Lab 1: Anemia

Question 1

ID

Answer 1

Iron Deficiency Anemia (IDA)

Question 2

ID

Answer 2

Iron Deficiency Anemia (IDA) - microcytic RBCs (smaller than lymphocytes), increased central palor (hypochromic), Echinocytes (Burr cells - no indicative of IDA)

Question 3

In Iron Defeciency Anemia what are some main causes of the anemia?

Answer 3

chronic blood loss (elderly with risk of colon cancer), and malnutriton

Question 4

Children <12 months old who drink a lot of cow milk are a group at risk for:

Answer 4

Iron Deficiency Anemia (IDA)

Question 5

Answer 5

D

Question 6

What test results would you expect?

Answer 6

Question 7

Answer 7

Anemia of chronic disease

Question 8

Additional laboratory studies are obtained, would you expect an increase of decrease in these values?

Answer 8

Question 9

What is the role of hepcidin in Anemia of chronic disease

Answer 9

Hepcidin increases in the setting of inflammation (like a patient with rheumatoid arthritis). When hepcidin is high, the iron transporter ferroportin is degraded. Ferroportin is found on duodenal epithelial cells and macrophages. This leads to
two major consequences: 1. Iron is not absorbed into the peripheral blood from duodenal epithelial cells and cannot be transported to tissues by transferrin and 2. Iron is not released from its storage site in macrophages. This creates the unusual situation of a patient having large amounts of stored iron (ferritin in macrophages) but low levels of iron available to RBC precursors for making hemoglobin, leading to anemia

Question 10

A 58-year-old male has become progressively more fatigued at the end of the day. This has
been going on for months. In the past month, he has noticed numbness in his hands
(paresthesia). A CBC and peripheral blood smear demonstrate the findings below.

Answer 10

Vitamin B12 deficiency

Question 11

ID

Answer 11

macrocytic anemia (either B12 or folate deficiency) - need clinical vignette to ID

Question 12

Answer 12

lead poisoning

Question 13

what two enzymes are inhibited by lead?

Answer 13

δ-ALA dehydratase and
ferrochelatase

Question 14

What physical signs and symptoms can you look for in lead poisoning?

Answer 14

“lead lines” in bones and gingiva (lines of increased bone density on radiograph, hyperpigmented lines in
gingiva)

Question 15

ID

Answer 15

Spherocytosis - Increased numbers of spherocytes, which are round RBCs without discernable
central pallor. There are also increased RBCs with polychromasia (lavender hue to their
cytoplasm)

Question 16

Answer 16

Spherocytosis- Hemolytic Anemia

Question 17

What other laboratory studies would be helpful to support a diagnosis of hemolytic anemia

Answer 17

LDH - increased
Haptoglobin - Decreased (binding to free hemoglobin that was lysed)
Bilirubin - Increased
Reticulocyte count - Increased

Question 18

What is the inheritence pattern for Spherocytosis?

Answer 18

Autosomal Dominant (AD)

Question 19

Answer 19

Question 20

In sickle cell disease a _______ in oxygen leads to sickling

Answer 20

decrease - when altitude changes you see sickle crisis

Question 21

Chloroquine or other anti-malarial drugs can produce an oxidant stress that leads to episodic
hemolysis in patients

Answer 21

G6PD Deficiency

Question 22

What surgical treatment might be considered for a patient if their hemolytic anemia is severe enough?
What would the surgical treatment put her at risk for in the future? How would the surgical
treatment affect the appearance of her RBCs on a peripheral smear

Answer 22

Splenectomy could be considered for this patient if her anemia was severe. Post-splenectomy,
she is at increased risk of infection and would need to be (re)vaccinated against encapsulated
organisms (such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis). Normally the spleen
filters these bacteria and decreases the risk of infection.
After a splenectomy, her RBCs may include Howell-Jolly bodies, which are nuclear remnants
that are typically removed from RBCs by the spleen (but can’t be removed when the spleen is
not there). Her peripheral smear would still include spherocytes, though her hemolytic anemia
would be resolved post-splenectomy.

Question 23

ID

Answer 23

Howell-Jolly bodies (nuclear remnants)

Question 24

Answer 24

Sickle Cell Disease

Question 25

ID

Answer 25

Sickle Cell Disease

Question 26

What are the clinical symptoms of the vaso-occlusive crises that characterize Sickle Cell Disease?

Answer 26

Vaso-occlusive crises (pain crises) are due to episodic hypoxic injury and infarction that cause
severe pain in affected tissues. Vaso-occlusive crises may be triggered by factors that favor
RBC sickling (infection, dehydration, acidosis), or may not have a clear precipitating factor

Question 27

Why does alpha thalassemia, in general, show a less severe phenotype than beta thalassemia?
What would you expect to see if a patient had both β gene variants and α gene variants?

Answer 27

If patients have both β and α globin variants leading to decreased production of both β and α
chains, the hemolytic anemia and ineffective erythropoiesis is typically less than that seen with
only β or only α gene variants. With defects in both types of globin chains, the imbalance in α
and β chains is lessened, leading to fewer opportunities for insoluble globin precipitate
formation

Question 28

Answer 28

normocytic anemia and thrombocytopenia,

Question 29

ID

Answer 29

Microangiopathic hemolytic anemia (MAHA) - schistocytes in the setting of anemia and thrombocytope

Schistocytes - general term for any fragmented red blood cell which can take on various shapes
Helmet Cells - larger, crescent-shaped schistocyte with a distinct, flat, amputated area

Question 30

What laboratory tests would be helpful to sort out the differential diagnosis for Microangiopathic hemolytic anemia (MAHA)

Answer 30

Laboratory tests to consider include D-dimer, fibrinogen activity, PT, aPTT, ADAMTS13 activity for TTP, and shiga-like toxin for HUS

Question 31

marked
elevation of D-dimer is an important laboratory test to clue to

Answer 31

Disseminated Intravascular Coagulation (DIC)

Question 32

The best treatment for DIC is:

Answer 32

identify and treat the underlying condition (whether
it’s cancer, sepsis, trauma, obstetric complications, etc.)

Question 33

ID

Answer 33

Bite Cell - G6PD Deficiency

Question 34

ID

Answer 34

Heinz Bodies (denatured hemoglobin) - removed by macrophages and why we see bite cells

Question 35

ID

Answer 35

ringed sideroblasts

Question 36

ID

Answer 36

Pseudo-Pelger-Huet Cells (top and bottom field seen in Myeldysplastic Syndrome)

Question 37

ID

Answer 37

Essential Thrombocytosis - platelets the size of red cells

Question 38

ID

Answer 38

Aplastic Anemia