Feature of chronic extravascular hemolysis

 # Which one of the following is a feature of chronic extravascular hemolysis? 

a. Raised serum conjugated bilirubin 

b. Low reticulocyte count 

c. Hypocellular bone marrow 

d. Gall stones

The correct answer is D. Gall stones.

Hemolytic anemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). This most commonly occurs within the spleen, but also can occur in the reticuloendothelial system or mechanically (prosthetic valve damage). Hemolytic anemia accounts for 5% of all existing anemias.  It has numerous possible consequences, ranging from general symptoms to life-threatening systemic effects. The general classification of hemolytic anemia is either intrinsic or extrinsic. Treatment depends on the type and cause of the hemolytic anemia.

Symptoms of hemolytic anemia are similar to other forms of anemia (fatigue and shortness of breath), but in addition, the breakdown of red cells leads to jaundice and increases the risk of particular long-term complications, such as gallstones and pulmonary hypertension. 

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Iron absorption will be increased in:

 # Iron absorption will be increased in: 

a. Pregnancy 

b. Chronic inflammation 

c. Iron overload 

d. Phosphates

The correct answer is A. Pregnancy.

Factors that increase iron absorption from GI tracts are:

• Dietary factors

• Increased heme iron (particularly in meat)

• Ferrous iron salts

• GI factors

         – Acid pH

• Increased requirement:

         – Iron deficiency

         – Increased erythropoiesis

         – Pregnancy

         – Hypoxia

Factors that decrease iron absorption are:

• Ferric iron salts

• Malabsorption

• Proximal bowel resection

• Presence of oxalates, phytates and phosphates in diet

• Inflammatory disorders (due to increased hepcidin level)

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First stage of iron deficiency:

 # Which is the first stage of iron deficiency? 

a. Negative iron balance 

b. Decreased iron stores 

c. Decrease MCV 

d. Decrease in Hemoglobin

The correct answer is A. Negative Iron Balance.

“Negative iron balance” describes a state in which body iron content is decreasing, secondary to relative decreases in iron intake and/or relative increases in iron losses. Over time, negative iron balance can progress to functional and absolute iron deficiency and anemia.

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Earliest recognizable change in RBC morphology:

 # Which of the following is earliest recognizable change in RBC morphology in case of iron deficiency? 

a. Hypochromia 

b. Anisocytosis 

c. Target cells 

d. Poikilocytosis

The correct answer is B. Anisocytosis. 

Anisocytosis is the medical term for having red blood cells (RBCs) that are unequal in size. Normally, a person’s RBCs should all be roughly the same size.

Anisocytosis is usually caused by another medical condition called anemia. It may also be caused other blood diseases or by certain drugs used to treat cancer. For this reason, the presence of anisocytosis is often helpful in diagnosing blood disorders like anemia.

Treatment for anisocytosis depends on the cause. The condition isn’t dangerous on its own, but it does indicate an underlying problem with the RBCs.

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