Hematology 1

Question 1

What do you give a warfarin patient who is presenting with an unstable GI bleed presentation?

Answer 1

FFP

Question 2

Common in kids.

Presents as ataxia, fatigue, learning disabilities, difficulty concentrating.

Neuropathic symptoms of wrist or food drop.

Intermittent abdominal pain, vomiting, loss of appetite and constipation.

Microcytic hypochromic anemia with basophilic stippling. Ringed sideroblasts in bone marrow.

Answer 2

Lead poisoning

Serum Lead > 10

Tx is removal of source of lead

Can use succimer (oral chelation) for inpatient management.

Question 3

Where is B12 mainly absorbed?

Answer 3

Distal ileum

Question 4

What test do you order to differentiate B12 vs Folate?

Answer 4

MMA

Question 5

Alcoholic patient or a patient with an unbalanced diet.

Fatigue, exercise intolerance, pallor, glossitis, apthous ulcer, diarrhea, malabsorption.

Absent neurologic symptoms.

Normal MMA.

Answer 5

Folate deficiency

Question 6

Increased ferritin + decreased TIBC + decreased serum iron

Answer 6

Anemia of chronic disease

Question 7

What should you think a patient has if they have a microcytic anemia with a normal or increased serum iron or no response to iron tx.

Answer 7

Thalassemia

Question 8

Microspherocytes and Coombs POSITIVE

Answer 8

Autoimmune hemolytic anemia

Question 9

Microspherocytes and coombs NEGATIVE

Answer 9

Hereditary spherocytosis

Question 10

Tx for a patient with recurrent episodes of hemolysis: anemia, jaundice, and splenomegaly.

Peripheral smear shows hyperchromic microcytosis, spherocytes

Increased MCHC

Coombs test negative.

Answer 10

Hereditary spherocytosis

Folic acid

Splenectomy if severe

Question 11

Patient with dactylitis.

Can present with splenomegaly and rapid decrease in hemoglobin.

Peripheral smear shows sickled erythrocytes and or Howell-Jolly bodies.

Answer 11

Sickle cell disease

Question 12

Tx for a patient with hemolytic anemia + pancytopenia and unexplained thrombosis in atypical veins.

Urin is dark cola colored during the night or early morning.

Hypercoagulability despite pancytopenia.

Answer 12

Paroxysmal nocturnal hemoglobinuria

Complement inhibitors Eculizumab

Question 13

Tx for sickle cell

Answer 13

IV hydration and oxygen for pain control

Question 14

Tx for a patient with mucocutaneous bleeding, anemia, jaundice and splenomegaly.

Patient may have neurologic symptoms such as headache, visual changes, confusion.

Labs show thrombocytopenia (low platelets) with normal PT and PTT.

Answer 14

TTP

plasmapheresis first line

Glucocorticoids or Rituximab

Question 15

Triad of low platelets, hemolytic anemia, and renal dysfunction.

Common in kids after recent hx of gastroenteritis

Associated with Enterohemorrhagic E. coli

Abd pain, bloody diarrhea, oliguria and hematuria

Increased BUN and creatinine

Answer 15

HUS

Tx supportive

Plasmapheresis