Normocytic
This type of anemia, is usually mild and associated with conditions such as CKD or Rheumatoid Arthritis.
What is Anemia of Chronic Disease?
This test is what will confirm iron deficiency in MOST patients who have IDA.
What is FERRITIN? Note that people with inflammatory disorders and CKD may have normal or high ferritins, in which case full iron studies can be helpful in confirming
For vitamin b12 levels from 150-400, consider getting this test to confirm b12 deficiency.
What is MMA ?
Although, I personally typically will trial patients on b12 at that point anyway, considering we just saw one snapshot in time, they may be on a trajectory for b12 deficiency
This is the first step in evaluating a normocytic anemia in a child.
What is retic count and peripheral blood smear?
If retic count is low this suggests bone marrow suppresion-ddx includes medical dz like thyroid, kindy, liver, or underlying inflammation-check iron studies to look for anemia of chronic disease, or if smear is abnormal there could be a leukemia, or myelofibrosis
This is the typical dosing for oral iron repletion in adults.
What is 325mg of ferrous sulfate every other day?
May use lower doses of liquid iron if the above is not tolerated. even 15mg liquid iron with OJ to help absorption may be effective.
This type of anemia is considered normal for this condition due to an increase in plasma volume.
What is pregnancy?
All men and postmenopausal women with IDA should have the following tests done.
What is colonoscopy and EGD? as 9% will find colon ca and 2% upper gi cancer; AGA also recommends these tests in premenopausal women as 1% will be dx with malignancy. Younger patients with a plausible cause of anemia, no further testing is needed.
For people with mild symptoms or incidental finding of B12 Deficiency, you can dose oral vitamin B12 as such.
What is 1-2 mg per day?
for severe sxs and neuro sxs you should give IM dosing to create more rapid absorpon and reach normal level
In premenopausal women with microcytic anemia and low ferritin, who do not respond to oral iron supplementation, this is the next step.
What is upper and lower endoscopies?
These 3 meds can lead to B12 deficiency and should be monitored periodically.
What is Metformin, PPIs, and H2 blockers (ie famotidine)? PPI and H2B for at least 2 years. Metformin for 4months of 850mg TID.
These two procedures are important to consider especially in males and postmenopausal females for working up anemia.
What is upper and lower endoscopy?
These two tests are non-invasive and should be considered with all patients with found to have unexplained IDA.
h. pylori and celiac disease
h. pylori causes hypochlorida and atrophic gastritis which result in reduced iron absorption
Celiac disease impairs absorpiton of many vitamins and minerals
These are some risk factors for B12 deficiency.
What are vegans/vegetarians, gastric bypass/bariatric surgery, Celiac disease, Crohns Dz, ileal disease, ETOH abuse, atrophic gastritis, older age, tapeworm infection.
It takes this long to see an improvement in anemia after starting iron therapy.
What is 1month? You should see 1g/dL increase. By 3 months the iron deficiency should resolve and iron may be discontinued unless there is ongoing cause.
This is how long the liver can store vitamin b12 for.
What is up to 1-2 years, maybe a bit longer?
A reticulocyte count over 2 suggests these problems.
What is hemolysis or acute/chronic blood loss or hypersplenism?
This disease could cause chronic microcytic anemia not due to iron deficiency
What is beta Thalassemia?
Upon discovering B12 Deficiency, patients with neurological symptoms can expect improvement to take this long.
What is 6wk to 3 months?
Blood transfusion should take place at this hemoglobin level.
What is under 7 for most people and under 8 for cardiac patients?
This blood test will help you determine if anemia is due to hypofunctioning bone marrow if it is low.
What is a low reticulocyte count?
Initial evaluation should include kidney, liver, thyroid, iron, and peripheral smear evaluation to eval for these diseases plus blood cancers
True or false: Someone can have iron deficiency anemia with a normal Ferritin level and normal MCV.
What is true?
All infants aged __ to __ should be screened for anemia.
What is the 9 to 12months
note: USPSTF says insuff evidence but AAP recommends screening all infants 9-12m old.
Consider checking vitamin B12 in individuals with these hematologic abnormalities.
What are macrocytic anemia, thrombocytopenia, thrombocytoisis, pancytopenia, leukopenia?
Patients with these conditions benefit from IV iron as opposed to oral iron repletion.
What is malabsorption such as gastric bypass, small bowel surgery, or if oral iron is intolerable or pt is not responding to oral therapy ? If no response to oral therapy and does not have the above conditions, definitely think of testing for Celiac disease.
A high reticulocyte count of less than or equal to 2% suggests one of these disorders?
What is vitamin b12 or folate deficiency?