Hemeonc 4

Question 1

If you have an anemia with normocytic MCV, what is the next test you should order? Why?

Answer 1

Reticulocyte count, to see if there is a production problem (organ dysfunction, chronic disease, HIV, myelosuppression) or bleeding problem (GI bleed, acute blood loss, hemolytic anemia)

Question 2

What type of anemia is persistent for greater than 1 to 2 months in patients with the associated conditions:

Infection
Malignancy
Endocrine disorders
Immune disorders (SLE, RA)
Others: 
HIV, DM, Heart failure

Answer 2

Anemia of Inflammation

Question 3

What signals the production of RBC’s? And where is it produced?

Answer 3

The hormone erythropoietin, produced in the kidneys

Question 4

Causes of anemia of inflammation (2)

Answer 4

suppressed erythropoiesis (renal issue)
inflammation (cytokines) results in poor iron metabolism/absorption

Question 5

Do you expect ferritin to be low in an anemia of chronic disease? Why?

Answer 5

No, because ferritin is an acute phase reaction and it is often normal in chronic disease

Question 6

What is the treatment for anemia of inflammation?

Answer 6

Treat the underlying cause

Question 7

What type of anemia results in Bone Marrow Failure: (Global decrease in your stem cells and consequently there is a deficiency in all blood cells.)
PANCYTOPENIA

Answer 7

Aplastic Anemia

Question 8

What is the major cause of aplastic anemia?

Other causes?

Answer 8

>50% AUTOIMMUNE (IDIOPATHIC)
Also caused by drug reaction (sulfa, chloramphenicol, chemo)
radiation
genetic
infection,
pregnancy

Question 9

What are common clinical features of aplastic anemia?

Answer 9

bleeding (thrombocytopenia)
infection (neutropenia)
fatigue/pallor (anemia)

Question 10

For aplastic anemia,what would you expect to see on a PBS? BMbx?

Answer 10

pancytopenia

Hypocellular marrow with excess fat (normal cytology, just too few)

Question 11

What is the treatment for aplastic anemia (after RFL to Hematologist)?

Answer 11

Immunosuppression

Allogenic BM transplant if 40 years

Question 12

Temporary shutdown of erythropoiesis due to acute infection, commonly associated with Parvo/5ths Disease?

Answer 12

Aplastic Crisis

Question 13

What changes lead to the aged (120 days) RBC being trapped and removed by the RE (reticuloendothelial) system (3)

Answer 13

1) Decrease in lipids in membrane
2) Less pliability
3) Shape becomes more spherocytic

Question 14

Premature or accelerated destruction of RBCs (<100 days) beyond the ability of the bone marrow to fully compensate

Answer 14

Hemolytic Anemia

Question 15

Clinical presentation of hemolytic anemia includes:

Answer 15

Jaundice, scleral ichterus, splenomegaly, gallstones, hypotension, hemoglobinuria

Question 16

In hemolytic anemia, Would you expect an increase in indirect bilirubin? Why?

Answer 16

Yes, because bilirubin is the byproduct of lysed RBC’s

Question 17

In hemolytic anemia, what would you expect to see on a PBS?

Answer 17

Nucleated red cells, high retic count, spherocytes, schistocytes

Question 18

What test specifically looks at hemolysis?

Answer 18

Coombs test (Cross and screen is indirect Coombs test)

Question 19

What genetic assay is associated with impaired metabolic pathways of RBC’s in hemolytic anemia?

Answer 19

G6PD assay (most common in males, blacks, Mediterraneans)

**Most common metabolic cause of hemolytic anemia, treat by avoiding oxidating drugs

Question 20

Reason for hemolysis is due to the RBC itself

Answer 20

intrinsic factors (issue with membrane, metabolic, hemoglobin type)

Question 21

Why would splenectomy often be effective tx for gallstones caused by hereditary spherocytes

Answer 21

because the spleen is breaking down the spherocytes rapidly and creating excess bilirubin that accumulates in the gallbladder

Question 22

What are 3 pathways that the rbc’s utilize in order to create ATP and break down glucose?

Answer 22

1) Glycolysis (Embden-Meyerhof) Pathway produces majority of ATP
2) Hexose Monophosphate Shunt produces 10%
3) Nucleotide Salvage Pathway (very little)

Question 23

Reason for hemolysis has nothing to do with properties of RBC itself:

Answer 23

Extrinsic factors (immune system, infection, mechanical destruction of RBC’s)

Question 24

development of antibodies that target the RBC membrane

Answer 24

Autoimmune hemolytic anemia

Question 25

When you think WARM autoimmune hemolytic anemia, think:

Answer 25

IgG, Fix complement weakly. Treat w/ steroids, splenectomy, immunosuppressants

Question 26

When you think COLD autoimmune hemolytic anemia, think:

Answer 26

IgM, Fix complement strongly. (Underlying lymphoma common). Treat w/ avoidance of cold, cytotoxic meds, plasmapheresis