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SP: Hematology Pearls (3%) > Anemias > Flashcards

Anemias Flashcards

1
Q

Normal or ↓ MCV, ↓ TIBC, ↑ Ferritin (high iron stores) ↓ serum erythropoietin

A

anemia of chronic disease

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2
Q

The only anemia where all three cell lines are decreased (pancytopenia) ↓ WBC, ↓ RBC, ↓ Platelets - will have normal MCV and ↓ Retic

A

aplastic anemia

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3
Q

↓ Folate, ↑ MCV (macrocytic anemia) looks like B12 but no neurologic symptoms. Common in alcoholics

A

folate deficiency

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4
Q

After infection or medication in an African American male + Heinz Bodies and Bite Cells on smear. Flare triggers: Fava beans, antimalarials, sulfonamides

A

G6PD deficiency

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5
Q

History of jaundice, transfusion, new medication or infection (+) direct coombs test

A

Autoimmune Hemolytic anemia

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6
Q

↓ MCV (microcytic), ↑ TIBC, ↓ Ferritin (low iron stores) ↓ MCH (hypochromic). Associated with pica and nail spooning, target cells

A

iron deficiency

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7
Q

African American, pain, family history of blood disorder. Hemoglobin electrophoresis: Hemoglobin S, Blood smear: Sickled RBCs, howell-Jolly bodies, target cells

A

sickle cell anemia

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8
Q

Microcytic hypochromic, elevated iron. Most severe, Mediterranean descent, failure to thrive. Hemoglobin electrophoresis: Hemoglobin A2 and F.

A

beta thalassemia major

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9
Q

Microcytic hypochromic, elevated iron. Mild anemia, often misdiagnosed as iron deficient. Hemoglobin electrophoresis: Hemoglobin A2

A

beta thalassemia trait

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10
Q

Chinese and southeast Asians. Hemoglobin electrophoresis: Hemoglobin H (H disease), Hemoglobin Bart’s (hydrops fetalis), Hemoglobin A (trait)

A

alpha thalassemia

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11
Q

↑ MCV (macrocytic anemia), Hypersegmented Neutrophils and normal folate, decreased vibratory and position sense

A

vit B12 deficiency

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12
Q

Less than 10% radiolabeled vitamin B12 in urine. Normal results when repeated with administration of intrinsic factor (test name)

A

Schilling test for the diagnosis of pernicious anemia (antibody to intrinsic factor)

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13
Q

What disorder is a hemoglobin electrophoresis result of “SS” indicative of?

A

sickle cell disease

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14
Q

What disorder is a hemoglobin electrophoresis result of “SA” indicative of?

A

sickle cell trait

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15
Q

What type of anemia are cephalosporins PCN NSAIDS methyldopa associated with?

A

immune hemolytic anemia

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16
Q

Erythropoietin analogs should be suspended once the hemoglobin is >_____?

A

11 mg/dL

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17
Q

Erythropoietin analogs should only be initiated if the hemoglobin is < ____?

A

10 mg/dL

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18
Q

What two types of anemia have macroovalocytes?

A

B12 & folate (B9) deficiency

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19
Q

Which anemia has a decreased MCV, decreased MCH (hypochromic) yet normal TIBC and ferritin?

A

thalassemia

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20
Q

Acute chest syndrome occurs during the acute phase of which anemia?

A

hemolytic sickle cell crisis

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21
Q

What are some common oxidative events which may trigger hemolysis in G6PD deficiency?

A 
Antimalarials
Sulfa drugs
Aspirin
Febrile Illness
Acidosis
Fava beans
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22
Q

What type of anemia does a + osmotic fragility test indicate?

A

Hereditary Spherocytosis

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23
Q

What do an increased LDH, decreased Haptoglobin and an increased indirect Bilirubin represent?

A

hemolysis

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24
Q

What type of anemia does a + direct coombs indicate?

A

Autoimmune hemolytic anemia

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25
Q

Which type of anemia is most likely with associated leukopenia and thrombocytopenia?

A

aplastic anemia

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26
Q

How would you expect TIBC and ferritin to present in anemia of chronic disease?

A

Decreased TIBC - Normal/increased Ferritin

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27
Q

Anemia of renal failure is defined by decreased levels of which hormone?

A

erythropoietin

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28
Q

Can oral B12 be used as an initial treatment in a B12 deficient patient?

A

Yes - Oral B12 is considered initial therapy - Other routes if oral fails or pernicious anemia is diagnosed

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29
Q

Which route is best for administering B12 to a deficient patient?

A

Sublingual, IM or deep subcutaneous

30
Q

What tests other than a Schilling test are used to diagnose pernicious anemia?

A

Increased Methylmalonic acid levels - + Intrinsic factor and parietal cell antibodies

31
Q

Increased MCV with smooth tongue, loss of proprioception and vibratory sense is likely which type of anemia?

A

B12 deficiency

32
Q

List 5 common causes of folate deficiency.

A 
EtOH abuse
Advancing age
Gastric bypass
Pregnancy
Methotrexate
33
Q

What symptom differentiates B12 from folate deficiency ?

A

Neuropathy occurs with B12 deficiency but not with folate deficiency

34
Q

Slowly decreasing MCV in an elderly patient?

