Anemias (Fitzgerald Review)

What is the average lifespan of a red blood cell?

120 days

What are normal Hematocrit values?

36% - 43%

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is: A. an increase in RBC distribution width (RDW). B. a reduction in measurable hemoglobin. C. a low MCH level. D. an increased platelet count.

A. an increase in RBC distribution width (RDW) due to cell size changes.

What type of anemia would present with these lab values? Hbg 10.1 HCT 32 RBC 3.2 million MCV 82 MCHC 34.8 RDW 12.1%

Acute blood loss or anemia of chronic disease normocytic, normochromic, normal RDW indicates that body is not trying to compensate or cannot compensate

What are at-risk groups for beta thalassemia minor?

African, Middle Eastern, Mediterranean ancestry

What are signs of heart failure are often seen in the elderly with severe anemia? (Select all that apply) A. distended neck veins B. rales C. tachypnea D. RUQ pain E. hepatomegaly

All of the above

What type of anemia would present with these lab values? Hgb 11.6 Hct 36.7% RBC 6.38 MCV 69.5 MCHC 22 RDW 13.8%

Alpha or Beta Thallasemia minor microcytic, hypochromic cells all about the same size

What process is defined as a decrease in the oxygen-carrying capability of the blood?

Anemia

Symptoms of anemia seldom occur, unless the hemoglobin level decreases to less than: A. 8 B. 10 C. 12 D. 6

B. 10 g/dL

Two month into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a: A. Schilling test B. hemoglobin measurement C. reticulocyte count D. serum cobalamin

B. Hemoglobin measurement

Which of the following is most common with iron-deficiency anemia? A. low MCV, normal MCH B. Low MCV, low MCH C. Low MCV, elevated MCH D. normal MCV, normal MCH

B. Low MCV, low MCH

You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hemoglobin (Hgb) = 15 g Hct = 45% RBC = 4.2 million mm3 MCV = 108 fL MCHC=33.2 g/dL These values are most consistent with: A. pernicious anemia. B. alcohol abuse. C. thalassemia minor. D. Fanconi disease.

B. alcohol abuse ( the sleep and pharyngeal anemia are clues; pernicious anemia is also macrocytic and normochromic).

A 40-year-old woman with pyelonephritis is taking two medications: ciprofloxacin and ferrous sulfate (for iron-deficiency anemia). She asks about taking both medications. You advise that: A. she should take the medications with a large glass of water. B. an inactive drug compound is potentially formed if the two medications are taken together. C. she can take the medications together to enhance adherence to therapy. D. the ferrous sulfate potentially slows gastrointestinal motility and results in enhanced ciprofloxacin absorption.

B. an inactive drug compound is potentially formed if the two drugs are taken together.

You examine a 57-year-old woman with rheumatoid arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram: Hgb = 10.5 g Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC=32.8 g/dL RDW= 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with: A. pernicious anemia. B. anemia of chronic disease. C. beta-thalassemia minor. D. folate-deficiency anemia.

B. anemia of chronic disease

Risk factors for folate-deficiency anemia include: A. menorrhagia B. chronic ingestion of overcooked foods C. NSAID use D. gastric atrophy

B. chronic ingestion of overcooked foods (the nutrients are destroyed by heat)

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: A. these usually resolve within days of appropriate therapy B. if present for longer than 6 months, these changes are usually permanent C. the use of parenteral vitamin B12 therapy is needed to ensure symptom resolution. D. cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy.

B. if present longer than 6 months, these changes are usually permanent

Pernicious anemia is usually caused by: A. dietary deficiency of vitamin B12 B. lack of production of intrinsic factor by the gastric mucosa C. RBC enzyme deficiency D. a combination of micro nutrient deficiencies cause by malabsorption

B. lack of production of intrinsic factor by the gastric mucosa.

A 68-year-old man who is usually health presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and hemic murmur. Hemogram results are as follows: Hgb 7.6 Hct 20.5% RBC 2.1 million MCV 76 MCHC 28 RDW 18.4% the most likely cause of these findings is: A. poor nutrition B. occult blood loss C. malabsorption D. chronic inflammation

B. occult blood loss

Which of the following conditions is unlikely to result in anemia of chronic disease? A. rheumatoid arthritis B. peripheral vascular disease C. chronic renal insufficiency D. osteomyelitis

B. peripheral vascular disease

Most of the body's iron is obtained from: A. animal-based food sources. B. recycled iron content from aged red blood cells (RBCs). C. endoplasmic reticulum production. D. vegetable-based food sources.

B. recycled iron content from aged red blood cells (RBCs).

Common physical exam findings in patients with pernicious anemia include: A. hypoactive bowel sounds B. stocking-glove neuropathy C. thin, spoon shaped nails D. retinal hemorrhages

B. stocking-glove neuropathy

When prescribing erythropoietin supplementation, the nurse practitioner considers that: A. the adrenal glands are its endogenous source B. the addition of micronutrient supplementation needed for erythropoiesis is advisable C. its use is as an adjunct in treating thrombocytopenia. D. with its use, the RBC life span is prolonged.

B. the addition of micronutrient supplementation needed for erythropoiesis is advisable

Intervention in anemia of chronic disease most often includes: A. oral vitamin B12 B. treatment of underlying cause C. transfusion D. parenteral iron

B. treatment of underlying disease

In health, the ratio of hemoglobin to hematocrit is usually: A. 1:1. B. 1:2. C. 1:3. D. 1:4.

