aenmia

Question 1

lab definition of anemia

Answer 1

1) men Hgb < 13 g/dL
2) women Hgb < 12 g/dL

Question 2

diagnosis of anemia - 3 steps

Answer 2

1) history taking
2) physical examination
3) lab evaluation

Question 3

diagnosis of anemia - history taking

Answer 3

1) blood loss
2) duration of anemia, genetic/acquired
3) any clinical features? due to infection or malignancy?

• jaundice, pallor in eyelid tongue, check nail bed

4) comorbidities
5) arthritis, IBD
6) any other complaints/sypmtoms

Question 4

diagnosis of anemia - lab evaluation

Answer 4

1) FBC: anemia, MCV
2) reticulocyte count: increase = negative feedback for anemia
3) peripheral smear

Question 5

general overview of types of anemia

Answer 5

1) iron deficiency anemia (IDA): microcytic anemia
2) Vit B12 or folate deficiency: macrocytic anemia
3) anemia of inflammation/chronic deficiency

Question 6

iron deficiency anemia (IDA)

Answer 6

• low MCV, low Hgb
• causes
  1) decreased iron absorption -> decreased ferritin store
  2) blood/iron loss
• treatment: 1000 - 1500mg elemental iron for at least 3 - 6 month

Question 7

Vit B12 or folate deficiency anemia - definition

Answer 7

high MCV, low Hgb

Question 8

Vit B12 or folate deficiency anemia - causes

Answer 8

1) reduced absorption
2) nutritional
3) other causes that disrupt gastric mucosa so no more acidic pH thats required to absorb iron and Vit B12 (PPi, H2RA, h. pylori)

Question 9

Vit B12 or folate deficiency anemia - treatment

Answer 9

1) Vit B12 IM/SQ

• 1000mg microgram OD 1 wk -> 1000 microgram every wk for 4 wks -> 1000 microgram every month for life

2) folate (B9)

• 1mg folate OD for 1 - 4 months or until recovery

Question 10

anemia of inflammation of chronic diseases - causes

Answer 10

malignancy, HIV, rheumatologic disorder, IBD, HF, renal insufficiency, COPD

Question 11

differentiate IDA and anemia of inflammation

Answer 11

1) measure ferritin

• low in IDA, normal/high in inflammation

2) measure TIBC

• high in IDA, low in inflammation

3) measure TSAT

• iron/TIBC X 100%
• low in IDA, high in inflammation

Question 12

types of drug induced haematological disorders

Answer 12

1) aplastic anemia
2) drug induced neutropenia or agranulocytosis WBC)
3) haemolytic anaemia (RBC)
4) megaloblastic anemia (RBC)
5) thrombocytopenia

Question 13

definition of aplastic anemia

Answer 13

• 2 or 3 types of blood cells affected
• any 2 of

1) WBC count ≤ 3500 cells/mm&3
2) platelet count ≤ 550000 cells/mm^3
3) Hgb ≤ 10 g/dL + reticulocyte count ≤ 30000 cells/mm^3

Question 14

drugs associated with aplastic anemia

Answer 14

furosemide, NSAID, phenobaribital, sulfonamide, phenytoin, carbamazepine, thiazide, chemo, radio

Question 15

treatment of asplastic anemia

Answer 15

• withhold offending drug
• immunosuppressant: glucocorticoid
• prevent opportunistic infection
  ** prophylactic Abx and antifungal when neutrophil ≤ 500
  ** start broad spectrum if febrile neutropenia
• prevent bleeding
  ** blood transfusion: iron chelation if too much transfusion, G-CSF or hematopoietic stem cell transplant

Question 16

definition of dug induced neutropenia or agranulocytosis (WBC)

Answer 16

1) neutropenia: absolute neutrophil count < 1500
2) agranulocytosis severe neutropenia, absent neutrophil count

Question 17

drugs associated with drug induced neutropenia or agranulocytosis (WBC)

Answer 17

anti thyroid, antipsychotic (clozapine), valproic acid, penicillin

Question 18

treatment of drug induced neutropenia or agranulocytosis (WBC)

Answer 18

• withhold offending drug and do not restart: can restart penicillin at lower dose once neutropenia resolved
• neutrophil nadir (lowest point) < 100: give filgrastim SQ 300 microgram/day

Question 19

diagnosis of hemolytic anemia

Answer 19

Coomb’s test

Question 20

causes of hemolytic anemia

Answer 20

1) IgM and IgG mediated RBC destruction
2) drug-induced: methyldopa, fluoroquinolones, sulfonylureas
3) G6PD deficiency

Question 21

treatment of haemolytic anemia

Answer 21

1) withhold offending drug
2) give supplement (Vit B12 or folate) if cannot withhold

Question 22

what is megaloblastic anaemia

Answer 22

large RBC but low number

Question 23

drugs causing folate deficiency

Answer 23

antimetabolites, cotrimoxazole, phenytoin, phenobarbital

Question 24

treatment of megaloblastic anemia

Answer 24

withhold offending drugs

• except cotrimoxazole give folinic acid 5 - 10mg up to 4 times a day

Question 25

definition of thrombocytopenia

Answer 25

platelet count < 100000 cells/mm^3 or > 50% reduction from baseline

Question 26

causes of thrombocytopenia

Answer 26

1) UFH not LMWH
2) GPIIb/GPIIa inhibitor

Question 27

treatment of thrombocytopenia

Answer 27

1) withhold offending drug
2) immunosuppressants: glucocorticoid
3) if severe: corticosteroid