Anemia 3

Question 1

hemolytic: LDH levels? why?

Answer 1

increased: enzyme found in red cells, released when RBC is broken open

Question 2

hemolytic: bilirubin levels? why?

Answer 2

increased bilirubin and unconjugated bilirubin. Hb released from RBC metabolized to bilirubin. when liver is overwhelmed by the increased bilirubin, it’s unable to keep up with the conversion to conjugated bilirubin

Question 3

hemolytic: haptoglobin levels?

Answer 3

decreased: present in blood to mop up toxic free hemoglobin, so decreased because it’s quickly consumed

Question 4

why do a blood film for hemolysis

Answer 4

red cells that are hemolyzing often change shape, and shape can be a clue to the cause

Question 5

why do a DAT (Coombs test) for hemolysis

Answer 5

look for antibodies bound to the RBC surface, supporting immune cause of hemolysis

Question 6

MAHA triad

Answer 6

low platelets. low hemoglobin. red cell fragmentation hemolysis

Question 7

MAHA: what is key to diagnosis

Answer 7

blood film:look for red cell fragments

Question 8

Life threatening conditions associated with MAHA

Answer 8

disseminated intravascular coagulopathy, thrombotic thrombocytopenia purpura, hemolytic uremic syndrome, syndrome in pregnancy, preeclampsia

Question 9

MAHA: platelet and Hb levels

Answer 9

both low. activated platelets

Question 10

immune mediated hemolytic anemia: mechanism

Answer 10

antibodies to RBC antigens: immune cells bite off bits of RBC membrane, hemolytic markers. red cells lose biconcave shape = spherocytes

Question 11

4 reasons for decreased marrow production

Answer 11

doesn’t have the “tools” needed, poisoned by toxins, normal cells being crowded by others, or bone marrow intrinsically failing

Question 12

bone marrow not having necessary tools to make RBCs: 4 explanations

Answer 12

hemantinic deficiency (low iron, B12, folate). low EPO (renal failure). anemia of inflammation (Fe stores present, but not accessible). hemoglobinopathy, thalassemia (abnormal Hb)

Question 13

bone marrow poisoned by toxins: 4 examples

Answer 13

alcohol, drugs like chemotherapy, infection by HIV, parvovirus, radiation therapy

Question 14

bone marrow being crowded out by others: explanation

Answer 14

by non hematologic malignancy aka metastatic cancer, or by hematologic malignancies. infection. myelofibrosis: BM replaced by collagenous deposition

Question 15

bone marrow failing (what would you call this) + examples

Answer 15

primary bone marrow failure: myelodysplasia, aplastic anemia, inherited BM failure syndromes

Question 16

how to diagnose primary bone marrow syndrome, or bone marrow being crowded out

Answer 16

bone marrow exam

Question 17

blood film for anemia

Answer 17

hypochromic microcytic anemia (could still be normocytic too)

Question 18

etiology of iron deficiency

Answer 18

premature infants, inadequate dietary iron, heavy menstrual loses, pregnancy, GI sources of blood loss, colon cancer, malabsoprtion like celiac or inflamm bowel disease

Question 19

how to determine iron deficiency

Answer 19

measure serum ferritin: indicates body’s total iron stores