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Questions and Answers
Which of the following is a common cause of iron deficiency anemia?
Which of the following is a common cause of iron deficiency anemia?
What symptom is associated with a deficiency of tissue enzymes requiring iron?
What symptom is associated with a deficiency of tissue enzymes requiring iron?
Which lab finding is indicative of iron deficiency anemia?
Which lab finding is indicative of iron deficiency anemia?
Which of the following is NOT a typical blood smear finding in iron deficiency anemia?
Which of the following is NOT a typical blood smear finding in iron deficiency anemia?
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What would the serum ferritin levels typically be in a patient with iron deficiency anemia?
What would the serum ferritin levels typically be in a patient with iron deficiency anemia?
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Which of the following is a characteristic of megaloblastic anemia?
Which of the following is a characteristic of megaloblastic anemia?
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Which condition is a cause of non-megaloblastic macrocytic anemia?
Which condition is a cause of non-megaloblastic macrocytic anemia?
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Which of the following is part of the investigation process for diagnosing anemia?
Which of the following is part of the investigation process for diagnosing anemia?
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Which type of anemia would a folic acid deficiency most likely cause?
Which type of anemia would a folic acid deficiency most likely cause?
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Which of these measures is not part of the initial steps in diagnosing the type of anemia?
Which of these measures is not part of the initial steps in diagnosing the type of anemia?
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Which of the following is a clinical feature of pernicious anemia?
Which of the following is a clinical feature of pernicious anemia?
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Which laboratory finding is specific for pernicious anemia?
Which laboratory finding is specific for pernicious anemia?
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What is typically observed in the bone marrow examination of patients with vitamin B12 deficiency?
What is typically observed in the bone marrow examination of patients with vitamin B12 deficiency?
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Which of the following is elevated in the serum of patients with pernicious anemia?
Which of the following is elevated in the serum of patients with pernicious anemia?
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Which of the following investigations would show increased values in both folate deficiency and vitamin B12 deficiency?
Which of the following investigations would show increased values in both folate deficiency and vitamin B12 deficiency?
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In pernicious anemia, which of the following is a characteristic finding from gastric analysis?
In pernicious anemia, which of the following is a characteristic finding from gastric analysis?
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According to WHO, what is the hemoglobin (Hb) threshold for diagnosing anemia in women?
According to WHO, what is the hemoglobin (Hb) threshold for diagnosing anemia in women?
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What effect does a reduction in plasma volume due to dehydration have on Hb concentration?
What effect does a reduction in plasma volume due to dehydration have on Hb concentration?
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Which of the following is NOT a symptom or sign of anemia?
Which of the following is NOT a symptom or sign of anemia?
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Which of the following factors does NOT affect the definition of anemia?
Which of the following factors does NOT affect the definition of anemia?
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What can an increase in plasma volume during pregnancy cause?
What can an increase in plasma volume during pregnancy cause?
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Which of the following symptoms of anemia is due to compensatory attempts of the body?
Which of the following symptoms of anemia is due to compensatory attempts of the body?
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Which of the following is a characteristic feature of the peripheral blood film in megaloblastic anemia?
Which of the following is a characteristic feature of the peripheral blood film in megaloblastic anemia?
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What is the primary cause of pernicious anemia?
What is the primary cause of pernicious anemia?
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Which population is most commonly affected by pernicious anemia?
Which population is most commonly affected by pernicious anemia?
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Which autoimmune diseases are associated with pernicious anemia?
Which autoimmune diseases are associated with pernicious anemia?
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Which neurological feature is associated with pernicious anemia?
Which neurological feature is associated with pernicious anemia?
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Which clinical feature is indicative of severe anemia in the context of megaloblastic anemia?
Which clinical feature is indicative of severe anemia in the context of megaloblastic anemia?
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Which of the following is a general clinical feature of hemolytic anemias?
Which of the following is a general clinical feature of hemolytic anemias?
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Which virus is associated with aplastic crises in hemolytic anemia patients?
Which virus is associated with aplastic crises in hemolytic anemia patients?
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Which of the following lab findings supports increased red cell production in the blood?
Which of the following lab findings supports increased red cell production in the blood?
