Clinical Integration Session

Question 1

What are the 2 things that cause jaundice?

Answer 1

Liver disease

Hemolytic anemia

Question 2

What 3 things do you expect to see on a lab report for hemolysis

Answer 2

Reticulocytosis (normocytic)
Increased LDH and unconjugated bilirubin
Decreased haptoglobin

Question 3

2 causes of spherocytes on a smear

Answer 3

Immune mediated hemolytic anemia

Hereditary spherocytosis

Question 4

Treatment for AIHA

Answer 4

Corticosteroids (prednisone)
Suppresses the immune system from making autoantibodies
Decreases reticuloendothelial activity

Question 5

Should retics be low or high with

1. Decreased production
2. Increased loss or destruction

Answer 5

1. Not high

2. High

Question 6

4 most important tests

Answer 6

Retic count
MCV
WBC and platelet count
Blood smear

Question 7

How does anemia of chronic disease work

Answer 7

Patients with inflammatory illnesses
Increased hepcidin so decreased iron absorption from the gut and iron is trapped in macrophages
Also relatively inadequate EPO and slightly shortened red cell survival

Question 8

What is the diagnostic test for iron deficiency

Answer 8

Ferritin

Question 9

What is the most common cause of iron deficiency in

1. Adults
2. Kids

Answer 9

1. Bleeding

2. Nutritional deficiencies

Question 10

Causes of normocytic anemia

Answer 10

Hemorrhage
Hemolysis
Early iron deficiency
CKD
Bone marrow suppression
Bone marrow disorder (infiltration or failure - can also be macrocytic)

Question 11

Bone marrow infiltration vs failure

Answer 11

Infiltration: no room to make blood cells (ex: acute leukemia)
Failure: no cells being made (ex: aplastic anemia)

Question 12

Factors that argue against a bad bone marrow disorder

Answer 12

Acute anemia
Reticulocytosis
Microcytic anemia
Normal WBC and PLT
No worrisome cells on peripheral smear
Obvious other cause for the anemia

Question 13

3 causes of megaloblastic anemia

Answer 13

B12 deficiency
Folate deficiency
Meds that interfere with DNA synthesis

Question 14

These anemias can be in multiple MCV categories. Which ones?

1. Iron deficiency
2. Anemia of chronic disease
3. Bone marrow disorders

Answer 14

1. Microcytic or normocytic
2. Microcytic or normocytic (lower limit of normal)
3. Normocytic or macrocytic

Question 15

3 anemias where the reticulocytes will be high

Answer 15

Thalassemia
Hemorrhage
Hemolysis

Question 16

Are most
1. Intrinsic
2. Extrinsic
red cell defects congenital or acquired

Answer 16

1. Congenital

2. Acquired

Question 17

Intrinsic red cell defects

Answer 17

Hemoglobin (sickle cell, thalassemia)
Membrane (hereditary spherocytosis)
Enzymes (G6PD deficiency, PK deficiency)

Question 18

MAHA

Answer 18

When you see schistocytes on peripheral smear!
Patients are also thrombocytopenic and can have organ ischemia from small vessel occlusion
Always indicates a serious illness (ex: TTP, HUS, DIC)