Anemia cases

Question 1

Why might you see a normal MCV in a patient with IDA?

Answer 1

If there was a reason for concurrent macrocytic anemia (ie. 6-mercaptopurine) the micro/macro cells would average out normal.

Question 2

Very mildly lowered Hgb and very microcytic anemia may indicate what? What test should be done?

Answer 2

Thalasemia minor (B-thalasemia trait)

Hgb electrophoresis

Question 3

Vitiligo associated with what type of anemia?

Answer 3

Pernicious

B12 absorbing problem

By definition is slow in onset.
More than just anemia. Neurological symptoms too.
When in doubt, send for MMA (methylmelonic acid)

Question 4

AIHA (autoimmune hemolytic anemia) pearls?

Answer 4

• Always get a thorough history that focuses on other autoimmune conditions (RA, SLE, hyper/hypothyroid, scleroderma), drugs (especially new ones, b-lactams) and recent transfusions of any blood product.
• AIHA is associated with lymphoid malignancies (esp CLL) and may precede the lymphoma diagnosis.
• Prolonged high dose steroids will lead to Cushing syndrome and comes with increased risk of PJP.

-Always give folate supplements with hemolytic anemias.
These patients present problems with transfusions.

Question 5

Nucleated RBCs are suspicious for?

Answer 5

Crowded bone marrow—cancer?