POM Anemia

Question 1

What are the major lab studies for anemia?

Answer 1

CBC: Hg, Hct, MCV;
Reticulocyte count: immature blood cells;
peripheral blood smear

Question 2

What does MCV 100?

Answer 2

Microcytic anemia; normocytic anemia; macrocytic anemia;

Question 3

5 microcytic anemia deficiencies?

Answer 3

1. Iron deficiency anemia (major)
2. Anemia of inflammation (major)
3. Thalassemia
4. Sideroblastic anemia
5. Lead poisoning

Question 4

Symptoms of iron deficiency anemia? Big lab results? Treatment?

Answer 4

1. General anemia signs
2. Melena
3. Pica
4. Koilonychia (spoon nails)
5. Plummer-Vinson’s (glossitis, dysphagia, esophageal webs: DEG);
   low MCV, low Hg/Hct, low ferritin, low serum iron, high IBC, (low serum iron/TIBC);
   ferrous sulfate or IV iron

Question 5

Symptoms of anemia of inflammation?

Answer 5

Microcytic or normocytic, PBS normal or microcytosis, ferritin normal or elevated; LOW SERUM TRANSFERRIN RECEPTOR

Question 6

Which genes contribute to thalassemia? Some presentations? Labs?

Answer 6

4 alpha globin genes, 2 beta globin genes; black, Asian, Mediterranean, Indian with
chipmunk face and expansion of bone trabeculae in the skull;
MICROCYTOSIS and use HG ELECTROPHORESIS!!

Question 7

Last two microcytic anemias?

Answer 7

Sideroblastic anemia, lead poisoning

Question 8

Macrocytic anemias?

Answer 8

Megaloblastic (hypersegmented neutrophils)
1. Vitamin B12 deficiency
2. Folic acid deficiency
3. Antimetabolites/antiviral;
Non-megaloblastic
1. Alcoholism
2. Liver Disease
3. Myelodysplastic syndrome (MDS)
4. Hypothyroidism
5. Drugs

Question 9

What is folate deficiency often associated with (3 things)?

Answer 9

chronic alcohol use, malabsorption, drugs (MTX, bactrim)

Question 10

For vitamin B12 deficiency, possible paths? Symptoms? Labs?

Answer 10

PERNICIOUS ANEMIA, ileal resection, gastrectomy, metformin, bacterial overgrowth);
affected dorsal column of the spinal cord, ataxia, confusion, dementia;
MACROCYTOSIS, HIGH LDH, INDIRECT BILIRUBIN, VIT B12 AND/OR FOLATE LOWER

Question 11

One test to distinguish folate or vit b12 deficiency?

Answer 11

See if MMA and HC are elevated (B12) or just HC (folate)

Question 12

Big example of normocytic anemias? What can you see?

Answer 12

HEMOLYTIC ANEMIA;

1. increased reticulocyte index
2. elevated LDH
3. Elevated indirect bilirubin
4. Low haptoglobin

Question 13

Two types of hemolytic anemia? Presentation?

Answer 13

Intravascular (RBC’s broken down inside blood vessels and you have hemoglobinuria ultimately);
extravascular (hemolysis occurring in the spleen and liver, have urine urobilinogen and fecal stercobilinogen);
anemia symptoms, jaundice, splenomeg, gall stones

Question 14

Key feature of increased red cell production? Red cell damage?

Answer 14

Reticulocytosis; microspherocytes and elliptocytes

Question 15

What is the pattern of presentation for sickle cell? What is the defective Hb? Complications? Treatment options?

Answer 15

See vaso-occlusive pain crises most often!!; HbS;
vaso-occlusion, splenic sequestration, stroke in kids <10 years old;
hydroxyurea, opioids, avoid dehydration and hypoxia, iron chelation if chronic transfusion

Question 16

What are key labs for autoimmune hemolytic anemia? Possible treatment options?

Answer 16

Positive direct Coombs test, spherocytes, cold agglutinin titers;
glucocorticoids, splenectomy, rituximab (warm AIHA) vs. rituximab and warm RBC transfusion (idiopathic cold AIHA)

Question 17

What can cause microangiopathic hemolytic anemia? Seen on labs?

Answer 17

Mech heart valves, DIC, hypertension, eclampsia;

schistocytes