Anemia/ Heam Flashcards
(163 cards)
1
Q
H&H low
MCV & MCHC Low
Iron Low
A
iron Deficiency
Anemia of Chronic Disease
Renal Disease
2
Q
H&H low
MCV & MCHC low
IRON normal
A
Hemoglobin electrophoresis for thalassemias
3
Q
H&H low
MCV & MHCH Low
IRON High
A
Bone Marrow Examination for sideroblastic anemia
4
Q
H&H low
MCV & MCHC Normal
A
Hz of acute blood loss
Autoimmune hemolytic anemia
Anemia of Chronic Disease
Dyserthropoesis
Anemia of Infection
Aplastic Anemia
Congenital dyserthropoiesis anemia
5
Q
H&H low
MCV High
Low B12
A
Pernicious anemia
Severe malnutrition
GI problem
6
Q
H&H low
MCV High
Low folate
A
Folate Malnutrtion
GI Problem
Liver Disease
7
Q
H&H low
MCV high
B12 and folate normal/high
A
Myleoproliferative dz
Liver Dz
Congenital dyserthropoesis anemia
8
Q
Microcytosis + target cells
A
Thalassemia Minor
9
Q
Severe microcytotic anemia, target cells, schistocytes, nucleated RBCs
A
Thalassemia Major
10
Q
Is thalassemia minor symptomatic or asymptomatic?
A
Asymptomatic
11
Q
How does thalassemia major present
A
Severe anemia w/ Severe microcytic anemia, targets, schistocytes, nucleated RBCs
12
Q
How does Hemoglobin H disease present
A
Moderately severe anemia, with severe microcytic, hypo chronic anemia
13
Q
How does hydrops fetalis present
A
Severe anemia, with severe microcytic hypo chronic anemia
14
Q
Microcytic Hypochromic Serum Iron high Ferretin High Iron Saturation high TIBC Low Transferring Low
A
Thalassemia
15
Q
Microcytic Hypochromic Iron Low Ferritin Low Iron Saturation Low TIBC high Transferrin High
A
Iron Def. Anemia
16
Q
Macrocytic Normochroomic Serum Iron High Ferritin High Iron Sat High TIBC low Transferring low
A
B12 deficiency anemia
17
Q
Hienz bodies correlate with…
A
G6PD deficiency
18
Q
Beta 4 bands in hemoglobin electrophoresis are assoc. with
A
Hemoglobin H disease
19
Q
Gamma 4 bands in hemoglobin electrophoresis is mostly assoc. w/
A
Hydrops Fetalis
20
Q
complicated infectious mono affects what cells most
A
Lymphocytes
21
Q
Where is vWF made
A
Endothelium of vessels
22
Q
What is the aggregate plug made of
A
Platelets
23
Q
What is the 1st stage of platelet plug formation
A
Platelet adhesion to exposed collagen(GP Ia/IIa) and vWF(GPIb-V-IX)
24
Q
What is the 2nd stage of platelet activation and degranulation
A
Pseudopod formation w/ Alpha granules (vWF, fibrinogen) And Dense granules (Ca++, Serotonin, ADP)
25
What is the 3rd stage of platelet plug formation
Platelet aggregation
IIb/IIIa to fibrinogen
26
What effect does Asprin have on platelet function
Aspirin inhibits the cyclo-oxygenase enzyme in platelets leading to the reduced formation of prostaglandin
Prevents aggregation
27
Abnormalities in primary hemostasis result in…
hemorrhage from mucosal surfaces (epistaxis, hematuria), petechial or ecchymotic hemorrhages, and prolonged bleeding after venipuncture or wounds.
28
PFA 100 contains what chemicals
Collagen/Epinephrine
Collagen/ADP
29
If the 1st PFA 100 (Col/Epi) is abnormal then the second test (Col/ADP) corrects, what is the likely problem
aspirin-induced platelet dysfunction is most likely.
30
If both tests of the PFA 100 are abnormal what is the likely Dz
Once anemia and thrombocytopenia have been excluded,
further evaluation to exclude von Willebrand disease and inherited/acquired platelet dysfunction such as renal failure storage pool disease, release defect, Bernard-Soulier disease, and Glanzmann thromboasthenia should be considered.
Long-term aspirin therapy may modestly prolong the Col/ADP.
