Hematology

Question 1

Autoimmune hemolytic anemias, typically

Answer 1

Normocytic anemia

Question 2

Acute blood loss anemia, typically

Answer 2

Normocytic anemia

Question 3

G6PD anemia type

Answer 3

Hemolytic anemia, normocytic

Question 4

Disseminated intravascular coagulopathy (DIC) anemia type

Answer 4

Hemolytic anemia, normocytic

Question 5

Hemolytic-uremic syndrome anemia type

Answer 5

Hemolytic anemia, normocytic

Question 6

Thrombotic thrombocytopenic purpura anemia type

Answer 6

Hemolytic anemia, normocytic

Question 7

General (3) mechanisms of normocytic anemia

Answer 7

1) Increase destruction or loss
2) Decreased production
3) Overexpansion of plasma volume

Question 8

Primary (4) causes of decreased RBC production

Answer 8

1) Marrow hypoplasia
2) Myelopathies
3) Myeloproliferative disease
4) Pure RBC aplasia

Question 9

Secondary (5) causes of decreased RBC production

Answer 9

1) CKD
2) Liver disease
3) Endocrine deficiency
4) Anemia of chronic disease
5) Sideroblastic anemias

Question 10

(2) Causes of overexpansion of plasma volume

Answer 10

1) Pregnancy

2) Hypervolemia

Question 11

Initially nearly all anemias are of what type?

Answer 11

Normocytic normochromic

Question 12

Most common cause of normocytic anemia?

Answer 12

Anemia of chronic disease/inflammation

Question 13

Hallmark ferrokinetic profile of anemia of chronic disease?

Answer 13

Present but inaccessible iron: decreased serum Fe, decreased transferrin, normal or elevated ferritin

Question 14

Endocrine (4) disorders resulting in normocytic anemia

Answer 14

1) Hypothyroidism
2) Adrenal or pituitary insufficiency
3) Hypogonadism
4) Hyperthyroidism

Question 15

How might endocrine deficiency result in secondary bone marrow failure?

Answer 15

Reduced stimulation of EPO secretion

Question 16

Anemia of chronic kidney disease is typically normocytic but may also be…?

Answer 16

Microcytic

Question 17

How do AKI and CKD result in anemia?

Answer 17

Increased uremic metabolites decrease RBC lifespan and reduce erythropoiesis

Question 18

EPO levels in anemia of CKD (2/2 uremia) vs. EPO levels in most other causes of anemia

Answer 18

Decreased vs. elevated

Question 19

G6PD deficiency anemia type

Answer 19

Transitory hemolytic anemia, normocytic

Question 20

Mechanism of G6PD hemolysis

Answer 20

Exposure to oxidative drug

Question 21

Anemia in hypersplenism, conditions?

Answer 21

Seen after spleen reaches 3-4x normal size, as in liver cirrhosis, chronic infection, myeloproliferative diseases

Question 22

Anemia in hypersplenism mechanism?

Answer 22

Primarily caused by removal of RBC from circulation (sequestering) but also increased RBC destruction

Question 23

Most common causes of microcytic anemia

Answer 23

1) Iron deficiency anemia
2) Anemia of chronic inflammation/disease
3) Thalassemia trait
4) Pregnancy
5) Lead poisoning

Question 24

Mechanisms of iron deficiency anemia

Answer 24

1) Occult blood loss
2) Decreased GI absorption as in Celiac disease and H. pylori infection
3) Menstrual blood loss
4) Malignancy
5) Poor intake/malnutrition

Question 25

Why is ferritin elevated in anemia of chronic disease

Answer 25

Acute phase reactant

Question 26

Acute phase reactants are either ____ or ____.

Answer 26

Positive or negative

Question 27

Role of ferritin as acute phase reactant

Answer 27

Sequester circulating/free iron to make less available to tumor cells or reduce microbial iron scavenging.

Question 28

Role of fibrinogen as acute phase reactant

Answer 28

Promote endothelial repair; correlates with ESR

Question 29

Erythrocyte sedimentation rate is a proxy for…?

Answer 29

Fibrinogen levels (as an acute phase reactant)

Question 30

What sort of acute phase reactant is albumin?

Answer 30

Negative

Question 31

During acute phase albumin production is reduced to conserve____ for positive acute phase proteins

Answer 31

Amino acids

Question 32

C-reactive protein’s function as an acute phase protein

Answer 32

Microbial opsonization, binding to degenerating cells, activate compliment pathways

Question 33

Pathophysiology of alcohol-related macrocytosis/anemia

Answer 33

Believed to be 2/2 direct marrow toxicity to hematopoeitic cells; doesn't result directly in folate deficiency though these often co-occur

Question 34

DDx: high RBC, normal-low Hgb, low MCV, normal-high RDW

Answer 34

Thalassemia; polycythemia with iron deficiency anemia

Question 35

DDx: normal-low RBC, low Hgb, normal-low MCV, normal-low MCH, normal-high RDW

Answer 35

Iron deficiency anemia (more normal in early disease); advancing anemia of chronic inflammation (resulting in iron deficiency anemia)

Question 36

Mechanism: anemia of chronic kidney disease

Answer 36

Chronic inflammation; decreased EPO production

Question 37

Mechanism: anemia of chronic disease/inflammation

Answer 37

Chronic release of cytokine interleukin-6 (IL-6) stimulates production of hepcidin leading to increased intracellular iron sequestration; also the chronic condition contributes to anemia, as in CKD