Anemias

Question 1

What is the MC anemia worldwide?

Answer 1

Iron Deficincy Anemia (microcytic anemia)

Question 2

Chronic blood loss is the MCC of what?

Answer 2

IDA in adults

Question 3

What is the MC source of chronic blood loss?

Answer 3

Menstrual loss

Question 4

What are 2 clinical features of microcytic IDA?

Answer 4

• Pica- ice chips

- Koilonchia (spoon nails)

Question 5

What is the most reliable test to diagnose microcytic IDA?

Answer 5

Serum Ferritin (low)

Question 6

What is the gold standard test to diagnose microcytic IDA but rarely done?

Answer 6

Bone marrow biopsy

Question 7

Tx for microcytic IDA?

Answer 7

Oral iron replacement (ferrous sulfate)

- a trial should be given to menstruating females.

Question 8

Beta-Thalassemia Major predominantly in what population?

Answer 8

Mediterranean population

Question 9

What are 2 clinical manifestations of microcytic Beta-Thalassemia Major?

Answer 9

• Severe anemia (microcytic hypochromic)

- Skull x-ray demonstrates “crew-cut” fuzzy appearance

Question 10

What lab test would you find to be elevated in a pt with microcytic Beta-Thalassemia Major?

Answer 10

Hgb Electrophoresis: Hgb F and Hgb A2

Question 11

What cells would be seen in a peripheral smear in a pt with microcytic Beta-Thalassemia Major?

Answer 11

Target cells

• Dacrocytes (teardrop cells)

Question 12

What is a general characteristic of normocytic Aplastic Anemia?

Answer 12

Massive bone marrow failure - results in pancytopenia

Question 13

What procedure is done to provide a definitive diagnosis of normocytic Aplastic Anemia?

Answer 13

Bone marrow bx

Question 14

Vitamin B12 is bound to what?

Answer 14

An intrinsic factor so it can be absorbed by the terminal ileum

Question 15

MCC of macrocytic Vitamin B12 Deficiency Anemia?

Answer 15

Pernicious anemia

• lack intrinsic factor
• MCC in western hemisphere

Question 16

What disease causes microcytic Vitamin B12 Deficiency Anemia?

Answer 16

Crohn Disease

Question 17

What clinical feature is present in microcytic Vitamin B12 Deficiency Anemia and not in Folate Deficiencies?

Answer 17

Neuropathy

Question 18

What causes hemolytic Sickle Cell Anemia?

Answer 18

• Autosomal recessive disorder (requires 2 genes from 2 carries)
• under hypoxic conditions the hbg molecule polymerize causing RBC to sickle

Question 19

Hemolytic sickle Cell Anemia is MC in what descent?

Answer 19

African descent (1 in 12)

Question 20

A pt with hemolytic Sickle Cell Anemia can experience aplastic crises, how is that provoked?

Answer 20

• Provoked by a viral infection (human parvovirus B19)

Question 21

Normocytic Aplastic crises reduced the ability of what?

Answer 21

• Reduces the ability of bone marrow to compensate

Question 22

What is the MC clinical manifestation secondary to vaso-occlusion in pts with hemolytic Sickle Cell Anemia?

Answer 22

Painful crises involving the bones

• osseous infarction leading to severe pain.
• last up to 1 wk

Question 23

What is the FIRST manifestation secondary to vaso-occlusion in pts with hemolytic Sickle Cell Anemia?

Answer 23

Hand-foot syndrome (dactylitis)

Question 24

Hand-foot syndrome (dactylitis) is what?

Answer 24

Painful swelling of the dorsal aspect of hands and feet, results from avascular necrosis of metacarpal and metatarsal bones.

Question 25

What diagnostic tests are used to dx a pt with hemolytic Sickle Cell Anemia?

Answer 25

- CBC showing anemia (MC finding) - Peripheral smear showing sickle-shaped RBCs - Hgb Electrophoresis- required to diagnose

Question 26

What is a tx for hemolytic Sickle Cell Anemia?

Answer 26

- Hydroxyurea

Question 27

What is hemolytic Hereditary Spherocytosis?

Answer 27

Autosomal dominant inheritance, loss of RBC membrane surface area (loss of biconcave) w/o decreased RBC volume which forces the spherical shape.

Question 28

Diagnostic test and tx for hemolytic Hereditary Spherocytosis?

Answer 28

- Splenectomy - tx of choice - RBC osmotic fragility - test the ability of RBCs to swell - Direct Coombs test - will be negative

Question 29

What are some general characteristics of hemolytic G6PD Deficiency?

Answer 29

- An X-linked recessive disorder that primarily affects men | - Protects against malaria

Question 30

What is known to precipitant hemolytic G6PD Deficiency?

Answer 30

- Antibiotics: Sulfonamides and Nitrofurantoin | - Fava beans

Question 31

What is some diagnostic test for hemolytic G6PD Deficiency?

Answer 31

- Deficient NADPH formation of G6PD levels | - Measurement of G6PD levels is diagnostic

Question 32

What are some general characteristics of Autoimmune Hemolica Anemia?

Answer 32

RBC destruction

Question 33

What are the clinical features of Autoimmune Hemolica Anemia: WARM AIHA?

Answer 33

- Leads to extravascular hemolysis, the primary site of RBC entrapment is in the spleen - More common than cold

Question 34

What are the clinical features of Autoimmune Hemolica Anemia: COLD AIHA?

Answer 34

Produces complement activation and intravascular hemolysis, the primary site of RBC sequestration is the liver

Question 35

What diagnostic test is done for Autoimmune Hemolica Anemia: WARM and COLD AIHA?

Answer 35

Direct Coombs test = positive

Question 36

Tx for Autoimmune Hemolica Anemia: WARM AIHA?

Answer 36

Glucocorticoids

Question 37

Tx for Autoimmune Hemolica Anemia: COLD AIHA?

Answer 37

Avoid exposure to the cold - helps prevent attacks of hemolysis and subsequent anemia

Question 38

Hemolytic Sickle cell anemia may cause Priapism what is the tx?

Answer 38

Terbutaline - helps w/ vasocontriction

Question 39

What test do you order if MCV is >100?

Answer 39

B12, folate, and review RDW

Question 40

What test do you order if MCV is <80?

Answer 40

Iron studies and review RDW

Question 41

A lead line along the epicondyle dic seen on an XR is d/t what?

Answer 41

Sideroblastic anemia