31
What does the Bleeding time test focus on
BT tests focus on the number of platelets present and their ability to form a plug
32
What is primary hemostasis
Interaction between platelets and walls of injured blood vessels forming a platelet plug that assists in clot formation
33
What is secondary hemostasis
Is the formation of FIBRIN through the intrinsic, extrinsic, and common pathways of the coagulation cascade.
34
Secondary hemostasis defects result in what kind of bleeding
more serious bleeding than with primary hemostasis, including bleeding into cavities (chest, joints) and subcutaneous hematomas.
35
What is the final product of the coagulation cascade
Final product is a fibrin mesh or clot which completely stops bleeding
36
What factors are in the extrinsic pathway
III and VII
37
What factors are in the intrinsic pathway
XII, XI, IX, VIII
38
What factor unites both the intrinsic and extrinsic pathways and is the common pathway
Factor X
39
What factors are in the common pathway
X, V, II, I
40
What is Christmas Factor
Factor IX
41
A deficiency in Factor IX is called what
Deficiency = Hemophilia B (Christmas disease)
42
What is factor VIII is a complex with what other factor
vWF
43
What is a factor VIII deficient known as
Deficiency Factor VIII = Hemophilia A
| (classic hemophilia), most common hereditary coagulation disorder
44
Why is vWF important
vWF is important in platelet adhesion
45
What is Factor X known as
Stuart Prower Factor
| Common pathway
46
What is factor XI known as
Plasma Thromboplastin Antecedent
Antihemophiliac C factor
47
What is factor XII known as
Hageman Factor
48
What is the first factor activated in the intrinsic pathway
Factor 12
49
What activates factor XII
Proenzyme activated by contact with foreign (negatively charged) surfaces:
Collagen (damaged endothelial lining)
Glass
50
What is the only factor deficiency that causes no coagulation problems in vivo
Factor XII
51
What is factor XIII also known as
Fibrin Stablizing Factor
52
What activates factor XIII
Thrombin in the common pathway
53
What
Stabilizes the fibrin clot by crosslinking fibrin monomers
54
What are the vitamin K dependent factors
II, VII, IX, X
55
What are the three stages of secondary hemostasis
Intrinsic/ Extrinsic pathway to Factor X
Prothrmobinas (X-V complex) converts prothrombin (II) into thrombin
Thrombin coverings fibrinogen into fibrin
56
What are D-Dimers
Crossed linked Fibrin Degradation Products
57
Fibrin fragments still cross-linked by Factor XIIIa are referred to as
D-Dimers
58
How are FDPs normally cleared
By the liver and reticuloendothelial system
59
What is AT III
Antithrombin III is synthesized by the liver and binds Thrombin and Factor Xa partially neutralizing their activity (Protease)
60
What is the relationship of AT III and heparin
Heparin released by vascular subendothelial cells enhances ATIII activity
61
Where is heparin naturally produced
Basophils and mast cells
62
Does heparin directly dissolve clots ?
Heparin does not directly dissolve clots but it does stop clot propagation and allows natural fibrinolysis to occur
63
What is protein C
A vitamin K dependent enzyme produced by the liver
Circulates in plasma in an inactive form
In its active form it inactivates factors Va and VIIIa (inhibits both the Common and Extrinsic Coagulation Pathways)
64
What does Protein C inhibit
In its active form it inactivates factors Va and VIIIa (inhibits both the Common and Extrinsic Coagulation Pathways)
65
Protein C requires what cofactors
Protein S
66
A decrease in Protein C or S increases the risk of
ntravascular coagulation
67
What does prothrombin time (PT) asses
Assesses the Extrinsic (and common) Coagulation Pathways
Screens for deficiencies of Factors I, II, V, VII, and X
68
What tube top is PT pulled in
Light blue, citrates plasma
69
What is added to the patients plasma in a PT test
Calcium + tissue thromboplastin (tissue factor) are added to the patient’s plasma and the time necessary for clot formation is measured
70
What test is used to monitor Coumadin/ Warfarin therapy
PT
71
What conditions is Coumadin/warfarin used for
Atrial fibrillation/flutter
Deep vein thrombosis
Heart valve replacement
Medication given orally to patients with certain medical conditions to prevent development of very small “micro” blood clots
72
What does the INR measure
Coumadin therapy
The INR value is a “normalized” PT time test result that provides a workable reference range that all laboratories can report (and clinicians can use!) to monitor patients on Coumadin therapy
73
Increases in the INR correspond to
Increases in the INR corresponds to increased anticoagulation
74
What is a mixing study
Performed on blood plasma to distinguish factor deficiencies from factor inhibitors, such as lupus anticoagulant
75
What does a correction or failure of a mixing study indicate
a correction with mixing indicates factor deficiency; failure to correct indicates an inhibitor.
