Anemia Cases

Question 1

What MUST you always do if a patient has a hemoglobin SUPER low (Hgb = 3.7)?

Answer 1

Must get EKG if patient had hemoglobin this low!

Question 2

What do red raised lesions on the forehead indicate?

Answer 2

Chrones Disease

Question 3

What is RDW?

Answer 3

Red blood cell distribution width - how much red cell diameter varies!

Question 4

Why is the MCV normal in a patient with Iron Deficiency Anemia and taking 6-mercaptopurine?

Answer 4

IDA - causes microcytosis
6-mercaptopurine - causes macrocytosis
-These two balance each other out!

Question 5

What must IDA history include?

Answer 5

• Bleeding risks: menorrhagia, frequent epistaxis

- GI bleeding risks: NSAIDs or anticoagulation, previous EGD or colonoscopy, prior surgeries

Question 6

What are pearls of IDA?

Answer 6

• Iron supplements?
• IDA leads to low iron sat & ferritin and high TIBC & transferrin
• ACD leads to low iron and low/normal TIBC (total iron binding capacity) & transferrin

Question 7

What is the gold standard test for IDA?

Answer 7

Bone marrow iron stain!

Question 8

Patient has pneumonia from streptococcus pneumoniae. What does his labs say?

Answer 8

MCV - 61 (very low)
HgB - 9.1
-Infections lower serum iron!
Iron saturation = 9% (low iron)

Question 9

When are patients with beta-thalassemia minor diagnosed?

Answer 9

• Often diagnosed as adults

- Have very mild but very microcytic anemias

Question 10

What do you need in your stomach/GI tract to absorb B12?

Answer 10

Intrinsic Factor

Question 11

How fast do you get better with B12 supplementation in pernicious anemia?

Answer 11

Within about a month.

Question 12

What is important to remember about pernicious anemia?

Answer 12

• Associated with vitiligo & auto-immune disorders
• By definition is slow in onset
• More than just anemia. Neurological symptoms too.
• When in doubt, send for MMA (methylmelonic acid)

Question 13

How do you treat AIHA (autoimmune hemolytic anemia)?

Answer 13

• Prednisone 1mg/kg/day for 2 weeks, slow taper over 8 weeks
• Refractory cases rituximab (anti0CD20 monoclonal antibody) is used, as are other immune suppressive agents. Splenectomy is last resort.
• Relapses common

Question 14

What is important when treating AIHA (autoimmune hemolytic anemia)?

Answer 14

-These patients have problems with transfusions - won’t be able to get a good compatible type - can only transfuse their blood type

Question 15

What are other AIHA pearls?

Answer 15

• Always get thorough history that focuses on other autoimmune conditions (RA, SLE, hyper/hypothyroid, scleroderma), drugs (especially new ones, Beta-lactams) and recent transfusions of any blood product
• AIHA is associated with lymphoid malignancies (esp. CLL) and may precede the lymphoma diagnosis
• Prolonged high dose steroids will lead to Cushing syndrome and comes with increased risk of PJP.
• Always give folate supplements with hemolytic anemias

Question 16

What should you ALWAYS give with hemolytic anemias?

Answer 16

FOLATE SUPPLEMENTS!!

Question 17

What will primary myelofibrosis show in a bone marrow aspirate?

Answer 17

• Increased cellularity - 70-95%
• Megakaryocytes increased
• Iron stores appear present
• hematopoeitic architecture is disrupted by fibrosis
• Dyspoietic megakaryocytes

Question 18

What are ‘clinical pearls’ associated with nucleated RBCs?

Answer 18

• THEY SHOULD NOT BE OVERLOOKED
• Present in any ‘overcrowding’ disorder of the bone marrow
• Usually present when the reticulocyte count is high