Blood smear Pale RBCs Target cells

Hb electrophoresis Normal a: normal; b: HbA2 (HY)

What happens if we give iron? Improvement No improvement (HY)
Tx Iron Transfusions if severe

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MEHLMANMEDICAL.COM

- 72M + fatigue + smear shows pale RBCs + Hb 9.4 g/dL; most likely cause? à answer = GI blood loss

(IDA) à must think dive[icular bleed, colorectal cancer, and angiodysplasia causing IDA in elderly

patient with fatigue; 2CK-level Qs will jump straight to colonoscopy as the answer.

- 65M + pain in `nge[ips for 3 weeks + facial plethora + splenomegaly + Hb 20.2 g/dL + WBCs 14,500

with normal diderential + normal platelets + O2 sats 94% on room air; Dx + Tx? à answer =

polycythemia vera (PCV); Tx = phlebotomy.

- Mechanism of PCV? à JAK2 mutation causing “proliferation of bone marrow stem cells.”

Erythropoietin (EPO) is decreased because it is suppressed. Although oxygen sats should be as close

to 100% as possible, patients generally hold up `ne with sats >94%.

- 48F + pruritis amer a shower + high WBCs + Hb 19.5 g/dL; Dx? à answer = PCV; pruritis amer a shower

is a classic `nding à renect basophilia; WBC count can be normal or elevated in PCV.

- 50F smoker + Hx of COPD + Hb 18.5 g/dL; Dx + mechanism? à answer = secondary polycythemia à

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increased EPO due to low oxygen tension (e.g., in COPD, CF, etc.) à mechanism is “proliferation of