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Which symptom is part of the triad of hemolytic anemia?
Which symptom is part of the triad of hemolytic anemia?
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What is a common biochemical finding in hemolytic anemia patients?
What is a common biochemical finding in hemolytic anemia patients?
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What morphologic evidence on a peripheral smear indicates red cell damage in hemolytic anemia?
What morphologic evidence on a peripheral smear indicates red cell damage in hemolytic anemia?
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What characterizes megaloblastic anemia?
What characterizes megaloblastic anemia?
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Which vitamin deficiency is a common cause of megaloblastic anemia?
Which vitamin deficiency is a common cause of megaloblastic anemia?
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Which of the following is NOT a known cause of folate deficiency?
Which of the following is NOT a known cause of folate deficiency?
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What is the most common cause of vitamin B12 deficiency?
What is the most common cause of vitamin B12 deficiency?
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Which drug category is associated with folate deficiency?
Which drug category is associated with folate deficiency?
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What role does vitamin B12 play in the body related to macrocytic anemia?
What role does vitamin B12 play in the body related to macrocytic anemia?
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Which of the following is impaired in megaloblastic anemia?
Which of the following is impaired in megaloblastic anemia?
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Which condition is NOT related to vitamin B12 deficiency?
Which condition is NOT related to vitamin B12 deficiency?
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Which of the following is a symptom of anemia?
Which of the following is a symptom of anemia?
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What is a characteristic feature of microcytic anemia?
What is a characteristic feature of microcytic anemia?
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Which of the following is NOT a classification for normocytic anemia?
Which of the following is NOT a classification for normocytic anemia?
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What is the underlying mechanism for blood loss causing anemia?
What is the underlying mechanism for blood loss causing anemia?
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Which of the following factors does NOT influence the presence or absence of anemia symptoms?
Which of the following factors does NOT influence the presence or absence of anemia symptoms?
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What classification would be given to an anemia with an MCV = 85 FL?
What classification would be given to an anemia with an MCV = 85 FL?
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Which process results in erythroid hyperplasia?
Which process results in erythroid hyperplasia?
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What occurs during intravascular hemolysis?
What occurs during intravascular hemolysis?
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Which of the following is NOT associated with intravascular hemolysis?
Which of the following is NOT associated with intravascular hemolysis?
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Which organ is primarily involved in extravascular hemolysis?
Which organ is primarily involved in extravascular hemolysis?
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What is one possible result of intravascular hemolysis?
What is one possible result of intravascular hemolysis?
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What type of anemia is usually found in blood films for hemolytic anemia?
What type of anemia is usually found in blood films for hemolytic anemia?
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What classification is based on the inheritance of hemolytic anemia?
What classification is based on the inheritance of hemolytic anemia?
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Which finding is typically seen in the urine with intravascular hemolysis?
Which finding is typically seen in the urine with intravascular hemolysis?
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What is the normal mean corpuscular volume (MCV) for red blood cells?
What is the normal mean corpuscular volume (MCV) for red blood cells?
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Which of the following conditions is NOT associated with microcytosis (MCV < 80 fL)?
Which of the following conditions is NOT associated with microcytosis (MCV < 80 fL)?
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Which of the following thalassemia types is associated with elevated MCHC?
Which of the following thalassemia types is associated with elevated MCHC?
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Which iron-containing component is found in muscle tissue?
Which iron-containing component is found in muscle tissue?
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Where are ferritin and hemosiderin primarily stored in the body?
Where are ferritin and hemosiderin primarily stored in the body?
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Which of the following is the most common cause of anemia?
Which of the following is the most common cause of anemia?
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Total iron binding capacity (TIBC) is a laboratory test that measures what?
Total iron binding capacity (TIBC) is a laboratory test that measures what?
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Which of these is NOT a stage of iron depletion and iron deficiency?
Which of these is NOT a stage of iron depletion and iron deficiency?
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Study Notes
Macrocytic Anemias
- Subdivided into megaloblastic and non-megaloblastic anemias based on erythroblast morphology in bone marrow.
Megaloblastic Anemia
- Characterized by presence of erythroblasts in BM with delayed nuclear maturation due to defective DNA synthesis.
