Anemia Theater - Kebbekus

Question 1

Case 1
Crohn's Disease
Low Hemoglobin
High RDW
Low Hematocrit
Low Iron
High TIBC
Low Iron Saturation
Normal Ferritin (due to inflammation - should be low)
Diagnosis:

Answer 1

Iron Deficiency Anemia

Macrocytosis due to 6-MP
Microcytosis due to IDA
==> “Normal” appearing MCV

Question 2

What is the gold standard for diagnosing IDA?

Answer 2

Bone Marrow Iron Stain

Question 3

IDA is generally associated with what risk?

Answer 3

Bleeding (usually GI Bleeding)

Question 4

Case 2: Pneumococcal Pneumonia
Sudden onset SOB
Banded WBC
Low Hemoglobin
VERY Low MCV
High RDW
Low Iron (due to infection)
Low Iron Saturation
Normal TIBC
What test would you run?

Answer 4

Hemoglobin Electrophoresis looking for Thalassemia

Diagnosis: B-Thalassemia Minor
Mild, but VERY Microcytic anemia

Question 5

Case 3
10 lbs weight loss, nausea, abdominal discomfort, pale with scleral icterus
VERY low Hemoglobin
Very low Platelets
Low Reticulocytes
Low Haptoglobin
Undetectable B12
High MCV
High RDW
HIGH LDH
Macrocytic anemia, thrombocytopenia, Polychromasia with spherocytes and teardrop forms
Diagnosis?

Answer 5

Pernicious Anemia

Absorption of B12 via Intrinsic Factor cannot be absorbed in the distal ilium

Slow onset associated with vitiligo and autoimmune disorders

Question 6

With a hemoglobin less than 4, what test should you order?

Answer 6

EKG

Question 7

If unsure of Pernicious Anemia diagnosis, what is the confirmatory lab test?

Answer 7

MMA = Methylmalonic Acid

Question 8

Case 4:
Jaundiced
High Total Bilirubin 
High Direct Conjugated Bilirubin
Low Hemoglobin
Low Haptoglobin
High MCV
High Reticulocyte (for low Hemoglobin)
HIGH LDH
See: Spherocytes and Bite Cells
Positive DAT
Diagnosis:

Answer 8

Warm Autoimmune Hemolytic Anemia

Question 9

What are the treatments for Warm Autoimmune Hemolytic Anemia?

Answer 9

ALWAYS give Folate
Prednisone
Rituximab (anti-CD20 MAB B-cells)
Splenectomy

Question 10

What malignancy is associated with WAHA?

Answer 10

CLL = Chronic Lymphocytic Leukemia

Question 11

Case 5: Chest pain and weakness
Low Hemoglobin
High RDW
High LDH
High Ferratin
See: Tear Drop and Nucleated RBCs, large platelets
Diagnosis?

Answer 11

Myelofibrosis

Question 12

What test needs to be performed to diagnose Myelofibrosis?

Answer 12

Bone Marrow Biopsy (overcrowding)