EXAM #1: ANEMIA 2.0

Question 1

What is polycythemia?

Answer 1

An abnormal increase in Hb concentration in the blood

Question 2

What is the RBC count in thalassemia?

Answer 2

High

Question 3

How do you calculate an absolute retic. count?

Answer 3

(RBC# x %reticulocytes)/ 100

Question 4

What do you know if the absolute retic. count is less than 100,000 microL?

Answer 4

NO retirculocytosis

Question 5

What are the two primary causes of megaloblastic anemia?

Answer 5

• Vitamin B12 deficiency
• Folic acid deficiency

*Drugs can also cause megaloblastic anemia

Question 6

What are the causes of nonmegaloblastic macrocytic anemia?

Answer 6

1) Hypothyroidism
2) Liver disease
3) Alcoholism
4) Myelodysplastic syndromes

Question 7

Outline the BIG FAT RED CELLS mnemonic.

Answer 7

B= B12
I= Inherited
G= GI disease/ surgery

F= Folic acid
A= Alcholism
T= Thiamine response

R= Reticlocyte miscount
E= Endocrine
D= Dietary

C= chemotherapy
E= Erythro
L= Liver
L= Lesch-Nyhan Syndrome
S= Splenectomy

Question 8

What are the signs of anemia?

Answer 8

Pallor
Pica
Koilonychia

Question 9

What are the PBS hallmarks of megaloblastic anemia?

Answer 9

1) MCV greater than 100

2) Hypersegmented neutrophils

Question 10

How do the total body stores of B12 and Folate compare?

Answer 10

B12= 2-5mg 
Folate= 5-10mg

Question 11

How does the daily requirement of B12 and Folate compare?

Answer 11

B12= 1-3 micrograms

Folate= 50-100 mircograms

Question 12

What is the source of B12? What is the source of Folate?

Answer 12

B12= animals 
Folate= plants

Question 13

Compare the sites of absorption for B12 and Folate.

Answer 13

B12= terminal ileum

Folate= proximal jejunum

Question 14

What is the main difference in symptomatic outcomes of B12 deficiency and Folate deficiency?

Answer 14

B12= neurologic complications

Folate= NTD

Question 15

List the specific causes of B12 deficiency.

Answer 15

1) Vegans–veggie man
2) Pernicious anemia–prune anemone
3) Gastric bypass–stomach stapler
4) Malabsorption–mallet
5) Celiac spure–sprouts
6) Enteritis–enter intestines
7) Diphyllobathrium latum–fish tapeworm
8) Chron’s Disease

Question 16

What is the functional role of Vitamin B12?

Answer 16

Vitaminc B12 is an important cofactor for for conversion of:

1) Methylmalonic acid to succinly-CoA (Methylmalonyl-CoA mutase)
2) Methylation of homocysteine to methionine (methionine synthase)

Question 17

How does B12 deficiency lead to neruologic symptoms?

Answer 17

Build-up of methylmalonic acid

Question 18

What is difference between folate and B12 deficiency in regards to methylmalonic acid?

Answer 18

B12= methylmalonic acid increase

Folate= no increase

BOTH will be high in homocysteine

Question 19

What is the presentation of Congenital Transcobalamin II Deficiency?

Answer 19

Infantile anemia in a few weeks of birth

Question 20

What is the presentation of Congenital Methylmalonic Acidemia?

Answer 20

Infants ill from birth

Question 21

What is the presentation of excessive NO inhalation?

Answer 21

• Irreversible oxidation of methylcobalamin*

- Presents like B12 deficiency

Question 22

What is the major difference between the symptoms of B12 deficiency and folate deficiency?

Answer 22

Neurological symptoms

Question 23

What lab values are diagnostic for B12 deficiency?

Answer 23

1) Increased MCV
2) Decresed retic.
3) High methylmalonic acid
4) High homocysteine

Question 24

How is B12 deficiency treated?

Answer 24

1) Find the cause

2) Supplement w/ 1,000 micrograms SC or IM for a month, then monthly

Question 25

What electrolyte needs to be monitored with B12 deficiency?

Answer 25

Potassium

Question 26

What are the complications of B12 deficiency?

Answer 26

1) Demyelination of the posterior spinal column and lateral corticospinal tract 2) Infertility 3) Cervical smear abnormalities

Question 27

What post-op patient populations must be B12 supplemented?

Answer 27

Total gastrectomy

Question 28

What is pernicious anemia?

Answer 28

- Autoimmune disorder directed against gastric parietal cells - Results in absent gastric acid and IF

Question 29

What test can be done to diagnose Pernicious Anemia?

Answer 29

Schilling Test

Question 30

What lab values are diagnostic for Pernicious Anemia?

Answer 30

1) Parietal cells and IF antibody positive 2) High serum gastrin 3) Low pepsingoen

Question 31

What are the major causes of folate deficiency?

Answer 31

Remember, causes a macrocytic, megaloblastic anemia b/c 1) Malabsorption--mallet 2) Poor dietary intake-- my chart 3) Elderly--tea and toast diet 4) Methotrexate- moth-T-rex ate 5) Trimethoprim--tampon 6) Increased need: - Hemolytic anemia - Pregnancy

Question 32

What lab values are diagnostic for Folate Deficiency?

Answer 32

NORMAL Methylmalonic acid

Question 33

How is a Folate Deficiency treated?

Answer 33

1) Consume foods rich in folic acid | 2) Supplement

Question 34

What is aplastic anemia?

Answer 34

Bone marrow failure to produce RBCs, WBCs, platelets i.e. bone marrow failure leading to PANCYTOPENIA

Question 35

What are the major causes of aplastic anemia?

Answer 35

1) SLE | 2) Drugs

Question 36

What are the symptoms of aplastic anemia?

Answer 36

Symptoms are related to the three blood cell line defects: 1) Anemia= weakness/fatigue 2) Neurtopenia= bacterial/fungal infection 3) Thrombocytopenia= bleeding

Question 37

What are the signs of aplastic anemia?

Answer 37

- Pallor, petechaie, purpura | - HSM?

Question 38

Is bone pain a normal finding in aplastic anemia?

Answer 38

NO--this is indicative of underlying cancer

Question 39

What lab values are diagnostic for aplastic anemia?

Answer 39

1) PANCYTOPENIA | 2) Reticulocytopenia

Question 40

How is aplastic anemia treated?

Answer 40

1) Stop offending agent and supportive care | 2) Severe cases are treated with bone marrow transplant