76
What should be ordered when the aPTT is prolonged and not corrected with mixing studies
Lupu anticoagulant study
77
What is the presence of lupus anticoagulant associated with
Is associated with an INCREASED formation of thrombi in vivo (misnomer)
78
What is a aPTT (activated partial thrmboplastin time)
Used to:
Monitor heparin anticoagulant therapy
Screen for coagulation disorders
Evaluate liver function (synthesis of liver produced coagulation factors)
79
What part of the coagulation cascade does aPTT monitor
The intrinsic and common pathways
80
What is added to the patients blood in a aPTT test
Calcium + phospholipid + a contact activator (e.g. kaolin) are added to the patient’s plasma and the time necessary for clot formation is measured
81
What does a Thrmobin Time test measure
Measures the rate of formation of fibrin and assesses the fibrinogen to fibrin conversion
82
What is added to a PTs blood for a thrombin time test
Calcium + thrombin are added to the patient’s plasma and the time necessary for clot formation is measured
83
What does a Thrombin Time test detect
Detect deficiency of fibrinogen as well as the presence of circulating inhibitors of fibrinogen function:
Fibrin Degradation Products interfere with fibrin monomer polymerization
Circulating natural anticoagulants (e.g. heparin)
84
What does a factor VIII assay detect
von Willebrand’s disease
| Hemophilia A
Classic hemophilia
85
What does a D dimer assay indicate
Indicates active intravascular clot formation is occurring
Indicates active fibrinolysis is also occurring
Used mainly to assess a patient for the presence of:
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Disseminated intravascular coagulation (DIC)
86
Can a D-Dimer rule in a specific clot?
NO
High Negative Predictive Power, i.e. can rule out, but not rule in
87
What causes deficient platelet production
Bone marrow infiltrative processes:
Leukemia, lymphoma
Aplasia:
Aplastic anemia
Drug effect(Chemotherapy)
Leads to a quantitative thrombocytopenia
88
how can hypersplenism affect platelet distribution
When spleen enlarges, more platelets can be sequestered in the spleen
Leads to a quantitative thrombocytopenia
89
What is a primary immune quantitative thrombocytopenia
Idiopathic Thrombocytopenic purpura
Or
Post transfusion purpura
90
What is a secondary immune quantitative thrombocytopenia
Systemic lupus erythematosus
Or
Viral infection(mononucleosis, HIV)
91
What are nonimmune quantitative thrombocytopenia
Hemolytic uremic syndrome
Disseminated intravascular coagulation (DIC)
92
What is Bernard Soulier Syndrome
Congenital Qualitatitve DO of adhesion
giant platelets;
decreased or absent expression of GPIb and or GPIX
93
What is the platelet type vWF Dz
defective platelet adhesion;
| reduced factor VIII levels
MOST COMMON
94
WHat is Glanzmann Thrombasthenia
autosomal recessive disorder; decreased or absent for either GPIIb or GPIIIa
Disorder of Aggregation
95
What condition presents with platelets that look empty or gray
Alpha granule disorder;
lack of alpha granules
AKA Storage pool disorder
96
What is a Dense granule disorders or delta granule deficiency
Congenital Storage pool DO
97
What is a defective TXA2 pathway classified as
Congenital Qualitative DO of secretion
98
What are the acquired platelet defects
Chronic Renal Failure
Myeloproliferative DO
Acute Luekemia
Drugs
- Asprin
- alcohol
- abx
99
How does Chronic renal failure present on PFA and BT
Prolonged
Decrease aggregation with collagen
100
Describe hemophilia A
(Classic Hemophilia):
X-linked recessive disorder in which there is a deficiency of Factor VIII
101
Describe Hemophilia B
(Christmas Disease):
X-linked recessive disorder in which there is a deficiency of Factor IX
102
If you suspect your patient has hemophilia (patient history + prolonged aPTT), order a…
Factor VIII assay
103
What is the first factor affected in a Vitamin K def.
