Heme

Question 1

Rouleaux Formation

Answer 1

RBCs stick together like “stack of coins” due to increase plasma proteins

Disease: Multiple Myeloma

Question 2

Auto Agglutination

Answer 2

Clumping of RBCs due to IgM auto-antibodies coating the surface of RBCs

Diseases: Cold agglutinin autoimmune hemolytic anemia

Question 3

Howell-Jolly Bodies

Answer 3

Small dense basophilic RBC inclusions (usually removed by the spleen)

Diseases:

• Decreased splenic function: autosplenectomy (ie sickle cell disease)
• Severe hemolytic anemia, megaloblastic anemia

Question 4

Hemolytic Cells

Answer 4

Bite Cells: bite-like deformity due to phagocyte removal of denatured Hgb
-Thalassemia, G6PD deficiency

Schistocytes: Fragmented RBCs
-Hemolytic anemia

Keratocytes: Helmet shaped RBCs; mechanical RBC damage in small vessels

Question 5

Basophilic stippling

Answer 5

-Coarse blue granules in RBCs evenly distributed throughout the RBC

Diseases: Sideroblastic anemia; Thalassemias

Question 6

Echinocytes

“Burr Cells”

Answer 6

RBCs w/ numerous, small, evenly spaced projections due to abnormal cell membrane

Disease: Uremia

Question 7

Acanthocytes

“Spur Cells”

Answer 7

Few large spiny, irregular projections on the RBC membrane

Diseases: Liver dz, post splenectomy, thalassemia, autoimmune hemolytic anemia, renal dz

Question 8

Target Cells (Condocytes)

Answer 8

HYPOchromic RBC w/ round area of central pigment “target-shaped”

Diseases:

• Sickle Cell
• Thalassemia
• Severe Fe deficiency

Question 9

Hypersegmented neutrophils

Answer 9

Neutrophils w/ >5 lobes

Diseases: B12 & Folate deficiencies

Question 10

Auer Rods

Answer 10

Acute Myelogenous Leukemia (AML)

Question 11

Reed-Sternberg Cells

Answer 11

Hodgkin Lymphoma

Question 12

MCC of anemia worldwide

Answer 12

Iron deficiency anemia

Question 13

MCC of iron deficiency anemia in the US

Answer 13

Chronic blood loss

• excessive menstruation
• occult GI bleed (colon cancer)

Question 14

MCC of iron deficiency anemia worldwide

Answer 14

Decreased absorption

-Diet

Question 15

Iron deficiency anemia patho

Answer 15

Decreased RBC production due to lack of iron & decreased iron stores (decreased ferritin)

Question 16

Iron deficiency anemia clinical manifestations

Answer 16

• fatigue, weakness, dyspnea, irritability, anorexia
• Pagophagia: craving for ice
• Pica: appetite for non-food substance

PE: koilonychia, angular cheilitis, tachycardia, glossitis, pallor

Question 17

Iron deficiency anemia lab findings

Answer 17

• Microcytic Hypochromic anemia classic
• Increased RDW
• DECREASED ferritin, INCREASED TIBC, decreased transferrin saturation

Question 18

Iron deficiency anemia management

Answer 18

Iron replacement w/ Ferrous sulfate

Question 19

How to increase iron absorption

Answer 19

Take iron replacement w/ Vitamin C (ascorbic acid) w/ water or orange juice on an empty stomach

Question 20

Clinical manifestations of lead poisoning

Answer 20

Ataxia, fatigue, learning disabilities, difficulty concentrating, peripheral neuropathy (wrist or foot drop)

Intermittent abdominal pain, vomiting, loss of appetite, constipation

Question 21

Lead poisoning diagnosis/ lab values

Answer 21

Serum lead levels >10 mcg/dL

Peripheral smear: microcytic hypochromic anemia w/ basophilic stippling.
Ringed sideroblasts in the bone marrow

“Lead lines” on x-rays

Question 22

Lead poisoning management

Answer 22

Removal of source of lead

Succimer first-line as inpatient (oral chelation)

Question 23

Idiopathic bone marrow failure

Answer 23

Aplastic anemia

Question 24

Aplastic anemia classically caused by what toxin?

Answer 24

Benzene

Question 25

Pancytopenia w/ bone marrow hypocellularity

Answer 25

Aplastic anemia

Question 26

Clinical manifestations aplastic anemia/ pancytopenia

Answer 26

Easy bruising, bleeding, frequent infections, fatigue -Thrombocytopenia: mucocutaneous bleeding

Question 27

Most accurate test for aplastic anemia/ pancytopenia

Answer 27

Bone marrow biopsy -hypocellular, fatty bone marrow Diagnosis of exclusion if bone marrow biopsy failure

Question 28

Initial treatment of choice for aplastic anemia/ pancytopenia

Answer 28

Supportive management

Question 29

Treatment of choice for sever aplastic anemia/ pancytopenia in otherwise healthy pt <50 yrs

Answer 29

Allogenic hematopoietic stem call transplantation

Question 30

X-linked recessive disorder common in African American males

Answer 30

G6PD deficiency

Question 31

In G6PD deficiency, denatured hemoglobin precipitated as ____

Answer 31

Heinz bodies

Question 32

Exacerbating factors for G6PD deficiency

Answer 32

- Infections (MCC) - Fava beans - Medications: oxidative drugs (dapsone, primaquine, nitrofurantoin)

Question 33

Peripheral smear diagnosis for G6PD

Answer 33

Normocytic hemolytic anemia during crisis - schistocytes (bite or fragmented cells) - Heinz bodies hallmark

Question 34

Causes of Hemolytic anemia

Answer 34

- G6PD deficiency - Sickle cell disease - TTP - HUS - DIC

Question 35

Lab findings hemolytic anemia

Answer 35

- INCREASED reticulocyte count - INCREASED unconjugated (indirect) bilirubin - DECREASED haptoglobin - INCREASED LDH