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SP: Hematology Pearls (3%) > Anemias > Flashcards

Anemias Flashcards

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1
Q

Normal or ↓ MCV, ↓ TIBC, ↑ Ferritin (high iron stores) ↓ serum erythropoietin

A

anemia of chronic disease

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2
Q

The only anemia where all three cell lines are decreased (pancytopenia) ↓ WBC, ↓ RBC, ↓ Platelets - will have normal MCV and ↓ Retic

A

aplastic anemia

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3
Q

↓ Folate, ↑ MCV (macrocytic anemia) looks like B12 but no neurologic symptoms. Common in alcoholics

A

folate deficiency

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4
Q

After infection or medication in an African American male + Heinz Bodies and Bite Cells on smear. Flare triggers: Fava beans, antimalarials, sulfonamides

A

G6PD deficiency

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5
Q

History of jaundice, transfusion, new medication or infection (+) direct coombs test

A

Autoimmune Hemolytic anemia

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6
Q

↓ MCV (microcytic), ↑ TIBC, ↓ Ferritin (low iron stores) ↓ MCH (hypochromic). Associated with pica and nail spooning, target cells

A

iron deficiency

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7
Q

African American, pain, family history of blood disorder. Hemoglobin electrophoresis: Hemoglobin S, Blood smear: Sickled RBCs, howell-Jolly bodies, target cells

A

sickle cell anemia

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8
Q

Microcytic hypochromic, elevated iron. Most severe, Mediterranean descent, failure to thrive. Hemoglobin electrophoresis: Hemoglobin A2 and F.

A

beta thalassemia major

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9
Q

Microcytic hypochromic, elevated iron. Mild anemia, often misdiagnosed as iron deficient. Hemoglobin electrophoresis: Hemoglobin A2

A

beta thalassemia trait

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10
Q

Chinese and southeast Asians. Hemoglobin electrophoresis: Hemoglobin H (H disease), Hemoglobin Bart’s (hydrops fetalis), Hemoglobin A (trait)

A

alpha thalassemia

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11
Q

↑ MCV (macrocytic anemia), Hypersegmented Neutrophils and normal folate, decreased vibratory and position sense

A

vit B12 deficiency

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12
Q

Less than 10% radiolabeled vitamin B12 in urine. Normal results when repeated with administration of intrinsic factor (test name)

A

Schilling test for the diagnosis of pernicious anemia (antibody to intrinsic factor)

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13
Q

What disorder is a hemoglobin electrophoresis result of “SS” indicative of?

A

sickle cell disease

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14
Q

What disorder is a hemoglobin electrophoresis result of “SA” indicative of?

A

sickle cell trait

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15
Q

What type of anemia are cephalosporins PCN NSAIDS methyldopa associated with?

A

immune hemolytic anemia

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16
Q

Erythropoietin analogs should be suspended once the hemoglobin is >_____?

A

11 mg/dL

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17
Q

Erythropoietin analogs should only be initiated if the hemoglobin is < ____?

A

10 mg/dL

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18
Q

What two types of anemia have macroovalocytes?

A

B12 & folate (B9) deficiency

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19
Q

Which anemia has a decreased MCV, decreased MCH (hypochromic) yet normal TIBC and ferritin?

A

thalassemia

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20
Q

Acute chest syndrome occurs during the acute phase of which anemia?

A

hemolytic sickle cell crisis

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21
Q

What are some common oxidative events which may trigger hemolysis in G6PD deficiency?

A 
Antimalarials
Sulfa drugs
Aspirin
Febrile Illness
Acidosis
Fava beans
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22
Q

What type of anemia does a + osmotic fragility test indicate?

A

Hereditary Spherocytosis

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23
Q

What do an increased LDH, decreased Haptoglobin and an increased indirect Bilirubin represent?

A

hemolysis

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24
Q

What type of anemia does a + direct coombs indicate?

