ANEMIA CASE STUDY-STUDENT VERSION WITH 70 QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES, Exams of Nursing

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ANEMIA CASE STUDY-STUDENT VERSION

WITH 70 QUESTIONS AND VERIFIED

ANSWERS WITH RATIONALES AFTER EVERY

ANSWER/LATEST UPDATED STUDY GUIDE

2024/2025 ALREADY GRADED A

A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What other findings would you expect to find? a. Serum Iron that is high b. Serum transferrin that is low c. Serum ferritin that is high d. TIBC that is high - ANSWER>>d. TIBC that is high Your TIBC would be high because you would have lots of binding capacity left over, since this is most likely Iron Deficiency anemia. A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What other physical exam findings would you expect to find? a. glove and stocking parasthesia b. wobbly gait c. tachycardia d. mild icterus - ANSWER>>c. tachycardia This is most likely iron deficiency anemia based on the physical exam findings. The other options were symptoms of B12 deficiency anemia. A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having have trouble swallowing and an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. The patient also has a smooth appearance to his tongue. To investigate the trouble swallowing you have your patient do a barium swallow and notice a web like appearance. You run a CBC as well and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What is the most likely diagnosis? a. iron deficiency anemia b. plummer-vision syndrome c. anemia of chronic disease d. B12 deficiency anemia - ANSWER>>b. plummer-vision syndrome

This patient does have iron deficiency anemia as show by the microcytic hypochromic CBC, but plummervision syndrome is the combination or triad of symptoms shown here: iron deficiency anemia demonstrated by many of these symptoms but most notably for this syndrome with glossitis, dysphagia, and an esophageal web. A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What would be the most appropriate treatment for this patient? a. Iron dextran IM 100mg x 10 doses b. Sodium Ferric Gluconate IM 125mg x 8 doses c. Ferrous Sulfate 325mg PO TID x 3-6 months d. folic acid supplementation 1mg/d PO x 4 months - ANSWER>>c. 325mg PO TID x 3-6 months PO is preferred and IV/IM is only used if PO therapy failed, they have higher iron requirements due to chronic heamodialysis, or iron malabsorption issues. Your patient is has iron deficiency anemia and failed oral therapy. You decide to put them on a parental iron therapy. What option would you be most concerned about anaphylaxis with? a. Iron Dextran b. Sodium Ferric Gluconate (ferrlecit) c. Iron Sucrose d. Ferrous sulfate - ANSWER>>a. Iron Dextran Iron dextran has a black box warning and requires a test dose to see how the patient handles it. Sodium Ferric gluconate (ferrlecit), can also cause anaphylaxis and a test dose is recommended, but there is no black box warning, so Iron Dextran you would worry the MOST about even though both could cause it. You know how they love to put these kind of questions on there. What kind of medication would you be worried about decreasing the absorption of iron therapy? a. Lisinopril b. Metroprolol c. Methyldopa d. Levothyroxine e. doxycycline - ANSWER>>e. doxycycline Doxycycline will decrease the iron absorption. Methyldopa, levothyroxine, AND doxycycline will all be affected by iron therapy and their effects will be decreased DUE TO the iron. Doxy is the only one that both decreases iron absorption and has it's effects decreased as well. A 50 year old female with a history of SLE presents with a chief complaint of fatigue for the past month. During the history the patient says she has noticed he gets tired very much easier than she used to when walking up a flight of stairs. She also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of her mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 75, RDW 17, MCHC 28. What other lab findings would you expect to find?

