Microcytic Anemias
Macrocytic Anemias
Normocytic Anemias & Hemochromatosis
Identifying Anemias
Treating Anemias
100
One of the most common yet unusual symptoms of iron deficiency anemia is chewing this substance alongside other things like dirt and starch
What is ice?
*This craving to chew stuff with no nutritional value is called pica
100
Alongside iron deficiency, vegans are often at risk of this vitamin deficiency often consumed through animal and shellfish products
What is vitamin B12 or cobalamin?
*Note that iron deficiency leads to microcytic anemia, B12 leads to macrocytic anemia
100
In a CBC, a patient with a normal MCV but high RDW most likely indicates a deficiency in these two substances in the patient
What are iron and folate?
*MCV is normal due to averaging microcytic RBCs from iron deficiency with macrocytic RBCs with folate!
100
According to the World Health Organization, WHO, an anemia is characterized with this value being less than 13.0 g/dL in males and 12.0 g/dL in females
What is hemoglobin?
*Children will have even lower Hgb levels, keep that in mind!
100
To help elemental iron become more easily absorbed as a supplement (and also to promote collagen formation), it will need to be reduced using this vitamin
What is vitamin C?
*Reducing Fe3+ to a more water-soluble Fe2+ to move within the body
200
This blood disorder/anemia impacts the production of either the alpha or beta globin molecules, leading to insufficient hemoglobin and thus microcytic RBCs
What is thalassemia?
*While we were taught mostly beta-globin, it can impact alpha-globin molecules too! Symptoms will present like hemolytic anemias
200
A patient comes in with pale skin, diarrhea, and a lack of energy a few weeks into her pregnancy. Iron studies are normal, so if it were an deficiency anemia, it would most likely be a deficiency in this compound
What is folate?
*Since the fetus siphons away folate stores for growth, the mother likely has a folate deficiency. The symptoms are some examples for this type of anemia
200
In hemochromatosis, the excess iron due to a lack of hepcidin secretion can cause your skin to turn this color (multiple answers, only one needed)
What is bronze, brown, OR gray?
*Other symptoms of note may include impotence in males, liver failure, memory fog, and even heart failure
200
The peripheral blood smear here indicates this type of macrocytic anemia often associated with primary or secondary folate deficiencies 
What is megaloblastic anemia?
*Key points are variable pallor sizes, macrocytic RBCs (harder to observe), and especially the hypersegmented neutrophil!
200
To combat the severe inadequate intake of folates/vitamin B9 in the US, this food product has been enriched in this substance
What are cereal grains?
*Other natural sources include leafy greens, citruses, and-perhaps the best- legumes
300
A patient who was diagnosed with rheumatoid arthritis about a year ago now presents with an iron deficiency. You suspect the deficiency stems from this type of anemia
What is anemia of chronic disease?
*Any inflammatory response will make the liver secrete hepcidin and thus increase iron stores
300
Macrocytic anemias not associated with DNA synthesis problems usually fall under this category of anemias, which can stem from hypothyroidism, myelodysplastic syndromes, and more
What are non-megaloblastic anemias?
*The B vitamin ones are megaloblastic. Remember a megaloblast is a really large, immature, and abnormal RBC in bone marrow
300
The most common HFE hemochromatosis mutation occurs at cysteine 282, which then transforms into this amino acid (Full name)
What is tyrosine?
*This is what C282Y means, C282 = Cysteine as the 282nd amino acid, Y = Tyrosine
*The other mutation is H63D, or histidine 63 to aspartic acid
300
After doing a physical exam, you notice an enlarged spleen and liver on your patient. Alongside pale skin and yellowing in the eyes, this likely indicates this category of anemias
What is hemolytic anemia?
*Destruction of red blood cells in spleen and liver leaves a lot of their contents in those organs, and bilirubin in particular can lead to jaundice
300
Except for patients that need blood like those with thalessemia or sickle cell anemia, use this method to treat HFE hemochromatosis
What is phlebotomy?
*Removing half a liter of blood will also remove ~200-250 mg iron!
400
Sideroblastic anemia generates sideroblasts, which are immature red blood cells with rings of this substance around a center that's often the nucleus
What is iron?
*The unused iron builds up as a ring in sideroblastic anemia within bone marrow, unable to be used
400
A patient presents with neuropsychiatric symptoms and weight loss, and lab tests show an autoantibody against parietal cell intrinsic factor. You then suspect the patient has this specific anemia
What is pernicious anemia?
*Intrinsic factor helps absorb vitamin B12, so this is a B12 deficiency!
400
Fanconi anemia affects the body's ability to repair damaged DNA, making it this category of anemias where all blood cell production is limited and thus presents as greater vulnerability to infection and difficulty creating blood clots
What are aplastic anemias?
*Affecting all blood cells is also called pancytopenia!
400
A patient with this high-performance liquid chromatography (HPLC) indicates this specific anemia
What is sickle cell anemia?
*The extremely large HbS peak is indicative of the mutation from glutamic acid 6 to valine to modify the beta-globin
400
To treat anemia of this diseased organ, providing recombinant human erythropoietin or erythropoiesis-stimulating agent (ESA) can resolve Hgb levels
What is the kidney?
*Major caveat is that there needs to be enough iron to let bone marrow create enough hemoglobin
500
Alongside abdominal pain and neurological impairments, poisoning due to this heavy metal can lead to a variety of microcytic anemias like sideroblastic anemia
What is lead?
*Lead can inhibit heme synthesis and impact iron metabolism
500
From a blood smear you find your patient has a non-megaloblastic anemia. Prior history indicates cirrhosis, which may likely suggest this disorder being the cause
What is alcohol use disorder/alcoholism?
*Most common form of non-megaloblastic anemia, but can also present itself in folate deficiency anemias
500
A patient complains of needing to urinate much more often, swelling of extremities, and high blood pressure. The likely affected organ may then have reduced production of this hormone and consequently lead to normocytic anemia
What is erythropoietin?
*These symptoms likely indicate kidney disease, and kidneys are associated with producing EPO to trigger RBC production
500
In this Prussian blue stain, the central cell indicates this specific microcytic anemia
What is sideroblastic anemia?
*The iron is stored in mitochondria outside the immature RBC that still has a nucleus and granules!
500
Diamond-Blackfan anemia is a failure for the bone marrow to produce RBCs, but it can be treated with these anti-inflammatory drugs
What are corticosteroids?
*With sustained responses to these substances, it can help bone marrow produce more RBCs