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Heme and Lymph Exam 2 > Anemia by PALES CIS - SRS > Flashcards

Anemia by PALES CIS - SRS Flashcards

1
Q

What does the presence of reticulocytes indicate?

A

Bone marrow is working alright

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2
Q

¨28 year old Arab-American female presents for routine physical. She has no symptoms and routine blood work was ordered. Below are the results:

WBC 6.5 (4.3 – 10.8)

RBC 6.2 (4.2 – 5.9)

Hemoglobin 11.1 (12-16)

Hematocrit 33% (37-48)

MCV 58 (80-100)

RDW 12 (11-15)

Platelets 320 (150-400)

Does this patient have anemia?

A

Yes. Hematocrit and Hb are low.

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3
Q

What is the relationship mathematically between RDW, Hb and Hct?

A

RDW = 3* RBC

Hct = 3 * Hb

Hb = Hb/3

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4
Q

What is the differential diagnosis for this patient?

¨WBC 6.5 (4.3 – 10.8)

¨RBC 6.2 (4.2 – 5.9)

¨Hb 11.1 (12-16)

¨Hct 33% (37-48)

¨MCV 58 (80-100)

¨RDW 12 (11-15)

¨Platelets 320 (150-400)

A

Microcytic anemia

    • Iron deficiency
    • sideroblastic anemia (not gonna be a question)
    • thalassemia
  4. lead poisoning
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5
Q

Does having normal Ferritin rule out iron deficiency?

A

No, can have elevated ferritin in anemia of chronic disease, since it is an acute phase reactant. If low, then pathongomonic for iron deficiency though.

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6
Q

¨What is the most likely diagnosis based on the iron studies results?

¨WBC 6.5 (4.3 – 10.8)

¨RBC 6.2 (4.2 – 5.9)

¨Hb 11.1 (12-16 female)

¨Hct 33% (37-48 female)

¨MCV 58 (80-100)

¨RDW 12 (11-15)

¨Platelets 320 (150-400)

¨Ferritin 115 (12-160 Female)

¨Iron 70 (26-170 Female)

¨TIBC 312 (262-474)

A

Thalassemia

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7
Q

How do you confirm diagnosis of thalassemia in the patient? 2

A
  1. Electrophoresis
  2. genotypical screening
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8
Q

What will happen with the RBC’s in a thalassemia?

A

Typically will see increased numbers of small RBCs as the marrow tries to compensate for the Hb binding problems.

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9
Q

What constitutes a positive hemoglobin electrophoresis?

What thalassemia does not show up on electrophoresis?

Why?

A

A positive hemoglobin electrophoresis is seen when you have multiple types of Hb.

Alpha thalassemias - since you cannot replace alpha chains.

Has only one type of hemoglobin.

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10
Q

What type of thalassemia can you dx with hemoglobin electrophoresis?

A

Beta

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11
Q

How would you treat this patient with thalassemia?

¨28 year old Arab-American female presents for routine physical. She has no symptoms and routine blood work was ordered. Below are the results:

¡WBC 6.5 (4.3 – 10.8)

¡RBC 6.2 (4.2 – 5.9)

¡Hemoglobin 11.1 (12-16)

¡Hematocrit 33% (37-48)

¡MCV 58 (80-100)

¡RDW 12 (11-15)

¡Platelets 320 (150-400)

A

Don’t, they are asymptomatic

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12
Q

35 year old male presents to his PCP with c/o fatigue, exercise intolerance, shortness of breath with stairs and cravings for ice.

PMH is remarkable for gastric bypass surgery he had 3 years ago for obesity, after which he lost 127 lbs

Patient is visibly pale on exam but has no abdominal tenderness.

Patient is taking Omeprazole, multivitamin and monthly vitamin B12 shots

WBC 5.1 (4.3 – 10.8)

RBC 2.6 (4.2 – 5.9)

Hb 7.7 (13.2-16.2 Male)

Hct 23 % (40-52 Male)

MCV 71 (80-100)

RDW 14 (11-15)

Platelets 190 (150-400)

What is the differential diagnosis?

A

Microcytic anemia

  1. Iron deficiency
  2. Thalassemia
  3. Lead poisoning
  4. Sideroblastic anemia
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13
Q

¨WBC 5.1 (4.3 – 10.8)

¨RBC 2.6 (4.2 – 5.9)

¨Hb 7.7 (13.2-16.2 Male)

¨Hct 23 % (40-52 Male)

¨MCV 71 (80-100)

¨RDW 14 (11-15)

¨Platelets 190 (150-400)

¨Iron (TSI) 34 (76-198 Male)

¨TIBC 590 (262-474 )

¨Ferritin 7 (18-250 Male)

What is the most likely anemia?

A

Iron deficiency anemia

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14
Q

What could be possible causes of this patient’s iron deficiency anemia and what other tests would we need to order to sort this out?

¨35 year old male presents to his PCP with c/o fatigue, exercise intolerance, shortness of breath with stairs and cravings for ice.

¨PMH is remarkable for gastric bypass surgery he had 3 years ago for obesity, after which he lost 127 lbs

¨Patient is visibly pale on exam but has no abdominal tenderness.

¨Patient is taking Omeprazole, multivitamin and monthly vitamin B12 shots

A

Gastric bypass - Not absorbin iron from the duodenum d/t no H+ iron to reduce the iron to ferrous state.