a. Serum Iron that is high b. Serum ferritin that is low c. TIBC that is low d. TIBC that is high - ANSWER>>c. TIBC that is low This is anemia of chronic disease or inflammation coexisting with iron deficiency anemia. TIBC would be low because serum Ferritin is usually elevated. Serum Ferritin would be high because this is an inflammatory mediator. In the case of infection our body cuts off the iron stores from releasing iron because bacteria cannot survive without iron and our body's cells can for a good amount of time. Chronic Inflammation sends the same signal to our body as an infection. In this case we have plenty of iron in our stores, but our body is not releasing the iron because of the chronic inflammation. A 50 year old female with a history of SLE and CKD presents with a chief complaint of fatigue for the past month. During the history the patient says she has noticed he gets tired very much easier than she used to when walking up a flight of stairs. She also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of her mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 75, RDW 17, MCHC 28. What would be the most appropriate treatment? a. Ferrous sulfate 325mg PO TID x 3-6 months b. Iron Dextran 100mg IM x 10 doses c. Procrit SQ 50 units/kg three times weekly d. Venfer 100mg 1-3x/week for 10 doses - ANSWER>>c. Procrit SQ 50 units/kg three times weekly erythropoietin stimulating agents ESA are indicated in patients on chemo, with CKD, or HIV under myelosuppressive therapy. This anemia is most likely caused by a decreased in erythropoietin being produced from the kidneys. Iron supplementation is not indicated in patients with an increased serum transferrin saturation (TIBC) or patient's with normal to increased ferritin levels, which this patient most likely has due to their CKD. NOTE: CKD is also seen in normocytic anemia, so it is not necessarily going to be microcytic. A 30 year old patient presents with a complaint of weakness and looking pale. After your workup you suspect aplastic anemia. What findings would be MOST likely to point you in this direction? a. purpura and petechiae b. Poorly healing ulcers over lower tibia c. Electrophoresis finding of HgbS d. Pancytopenia - ANSWER>>d. Pancytopenia What anemia is most likely to present with bite cells on peripheral smear and heinz bodies if stained? a. sickle cell anemia b. sideroblastic anemia c. Beta thalassemia anemia d. G6PD deficiency anemia - ANSWER>>d. G6PD deficiency anemia What is the most common anemia? a. Iron deficiency anemia b. sideroblastic anemia c. Beta thalassemia anemia

d. G6PD deficiency anemia - ANSWER>>a. Iron deficiency anemia What would NOT be a likely cause for iron deficiency anemia? a. menorrhagia b. bleeding, wound/trauma c. occult cancer d. indadequate dietary intake e. alcoholism - ANSWER>>e. alcoholism This is usually associated with folate deficiency anemia You have a patient that is from southeast Asia. What thalassemia are they most likely to be afflicted by? a. Alpha 1 thalassemia b. Alpha 2 thalassemia c. Beta thalassemia - ANSWER>>a. Alpha 1 thalassemia You have a patient that is black. What thalassemia are they most likely to be afflicted by? a. Alpha 1 thalassemia b. Alpha 2 thalassemia c. Beta thalassemia - ANSWER>>b. Alpha 2 thalassemia You have a patient that is from the mediteranean (italian, greek). What thalassemia are they most likely to be afflicted by? a. Alpha 1 thalassemia b. Alpha 2 thalassemia c. Beta thalassemia - ANSWER>>c. Beta thalassemia In which thalassemia would you see basophilic stippling? a. Alpha thalassemia trait b. Alpha 2 thalassemia c. Beta thalassemia - ANSWER>>c. Beta thalassemia A 30 year old patient presents with cheif complaint of feeling fatigued and looking pale. During the history the patient complains of feeling clumsy lately, and the feelings of pins and needles in their hands and feet. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 105, RDW 17, MCHC 32. What would you expect to see on a peripheral blood smear in this patient? a. schistocytes b. heinze bodies c. target cells d. hyper-segmented neutrophils - ANSWER>>d. hyper-segmented neutrophils These are neurological signs and CBC results are consistant with B12 deficiency which is a megaloblastic type of macrocystic anemia. A 30 year old patient presents with cheif complaint of feeling fatigued and looking pale. During the history the patient complains of feeling clumsy lately, and the feelings of pins and needles in their hands and feet. Exam shows glossitis and increase DTRs. You run a CBC and these are your results: WBC 8,000,

RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 105, RDW 17, MCHC 32. Serum folate is normal and B12 is low. What is the most appropriate treatment? a. Nasocobal- Intranasal cyanocobalamin gel 500mcg every week for life b. 1000 mcg PO QD one month than 100mcg PO QD for life c. Cyanocobalamin 1000mcg IM every day for a week until Hb/hct normal then monthly injections for life d. 1 - 2 mg/day x 1 month then 500 mcg/day for life - ANSWER>>c. Cyanocobalamin 1000mcg IM every week until Hb/hct normal Parental therapy is preferred in those with neurologic symptoms A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. During the history the patient complains of feeling clumsy and the feelings of pins and needles in their hands and feet for the past month. Exam shows glossitis and increase DTRs. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 115, RDW 17, MCHC 32. Serum folate is normal and B12 is low. You treat this patient with cyanobalamin through parental injections. When do you expect to see their Hgb to rise? a. Withing days- 48 hrs b. after first week c. 1 - 2 months d. 4 - 6 months - ANSWER>>b. after first week Neurological symptoms should improve within a couple days and bone marrow should be normoblastic withing 48 hours. A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. During the history the patient complains of feeling clumsy and the feelings of pins and needles in their hands and feet for the past month. Exam shows glossitis and increase DTRs. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 115, RDW 17, MCHC 32. Serum folate is normal and B12 is low. You treat this patient with cyanobalamin through parental injections. When should you recheck their CBC and serum cobalamin after therapy initiation? a. Withing days- 48 hrs b. after first week c. 1 - 2 months d. 4 - 6 months - ANSWER>>c. 1-2 months You should check serum cobalamin 1-2 months after therapy initiation and then every 3-6 months. A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Exam shows glossitis and mild icterus. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 115, RDW 17, MCHC 32. You order a peripheral blood smear and find macroovalocytes and hypersegmented neutrophils. Serum folate is low and B12 is low. What would be the next test you should run to BEST identify the cause? a. homocysteine b. Methylmalonic acid c. Serum ferratin d. TIBC - ANSWER>>b. Methylmalonic acid You know you have a megaloblastic anemia you just need to differentiate between folate and b deficiency. MMA will be raised in B12 deficiency and normal in folate deficiency.

A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Exam shows glossitis and mild icterus. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 115, RDW 17, MCHC 32. You order a peripheral blood smear and find macroovalocytes and hypersegmented neutrophils. Serum folate is low and B12 is normal. What is the most appropriate treatment of folic acid? a. 1 - 5 mcg PO daily for at least 4 months b. 100 - 200 mcg PO daily for 1-2 months c. 1 - 5 mg PO daily for at least 4 months d. 100 - 200 mg PO daily for 1-2 months - ANSWER>>c. 1-5 mg PO daily for at least 4 months A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Exam shows glossitis and mild icterus. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 115, RDW 17, MCHC 32. You order a peripheral blood smear and find macroovalocytes and hypersegmented neutrophils. Serum folate is low and B12 is normal. You treat the patient with 1 mg of folic acid for 4 months. When do you expect to see the anemia corrected? a. 24- 48 hours b. 2 - 3 days c. 10 days d. 1 - 2 months - ANSWER>>d. 1-2 months RBC morphology should normalize in 24-48 hours, Reticulocytosis should appear in 2-3 days according to our slides and 5-7 days according to CMDT, serum chemistry and blood counts normalize in 10 days, and Hct will rise in 2 weeks, but again will not be normal for 2 months. A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. What test would be the MOST appropriate to order next? a. Bone marrow biopsy b. Electrophoresis c. Direct Coombs Test d. Serum folate and B e. Methylmelonic acid- MMA - ANSWER>>c. Direct Coombs Test- also known as direct antiglobulin test You should order this when spherocytes are present A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is positive. What is the most likely diagnosis? a. DIC b. hereditary Spherocytosis c. G6PD deficiency d. Autoimmune anemia - ANSWER>>d. Autoimmune anemia

A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is negative. What is the most likely diagnosis? a. DIC b. hereditary Spherocytosis c. G6PD deficiency d. Autoimmune anemia - ANSWER>>b. hereditary Spherocytosis A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows a significant amount of RBCs that look like army helmets also known as schistocytes. What is the most likely diagnosis? a. DIC b. hereditary Spherocytosis c. G6PD deficiency d. Autoimmune anemia - ANSWER>>a. DIC A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is negative. You suspect hereditary spherocytosis. What is the MOST likely think you would find if this is the correct diagnosis? a. history of Gallstones b.Surgical history of Mechanical heart valve replacement. c. Pain that radiates to the shoulders and back d. Thrombocytopenia - ANSWER>>a. Gallstones

