OnlineMedEd: Hematology Oncology - "Normocytic Anemia"

Question 1

When you see a normocytic anemia on CBC->MCV, you should reflexively look for ______________.

Answer 1

hemolysis labs: LDH, haptoglobin, and bilirubin

Question 2

In addition to the three hemolysis labs mentioned in another card, you should also check a ____________ when you see normocytic anemia.

Answer 2

the blood smear (for cancer, MDS, sickle cell, G6PD deficiency, hereditary spherocytosis, microangiopathic anemia)

Question 3

If the hemolysis labs and the blood smear are negative, then the diagnosis is likely ______________.

Answer 3

occult hemorrhage or CKD

Question 4

Spherocytosis doesn’t always mean hereditary spherocytosis. It can signal _____________.

Answer 4

autoimmune hemolytic anemia

Question 5

In vaso-occlusive crisis, ___________ causes pain.

Answer 5

ischemia

Dying tissue hurts.

Question 6

List three worrisome forms of vaso-occlusive crisis.

Answer 6

• Acute chest syndrome
• Acute brain syndrome (not sure if this is a technical term, but point is that they look like they’re having a stroke)
• Priapism

Question 7

Three things that induce sickling: _____________.

Answer 7

acidosis, hypoxemia, dehydration

Question 8

Why is blood smear not the best way to diagnose sickle cell?

Answer 8

Those with sickle cell generally only have significant sickling during crises!

Thus, the initial diagnosis should be with hemoglobin electrophoresis.

Question 9

Transfusion in sickle cell patients is guided by symptoms rather than hemoglobin level. Why?

Answer 9

Those with SC typically have baseline hemoglobins around 7-8.

Question 10

Transfusion should be done for what three complications of sickle cell?

Answer 10

• Priapism
• Acute chest syndrome
• Neurologic deficits

Question 11

What is the treatment protocol for vaso-occlusive crisis?

Answer 11

• IVF (to correct potential dehydration)
• O2 (to correct potential hypoxemia)
• Pain control
• Etiology-specific treatments (i.e., address the cause of vaso-occlusive crisis: antibiotics, etc.)

Question 12

You should not check G6PD levels during a hemolytic attack. Why?

Answer 12

The new cells have G6PD. During an attack, the old cells died off. Thus, during an attack G6PD levels can be normal.

Later –when the patient has resolved their hemolytic episode –the G6PD level can be used to assess for G6PD deficiency.

Question 13

The three proteins that are defective in hereditary spherocytosis are _______________.

Answer 13

spectrin, ankyrin, and pallidin

Question 14

Give three medications that can cause G6PD crises.

Answer 14

• Dapsone
• Bactrim
• Nitrofurantoin

Question 15

Cold AIHA is Ig_-mediated.

Answer 15

M

Question 16

Warm AIHA is associated with ________________.

Answer 16

mononucleosis and Mycoplasma infections

Question 17

What is the molecular basis of paroxysmal nocturnal hemoglobinuria?

Answer 17

Lack of the GPI anchoring protein that protects RBCs against complement.

Question 18

Why does PNH happen at night?

Answer 18

We breathe less deeply at night. This mild hypoxemia and acidosis can induce complement fixation.

Question 19

PNH stands for Paroxysmal Nocturnal ____________.

Answer 19

Hemoglobinuria (it just looks like blood)

Question 20

How is PNH treated?

Answer 20

• Supportive treatment (managing low Hgb if it is severe)

* Eculizumab

Question 21

You diagnose PNH with ______________.

Answer 21

flow cytometry showing CD-55-negative cells

Question 22

Hereditary spherocytosis is diagnosed with ________________.

Answer 22

osmotic fragility testing