Hematology

Question 1

In a patient with anemia where the MCH high at 105, MCHC low at 29, and a ferritin that is normal, what disorder is suspected indicating which test should be performed?

Answer 1

Thalassemia minor and hemoglobin electrophoresis

Question 2

What tests can help to differential Folate Deficiency from B12 deficiency?

Answer 2

Homocystine and methylmalonic acid (MMA). Both are elevated in B12 deficiency and only homocystine in Folate Deficiency.

Question 3

What test should be performed to diagnose perniscious anemia?

Answer 3

Parietal antibody test (antiparietal antibody) or intrinsic factor antibody (Anti-IF)

Question 4

When treating a vitamin deficient anemic patient with presumed normal bone marrow, when would you expect to see an elevation in Hct/Hgb and when would you expect it to return to normal?

Answer 4

Increased in 1-2 weeks, normal 4-6 weeks.

Question 5

What is the primary differentiating symptom between folate and B12 deficiency anemias?

Answer 5

Neurological impairment (gait, balance, mentation)

Question 6

A patient with MCV of 76, low hct/hgb and rbc-the next step is to order TICB, Ferritin and Serium iron. If the ferritin and iron levels are low- which form of anemia is diagnosed

Answer 6

IDA

Question 7

In anemia patient with MCV >100, what studies should be ordered?

Answer 7

Folate & B12 levels

Question 8

CAGE tool helps to screen for what condition?

Answer 8

Alcohol abuse

Question 9

Reticulocyte count decreases with___?

Answer 9

Hypoproliferative disorders such as Nutritional deficiencies and bone marrow diseases

Question 10

Reticulocyte count increases with?

Answer 10

Hemolytic anemia and sickle cell crisis

Question 11

What does MCV determine?

Answer 11

Size of cell: microcytic (less than 80), normocytic (80-100) and macrocytic (>100)

Question 12

What are two key differentiators in IDA?

Answer 12

Low ferritin and high TIBC

Question 13

When differentiation thalassemia from IDA- what is one key finding?

Answer 13

In thalassemia, the TIBC will be normal and iron will be normal/high

Question 14

MCV and MCH high, what kind of anemia is it?

Answer 14

Macrocytic, usually B12 or folate deficiency

Question 15

Elevated neutrophils usually indicates what type of infection?

Answer 15

Bacterial

Question 16

Elevated lymphocytes usually indicates what type of infection?

Answer 16

Viral

Question 17

Aside from acute bacterial infections, what else may cause elevated neutrophils?

Answer 17

Leukemia and tissue distruction such as burns

Question 18

What finding in a Left shift is considered to be suggestive of poor outcomes?

Answer 18

Elevated bands without leukocytosis

Question 19

What defines a Right shift?

Answer 19

Low bands and elevated segs- often found with liver disease, megaloblastic anemias, and hemolysis

Question 20

When H&H is low, MCV/MCHC normal, ferritin is high and tibc is low, what anemia is suspected

Answer 20

Anemia of chronic illness (ACD)

Question 21

What defines a chronic cough?

Answer 21

Cough that lasts >8 weeks