IM Heme RBC USMLE 2
Terms
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Symptoms of Iron deficiency Anemia
(5)* -
Fe KAP:
Fatigue;
Exercise tolerance decrease;
Koilonychia (spoon nails);
Angular Cheilosis (cracking at mouth corners);
Pica (eating clay or ice); Pallor -
Iron Deficiency Anemia labs (high or low):
1. Hemoglobin/hematocrit
2. MCV
3. TIBC, ferritin -
1. low
2. low
3. low -
Dx:
38-yo male w/ HIV on HAART w/ macrocytosis. What is cause? - AZT
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Dx:
28-yo alcoholic w/ diarrhea, cheilosis and glossitis
Tx? -
Folate deficiency
Tx: oral folate -
what is seen in Blood smear w/ Folate deficiency or Vitamin B-12 deficiency?
(3) -
1. Macrocytosis (inc MCV)
2. Basophilic stippling
3. Hypersegmented PMN -
Etiology of Vitamin B-12 deficiency?
(8)* -
VITAMIN B:
Vegan;
Ileal resection;
Tapeworm (D. Latum);
Autoimmune (pernicious anemia);
Megaloblastic anemia;
Inflammation of terminal ileum;
Nitrous Oxide;
Bacterial overgrowth -
Dx:
Anemic patient w/ paresthesias, positive Rhomberg, slowed reflexes, ataxia, dementia and glossitis
Tx? -
Vitamin B-12 Deficiency
Tx: B-12 replacement IM -
Definition:
Absence of Intrinsic Factor due to Ab against parietal cells, causing Vitamin B-12 anemia - Pernicious Anemia
- (2) Dx tests for Pernicious Anemia
-
1. Anti-IF Ab levels
2. Schilling Test - What can Pernicious anemia lead to?
- Gastric Cancer
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Causes of Normochromic normocytic anemia
(3) -
Bone marrow problems
Anemia of Chronic dz
Early deficiency in Iron, B-12 or Folate -
Definition:
X-linked condition resulting in reduced Glutathione; leads to hemolysis of RBC w/ oxidative stresses - G6PD Deficiency
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Dx:
35-yo Italian male presents w/ weakness, back pain and jaundice. He was started on Cipro 2 days ago for pneumonia - G6PD deficiency
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Smear Dx:
Microcytosis; schistocytes; Heinz Bodies - G6PD deficiency
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Dx:
Marrow failure resulting in severe pancytopenia - Aplastic Anemia
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Dx:
normochromic, normocytic pancytopenia; low reticulocyte count, weakness, fatigue, mucosal bleeding, pallor - Aplastic Anemia
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What patients need to avoid Parvovirus B-12?
(2) -
Sickle cell anemia pt
Immunocompromised pt - Tx of choice for Aplastic Anemia
- Bone marrow (stem cell) transplant
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Etiology of Anemia of Chronic Dz
(3) -
TB;
Malignancies;
Rheumatologic disorders -
Dx:
Ferrin is normal -> increased;
Iron, TIBC and transferrin are decreased;
Erythropoietin is high - Anemia of Chronic Dz
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Thalassemia trait (genetic defect of the alpha chain)most common in:
1. Asians
2. Africans -
1. aa/--
2. a-/a- - AA substitution in Sickle cell
- Valine for glutamine on Beta-chain
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Indication for exchange transfusion in Sickle cell Dz
(5)* -
SAP IT:
Stroke/TIA;
Acute Chest syndrome;
Priapism;
Intractable vaso-occlusive crisis;
Third-term pregnancy -
Signs of Sickle cell
(6)* -
SICKLE:
Splenomegaly;
Infection;
Cholelitiasis;
Kidney - hematuria;
Liver congestion; Leg ulcers;
Eye changes -
Smear Dx:
Howell-Jolly bodies; odd-shaped RBC - Sickle cell
- What should be given to reduce the recurrence of a sickle cell crisis?
