Hematology: Anemia and Answer Key Case

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Case 1
1.Iron deficiency vs thalassemia vs anemia of chronic disease. 2.Serum iron, TIBC, ferritin.
3.Blood loss, likely GI. A GI evaluation is indicated.
4.Slow response (weeks) to oral iron.
5.Incorrect diagnosis, non-compliance, continued blood loss.

Case 2
1.Anemia of chronic disease vs iron deficiency.
2.Serum iron, TIBC, ferritin.
3.Consistent with ACD, but also iron deficiency with inflammation. 4.Bone marrow iron stain could resolve the possibilities.
5.Trial of oral iron could be considered.

Case 3
1. Macrocytic anemia.
2.B12, folate deficiency, liver disease, reticulocytosis, myelodysplasia. 3.Blood smear, serum B12, red cell folate levels, Schilling test. 4.Parenteral B12.
5.Not in the absence of symptoms.

Case 4
1. MCV =Hct/liter= 103 fl rbc x 1012/liter
Hemolytic anemia
Reticulocytosis, indirect hyperbilirubinemia
2. Compensated hemolytic anemia.
Decreased reticulocyte count -~ worsened anemia
3. Family history of anemia or gallstones.
4. Autosomal dominant.
5. Blood smear, osmotic fragility test.
6. Splenectomy. Increased risk of infection.
7. Blood smear shows Howell-Jolly bodies.

Case 5
Fetal hemoglobin production ameliorates sickle cell disease. Autosplenectomy due to recurrent splenic infarction.
Encapsulated organisms (salmonella, pneumococcus, etc.).
Vascular occlusion of viscera.
Bone, kidney, brain, etc.
Hypoxemia, dehydration, acidosis
6. All children will have Hb AS, which is not associated with significant clinical problems.

Case 6
Fetal hemoglobin production.
3. Iron overload due to rbc transfusions and non-compliance with iron chelation therapy. Less severe disease.
Reduced hemolysis and decreased marrow expansion.
6. p-chains are more soluble, so less precipitation of 6-chains occurs...
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