NURS 5461/62 UNCOMMON ANEMIAS EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
Anemia is
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
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]
• Microcytic - MCV <80 • Normocytic - MCV 80-100 • Macrocytic - MCV >100
Basic Mechanism of Anemia
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-
reticulocyte count x patient's Hct/45
, Basic Mechanism of Anemia
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 Problems Commonly Associated with Anemia
G6PD Deficiency • Hemoglobinopathies • Thalassemia • Immune hemolysis after a virus
• Chronic inflammation • Malignancies • Hypothyroidism • Hyperthyroidism • Renal
Failure • Aortic Valve Replacement • Rheumatoid Arthritis • Collagen Vascular Disease
Drugs Associated with Anemia
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
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
iN a child, man or postmenopausal woman aaa should be considered GI bleeding until
proved otherwise
IDA
- History of eating ice, starch or clay • Pica - on PE sore tongue, brittle ridged nails,
spoon nails or cheilosis •
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
Anemia is
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
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]
• Microcytic - MCV <80 • Normocytic - MCV 80-100 • Macrocytic - MCV >100
Basic Mechanism of Anemia
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-
reticulocyte count x patient's Hct/45
, Basic Mechanism of Anemia
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 Problems Commonly Associated with Anemia
G6PD Deficiency • Hemoglobinopathies • Thalassemia • Immune hemolysis after a virus
• Chronic inflammation • Malignancies • Hypothyroidism • Hyperthyroidism • Renal
Failure • Aortic Valve Replacement • Rheumatoid Arthritis • Collagen Vascular Disease
Drugs Associated with Anemia
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
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
iN a child, man or postmenopausal woman aaa should be considered GI bleeding until
proved otherwise
IDA
- History of eating ice, starch or clay • Pica - on PE sore tongue, brittle ridged nails,
spoon nails or cheilosis •
