RBC part 2

Question 1

what are the two most common causes of megaloblastic anemias

Answer 1

B12 and folate deficiencies

Question 2

CBC in megaloblastic anemia shows what

Answer 2

pancytopenia- decreased RBC counts, WBC counts and platelet counts

Question 3

the bone marrow in megaloblastic anemia shows what

Answer 3

giant bands

nuclear-cytoplasmic asynchrony

Question 4

the peripheral blood in megaloblastic anemia shows what

Answer 4

macrocytic anemia
macro-ovalocytes
anisopoikilocytosis
hypersegmented neutrophils

Question 5

neurological defects are associated with what cause of megaloblastic anemia

Answer 5

B12 deficiency

Question 6

signs and symptoms of B12 and folate deficiencies

Answer 6

anemia
atrophic glossitis
gastric gland atrophy
neurologic (B12 only)

Question 7

neurologic effects of B12 are due to what

Answer 7

demyelination of white matter of brain and dorsolateral columns of spinal chord
methylmalonic acid does this

Question 8

in anemias of chronic disease where are iron levels increased

Answer 8

bone marrow- mostly macrophages

Question 9

pernicious anemia is due to what

Answer 9

absent intrinsic factor (IF) which binds vitamin B12

Question 10

pernicious anemia is likely what kind of disease

Answer 10

autoimmune

Question 11

the autoantibodies in pernicious anemia are divided up how

Answer 11

Type I- (blocking)- block binding of B12 to IF
Type II (binding)- bind B12-IF complex

Question 12

pernicious anemia is associated with what

Answer 12

autoimmune disease:
hashimotos thyroiditis
adrenalitis
Grave’s disease

Question 13

the shilling test is used to measure what

Answer 13

absorption of B12

Question 14

folate deficiency is usually due to what

Answer 14

dietary insufficiency

Question 15

folate can be stored for how long and where

Answer 15

3-6 months in liver

Question 16

stage 1 of shilling test is done how

Answer 16

give radio labeled oral B12 and inject unlabeled B12 in bone
collect urine after 24 hours
Normal if a lot of of radio labeled B12 excreted
if abnormal proceed to stage II

Question 17

stage 2 of shilling test is done how

Answer 17

oral radiolabled B12 + IF
Inject IM unlabeled B12
if results are normal there is a IF deficiency (pernicious anemia)
if abnormal results small bowel malabsorption (celiac)

Question 18

If shilling test results yields abnormal stage I but normal stage II what does this mean

Answer 18

the stomach cannot make intrinsic factor/IF as in pernicious anemia

Question 19

If shilling test results yields abnormal stage I and stage II what does this mean

Answer 19

malabsorption of vitamin B12 and IF in the small intestine as in biliary disease, celiac disease, hypothyroidism, liver disease

Question 20

macrocytic anemia causes other than folate and B12

Answer 20

chemo
alcoholism
hypothyroidism
liver disease

Question 21

Diamond-Blackfan syndrome is the primary form of what

Answer 21

Pure Red Cell aplasia

Question 22

what is seen the peripheral blood of aplastic anemia

Answer 22

no reticulocytosis
pancytopenia
normocytic, normochromic anemia

Question 23

a dry tap is seen in what anemia

Answer 23

aplastic anemia

Question 24

what is seen clinically in aplastic anemia

Answer 24

anemia
neutropenia (infections)
thrombocytopenia (bleeding)

Question 25

how is aplastic anemia acquired

Answer 25

chemical, toxins, drugs, radiotherapy/irradiation, viral infections, SLE

Question 26

what is the most common acquired cause of aplastic anemia

Answer 26

autoimmune suppression by a T-cell mediated cell mechanism

Question 27

half of acquired aplastic anemias are due to what

Answer 27

idiopathic

Question 28

heridary aplastic anemia is also known as what

Answer 28

Fanconi's anemia

Question 29

hereditary aplastic anemia is due to defects in what

Answer 29

DNA repair mechanism

Question 30

what congenital anomalies are seen with Fanconi's anemia

Answer 30

hypoplastic radii thumbs organs

Question 31

Pure Red Cell Aplasia is what

Answer 31

``` only erythroid (RBC) cell line affected myeloid and platelet lines normal ```

Question 32

Pure Red Cell Aplasia what is seen in bone marrow

Answer 32

few to absent erythroid (RBC) precursors (erythroblasts)

Question 33

Pure Red Cell Aplasia is what type of disease and what mediates it

Answer 33

autoimmune disease mediated by T-lymphs or IgG antibody vs red cell precursors

Question 34

what viruses can cause aplastic anemia

Answer 34

Hepatitis, EBV, HIV, parvovirus

Question 35

pure red cell aplasia is associated with what

Answer 35

SLE CLL thymomas chloramphicol

Question 36

what is diamond-blackfan syndrome

Answer 36

severe anemia in first year of life, with congenital anomalies

Question 37

secondary form of pure red cell aplasia is due to what most of the time

Answer 37

infections especially parvovirus B19

Question 38

sideroblastic anemia is characterized by what histologically

Answer 38

ringed sideroblasts (cells with iron granules around the nucleus)

Question 39

sideroblastic anemia is due to what

Answer 39

failure to incorporate heme into protoporphyrin to form hemoglobin (adequate iron stores but defective utilization of red blood cells

Question 40

in sideroblastic anemia what are serum iron, transferrin saturation, and ferritin levels

Answer 40

all high

Question 41

hereditary sideroblastic anemia is transmitted via what pattern

Answer 41

X-linked recessive

Question 42

hereditary sideroblastic anemia is due to what

Answer 42

ALA synthase defect (rate limiting step in heme synthesis)

Question 43

how can sideroblastic anemia be acquired

Answer 43

myelodysplasia drugs (alcohol, isoniazid) LEAD nutritional deficiency

Question 44

how do you treat sideroblastic anemias

Answer 44

pyridoxine (vit b6)