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OS 216 - Hematology Exam > Acquired Hemolytic Anemia, Blood Loss, Metabolic and Nutritional Causes of Anemia (Angelina L. Mirasol, MD) > Flashcards

Acquired Hemolytic Anemia, Blood Loss, Metabolic and Nutritional Causes of Anemia (Angelina L. Mirasol, MD) Flashcards

1
Q

Electrophoresis pattern in patient with hemoglobin H disease:

a. A1 increased, A2 increased
b. A1 decreased, A2 increased
c. A1 increased, A2 decreased
d. A1 decreased, A2 decreased

A

D. A1 decreased, A2 decreased

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2
Q

T/F: In terms of treatment, Iron deficiency is a more serious condition than iron overload.

A

False

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3
Q

T/F: Iron supplementation is a necessity in hemoglobin H patients.

A

False

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4
Q

T/F: Blood transfusion is a strong recommendation for treatment of hemoglobin H disease.

A

True

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5
Q

T/F: Conducting a peripheral blood smear is a necessity for the diagnosis of hemoglobin h disease as CBC results will suffice.

A

True

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6
Q

In severe iron deficiency anemia with symptoms of high output failure, which is the best blood product for transfusion?

a. packed RBC
b. fresh whole blood
c. whole blood
d. heparinized whole blood

A

A. packed RBC

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7
Q

The most common single cause of iron deficiency in women is

a. poor intake of iron
b. obesity
c. poor release of iron by the reticulo-endothelial system
d. menstrual blood loss

A

D. menstrual blood loss

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8
Q

Parenteral iron is given if (2012, 2014)

a. rapid increase in hemoglobin (HB) is desired
b. malabsorption syndrome exists
c. the patient requests for it
d. rapid utilization of iron by the body

A

B. malabsorption syndrome exists

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9
Q

Infants should be given iron supplements as early as 2 months of age because

a. they are easily prone to colic
b. human and cow’s milk are poor sources of iron
c. they bleed easily
d. they have poor iron absorption

A

B. human and cow’s milk are poor sources of iron

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10
Q

Iron Deficiency Anemia produces this type of anemia

a. hypochromic, macrocytic
b. normochromic, macrocytic
c. hypochromic, microcytic
d. normochromic, microcytic

A

C. hypochromic, microcytic

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11
Q

Regulatory hormone for erythropoiesis

A

Erythropoietin (EPO)

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12
Q

Normal levels of EPO

A

10 - 25 U/L

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13
Q

Average life span of adult RBC

A

100 - 120 days (3 - 4 months)

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14
Q

Normal daily rate of RBC replacement

A

0.8 - 1.0% (2.5 M)

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15
Q

Machinery for RBC production

A

Erythron

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16
Q

Enumerate the critical elements for erythropoiesis

A

EPO
Iron Availability (+B12 & Folic Acid)
Proliferative Capacity of Bone Marrow
Effective Maturation of Red Cell Precursors

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17
Q

Responsible for destroying abnormal RBCs

A

Reticuloendothelial System (RES)

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18
Q

Sites of RBC production

A

Children < 5 y/o - marrow in all bones

Adults - marrow of spine, ribs and pelvis

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19
Q

Where are bone marrow samples taken from?

A

Sternum & Tibia (Biopsy)

Posterior Superior Iliac Spines of Pelvis (Aspiration)

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20
Q

Normal RBC levels according to WHO

A

Male: 130 - 170 g/L
Female: 120 - 170 g/L

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21
Q

RBC level range for mild anemia

A

80 - 120 g/L

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22
Q

Most common symptom of anemia

A

Weakness and fatigue

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23
Q

Present in 25 - 30% of people with iron deficiency and possibly due to dopamine abnormalities in the brain

A

Restless Leg Syndrome (RLS)

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24
Q

RBC level range for severe anemia

A

< 80 g/L

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25
Q

Cause and duration of acute anemia

A

Cause: blood loss
Duration: several hours to a few days only

Note: Body has no time to compensate.

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26
Q

It is safe to lose up to how much of your blood volume?

A

15%

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27
Q

Ranges of proportion of volume loss in the different classes of hypovolemic shock

A

Class I - 40%

28
Q

T/F: There is increased peripheral resistance in chronic anemia because blood is more viscous.

A

False

Decreased peripheral resistance because blood is less viscous

29
Q

T/F: In chronic anemia, it is symptomatic because the body has time to compensate

A

False

Asymptomatic

30
Q

Compensatory mechanisms for chronic anemia

A

Tachycardia
Increased DPG
Increased O2 delivery

31
Q

Laboratory tests for anemia

A

Complete Blood Count (CBC)
Reticulocyte Index/Count
Iron Supply Studies
Marrow Examination

32
Q

Define: Reticulocyte

A

Immature RBC

33
Q

What should be done prior to a marrow iron stain?