Factor VII is the first coagulation factor to become deficient (the only vitamin K dependent factor in the Extrinsic pathway and the deficiency causes a prolonged PT only)
104
What are the earliest indications of impaired hemostasis
The earliest indicators of impaired hemostasis are prolonged PT and aPTT tests (the vitamin K dependent factors are affected first)
105
What disease is Characterized by hyper-stimulation of all coagulation and fibrinolytic activity simultaneously
And The condition is diffuse (affects the entire body)
DIC
106
What is the progression of DIC
Diffuse small thrombi are formed followed by blood ooze from many sites (i.e., surgical sites, IV sites, venipuncture sites)
Patients then develop petechiae indicating the presence of microthrombi
The patient then develops organ failure
107
What is often used to monitor Therapy in DIC
D-dimer assay
108
```
How does DIC present with
PT
APTT
BT
Platelet count
```
PT- prolonged
aPTT- Prolonger
BT-Prolonged
Platelets- decreased
109
```
How does Vit. K present in
PT
APTT
BT/PHA100
Platelets
```
PT- Prolonged
aPTT- normal to mild prolonged
PFA100- unaffected
Platelets- unaffected
110
```
How does vWF DZ present with
PT
APTT
PFA 100
Platelets
```
PT-unaffected
aPTT- pROlonged
PFA100- prolonged
Platelets -unaffected
111
```
How does hemophilia present on
PT
APTT
PFA100
Platelets
```
Pt-unaffected
APTT- prolonged
PFA100-unaffected
Platelets unaffected
112
```
How does thrombocytopenia present on
PT
APTT
PFA100
Platelets
```
PT-unaffected
APTT- unaffected
PFA100- prolonged
Platelets- decreased
113
```
How does early liver failure present on
PT
APTT
PFA100
platelets
```
PT- prolonged
APTT- unaffected
PFA100- unaffected
Platelets- unaffected
114
```
How does late liver failure present on
PT
APTT
PFA100
Platelet count
```
All are prolonged with platelet count decreased
115
IF only the PT is abnormal then what could be the cause
Factor VII or III (DEAD) def.
Warfarin ingestion
Mild Vit K def.
Or lupus anticoagulant
116
What is the difference between Glazmanns and Bernads
Platelet count is normal in Glanzmanns
Both have normal PT and APTT
Both have prolonged PFA100
117
Restore or maintain oxygen-carrying capacity or hemoglobin. Best achieved by..
utilizing packed red blood cells (pRBCs)
118
How are ABO blood group antigens formed
ABO blood group antigens are formed when transferases add specific sugars to the H substance on the membrane.
119
What are the 9 ABO blood groups of clinical significance
```
ABO,
Rhesus,
Kell,
Kidd,
Duffy,
MNS,
P,
Lewis,
and Lutheran
```
120
What is the Antihuman globulin test
Anti-human Globulin (AHG or Coombs reagent) is used to detect the presence of antibodies coating the surface of RBCs.
Red cell coating may occur in vivo or in vitro
121
What is the DAT
The DAT is an important diagnostic serologic technique used for the detection of antibody binding to RBC membranes in vivo.
122
What are the clinical indications for a DAT
Clinical indications include
Testing cord cells for Hemolytic Disease of Fetal Newborn(HDFN)
Hemolytic Transfusion Reactions (HTR)
Autoimmune Hemolytic Anemia (AIHA) studies
123
What is a IAT
The IAT is an important diagnostic serologic technique used for the detection of antibody binding to RBC membranes in vitro.
124
What are the uses of a IAT
Laboratory indications include
Antibody detection
(crossmatch and antibody screening)
Antibody identification
Antibody titration
RBC phenotyping
125
How long is a pre transfusion sample good for
72 hours
126
What is the most important step in administration of blood products
Correctly identifying the donor unit and recipient is the most important step in the safe administration of blood products.
127
What is the specimen of choice for pre transfusion testing
Specimen of choice: EDTA-anticoagulated blood specimen (lavender/pink top tube).
128
How is an antibody screen preformed
Antibody Screen: the patient’s serum is screened for unexpected antibodies using IAT.
129
Explain the cross-match procedure
Crossmatch Procedure: before blood can be administered, the recipient’s SERUM must be tested against donor RBCs.
130
What temp must all pre transfusion samples be stored at
1-6 degrees C
For at least 7 days
along with at least one representative segment from each of the donor units crossmatched on the recipient.
