Hematology

Question 1

Define anemia.

Answer 1

Low Hgb, Hct, or RBC

Question 2

What is the role of evaluating reticulocytes in evaluating anemia?

Answer 2

Normal reticulocyte count (> 2) indicates healthy marrow and bleedign is most likely cause of anemia. Low reticulocyte count indicates marrow failure or lack of eryhtropoietin (EPO).

Question 3

What are common S/S associated with anemia?

Answer 3

Weakness, fatigue, palpitations, tachycardia, dyspnea, positional dizziness, syncope, hemorrhage, pallor.

Question 4

What type of anemia is indicated by “spoon nails” on physical exam?

Answer 4

Iron deficiency

Question 5

What types of anemia should be suspected in nutritional disorders or malabsorption?

Answer 5

B12, Folate, iron deficiency

Question 6

What physical exam finding indicates B12 deficiency?

Answer 6

Neuro symptoms –> dec vibratory and position sense.

Question 7

Define pica and state the type of anemia it is associated with.

Answer 7

Eating things not usually considered food –> iron deficiency

Question 8

What type of anemia is most commonly associated with alcohol use disorder?

Answer 8

Folate (vitamin B9) deficiency

Question 9

List 4 types of anemia that are most commonly microcytic.

Answer 9

Thalassemia, iron deficiency, chronic inflammation, sideroblastic (lead excess)

Question 10

Define thalassemia.

Answer 10

Under production of alpha or beta globin chains leading to decreased Hgb synthesis and increased RBC hemolysis.

Question 11

State the number of alpha chains present on Hgb and describe the thalassemia associated with deficiency in the varied number of alpha chains.

Answer 11

4: normal number of Hgb alpha globins
3: silent (asymptomatic) carrier
2: mild anemia
1: severe anemia that worsens with fever or exposure to certain meds –> requires transfusions
0: causes hydrops fetalis and usually stillbirth

Question 12

Differentiate beta thalassemia major from minor.

Answer 12

Major: AKA Cooley anemia. S/S begin at 4-6 months (switch from maternal to fetal Hgb) –> severe anemia requiring transfusions. Many die before age 30.
Minor: Only one gene is damaged producing no or minor symptoms.

Question 13

Describe the two subtypes of beta thalassemia minor.

Answer 13

Minima: few or no symptoms
Intermedia: moderate to severe anemia

Question 14

How is beta thalassemia differentiated clinically from iron deficiency anemia?

Answer 14

Beta: serum iron and ferritin usually normal or elevated, Hgb between 3 and 6, microcytosis is more severe than in iron deficiency.

Question 15

What is the most common cause of anemia worldwide?

Answer 15

Iron deficiency

Question 16

What is the most common cause of ion deficiency and what are other causes?

Answer 16

Blood loss –> PUD/NSAIDs, CA, heavy menstruation.

Other - decreased intake or absorption

Question 17

What serum lab findings are indicative of iron deficiency anemia?

Answer 17

Hgb and Hct decreased
Hypochromic and microcytic
Ferritin < 20, transferrin < 15%, TIBC elevated

Question 18

What is the treatment for iron deficiency?

Answer 18

Find source of bleeding

Ferrous sulfate in slowly escalating doses taken on empty stomach and with vitamin C (iron likes acid)

Question 19

T/F: Anemia of chronic disease is most often a microcytic anemia.

Answer 19

False: about 70% normocytic, 30% microcytic

Question 20

List some common diseases that may produce anemia of chronic disease.

Answer 20

infection, neoplasm, autoimmune (SLE, RA)

Question 21

List common causes of sideroblastic anemia.

Answer 21

Lead poisoning, AUD, myelodysplasia

Question 22

What serum lab findings are indicative of sideroblastic anemia?

Answer 22

Low Hct, hypochromic

Question 23

What finding will be evident on peripheral smear on a patient with lead poisoning?

Answer 23

Basophilic stippling

Question 24

What is the treatment for sideroblastic anemia?

Answer 24

Chelation if lead toxicity, transfusion if symptomatic

Question 25

What are the most common causes of normocytic anemia?

Answer 25

Acute blood loss, chronic disease, organ failure, impaired marrow function.

Question 26

List some conditions that may cause impaired marrow function.

Answer 26

Infection, medications, chemo/radiation, aplastic anemia

Question 27

What are the two most common causes of macrocytic anemia?

Answer 27

Folate deficiency, B12 deficiency

Question 28

List the causes of folic acid deficiency and state which is most common.

Answer 28

MC = poor dietary intake (anorexia is ex). Others = pregnancy, AUD, chronic hemolytic anemia, malabsorption (rare)

Question 29

What are the most important clinical features of folate deficiency anemia?

Answer 29

Sore toungue, vague GI S/S, absence of neuro S/S (differentiates from B12 deficiency)

Question 30

What lab finding is pathognomonic for folate deficiency?

Answer 30

hypersegmented polymorphonuclear cells

Question 31

What is the treatment for folic acid deficiency?

Answer 31

1st line = PO replacement with 1mg per day | Other: Decrease ETOH, avoid meds that hinder folic acid metabolism (Bactrim, seizure meds)

Question 32

Name and describe the most common cause of B12 deficiency.

Answer 32

Pernicious anemia - lack of intrinsic factor which is necessary for B12 absorption.

Question 33

Other than the most common, what are some causes of vitamin B12 deficiency?

Answer 33

Strict vegan diet, gastric surgery, pancreatic insufficiency, metformin, crohn’s

Question 34

What clinical feature differentiates B12 deficiency from folate deficiency and other causes of anemia?

Answer 34

Neurological symptoms

Question 35

How is B12 deficiency anemia treated?

Answer 35

B12 supplementation, PO cobalamin

Question 36

List three broad causes of hemolytic anemia and give examples of each.

Answer 36

Hereditary: Thalassemia, SCD, G6PD Immune: TTP, HUS, DIC Trauma: Burns

Question 37

What lab findings are consistent with hemolytic anemia?

Answer 37

Reticulocyte count > 2, dec Hgb, elevated indirect bilirubin (jaundice), elevated LDH

Question 38

What testing is done to detect antibodies for RBCs that may be a cause of hemolytic anemia?

Answer 38

Indirect Coombs Test: Looks for antibodies floating in blood --> done before blood transfusion or in pregnancy to determine sensitization to Rh Direct Coombs Test: Looks for antibodies on RBCs --> presence of clumping of RBCs (agglutination) is positive

Question 39

Describe S/S associated with polycythemia.

Answer 39

HA, dizziness, pruritis after showering, splenomegaly

Question 40

What is the most common cause of polycythemia?

Answer 40

Mutation of JAK2 gene

Question 41

What are the treatment options for polycythemia?

Answer 41

phlebotomy, hydroxyurea, aspirin

Question 42

Describe the type of pateint that will most commonly present with idiopathic thrombocytopenic purpura (ITP).

Answer 42

Child 2-6 years old with history of recent viral infection.

Question 43

What S/S are most commonly associated with ITP?

Answer 43

Easy bleeding/bruising, petechiae, purpura, and gingival bleeding

Question 44

What lab finding is most consistent with ITP?

Answer 44

Platelets < 50,000

Question 45

What is the treatment for ITP?

Answer 45

observation, steroids, IVIG