Acquired Hemolytic Anemia, Blood Loss, Metabolic and Nutritional Causes of Anemia (Angelina L. Mirasol, MD)

Question 1

Electrophoresis pattern in patient with hemoglobin H disease:

a. A1 increased, A2 increased
b. A1 decreased, A2 increased
c. A1 increased, A2 decreased
d. A1 decreased, A2 decreased

Answer 1

D. A1 decreased, A2 decreased

Question 2

T/F: In terms of treatment, Iron deficiency is a more serious condition than iron overload.

Answer 2

False

Question 3

T/F: Iron supplementation is a necessity in hemoglobin H patients.

Answer 3

False

Question 4

T/F: Blood transfusion is a strong recommendation for treatment of hemoglobin H disease.

Answer 4

True

Question 5

T/F: Conducting a peripheral blood smear is a necessity for the diagnosis of hemoglobin h disease as CBC results will suffice.

Answer 5

True

Question 6

In severe iron deficiency anemia with symptoms of high output failure, which is the best blood product for transfusion?

a. packed RBC
b. fresh whole blood
c. whole blood
d. heparinized whole blood

Answer 6

A. packed RBC

Question 7

The most common single cause of iron deficiency in women is

a. poor intake of iron
b. obesity
c. poor release of iron by the reticulo-endothelial system
d. menstrual blood loss

Answer 7

D. menstrual blood loss

Question 8

Parenteral iron is given if (2012, 2014)

a. rapid increase in hemoglobin (HB) is desired
b. malabsorption syndrome exists
c. the patient requests for it
d. rapid utilization of iron by the body

Answer 8

B. malabsorption syndrome exists

Question 9

Infants should be given iron supplements as early as 2 months of age because

a. they are easily prone to colic
b. human and cow’s milk are poor sources of iron
c. they bleed easily
d. they have poor iron absorption

Answer 9

B. human and cow’s milk are poor sources of iron

Question 10

Iron Deficiency Anemia produces this type of anemia

a. hypochromic, macrocytic
b. normochromic, macrocytic
c. hypochromic, microcytic
d. normochromic, microcytic

Answer 10

C. hypochromic, microcytic

Question 11

Regulatory hormone for erythropoiesis

Answer 11

Erythropoietin (EPO)

Question 12

Normal levels of EPO

Answer 12

10 - 25 U/L

Question 13

Average life span of adult RBC

Answer 13

100 - 120 days (3 - 4 months)

Question 14

Normal daily rate of RBC replacement

Answer 14

0.8 - 1.0% (2.5 M)

Question 15

Machinery for RBC production

Answer 15

Erythron

Question 16

Enumerate the critical elements for erythropoiesis

Answer 16

EPO
Iron Availability (+B12 & Folic Acid)
Proliferative Capacity of Bone Marrow
Effective Maturation of Red Cell Precursors

Question 17

Responsible for destroying abnormal RBCs

Answer 17

Reticuloendothelial System (RES)

Question 18

Sites of RBC production

Answer 18

Children < 5 y/o - marrow in all bones

Adults - marrow of spine, ribs and pelvis

Question 19

Where are bone marrow samples taken from?

Answer 19

Sternum & Tibia (Biopsy)

Posterior Superior Iliac Spines of Pelvis (Aspiration)

Question 20

Normal RBC levels according to WHO

Answer 20

Male: 130 - 170 g/L
Female: 120 - 170 g/L

Question 21

RBC level range for mild anemia

Answer 21

80 - 120 g/L

Question 22

Most common symptom of anemia

Answer 22

Weakness and fatigue

Question 23

Present in 25 - 30% of people with iron deficiency and possibly due to dopamine abnormalities in the brain

Answer 23

Restless Leg Syndrome (RLS)

Question 24

RBC level range for severe anemia

Answer 24

< 80 g/L

Question 25

Cause and duration of acute anemia

Answer 25

Cause: blood loss Duration: several hours to a few days only Note: Body has no time to compensate.

Question 26

It is safe to lose up to how much of your blood volume?

Answer 26

15%

Question 27

Ranges of proportion of volume loss in the different classes of hypovolemic shock

Answer 27

Class I - 40%

Question 28

T/F: There is increased peripheral resistance in chronic anemia because blood is more viscous.

Answer 28

False Decreased peripheral resistance because blood is less viscous

Question 29

T/F: In chronic anemia, it is symptomatic because the body has time to compensate

Answer 29

False Asymptomatic

Question 30

Compensatory mechanisms for chronic anemia

Answer 30

Tachycardia Increased DPG Increased O2 delivery

Question 31

Laboratory tests for anemia

Answer 31

Complete Blood Count (CBC) Reticulocyte Index/Count Iron Supply Studies Marrow Examination

Question 32

Define: Reticulocyte

Answer 32

Immature RBC

Question 33

What should be done prior to a marrow iron stain?

