Pales CIS

Question 1

problem with retic count labs

Answer 1

it takes 5 days or more for it to be elevated in many types of anemia that would cause an elevation

Question 2

RBC mass depends mostly on

Answer 2

hematocrit

Question 3

relationship between RBC, hemoglobin, and hematocrit

Answer 3

Hemoglobin - 3x RBC

hematocrit- 3x hemoglobin

Question 4

microcytic anemia differential?

Answer 4

iron deficiency
thalassemias
chronic disease
lead poisoning
sideroblastic

Question 5

how to differentiate between microcytic anemias?

Answer 5

iron studies:

• ferritin
• TIBC
• iron
• +/- transferrin

Question 6

Does having normal ferritin rule out iron deficiency?

Answer 6

no, normal or high ferritin doesn’t rule it out BUT low ferritin can diagnose it.

ferritin can go up in infection (it is an acute phase reactant)

Question 7

microcytic anemia with normal iron studies suggests what?

Answer 7

probably a thalassemia (will see target cells)

in chronic disease the TIBC would be low to reflect the difficulty in using the iron.

Question 8

how do we confirm thalassemia?

Answer 8

hemoglobin electrophoresis

if it’s negative, still consider genetic studies for an alpha thalassemia.

Question 9

thalassemia minor patients do not need

Answer 9

iron supplements

Question 10

why do we need the stomach for iron absorption?

Answer 10

H+ ions to reduce the Fe3+

Question 11

most common cause of iron deficience in the US

Answer 11

chronic bleeding

Question 12

reticulocyte count in iron deficient anemia

Answer 12

low; need iron to build reticulocytes

Question 13

EPO tests in anema

Answer 13

never necessary.

It’s only useful in distinguishing between polycythemias (primary/ secondary)

Question 14

neurological condition associated with iron deficiency?

Answer 14

restless leg syndrome

Question 15

esophageal condition associated with iron deficiency?

Answer 15

Vinson-Plummer

atrophic gastritis, esophageal webs, happens to women usually

Question 16

gastric bypass pt gets B12 shots. Why?

Answer 16

loss of intrinsic factor from the stomach –> no longer can absorb B12

Question 17

why do we give iron orally?

Answer 17

shots leave a tattoo mark

IV is complicated and related to high allergic reaction rates

oral is best

Question 18

after treating iron deficiency anemia with iron the RDW goes up. WhY?

Answer 18

increased reticulocytes (big), some normal RBCs, and still the old small ones around.

Question 19

stuff we see in alcoholics

Answer 19

a little macrocytosis without anemia can be present just from the alcohol.

folate/ other nutritional deficiencies can be present from not eating, but iron can also be mising from pancreatitis

normocytic (mixed anemia or acute bleed) and microcytic (chronic bleed) could also be present in alcoholics

toxic effect on bone marrow can –> pancytopenia

Question 20

pancytopenia or decreased platelets in alcoholics. causes?

Answer 20

bone marrow suppression

splenic sequestration

microangiopathic hemolytic anemia

Question 21

haptoglobin diagnoses

Answer 21

hemolysis when it is down.

its elevation is of no clinical significance.

Question 22

does methotrexate cause folate deficiency?

Answer 22

no, folate is there but not able to be used.

Question 23

tests that would be positive in hemolysis

Answer 23

elevated unconjugated bilirubin
reticulocytosis
hemosiderin
free serum hemoglobin

Question 24

to diagnose autoimmune hemolytic anemia you order

Answer 24

coombs test

Question 25

to diagnose microangiopathic anemia order

Answer 25

peripheral smear to look for schistocytes
bleeding studies (consumption of the coagulation factors, etc.)  --> elevated PT, PTT, decreased platelets and fibrinogen

Question 26

what must we give with EPO?

Answer 26

iron

Question 27

2 times to give EPO

Answer 27

end-stage renal disease

after chemotherapy

otherwise, too many side effects.