Anemia for NP
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Anemia for the Nurse Practitioner Licensing Exam
Overview of Anemia
- Definition:
- Anemia is a reduction in hemoglobin (Hb) or hematocrit (Hct) levels, resulting in decreased oxygen-carrying capacity of the blood.
- Diagnostic thresholds:
- Men: Hb <13.5 g/dL
- Women: Hb <12 g/dL
- Classification by Mean Corpuscular Volume (MCV):
- Microcytic (MCV <80 fL): Commonly from iron deficiency, thalassemia, or anemia of chronic disease (ACD).
- Normocytic (MCV 80–100 fL): Seen in ACD, hemolytic anemia, or blood loss.
- Macrocytic (MCV >100 fL): Often due to vitamin B12 or folate deficiency, alcohol use, or liver disease.
Common Types of Anemia
- Iron Deficiency Anemia:
- Etiology: Often from chronic blood loss (e.g., GI bleeding), poor dietary intake, or malabsorption.
- Diagnosis: Low serum iron, ferritin, high total iron-binding capacity (TIBC).
- Treatment: Oral or IV iron replacement and management of underlying cause.
- Anemia of Chronic Disease (ACD):
- Etiology: Often seen in chronic infections, inflammation, or malignancies.
- Diagnosis: Low serum iron and TIBC, normal or elevated ferritin.
- Treatment: Address underlying condition; ESAs in specific cases.
- Vitamin B12 Deficiency:
- Etiology: Due to malabsorption (e.g., pernicious anemia) or dietary insufficiency.
- Diagnosis: Low serum B12, elevated methylmalonic acid (MMA).
- Treatment: B12 supplementation (oral or parenteral).
- Folate Deficiency:
- Etiology: Malnutrition, alcoholism, pregnancy.
- Diagnosis: Low serum folate, elevated homocysteine, normal MMA.
- Treatment: Oral folate supplementation.
Diagnostic Approach
- Complete Blood Count (CBC):
- Provides Hb, Hct, MCV, and red cell distribution width (RDW) to classify anemia.
- Iron Studies and Reticulocyte Count:
- Assess iron status, erythropoiesis, and determine if anemia is from blood loss or impaired production.
Key Points
- Anemia is classified by MCV into microcytic, normocytic, and macrocytic types to guide further evaluation.
- Iron deficiency and chronic disease are common causes of microcytic anemia.
- Normocytic anemia can result from blood loss, hemolysis, or chronic disease.
- Macrocytic anemia is often due to B12 or folate deficiency; specific lab tests (MMA, homocysteine) confirm the deficiency.
- Treatment is based on the underlying cause, with iron, B12, or folate supplementation and addressing chronic disease or blood loss.