Anemias

Question 1

Ratio of Hgb to Hct

Answer 1

1:3

Ex. Men: Hgb 14-18, Hct 40-50%

Question 2

MCV

Answer 2

Mean corpuscular volume

-normal is 80-100

Question 3

MCH

Answer 3

Mean corpuscular Hemoglobin

Avg mass of Hgb per RBC”how much color?”

• Low MCH/MCHC = hypchromic
• Normal MCH/MCHC = normochromic
• High MCH/MCHC = hyperchromic

Question 4

RDW

Answer 4

Red cell distribution width

Normal is 11-15%

Question 5

Causes of increased RBC count

Answer 5

• Dehydration
• COPD
• Polycythemia vera

Question 6

Signs of Anemia

Answer 6

Early:

• pallor
• tachycardia
• hypotension
• orthostatic changes

Late:

• glossitis
• chelitis
• Jaundice (hemolytic anemia, indirect bili)
• koilonchia

Question 7

What is the best indicator of iron deficiency anemia

Answer 7

low ferritin (<12ng/mL)

Question 8

Signs of Fe Deficiency Anemia

Answer 8

• Pica
• Dysphagia (Plummer-Vinson Syndrome)
• Restless leg syndrome
• Glossitis

Question 9

How long do you give ferrous sulfate 325mg in Fe deficiency anemia?

Answer 9

give until corrected.

Continue 3-6 months after corrected

Question 10

Thalassemia

Answer 10

• microcytic (low MCV)
• hypochromic
• Normal RDW**
• HIGH ferritin
• Target cells*
• Poikilocytosis

Dx: hemoglobin electrophoresis

Tx: transfusions, avoid iron supplements.

• Folic acid supplemention
• Consider removing spleen

Question 11

What can make MCV falsely big?

Answer 11

1. reticulocytes

2. RBC clumping

Question 12

What are two characteristic findings on peripheral blood smear for megaloblastic anemias (ex. Folate deficiency, B12 deficiency)

Answer 12

1. Hypersegmented neutrophils

2. Macro-ovalocytes

Question 13

Macrocytic anemia with reticulocyte elevation

Answer 13

-Hemorrhage

or

-Hemolysis

Question 14

Where is folate absorbed in the small bowel?

Answer 14

Jejunum

Question 15

Folic acid deficiency: causes

Answer 15

• alcoholism
• hemodialysis
• anticonvulsants

Question 16

Folic acid deficiency: clinical features

Answer 16

• anemia sx
• glossitis
• NO neurologic abnormalities

Question 17

What labs will help you tell if folic acid deficiency is the issue?

Answer 17

elevated homocysteine

normal methylmalonic acid

Question 18

B12 Deficiency

Answer 18

• only available in diet
• MC cause is inability to absorb (needs intrinsic factor [made by parietal cells])

-B12 absorbed in the ileum

Question 19

Pernicious Anemia

Answer 19

• type of B12 deficiency

- Autoimmune destruction of parietal cells so, absent gastric acid and intrinsic factor

Question 20

Pernicious anemia: clinical features

Answer 20

• atrophic gastritis –>increased risk for gastric CA

- Neurologic findings (decreased vibration sense, ataxia, parethesias, confusion)

Question 21

B12 deficiency labs

Answer 21

Positive schilling test
or
Antibodies to IF (pernicious anemia)

Elevated methylmalonic acid and homocysteine levels

Question 22

Hemolytic anemia: Labs

Answer 22

-Elevated reticulocyte count**

• Increased unconjugated bilirubin (indirect)
• Elevated LDH (lactic acid dehydrogenase)
• Low haptoglobin

Question 23

Hemolytic anemia: peripheral smear

Answer 23

• reticulocytes

- schistocytes

Question 24

Haptoglobin

Answer 24

protein produced in the liver that binds to hemoglobin that has been released from lysed RBCs

so, more lysing the less free haptoglobin

Question 25

Hemolytic anemia: clinical features

Answer 25

- anemia sx - jaundice - gallstones (bilirubin stones) - increased risk of infection with salmonella and pneumococcus** (infection with parvovirus B19 can lead to transient aplastic crisis)

