Linger/Pales CIS

Question 1

what are myeloid growth factors used for

Answer 1

neutropenia to stimulate peripheral blood

Question 2

35 y.o weakness, dizziness, epigastric pain
peptic ulcer disease
heavy menstrual bleeding
chronic HA
Hb low Hct low serum ferritin low and 4+ guaiac stools
takes tetracycline, ibuprofen and esomeprazole

Answer 2

iron deficient anemia from drug combination and high Fe baseline needed from recent pregnancies

Question 3

how does ibuprofen affect iron

Answer 3

dec iron absorption

Question 4

how do proton pump inhibitors affect iron levels

Answer 4

dec the uptake of iron

Question 5

how does dairy products affect iron levels

Answer 5

dec absorption

Question 6

what is the PO version of deferoxamine

Answer 6

deferasirox

Question 7

38 y.o F with advanced epithelial ovarian cancer
3/6 cycles chemo of carboplatin and paclitaxel
SOB and fatigue when walks up stairs
low Hb, low Hct, normal chromic and normocytic RBC
most likely Dx?

Answer 7

anemia of chronic disease

Question 8

what disorders are assoc with anemia of chronic disease

Answer 8

RA
SLE
chronic infections
chronic renal failure
AIDS

Question 9

what chemotherapy agents can cause anemia

Answer 9

antimetabolites: folic acid analogs, hydrozyurea, purine antagonists, pyridimine antagonists
alkylating agents

Question 10

which agent stimulates increase in production reticulocytes and most appropriate Tx for this patient?
cyanocobalamin
epoetin alpha
filgrastim
oprelvekin
pegfilgrastim

Answer 10

epoeitin alpha

Question 11

oprelvekin is used to Tx what

Answer 11

thrombocytopenia

Question 12

what are they myeloid growth factor drugs

Answer 12

filgrastim and pegfilgrastim

Question 13

what are balck box warnings of erythropoiesis stimulating agents

Answer 13

increased mortality in cancer patients

not rec for anemic cancer patients receiving myelosuppressive chemotherapy

Question 14

causes of megaloblastic anemia

Answer 14

B12 def
folic acid deg
metabolic or inherited defects

Question 15

normal WBC elevated RBC
Hb low, Hct low
low MCV
normal RDW
normal platelets
does he have anemia

Answer 15

lead poisoning,
anemia of inflammation
sideroblastic anemias
thalassemia trait

Question 16

lead poisoning,
anemia of inflammation
sideroblastic anemias
thalassemia trait
labs?

Answer 16

peripheral smear
iron levels, ferritin levels
TIBC total iron binding capacity

Question 17

does having normal ferritin rule out iron deficiency

Answer 17

no

Question 18

normal WBC elevated RBC
Hb low, Hct low
low MCV
normal RDW
normal platelets
normal ferritin, iron and TIBC
now ddx

Answer 18

thalassemia

Question 19

how to Dx thalassemia

Answer 19

Hb electrophoresis

Question 20

does a normal Hb electrophoresis rule out thalassemia

Answer 20

no

Question 21

how do you Tx thalassemia

Answer 21

don’t give anything

just let them know and educate them

Question 22

35 y/o M with fatiuge, exercise intolerance, SOB and cravings for ice
gastric bypass surgery 3 yrs ago
pale no abdominal tenderness
taking omeprazole
MVI and B12 shots
norm WBC, low RBC, low Hb, low Hct low MCV, normal RDW platelets normal
what labs do you what? ddx?

Answer 22

iron panel
thalassemia
lead poisoning
sideroblastic anemias

Question 23

35 y/o M with fatiuge, exercise intolerance, SOB and cravings for ice
gastric bypass surgery 3 yrs ago
pale no abdominal tenderness
taking omeprazole
MVI and B12 shots
norm WBC, low RBC, low Hb, low Hct low MCV, normal RDW platelets normal
low iron, high TIBC and low ferritin

Answer 23

iron deficiency anemia

Question 24

causes iron deficiency anemia

Answer 24

gastric bypass surgery can change pH and affect duodenum absorption of Fe
lack of intake
chronic blood loss

Question 25

why does patient with gastric bypass surgery take B12 shots

Answer 25

because parietal cells are bypassed which produce IF

B12 coated with IF

Question 26

common problem from IV iron

Answer 26

anaphylaxis

Question 27

quickest way to replace iron

Answer 27

blood transfusion

Question 28

elevated RDW means what

Answer 28

microcytic and macrocytic mixture

Question 29

alcoholic male with cirrhosis and grade 3 esophageal varices
presents with anemia and delerium
Hx RA and DM
what MCV would you expect

Answer 29

macrocytic- cirrhosis

mixed

Question 30

cirrhosis causes what type anemia

Answer 30

macrocytic

Question 31

how does alcohol affect bone marrow

Answer 31

suppression of blood marrow production

Question 32

portal HTN leads to what

Answer 32

varices, ascites and splenomegaly (sequestration RBC)

Question 33

how Dx anemia of chronic disease

Answer 33

iron studies
norm- elevated ferritin
TIBC!! and Fe will be low!!
binding sites available for iron are low

Question 34

how do you rule out hemolytic anemia

Answer 34

-Haptoglobin!!!! (would be dec in hemolytic anemia)
-measure unconjug bilirubin (indirect)
should be elevated in hemolytic anemia
-LDH

Question 35

what should reticulocyte count be in anemia

Answer 35

high because need more production RBC, if normal or low then bad because bone marrow is not responding

Question 36

35 y.o F with weakness, fever, dysuria nd abdominal pain, type I DM, RA and HTN
insulin, methatrexate, diclofenac, adalimumab
lethargic, hypotensive, suprapubic and LUQ pain, lloydsis + on L
ddx?

Answer 36

pyelonephritis

Question 37

woman with pyelonephritis taking methetrexat and adalimumab has high WBC, low RBC, low Hb, low Hct, hgih MCV, high RDW, low platelets, high reticulocytes
additional tests? ddx?

Answer 37

increased MCV: Tx with drugs that interfere with DNA synthesis and cell division, myelodyspplasia, folate deficiency, vit12 def, hypothyroidism, liver disease