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PCM III Test 2 > Anemia/CBC/Blood smears > Flashcards

Anemia/CBC/Blood smears Flashcards

1
Q

Anemia

A

laboratory measurement indicating the red cell mass measurement (Hgb or Hct) in a patient is:
< than 2.5 percentile value of reference range

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2
Q

3 reasons to be anemic?

A

blood loss, hemolysis, decreased RBC production

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3
Q

microcytic, normocytic, macro?

A

MCV = mean cell volume

microcytic = 100

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4
Q

microcytic anemias?

A

iron defic.
anemia of CD
thalassemia
lead toxicity

“I love the CD’s”

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5
Q

normocytic anemias?

A
  • hemolytic
  • aplastic anemia
    -hypersplenism
    -acute bleeding
    -anemia of CD- renal failure
    -hemodilution
    -uremia
    -marrow -replacement/fibrosis
    sickle cell anemia
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6
Q

macrocytic anemias?

A

B12 deficiency
Folate deficiency
alcoholic liver disease
MDS

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7
Q

MCHC

A

mean cell hgb. concentration

= : average hemoglobin concentration in a volume of red cells in grams/dL; surrogate measure of hemoglobin concentration within an average sized red cell.

Reference Range = 33 - 37 gm/dL

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8
Q

normochromic normocytic anemia?

A

think hemolytic anemia

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9
Q

retics?

A

Immature erythrocytes contain remnant endoplasmic reticulum & ribosomal RNA (Rough ER) that forms a reticulum (net) within RBC cytoplasm

**This remnant Ribosomal RNA reticulum stains blue with Methylene Blue (seen as blue speckles)

Retics circulate 2-3 days before all ribosomal structures are extruded - they are present normally in 2% of population

  • provide a measure of the rate of production and release of red cells by the marrow into the peripheral blood

adults: .5-1.5%
kids: 3-7% retics

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10
Q

reticulocytosis

A

release of retics from marrow 3-4 days after an acute episode of hemorrhage

(reticulocyte count) should peak in 6-10 days

causes:
Acute blood loss or hemorrhage

Acute hemolysis

Hemolytic anemia

Response to therapy (Fe or other
nutritional correction of deficiency)

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11
Q

iron deficiency anemia vs. anemia of CD?

A

IDA:

  • ferritin is low
  • TIBC is high
  • serum iron - low
  • hepcidin low

ACD:

  • ferritin is high
  • TIBC is low
  • serum iron is low
  • hepcidin high
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12
Q

hemolytic anemia

A 
retics: high
coombs test: positive
haptoglobin: low
bilirubin: elevated (conj and unconj.)
RDW: high 
peripheral smear: fragmented RBCs, spherocytes,
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13
Q

differentiating b/t cells

A 
neutrophils = 3-5 lobes
monocytes = kidney lobes
lymphocytes: no lobes, just a circle
eosinophils: 2 lobes
basophils: just dots
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14
Q

normal number of RBCs?

A

4-6 x 106/μL

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15
Q

anisocytosis

A

variation in the SIZE of cells that are normally uniform, especially such a variation in red blood cells.

ex: Fe defic, sideroblastic anemia, MDS, B12/folate defic.

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16
Q

hypersegmented neutrophils?

A

B12 defic, folate defic.

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17
Q

Poikilocytosis

A

variations in RBC SHAPE

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18
Q

macroovalocytes

A

oval cells that are large - seen in megaloblastic anemia

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19
Q

schistocytes

A

fragmented erythrocytes

seen in TTP, DIC, HUS, defective heart valves, hemolytic anemias

20
Q

acanthocyte

A

“burr cell”

RBC w/ irregularly spaced projections = liver disorders

21
Q

Codocyte

A

“target cell” - seen in sickle cell and thalassemias

22
Q

dacrocyte

A

tear drop cell- seen in myeloproliferative disorders, myelofibrosis, pernicious anemia and thalassemias

23
Q

stomatocyte

A

folded RBC that mimcs lips/mouth/slit like appearance

seen in hemolytic anemias

24
Q

2 classic poikilocytes of SSD?

A

sickle cells, target cells

25
Q

hypochromic?

A

think thalassemia, IDA, sideroblastic anemia

26
Q

decreased central pallor? more red?

A

hereditary spherocytosis

AI hemolytic anemia

27
Q

rouleax

A

stack of coins - seen in MM

  • due to elevated plasma fibrinogen/globulins
28
Q

clumping of RBC/s?

A

due to cold agglutinins

29
Q

pyknotic ?

A

dense nucleus seen in RBCs - these are immature RBC progenitors not normally seen in blood

indicates “stressed” bone marrow unable to meet increased red cell requirements. They are seen in patients undergoing hemolytic crises.

30
Q

what do you think of if see retics and nucleated RBCs?

A

Indicative of hemolytic process, stress, hypoxemia, or myelofibrosis- Except in newborns

31
Q

basophilic stippling

A

“inclusion bodies”

round, dark-blue granules in reticulocytes on smears stained with supra vital stains (brilliant cresyl blue).

granules are precipitated ribosomes and mitochondria. Classic finding in lead poisoning.

32
Q

howell-jolly bodies

A

“inclusion bodies”

They are nuclear fragments of condensed DNA, 1-2 µm diameter, normally removed by the spleen. Seen in severe hemolytic anemias and in post-splenectomy patients (below).

33
Q

normal WBC range?

A

4.0-10.9 x 103/ μL

34
Q

neutrophils range?

A

50-60%

Elevated in bacterial infections, stress, corticosteroid therapy (see demargination)

Immature forms
often present with
elevated count

35
Q

lymphocytes range?

A

30-40% of circulating WBCs

Elevated in viral infections (Epstein-Barr, etc.)

36
Q

smudge cells?

A

Fragile lymphocytes (smudge or basket cells) are common in chronic lymphocytic leukemia (CLL)

37
Q

atypical lymphocytes?

A

mono

38
Q

eosinophils/basophils?

A

Eosinophils - < 5%
Elevated in parasitic infections, allergies

Basophils - < 1%
Elevated in chronic
myelogenous leukemia (CML)

39
Q

left shift?

A

: increase in immature forms in peripheral blood due to increased production:
Infections, myeloid cancers

see predominance of band cells (immature) over segmented cells (mature cells)

40
Q

dohle bodies

A

inclusions in neutrophils

seen in sepsis!

Seen in systemic infectious or inflammatory disease

Often accompanied by a left shift, toxic granulation and cytoplasmic vacuoles

41
Q

hypersegmented neutrophils?

A

> 5 lobes

Can be seen in megaloblastic anemias

42
Q

reduced lobulation of mature neutrophils?

A

Pelger-Huet anomaly

Often associated with myelodysplastic syndromes

43
Q

blasts

A

indicate WBC neoplasia (myeloid= leukemia or lymphoid= lymphoma)

44
Q

plasma cells

A

indicate lymphoid neoplasia (e.g., multiple myeloma)

45
Q

normal platelet count?

A

150,000-450,000/μL

46
Q

giant platelets in periphery?

A

Suggest marrow response secondary to increased platelet destruction or consumption

Congenital disorders
Immune destruction
Disseminated intravascular coagulation (DIC)
Hemolytic uremic syndrome (HUS)
Thrombotic thrombocytopenic purpura (TTP)

PCM III Test 2 (6 decks)

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