Hematalogic Disorders

Question 1

Most common type of anemia?

Answer 1

Iron deficiency anemia (IDA)

Question 2

Medications that prevent micronutrient absorption & contribute to anemia

Answer 2

Chronic (>8 wks) PPI use (vitamin B12 & Iron malabsorption), Metformin (Vitamin B12 malabsorption)

Question 3

Normal RBC lifespan?

Answer 3

90-120 days

Question 4

Hemoglobin to hematocrit (H&H) ratio?

Answer 4

1:3 (*may be altered in dehydration)

Question 5

Microcytic cell size?

Answer 5

MCV <80 fL

Question 6

Normocytic cell size?

Answer 6

MCV 80-96 fL

Question 7

Macrocytic cell size?

Answer 7

MCV >96 fL

Question 8

Small RBCs are always ____ RBCs? (hint: color)

Answer 8

Pale

Question 9

What is a normal RDW (RBC distribution width)?

Answer 9

11.5-15%
– >15% = new cells differ in size (larger or smaller) when compared with older cells
– likely earliest lab indicator of evolving micro/macrocytic anemia

Question 10

What are reticulocytes?

Answer 10

Young RBCs (Normal = 1-2%)

Question 11

Most common etiologies for normocytic anemia in primary care (rank order)?

Answer 11

1. Anemia of chronic disease
2. Chronic kidney disease
3. Acute blood loss

Question 12

Most common etiologies for microcytic anemia with elevated RDW in primary care?

Answer 12

1. Iron deficiency
2. Plumbism (lead toxicity)

Question 13

What is ferritin testing used to identify?

Answer 13

Estimate of iron stores
*Tip: always order ferritin over iron studies (those are done in specialty areas)

Question 14

Most common etiology for microcytic anemia with normal RDW in primary care?

Answer 14

Alpha or beta thalassemia minor

Question 15

At-risk ethnic groups for alpha thalassemia minor? (hint: AAA)

Answer 15

Asian, African ancestry

Question 16

At-risk ethnic groups for beta thalassemia minor? (hint: BAMME) *more common in North America

Answer 16

African, Mediterranean, Middle Eastern ancestry

Question 17

Most common etiology for macrocytic anemia with elevated RDW in primary care?

Answer 17

1. Vitamin B12 deficiency (especially pernicious anemia)
2. Folate deficiency anemia

*Vit B12 deficiency will give most macrocytic in size

Question 18

Types of drug-induced macrocytosis usually without anemia?

Answer 18

1. Alcohol excess (men >5/day, women >3/day) *RBCs are “swollen”
2. Antiepileptic drugs –> carbamazepine (Tegretol), phenytoin (Dilantin), methotrexate

**Medical treatment typically not needed; counsel about ETOH use

Question 19

How to differentiate IDA vs thalassemia trait anemia (both microcytic)?

Answer 19

Increased RDW in IDA vs. normal RDW in thalassemia trait

Question 20

What micronutrient may be deficient in someone who follows a vegan diet?

Answer 20

Vitamin B12 (common in animal foods –> meat, poultry, eggs, milk, cheese)

Question 21

Most common types of anemia in the elderly (rank order)?

Answer 21

1. Anemia of chronic disease (ACD)
2. IDA
3. Pernicious anemia (distant 3rd)

Question 22

How is oral iron therapy best absorbed?

Answer 22

On an empty stomach

**Avoid taking with antacids or milk (med will bind to substances & may cause to be less effective). May cause GI upset (nausea, constipation)
**Vit C is marginally effective in increasing absorption

Question 23

Pale conjunctiva on physical exam is a(n) (earlier/later) sign of anemia?

Answer 23

Later sign (usually present in hgb < 9 g/dL)

Question 24

A hemic murmur may be caused from?

Answer 24

Profound dehydration, febrile, hyperthyroid toxicosis

Question 25

Profound anemia (ex: hgb=6 g/dL) may increase the risk for? (hint: cardiac)

Answer 25

Myocardial ischemia

Question 26

Glossitis (smooth, red tongue) may be present in what type of anemia?

Answer 26

Vit B 12 deficiency (ex: pernicious anemia)

Question 27

What nutritional supplements can increase the bleeding risk?

Answer 27

Ginseng, gingko, garlic, fish oil **should be discontinued at least 7-10 days prior to surgical procedure & use in caution with ASA, DOACs, warfarin

Question 28

What is the average lifespan of a platelet?

Answer 28

7-10 days **Platelet life is permanently altered by med for life span (ex: aspirin)

Question 29

Normal hgb?

Answer 29

Female: 12-16 g/dL Male: 14-18 g/dL

Question 30

Normal hct?

Answer 30

Female: 36-47% Male: 42-52%

Question 31

Normal RBC for female?

Answer 31

4.2-5.4 million/mm3

Question 32

Normal MCV?

Answer 32

80-96 fL

Question 33

Normal MCH?

Answer 33

25-35 pg/cell

Question 34

Normal MCHC?

Answer 34

31-37 g/dL

Question 35

Total iron-binding capacity (TIBC) is (elevated/decreased) in IDA?

