Internal Medicine Essentials Questions: Hematology

Question 1

What labs suggest iron-deficiency anemia combined with anemia of chronic disease?

Answer 1

• Normal ferritin and TIBC
• Low iron

Ferritin is an acute phase reactant and as such cannot be relied on to diagnose iron-deficiency in someone with chronic inflammation (like RA).

Question 2

A patient has elevated MCV and B12 in the low-normal range. Next step?

Answer 2

Test homocysteine and methylmalonic acid

Question 3

Labs show decreased MCV, increased RDW, and platelets of 625,000. What is the likely diagnosis?

Answer 3

Iron-deficiency anemia

IDA can cause transient thrombocytosis. Correcting with oral ferrous sulfate will usually correct the elevation.

Question 4

IV iron is reserved for those who ___________.

Answer 4

cannot tolerate oral iron

Question 5

Which sickle cell patients should be given prophylactic penicillin?

Answer 5

Those 5 and younger

Question 6

Those with HIT are at increased risk of _______________.

Answer 6

additional DVT

Question 7

Therapy for ITP is usually reserved for ______________.

Answer 7

those with platelets less than 30,000 or those with bleeding symptoms; otherwise, weekly CBCs and observation are recommended

Question 8

Describe the treatment protocol for polycythemia vera.

Answer 8

• Aspirin
• Phlebotomy to Hgb less than 45%
• Hydroxyurea for those older than 60 or with thrombosis risk factors

Question 9

Explain the diagnostic protocol for myelodysplastic syndrome.

Answer 9

• Background: MDS is a disorder of bone marrow production. It will lead to decreased production of all hematopoietic cell lines, so symptoms include fatigue (anemia), infections (neutropenia), and easy bleeding (thrombocytopenia).
• Diagnosis: CBC showing pancytopenia with evidence of dysplasia such as nucleated RBCs or hypogranular myelocytes.

Question 10

What lab finding is diagnostic of leukemoid reactions?

Answer 10

Leukocytosis (exceeding 50,000) due to early neutrophils

Question 11

Some risk factors for development of myelodysplastic syndrome include __________________.

Answer 11

radiation therapy and chemotherapy

Question 12

Patients with MDS should be treated with ____________ to delay transition to AML.

Answer 12

azacitidine

Question 13

A person with elevated serum protein, elevated IgG, and no symptoms likely has _________________.

Answer 13

monoclonal gammopathy of unknown significance (MGUS)

Note: you must distinguish this diagnosis from (1) smoldering multiple myeloma (which would be the same presentation but with IgG greater than 3 g/dL) and (2) amyloidosis (which would be this presentation but with symptoms of neuropathy, cardiomyopathy, and hepatomegaly).

Question 14

List the ways to diagnose multiple myeloma.

Answer 14

• Bone marrow biopsy showing greater than 10% plasma cells
• Serum electrophoresis demonstrating M protein
• Urine immunofixation of M protein

Note: some multiple myelomas may not have hypergammaglobulinemia.

Question 15

Why is hypercalcemia in the presence of kidney failure a specific sign for multiple myeloma?

Answer 15

Kidney failure usually causes hypocalcemia because of hyperphosphatemia and decreased vitamin D synthesis.

Question 16

Other than elevations in BUN and creatinine, what might you notice in the BMP of someone with multiple myeloma?

Answer 16

Decreased anion gap

Question 17

When you have a strong suspicion of von Willebrand factor deficiency, the most appropriate first test is _____________.

Answer 17

CBC followed by vWF antigen studies

Question 18

What is the accepted way of screening for bleeding disorders prior to elective surgery?

Answer 18

Clinical history

In the absence of episodes of unusual bleeding, bleeding disorders are highly unlikely.

Question 19

List the three most common scenarios in which DIC arises.

Answer 19

• Infection
• Cancer
• Pregnancy

Question 20

Differentiate primary versus secondary hemostasis.

Answer 20

• Primary: platelets

* Secondary: clotting factor

Question 21

When you suspect hemophilia, the best first test is _______________.

Answer 21

measurement of factors VIII and IX

Question 22

Thrombotic events can alter the levels of which proteins that may be causing thrombophilia?

Answer 22

• Protein C
• Protein S
• Antithrombin

With these proteins, you need to wait until two weeks after warfarin treatment for a clot to measure for possible abnormalities.