Anemia: Goljan vs. FA

[HTxFrog]

Has anyone noticed that Goljan and First Aid don't really seem to agree on anemias. I don't really know which one to trust b/c I had been going with Goljan and I didn't even read FA's anemia section but on one of my previous practice tests there were some anemia questions where I was thinking, "well Goljan said TIBC goes down in sideroblastic anemia and this TIBC is normal but the kid is eating paint chips so I guess I'm going to just ignore Goljan" come to find out FA disagrees on some stuff like that example and a few where Goljan says intravascular hemolysis and FA says extravascular etc. Anyways, anyone else had this problem or any opinion on what to trust. I also looked it up in Current Medical Dx and Tx and it says sideroblastic anemia has increased MCV, wtf? I'm confused

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[Domenech]

Hmm sideroblastic anaemia should have decreased MCV because all it does is just precipitate iron deficiency anaemia, when Iron infact is in excess so you can guess the lab values of TIBC and ferritin to correlate with excess iron.

 

[aashkab]

could it also be that the iron is depositing around the mitochondria ("iron laden mitochondria") and thats why TIBC is down?

 

[turkeyjerky]

Sideroblastic anemia is an iron-overload condition and hence has decreased TIBC (just like thalassemia). I say f^ck first aid on this one, goljan is golden for anemia.

Keep in mind though, that none of the lab studies (aside from a bone marrow bx) are 100%. The notes in rr path are ideal situations and there's guarantee that patients, or test questions, will conform to them.

Btw, sideroblastic anemia, if part of a MDS, is usually macrocytic--that's probably what the note above refers too. On another aside, some authors maintain that lead poisoning doesn't actually cause sideroblastic changes and others say that whatever microcytosis is present in lead poisoning is likely due to concomitant iron deficiency.

 

[Sol Rosenberg]

Sideroblastic anemia is an iron-overload condition and hence has decreased TIBC (just like thalassemia). I say f^ck first aid on this one, goljan is golden for anemia.

Emphatically agree with this. Goljan heme is MONEY. Heme was one of my weaker subjects this past year (I didn't listen to Goljan lectures THAT block because I didn't think I had the time to spare ). But now all these questions seem like pretty easy points.....