64 Questions
Which of the following is a common cause of iron deficiency anemia?
Rapid growth
What symptom is associated with a deficiency of tissue enzymes requiring iron?
Fatigue
Which lab finding is indicative of iron deficiency anemia?
Low Hb
Which of the following is NOT a typical blood smear finding in iron deficiency anemia?
Macrocystosis
What would the serum ferritin levels typically be in a patient with iron deficiency anemia?
Low
Which of the following is a characteristic of megaloblastic anemia?
Vit B12 Deficiency
Which condition is a cause of non-megaloblastic macrocytic anemia?
Liver disease
Which of the following is part of the investigation process for diagnosing anemia?
Assessing Hb level
Which type of anemia would a folic acid deficiency most likely cause?
Megaloblastic
Which of these measures is not part of the initial steps in diagnosing the type of anemia?
Blood glucose levels
Which of the following is a clinical feature of pernicious anemia?
Dementia
Which laboratory finding is specific for pernicious anemia?
Anti-intrinsic factor antibodies
What is typically observed in the bone marrow examination of patients with vitamin B12 deficiency?
Erythroid hyperplasia and presence of megaloblasts
Which of the following is elevated in the serum of patients with pernicious anemia?
Serum methylmalonic acid
Which of the following investigations would show increased values in both folate deficiency and vitamin B12 deficiency?
Serum/plasma homocysteine
In pernicious anemia, which of the following is a characteristic finding from gastric analysis?
Achlorhydria
According to WHO, what is the hemoglobin (Hb) threshold for diagnosing anemia in women?
12 g/dL
What effect does a reduction in plasma volume due to dehydration have on Hb concentration?
Apparent increase in Hb level
Which of the following is NOT a symptom or sign of anemia?
Increased concentration ability
Which of the following factors does NOT affect the definition of anemia?
Skin color
What can an increase in plasma volume during pregnancy cause?
Wrong diagnosis of anemia
Which of the following symptoms of anemia is due to compensatory attempts of the body?
Palpitation
Which of the following is a characteristic feature of the peripheral blood film in megaloblastic anemia?
Oval macrocytes with hypersegmented neutrophils
What is the primary cause of pernicious anemia?
Intrinsic factor deficiency
Which population is most commonly affected by pernicious anemia?
Females over 60 years old
Which autoimmune diseases are associated with pernicious anemia?
Thyroid disease, Addison's disease, and Vitiligo
Which neurological feature is associated with pernicious anemia?
Symmetrical paresthesia in the fingers and toes
Which clinical feature is indicative of severe anemia in the context of megaloblastic anemia?
Pancytopenia
Which of the following is a general clinical feature of hemolytic anemias?
Splenomegaly
Which virus is associated with aplastic crises in hemolytic anemia patients?
Parvovirus B19
Which of the following lab findings supports increased red cell production in the blood?
Elevated reticulocyte count
Which symptom is part of the triad of hemolytic anemia?
Pallor
What is a common biochemical finding in hemolytic anemia patients?
Elevated LDH levels
What morphologic evidence on a peripheral smear indicates red cell damage in hemolytic anemia?
Reduced red cell lifespan
What characterizes megaloblastic anemia?
Delayed nuclear maturation due to defective DNA synthesis
Which vitamin deficiency is a common cause of megaloblastic anemia?
Vitamin B12
Which of the following is NOT a known cause of folate deficiency?
Hypertension
What is the most common cause of vitamin B12 deficiency?
Pernicious anemia
Which drug category is associated with folate deficiency?
Antifolate drugs
What role does vitamin B12 play in the body related to macrocytic anemia?
Involved in DNA synthesis
Which of the following is impaired in megaloblastic anemia?
DNA synthesis
Which condition is NOT related to vitamin B12 deficiency?
Hypertension
Which of the following is a symptom of anemia?
Yellowish skin
What is a characteristic feature of microcytic anemia?
MCV < 80 FL
Which of the following is NOT a classification for normocytic anemia?
Iron deficiency anemia
What is the underlying mechanism for blood loss causing anemia?
Bleeding
Which of the following factors does NOT influence the presence or absence of anemia symptoms?
Type of anemia
What classification would be given to an anemia with an MCV = 85 FL?
Normocytic
Which process results in erythroid hyperplasia?
Expansion of erythroid lineage
What occurs during intravascular hemolysis?
Free hemoglobin is released into the circulation
Which of the following is NOT associated with intravascular hemolysis?
Removal of antibody-coated red blood cells by macrophages
Which organ is primarily involved in extravascular hemolysis?
Spleen
What is one possible result of intravascular hemolysis?
Red plasma
What type of anemia is usually found in blood films for hemolytic anemia?
Normocytic or macrocytic anemia
What classification is based on the inheritance of hemolytic anemia?
Acquired versus congenital
Which finding is typically seen in the urine with intravascular hemolysis?
Hemosiderinuria
What is the normal mean corpuscular volume (MCV) for red blood cells?
MCV = 80-100 fL
Which of the following conditions is NOT associated with microcytosis (MCV < 80 fL)?
Vitamin B12 Deficiency
Which of the following thalassemia types is associated with elevated MCHC?
Beta Thalassemia
Which iron-containing component is found in muscle tissue?
Myoglobin
Where are ferritin and hemosiderin primarily stored in the body?
Bone marrow, liver, and spleen
Which of the following is the most common cause of anemia?
Iron deficiency
Total iron binding capacity (TIBC) is a laboratory test that measures what?
Capacity of transferrin to bind iron
Which of these is NOT a stage of iron depletion and iron deficiency?
Iron sufficiency
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.
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.
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