Hematology

Question 1

Best initial test for B12 or folate deficiency

Answer 1

Peripheral smear: shows hypersegmented neutrophils (GE 5 lobes)

Question 2

What is the difference in signficance between the serum folate level and RBC folate level?

Answer 2

Serum folate level is an indication of recent folate intake, while RBC folate is the best indicator of long-term folate stores (higher sensitivity)

Question 3

What is the best way to treat anemia of chronic disease?

Answer 3

The primary Rx of anemia of chronic disease is through controlling the underlying dx process. If this is ineffective or impossible, Rx with erythropoietin injections for target hemoglobin of 12g/dL is appropriate

Question 4

What is the leading cause of anemia in infants and children in the US?

Answer 4

Iron-deficiency anemia

Question 5

Diseases with similar findings to anemia

Answer 5

• Hypoxia
• Carbon monoxide poisoning
• Methemoglobinemia
• Ischemic heart disease

Question 6

Best initial test for anemia

Answer 6

CBC with peripheral smear (pay special attention to the MCV/ MCHC)

Question 7

Additional initial tests for a case of anemia

Answer 7

Reticulocyte count

Haptoglobin

LDH ()

Total and direct bilirubin

TSH with T4

B12/ folate levels

Iron studies

Also order urinalysis with microscopic analysis

Question 8

What tests are used to categorize anemia

Answer 8

MCV (mean corpuscular hemoglobin), which is used to determine if the anemia is microcytic, macrocytic or normocytic

MCHC () may tell you if there is a problem with the synthesis of hemoglobin. The anemia could then be categorized as hypochromic, hyperchromic or normochromic

Question 9

What is the best initial diagnostic test for iron deficiency anemia?

Answer 9

Serum ferritin: Low ferritin

  Total iron binding capacity: High TIBC

 Serum iron: Low Fe

   Serum iron saturation: Low Fe sat

   Red blood cell width (RDW): Elevated RDW

Question 10

What is the most accurate diagnostic test for iron deficiency anemia (IDA)?

Answer 10

Bone marrow biopsy (N/B: Do not answer this in CCS)

Question 11

What is the best initial therapy for IDA?

Answer 11

Ferrous sulfate orally

Question 12

What is the best initial diagnostic test for anemia of chronic disease?

Answer 12

Iron studies:

• High ferritin
• Low TIBC
• Low Fe
• Normal or low Fe sat

Question 13

What is the best initial diagnostic test for Thalassemia?

Answer 13

Iron studies: Normal

Question 14

What is the most accurate diagnostic test for Thalassemia?

Answer 14

Hemoglobin Electrophoresis:

Beta: Elevated HgA2, HgF

Alpha: Normal

Question 15

What is the usual hx, physical and CBC/peripheral smear findings in Thalassemia?

Answer 15

Very small MCV with few or no symptoms

Target cells

Question 16

Best accurate diagnostic test for alpha Thalassemia

Answer 16

Alpha thalassemia is most accurately diagnosed by DNA sequencing

Question 17

Best initail diagnostic test for Sideroblastic anemia

Answer 17

Iron studies:

High Fe

Question 18

What is the most accurate diagnostic test for Sideroblastic anemia?

Answer 18

Prussian blue stain

Question 19

List 3 causes of Sideroblastic anemia?

Answer 19

Alcohol

INH

Lead expopsure

Question 20

What is the best initial therapy for sideroblastic?

Answer 20

Mild: Pyridoxin replacement

Severe: Remove the toxin exposure

Question 21

Name the 2 organs where “extravascular” hemolysis occurs

Answer 21

Spleen

Liver