Answer 35

Elevated (not enough iron to transport) *TIBC normal in thalassemia, vit B12 deficiency, folate-deficiency anemia (iron levels are normal)

Question 36

What is total iron-binding capacity (TIBC)?

Answer 36

Measure of available transferrin left unbound to iron *Normal= 250-410 *Elevated if not enough iron to transport (ex: IDA)

Question 37

What is the most sensitive test for IDA?

Answer 37

Serum ferritin *Decreased in IDA; normal to high in thalassemia minor/trait *Normal: 20-40 ng/mL

Question 38

What is serum ferritin?

Answer 38

Stored form of iron

Question 39

What is anisocytosis?

Answer 39

RBCs with variable sizes

Question 40

What is poikilocytosis?

Answer 40

RBCs with variable shapes (seen with severe IDA)

Question 41

Normal RDW?

Answer 41

11.5-15%

Question 42

Normal total WBC?

Answer 42

6,000-10,000

Question 43

Neutrophils (poly/segs) are associated with?

Answer 43

Bacteria **Normal % in differential = ~60%

Question 44

Lymphocytes are associated with?

Answer 44

Virus **Normal % in differential = ~30%

Question 45

Monocytes are associate with?

Answer 45

Debris **"Monos tidy up debris". May have increase in % a few days after illness, surgery, etc. **Normal % in differential= ~6%

Question 46

Eosinophils are associated with?

Answer 46

Allergens, parasites ("worms, wheezes, weird diseases") **Normal % in differential= ~3%

Question 47

Basophils are associated with?

Answer 47

Anaphylaxis **Normal % in differential= ~1%

Question 48

Mnemonic to help recall WBC cell lines & order of reporting?

Answer 48

Nobody (neutrophil; 60%) Likes (lymphocyte; 30%) My (monocyte; 6%) Educational (eosinophil; 3%) Background (basophil; 1%)

Question 49

What occurs in a "left shift?"

Answer 49

Leukocytosis (elevated WBC >10,000), neutrophilia (neutrophils >60%), bandemia (bands >4%)

Question 50

Neutropenia defined by ANC of?

Answer 50

<1,500/mm3

Question 51

Medication causes of neutropenia?

Answer 51

psychotropics, antivirals, antibiotics, NSAIDs, antithyroids, ACEIs, propranolol

Question 52

Clinical presentation of vitamin B12 deficiency?

Answer 52

Gradual onset of symmetric peripheral neuropathy (starting in feet and/or arms) Other: numbness, ataxia (+ Romberg test), impaired memory, loss of vibration & position sense

Question 53

Hodgkins Lymphoma clinical presentation? (cancer of beta lymphocytes/B cells)

Answer 53

Night sweats, fevers, pain with ingestion of alcoholic drinks Other: generalized pruritis with painless enlarged lymph nodes (neck), anorexia, weight loss. ("B" symptoms) *Presence of Reed-Sternberg cells

Question 54

Non-Hodgkin's Lymphoma clinical presentation? (cancer of lymphocytes/B cells and killer cells

Answer 54

Night sweats, fever, weight loss, generalized lymphadenopathy (painless) *Poor prognosis

Question 55

Multiple myeloma clinical presentation? (cancer of plasma cells)

Answer 55

Fatigue, weakness, bone pain (back or chest) *CRAB (hypercalcemia, renal failure (Bence-Jones proteinuria), anemia, bone disease

Question 56

Hemophila A (X-linked recessive disease) is caused by Factor ___ deficiency?

Answer 56

VIII

Question 57

Total iron-binding capacity (TIBC) is (elevated/decreased) in IDA?

Answer 57

Elevated (not enough iron to transport) *TIBC normal in thalassemia, vit B12 deficiency, folate-deficiency anemia (iron levels are normal)

Question 58

What is anisocytosis?

Answer 58

RBCs with variable sizes

Question 59

Gold-standard test to diagnose hemoglobinopathies (ex: sickle cell anemia, thalassemias)

Answer 59

Hemoglobin electrophoresis (only need to do once)

Question 60

Examples of iron-rich foods?

Answer 60

Red meat, some beans (ex: black beans), green leafy vegetables

Question 61

Types of antibiotics to avoid taking with iron supplement?

Answer 61

Quinolones, tetracyclines (iron binds to substances and becomes inactivated)

Question 62

Homocysteine levels are increased in _____ & _____ deficiency anemia?

Answer 62

Folate (primarily) & Vit B 12

Question 63

Antiparietal antibodies are elevated in ____ anemia?

Answer 63

Pernicious anemia

Question 64

Average life span of RBC in sickle-cell anemia?

Answer 64

10-20 days *Howell-Jolly bodies and target cells present on peripheral smear

Question 65

Best absorbed and cheapest iron supplementation available OTC?

Answer 65

Ferrous sulfate

Question 66

Aplastic anemia lab presentation?

Answer 66

Pancytopenia (leukopenia, anemia, thrombocytopenia) *May be related to radiation, drug ADRs, viral infection) *Bone marrow biopsy is gold standard diagnostic test

Question 67

Ferritin, serum iron, TIBC, and MCHC are all normal/abnormal in thalassemia trait compared to IDA

Answer 67

Normal