A

Bone marrow aspiration

34
Q

Disorders with decreased serum EPO

A

Renal disease
Endocrine deficiencies (Hypopituitarism, hypothyroidism, hypocorticoidism and hypogonadism)
Starvation
Chronic disease anemia

35
Q

Disorders with marrow unresponsiveness to EPO

A

Nutritional deficiency
Sideroblastic anemias
Pure red cell aplasia (e.g. Fanconi’s Anemia)

36
Q

Typical RBC deformities

A

Burr cells

Acanthocytes

37
Q

What is the EPO treatment of choice for disorders with impaired erythropoiesis?

A

3000 units subcutaneous 3x/day (up to as much as 10k units)

38
Q

T/F: Anemia of chronic diseases is caused by inadequate delivery of iron to marrow despite normal or increased iron stores.

A

True

39
Q

Three stages leading from iron deficiency to anemia

A

Stage 1 - Negative Iron Balance
Stage 2 - Iron-deficient Erythropoiesis
Stage 3 - Iron Deficiency Anemia

40
Q

Enumerate the stages of pregnancy and the iron blood level cut-offs for IDA

A

1st Trimester - <11.0

41
Q

Iron used in heme is transported from GIT to RES to red cell precursors by what?

A

Transferrin

42
Q

Describe: Polycythemia Vera

A

Panhyperplastic, malignant, neoplastic marrow disorder

Uncontrolled RBC production

43
Q

Which part of the GIT is iron absorbed?

A

Proximal small intestines

44
Q

T/F: Total Iron Binding Capacity (TIBC) is decreased in Iron Deficiency Anemia

A

False

It is increased!

45
Q

T/F: RBCs may be normocytic and normochromic in Sideroblastic Anemia.

A

True

46
Q

Differentiate ferritin levels in IDA, Thalassemia and Sideroblastic Anemia

A

IDA - low

Thalassemia & Sideroblastic Anemia - normal

47
Q

Shelf life of PRBC depending on anticoagulant

A

Acid-Citrate-Dextrose (ACD) - 21 days
Citrate-Phosphate-Dextrose-Adenine (CPDA) - 28 days
Saline-Adenine-Glucose-Mannitol (SAGM) - 42 days

48
Q

Describe the ineffective erythropoiesis in megaloblastic anemia

A

Cellularity increased but production is decreased since cells tend to be destroyed in the bone marrow.

49
Q

Major causes of Megaloblastic Anemia

A

Vit. B12 (cobalamin) deficiency (Type I)

Folic acid deficiency (Type II)

50
Q

Major storage site of cobalamin

A

Liver

51
Q

Minimum daily folic acid requirement

A

50 micrograms

52
Q

Major absorptive site of folic acid

A

Proximal jejunum

53
Q

Minimum daily Vitamin B12 requirement

A

1 - 2.5 micrograms

54
Q

Major absorptive site of cobalamin

A

Ileum

55
Q

Common causes of Megaloblastic Anemia in the temperate zone

A

Folate deficiency - alcoholics

Cobalamin deficiency - pernicious anemia or achlorhydria

56
Q

Common cause of Megaloblastic Anemia near the equator

A

Tropical sprue (malabsorption due to villi flattening)

57
Q

Common cause of Megaloblastic Anemia in Scandinavian countries

A

Diphyllobotrium latum

58
Q

Laboratory findings that diagnose Megaloblastic Anemia

A

Hypersegmentation in blood smear

Improvement of urine Vit B12 with IM and oral doses in Schilling’s test

59
Q

Cause of pernicious anemia

A

Absence of intrinsic factor (IF)

60
Q

Individuals predisposed to developing pernicious anemia

A

Northern Europeans & African Americans
Elderly
Patients with immunologic diseases

61
Q

Major concern of patients with pernicious anemia and Vit. B12 deficiency anemia

A

Folic acid supplements can mask presence of diseases but not cure them

62
Q

T/F: Autoimmune Hemolytic Anemia is linked to a higher incidence of lymphoproliferative disorders.

A

True

63
Q

Characterized by polychromatophilic blood smear and elevated reticulocyte count

A

Autoimmune Hemolytic Anemia

64
Q

Describe the haptoglobin and bilirubin levels in Autoimmune Hemolytic Anemia patients

A

Haptoglobin is low.

Bilirubin is high.

65
Q

Diagnostic test for Autoimmune Hemolytic Anemia

A

Direct Coombs’ Test

66
Q

T/F: Mainly intravascular Autoimmune Hemolytic Anemias are detected.

A

False

Extravascular

OS 216 - Hematology Exam (8 decks)

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