Ch 3 Hematological Disorders

Question 1

small RBC are always…

Answer 1

pale RBC/hypochromic

Question 2

if MCV, MCHC, and RDW are within normal limits, what deficiencies are ruled out?

Answer 2

iron, vitamin B12, folate deficiencies

Question 3

microcytic (MCV < 80), hypochromic ( low MCHC) anemia with elevated RDW

most common etiology? next step?

Answer 3

iron deficiency
plumbism (lead toxicity)

get ferritin levels to estimate iron stores
add lead testing in children if sus

Question 4

microcytic (MCV < 80) hypochromic anemia
Normal RDW
High RBCs

most common etiology?
next step?

Answer 4

alpha thalassemia minor
*think AAA (Asians,, African)

Beta thalassemia minor
*think BAMME (Beta: African, Mediterranean, Middle Eastern ancestory)

get hemoglobin electrophoresis for evaluation of hemoglobin variants

Question 5

normocytic, normochromic anemia with NL RDW

most common etiology?

Answer 5

• anemia of chronic disease
• chronic kidney disease (CKD)
• acute blood loss

Question 6

remember, anemia has low __ and low ___

Answer 6

hematocrit (<36%) and hemoglobin (<12)

Question 7

macrocytic (high MCV), normochromic (MCHC), high RDW anemia

most common etiologies?
next step?

Answer 7

vitamin B12 deficiency, esp pernicious anemia
folate deficiency anemia

get serum vitamin b12 and RBC folate levels

Question 8

drug induced macrocytosis, usually WITHOUT anemia
only high is MCV

most common etiology?

Answer 8

Alcohol (excess) >5/day male, >3/day female
anti-epileptic drugs:(carbamazepine/Tegretol, phenytoin (Dilantin), methotrexate)