — MCV? Correct Answer - (Size)
High value = macrocytosis
Low value = microcytosis
Wha is RBC indices — MCH? Correct Answer - (color)
,High value = hyperchromic
Low value = hypochromic
Wha is RBC indices — reticulocytes? Correct Answer -
Immature RBCs
Increased value = body tries to replenish when loss occurs
Decreased value = bone marrow failure or nutritional deficiency
What is Mentzer index? Correct Answer - 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 Answer - -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 Answer - 2 different tests but measure the
same thing --> how much transferrin is available for iron to attach
to.
Studies interpretation Correct Answer -
What is TIBC (Total Iron Binding Capacity) Correct Answer -
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 Answer - ACD: anemia of chronic
disease
AID: anemia of inflammation- usually work the same
Low serum ferritin + TIBC = Correct Answer - iron deficient
anemia
Microcytic -- what are diagnosis help w/ MCV? Correct Answer -
-Fe Deficiency
-Thalassemia
Normocytic -- what are diagnosis help w/ MCV? Correct Answer -
-Anemia of Chronic Disease
-Anemia of Inflammation
Macrocytic -- what are diagnosis help w/ MCV? Correct Answer -
-B12 Deficiency
-Folate Deficiency
