Review- Heme

Question 1

What is the normal size and shape of erythrocytes?

Answer 1

Red, Biconcave discs.

Red color is from hemoglobin, which contains iron

Question 2

What are reticulocytes?

Answer 2

Polychromatophilic macrocytes in the blood smear that represent RBC precursors

Question 3

Which hemoglobin is most common (97%) and what chains is it composed of?

Answer 3

HgA

two alpha + two beta chains

Question 4

Which hemoglobin makes up 1.5-3% and is composed of 2 alpha and 2 delta chains. What disease is this type of hemoglobin increased in?

Answer 4

HgA2

Increased in beta-thalassemia

Question 5

Which type of hemoglobin? Increased in what disease?

50-90% at birth, <1% in adults

2 alpha + 2 gamma chains

Answer 5

HgF

Increased in beta-thalassemia

Question 6

What are the normal percentages of human hemoglobin in an adult? (Hemoglobin A, A2 and F)

Answer 6

HgA= 97% (MC)

HgA2= 1.5-3%

HgF= 50-90%

Question 7

what is the name of the big pieces of bone between marrow elements in normal bone?

Answer 7

bony trabeculae or cancellous bone

Question 8

How many days do RBCs live?

Answer 8

120 days

Question 9

What are the normal components of bone marrow?

Answer 9

• Fat
• Trabecular bone
• Hematopoietic elements

Question 10

What is anisocytosis vs. Poikilocytosis?

Answer 10

Anisocytosis= Size of RBC

Poikilocytosis= Shape of RBC

Question 11

Which anemia?

• MC type of megaloblastic anemia
• Malabsorption of B12 due to lack of gastric intrinsic factor
• Can be caused by gastrectomy

Answer 11

Pernicious anemia

Question 12

Which anemia?

• Raw beefy tongue
• CNS- loss of vibratory sense and proprioception
• Loss of DTRs
• _Can’t walk w/o looking at their legs**_

Answer 12

Pernicious anemia

(Vit B12 deficiency due to lack of gastric IF)

*note- megaloblastic anemia due to folate deficiency will NOT have CNS sxs

Question 13

What is the schilling test and what is it used for?

Answer 13

• Cobalamine absorption measured indirectly by giving radioactive cobalamine and measuring its excretion in the urine
• Tests for pernicious anemia (vit B12 deficiency due to lack of gastric IF)- ptsmaren’t able to absorb PO cobalamine

Question 14

Which Megaloblastic anemia is MC in:

• late adult life (> 30y/o)
• Scandanavians, English or Irish

Answer 14

Pernicious Anemia

(Vitamin B12 def due to lack of gastric IF)

Question 15

Basophilic Stippling is seen in which anemia?

Answer 15

Megaloblastic anemia

(Caused by vit B12 or folate deficiency)

Question 16

How do you tx pernicious anemia?

Answer 16

Cobalamine IM, IV or SQ

(Cant give PO b/c of the lack of intrinsic factor)

Question 17

Which megaloblastic anemia?

• Common in alcoholics, pregnancy and malnourished
• Raw beefy tongue
• weakness, fatigue, weight loss, loss of appetite, abdominal pain
• NO CNS SXS

Answer 17

Folate deficiency

sxs are similar to pernicious anemia EXCEPT for CNS sxs

Question 18

Description of a patient with which anemia

• Blue eyes
• grey hair
• pallor (low Hgb level)
• lemon yellow tinge
• Raw beefy tongue

Answer 18

Pernicious anemia

Question 19

How do you tx a megaloblastic anemia caused by folate deficiency?

Answer 19

PO folic acid

Question 20

Is pernicous anemia and folate microcytic, normocytic or macrocytic anemia

Answer 20

Macrocytic, normochromic

Question 21

What are aplastic anemias usually due to?

Answer 21

• a rare but serious form of anemia due to bone marrow hypoplasia or aplasia
• Either due to idiopathic (MC) or
• Cytotoxic drugs, viral infections, radiation therapy or benzene

Question 22

The following are causes of which type of anemias?

1. Cytotoxic Drugs (NSAIDS, Alkylating Chemotherapeutic Agents, Insecticides, Arsenicals, and Anticonvulsants)
2. Viral Infections (CMV, EBV, HIV, Parvovirus B19, and Hep C)
3. Radiation Therapy
4. Chemicals such as Benzene

Answer 22

Aplastic anemias

(a rare but seious form of anemia due to bone marrow hypoplasia or aplasia)