PPI - further decreasing Iron reduction.

Chronic bleeding - from the bypass surgery.

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15
Q

Most common cause of iron deficiency in premenopausal female is?

A

Menses

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16
Q

Why was that patient craving ice?

A

Iron deficiency anemia causes pica

17
Q

What neurological condition is associated with iron deficiency?

A

Restless Leg syndrome

18
Q

Why was that patient on B12 shots?

A

Gastric bypass surgery = decreased intrinsic factor

19
Q

How would you treat that patient?

A

Iron supplements, with orange juice or vitamin C

Could also do IM or IV if necessary, but will stain the skin badly.

20
Q

¨After 2 weeks of iron replacement, hemoglobin has improved, but his RDW went up. Why?

A

Reticulocytosis

21
Q

52 year old alcoholic male admitted to the hospital with delerium tremens.

He has a history of alcoholic cirrhosis

Last year was in the hospital for upper GI bleeding

EGD showed Grade 3 esophageal varices

Quick H/H was done in ER and showed anemia

What MCV would you expect to see on this patient’s CBC based on the history?

A

Macrocytic, or microcytic, or normocytic

Cirrhosis - macrocytic

Bleed - normocytic

Microcytic - maybe iron def.

22
Q

¨52 year old alcoholic male admitted to the hospital with delerium tremens.

¨He has a history of alcoholic cirrhosis

¨Last year was in the hospital for upper GI bleeding

¨EGD showed Grade 3 esophageal varices

¨Quick H/H was done in ER and showed anemia

¨WBC 2.9 (4.3 – 10.8)

¨RBC 3.3 (4.2 – 5.9)

¨Hb 9.1 (13.2-16.2 Male)

¨Hct 28 % (40-52 Male)

¨MCV 95 (80-100)

¨RDW 19 (11-15)

¨Platelets 105 (150-400)

¨Pancytopenia is present. What could explain this based on the patient’s history?

A

Bone marrow suppression from alcohol

Drugs

Chemical exposure

Cirrhosis

Splenomegaly with sequestration

23
Q

What does increased RDW suggest in the last patient?

A

Mixed population of cells

or mixed anemia

or reticulocytosis

24
Q

¨What is most likely cause(s) of anemia in this patient based on these findings?

¨WBC 2.9 (4.3 – 10.8)

¨RBC 3.3 (4.2 – 5.9)

¨Hb 9.1 (13.2-16.2 Male)

¨Hct 28 % (40-52 Male)

¨MCV 95 (80-100)

¨RDW 18 (11-15)

¨Platelets 105 (150-400)

¨Retic Count 0.8 (0.5-1.2)

¨Iron (TSI) 101(76-198 Male)

¨TIBC 250 (262-474 )

¨Ferritin 110 (18-250 Male)

¨Vit. B12 725 ( 180-800)

¨RBC Folate 320 (187-645)

¨Haptoglobin 270 (41–165)

¨Stool is hemocult positive

A

Mixed anemia!

Cirrhosis

Anemia of chronic disease

Acute bleed

25
Q

35 year old female presents with weakness, fever, dysuria and abdominal pain

Symptoms are getting progressively worse over the last week

PMH: Type I DM, Rheumatoid Arthritis, Hypertension

Medications: Insulin, Methatrexate, Diclofenac, Adalimumab (Humira) injections

On exam: lethargic, hypotensive, suprapubic and LUQ pain. Lloyd’s is positive on the left

¨WBC 25 (4.3 – 10.8)

¨RBC 2.3 (4.2 – 5.9)

¨Hb 7.5 (13.2-16.2 Male)

¨Hct 28 % (40-52 Male)

¨MCV 105% (80-100)

¨RDW 18.3 (11-15)

¨Platelets 61 (150-400)

¨Reticulocytes 3 (0.5-1.5)

¨Urine showed UTI

What is the differential?

A
  • folate deficiency d/t methotrexate
  • NSAID to GI
  • anemia of chronic disease - DM and RA
  • DIC
26
Q

What type of anemia does DIC cause?

A

Microangiopathic hemolytic anemia

MAHA

27
Q

What tests would you use to identify hemolysis?

A
  1. PTT/PT for DIC derived hemolysis
  2. Indirect bilirubin for general
  3. Haptoglobin for general hemolysis
  4. Urine hemosiderin
  5. LDH
  6. Coombs test - autoimmune hemoylticanemia
  7. Serum/plasma free hemoglobin
28
Q

List the four main causes of microcytic anemia!

A
  1. Iron deficiency
  2. Anemia of chronic disease
  3. Thalassemia
  4. Lead toxicity
29
Q

What are the 8 big causes of normocytic anemia?

A
  1. Hemolytic
  2. Aplastic
  3. Hypersplenism
  4. Mixed
  5. Hemodilution
  6. Anemia of Chronic Disease
  7. Anemia of Uremia
  8. Acute Bleeding
30
Q

What are the four main causes of macrocytic anemia?

A
  1. B12 deficiency
  2. Folate deficiency
  3. Alcoholic Liver Disease
  4. Myelodysplastic Syndromes
31
Q

What is anemia of uremia?

A

Low EPO d/t renal failure

Heme and Lymph Exam 2 (9 decks)

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