Question 26

Micro versus Macroangiopathic hemolytic anemia

Answer 26

Macro - from prosthetic heart valve Micro - from fibrin strands in the vessels

Question 27

G6PD Deficiency

Answer 27

- X-linked recessive disorder - More common in black males and Mediterranean men - Fava bean is common trigger**

Question 28

G6PD Deficiency: Labs

Answer 28

During episode: - Increased reticulocytes - Increased serum bilirubin - Low G6PD Peripheral smear: - Heinz bodies (denatured hemoglobin) - Bite cells

Question 29

G6PD: Tx

Answer 29

- self limited | - Avoid oxidative drugs

Question 30

Hereditary Spherocytosis

Answer 30

- Autosomal dominant - Normal MCV, but smaller surface area, dense, globe appearance (no central pallor) - Poorly deformable, so get stuck in spleen and get phagocytized by splenic macrophages - Chronic hemolysis creates need for increased folate

Question 31

Hereditary Spherocytosis: Dx and Tx

Answer 31

clinical manifestion: - splenomegaly - jaundice Dx: Osmotic fragility test Tx: remove the spleen (in adulthood if possible) -Give PNA vaccine

Question 32

Sickle Cell Disease: General

Answer 32

- Autosomal recessive - HbSS (sickle cell disease) - HbS + Hb A (sickle cell trait)

Question 33

Sickle cell disease: clinical features

Answer 33

- symptoms start at 4-6 months with change from fetal hemoglobin to adult hemoglobin - INCREASED susceptibility to infection Symptoms precipitated by dehydration, hypoxia, high altitude, intense exercise

Question 34

Sickle cell disease: more clinical features

Answer 34

- chronic hemolysis (bilirubin rises) - Vaso-occlusive ischemic tissue injury - PAIN CRISIS** (MC feature of disease) - osteonecrosis of femoral and humeral heads from bone infarcts - Splenic infarcts lead to functional asplenism - leg ulcers

Question 35

Sickle cell disease: labs

Answer 35

- Reticulocyte count is elevated** - Hgb electrophoresis shows HbS*** (best test to confirm diagnosis) Peripheral smear: -Howell-jolly bodies (nuclear remnants usually removed by the spleen)

Question 36

Sickle cell disease: Tx

Answer 36

-Hydroxyurea (suppresses bone marrow to decrease incidence of painful crises) - PNA vaccine - Folate supplementation

Question 37

Autoimmune Hemolytic Anemia: general

Answer 37

- antibodies adhere to surface of RBC | - Complexed antibody and cell are phagocytized leaving -->spherocytes*

Question 38

Autoimmune hemolytic anemia: Labs/peripheral smear

Answer 38

- Polychromasia - spherocytosis - (+) Coombs test**

Question 39

Incompatible blood transfusion

Answer 39

- Antibodies to ABO/RH blood group antigen | - (+) Coombs test**

Question 40

Treatment for hemolytic anemias

Answer 40

- Folic acid supplementation** | - Splenectomy (to consider)

Question 41

Anemia of Chronic Disease

Answer 41

- normocytic, normochromic - normal or increased ferritin - Fe and TIBC are low in setting of inflammation

Question 42

Myelodysplastic Syndrome: Tx

Answer 42

bone marrow biopsy*

Question 43

Sideroblastic anemia: general

Answer 43

Marrow doesn't use iron for heme synthesis very well Bone marrow: ringed sideroblasts**** (these are produced instead of healthy RBCs)

Question 44

Ringed sideroblasts

Answer 44

- seen in sideroblastic anemia - they are erythroblasts with perinuclear iron-engorged mitochondria - subtype of myelodysplastic syndrome

Question 45

Sideroblastic anemia: Dx

Answer 45

Marked anisocytosis Marked poikilocytosis Systemic iron overload** BMbx: ring sideroblasts

Question 46

Sideroblastic anemia: Tx

Answer 46

treat underlying cause If Congenital sideroblastic anemia... -Pyridoxine (vitamin B6)

Question 47

What is the most common cause of aplastic anemia?

Answer 47

idiopathic

Question 48

Aplastic Anemia: clinical features

Answer 48

Pancytopenia**

Question 49

Aplastic Anemia: Tx

Answer 49

bone marrow transplant

Question 50

When are helmet cells seen on peripheral smear?

Answer 50

hemolytic anemias