• gallstones are more common and appear in 50% of these patients. A 30 year male old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is negative. You suspect hereditary spherocytosis. What treatment is appropriate? a. FFP b. Platelet transfusion c. Warfarin d. splenectomy - ANSWER>>d. splenectomy
• transfusions can be used in a crisis A 30 year old black male presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32., but there are no spherocytes or significant schistocytes on peripheral blood smear, but you do note heinze bodies. What is the most likely cause of this anemic exacerbation? a. Trauma

b. GI bleed c. Penicillin d. Fava beans - ANSWER>>d. Fava beans

• These are characteristic findings of GP6D deficiency anemia other causes are infections, and medications like primaquine, quinine, nitrofurantoin, and sulfa drugs. A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripheral blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is positive. What other lab findings would you expect? a. Decreased unconjugated bilirubin b. Increased direct bilirubin c. increased haptoglobin d. decreased haptoglobin - ANSWER>>d. decreased haptoglobin This is a hemolytic anemia so haptoglobin would be decresed in the serum. Unconjugated bilirubin would be increased. A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32 and a platelet count of 25,000. Your peripheral blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is positive. What is the most likely diagnosis? a. autoimmune hemolytic anemia b. G6PD deficiency anemia c. Evans syndrome d. sickle cell anemia - ANSWER>>c. Evans syndrome This is when a person has both autoimmune hemolytic anemia and ITP. A 5 year old male patient presents with recurrent episodes of bone pain and a ulcer over both of his tibia's. Patient has jaundice and hyperdynamic precordium and systolic mumurs. CBC comes back with a high WBC, platelet, and reticulocyte count as well as a low hematocrit. Indirect Bilirubin is elevated on urinalysis and a peripheral blood smear shows sickled cells, nucleated RBCs, Target cells and Howell- Jolley bodies. You suspect Sickle cell anemia. What would be the best test to confirm your diagnosis? a. Bone marrow biopsy b. Electrophoresis c. Direct Coombs Test d. Serum folate and B e. Methylmelonic acid- MMA - ANSWER>>b. Electrophoresis
• This will show Hgb S comprising 85-98% of the hemoglobin A 5 year old male patient presents with recurrent episodes of bone pain and a ulcer over both of his tibia's. Patient has jaundice and hyperdynamic precordium and systolic mumurs. CBC comes back with a high WBC, platelet, and reticulocyte count as well as a low hematocrit. Indirect Bilirubin is elevated on urinalysis and a peripheral blood smear shows sickled cells, nucleated RBCs, Target cells and

HowellJolley bodies. You confirm it is Sickle cell anemia through electrophoresis. What is the mainstay of treatment in sickle cell anemia? a. supportive care b. transfusions c. Folic acid 1mg PO daily d. Hydroxyurea 500-750mg daily - ANSWER>>a. supportive care Supportive care is the mainstay of treatment according to CMDT. Folic acid 1mg PO daily is part of supportive care but hydration, analgesics, oxygen, and pneumococcal vaccines are also include in supportive care so it is the MOST correct answer. Transfusions are given in hemolytic crises Allogenic hematopoietic stem cell transplantation is another answer that may have been appropriate in this patient if performed before the onset of significant end-organ damage in some cases and can cure more than 80% of children with sickle cell anemia who have suitable HLA-matched donors. This has not been proven as a useful treatment in adults. Other therapies include cytotoxic agents such as hydroxyurea 500-750 mg PO daily. Omega 3 fatty acids may help reduce vaso-occlusive episodes and reduce transfusion needs. A 5 year old male patient presents with recurrent episodes of bone pain and a ulcer over both of his tibia's. Patient has jaundice and hyperdynamic precordium and systolic mumurs. CBC comes back with a high WBC, platelet, and reticulocyte count as well as a low hematocrit. Indirect Bilirubin is elevated on urinalysis and a peripheral blood smear shows sickled cells, nucleated RBCs, Target cells and HowellJolley bodies. You confirm it is Sickle cell anemia through electrophoresis. What is the PREFERRED treatment in a crisis of sickle cell anemia? a. supportive care b. transfusions c. Folic acid 1mg PO daily d. Hydroxyurea 500-750mg daily - ANSWER>>d. Transfusion Transfusions are given in hemolytic crises A 5 year old male patient presents with recurrent episodes of bone pain and a ulcer over both of his tibia's. Patient has jaundice and hyperdynamic precordium and systolic mumurs. CBC comes back with a high WBC, platelet, and reticulocyte count as well as a low hematocrit. Indirect Bilirubin is elevated on urinalysis and a peripheral blood smear shows sickled cells, nucleated RBCs, Target cells and HowellJolley bodies. You confirm it is Sickle cell anemia through electrophoresis. What is the only treatment in sickle cell anemia that has been shown to improve over all survival? a. supportive care b. transfusions c. Folic acid 1mg PO daily d. Hydroxyurea 500-750mg daily - ANSWER>>d. Hydroxyurea 500-750mg daily This has been started in patients as young as 2 years old and can help decrease or PREVENT crisis and complications as well as reduce painful crises in patients whose pain is disrupting their quality of life. This has been shown to improve overall survival and quality of life. A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae,

jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is positive. You diagnose your patient with autoimmune heolytic anemia. What is the PREFERRED treatment? a. Splenectomy b. Rituximab 375 mg IV weely for four weeks c. Prednisone 1-2 mg/kg daily PO d. Danazol 400-800mg daily PO - ANSWER>>c. Prednisone 1-2 mg/kg daily PO First line is corticosteroids A 30 year old patient presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32. Your peripherall blood smear shows spherical red blood cells that have no area of central pallor and could be described as spherocytes. Direct coombs test is positive. You diagnose your patient with autoimmune heolytic anemia. What is the PREFERRED treatment if Prednisone 1-2 mg/kg daily PO fails? a. Splenectomy b.Rituximab 375 mg IV weely for four weeks c. Danazol 400-800mg daily PO - ANSWER>>a. Splenectomy Third line is Rituximab and Danazol. Danazol is indicated for long term use because of it's low toxicity profile, but is less effective than Rituximab. A 30 year old black male presents with chief complaint of feeling fatigued and looking pale. Patient also complains of abdominal pain and itching for the past week as well as dark urine. Exam shows petichiae, jaundice, and splenomegaly. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 95 , RDW 14, MCHC 32., but there are no spherocytes or significant schistocytes on peripheral blood smear, but you do note heinze bodies. What is the most appropriate treatment? a. Splenectomy b. Rituximab c. Prednisone 1-2 mg/kg daily PO d. No treatment just avoid offending agents - ANSWER>>d. No treatment just avoid offending agents CMDT says no treatment necessary just avoid known oxidant drugs. A 32 year old patient presents with a complaint of weakness and looking pale. Physical exam shows pallor and purpura. Your CBC shows WBC 450, platelets 18,000 and reticulocytes .5%. After your workup you suspect aplastic anemia. What is the PREFERRED treatment in this case? a. Procrit (Epoetin alfa) + filgrastin (myeloid growth factor) + RBC transfusion and platelet transfusions. b. Immunosuppression therapy with Equine ATG IV = Cyclosproine + prednisone c. Rituximab d. allogenic bone marrow transplantation from HLA-matched sibling - ANSWER>>d. allogenic bone marrow transplantation from sibling

• This is the preferred treatment in young adults with HLA matched sibling.

• If there is no HLA matched sibling than B, the immunosuppression, would be the best choice. - IF choice B immunosuppression fails and there is no HLA matched sibling than the next choice is from another donor that can be HLA matched. A 32 year old patient presents with a complaint of weakness and looking pale. Physical exam shows pallor and purpura. Your CBC shows WBC 1000, platelets 35,000 and reticulocytes %1. After your workup you suspect aplastic anemia. What is the most appropriate treatment in this case? a. Procrit (Epoetin alfa) + filgrastin (myeloid growth factor) + RBC transfusion and platelet transfusions. b. Immunosuppression therapy with Equine ATG IV = Cyclosproine + prednisone c. Rituximab d. allogenic bone marrow transplantation from HLA-matched sibling - ANSWER>>a. Procrit (Epoetin alfa)
  • filgrastin (myeloid growth factor) + RBC transfusion and platelet transfusions.
• In a mild case of aplastic anemia ESA agents alone or with myeloid growth factors can be used. RBC transfusions and platelet transfusions are given as needed. Which blood disorder is associated with a JAK2 gene mutation? a. Sickle cell anemia b. polycythemia vera c. aplastic anemia d. Beta thalassemia - ANSWER>>b. polycythemia vera In polycythemia vera would you see an increase or decrease in the EPO levels? - ANSWER>>Decreased