NURS 5461/62 Uncommon Anemias New Exam
100% Verified
Anemia is - ANSWER a decrease in RBCs or Hbg- always reflects underlying disease •
Diagnosis depends on Hct [amount of RBCs in whole blood] or Hbg - Men- Hct <42% or
Hbg <14g - Women- Hct <37% or Hbg <12g
Approach to Evaluation of Anemia - ANSWER Data to be obtained on all anemic patients
- Hct and Hbg - MCV; MCHC - Reticulocyte Count - Smear of peripheral blood
Three questions should be asked - What is MCV? - What is basic mechanism of the
anemia? - Does patient have another problem associated with anemia?
Mean Corpuscular Volume [MCV] - ANSWER • Microcytic - MCV <80 • Normocytic - MCV
80-100 • Macrocytic - MCV >100
Basic Mechanism of Anemia - ANSWER Decreased production of RBC by marrow •
Bleeding • Hemolysis • Reticulocyte count used to assess response of marrow to
anemia- normal reticulocyte count is 1% • 1% of new cells that are being released daily
into circulation from the marrow
Reticulocyte Index- - ANSWER reticulocyte count x patient's Hct/45
Basic Mechanism of Anemia - ANSWER If patient is anemic, marrow should be able to
acutely triple its output of new cells • Reticulocyte count must be adjusted for level of
anemia to obtain reticulocyte index
In patients with bleeding or hemolysis, RI should be > or = 3% • Patients anemic from
abnormal production of RBCs have RI <3%, often <1.5%
Other Conditions Commonly Associated with Anemia - ANSWER G6PD Deficiency •
Hemoglobinopathies • Thalassemia • Immune hemolysis post virus • Chronic
, inflammation • Malignancies • Hypothyroidism • Hyperthyroidism • Renal Failure • Aortic
Valve Replacement • Rheumatoid Arthritis • Collagen Vascular Disease
Drugs Associated with Anemia - ANSWER Methyldopa • Quinine-pancytopenia •
Quinidine • Chloramphenicol • Gold Salts • Anti-TB drugs • Dilantin • Sulfa drugs-chronic
dose • Methotrexate • Amphotericin • Cis-platinum • Zidovudine
Anemia with a Low MCV - ANSWER For the most part, anemia with low MCV is iron
deficiency or thalassemia, Occasionally, anemia of chronic disease can be microcytic if
**longstanding ONLY
Iron Deficiency Anemia - ANSWER iN a child, man or postmenopausal woman aaa
should be considered GI bleeding until proved otherwise
IDA - ANSWER - History of eating ice, starch or clay • Pica - on PE sore tongue, brittle
ridged nails, spoon nails or cheilosis •
Serum Ferritin - Low - This **always reflects iron deficiency • Reticulocyte Index -
Inappropriately low for degree of anemia
Check stools for OB • TIBC- elevated • Serum Iron- low
IDA Treatment - ANSWER Treat patient based on cause • If iron therapy is given,
reticulocyte count hh after 7-10 days and Hct begins to hh after 7-10 days
Thalassemia - ANSWER In the adult, 3 Hbgs present in the mature RBC - Hbg A1 97% -
Hbg A2 02% - Hbg F 01%
Thalassemia 2 - ANSWER All 3 Hbgs have 2 alpha globin chains, but differ in the 2nd set
of globin chains
• Hbg A1 - 2 alpha chains - 2 beta chains • Hbg A2 - 2 alpha chains - 2 delta chains • Hbg
F - 2 alpha chains - 2 gamma chains
Hemoglobin F - ANS During 1st year of life, Hbg. F is replaced by production of adult
100% Verified
Anemia is - ANSWER a decrease in RBCs or Hbg- always reflects underlying disease •
Diagnosis depends on Hct [amount of RBCs in whole blood] or Hbg - Men- Hct <42% or
Hbg <14g - Women- Hct <37% or Hbg <12g
Approach to Evaluation of Anemia - ANSWER Data to be obtained on all anemic patients
- Hct and Hbg - MCV; MCHC - Reticulocyte Count - Smear of peripheral blood
Three questions should be asked - What is MCV? - What is basic mechanism of the
anemia? - Does patient have another problem associated with anemia?
Mean Corpuscular Volume [MCV] - ANSWER • Microcytic - MCV <80 • Normocytic - MCV
80-100 • Macrocytic - MCV >100
Basic Mechanism of Anemia - ANSWER Decreased production of RBC by marrow •
Bleeding • Hemolysis • Reticulocyte count used to assess response of marrow to
anemia- normal reticulocyte count is 1% • 1% of new cells that are being released daily
into circulation from the marrow
Reticulocyte Index- - ANSWER reticulocyte count x patient's Hct/45
Basic Mechanism of Anemia - ANSWER If patient is anemic, marrow should be able to
acutely triple its output of new cells • Reticulocyte count must be adjusted for level of
anemia to obtain reticulocyte index
In patients with bleeding or hemolysis, RI should be > or = 3% • Patients anemic from
abnormal production of RBCs have RI <3%, often <1.5%
Other Conditions Commonly Associated with Anemia - ANSWER G6PD Deficiency •
Hemoglobinopathies • Thalassemia • Immune hemolysis post virus • Chronic
, inflammation • Malignancies • Hypothyroidism • Hyperthyroidism • Renal Failure • Aortic
Valve Replacement • Rheumatoid Arthritis • Collagen Vascular Disease
Drugs Associated with Anemia - ANSWER Methyldopa • Quinine-pancytopenia •
Quinidine • Chloramphenicol • Gold Salts • Anti-TB drugs • Dilantin • Sulfa drugs-chronic
dose • Methotrexate • Amphotericin • Cis-platinum • Zidovudine
Anemia with a Low MCV - ANSWER For the most part, anemia with low MCV is iron
deficiency or thalassemia, Occasionally, anemia of chronic disease can be microcytic if
**longstanding ONLY
Iron Deficiency Anemia - ANSWER iN a child, man or postmenopausal woman aaa
should be considered GI bleeding until proved otherwise
IDA - ANSWER - History of eating ice, starch or clay • Pica - on PE sore tongue, brittle
ridged nails, spoon nails or cheilosis •
Serum Ferritin - Low - This **always reflects iron deficiency • Reticulocyte Index -
Inappropriately low for degree of anemia
Check stools for OB • TIBC- elevated • Serum Iron- low
IDA Treatment - ANSWER Treat patient based on cause • If iron therapy is given,
reticulocyte count hh after 7-10 days and Hct begins to hh after 7-10 days
Thalassemia - ANSWER In the adult, 3 Hbgs present in the mature RBC - Hbg A1 97% -
Hbg A2 02% - Hbg F 01%
Thalassemia 2 - ANSWER All 3 Hbgs have 2 alpha globin chains, but differ in the 2nd set
of globin chains
• Hbg A1 - 2 alpha chains - 2 beta chains • Hbg A2 - 2 alpha chains - 2 delta chains • Hbg
F - 2 alpha chains - 2 gamma chains
Hemoglobin F - ANS During 1st year of life, Hbg. F is replaced by production of adult