A

Occult GI blood loss

35
Q

Pica is a specific symptom of which type of anemia?

A

iron deficiency anemia

36
Q

Decreased Ferritin and Increased TIBC?

A

iron deficiency anemia

37
Q

What surgery can induce B12 deficiency?

A

gastric bypass

38
Q

Anemia due to renal failure may be confirmed by which test?

A

Decreased Serum erythropoietin levels

39
Q

What type of megaloblastic anemia causes neurologic deficits?

A

B12 deficiency

40
Q

What type of anemia can occur in hypothyroidism?

A

Macrocytic non-megaloblastic anemia

41
Q

What factor is produced in the stomach and required for Vitamin B12 absorption?

A

intrinsic factor

42
Q

What test confirms the diagnosis of pernicious anemia?

A

Schilling test or + antibodies to intrinsic factor and parietal cells

43
Q

Which anemia is associated with bilirubin cholelithiasis?

A

Hereditary spherocytosis

44
Q

What is the best test to determine whether a patient as a hemolytic anemia?

A

Reticulocyte count and haptoglobin

45
Q

Which anemia has all 3 cells lines affected: Anemia leukopenia and thrombocytopenia?

A

aplastic anemia

46
Q

What is the Dx? Very low MCV, normal/high RBC, normal RDW and high/normal serum iron normal TIBC.

A

thalassemia

47
Q

What is the Dx? Low MCV, low RBC, high RDW, low serum iron, high TIBC.

A

iron deficiency anemia

48
Q

What is the Dx? Microcytic hypochromic anemia, low serum iron and low TIBC. Unresponsive to iron therapy.

A

anemia of chronic disease

49
Q

Basophilic stippling of RBCs?

A

Lead poisoning (May also occur in thalassemia and chronic EtOH abuse)

50
Q

Type of anemia in which serum iron is decreased and TIBC is increased?

A

iron deficiency anemia

51
Q

What is the Dx? Teenage African American with severe bone and joint pain severe anemia

A

sickle cell disease

52
Q

What is the etiology of pernicious anemia?

A

Antibodies to gastric parietal cells and intrinsic factor

53
Q

Which anemia is most commonly associated with EtOH abuse?

A

folate (B9) deficiency

54
Q

List three medications which may trigger autoimmune anemia.

A

Cephalosporins
Penicillins
NSAIDs

55
Q

Priapism may occur in which acute anemia?

A

sickle cell crisis

56
Q

What test is diagnostic for sickle cell disease?

A

Hemoglobin electrophoresis

57
Q

Which test is more sensitive than B12 levels for B12 deficiency in early disease?

A

Increased Methylmalonic acid levels occur in early B12 loss and may precede decreased serum B12 levels

58
Q

What are the two medications available for treatment of anemia due to renal failure?

A

epoetin alfa and darbepoetin alfa

59
Q

Which test is most specific for hemolysis?

A

Haptoglobin is decreased in both extra and intravascular hemolysis

60
Q

List three medications which may cause aplastic anemia.

A

ACE inhibitors
Sulfonamides
Phenytoin

61
Q

What heritage is associated with an increased chance of thalassemia?

A

Mediterranean descent

62
Q

A 31 year old Mediterranean female has a hemoglobin of 10.3 gm/dl, MCV of 54, TIBC and Ferritin are normal. What is the most likely etiology of her anemia?

A

thalassemia minor

63
Q

What anemia should be suspected in a 3 year old black male with anemia and priapism?

A

sickle cell anemia

64
Q

Measurement of which laboratory value is the best indicator of whether or not a sickle cell crisis is resolving?

A

Reticulocyte count - Decreasing reticulocyte counts are the best indicator that a crisis is resolving

65
Q

What medications related to travel can be an oxidative trigger for a patient with G6PD?

A

anti-malarial meds

66
Q

A 42 year-old black female with SLE has an increased bilirubin and a mild anemia. Which test is most definitive to evaluate this patient’s anemia?

A

Direct coombs in patient with autoimmune anemia

67
Q

A patient who recently started lisinopril has a hemoglobin 7.4, WBC 1.1, platelets 55. What is the most likely disorder?

A

aplastic anemia

68
Q

A dialysis patient has been on darbepoetin alfa for 3 months. His most recent hemoglobin is 11.3 gm/dl. Should he continue to use this medication?

A

No. erythropoetin analogs must be stopped when the hemoglobin is greater than 11 gm/dL

69
Q

A 36 year old black male s/p gastric bypass surgery has peripheral neuropathy. Oral B12 has not improved his symptoms. What is the next step?

A

sublingual or IM B12

70
Q

What antibody test would confirm a diagnosis of pernicious anemia?

A

Intrinsic factor and parietal cell antibodies

71
Q

A 74 year old white male with a history of chronic ETOH abuse has an MCV of 102. Physical exam finds no neurological deficit. What is the most likely diagnosis?

A

folate (B9) deficiency

72
Q

A 23 year old white female has weakness, fatigue and has developed a habit of chewing ice. What are the expected findings in regard to TIBC and Ferritin?

A

Increased TIBC and decreased Ferritin in patient with iron deficiency anemia

SP: Hematology Pearls (3%) (3 decks)

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