Heme Onc

Question 1

What is the most common cause of iron deficiency anemia in elderly?

Answer 1

colon polyps/carcinoma. Ancylostoma duodenale and necator americaus inthe devloping world

Question 2

In adults, what is the most common cause of iron deficiency anemia?

Answer 2

males: peptic ulcer disease
females: menorrhagia or pregnancy

gastrectomy–iron is absorbed best in acidic environements

Question 3

What is the most common cause of iron deficiency anemia in infants

Answer 3

breastmilk has low iron

Question 4

Lab findings of iron deficiency anemia?

Size, color, RDW, ferritin, TIBC, serum iron, %sat, FEP?

Answer 4

microcytic, hypochromic, inc RDW, dec ferritin, inc TIBC, dec serum iron, dec % sat, inc FEP

Question 5

Where does the final step of heme synthesis take place and what enzyme?

Answer 5

in the mitochondria. Ferrochetalase attaches protporphyrin to iron to make heme

Question 6

First line treatment for lead poisoning?

Answer 6

Dimercaprol and EDTA. Succimer in children

Question 7

Where is folate absorbed?

Answer 7

jejunum

Question 8

Where is B12 absorbed?

Answer 8

ileum

Question 9

Where is iron absorbed?

Answer 9

duodenum

Question 10

What two reactions require B12?

Answer 10

1. Homocysteine conversion to methionine
2. Fatty acid metabolis: methylcalonic acid to succinyl CoA

Question 11

Describe the breakdown products of heme?

Answer 11

Heme is broken down into iron and protporphyrin. Iron is recycled and protoporyphyrin is broken down into UCG bilirubin, which is delivered to the liver for conjugation and excretion into the bile.

Question 12

What is the most common cause of death in children with sickle cell anemia?

Answer 12

infections due to autosplenectomy (S. pneumo, H. flu)

Question 13

What is the most common cause of death in adult patients with sickle cell anemia?

Answer 13

acute chest syndrome

Question 14

What is the complication commonly seen in sickle cell trait?

Answer 14

sickling in the renal medulla leading to microinfarction that lead to microscipic hematuria and eventually decreased ability to concentrate urine

Question 15

What cancers produce excessive EPO?

Answer 15

1. RCC
2. Pheo
3. HCC
4. Hemangioblastoma

Question 16

When do you see HbH?

Answer 16

tetramers of beta globin chains. Seen in 3 gene deletions in alpha-thalassemia

Question 17

When do you see Hb Barts and what are they made of?

Answer 17

4 gene deletion in alpha-thalassemia. Made of gamma tetramers (from fetal hemoglobin)

Question 18

What drugs cause aplastic anemia?

Answer 18

Can’t Make New Blood Cells Properly

Carbamazepine

Methimazole

NSAIDs

Benzene

Chloramphenicol

Propylthiouracil

Question 19

What is a common complication of paroxysmal nocturnal hemglobinuria?

Answer 19

acute myeloid leukemia

Question 20

?What is the main cause of death in PNH

Answer 20

thombosis of the hepatic, portal or cerebral veins

Question 21

What is the defect in paroxysmal nocturnal hemoglobinuria?

Answer 21

acquired defect in myeloid stem cells resulting in absense of GPI so no DAF or MIRL (CD55)