Heme/Onc E1: In-class Review

Most abundant cell type in the blood?

Erythrocytes

Hemoglobin composition?

4 globin chains (2 alpha, 2 beta); 4 heme groups

Two types of lymphocytes?

T-lymphocytes and B-lymphocytes

Macrocytosis: MCV =

>100

Microcytosis: MCV =

<80

Most common microcytic anemia?

Iron Deficiency Anemia

Iron Deficiency Anemia:
Ferritin?
Serum Iron?
TIBC?

Low
Low
High

New onset IDA in elderly male. What procedure needs to be ordered?

Colonoscopy

Thalassemia most commonly affects which demographics?

Mediterranean, Asian, African

Acute blood loss will present with which type of anemia?

Normocytic Anemia

Labs in hemolytic anemia:
Bilirubin?
LDH?
Reticulocyte count?
Haptoglobin?

High
High
High
Low

Autoimmune Hemolytic Anemia: 4 possible treatments?

Steroids
IVIG
Rituximab
Splenectomy

Most common cause of normocytic anemia?

Anemia of chronic disease

Anemia of chronic kidney disease is caused by what low hormone?

Erythropoietin (EPO)

Aplastic Anemia:
Hgb?
WBC?
Plt?

Low
Low
Low

Megaloblastic anemia. What two causes?

B12 deficiency and folate deficiency

B12 deficiency can present with anemia and what other symptoms?

Neurologic manifestations

Labs in B12 deficiency:
B12 level?
Homocysteine?
Methylmalonic Acid?

Normal or low
High
High

What causes sickle cells to sickle?

Impaired oxygen, abnormal acid-base status, dehydration, stress

What drug can be used in sickle cell disease to increase hemoglobin F?

Hydroxyurea

Treatment of Iron Deficiency Anemia?

Oral Ferrous Sulfate 325mg BID (with Vitamin C) and stool softener

IV Iron

Blood transfusion if severe

Most common RBC enzyme defect?

G6PD Deficiency

Pathognomonic finding on G6PD peripheral smear?

Heinz bodies and bite cells

Warm Autoimmune Hemolytic Anemia
Hgb?
LDH?
Reticulocyte?
Bilirubin?
Haptoglobin?
Coombs/Direct Antiglobulin Test (DAT)?

Low
High
High
High
Low
Positive

Treatment of Aplastic Anemia?

Immune Suppression - ATG, steroids, CyclosporineAllogeneic Transplant

This anemia is a deficiency in intrinsic factor. What does intrinsic factor do? How do you treat?

Pernicious Anemia
Allows absorption of B12 in the small intestines
IM/IV B12 supplementation

Folate Deficiency
Serum folic acid?
Homocysteine?
Methylmalonic Acid/

Low
High
Normal

Which populations need prophylactic folate supplementation?

Women of childbearing potential
Pregnant/lactating women
Chronic hemolytic syndromes

Identify some presentations of sickle cell crisis. Which of these is a medical emergency?

Pain crisis

Acute chest syndrome - emergency

Bone infarctions

Splenic infarctions

CVA

Priapism

Dactylitis

Cutaneous ulcers