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20 Cards in this Set
- Front
- Back
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41. Best initial test for macrocytic anemia?
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a. CBC with peripheral smear (look for hyper-segmented neutrophils and oval cells.
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42. What is the average number of lobes in the normal white cell?
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a. 3.5.
b. If the average is >4 or if more than 5% of cells have >5 lobes, the patient has megaloblastic anemia, as well as macrocytosis. |
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43. Macrocytosis?
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a. “big cells” ( i.e. large MCV).
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44. Megaloblastic anemia?
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a. Means the presence of hyper segmented neutrophils as well.
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45. What all should be ordered for microcytic anemia on CCS?
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a. Bilirubin level and LDH, which are commonly elevated.
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46. Reticulocyte count with megaloblastic anemia?
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a. Will be decreased
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47. Which common diabetic drug blocks B12 absorption?
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a. Metformin.
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48. Note: up to 30% of those with B12 deficiency can have a normal B12 level, because transcobalamine is an acute phase reactant and any a form of stress can cause its elevation.
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Note: up to 30% of those with B12 deficiency can have a normal B12 level, because transcobalamine is an acute phase reactant and any a form of stress can cause its elevation.
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49. If you suspect B12 deficiency, but the B12 level is normal, what should you do?
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a. Order a methylmalonic acid level.
b. Homocystine levels go up in both vitamin B12 deficiency and folate deficiency. |
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50. When asked, after finding a low B12 or elevated methylmalonic acid level, what is the next best step to confirm the etiology of a B12 deficiency?
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a. Anti-parietal cell antibodies and anti-intrinsic factor antibodies.
b. Antiparietal cell antibodies and anti-intrinsic factor antibodies confirm pernicious anemia is the etiology of B12 deficiency. c. Essentially, pernicious anemia is an allergy to parietal cells; it is a kind of autoimmune disorder against this part of the stomach. |
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51. Note: Schilling's test is an older, rarely done method of confirming the etiology and is not necessary if the antibodies are present.
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Note: Schilling's test is an older, rarely done method of confirming the etiology and is not necessary if the antibodies are present.
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52. Will fully correct the blood problems in B12 deficiency?
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a. Yes/
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53. Treatment of B12 and fully deficiency?
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a. Replacement
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54. Presentation of all forms of hemolytic anemia?
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a. Sudden onset of weakness and fatigue associated with anemia.
b. The first thing to improve is a reticulocyte count, followed by elimination of hyper-segmented neutrophils. |
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55. 4 lab findings associated with hemolytic anemia?
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1. Elevated indirect bilirubin level
2. elevated reticulocyte count 3. elevated LDH 4. decreased haptoglobin. b. For CCS, what else should be ordered with hemolytic anemia (on the first CCS screen)? 1. Peripheral smear 2. LDH 3. bilirubin level 4. reticulocyte count 5. haptoglobin level |
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56. Other key features of intravascular hemolysis?
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1. Abnormal peripheral smear (schistocytes, helmet cells, fragmented cells)
2. Hemoglobininuria 3. Hemosiderinuria (metabolic, oxidized product of hemoglobin in the urine). b. What metabolic abnormality should you watch for after treating B-12 deficiency? 1. Low potassium. |
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57. What will a question about sickle cell like we describe?
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a. Pain in the chest, back, and thighs that is very severe.
b. Acomplete physical examination is VERY important for the sickle cell case. |
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58. Note: if there is a fever AFTER you give oxygen, fluids, analgesics, and antibiotics, then perform a complete physical examination.
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Note: if there is a fever AFTER you give oxygen, fluids, analgesics, and antibiotics, then perform a complete physical examination.
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59. HEENT findings for Sickle Cell Anemia?
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a. Retinal infarction
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60. CV findings for Sickle Cell Anemia?
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a. Flow murmur from anemia
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