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FHEA Hematologic Disorders: Questions & Solutions
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FHEA Hematologic Disorders: Questions & Solutions
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FHEA Hematologic Disorders: Questions & SolutionsIn what type of anemia (macro or microcytic) would you check Vitamin B12
and folate levels? Right Ans - Macro
Best way to take oral iron therapy to maximize absorption? Right Ans - on
empty stomach - it's tough on the stomach and we often tell patients to take
with food. But for exam, pay attention to the question - how to MAXIMIZE
absorption
In what type of anemia are you likely to see neuro symptoms? What are other
signs and symptoms of this anemia? Right Ans - Vit B12 Deficiency
Anemia Right Ans - A complex of signs and symptoms characterized by
decreases in numbers of RBCs or Hb content caused by blood loss, deficient
erythropoiesis, excessive hemolysis, or a combination of these changes
*Anemia only occurs when insult is severe enough to disturb normal
homeostatic mechanisms and exceed reserves*
4 components necessary for RBC formation Right Ans - 1. Functional
erythropoietin (hormone) mechanism: source 90% renal, 10% hepatic.
(erythropoietin supply is diminished in advancing renal failure, usually
beginning when GFR <49 mL/min.
2. Uncompromised DNA synthesis: impaired by chronic inflammation (ex.
autoimmune disorders including SLE, RA, and chronic infection). Reversible
when inflammation tx.
3. Hemoglobin synthesis unimpaired by lack of iron, vitamin or globin
production: need iron, B vitamins, vitamin C, protein and others
4. Intact marrow microenvironment - revealed in production of reticulocytes
(N 1-2% of total RBC). Reticulocytosis = body working to correct anemia.
Absence of reticulocytosis or presence of reticulocytopenia = inadequate bone
marrow response.
Causes of anemia: Blood loss
What are some primary care causes and corresponding questions you'd ask?
Right Ans - Clinically significant = 1 L sudden, as little as a few mL/d for
chronic
, Causes: miscarriage, erosive gastritis, menorrhagia, GI malignancy. Are you
bleeding from your rectum, vagina, are you throwing up blood?
Causes of anemia: Premature destruction of RBC
Normal lifespan of RBC? Right Ans - Hemolysis - shortened RBC lifespan
(<90 d)
Normal = 90-120
Part of mechanism of ACD
CBC Evaluation of Anemia: which 7 lab values to look at Right Ans - Hb, Hct,
and RBC count - values should be proportionately decreased (normal H&H
ratio 1:3)
Cell size: MCV (microcytic=<80 fL, normocytic 80-96 fL, macrocytic >96 fL)
Hb content: Mean cell hb (MCH), mean cell hb concentration (MCHC) - hb
gives cell color (-chromic)
Hypochromic = pale = MCHC <31 g/dL
RBC distribution width (RDW): an index of variation of RBC size. >15% = new
cells differ in size (larger or smaller) when compared with older cells. One of
earliest signs of evolving micro or macro anemia.
Reticulocyte percentage - 1-2% N. NL response to anemia is reticulocytosis
(>2%).
What type of Anemia? Most common etiologies?
- Decreased Hg, Hct and RBC. Normocytic (MCV =80-96 fL), normochromic
anemia with NL RDW
MCV=NL
MCHC=NL
RDW=NL Right Ans - *Anemia of acute blood loss* - ex. 72 year old man
with acute GI bleed
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