3.19.14* Clinical Presentation and Work-Up of Anemias

Question 1

A 50 year old patient with MCV of 70. What is the most important next test to do?

Answer 1

ferritin

Question 2

What cell type would you expect to see with icteric sclera and positive DAT

Answer 2

microspheres

Question 3

50 year old female. She is tired/pale, you suspect anemia. You use history, physical, CBC, reticulocyte count, microscope and one other blood test.

a. What history questions are important?
b. related physical findings?
c. What 3 tests will help diagnosis? additional tests?

Answer 3

a. transfusions, medications, infection, blood in urine/stool, SOB when moving, weight lost, how long have you been fatigued
b. bruising, icterus, pallor of mucus membranes, spooning nails, BP/HR, gum lead line, hepatosplenomegaly, palpable cervical nodes.
c. CBC, reticulocyte count, PBS: additional ferritin, hemoglobin electrophoresis, DAT (direct coombs), unconjugated bilirubin, LDH, B12 Folate, liver enzymes

Question 4

CBC includes

Answer 4

Hb, Hct
red cell count
MCHC
white cell count

Question 5

Why check liver enzymes

Answer 5

liver disease can cause macrocytic anemia and icterus sclera

Question 6

How do you treat autoimmune hemolytic anemia?

Answer 6

steriods to reduce

Question 7

What are the two important reasons to do a physical exam in an anemic patient?

Answer 7

discover the cause of the anemia

discover the severity of the illness

Question 8

What physical signs tell about severity of anemia?

Answer 8

tachycardia, orthostatic hypotension

Question 9

RDW tells

Answer 9

means variation in cell size

goes up early in iron deficiency anemia

Question 10

18 year old with severe fatigue, jaundice and acanthocytes on the blood smear.
a. what historical questions do i need to ask?

Answer 10

(acanthocytes are seen in liver disease, abetalipoproteinaemia, renal failure)
a. alcohol use, familial lipid deficiency

Question 11

*what are the four major etiological categories of anemia

Answer 11

decreased production
increased destruction
blood loos
sequestration

Question 12

*examples of macrocytic anemias

Answer 12

*

Question 13

*examples of microcytic anemias

Answer 13

*

Question 14

*Formula for adjusted reticulocyte count

Answer 14

Reticulocyte count% X hct/45

Question 15

*microspherocytes seen it

Answer 15

*

Question 16

*target cells seen in

Answer 16

*

Question 17

*appearance of iron deficient cell

Answer 17

*

Question 18

*fragmented cells seen in

Answer 18

*

Question 19

*normal range of Hct

Answer 19

men 41-50

women 36-45

Question 20

*normal range of Hb

Answer 20

men 14-17

women 12-15

Question 21

*normal range for MCV

Answer 21

80-96

Question 22

*Normal range for reticulocyte count

Answer 22

0.5-2.5%

Question 23

*physical findings of severe anemia

Answer 23

tachycardia

orthostatic hypotension

Question 24

*indications for bone marrow exam

Answer 24

Multiple cell lines affected
Unresolved hyporegenerative anemia
Abnormal cells in peripheral blood

Question 25

How do patients with telangectasia become anemia?

Answer 25

chronic blood loos leads to iron deficiency anemia.

Question 26

Red cell abnormalities and associated anemias

Answer 26

``` Micro Macro Schistocytes Spherocyctes Sickled cells Target cells Teardrops ```

Question 27

Types of red cell inclusions

Answer 27

Howell-Jolly bodies Nucleated RBC precursors basophilic stipling Heinz body inclusions

Question 28

what is the difference between hypersegmented neutrophils of b12 deficiency vs. folate

Answer 28

Folate often has "strings" connecting the nuclei.