C. 1:3

Which of the following is not consistent with anemia of chronic disease (ACD)? A. NL RDW B. NL MCHC C. Hct less than 24% D. NL to slightly elevated serum ferritin

C. Hct less than 24%

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? A. "Take with other medications" B. "Take on a full stomach" C. "Take on an empty stomach" D. "Do not take with vitamin C"

C. Take on an empty stomach

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g (normal 12 to 14 g) Hct = 28% (normal 36% to 42%) RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3) MCV = 68 fL (normal 80 to 96 fL) MCHC=33.2 g/dL (normal 32-36 d/dL) RBC distribution width (RDW) = 13% (normal ≤15%). Reticulocytes = 1.5% This is most consistent with the laboratory assessment of: A. iron-deficiency anemia. B. Cooley anemia. C. alpha-thalassemia minor. D. hemoglobin Barts.

C. alpha-thalassemia minor

An increase in the normal variation of RBC size is known as: A. poikilocytosis. B. granulation. C. anisocytosis. D. basophilic stippling.

C. anisocytosis

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? A. iron B. niacin C. folic acid D. vitamin C

C. folic acid

In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with hypertension who is taking a thiazide diuretic, the patient should be carefully monitored for: A. hypernatremia B. dehydration C. hypokalemia D. acidemia

C. hypokalemia

When the cause of macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following? A. haptoglobin and reticulocyte count B. Schilling test and gastric biopsy C methylmalonic acid and homocysteine D. tranferrin and prealbumin

C. methylmalonic acid and homocysteine

Results of hemogram in a person with anemia of chronic disease include: A. microcytosis B. anisocytosis C. reticulocytopenia D. macrocytosis

C. reticulocytopenia A decrease in reticulocytes occurs because of impaired EPO and ferritin production/absorption, especially in kidney failure.

A 48-year-old woman developed iron-deficiency anemia after excessive perimenopausal bleeding, successfully treated by endometrial ablation. Her HCT level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible oberseved change in laboratory parameters would include: A. a correction of mean cell volume B. an 8% increase in hematocrit level C. reticulocytosis D. a correction in ferritin level

C. reticulocytosis - the body is releasing new RBCs

Poikilocytosis refers to alterations in a red blood cells: A. thickness. B. color. C. shape. D. size.

C. shape

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: A. this is a prudent measure to ensure health. B. iron-deficiency anemia is a common problem in men of his age. C. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload. D. excess iron is easily excreted.

C. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload.

What lab tests are used to diagnose anemia?

CBC, iron studies most common If unknown macrocytic anemia, serum methylmalonic acid and homocysteine levels are found with pernicious anemia, and elevated homocysteine levels with normal MMA levels are found in folic acid deficiency

Worldwide, which of the following is the most common type of anemia? A. pernicious anemia B. folate-deficiency anemia C. anemia of chronic disease D. iron-deficiency anemia

D. Iron-deficiency anemia

In children younger than age 6 years, accidental overdose of iron-containing products is: A. easily treated B. a source of significant gastrointestinal (GI) upset C. worrisome but rarely causes significant harm D. a leading cause of fatal poisoning in the age group.

D. a leading cause of fatal poisoning in the age group

Folate-deficiency anemia causes which of the following? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

D. macrocytic, normochromic

Pernicious anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

D. macrocytic, normochromic

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g Hct = 32% RBC = 2.9 million mm 3 MCV = 72 fL MCHC=28.2 g/dL RDW = 18.9% Physical examination is likely to include: A. conjunctiva pallor. B. hemic murmur. C. tachycardia. D. no specific anemia-related findings.

D. no specific anemia-related findings The anemia is not severe enough to expect other findings, and is most likely related to her period blood loss.

Erythropoietin is a glycoprotein that influences a stem cell to become a: A. lymphocyte B. platelet C. neutrophil D. red blood cell

D. red blood cell

What type of anemia would present with these lab values? Hgb 12 HCT 37% RBC 4.2 MCV 105.5 MCHC 31 RDW 12.8%

Drug induced macrocytosis usually without anemia Macrocytic, normochromic, normal RDW

What is a hemic murmur?

Early systolic murmur due to severe anemia. Can hear increase of blood flow across heart valves

True or False: The body's normative response to anemia is reticulocytopenia.

False. Reticulocytosis is the increase in the number of new RBCs.

What type of anemia would present with these lab values? Hbg 10.1 HCT 32% RBC 3.2 million MCV 72 MCHC 26.8 RDW 18%

Iron deficiency anemia microcytic, hypochromic (not enough hemoglobin) anemia with elevated reticulocyte count (more new cells)

What are normal Hemoglobin values?

Men 13.5 - 17.5 Women 12 - 15.5

What are at-risk groups for alpha thalassemia minor?

Those of Asian or African ancestry

True or False: Anemia in children is potentially associated with poorer school performance?

True

True or False: During pregnancy, folic acid requirements increase twofold to fourfold.

True

True or False: The red blood cell content is approximately 90% hemoglobin.

True

What type of anemia would present with these lab values? Hgb 10.2 HCT 32% RBC 3.2 million MCV 125.5 MCHC 31 RDW 18.8%

Vitamin B12 deficiency, pernicious anemia, folate-deficiency anemia macrocytic, normochromic, wiht elevated RDW showing new cells larger than old - that means it's not brand new

What vitamin enhances iron absorption?

Vitamin C

What medications can cause macrocytosis usually without anemia?

carbamazepine, zidovudine, valproic acid, phenytoin, alcohol, and others. The macrocytosis is owning to altered RNA:DNA ratio.

What are some common causes of iron deficiency anemia?

chronic blood loss; occult gastrointestinal blood loss; excessive menstrual flow

What is the most common cause of anemia worldwide?

iron deficiency anemia

What value measures RBC size and what is the normal range?

mean corpuscular volume (MCV): 80%-100%

What are some neurological findings in B12 deficiency?

paresthesia, stocking-glove neuropathy, balance difficulty; and in severe cases, confusion.