A

Autoimmune hemolytic anemia

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25
Which type of anemia is most likely with associated leukopenia and thrombocytopenia?
aplastic anemia
26
How would you expect TIBC and ferritin to present in anemia of chronic disease?
Decreased TIBC - Normal/increased Ferritin
27
Anemia of renal failure is defined by decreased levels of which hormone?
erythropoietin
28
Can oral B12 be used as an initial treatment in a B12 deficient patient?
Yes - Oral B12 is considered initial therapy - Other routes if oral fails or pernicious anemia is diagnosed
29
Which route is best for administering B12 to a deficient patient?
Sublingual, IM or deep subcutaneous
30
What tests other than a Schilling test are used to diagnose pernicious anemia?
Increased Methylmalonic acid levels - + Intrinsic factor and parietal cell antibodies
31
Increased MCV with smooth tongue, loss of proprioception and vibratory sense is likely which type of anemia?
B12 deficiency
32
List 5 common causes of folate deficiency.
``` EtOH abuse Advancing age Gastric bypass Pregnancy Methotrexate ```
33
What symptom differentiates B12 from folate deficiency ?
Neuropathy occurs with B12 deficiency but not with folate deficiency
34
Slowly decreasing MCV in an elderly patient?
Occult GI blood loss
35
Pica is a specific symptom of which type of anemia?
iron deficiency anemia
36
Decreased Ferritin and Increased TIBC?
iron deficiency anemia
37
What surgery can induce B12 deficiency?
gastric bypass
38
Anemia due to renal failure may be confirmed by which test?
Decreased Serum erythropoietin levels
39
What type of megaloblastic anemia causes neurologic deficits?
B12 deficiency
40
What type of anemia can occur in hypothyroidism?
Macrocytic non-megaloblastic anemia
41
What factor is produced in the stomach and required for Vitamin B12 absorption?
intrinsic factor
42
What test confirms the diagnosis of pernicious anemia?
Schilling test or + antibodies to intrinsic factor and parietal cells
43
Which anemia is associated with bilirubin cholelithiasis?
Hereditary spherocytosis
44
What is the best test to determine whether a patient as a hemolytic anemia?
Reticulocyte count and haptoglobin
45
Which anemia has all 3 cells lines affected: Anemia leukopenia and thrombocytopenia?
aplastic anemia
46
What is the Dx? Very low MCV, normal/high RBC, normal RDW and high/normal serum iron normal TIBC.
thalassemia
47
What is the Dx? Low MCV, low RBC, high RDW, low serum iron, high TIBC.
iron deficiency anemia
48
What is the Dx? Microcytic hypochromic anemia, low serum iron and low TIBC. Unresponsive to iron therapy.
anemia of chronic disease
49
Basophilic stippling of RBCs?
Lead poisoning (May also occur in thalassemia and chronic EtOH abuse)
50
Type of anemia in which serum iron is decreased and TIBC is increased?
iron deficiency anemia
51
What is the Dx? Teenage African American with severe bone and joint pain severe anemia
sickle cell disease
52
What is the etiology of pernicious anemia?
Antibodies to gastric parietal cells and intrinsic factor
53
Which anemia is most commonly associated with EtOH abuse?
folate (B9) deficiency
54
List three medications which may trigger autoimmune anemia.
Cephalosporins Penicillins NSAIDs
55
Priapism may occur in which acute anemia?
sickle cell crisis
56
What test is diagnostic for sickle cell disease?
Hemoglobin electrophoresis
57
Which test is more sensitive than B12 levels for B12 deficiency in early disease?
Increased Methylmalonic acid levels occur in early B12 loss and may precede decreased serum B12 levels
58
What are the two medications available for treatment of anemia due to renal failure?
epoetin alfa and darbepoetin alfa
59
Which test is most specific for hemolysis?
Haptoglobin is decreased in both extra and intravascular hemolysis
60
List three medications which may cause aplastic anemia.
ACE inhibitors Sulfonamides Phenytoin
61
What heritage is associated with an increased chance of thalassemia?
Mediterranean descent
62
A 31 year old Mediterranean female has a hemoglobin of 10.3 gm/dl, MCV of 54, TIBC and Ferritin are normal. What is the most likely etiology of her anemia?
thalassemia minor
63
What anemia should be suspected in a 3 year old black male with anemia and priapism?
sickle cell anemia
64
Measurement of which laboratory value is the best indicator of whether or not a sickle cell crisis is resolving?
Reticulocyte count - Decreasing reticulocyte counts are the best indicator that a crisis is resolving
65
What medications related to travel can be an oxidative trigger for a patient with G6PD?
anti-malarial meds
66
A 42 year-old black female with SLE has an increased bilirubin and a mild anemia. Which test is most definitive to evaluate this patient's anemia?
Direct coombs in patient with autoimmune anemia
67
A patient who recently started lisinopril has a hemoglobin 7.4, WBC 1.1, platelets 55. What is the most likely disorder?
aplastic anemia
68
A dialysis patient has been on darbepoetin alfa for 3 months. His most recent hemoglobin is 11.3 gm/dl. Should he continue to use this medication?
No. erythropoetin analogs must be stopped when the hemoglobin is greater than 11 gm/dL
69
A 36 year old black male s/p gastric bypass surgery has peripheral neuropathy. Oral B12 has not improved his symptoms. What is the next step?
sublingual or IM B12
70
What antibody test would confirm a diagnosis of pernicious anemia?
Intrinsic factor and parietal cell antibodies
71
A 74 year old white male with a history of chronic ETOH abuse has an MCV of 102. Physical exam finds no neurological deficit. What is the most likely diagnosis?
folate (B9) deficiency
72
A 23 year old white female has weakness, fatigue and has developed a habit of chewing ice. What are the expected findings in regard to TIBC and Ferritin?
Increased TIBC and decreased Ferritin in patient with iron deficiency anemia

SP: Hematology Pearls (3%) (3 decks)

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