Final Exam - Anemias

Question 1

Splenic sequestration

Answer 1

Results when large numbers of sickled erythrocytes become lodged in an engorged, functional spleen during early childhood, resulting in severe anemia and potentially fatal hypovolemic shock, with a mortality rate of 10% to 15%.

Because this condition tends to be recurrent, splenectomy is often performed after the first episode

Question 2

Signs and symptoms of splenic sequestration

Answer 2

• Abdominal pain
• pallor
• tachycardia

Question 3

Parent education on splenic sequestration

Answer 3

Early recognition of splenic sequestration can be a lifesaving skill. Parents can be taught to recognize signs of increasing anemia and enlarging spleen.

• Abdominal pain
• pallor
• tachycardia

How to recognize increasing abdominal girth or abdominal pain, as well as how to palpate the spleen.

Question 4

What type of anemia is folic acid anemia?

Answer 4

macrocytic normochromic anemias in which the cell size is large and irregular

Question 5

What type of anemia is vitamin B12 deficiency anemia?

Answer 5

macrocytic normochromic anemias in which the cell size is large and irregular

Question 6

What is Glucose-6-phosphate dehydrogenase (G6PD) deficiency?

Answer 6

An X-linked recessive disorder commonly seen in African American males. It is an enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stress.

Question 7

Gold standard for diagnosis of sickle cell anemia

Answer 7

a hemoglobin electrophoresis, a test that determines the presence of hemoglobin S

Question 8

Folate deficiency anemia

Answer 8

Not enough building blocks (vit c, folic acids, B12) to make DNA so cells get bigger instead of dividing

Insufficient folate intake or absorption from diet due to GI problems leads to abnormal blood cell formation and death of immature red blood cells

Question 9

Causes of folate deficiency anemia

Answer 9

Malnutrition
Alcoholism
Anticonvulsant medications

Question 10

Iron supplementation

Answer 10

Start with PO ferrous sulfate, can give parenterally if patient cannot tolerate PO or cannot absorb it and levels keep dropping despite iron supplementation

Question 11

Anemia of chronic disease

Answer 11

A low serum iron level, low total iron binding capacity (TIBC) and low transferrin saturation.

The serum transferrin level is either normal or increased in patients with anaemia of chronic disease

Question 12

Risk factors for iron deficiency anemia

Answer 12

• older than 60
• poverty
• recent illnesses like ulcer, diverticulitis, colitis, hemorrhoids, and gastrointestinal tumors

Question 13

How should PO iron be taken?

Answer 13

on an empty stomach

Question 14

Signs of iron deficiency anemia

Answer 14

• pale conjunctivae and nail beds
• tachycardia
• heart murmur
• cheilosis (reddened lips with fissures at the angles)
• stomatitis
• splenomegaly
• koilonychia (thin and concave fingernails with raised edges)
• glossitis.

Signs may also include esophageal webs (Plummer-Vinson syndrome), melena, and menorrhagia

Question 15

What does a serum ferritin measurement tell you?

Answer 15

Ferritin is the body’s iron-storing protein, can tell exactly how much iron is on hand in the body. It is the best way to spot an iron deficiency early, before it progresses to full-blown anemia.

If the ferritin level is borderline, a dietary and supplemental regimen of iron will rebuild the iron stores.

Question 16

What test should be done on all patients suspected to have iron deficiency anemia?

Answer 16

Fecal occult blood test.

In the early stages of iron deficiency anemia, both hemoglobin and hematocrit levels are normal to slightly reduced. It is necessary to determine whether the iron deficiency is related solely to inadequate dietary intake or to decreased absorption or chronic blood loss.

Question 17

First line treatment for iron deficiency anemia

Answer 17

an increase in dietary iron and thereafter with supplemental iron

Question 18

Reticulocyte count

Answer 18

The percentage of newly maturing red blood cells (RBCs) released into the circulating blood from the bone marrow.

Is elevated in cases of blood loss as the body tries to replace the loss; it might also be elevated during treatment of anemias (eg, iron, folic acid, and vitamin B12) and bone marrow disorders, when immature RBCs are displaced by other proliferating cells

Question 19

Mean corpuscular volume (MCV)

Answer 19

MCV indicates the average size of individual red blood cells (RBCs). MCV is increased (macrocytic) in megaloblastic anemias (ie, vitamin B12 deficiency and folate deficiency) and liver disease (such as that resulting from alcohol abuse) as well as with the use of some drugs (eg, zidovudine).