- Causes: Vitamin B12 deficiency or abnormal B12 metabolism, folic acid deficiency or abnormal folate metabolism, and other defects of DNA synthesis.
Non-Megaloblastic Anemia
- Causes: Liver disease, alcoholism, hypothyroidism, aplastic anemia, anemia of acute bleeding, and hemolytic anemias.
Diagnosis and Investigations
- Determine if patient is anemic, type of anemia, and cause of anemia.
- Investigations: Hb level, RBC count, Hct, red cell indices (MCV, MCH, MCHC), red cell morphology (peripheral smear), and iron studies (serum iron, TIBC, serum ferritin).
Iron Deficiency Anemia
- Causes: rapid growth, pregnancy, lactation, inadequate intake, inadequate absorption, chronic blood loss (menstrual flow, gastrointestinal bleeding), and decreased iron stores.
- Clinical features: fatigue, pallor, glossitis, angular stomatitis, nail changes, hair loss, and developmental problems.
- Laboratory features: low Hb, Hct, RBC, MCV, MCH, MCHC, RDW, and high platelet count.
Anemia
- Definition: reduction in hemoglobin concentration below reference values for age and sex.
- Factors affecting diagnosis: plasma volume, age, sex, race, and altitude.
Clinical Features of Anemia
- Symptoms and signs: fatigue, weakness, tiredness, palpitation, dyspnea, and pale mucous membranes.
- Tissue hypoxia and compensatory attempts: fatigue, tachycardia, and hyperventilation.
Classification of Anemia
- Morphologic: microcytic, normocytic, and macrocytic.
- Pathogenic (underlying mechanism): blood loss, decreased RBC production, and increased RBC destruction (hemolytic anemia).
Microcytic Anemias
- Iron deficiency anemia, thalassemia, lead poisoning, and anemia of chronic diseases.
Microcytosis
- Iron deficiency, thalassemia, hemoglobinopathies, inflammation, and rare causes (sideroblastic anemia, lead poisoning, hyperthyroidism).
Body Iron
- Total amount: 3-5 gm.
- Distribution: Hb (1.5-2 gm), myoglobin, iron-containing enzymes, and storage forms (ferritin and hemosiderin).
Total Iron Binding Capacity (TIBC)
- Measures transferrin's capacity to bind iron.
- Calculated as: serum iron/TIBC %.
Pernicious Anemia
- Autoimmune disorder characterized by destruction of parietal cells, leading to intrinsic factor deficiency and vitamin B12 deficiency.
- More common in elderly females, associated with other autoimmune diseases (thyroid disease, Addison's disease, and vitiligo).
- Increased risk of gastric carcinoma.
Hemolytic Anemias
- Definition: group of disorders characterized by decreased RBC lifespan.
- Clinical features: splenomegaly, increased incidence of pigmented gallstones, dark urine, and chronic ankle ulcers.
- Laboratory findings: evidence of increased RBC destruction and production.
Macrocytic Anemia
- Megaloblastic anemia: defective DNA synthesis, characterized by large immature erythroblasts (megaloblasts).
- Causes: vitamin B12 deficiency, folic acid deficiency, and other defects of DNA synthesis.
Hemolytic Anemia Triad
- Pallor, jaundice, and splenomegaly.
Laboratory Evidence of Hemolysis
- Biochemical findings: elevated LDH, bilirubin, and decreased haptoglobin.
- Morphologic evidence: red cell damage on peripheral smear.
Bone Marrow Examination
- Evidence of increased RBC production: reticulocytosis, nucleated RBCs, and normoblasts.
- Evidence of megaloblastic anemia: megaloblasts, delayed nuclear maturation.
Folate Deficiency
- Causes: poor intake, malabsorption, pregnancy, lactation, and antifolate drugs.
Vitamin B12 Deficiency
- Causes: pernicious anemia, low dietary intake, gastrectomy, ileal disease, and Crohn's disease.
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Description
This quiz covers the different types of macrocytic anemias, including megaloblastic and non-megaloblastic, and the diagnosis and investigation of these conditions. It also touches on the causes and characteristics of each type.
