Hematology: 1. investigation of an anemic patient

Question 1

how is anemia defined?

Answer 1

decreased RBC mass:
Men- Hct<41% or Hgb<13g/dL or RBC<4.5 million/mcL
women- Hct<36% or Hgb<12g/dL or RBC<3.8 million/mcL

Question 2

when is splenomegaly seen with anemia?

Answer 2

thalassemia
neoplasm
chronic hemolysis

Question 3

symptoms and signs of anemia

Answer 3

fatigue 
pallor 
tachycardia 
jaundice (hemolysis) 
purpura (bleeding disorder) 
glossitis (folate, vitamin B12 deficiency)
koilonychia (iron deficiency)

Question 4

increased sympathetic tone (HR and CO ) and 2,3 BPG are physiologic responses for?

Answer 4

anemia

Question 5

diagnostic evaluation for anemia

Answer 5

1. History
2. CBC
3. Peripheral smear
4. iron studies
5. Reticulocyte studies
6. Hemolysis labs

Question 6

Microcytic anemia (<80 fL MCV)

Answer 6

TAIL: 
Thalassemia 
Anemia of chronic disease 
Iron deficiency (early ) 
Lead poisining

Question 7

Normocytic anemia

Answer 7

nonhemolytic: CIAA
Chronic kidney disease 
Iron deficiency (early) 
Anemia of chronic disease 
Aplastic anemia 

Hemolytic:
intrinsic- hereditary spherocytosis, PNH, G6PD deficiency, Sickle cell anemia
extrinsic- autoimmune, micro/macroangiopathic, infections

Question 8

macrocytic anemia

Answer 8

Megaloblastic anemia- folate, B12 deficiency, orotic aciduria, fanconi anemia
Nonmegaloblastic- LAD: Liver disease, Alcoholism, Diamond-Blackfan anemia