Decreased MCV and MCHC are indicative of a microcytic hypochromic anemia. To make a more final diagnosis, the NP needs to order a serum iron level, a TIBC level, and a serum ferritin level.

Question 20

Normal range for MCV

Answer 20

76 to 96 fL.

Question 21

Cause of Megaloblastic/Pernicious anemia

Answer 21

Vitamin B12 deficiency is the most common cause of megaloblastic anemia.

Question 22

Megaloblastic or pernicious anemia, what show what type of cells?

Answer 22

Macrocytic and normochromic cells

Question 23

Sideroblastic anemia

Answer 23

Group of blood disorders in which the body has enough iron but is unable to use it to make hemoglobin, which carries oxygen in the blood. As a result, iron accumulates in the mitochondria of red blood cells, giving a ringed appearance to the nucleus

Question 24

Diagnostic test for sideroblastic anemia

Answer 24

Prussian blue stain is the diagnostic test used to identify sideroblastic anemia. Ringed sideroblasts would be seen in this stain.

Question 25

Cause of Microcytic Hypochromic Anemia

Answer 25

disruption of iron supply in diet due to decreased iron content in the diet, pathology of the small intestines like sprue and chronic diarrhea, gastrectomy, and deficiency of vitamin C in the diet

Question 26

Diagnosis of microcytic hypochromic anemia

Answer 26

The absence of iron stores in the bone marrow remains the most definitive test for differentiating iron deficiency from the other microcytic states, ie, anemia of chronic disease, thalassemia, and sideroblastic anemia.

CBC
Peripheral smear

Question 27

Acute Lymphoblastic Leukemia

Answer 27

A type of cancer characterized by the rapid proliferation of immature lymphoblasts, which are abnormal white blood cells. ALL affects the bone marrow and blood cells.

Commonly affects children

Question 28

Acute Lymphoblastic Leukemia Risk Factors

Answer 28

• Genetic predisposition
• Exposure to high levels of radiation or chemicals

Question 29

Symptoms of Acute Lymphoblastic Leukemia

Answer 29

• Fatigue
• Pale skin and shortness of breath
• Frequent infections and fever
• Easy bruising or bleeding
• Bone and joint pain
• Enlarged lymph nodes

Question 30

Diagnosing Acute Lymphoblastic Leukemia

Answer 30

• Blood tests to analyze blood cell counts and markers
• Bone marrow biopsy
• Lumbar puncture (to check for central nervous system involvement)

Question 31

Treatment for Acute Lymphoblastic Leukemia

Answer 31

-Chemotherapy
- Radiation therapy (in specific cases)
- Stem cell transplant (in high-risk cases)
- Supportive care (pain management, infection prevention, blood transfusions)

Question 32

Chronic Lymphocytic Leukemia

Answer 32

A type of cancer affecting the white blood cells (lymphocytes), characterized by the accumulation of abnormal lymphocytes in the bone marrow, blood, and lymph nodes. CLL progresses slowly over time.

Most common leukemia.
Usually found in those over 70.

Question 33

Risk factors for chronic lymphocytic leukemia

Answer 33

• Age (more common in older adults)
• Family history of CLL or other lymphoid malignancies
• Male gender
• Caucasian race
• Prolonged exposure to certain chemicals

Question 34

Symptoms of Chronic Lymphocytic Leukemia

Answer 34

• Fatigue and weakness
• Enlarged lymph nodes (neck, armpits, groin)
• Recurrent infections (pneumonia, sinusitis)
• Night sweats
• Unexplained weight loss
• Abdominal discomfort or swelling
• Easy bruising or bleeding

Question 35

Treatment of Chronic Lymphocytic Leukemia

Answer 35

• Watchful waiting (for early-stage, asymptomatic cases)
• Chemotherapy
• Immunotherapy (e.g., monoclonal antibodies)
• Targeted therapy (e.g., BTK inhibitors, BCL2 inhibitors)
• Stem cell transplant (in select cases)