Normocytic Anemias

Question 1

Inflammatory anemia (ACD) is common in what population of patients?

Answer 1

hospitalized patients

Question 2

What is the cause of anemia of chronic disease?

Answer 2

increased inflammatory cytokines result in increased hepcidin and reduced EPO

Question 3

What is the classic iron study profile for anemia of chronic disease?

Answer 3

• increased ferritin
• decreased serum iron
• decreased TIBC
• transferrin saturation can increase or decrease

Question 4

What is the main treatment for anemia of chronic disease?

Answer 4

• treat underlying cause

Question 5

What is the medical treatment for anemia of chronic kidney disease?

Answer 5

• ESAs (Recombinant human EPO) is first line treatment
• iron, vitaminB12, folate PRN
• renal transplant last choice

Question 6

In anemia of chronic kidney disease, EPO should be elevated in proportion to what?

Answer 6

to the anemia

Question 7

What is the goal Hgb with medical treatment for anemia of chronic kidney disease?

Answer 7

10

Question 8

With acute blood loss anemia how low does it take for equilibration to occur?

Answer 8

6 hours

*use vital signs and clinical judgement to determine transfusion needs acutely

Question 9

How long should it take for the reticulocyte to respond to acute blood loss anemia if the marrow is normal?

Answer 9

4-5 days

Question 10

What are the 4 specific hemolysis labs?

Answer 10

• bilirubin ( indirect > direct)
• lactate dehydrogenase (LDH)
• Haptoglobin
• Direct Coombs test (Direct antiglobulin test)

Question 11

What antibodies mediate a “warm” vs “cold” AIHA?

Answer 11

warm = IgG mediated
cold = IgM mediated

Question 12

How is a “warm” AIHA diagnosed? (2 components)

Answer 12

• Positive direct Coombs test (C3 and/or IgG)

- spherocytes/ microspherocytes on smear

Question 13

How is “cold” AIHA diagnosed? (2 components)

Answer 13

• Positive cold agglutinins (+C3, -IgG)

- agglutinated RBCs (clumps) on smear

Question 14

Mycoplasma pneumoniae is associated with what type of AIHA?

Answer 14

“Cold” AIHA

Question 15

How is microangiopathic hemolytic anemia (MAHA) diagnosed?

Answer 15

• 3 or more schistocytes per HPF on peripheral smear

Question 16

What is the cause of meylophthisic anemia?

Answer 16

• bone marrow replacement/infiltration by fibrosis or tumor

Question 17

Tear drop cells on peripheral blood smear is pathognomonic for what type of anemia?

Answer 17

• myelophthisic anemia

Question 18

What is the hallmark sign of aplastic anemia?

Answer 18

• pancytopenia

Question 19

How is aplastic anemia diagnosed?

Answer 19

• bone marrow biopsy shows aplasia of all 3 lineages

Question 20

How is aplastic anemia treated?

Answer 20

ATG/cyclosporine if >40; HSCT if <40

Question 21

Anemia only, with preserved WBC/Plts, is consistent with what bone marrow failure syndrme?

Answer 21

Pure red cell aplasia

Question 22

What are the 3 common etiologies of pure red cell aplasia?

Answer 22

• viral
• autoimmune
• thymoma

Question 23

In a patient who presents with acute blood loss anemia which of the following should you NOT use to determine if transfusion is needed acutely?

a. vital signs
b. clinical judgement
c. hemoglobin
d. all of them can be used

Answer 23

c. hemoglobin

* IT TAKES 6 HOURS FOR EQUILIBRATION TO OCCUR CANT USE Hgb*

Question 24

On peripheral blood smear you see numerous schistocytes and the patient also presents with thrombocytopenia. What is the diagnoses?

a. warm AIHA
b. cold AIHA
c. acute blood loss anemia
d. MAHA

Answer 24

d. MAHA

* microangiopathic hemolytic anemia*

Question 25

How can you differentiate between the following 2 bone marrow failure syndromes: aplastic anemia and pure red cell aplasia?

Answer 25

• aplastic anemia = pancytopenia

- pure red cell aplasia = anemia ONLY, normal WBC/Plts