Anemia

Question 0

Autoimmune Hemolytic Anemia

Answer 0

Warm Agglutinins - IgG

Cold Agglutinins - IgM

Question 1

Approach to anemia

Answer 1

1. Check the WBC and platelets to see if they are abnormal
   - coagulation, marrow or complex problem
2. Check the MCV to determine micro or macrocytic anemia

Question 2

Lab tests used to evaluate anemia

Answer 2

Retic count
Serum folate/B12
Serum iron, TIBC, ferritin
Serum transferin receptor concentration
ESR, CRP fibrinogen and haptoglobin
Serum creatinine
Erythropoietin
TSH
LDH, bilirubin, haptoglobin
Urine hemosederin and hemoglobin
SPEP, UPEP and quantitative immunoglobulins

Question 4

Retic count

Answer 4

High - bleeding, hemolysis
Low - hypo proliferative bone marrow
>100, 100/uL - increased erythropoiesis and shift in reticulocyte pool from marrow to peripheral blood - bleeding, hemolysis, response to treatment
- calculate RPI - <2 implies inadequate bone marrow response

Question 5

Folate/B12

Answer 5

Detects deficiency in macrocytic anemia

- will show hyper segmentation of neutrophils

Question 5

ESR, CRP fibrinogen and haptoglobin

Answer 5

acute phase reaction due to inflammatory cytokines,

• decrease erythropoietin production,
• decrease responsivemess to erythropoietin
• block iron transport

Question 6

Serum creatinine

Answer 6

high - underproduction of erythropoietin

Question 7

Serum iron, TIBC, ferritin

Answer 7

Low serum iron - iron deficiency, anemia of chronic disease or inflammation
iron deficiency - high TIBC, low ferritin, low % sat
chronic disease - low TIBC, normal/high ferritin, low/normal transferrin
inflammation - low TIBC

Question 8

Erythropoietin

Answer 8

rises logarithmically above normal levels in relation to decreasing hematocrit

Question 9

TSH

Answer 9

hypothyroidism which can cause anemia

Question 10

Haptoglobin, LDH, bilirubin

Answer 10

Hemolysis:

• Hapto < 20 - hemolysis
• elevated LDH and total bilirubin levels

Question 11

Urine hemosiderin and hemoglobin

Answer 11

intravascular hemolysis

Question 12

SPEP, UPEP, immunoglobulins

Answer 12

possible plasma cell myeloma or lymphoma

Question 13

Intravascular hemolysis

Answer 13

Hemolysis associated with cold agglutinin disease (IgM) or thrombotic microangiopathy

Question 14

Extravascular hemolysis

Answer 14

Hemolysis mediated by the spleen

supported by IgG - spleen, macrophages, cells opsinized, phagocyte activity

Question 15

Ddx for Microcytic Anemia

Answer 15

Iron deficiency anemia - increased RDW
a-thalassemia trait - normal RDW
B-thalassemia trait
B-thalassemia intermedia
Sickle cell-B-thalassemia

Question 16

Ddx for Megaloblastic Anemia

Answer 16

Folate deficiency
VB12 deficiency
Drug-induced changes in erythrocytes
Erythroleukemia

Question 17

Ddx for Hemolytic Anemia

Answer 17

Membrane defect
Enzymopathy
Hemoglobinopathy
Autoimmune hemolytic anemia
Erythrocyte fragmentation (TTP, HUS, DIC
Infection - malaria
Hypersplenism

Question 18

DDx for Normocytic anemia

Answer 18

Acute blood loss
CKD
Red cell aplasia
Malignancy
Alcoholic liver disease
Anemia of inflammation
Hemolytic anemia

Question 19

Treatment of sickle cell

Answer 19

hydroxyurea

Question 20

Complications of Hodgkin’s

Answer 20

Myelodysplastic syndrome and acute leukaemia in 3 - 11 years

Question 21

Human parovirus B19

Answer 21

Server chornic anemia in HIV patients
- lg multinucleated dysplastic proerythroblasts
- cessation of erythropoiesis with associated reticulocytopenia
Dx: paravirus in serum
Tx: IV immunoglobin

Question 22

Thalassemia

Answer 22

Betathalassemia - increased A2

Question 23

Symptoms of multiple myeloma

Answer 23

Anemia
Hypercalcemia
Renal dysfunction
Total protein level is increased in the presence of normal albumin

Question 24

Causes of Nucleated RBC

Answer 24

sickle cell disease/thalassemia
Myelofibrosis/metastatic disease
Sepsis/Life threatening trauma

Question 25

Diagnosis of hemolytic anemia

Answer 25

Elevated retic count
Elevated LDH
Elevated indirect bilirubin