Hematology Case Day

Question 1

Normal Number for Iron

Answer 1

50

Question 2

Normal number for TIBC

Answer 2

200-350

Question 3

Normal number for Ferratin

Answer 3

10-200

Question 4

What is PICA?

Answer 4

Strange craving to chew on things common in iron deficiency anemia
(Pagophagia – chewing on ice)

Question 5

Pertinent past medical and surgery examples given for diagnosis of anemia

Answer 5

IBD – Decreased B12 reabsorption

Gastric Bypass

Question 6

What does Hepcidin do

Answer 6

Decreases the transport of Iron

Question 7

Important anemia signs to look for on physical exam

Answer 7

Vital Sign Changes
Pallor
Splenomegaly
Neurologic Signs
Guiac Check in Rectal Exam

Question 8

Three crucial initial anemia labs

Answer 8

Reticulocyte Count
MCV
Peripheral Smear

Question 9

How to calculate absolute reticulocyte count (ABR)

Answer 9

(% retic count) * (RBC count)

Question 10

MCV= ______/________

Answer 10

Hct / RBC

Question 11

Low Retic. Count. Low MCV – Heme Defect – Name them

Answer 11

Iron Deficiency
Anemia of inflammation
Congenital Sideroblastic Anemia
Lead poisoning

Question 12

Low Retic Count, Low MCV – Globin Defect – Name them

Answer 12

Thalassemias

Question 13

What do you see on a peripheral smear with Iron Deficiency

Answer 13

Poikilocytosis

Thrombocytosis

Question 14

What do you see on a peripheral smear with Thalassemias

Answer 14

Target RBCs

Question 15

What do you see on a peripheral smear with Lead Poisoning

Answer 15

Basophillic stippling

Question 16

What do you see on a peripheral smear with Anemia of Inflammation

Answer 16

Toxic Granulation in neutrophils

Question 17

Iron Deficiency. Serum Iron, TIBC, Ferratin?

Answer 17

Iron – Low
TIBC – High
Ferritin – Low

Question 18

Anemia of Inflammation. Serum Iron, TIBC, Ferratin?

Answer 18

Iron – Low
TIBC – Low
Ferratin – Normal/High

Question 19

Thalassemia. Serum Iron, TIBC, Ferratin?

Answer 19

Iron – Normal
TIBC – Normal
Ferratin – Normal/High

Question 20

Def. megaloblastois if MCV is over

Answer 20

115

Question 21

Cause of megaloblastosis? non-megaloblastic anemias w/ low retic and high mcv?

Answer 21

Mega – DNA synth problem

Non-mega – Cholesterol membrane defects

Question 22

Two meds that may cause megaloblastic anemias

Answer 22

Hydroxyurea

Methotrexate

Question 23

What is seen in peripheral smears in B12/Folate Deficiency?

Answer 23

HYPERSEGMNETED NEUTROPHILS
Leukopenia
Thrombocytopenia

Question 24

What is seen in peripheral smears in MDS?

Answer 24

Pelger-Huet Anomaly of PMNs
Basophilic Stippling
Varying RBC Shapes

Question 25

What is a Pelger-Huet anomaly of PMNs?

Answer 25

Bilobed Neutrophil

Question 26

What might a low retic. count with a normal MCV mean

Answer 26

Primary BM failure (aplastic anemia, BM infiltration) | Secondary BM failure (Low EPI, Meds, Parvo, HIV)

Question 27

Describe the peripheral smear of a patient with marrow infiltration

Answer 27

Leukoerythroblastic (not enough room in the marrow to finish maturing, so imature RBCs and WBCs are released into the blood)

Question 28

Describe the peripheral smear of an aplastic anemia patient

Answer 28

Leukopenia and thrombocytopenia

Question 29

Describe the peripheral smear of a secondary marrow failure patient

Answer 29

Normal

Question 30

Anemia with a high reticulocyte count means,,,

Answer 30

Shortened RBC survival (Hemolysis or Blood Loss)

Question 31

General lab findings commonly seen in hemolytic anemia

Answer 31

High Retic, LCH, Bilirubin Low Haptoglobin Urine hemosiderin

Question 32

What is haptoglobin?

Answer 32

Its the guy that carries Iron back to the marrow

Question 33

If you do a Coombs test on a hemolytic anemia, what antibodies do you use?

Answer 33

IgG -- Warm | IgM -- Col

Question 34

What peripheral smear finding is associated with autoimmune hemolysis?

Answer 34

spherocytosis

Question 35

Common causes of mechanical hemolysis

Answer 35

TTP/HUS (Microangiopathic Hemolytic Anemia) | Prosthetic Valve Hemolysis

Question 36

Hereditary conditions associated with non-immune hemolysis?

Answer 36

``` Hemoglobinopathies (Sickle Cell) Enzyme defects (G6PD) Membrane Defects (hereditary spherocytosis) ```

Question 37

Spur cell anemia is found in...

Answer 37

Liver Failure

Question 38

Infection related hemolysis is foudn in...

Answer 38

malaria and babesiosis

Question 39

Difference between a B12 and a folate deficiency

Answer 39

B12 has neuro symptoms and folate does not

Question 40

Test for hereditary spherocytosis

Answer 40

Osmotic Fragility Test