Hem 5 - Nonhemolytic Anemias

Question 1

What is the most common cause of microcytic anemia?

Answer 1

Iron deficiency anemia.

Question 2

What lab value is looked at to determine the size of the RBC, therefore able to say if the anemia is macrocytic, normocytic or microcytic?

Answer 2

MCV: mean corpuscular volume.

Question 3

What is the triad of Plummer-Vinson syndrome?

Answer 3

Iron deficiency anemia. esophageal webs. Atrophic glossitis.

Question 4

What is an alpha-thalassemia? Explain the pathophysiology of alpha-thalassemia.

Answer 4

A defect in alpha-globin. There are 4 alpha-globin alleles (2 from mom and 2 from dad). If there is mutation in of the alleles, it does not cause anemia. If there is 2 mutated alleles, there is still no anemia but it is called alpha-thalassemia trait. If there is 3 mutated alleles and left w/ only 1 functioning allele, it is called Hemoglobin H disease and substantial amount of hemoglobin is made up of 4 beta globins. 4 mutations of alleles is incompatible w/ life.

Question 5

What is the difference b/w beta-thalassemia minor and beta-thalassemia major?

Answer 5

There are only 2 genes for beta globin. Minor: decreased amount of beta-globin, Minimal anemia and increased hemoglobin A2. Major: no beta-globins, severe anemia requiring blood transfusions.

Question 6

What must we do in a patient w/ microcytic anemia?

Answer 6

Check iron studies first and confirm the diagnosis of iron deficiency before you start iron supplements; you do not want to cause hemochromatosis.

Question 7

What are the symptoms of beta-thalassemia major?

Answer 7

Marrow hyperplasia: on the skull creates a “hair-on-end” or “crew-cut” on xray. Also causes “chipmunk” facies and increased hemoglobin F.

Question 8

What is the treatment for sideroblastic anemia?

Answer 8

Treat w/ B6.

Question 9

What is Anemia of chronic disease?

Answer 9

Defective iron utilization because inflammatory mediators makes the liver make Hepcidin, which inhibits ferroportin in the macrophages so iron gets trapped in macrophages. Seen in chronic inflammatory disease. There is plenty of iron; it is just trapped inside macrophages.

Question 10

What would be the lab of ferritin and serum iron in someone w/ anemia of chronic disease?

Answer 10

Ferritin is normal or high. Serum iron is low.

Question 11

How can we differentiate iron deficiency anemia (IDA) vs anemia of chronic disease (AOCD)?

Answer 11

Serum iron is low on both. Transferrin (or TIBC) is going to be elevated for IDA and low on AOCD. Ferritin is low in IDA and high in AOCD. In % transferrin saturation, decreased around less than 12% in IDA, and above 18% in AOCD (Normal range is b/w 12 to 40%).

Question 12

How is Total iron binding capacity (TIBC) calculated?

Answer 12

TIBS = Transferrin X 1.4

Question 13

What is % transferrin saturation?

Answer 13

It is the ratio of serum iron to TIBC (total iron binding capacity).

Question 14

How do the iron lab values look in hemochromatosis?

Answer 14

Serum iron is elevated. Transferrin is low. Ferritin is elevated. % transferrin saturation is going to be very high/

Question 15

How does iron labs look in high estrogen states like pregnancy/OCP use?

Answer 15

Transferrin increased and % transferrin saturation decreased. Serum iron and ferritin will be normal.

Question 16

How does iron labs look in soderoblastic anemia?

Answer 16

Serum iron is low. Transferrin will be low. Ferritin is normal or increased. %transferrin saturation is increased.

Question 17

What finding other than big RBCs on blood smear can we see in megaloblastic anemia?

Answer 17

Hypersegmented (more than 6 lobules) neutrophils.

Question 18

What difference in lab value would you see in folate deficiency vs B12 deficiency?

Answer 18

Methylmelonic acid (MMA) will be normal in folate deficiency. In B12 deficiency, it will be increased. In practice, just check folate and B12 deficiency.

Question 19

What infection can cause B12 deficiency?

Answer 19

The fish tapeworm Diphyllobothrium latum.

Question 20

What megaloblastic anemia is NOT correctable by B12 or folic acid?

Answer 20

Orotic aciduria: deficiency of UMP synthase which is involved in pyrimidine synthesis. This causes orotic acid in urine, megaloblastic anemia, but no hyperammonemia.

Question 21

What would be the cause of Macrocytic anemia w/o megaloblastic and no hypersegmented neutrophils?

Answer 21

Liver disease. Alcoholims (bone marrow suppresion). Drugs (5-fluorouracil, Zidovudine, Hydroxyurea).

Question 22

What are the cause of nonhemolytic normocytic anemia?

Answer 22

Initial stages of anemia of chronic disease. Aplastic anemia. Renal failure.

Question 23

What would be the causes of Aplastic anemia?

Answer 23

Radiation. Benzene. Drugs (chlormaphenicol, cancer drugs). Viral infections (parvovirus B19, EBV, HIV). Fanconi anemia (inherited defect of DNA repair). Idiopathic.

Question 24

What would be treatment for aplastic anemia?

Answer 24

Stop the offending agent. Immunosuppressants. Transfusions. G-CSF or GM-CSF. Bone marrow transplant.

Question 25

What test can be used to diagnose beta-thalassemia minor?

Answer 25

Hemoglobin electrophoresis.

Question 26

What lab findings allow you to distinguish iron deficiency anemia from a microcytic, hypochromic anemia resulting from thalassemia?

Answer 26

Iron deficiency anemia: decreased serum iron, increased TIBC, decreased ferritin. Thalassemia: normal iron, normal TIBC, Normal ferritin.

Question 27

What should you rule out in a mover 50 w/ new-onset iron deficiency anemia?

Answer 27

Colon cancer.

Question 28

A patient is diagnosed w/ a macrocytic, megaloblastic anemia. What is the danger of giving folate alone?

Answer 28

You might correct the anemia w/o correcting the B12 deficiency. Patient might end up with peripheral neuropathy.

Question 29

What is the cause of anemia base on the following statement: Microcytic anemia + swallowing difficulty + glossitis.

Answer 29

Plummer-Vinson syndrome.

Question 30

What is the cause of anemia base on the following statement: microcytic anemia + more than 3.5 Hb A2.

Answer 30

Beta-thalassemia minor.

Question 31

What is the cause of anemia base on the following statement: megaloblastic anemia not correctable by B12 or folate/

Answer 31

Orotic aciduria.

Question 32

What is the cause of anemia base on the following statement: megaloblastic anemia w/ peripheral neuropathy.

Answer 32

B12 deficiency.

Question 33

What is the cause of anemia base on the following statement: microcytic anemia + basophilic stippling.

Answer 33

Lead poisoning.

Question 34

What is the cause of anemia base on the following statement: Microcytic anemia reversible w/ B6.

Answer 34

Sideroblastic anemia.

Question 35

What is the cause of anemia base on the following statement: HIV (+) patient w/ macrocytic anemia.

Answer 35

Zidovudine.

Question 36

What is the cause of anemia base on the following statement: normocytic anemia and elevated creatinine.

Answer 36

Chronic kidney disease resulting in low EPO levels.

Question 37

RFF: Causes of hypochromic, microcytic anemia.

Answer 37

Iron deficiency, thalassemia, and lead poisoning.

Question 38

RFF: Hypersegmented neutrophils.

Answer 38

Megaloblastic anemia.

Question 39

RFF: Skull x-ray shows a “hair-on-end” appearance.

Answer 39

Marrow hyperplasia.

Question 40

RFF: Basophilic stippling of RBCs.

Answer 40

Lead poisoning.