#52: Anemia: Tips, and tools for diagnosis and treatment

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 14 August 2017

⏱️ 66 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Master the anemia algorithm, and take a deep dive on iron deficiency, anemia of chronic kidney disease, anemia of chronic inflammation, causes of macrocytic anemia and more in this discussion with international expert, Dr. David P. Steensma, Senior Physician from Dana Farber Institute, and Associate Professor of Medicine at Harvard Medical School.

Full show notes available at http://thecurbsiders.com/podcast

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Cases from Kashlak Memorial:

62 yo M with diabetes and CKD with asymptomatic Hgb 10, MCV 90, and Cr. 1.9?
72 yo F with HTN with asymptomatic Hgb of 11, MCV 85 and Cr. 0.6.
72 yo F with breast cancer in remission after lumpectomy, adjuvant chemo, and XRT treated 6 years ago presents with fatigue and some dyspnea on exertion. Hgb 9.6, MCV 102.

Time Stamps

00:00 Intro

01:18 Listener feedback

04:05 Announcement: We’re looking for on air correspondents to join The Curbsiders

05:05 Picks of the week

11:12 Getting to know our guest

17:50 Case #1 Normocytic anemia

19:15 Defining anemia (WHO criteria)

21:10 Epidemiology of anemia

23:45 Normocytic anemia

25:55 Erythropoietin for diagnosis and treatment

28:22 Anemia of CKD or chronic inflammation?

31:37 Discussion of ferritin and soluble transferrin receptor

33:47 Case #1 Conclusion

35:45 Hemoglobin targets in CKD

36:53 Case #2 Microcytic anemia

37:43 Correct reticulocyte count and reticulocyte index

40:45 Deciding on dose and route for iron repletion

43:44 Does vitamin C improve iron absorption?

45:27 Case #3 Macrocytic anemia

46:54 Vitamin B12 deficiency

51:54 Medication related B12 deficiency

52:35 Myelodysplastic syndrome

55:00 Side effects of common MDS treatments

56:18 Take home points

57:35 The Curbsiders post game analysis

64:16 Outro

Tags: anemia, hemoglobin, i

Transcript

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0:00.0	Somebody calculated how much you'd have to eat in red meat in order to come up with the equivalent of one dose of IV iron.
0:09.2	It was like 140,000 calories worth of stuff.
0:13.2	It was some astronomical figure.
0:15.4	So that's a common bit of advice, but it actually doesn't work.
0:30.2	Welcome back to the curbsiders, the internal medicine pod.
0:33.8	Hello.
0:34.8	That that was way delayed steward.
0:37.8	I think you're half asleep.
0:39.4	The internal medicine podcast that uses expert interviews to bring you clinical
0:44.0	pearls and practice changing knowledge.
0:46.8	I'm Dr. Matthew Wato here with my co-host, Dr. Stewart Kent Brigham and Dr.
0:51.0	Paul Nelson Williams.
0:55.5	Sorry. Hey, Matt.
0:56.6	How are you?
0:57.0	Stewart, great to be with you as always.
0:59.2	Hello, Paul.
0:59.9	Hello, hello, Matt.
1:01.2	I think the audience appreciates what we cut to like five seconds of awkward silence right off the bat.
1:06.0	Yeah.
1:06.2	So please leave that.
1:07.1	I was just sort of marveling Stewart rather than interrupting it and just made it a thoughtful, hmm sound.
1:11.7	I just I'm going to be quietly obsessing over for the rest of the episode now.
	...

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