FHEA - Hematologic Disorders UPDATED
ACTUAL Questions and CORRECT
Answers
Anemia - CORRECT ANSWER -A complex of signs and symptoms characterized by
decreases in numbers of RBCs or Hb content caused by blood loss, deficient erythropoiesis,
excessive hemolysis, or a combination of these changes
*Anemia only occurs when insult is severe enough to disturb normal homeostatic mechanisms
and exceed reserves*
4 components necessary for RBC formation - CORRECT ANSWER -1. Functional
erythropoietin (hormone) mechanism: source 90% renal, 10% hepatic. (erythropoietin supply is
diminished in advancing renal failure, usually beginning when GFR <49 mL/min.
2. Uncompromised DNA synthesis: impaired by chronic inflammation (ex. autoimmune
disorders including SLE, RA, and chronic infection). Reversible when inflammation tx.
3. Hemoglobin synthesis unimpaired by lack of iron, vitamin or globin production: need iron, B
vitamins, vitamin C, protein and others
4. Intact marrow microenvironment - revealed in production of reticulocytes (N 1-2% of total
RBC). Reticulocytosis = body working to correct anemia. Absence of reticulocytosis or presence
of reticulocytopenia = inadequate bone marrow response.
Causes of anemia: Blood loss
What are some primary care causes and corresponding questions you'd ask? - CORRECT
ANSWER -Clinically significant = 1 L sudden, as little as a few mL/d for chronic
Causes: miscarriage, erosive gastritis, menorrhagia, GI malignancy. Are you bleeding from your
rectum, vagina, are you throwing up blood?
Causes of anemia: Premature destruction of RBC
, Normal lifespan of RBC? - CORRECT ANSWER -Hemolysis - shortened RBC lifespan
(<90 d)
Normal = 90-120
Part of mechanism of ACD
CBC Evaluation of Anemia: which 7 lab values to look at - CORRECT ANSWER -Hb,
Hct, and RBC count - values should be proportionately decreased (normal H&H ratio 1:3)
Cell size: MCV (microcytic=<80 fL, normocytic 80-96 fL, macrocytic >96 fL)
Hb content: Mean cell hb (MCH), mean cell hb concentration (MCHC) - hb gives cell color (-
chromic)
Hypochromic = pale = MCHC <31 g/dL
RBC distribution width (RDW): an index of variation of RBC size. >15% = new cells differ in
size (larger or smaller) when compared with older cells. One of earliest signs of evolving micro
or macro anemia.
Reticulocyte percentage - 1-2% N. NL response to anemia is reticulocytosis (>2%).
What type of Anemia? Most common etiologies?
- Decreased Hg, Hct and RBC. Normocytic (MCV =80-96 fL), normochromic anemia with NL
RDW
MCV=NL
MCHC=NL
ACTUAL Questions and CORRECT
Answers
Anemia - CORRECT ANSWER -A complex of signs and symptoms characterized by
decreases in numbers of RBCs or Hb content caused by blood loss, deficient erythropoiesis,
excessive hemolysis, or a combination of these changes
*Anemia only occurs when insult is severe enough to disturb normal homeostatic mechanisms
and exceed reserves*
4 components necessary for RBC formation - CORRECT ANSWER -1. Functional
erythropoietin (hormone) mechanism: source 90% renal, 10% hepatic. (erythropoietin supply is
diminished in advancing renal failure, usually beginning when GFR <49 mL/min.
2. Uncompromised DNA synthesis: impaired by chronic inflammation (ex. autoimmune
disorders including SLE, RA, and chronic infection). Reversible when inflammation tx.
3. Hemoglobin synthesis unimpaired by lack of iron, vitamin or globin production: need iron, B
vitamins, vitamin C, protein and others
4. Intact marrow microenvironment - revealed in production of reticulocytes (N 1-2% of total
RBC). Reticulocytosis = body working to correct anemia. Absence of reticulocytosis or presence
of reticulocytopenia = inadequate bone marrow response.
Causes of anemia: Blood loss
What are some primary care causes and corresponding questions you'd ask? - CORRECT
ANSWER -Clinically significant = 1 L sudden, as little as a few mL/d for chronic
Causes: miscarriage, erosive gastritis, menorrhagia, GI malignancy. Are you bleeding from your
rectum, vagina, are you throwing up blood?
Causes of anemia: Premature destruction of RBC
, Normal lifespan of RBC? - CORRECT ANSWER -Hemolysis - shortened RBC lifespan
(<90 d)
Normal = 90-120
Part of mechanism of ACD
CBC Evaluation of Anemia: which 7 lab values to look at - CORRECT ANSWER -Hb,
Hct, and RBC count - values should be proportionately decreased (normal H&H ratio 1:3)
Cell size: MCV (microcytic=<80 fL, normocytic 80-96 fL, macrocytic >96 fL)
Hb content: Mean cell hb (MCH), mean cell hb concentration (MCHC) - hb gives cell color (-
chromic)
Hypochromic = pale = MCHC <31 g/dL
RBC distribution width (RDW): an index of variation of RBC size. >15% = new cells differ in
size (larger or smaller) when compared with older cells. One of earliest signs of evolving micro
or macro anemia.
Reticulocyte percentage - 1-2% N. NL response to anemia is reticulocytosis (>2%).
What type of Anemia? Most common etiologies?
- Decreased Hg, Hct and RBC. Normocytic (MCV =80-96 fL), normochromic anemia with NL
RDW
MCV=NL
MCHC=NL
