Hematology 2

Question 1

iron-deficiency anemia: characteristics

Answer 1

Microcytic and hypochromic anemia (small and pale RBCs) caused by iron deficiency.
It is the most common type of anemia in the world for all races, ages, and gender.

Question 2

iron-deficiency anemia: S/Sx

Answer 2

Pallor of the skin, conjunctiva, and nail beds. Daily fatigue and exertional dyspnea. May have glossitis and angular cheilitis. Cravings for ice or dirt. Severe case will cause spoon-shaped nails, systolic murmurs, tachycardia, or HF

Question 3

iron-deficiency anemia: etiology

Answer 3

Most common–> blood loss. Risk factors: reproductive-aged female (heavy periods, pregnancy), poor diet, GI bleed, postgastrectomy, increased physiologic requirement.
Infants: r/o chronic intake of cow’s milk before 12 m.o. of age (causes GI bleeding)

Question 4

iron-deficiency anemia: lab

Answer 4

Decreased: Hgb/Hct, microcytic (MCV<80 fL), MCHC, ferritin and iron level.
Increased: TIBC, RDW
Blood smear: anisocytosis and poikilocytosis

Question 5

iron-deficiency anemia: Tx plan

Answer 5

*R/o GI malignancy
Ferrous sulfate 325 mg PO TID btw meals (take w/ vit. C or OJ) for 3-6 m.o.
Iron-rich food: red meat, green leafy vege.
Increase fiber and fluids to prevent constipation.
F/u retic and CBC counts in 2 wks (retic, Hgb, Hct will increase)

Question 6

Thalassemia minor: characteristics

Answer 6

Genetic Dz in which the bone marrow produces abnormal Hgb. Results in microcytic/hypochromic anemia. Occurs in ppl from Mediterranean, North Africa, Middle East, and Southeast Asia (incl. China).
Asymptomatic and no Tx needed.

Question 7

Thalassemia minor: diagnostic

Answer 7

Gold-std diagnostic test is Hgb electrophoresis

Question 8

anemia of CKD: characteristics

Answer 8

Hypoproliferative, normocytic, normochromic
Hgb < 11 g/dL in pregnant F, < 12 g/dL in nonpregnant F, < 13 g/dL in M
Occurs 2/2 decrease in renal EPO production secondary to CKD

Question 9

anemia of CKD: initial testing

Answer 9

CBC, serum ferritin, serum transferrin saturation, B12, folate, and retic count

Question 10

aplastic anemia: characteristics

Answer 10

Destruction of the pluripotent stem cells inside the bone marrow 2/2 multiple causes (radiation, adverse effect of a drug, viral infection, etc.). Results in pancytopenia (leukopenia, anemia, thrombocytopenia)

Question 11

aplastic anemia: S/Sx

Answer 11

Severe case of anemia w/ fatigue and weakness. Pallor of skin and mucosa. Tachy and systolic murmur. Recurrent bacterial/fungal infections. Large bruises from trauma and bleeding 2/2 thrombocytopenia.

Question 12

aplastic anemia: lab

Answer 12

CBC w/ differential, Plt count, gold-std is bone marrow biopsy

Question 13

aplastic anemia: Tx

Answer 13

hematologist referral ASAP

Question 14

Vit. B12 deficiency anemia: characteristics

Answer 14

The most common cause is pernicious anemia (autoimmune disorder)
Other causes: B12 malabsorption (GI Dz, infection, medications such as antacids, H2-receptor antagonist, PPI, metformin)
Chronic B12 deficiency causes nerve damage (peripheral neuropathy, paraplegia) and brain damage (dementia)
Highest incident in older women

Question 15

pernicious anemia: characteristics

Answer 15

Autoimmune caused by the destruction of parietal cells in the fundus resulting in cessation of intrinsic factor production.
Iron deficiency commonly coexist w/ pernicious anemia

Question 16

pernicious anemia: S/Sx

Answer 16

Tingling/numbness of hands and feet, difficulty walking, difficulty performing fine motor skills (hands)
Decreased reflexes in affected extremity.
Weak hand grip, abnormal Romberg, decreased vibration sense

Question 17

pernicious anemia: labs

Answer 17

Antibody tests: parietal Ab test, intrinsic factor Ab test –> if positive, Pt has pernicious anemia

Question 18

pernicious anemia: Tx

Answer 18

Initial: B12 injection 1 mg per wk for 4 wks
Maintenance: B12 injection 1 mg per month for lifetime

Question 19

B12 deficiency: clinical pearl

Answer 19

B12 level in a Pt w/ B12 deficiency may be normal (< 5%).
Check B12 level as well as antibodies, urine MMA, etc.
Any Pt complaining of neuropathy or who has demential should have B12 level checked.

Question 20

folic acid-deficiency anemia: characteristics

Answer 20

Macrocytic (MCV > 100 fL)

Question 21

folic acid-deficiency anemia: S/Sx

Answer 21

Elderly and/or alcoholic Pt complains of anemia S/Sx (tired, fatigue, pallor, reddened and sore tongue). No neurological complaints. If anemia is severe, may hav tachy, palpitations, angina, or HF.

Question 22

folic acid-deficiency anemia: causes

Answer 22

Most common: inadequate dietary intake (alcoholism, overcooking veges, low citrus intake).
Long term meds use: phenytoin (Dilantin), trimethoprim-sulfa, metformin, methotrexate, sulfasalazine, zidovudine (Retrovir, azidothymidine), etc.

Question 23

folic acid-deficiency anemia: labs

Answer 23

CBC (decreased Hgb, Hct; increased MCV). Blood smear (macro-ovalocytes, hypersegmented neuts. Folate level < 4 ng/mL

Question 24

What to look out for a woman of childbearing age regarding folic acid

Answer 24

Advise all women to take 400 mcg folic acid supplement daily at least 1 mo prior to getting pregnant. –> For normal fetal development and decrease the incidence of neural tube defects.

Question 25

sickle cell anemia: characteristics

Answer 25

Autosomal recessive hemolytic anemia. Increased resistance to malarial infection. Higher risk of death from infection w/ encapsulated bacteria (eg Strep. pneumo, Haemophilus influenzae) 2/2 hyposplenia.

Question 26

If Pt has anemia w/ MCV 76, which lab orders will you make next?

Answer 26

TIBC, ferritin, serum iron
low iron: iron-deficiency anemia
normal iron: likely thallassemia trait

Question 27

If Pt has MCV > 100 fL, which lab orders will you make next?

Answer 27

B12 and folate levels

Question 28

Which type of anemia has neurologic symptoms?

Answer 28

B12 deficiency anemia is the only anemia w/ neurologic symptoms (eg tingling, numbness)