RBC Disorders

Question 1

What is the definition of anemia according to the WHO?

Answer 1

Hemoglobin less than 13 in men and 12 in women

Question 2

How do we calculate mean corpusclar hemoglobin and mean corpuscular hemoglobin concentration?

Answer 2

Hemoglobin divided by RBC count

Hemoglobin divided by HCT

Question 3

What is a reticulocyte count that indicates appropriate bone marrow response and what is an RPI value that implies inadequate bone marrow response?

Answer 3

Over 100k

RPI under 2

Question 4

Symptoms in aplastic anemia result from what, and what are those symptoms?

Answer 4

They result from pancytopenia, so fatigue, dyspnea, bleeding and infection.

Question 5

What will the peripheral blood and bone marrow show in aplastic anemia?

Answer 5

Peripheral blood will show anemia, thrombocytopenia, and leukopenia
BM will show hypocellularity and lots of fat

Question 6

Two treatment options for aplastic anemia?

Answer 6

If under 40 and qualify for allergenic HSC transplantation, this is the go to.
If patients don’t qualify, then they will need immunosuppressive therapy with antithymocyte globulin and cyclosporine

Question 7

What disease can affect the duodenum and hinder iron absorption?

Answer 7

Celiac disease

Question 8

What is the diagnostic lab value for iron deficiency, but what is the catch?

Answer 8

Serum ferritin less than 10-15, but it doesn’t have diagnostic value in iron deficiency with inflammation because ferritin is an acute phase reactant out of the liver.

Question 9

What is the usual treatment for iron deficiency anemia?

Answer 9

Oral ferrous sulfate for 6 months to a year to get hemoglobin levels and iron stores back to normal.

Question 10

What is considered acquired Spherocytic hemolytic anemia?

Answer 10

Immune hemolytic anemia

Question 11

What is a byproduct of oxidative hemolysis and what will the result be?

Answer 11

Methemoglobin

Patients will have arterial PO2 levels that appear higher than the expected oxygen saturation

Question 12

An MCV over 115 is almost always due to what kind of cause?

Answer 12

Megaloblastic cause

Question 13

Three lab value consequences of iron deficiency due to inflammation?

Answer 13

Serum iron is down, transferrin is down, and ferritin is up

Question 14

What are the 5 things cytokines do in inflammation that add to the anemic state?

Answer 14

Reduce EPO
Reduce responsiveness of precursors cells to EPO
Reduce iron absorption
Reduce transferrin levels
Increase ferritin levels

Question 15

So then, what is the value we look at to determine anemia due to inflammation?

Answer 15

Ferritin

Question 16

What is the idea to keep in mind when treating anemia due to inflammation?

Answer 16

Treat the underlying inflammatory condition and if that doesn’t help give EPO

Question 17

What is best for management of anemia-associated symptoms?

Answer 17

Supportive blood transfusions

Question 18

What is the treatment of a newborn once we know they have sickle cell disease and why?

Answer 18

Give prophylactic penicillin or a macrolide if allergic, for 5 years which has shown to reduce mortality and co-morbidity from pneumococcal infections.

Question 19

What is a big time complication to know of with sickle cell trait?

Answer 19

Increased risk of sudden death with intense physical activity

Question 20

3 clinical symptoms these patients will have with sickle cell?

Answer 20

Acute pain, chronic pain and anemia

Question 21

What is the hemoglobin level, reticulocyte count, and type of anemia in these patients?

Answer 21

7-8
High
Normocytic normochromic

Question 22

What is the most common abnormality found on an echo for sickle cell patients?

Answer 22

Pulmonary HTN associated with older age and prior history of ACS.

Question 23

What are two additional lab values he wants us to now for sickle cell disease due to the spleen not working?

Answer 23

High platelets and leukocytes

Question 24

What is the only FDA approved for sickle cell and what are 4 major effects of it?

Answer 24

Hydroxyurea
Augments fetal hemoglobin, inhibits polymerization of sickle hemoglobin, reduces incidence of ACS, dropped reticulocyte and neutrophil counts with decreased adhesiveness and greater flow.

Question 25

What is another treatment to consider outside of hydroxyurea for sickle cell?

Answer 25

Exchange transfusions.

Question 26

What two things to give for patients with sickle cell and kidney problems/failure?

Answer 26

ACE inhibitors to lower intraglomerula pressure and reduce the progression of the kidney disease.
EPO because the kidney ain’t making enough.

Question 27

What would we do for all the hemolysis and what would we do for the concern of infections because of the spleen not working?

Answer 27

Give folate

Pneumococcal, h influenza b and influenza vaccinations

Question 28

When patients have acute pain crisis and go to the ER, what 4 meds can we give them?

Answer 28

Tylenol, NSAIDS, morphine and any adjuvant therapy they need.

Question 29

When do we give supplemental oxygen to sick cell disease patients?

Answer 29

Only when hypoxia is present, so o2 sat less than 92 or arterial PO2 less than 70

Question 30

What can we do for patients with severe symptoms of anemia?

Answer 30

Blood transfusions, just don’t get hemoglobin over 10 because the blood will be too viscous

Question 31

When do we do allergenic bone marrow transplantation in patients with sickle cell disease?

Answer 31

In patients who are less than 16 years of age and severe symptoms.

Question 32

What is unique about the result of doing bone marrow transplantation in a patient with sickle cell anemia?

Answer 32

It can be curative