Podcast
Questions and Answers
Match the following laboratory findings with their corresponding anemia type:
Match the following laboratory findings with their corresponding anemia type:
Decreased serum ferritin = Iron-deficiency anemia Elevated mean corpuscular volume = Macrocytic anemias Normal or increased serum ferritin = Anemia of inflammation (AI) Decreased serum vitamin B12 = Vitamin B12-deficiency anemia
Match the following treatment options with the appropriate anemia type:
Match the following treatment options with the appropriate anemia type:
Oral iron therapy with soluble ferrous iron salts = Iron-deficiency anemia Parenteral iron therapy = Iron-deficiency anemia Vitamin B12 supplementation = Vitamin B12-deficiency anemia Folate supplementation = Folate-deficiency anemia
Match the following diagnostic tests with their purpose in anemia evaluation:
Match the following diagnostic tests with their purpose in anemia evaluation:
Complete blood cell count (CBC) = Initial evaluation of anemia Reticulocyte index = Initial evaluation of anemia Serum iron measurement = Distinguishing IDA from AI Measurement of serum vitamin B12 levels = Distinguishing B12-deficiency anemia
Match the following statements with the appropriate fact about anemia diagnosis and severity:
Match the following statements with the appropriate fact about anemia diagnosis and severity:
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Match the following sources with the best absorption of iron:
Match the following sources with the best absorption of iron:
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Iron is best absorbed from vegetables and fruits.
Iron is best absorbed from vegetables and fruits.
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Macrocytic anemias always present with low mean corpuscular volume (MCV).
Macrocytic anemias always present with low mean corpuscular volume (MCV).
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Decreased serum ferritin is the earliest and most sensitive laboratory change in iron-deficiency anemia.
Decreased serum ferritin is the earliest and most sensitive laboratory change in iron-deficiency anemia.
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Anemia with folate deficiency can be associated with neurologic symptoms.
Anemia with folate deficiency can be associated with neurologic symptoms.
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The diagnosis of anemia always requires examination of the stool for occult blood.
The diagnosis of anemia always requires examination of the stool for occult blood.
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In iron-deficiency anemia, serum ferritin is usually normal or increased.
In iron-deficiency anemia, serum ferritin is usually normal or increased.
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Treatment goals for iron-deficiency anemia include restoring normal hematologic parameters.
Treatment goals for iron-deficiency anemia include restoring normal hematologic parameters.
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Psychiatric findings are commonly associated with vitamin B12 deficiency but not neurologic symptoms.
Psychiatric findings are commonly associated with vitamin B12 deficiency but not neurologic symptoms.
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Initial evaluation of anemia involves a complete blood cell count (CBC) and examination of the stool for occult blood.
Initial evaluation of anemia involves a complete blood cell count (CBC) and examination of the stool for occult blood.
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Iron therapy for iron-deficiency anemia should include enteric-coated and slow-release formulations.
Iron therapy for iron-deficiency anemia should include enteric-coated and slow-release formulations.
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Study Notes
Anemia Introduction
- Anemia is a group of diseases characterized by a decrease in either hemoglobin (Hb) or the volume of red blood cells (RBCs), resulting in decreased oxygen-carrying capacity of blood.
- The World Health Organization defines anemia as Hb less than 13 g/dL in men or less than 12 g/dL in women.
Pathophysiology
- Functional classification of anemias is based on the underlying mechanism.
- Morphologic classifications are based on cell size:
- Macrocytic cells are larger than normal and are associated with deficiencies of vitamin B12 or folic acid.
- Microcytic cells are smaller than normal and are associated with iron deficiency.
- Normocytic anemia may be associated with recent blood loss or chronic disease.
Iron-Deficiency Anemia (IDA)
- Characterized by decreased levels of ferritin (most sensitive marker) and serum iron, and decreased transferrin saturation.
- Can be caused by:
- Inadequate dietary intake.
- Inadequate gastrointestinal (GI) absorption.
- Increased iron demand (e.g., pregnancy).
- Blood loss.
- Chronic diseases.
Vitamin B12- and Folic Acid-Deficiency Anemias
- Macrocytic in nature.
- Can be caused by:
- Inadequate dietary intake.
- Malabsorption syndromes.
- Inadequate utilization.
- Deficiency of intrinsic factor causes decreased absorption of vitamin B12 (e.g., pernicious anemia).
- Folic acid-deficiency anemia can be caused by:
- Hyperutilization due to pregnancy, hemolytic anemia, malignancy, chronic inflammatory disorders, long-term dialysis, or growth spurt.
- Drugs can cause anemia by reducing absorption of folate (e.g., phenytoin) or through folate antagonism (e.g., methotrexate).
Anemia of Inflammation (AI)
- A newer term used to describe both anemia of chronic disease and anemia of critical illness.
- Associated with:
- Malignant, infectious, or inflammatory processes.
- Tissue injury.
- Conditions associated with release of proinflammatory cytokines.
- Serum iron is decreased, but serum ferritin concentration is normal or increased.
Clinical Presentation
- Acute-onset anemia is characterized by:
- Cardiorespiratory symptoms (e.g., palpitations, angina, orthostatic light-headedness, and breathlessness).
- Chronic anemia is characterized by:
- Weakness, fatigue, headache, orthopnea, dyspnea on exertion, vertigo, faintness, cold sensitivity, and pallor.
- IDA is characterized by:
- Glossal pain.
- Smooth tongue.
- Reduced salivary flow.
- Pica (compulsive eating of nonfood items).
- Pagophagia (compulsive eating of ice).
- Vitamin B12 deficiency may cause:
- Neurologic effects (e.g., numbness and paraesthesisas).
- Psychiatric findings (e.g., irritability, depression, and memory impairment).
Diagnosis
- Rapid diagnosis is essential because anemia is often a sign of underlying pathology.
- Severity of symptoms does not always correlate with the degree of anemia.
- Initial evaluation of anemia involves:
- Complete blood cell count (CBC).
- Reticulocyte index.
- Examination of the stool for occult blood.
- The earliest and most sensitive laboratory change for IDA is decreased serum ferritin (storage iron).
- In macrocytic anemias, mean corpuscular volume is usually elevated.
- Vitamin B12 and folate concentrations can be measured to differentiate between the two deficiency anemias.
- In AI, serum iron is usually decreased, but serum ferritin is normal or increased.
Treatment
- Goals of treatment:
- Return hematologic parameters to normal.
- Restore normal function and quality of life.
- Prevent long-term complications.
- Iron-deficiency anemia:
- Oral iron therapy with soluble ferrous iron salts.
- Daily dosage of 150–200 mg elemental iron in two or three divided doses.
- Iron is best absorbed from meat, fish, and poultry.
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Description
Learn about the basics of anemias, a group of diseases characterized by a decrease in hemoglobin or red blood cells, leading to reduced oxygen-carrying capacity of blood. Explore the World Health Organization's definition of anemia and the functional classification of anemias.