Answer 33

Bone marrow aspiration

Question 34

Disorders with decreased serum EPO

Answer 34

Renal disease Endocrine deficiencies (Hypopituitarism, hypothyroidism, hypocorticoidism and hypogonadism) Starvation Chronic disease anemia

Question 35

Disorders with marrow unresponsiveness to EPO

Answer 35

Nutritional deficiency Sideroblastic anemias Pure red cell aplasia (e.g. Fanconi's Anemia)

Question 36

Typical RBC deformities

Answer 36

Burr cells | Acanthocytes

Question 37

What is the EPO treatment of choice for disorders with impaired erythropoiesis?

Answer 37

3000 units subcutaneous 3x/day (up to as much as 10k units)

Question 38

T/F: Anemia of chronic diseases is caused by inadequate delivery of iron to marrow despite normal or increased iron stores.

Answer 38

True

Question 39

Three stages leading from iron deficiency to anemia

Answer 39

Stage 1 - Negative Iron Balance Stage 2 - Iron-deficient Erythropoiesis Stage 3 - Iron Deficiency Anemia

Question 40

Enumerate the stages of pregnancy and the iron blood level cut-offs for IDA

Answer 40

1st Trimester - <11.0

Question 41

Iron used in heme is transported from GIT to RES to red cell precursors by what?

Answer 41

Transferrin

Question 42

Describe: Polycythemia Vera

Answer 42

Panhyperplastic, malignant, neoplastic marrow disorder | Uncontrolled RBC production

Question 43

Which part of the GIT is iron absorbed?

Answer 43

Proximal small intestines

Question 44

T/F: Total Iron Binding Capacity (TIBC) is decreased in Iron Deficiency Anemia

Answer 44

False It is increased!

Question 45

T/F: RBCs may be normocytic and normochromic in Sideroblastic Anemia.

Answer 45

True

Question 46

Differentiate ferritin levels in IDA, Thalassemia and Sideroblastic Anemia

Answer 46

IDA - low | Thalassemia & Sideroblastic Anemia - normal

Question 47

Shelf life of PRBC depending on anticoagulant

Answer 47

Acid-Citrate-Dextrose (ACD) - 21 days Citrate-Phosphate-Dextrose-Adenine (CPDA) - 28 days Saline-Adenine-Glucose-Mannitol (SAGM) - 42 days

Question 48

Describe the ineffective erythropoiesis in megaloblastic anemia

Answer 48

Cellularity increased but production is decreased since cells tend to be destroyed in the bone marrow.

Question 49

Major causes of Megaloblastic Anemia

Answer 49

Vit. B12 (cobalamin) deficiency (Type I) | Folic acid deficiency (Type II)

Question 50

Major storage site of cobalamin

Answer 50

Liver

Question 51

Minimum daily folic acid requirement

Answer 51

50 micrograms

Question 52

Major absorptive site of folic acid

Answer 52

Proximal jejunum

Question 53

Minimum daily Vitamin B12 requirement

Answer 53

1 - 2.5 micrograms

Question 54

Major absorptive site of cobalamin

Answer 54

Ileum

Question 55

Common causes of Megaloblastic Anemia in the temperate zone

Answer 55

Folate deficiency - alcoholics | Cobalamin deficiency - pernicious anemia or achlorhydria

Question 56

Common cause of Megaloblastic Anemia near the equator

Answer 56

Tropical sprue (malabsorption due to villi flattening)

Question 57

Common cause of Megaloblastic Anemia in Scandinavian countries

Answer 57

Diphyllobotrium latum

Question 58

Laboratory findings that diagnose Megaloblastic Anemia

Answer 58

Hypersegmentation in blood smear | Improvement of urine Vit B12 with IM and oral doses in Schilling's test

Question 59

Cause of pernicious anemia

Answer 59

Absence of intrinsic factor (IF)

Question 60

Individuals predisposed to developing pernicious anemia

Answer 60

Northern Europeans & African Americans Elderly Patients with immunologic diseases

Question 61

Major concern of patients with pernicious anemia and Vit. B12 deficiency anemia

Answer 61

Folic acid supplements can mask presence of diseases but not cure them

Question 62

T/F: Autoimmune Hemolytic Anemia is linked to a higher incidence of lymphoproliferative disorders.

Answer 62

True

Question 63

Characterized by polychromatophilic blood smear and elevated reticulocyte count

Answer 63

Autoimmune Hemolytic Anemia

Question 64

Describe the haptoglobin and bilirubin levels in Autoimmune Hemolytic Anemia patients

Answer 64

Haptoglobin is low. | Bilirubin is high.

Question 65

Diagnostic test for Autoimmune Hemolytic Anemia

Answer 65

Direct Coombs' Test

Question 66

T/F: Mainly intravascular Autoimmune Hemolytic Anemias are detected.

Answer 66

False Extravascular