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Hemoglobin: 4.0 PCT- 14% RBC 1.

85 times 10 to the 5 RDW 18 Microcytic anemia Most likely cause is iron deficiency anemia due to chroni blood loss 2. Hemoglobin 7.0 PCV or Hct 20% RBC 2.3 times 106 Reticulocyte: 10% What addtiaonl information woul be needed to determine the reticulocyte index? Peripheral blood smear 3. patient admitted with following Hemoglboin: 6.5 gm% PCV or Hct: 19.5% RBC: 21.2 times 106 /microliter Reticulocyte index: 4.0% T bilibrubin, direct bilirubin: 1.5 mg%/0.2 mg% Most likely reason: Increased destruction 4. 80 yo man hemoglobin: 10.0 gm% PCV or HCt: 30% RBC: 2.5 times 10 to the 6 Reticulocyte index: less than 0.1% (less than 2500 absolute count) Total bilirubin: 2.1%, 0.1mg LDH: 1000 lu/ml (normal 100-250) Ineffective RBC production 5. hemoglobin 10.0% PCV: 30% RBC: 3.2 times 10 6 Reticulocyte: less than 0.7% WBC: 7500 Platelet count: 200000/uL Total/;direct bili: 0.4%, 0.1% LDH: 1110lu/ml 6. history: a 28 yo man was admitted ecause of poor healing of his left leg. He had bene inurined ina abaseball game when his left shin was cut deeply by spikes. The cut healed but erthmea persisted . osteomyelitis 11.4%

33% 375 times 106 reticulocyte 480000 RDW: 13 Wbc: 91000 I; wotj 71% neutrophils, 17% lympho, and 13% onocytges Platelets: 3891,0000 Total 05., direct 01 33 times 10/3.75 times 10 6 MCV normal Anemia is His iron studies will most likely how low serum iron, low iron bidning capacity and normal or increased ferritin Diagnosis of anemia of chronic diease: normochromic, normal RDW, serum fe decreased, serum fe c decreased, percent saturation decreaed, ferritirin normal to increased, transferrin receptor Normal Serum erythropoietin wlvel will mostliekly be Increased slightly but not shigh as mighr be expected. Percentage of erhtrodi percuros I the bone marrow containing hemosiderin grnaules will be decreased or absent Iron definiciency vs anemia of chrnoica disease s Iron def Serum Fe Decreased Fe BC Normal or increased Ferritin Decreased Transf. receptor Increased BM sideroblasts Decreased BM macrophage Decreased Which of the llowin is the best way to treat the anemia: Treat the underlying disease: antibiotics 7. 63 yo women admitted becaue of nausea and vomited, easy fatigability, SOB, and ffever. She has not abdominal pain and no history of GI bleeding. SOB had increased in severity so that she was sympmtomati at rest and coud not life flat. Easy bruising and gum bleeding. Pale, obest female Bp 190/80. Pulse 86, RR 16, Temp 98.6. Poror dentalhygiene. Mucoas was pal/ Vervial venous distention at 45 degrees. Scarttered basilar rales int eh lungs bilaterally. The poiont of maximum impulse at the heart aws in the 6th intercoast space. Therw as an s4 gallop. There was no hepatosphlenomegaly. The was 2 plus pitting edea to the knees and scattered petechiae and ecchymoses. Petechiae: only occur when no platelets or endothelilum cell damage Ecchyoses: all sorts of things

ACD Decreased Decreased Normal to increased Normal Decreased to absent normal

Lab: Hgb: 5.8 PCV: 18% RBC 1.88 times 106 Retic: 0.1% WBC: 2000/ul 25% neutrophils, ymphs 60&+% monos 15% platelets 18000 biliruid T/D 05, 0.2 MCV 90s normocytic Hypopoiferative process low retic coutn , Which of the following tests would you do; Serum ferritin, serum B12 flevel and folate levels, serum epo level, bone marrow aspirate and biospcy BM aspirate and biopsy hypopoliferative (something has to be wrong in the bone marrow)

diagnosis: aplastic anemia 86 what wouldnt help determine the precise underlying cause: dietary history iron deficiency anemia why does the patient have it no obvious reason parasitology Case 9: this isa 51 yo women admitted for eval of generazlied weaknes gradually grogressing over the alst 3-4 months until she was unable to stand. Her dieteray intake ahd been poor because hse was caring for her mother and also trying to Physical exam: pale mon colored with mutliplte bruises. Sh ew as bedign from her gums. Conjutivae waere plae. Questionaalbe scleral iceterus. Basilar rales at he elft lung base. Tachycardia of and grae II/VI Lab data: hG 9.0 hct: 28% RB: 286 times 10 to the 6 Retics: 1.6% (46000 absolute) RDW: 20 WBC: 2500 (N 35%, lmphs 60%, mono 5%) Patekeete 25000 Bilirubin T/D: 3.0 /0.3 LDH: 2180 IU/ml (normal 100-250) MCV 90 normal (but received fom other person so the MCV should be high)

5 units of normal blood received WBC with 8 lobed nucleus (hypersegmeneted) ineffective ethroypoeiss serum B1`2 and folate detailed dietary hx folate deficiency 10. 45 yo womean who was noted have pallor in 1975. Her hemoglobin pat hx: cholecystectomy at age 21 for gallstones, hysterectomy at age 31 lab: 11.3 33 RBC: 3.66 Retics: 6.6 RDW 16 wBC 5500 platelete 250000 bilirubinL 1.8, 0.2 LDH anemia: increased destruction (hemolytic disease) gallstones hereditary test review peripheral blood smear because that will give you the answer most of the time what of the following diagnoses would not be part of the differential diagnosis of anesmia in this patient? Hereditary spherocytosis (NO SPHEROCYTES) 11. 70 yo guatemalana woman who has een in USA for 4 years. She was ll until 6-8 months ago when she developed progressive weakness, anorexia, occasionall vomiting and a 15 lb weight loss phsycial exam: cahcetc female with no burinsingn. She was pale. Liver and speeln noplapable hbg: 6.4 hct: 20% RBC: 1.6 times 10 to the 6 Retics: 3% nocrrected (48000 absolute) RDW: 19 WBC 3900 (neurs 35%, lymphs 60%, monos 5%) Platelet 35000 Bilirubin 2/0.2 lDH: 1600 IU pH gastric juie 2.0 (IF should be normal, if IF was bad pH sould be higher. Parietal cell makes HCl acid and IF)

Macrocytosis ineffective erythropoiesis hypersegmented nucleus oval macrocytes vitamin b12 and folate acid levels most probably underlying dieases is GI lumen abnormality no reason to believe patient as PA because pt has enough HCl 12. 22 yo jaundice, spehnomegnoly Hgb: 5 gm/dl Hct 15% 1.5 times 10 to the 6 retic: 10% corrected wbc: 6500 platelet 300000 bilrubinL 2.5, 0.4 Hemolytic increaedd Increased +/None Abnormal Acute blood loss Increased normal Normal Yes normal

Retic index bilirubin LDH Evidence of blood loss Bood smear

->increased destruction look at blood loss know patient has hemolysis diagnosis: autoimmune hemolytic