Anemia I

Question 1

anemia

Answer 1

decrease in circulating RBC mass

Question 2

volume of packed RBC

Answer 2

Hematocrit

Question 3

usual ratio of Hgb to Hct

Answer 3

Hgb:Hct = 1:3

Question 4

RBC life span

Answer 4

120

• old RBCs are removed by the spleen

Question 5

reticulocyte count

Answer 5

indication of bone marrows production of RBC

• normal 1-2%

Question 6

polychromasia

Answer 6

reticulocytosis

• except to see lots of blue on peripheral smear
  
  • “lots of blue means lots of new”

Question 7

nomenclature for RBC size

Answer 7

• normocytic: normal size RBC
• microcytic: small than normal
• macrocytic: larger than normal

Question 8

Mean corpuscular volume. List MCV values for Micro, Normo, and Macro

Answer 8

• calculated value to determine average volume of RBC
• Microcytic: < 80 fL
• Normocytic: 80-100 fL
• Macrocytic: > 100 fL

Question 9

mean corpuscular hemoglobin concentration

Answer 9

a measure of the concentration of hemoglobin in a given volume of packed red blood cells

• normochromic vs hypochromic

Question 10

anisocytosis

Answer 10

variation in size of RBC

Question 11

red cell distribution width

Answer 11

measurement of variation in the size of RBC

Question 12

symptoms often occur when Hgb drops below

Answer 12

7 g/dL

Question 13

What conditions falls under microcytic, hypochromic

Answer 13

• iron deficiency
• thalassemia
• sideroblastic

Question 14

What conditions falls under normocytic, normochromic

Answer 14

• Hypothyroidism
• liver disease
• chronic disease

Question 15

What conditions falls under macrocytic (megaloblastic)

Answer 15

• folate defiency
• vitamin B12 deficiency

Question 16

Presentation

• MCV low <80
• Low Fe
• High TIBC
• low ferritin

Answer 16

• iron deficiency: determine cause

Question 17

Presentation

• MCV low <80
• Low Fe
• Normal or low TIBC
• normal or high ferritin

Answer 17

• anemia of chronic disease
  
  • infection
  • inflammation
  • malignancy

Question 18

Presentation

• MCV low <80
• normal to high Fe
• any TIBC
• normal to high ferritin

Answer 18

• sideroblastic anemia

OR

• alpha or beta thalassemia

Question 19

Which test is most sensitive for iron defiency

Answer 19

decrased ferritin: depletion of iron stores occurs first

Question 20

TIBC. High or low in iron deficiency anemia

Answer 20

total iron binding capacity

• measures transferrin (what serum iron binds to in the body)
• transferrin will increrase to maximize the low iron available

Question 21

IS RDW increased or decreased in iron deficiency anemia

Answer 21

increased: variation in RBC size

Question 22

Clinical presentation

• glossitis, cheilitis, koilonychia
• pica
• dysphagia
• restless leg syndrome

Answer 22

iron deficiency anemia

Question 23

treatment of iron deficiency anemia

Answer 23

• **treat underlying cause
• replace iron stores
  
  • oral ferrous sulfate 325 mg BID-TID until anemia corrected + 3-6 months
  • blood transfusions (select patients)

Question 24

what is considered a low ferritin level

Answer 24

< 12 ng/mL

Question 25

Alpha thalassemia is a deletion of

Answer 25

one or more of the four **alpha globin chains**

Question 26

normal Hb genetic makeup

Answer 26

aa/aa + B/B

Question 27

list number of deletions of a-globin chains and manifestation in alpha thalassemia

Answer 27

* 1 deletion: silent carrier (-a/aa + B/B) * 2 deletions: alpha-thalassemia trait * mild microcytic anemia * 3 deletions: hemolytic anemia * 4 deletions: hydrops fetalis * not compatible with life

Question 28

beta thalassemia

Answer 28

reduced or absent beta-globulin chains

Question 29

list number of deletions of b-globin chains and manifestation in beta thalassemia

Answer 29

* dysfunction of one B-globin chain -\> thalassemia minor * asymptomatic * microcytic, hypochromic anemia * severe dysfunction of both B globin chains -\> thalassemia major (cooley anemia) * patients die before age 30

Question 30

poikilocytosis

Answer 30

abnormal shaped RBC

Question 31

RDW is normal or elevated in thalassemia

Answer 31

normal

Question 32

diagnosis of thalassemia

Answer 32

Hgb electrophoresis

Question 33

peripheral smear of thalassemia

Answer 33

* target cells * teardrop red cells * poikilocytosis

Question 34

treatment of thalassemia

Answer 34

* folic acid supplementation * regular transfusion schedule (severe cases) * hematopoietic cell transplantation (severe Beta-T) * Avoid iron supplementation\*\*

Question 35

presentation * MCV normal to decreased * Serum FE normal to decreased * TIBC: normal to decreased * Ferritin: normal to increased

Answer 35

anemia of chronic disease/inflammation

Question 36

What is Myelodysplastic syndromes

Answer 36

* acquired disorder to hematopoietic stem cells * ineffective blood cell production

Question 37

Myelodysplastic syndromes can progress to what conditions

Answer 37

* marrow failure * leukemia

Question 38

What is Sideroblastic anemia

Answer 38

* hereditary or acquired RBC disorder * abnormal RBC iron metabolism -\> diminished heme synthesis * bone marrow produces ringed sideroblasts

Question 39

what are sideroblasts

Answer 39

* normally found in bone marrow of healthy people * nucleated RBC precursors (erythroblasts) * contains iron-containing granules in cytoplasm * \*\*abnormal form: ringed

Question 40

sideroblastic anemia is most often a subtype of what condition

Answer 40

myelodysplastic syndrome

Question 41

Presentation * MCV varied * moderate anemia (Hct 20-30%) * normal or elevated ferritin * marked anisocytosis and poikilocytosis * systemic iron overload

Answer 41

sideroblastic anemia

Question 42

what are some other causes of sideroblastic anemia

Answer 42

* chronic alcoholism * lead poisoning * medications * chronic infection or inflammation