AHN 568 FLUIDS ELECTROLYTES ACTUAL

AHN 568 FLUIDS ELECTROLYTES ( / )

QUESTIONS AND

Iron deficiency anemia: LAB and diagnostics - ---Answers_---

• Elevation of red cell distribution width (RDW)
• retic count decreased,
• ferritin (less than 10-12 mcg/dl) TIBC (greater

than 300 mg/dl)

• Fe below 50 mg/dl
• platelets elevated, elevation in WBC in severe
• GOLD STANDARD BONE MARROW IRON STAIN; Prussian

blue negative; marrow hyperplasia, micronormoblastic******

Iron deficiency anemia: Management - ---Answers_---1. oral

ferrous sulfate 300-325 mg tid one-hour ac meals for 6 mo.; follow up in 6-8 weeks with cbc, transfusion of packed RBC may be necessary is anemia symptomatic, each mml of transfused RBC delivers 1 mg of iron

• parenteral iron or IM is reserved for intolerance or

noncompliance; test dose of 0.5ml; Benadryl and epi should be available, painful; give in large muscles; may stain skin; IV 1 / 3

admin may cause phlebitis; 7-10 days you should see retic response and increase in HCT; failure to respond within 5-8 weeks warrants further eval

Folic acid deficiency: Diagnostic findings - ---Answers_---1.

Normal stores 5000-20,000 mcg

• Signs of folate def take about 4 months
• Fatigue, pallor, mouth/tongue pain, may not present till

anemia severe; may show signs of malnutrition, glossitis, stomatitis, GI symptoms, hyperpigmentation, infertility, ortho hypo, weight loss, neurological symptoms less common.

Folic acid deficiency: Lab findings - ---Answers_---1. folate

less than 4 mcg/L

• RBC folate better indicator of tissue levels less than 100

ng/ml

• MCV usually greater than 115 or may gradually increase over

several months to years and remain in normal range

Folic acid deficiency: Management - ---Answers_---1. Correct

diagnosis;

• oral folate 1-5mg daily for 3-4 months
• folate to be given with b12 when both are deficient, after

initiation of folate peak of retic 6-8 days followed by a slow increase in hgb

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Chronic anemia: Physical exam findings - ---Answers_---1.

S&S: frequently none; may complain of symptoms of disease;

physical findings of primary disease

Chronic anemia: Lab findings - ---Answers_---1. Mild to

moderate anemia

• red cells normocytic and normochromic
• retic count less than 1% or low absolute number
• normal or increased iron stores (Differs from iron def

anemia******)

• ferritin usually high greater than 100, TIBC usually

depressed less than 250.; RED cell morphology varies very little; RDW usually normal; sideroblasts are absent in bone marrow but iron stores are normal or increased

• leukocytosis and thrombocytosis often seen in peripheral

smear if infection or malignancy present

• LOOK at the ESR

Chronic anemia: Management - ---Answers_---1.

Premenopausal women: trial of iron may be given: check cbc in 2-3 weeks; 1.5 g/dl increase should have occurred; failure warrants further investigation

• not appropriate for men and postmenopausal women
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