Week 4 Case

Question 1

Definition of anemia

Answer 1

Reduction in the total red cell mass

Lower hemoglobin is indicator of anemia, but it is a surrogate value. In pregnancy, the cells are larger but the % of hemoglobin in cells is lower. There is no anemia.

Cell counts are dependent on sex, race, age, and ect.

Question 2

What % of normal people will be defined anemic?

Answer 2

2.5% because of 2 SD

Question 3

Why males have higher hemoglobin contect?

Answer 3

Not before puberty. “We all are born females.”

After puberty, it is due to androgens.

Question 4

How anemia can be classified in 3 categories?

Answer 4

Production

Destruction

Blood Loss

Question 5

How to distinguish between anemia due to production disorders and anemia due to destruction disorders?

Answer 5

Reticulocytes count

Question 6

What is a difference between differential diagnosis and

Answer 6

differential diagnosis = diagnostic method used to identify the presence of an entity where multiple alternatives are possible

etiology = cause of the disease

Question 7

Blood disorder hints

Answer 7

Skin, Facies (facial expressions), Sclera, Mucous membranes, Skeletal/Muscular, Lymph nodes, Liver/Spleen, Nails

Question 8

Is pale skin a symptom of anemia?

Answer 8

Not necessarily. It is usally a sign of vasoconstriction.

Question 9

Production disorders

Answer 9

1. Hypoplastic/aplastic (normocytic) due to infections/drugs/systemic
2. Replaced marrow (normocytic) due to leukemias/neuroblastoma
3. Substrate deficiency (microcytic/macrocytic) due to iron/folate/B12

Ineffective? Failure?

Folate deficiency = iron absorption deficiency

Question 10

Destruction disorders

Answer 10

Extrinsic

1. Environment due to MAPHA (cells banged up)
2. Antibody due to ABO-Rh/AIHA (warm-IgG/cold-IgM)

Intrinsic

1. Membrane due to spherocytosis/eliptocytosis
2. Structural qualitative/quantative
3. Enzymes

Question 11

Which variables on the blood tests are directly measured and not calculated?

Answer 11

Hemoglobin content

Blood counts

MCV

Question 12

Possible blood tests to study anemia

Answer 12

Hemoglobin

MCV

RDW
Reticulocyte

Peripheral smear

Coombs (antibody)

Hemoglobin electrophoresis (hemoglobin sturcture)

Enzymes

Question 13

Ferroportin

Answer 13

Transports iron across cell membrane (in->out)

Found in intestinal

Question 14

Ferritin

Answer 14

It is a ubiquitous intracellular protein that stores iron and releases it in a controlled fashion.

Question 15

How chronic diseases may affect level of iron?

Answer 15

IL6 -> hepcidin (negative iron regulator) -> decreases iron absorption from intestine & decreases release from stores

IL6 -> Binds to and degrades ferroportin

Question 16

Alpha-thalassemia (HbH)

Answer 16

Involve genes HBA1 and HBA2 that encode alpha chain of hemoglobin leading to excess of beta chain.

Question 17

Fetal hemoglobin

Answer 17

Alpha2Gamma2

Question 18

Adult hemoglobin

Answer 18

Alpha2Beta2

Question 19

Hemoglobin chains over time

Answer 19

Question 20

Changes in bilirubin levels and associated diseases

Answer 20

Question 21

Ecchymosis

Answer 21

A discoloration of the skin resulting from bleeding underneath, typically caused by bruising.

Question 22

Pallorous

Answer 22

Pale appearance

Question 23

Abnormal findings in patient?

WEEK4

Answer 23

Hepatosplenomegaly

Holosystolic murmur

Hyperdynamic precordium

Hypertensive

Low weight

Question 24

Laboratory abonrmalities and reflection of them on physical

WEEK4 CASE

Answer 24

Low hemoglobin - pale mucus

MCV low (microcytic anemia) - tiredness

Bilirubin concentration - jaundice

Question 25

Probably diagnosis

WEEK4 CASE

Answer 25

beta-thalassemia:

• Cyprus
• microcytic anemia
• pallor
• abdominal distension
• jaundice
• holosystolic murmur

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Question 26

Testing for thalassemia before birth