Anemia

Question 1

What are the 3 main categories of anemia based on MCV?

Answer 1

Microcytic (<80 fL), Normocytic (80-100 fL), Macrocytic (>100 fL)

Question 2

Microcytic Anemias Mnemonic?

Answer 2

“Small TICS cause microcytic anemia!”

T: Thalassemia, I: Iron Deficiency Anemia (IDA), C: Chronic Disease (ACD, sometimes microcytic), S: Sideroblastic Anemia

Question 3

Macrocytic Anemias Mnemonic?

Answer 3

“BIG FAT- RBCs”
for Macrocytic Anemia

B: B12 Deficiency, I: Inherited (rare), G: Gastrointestinal issues (malabsorption), F: Folate Deficiency, A: Alcoholism, T: Thyroid (hypothyroidism), R: Reticulocytosis, B: Bone Marrow Disorders (MDS), C: Cirrhosis/Liver Disease

Question 4

Normocytic Anemias Mnemonic?

Answer 4

“NORMAL SIZE”

N: Normal pregnancy, O: Overhydration, R: Renal Disease (↓ erythropoietin), M: Malignancy (cancer), A: Acute Blood Loss, L: Liver Disease, S: Systemic Inflammation (Anemia of Chronic Disease), I: Iron Redistribution (ACD, CKD), Z: Zero production (Aplastic Anemia), E: Endocrine (Hypothyroidism, Adrenal Insufficiency)

Question 5

How do you differentiate IDA from Thalassemia?

Answer 5

“TICS vs. IRON”

T: Thalassemia → Target cells, normal/high ferritin; I: Iron Deficiency → Low iron, ↑ RDW; C: Chronic Disease → Chronic inflammation, normal/high ferritin; S: Sideroblastic → Stippling on smear (think lead poisoning!)

Question 6

What are the key lab values to differentiate IDA from Thalassemia?

Answer 6

Lab Test | IDA ⛔ | Thalassemia 🧬 |
|———————-|————|—————-|
| MCV (size) | Low (75-80) | Very low (<75, even <60) |
| RDW (variation) | High | Normal |
| Ferritin (iron stores) | Low | Normal/High |
| Mentzer Index (MCV/RBC count) | >13 (IDA) | <13 (Thalassemia) |
| Peripheral Smear | Small, pale RBCs | Target cells, basophilic stippling |
| Response to Iron? | Yes, improves | No, iron overload risk! |
| Hb Electrophoresis? | Normal | Abnormal (↑ HbA2, HbF in β-thalassemia)

Question 7

Which anemia is associated with SLE?

Answer 7

Autoimmune Hemolytic Anemia (AIHA) (Dx Coombs +, reticulocytosis, spherocytes)

Question 8

What’s the triad of Meniere’s Disease?

Answer 8

Vertigo, Tinnitus, Sensorineural Hearing Loss

Question 9

What’s the most common cause of Otitis Externa?

Answer 9

Pseudomonas aeruginosa (Green discharge, tragus tenderness)

Question 10

Test Day Hack for microcytic anemia?

Answer 10

If a patient has microcytic anemia and you get an iron panel:
- Low ferritin + high RDW? → IDA
- Normal ferritin + normal RDW? → Thalassemia
- High ferritin + chronic disease history? → Anemia of Chronic Disease