Hematology Anskar

Question 1

What does rouleaux in peripheral blood mean

Answer 1

hypergammaglobulinemia

Question 2

Ix for MM and what are the findings

Answer 2

• CBC (pancytopenia, reversed AG ratio)
• serum electrolytes (hypercalcemia)
• Serum Ig levels (immunoparesis)
• Peripheral blood smear (rouleaux)
• Serum protein electrophoresis (monoclonal gammopathy)
• immunofixation (eg IgG kappa monoclonal gammopathy)
• BM biopsy (predominance of abnormal plasma cells)

Question 3

how would ppi abuse/ gastrectomy lead to anemia

Answer 3

chronic lack of acidity –> cant convert natural 3+ state to absorbable 2+ state –> malabsorption of iron

Question 4

function of hepcidin

Answer 4

ferroportin expression

macrophage

Question 5

clinical presentation of anemia

Answer 5

• sob, palpitation, dizziness, syncope, fatigue, decreased exercise tolerance, pallor
• menorrhagia, tarry stool
• bone pain
• uremic complexion
• jaundice
• early greying and glossitis
• shock/tachycardia
• isolated splenomegaly
• lymphadenopathy and hepatosplenomegaly
• abdominal mass

Question 6

causes of anemia

Answer 6

1 Decrease production

• nutritional – iron, b12, folate
• BM disorder – aplastic anemia, pure red cell aplasia, neoplastic diseases
• BM suppression – drugs, chemo, RT
• reduced trophic hormones – erythropoietin, thyroid hormone
• anemia of chronic disease – infections, CA, AI, chronic rejection after solid-organ transplant, CKD, chronic inflammation

2 increase destruction
intrinsic rbc defects
- enzyme deficiency – G6PD
- hb defects – thalassemia, hbopathies
- membrane defects – hereditary spherocytosis, elliptocytosis
extrinsic rbc defects
- liver disease + hypersplenism
- infection – malaria
- AIHA – warm/cold reacting, drugs
- microangiopathy – prosthetic valve leak, ttp, dic
- transfusion reactions – abo incompatibility

3 blood loss

Question 7

microcytic anemias

Answer 7

thalassemia
fe deficiency
sideroblastic anemia

Question 8

normocytic anemias

Answer 8

anemia of chronic disease
acute blood loss
dimorphic anemia

Question 9

macrocytic anemias

Answer 9

aplastic anemia
chronic liver disease
chemo
alcohol
vitb12/folate deficiency
hemolytic anemia
myelodysplasia

Question 10

polychromasia on blood film

Answer 10

increased reticulocyte

Question 11

agglutination on blood film

Answer 11

raised globulin level

Question 12

pencil cells on blood film

Answer 12

fe def anemia

Question 13

macroovalocytes on blood film

Answer 13

vitb12 def anemia

Question 14

tear-drop cells on blood film

Answer 14

fibrosing marrow

Question 15

echinocytes

Answer 15

renal failure

Question 16

spur cells

Answer 16

alcoholic liver disease

Question 17

bite cells

Answer 17

oxidative damage on rbc, g6pd def

Question 18

what organelle produces heme

what enzyme rate limiting

Answer 18

mito

ALAS2

Question 19

iron restricted erythropoiesis

Answer 19

absolute iron deficiency

• blood loss
• malabsorption – gastrectomy, ppi, atrophic gastritis
• increased demand in pregnancy
• inadequate intake in anorexia

iron sequestration syndromes
- anemia of chronic disease

functional iron deficiency
- use of erythropoiesis stimulating agent like erythropoietin