Anemias

Question 1

Iron difficiency

Answer 1

Microcytic, hypochromic
Pregnancy, growth spurts, vegetarian
If over 50 with low iron, think colon CA
Bone marrow Fe stain is gold standard Dx
Chrons and ciliac can cause this

Question 2

alpha thalassemia

Answer 2

Microcytic, hemolytic

Can get hemochromatosis (iron overload)

Question 3

Beta thalassemia

Answer 3

Microcytic, hemolytic
Minor-Dx with a2delta2 band
Major- xray crewcut

Question 4

Sideroblastic anemia

Answer 4

Microcytic
X linked defect in ALAS
Treat with B6

Also ETOH and Pb (basophilic stipling) can cause it

Question 5

Pb poisoning

Answer 5

Can see lead lines, encephelopathy, abd pain, foot/wrist drop, and microcytic anemia

Question 6

Macrocytic with megaloblast

Answer 6

Hypersegmented neutrophil
Folate: low folate, high homocysteine, normal methylmalonic acid
Low RBC, WBC, and platelets

B12: low B12, high homocysteine, high methylmalonic acid

Question 7

Low b12 causes

Answer 7

Poor nutrition/chrons/ileal resection
Pernicious anemia against parietal or intrinsic factor. Higher risk for gastric carcinoma
D. latum fish worm
Has neuro symptoms
Elevated homocysteine and methylmalonic acid

Question 8

What causes Low folate

Answer 8

Alcoholism and malnutrition can cause this and methotrexate

Question 9

Nonmegaloblastic macrocytic anemia

Answer 9

Bleeding disorders, liver disease, alcoholism, reticulocytosis

Question 10

Non-hemolytic normocytic anemia

Answer 10

Anemia of chronic disease
Aplastic anemia
Can also present as microcytic

Question 11

Anemia of chronic disease

Answer 11

Inflamation–increased hepcidin—decreased macrophage and transferrin to release iron

Labs: low iron, low TIBC, High ferritin

If kidney: treat with EPO if low hematopoiesis

Question 12

Aplastic anemia

Answer 12

Pancytopenia—petechiae, bleeding, infection, neutropenia

Causes: radiation, viruses, fanconi, ideopathic following hepatitis

Tx: Eliminate cause, BMT, GM-CSF

Question 13

Intravascular hemolysis

Answer 13

Low haptoglogin, high LDH, hemoglobinuria

Question 14

Extravascular hemolysis

Answer 14

High LDH, high unconjugated bilirubin

Question 15

Spherocytosis

Answer 15

RBC become spherical and weak
Splenomegaly (Howell jolly bodies if no spleen)
\+ Osmotic fragility test
Aplastic crisis (Parvo B19)
Increase RDW and MCHC

Question 16

G6PD

Answer 16

More common in African Americans
Low glutathione and NADPH so more oxidative stress
Get heinz bodies with precipitating factors:
Fava beans, sulfonamides, primaquine, anti TB

Question 17

Sickle cell anemia

Answer 17

Can also show up as crew cut
Valine for glutamic acid
Aplastic crisis (Parvo B19), autosplenectomy, pain, renal papillary necrosis, avascular necrosis of hip, Salmonella osteomelitis

Tx: hydroxyurea (increases HbF)

Question 18

HbC defect

Answer 18

Lysine for glutamic acid. Like Sickle cell but not as bad

Question 19

Haptiglobin

Answer 19

Binds hemoglobin in the serum. If RBCs lysed, more binds to RBC and total in serum is decreased.

Question 20

B symptoms-

Answer 20

Worry about cancers

Fever, night sweats, or weight loss

Question 21

Jak2 mutation

Answer 21

Too much RBC, WBC, Platelets

Polycythemia vera

Question 22

Warm antibody

Answer 22

IgG
SLE, Lymphoma, CLL
Drug induced (PCN and Quinidine)
Use prednisone or anti CD20 Ab (rutiximab) 
Can do spleenectomy 

Confirm with direct coombs test

Question 23

CLL

Answer 23

Relisten to lecture around 40 minutes in

Question 24

Cold antibody

Answer 24

IgM
Mycoplasma infection, viral, CLL, Lymphoma
Tx: stay warm, treat problem, rituximab

Question 25

Coombs test/Direct indirect

Answer 25

Testing Ab against RBCs
Direct: Ab to RBC
Test newborn
Indirect: Ab in serum to R
Test for mother

Question 26

TTP

Answer 26

Negative direct coombs
High LDH
Plasma exchange

Thrombocytopenia, microangiopathic hemolytic anemia, neuro, kidney failure, fever

Question 27

Heinz body

Answer 27

Heinz bodies are formed by damage to the hemoglobin component molecules, usually through oxidant damage, or from an inherited mutation
Liver disease, G6PDH, NADPH, a-thalla

Question 28

Hypersegmented neutophils

Answer 28

B12, Folate, myodisplastic syndrome

Question 29

Other causes of megoloblastic anemias

Answer 29

Drugs that impair DNA metabolism
Metabolic disorders (orotic aciduria, lesch nyhan)
Refractory megaloblastic anemia
Di guglielmos syndrome

Question 30

Causes of folic acid deficiency

Answer 30

Inhibitors of dihydrofolate reductase: methotrexate, pyrimethamine, triamterene, pentamidine, trimethoprim
Alcohol
Rare enzyme deficiencies: dihydrofolate reductase, others

Question 31

Indirect/Unconjugated bilirubin

Answer 31

Hemolytic anemia

Question 32

Direct/conjugated bilirubin

Answer 32

Biliary obstruction

Question 33

Alpha thalassemia trait

Answer 33

Wont show up on hemoglobin electrophoresis

Question 34

Sickle cell vaccines

Answer 34

Salmonela, S.aureus, H. flu, S. pneumo,, M. pneumo

Give 2 weeks before spleen removal

Question 35

Target cell

Answer 35

HALT
HbC
Asplenia
Liver disease
Thalassemia

Question 36

Schistocytes

Answer 36

DIC/TTP/HUS, trauma

Question 37

Bite cell

Answer 37

G6PDH deficiency

Question 38

Basophilic stippling

Answer 38

TAIL
Thalassemia
Anemia of chronic disease
Iron difficiency
Lead poisoing

Question 39

Acanthocyte spur cell

Answer 39

Liver disease, abetalipoproteinemia

Question 40

Heinz bodies

Answer 40

Denatured hb seen in a-thalassemia and G6PDH deficiency

leads to bite cells

Question 41

Howell jolly bodies

Answer 41

Nuclear remnants found in asplenic patients