hematologic disorders Flashcards
You advise a 28-year-old woman who follows a vegan diet to supplement with:
Vitamin A.
Iron.
Vitamin B12.
Folic acid.
Correct answer: Vitamin B12
A 78-year-old woman presents with fatigue, spoon-shaped nails and the following laboratory results.
Hb=9 g/dL (11.8–14 g/dL) (90 g/L [118–140 g/L])
Hct=28.1% (35.4–42%) (0.281 proportion [0.354–0.42 proportion])
RBC=2.4 million/mm³ (4.2–5.4 million/mm³)
MCV=70 fL (80–96 fL)
MCHC=24.2 g/dL (31–37 g/dL) (242 g/L [310–370 g/L])
RDW=19% (11–15%) (0.19 proportion [0.11–0.15 proportion])
A critical causative diagnosis to consider as origin of her anemia is:
Gastrointestinal blood loss.
Micronutrient malabsorption.
Chronic ileitis.
Folic acid deficiency.
Correct answer: Gastrointestinal blood loss.
Which of the following represents the optimal advice to a patient who is taking oral iron therapy to maximize the medication’s effectiveness?
Take your medication with an antacid.
Take your medication on an empty stomach.
Take your medication after the largest meal of the day.
Take your medication with a large glass of milk.
Correct answer: Take your medication on an empty stomach.
A 68-year-old woman presents with a 6-month history of increasingly severe peripheral numbness and oral irritation. She denies lightheadedness or chest pain but does notice she is more short of breath when climbing a flight of stairs. Hemogram results are as follows.
Hb=6.2 g/dL (12–14 g/dL) (62 g/L [120–140 g/L])
Hct=20% (36–42%) (0.2 proportion [0.36–0.42 proportion])
RBC=2.1 million/mm³ (4.2–5.4 million/mm³)
MCV=132 fL (80–96 fL)
MCHC=32.4 g/dL (31–37 g/dL) (324 g/L [310–370 g/L])
RDW=19% (11–15%) (0.19 proportion [0.11–0.15 proportion])
Physical exam reveals pale conjunctiva, a grade 2/6 systolic ejection murmur over the precordium without radiation, and a smooth, red tongue. BP= 128/80 mm Hg, resting pulse= 92 BPM, RR= 18 BPM. The most likely cause of this anemia is:
Vitamin B12 deficiency.
Iron deficiency.
Hemolysis.
Chronic disease.
Correct answer: Vitamin B12 deficiency.
The heart murmur noted in the above-mentioned patient has not been present on previous examination. As a result, you consider that this is likely a _________ murmur and will resolve with anemia treatment.
Pathologic
Hemic
Venous hum
Congenital
Correct answer: Hemic
A 65-year-old woman with rheumatoid arthritis who is on optimized therapy and continues to have significant symptoms presents with the following hemogram.
Hb=10.1 g/dL (12–14 g/dL) (101 g/L [120–140 g/L])
Hct=32% (36–42%) (0.32 proportion [0.36–0.42 proportion])
RBC=3.2 million/mm3 (4.2–5.4 million/mm3)
MCV=82 fL (80–96 fL)
RDW=12.8% (11–15%) (0.128 proportion [0.11–0.15 proportion])
Reticulocytes=0.7% (1–2%) (0.007 proportion [0.01–0.02 proportion])
These findings are most consistent with:
Iron deficiency anemia.
Folate deficiency anemia.
Anemia of chronic disease.
Alpha thalassemia minor.
Correct answer: Anemia of chronic disease.
True or False?
(T/F) The use of all of the following nutritional supplements is potentially associated with increased bleeding risk and should be discontinued at least 7‒10 days prior to elective surgical procedure and used with caution with drugs such as aspirin, direct oral anticoagulants (DOAC; rivaroxaban [Xarelto®], apixaban [Eliquis®]), and warfarin.
Ginseng
Gingko
Fish oil
Vitamin D
true
true
true false
You see Maria, a 32-year-old well woman of Mediterranean ancestry. Hemogram results are as follows.
Hb=10.6 g/dL (12–14 g/dL) (106 g/L [120–140 g/L])
Hct=32% (36–42%) (0.32 proportion [0.36–0.42 proportion])
RBC=6.2 million/mm3 (4.2–5.4 million/mm3)
MCV=71 fL (80–96 fL)
MCHC=25.2 g/dL (31–37 g/dL) (252 g/L [310–370 g/L])
RDW=12% (11–15%) (0.12 proportion [0.11–0.15
These findings are most consistent with:
Iron deficiency anemia.
Cooley’s anemia.
Beta thalassemia minor.
Acute blood loss.
Beta thalassemia minor.
Follow up lab to order for the following CBC results:
MCV LOW
MCHC LOW
RDW HIGH
Ferritin (iron)
Primary care of Sarah, a 27-year-old woman with beta thalassemia minor, should include:
Prescribing a low-dose iron supplement to counteract microcytosis.
An evaluation of hemoglobin electrophoresis every 5 years.
Advising taking a multivitamin with high-dose folate supplementation daily.
Offering genetic counseling prior to pregnancy.
Feedback
Correct answer: Offering genetic counseling prior to pregnancy.
Correct answer: Offering genetic counseling prior to pregnancy.
Supplements are not effective
Follow up lab to order for the following CBC results:
MCV LOW
MCHC LOW
RDW NL
Hemoglobin electrophoresis (beta-thalassemia minor)
Follow up lab to order for the following CBC results:
MCV HIGH
MCHC NL
RDW HIGH
Vitamin B12 and folate
Most common normocytic normochromic anemia
Anemia of chronic disease
Most common microcytic/hypochromic anemia
iron deficiency
Most common Macrocytic/normochromic anemia
B12 and folate deficiency
