Anemia

Question 1

Right shift Hgb-O2 curve

Answer 1

Increases O2 delivery to tissues
Acidosis
Increased temp
High altitude
Exercise
Increased CO2
Increased 2,3-DPG

Question 2

Left shift Hgb-O2 curve

Answer 2

Decreases O2 delivery to tissues
Alkalosis
Decreased temp
Increased Hgb F concentration
Decreased CO2
Decreased 2,3-DPG

Question 3

Microcytic anemias

Answer 3

Iron deficiency (MC)
Lead poisoning
Sideroblastic
Thalassemias
Chronic disease (usu normocytic)

Question 4

Normocytic anemias

Answer 4

Hemolytic
Chronic disease (rarely microcytic)
Hypovolemia

Question 5

Macrocytic anemias

Answer 5

Folate deficiency
B12 deficiency
Liver disease
Alcohol abuse

Question 6

Hemolytic anemia labs

Answer 6

Decreased H/H
Increased reticulocytes
Increased bilirubin (indirect)
Increased LDH (from RBC lysis)
Normal MCV
Decreased serum haptoglobin (used up)

Question 7

Hemolytic anemia blood smear

Answer 7

Schistocytes, spherocytes, burr cells

Question 8

Coombs test, direct

Answer 8

Agglutination indicates presence of IgG and complement on RBC membranes (eg warm/cold agglutinin)

Question 9

Coombs test, indirect

Answer 9

Agglutination indicates presence of anti-RBC antibodies in serum (eg Rh alloimmunization)

Question 10

Direct Coombs+ hemolytic anemia + antidrug antibodies, immune complexes or anti-Rh antibodies

Answer 10

Drug-induced hemolytic anemia

Question 11

Drugs causing drug-induced hemolytic anemia

Answer 11

Penicillin
Methyldopa
Quinidine
Cephalosporins
NSAIDs

Question 12

Drugs causing G6PD deficiency hemolysis

Answer 12

High dose ASA
Sulfa drugs
Dapsone
Quinine,quinidine, primaquine
Nitrofurantoin

Question 13

Direct Coombs+ hemolytic anemia + anti-RBC antibodies

Answer 13

Warm-reacting (IgG) or cold-reacting (IgM) immune mediated hemolytic anemia

Question 14

Hemolytic anemia + schistocytes

Answer 14

Mechanical (eg prosthetic heart valve)

Question 15

Hemolytic anemia + spherocytes

Answer 15

Hereditary spherocytosis (+osmotic fragility test, +MHCH, decreased diameter)

Question 16

Hemolytic anemia + bite cells or Heinz bodies

Answer 16

G6PD deficiency

Question 17

Iron labs for iron deficiency anemia

Answer 17

Low iron, low ferritin
High TIBC/transferrin
Low Iron:TIBC ratio (<12%)

Question 18

Iron labs for lead poisoning anemia

Answer 18

Normal/high iron

Normal ferritin, TIBC/transferrin

Question 19

Iron labs for anemia of chronic disease

Answer 19

Low iron
Normal/high ferritin
Low TIBC/transferrin
Normal Iron:TIBC ratio (>18)

Question 20

Iron labs for sideroblastic anemia

Answer 20

High iron, ferritin

Low TIBC/transferrin

Question 21

Iron labs for thalassemia

Answer 21

Normal

Question 22

Blood smear for iron deficiency anemia

Answer 22

Microcytic, hypochromic

Question 23

Blood smear for lead poisoning anemia

Answer 23

Microcytic
Basophilic stippling
May have ringed sideroblasts in BM

Question 24

Blood smear for anemia of chronic disease

Answer 24

Hypochromic

Normocytic or microcytic

Question 25

Blood smear for sideroblastic anemia

Answer 25

Microcytic | May have ringed sideroblasts in BM

Question 26

Blood smear for thalassemia

Answer 26

``` Microcytic Target cells (alpha) Basophilic stippling (beta) ```

Question 27

Megaloblastic anemia

Answer 27

Macrocytic; hypersegmented neutrophils B12/folate deficiency (Folate = MC) Caused by problem w/ DNA synthesis

Question 28

Causes of aplastic anemia

Answer 28

``` Radiation = MC Drugs (chloramphenicol, sulfonamides, phenytoin, chemo) Toxins Viral (parvovirus, EBV, HIV) Idiopathic Congenital ```

Question 29

Schistocytes

Answer 29

Hemolytic anemia | DIP/TIP/HUS

Question 30

Acanthocytes (spur cells)

Answer 30

Irregular spokes | Abetaproteinlipidemia

Question 31

Echinocytes (burr cells)

Answer 31

Regular spokes | Hemolytic anemia

Question 32

Bite cells

Answer 32

G6PD deficiency

Question 33

Basophilic RBC stippling

Answer 33

Lead poisoning | Thalassemia

Question 34

Peripheral neuropathy + ringed sideroblasts in BM

Answer 34

Lead poisoning

Question 35

Hypersegmented neutrophils

Answer 35

Megaloblastic anemia (folate/b12)

Question 36

Heinz bodies (denatured Hgb in RBC)

Answer 36

G6PD deficiency