- Hydroxyurea
- Difference b/t Warm and Cold Hemolytic anemia
-
Warm:
IgG to Rh factor;
no complement involvement
Cold:
IgM antibodies;
Fixes complement - Tx for Warm or Cold hemolytic anemias
- Steroids
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With what Dx do you see Cold Hemolytic Anemias?
(3)* -
MMM:
Mycoplasma;
Mononucleosis;
Myleoproliferative disorders - What causes acute hemolytic transfusion reactions?
-
ABO incompatability
(usually human error) -
Definition:
Myeloproliferative Dz that results in an increase in RBC in addition to mild increase in Leukocytes and Platelets - Polycythemia vera
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Etiology of Primary (1) and Secondary (3) Polycythemia vera
Which has low vs. high erythropoietin? -
Primary:
Bone marrow cause
(low erythropoietin)
Secondary:
Hypoxia (high altitdues, lung dz);
Smoking;
Renal Cell CA
(high erythropoietin) -
Dx:
pruritus, plethora, splenomegaly, epitaxis, neuro symptoms (vision changes), inc RBC - Polycythemia vera
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Tx for polycythemia vera
(2)
what additional Tx for Primary type? -
Both types:
Serial Phlebotomy (dec blood volume);
Aspirin (prevent thrombosis)
Primary only:
Hydroxyurea (myelosuppression) - What is a late complication of polycythemia vera?
- Bone marrow fibrosis
- Most accurate test if suspecting B-12 or folate deficiency?
- B-12 and Folate levels
-
Dx:
middle-aged man w/ gradual onset of fatigue, massive splenomegaly, enlarged liver and Pancytopenia
Most accurate test? -
Hairy Cell Leukemia
test:
Tartrate-Resistant Acid Phosphase (TRAP) -
Dx:
Pancytopenia and blasts in peripheral smear; greater then 20% blasts in bone marrow; Auer Rod on smear -
Acute Myelogenous Leukemia
(AML) -
What hemolytic disorder creates "Bite Cells"?
Hemolytic anemia can occur with this d/o in response to what type of drugs? -
G6PD Deficiency
(formed when Heinz bodies are removed from the cells by the spleen)
drugs causing it: Sulfonamides
(Dapsone and Sulfasalazine) -
With what disorders do you see fragmented cells like Schistocytes and Helmet cells?
(7)* -
SHIT PAD:
Snake bites;
HUS;
Incompatible blood groups;
TTP;
PNH;
Artificial heart valves;
DIC -
Dx:
microcytic anemia w/ elevated serum iron level in an alcoholic
Dx test? -
Sideroblastic Anemia
Dx test: Prussian Blue stain -
Dx:
recurrent hemolysis, big spleen, family history of anemia. CBC reveals anemia and high MCHC.
most accurate test? -
Spherocytosis
most accurate test: Osmotic Fragility test - Most accurate test to Dx Sickle Cell?
- Hemoglobin Electrophoresis
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what hemoglobinopathies are assoc w/ Target cells?
(4)* -
HITS the target:
Hemoglobin C disese (MC Dx);
Iron Deficiency anemia;
Thalassemia;
Sickle cell Dz - What do Tear Drop cells indicate?
-
a Bone Marrow Disease
(such as Myelofibrosis) - What (2) antibodies are seen w/ Pernicious Anemia?
-
1. Anti-Intrinsic Factor Ab
2. Anti-Parietal Cell Ab - What does "Bleeding Time" test specifically?
- Tests the ability of the platelets to adhere to the endothelial lining of the capillary
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A patient has abnormal bleeding that stems from a platelet disorder but the platelet count is normal. What test?
what (2) possible Dx? -
Bleeding time
possible Dx:
1. Von Willebrand's Disease
2. Uremia-induced platelet dysfunction -
Dx:
patient has intermittent dark urine in the morning, pancytopenia and large vessel thrombosis
Most accurate test? -
Paroxysmal Noctournal Hemoglobinuria (PNH)
most accurate test:
Decay-Accelerating Factor (DAF)
(also known as CD55/59)