ANEMIA

Question 1

What is the threshold for blood transfusion? How much does 1 unit pRBC increase Hgb?

Answer 1

Hgb < 70 AND symptomatic

1 pRBC raises Hgb by 10 g / L

Question 2

5 clinical features/Symptoms

Answer 2

Fatigue
Shortness of breath
Faintness / Light head
Syncope / Presyncope 
Palpitations

Question 3

4 Red Flags

Answer 3

Tachycardia
Hypotension
Hypothermia
Decreased LOC

Question 4

3 vital signs

Answer 4

HR: Tachycardia
RR: Tachypnea
BP: HoTN

Question 5

6 Physical Exam Features

Answer 5

Murmur
Hyperdynamic precordium
Pallor
Koilonychia
Petechiae / Purpura
Enlarged lymph nodes
Enlarged spleen (hemolysis)
DRE
Proprioception deficits (Romberg)

Question 6

6 specific lab tests

Answer 6

Serum Hemoglobin
Mean Cell Volume
Consider platelets (r/o pancytopenia)
Reticulocyte 
Serum Ferritin
Serum Iron
Total Iron Binding Capacity
Peripheral Blood Smear
Beta-HcG
Hb Electrophoresis
LDH
Bilirubin
Haptoglobin
Consider COOMB’s test
TSH / B12 / Folate
DIC Panel

Question 7

2 specific adjunct investigations

Answer 7

Colonoscopy

Bone Marrow Biopsy

Question 8

Differential Diagnosis for Microcytic Anemia (MCV < 80)

Answer 8

TAILS
•	Thalassemia
•	Anemia of Chronic Inflammation
•	Iron Deficiency
•	Lead Poisoning
•	Sideroblastic Anemia

Question 9

D/Dx / Risk Factors for Iron Deficiency Anemia

Answer 9

Women
Children
↓Supply: dietary, malabsorption
↑Loss: hemorrhage (PUD, menorrhagia, GI bleed etc).

Question 10

3 specific iron studies and what their values will be

Answer 10

↓↓ Serum Ferritin
↓Serum Fe
↑TIBC

Question 11

What is the treatment for iron deficiency anemia? What are recommended doses? How long do you treat for after resolution? What has the highest content iron? What timing of dosing is best absorbed, with what adjunct? What is best for children? What treatment is used if oral is not adequate?

Answer 11

100-200 mg elemental iron / d
Treat for 4-6 months after resolution 
Highest Content: Ferrous Fumarate
Best Absorbed: every other day, with Vit C, NO tea
Best for Children: Ferrous Sulfate
If Oral is ineffective: IV iron dextran

Question 12

6 Risk factors for Thalassemia (locations)

Answer 12

Africa
Middle East
Caribbean
Mediterranean
South East Asia
South American

Question 13

3 Red Flag questions for Thalessemia

Answer 13

Any chance you’re pregnant
Are you TRYING to get pregnant?
Does your partner have thalassemia?

Question 14

3 specific iron studies and what their values will be. for Thalessemia? What other blood test is needed to confirm the diagnosis of Thalessemia?

Answer 14

↑/N Serum Ferritin
↑/N Serum Fe
↓TIBC
Hemoglobin Electrophoresis

Question 15

Clinical Features of Lead Poisoning

Answer 15

L: Lead lines on gingiva + epiphysis of long bones
E: Encephalopathy
A: Abdo Colic
D: Foot / Wrist Drop

Question 16

First line treatment of Lead Poisoning

Answer 16

Dimercaprol + EDTA

Question 17

3 specific iron studies for anemia of chronic disease and what their values will be.

Answer 17

↑/N Serum Ferritin
↓Serum Fe
↓TIBC

Question 18

D/Dx for normocytic anemia with an elevated reticulocyte count (RBC > 2%)

Answer 18

Hemorrhage

Hemolysis

Question 19

6 D/Dx for normocytic anemia with a decreased reticulocyte count (RBC < 2%)

Answer 19

CKD
Marrow Disorder (Pure Red Cell Aplasia)
Marrow Suppression (↓WBC, ↓platelets)
Infiltrative (leukemia, infection)
Anemia of chronic disease
Sequestration
Pregnancy
Endocrinopathy

Question 20

4 specific labs when suspecting hemolysis

Answer 20

LDH
Haptoglobin
Indirect Bili
Blood Smear: Red Cell Fragmentation, Tear Drop RBC, Microspherocytes

Question 21

6 D/Dx for hemolytic anemia

Answer 21

spherocytosis 
G6PD
sickle cell
thalassemia
autoimmune
MAHA
thrombotic thrombocytopenic purpura
malaria
PNH

Question 22

3 clinical features of hemolysis

Answer 22

Jaundice
dark urine
cholelithiasis

Question 23

5 risk factors for B12 deficiency

Answer 23

Gastric Surgery
Strict Vegan
Breastfed Children of # 2
Elderly
Psychiatric