131
Describe a major cross match
The antiglobulin (AHG) crossmatch:
Major crossmatch
Performed when antibody is present
(Positive antibody screen).
3 steps:
-It starts with an immediate spin crossmatch followed by an incubation of the patient's serum at 37º C and an indirect antiglobulin test.
-Crossmatch is incompatible if agglutination is observed during any of the three steps of testing.
132
When should a type and screen be performed
For surgical cases where blood usage is infrequent, yet possible, the patient should be should be tested using a Type and Screen procedure.
ABO, Rh testing, and a screen for unexpected antibodies are performed on the patient’s blood.
133
When is a type and cross performed
For surgical cases where blood usage is probable or whenever transfusion of blood is required, a Type and Cross is ordered.
ABO, Rh testing, and a screen for unexpected antibodies are performed on the patient’s blood.
The number of packed Red Blood Cell (pRBCs) units requested are then crossmatched with the patient’s serum
134
Can Rh positive receive Rh negative blood ?
Yes
135
Should Rh negative patients received Rh positive blood
No, should be avoided
136
Plasma from blood type AB can be given to who
Plasma from blood type AB individuals may be given to patients of any type.
137
What can lead to rare RhD alloimmunization in the recipient
Although platelets do not express Rh antigens, they contain small numbers of intact red blood cells or fragments, which can lead to rare RhD alloimmunization in the recipient.
138
Which coag factors are Labile
Factors V and VIII are labile and are significantly decreased after 7 days (or sooner).
139
Washed RBCs must be given within
24 hrs
140
What can reduce Graft vs Host Dz
Lueke reduced RBCs
| And Gamma Irradiated Blood components
141
What is the shelf life of Gamma irradiated products
28 days
142
When should CMV negative RBCs be used
Indications - CMV negative blood products are indicated for patients in the following categories, regardless of CMV status of the mother:
Premature infants.
Infants under four weeks of age.
Patients requiring intrauterine transfusion.
CMV negative blood products are indicated for CMV negative patients in the following categories:
Bone marrow or organ transplant recipients
(if the marrow or the organ donor is also CMV negative).
Potential candidates for transplant.
AIDS or HIV infected patients.
Patients who have congenital immune deficiency.
Patients undergoing splenectomy.
Pregnant women.
143
When should FFP be transfused
Indications - FFP is indicated for patients with documented coagulation factor deficiencies who are actively bleeding or who are about to undergo an invasive procedure.
FFP is also indicated in treatment of Thrombotic Thrombocytopenic Purpura (TTP), usually in conjunction with plasma exchange.
The FFP specifically replaces a missing enzyme found in these patients.
Both FFP and FP24 are thawed at 37°C and must be transfused within 24 hours.
144
What is the indication of cryoprecipitaite
Indication – Cryo is used mainly as a source of fibrinogen. CRYO is indicated for bleeding or imminent invasive procedures for patients with significant hypofibrinogenemia (<100 mg/dL).
To limit exposure to transfusion related pathogens commercial clotting factor concentrates made with viral inactivation methods are preferred over CRYO for Hemophilia A and von Willebrand treatment.
145
What factors are present in CRYO
VIII, XIII, vWF
146
What is the indication for platelets
Indications - Platelet transfusions are indicated for patients with bleeding due to either thrombocytopenia, platelet dysfunction or some combination of the two conditions.
147
What are the admin time frames for Rhogam
Used for the prevention of Rh HDN:
Antepartum dose given at 28 weeks.
Postpartum dose given within 72 hours of delivery.
Postpartum sample from mother is obtained/screened for feto-maternal hemorrhage.
148
In HDN what is the DAT of cord blood
Cord blood will have a positive DAT
149
What is the Kleihauer-Betke test
Fetal Hemoglobin (Hb F) is evaluated in the mother’s blood to estimate volume of fetal hemorrhage into maternal circulation.
150
When should septic testing be ordered
Should be done if suggested by clinical data, for example:
a) Temperature greater than 102 F
b) Temperature increase greater than a specified amount (2 or 3 degrees F)
151
What is the most common cause of Acute Hemopytic Transfusion Reactions
Clerical errors (both in transfusion service and at bedside) are most common cause
152
What are schistocytes
Intravascular hemolysis
153
What are spherocytes
Extra vascular hemolysis
154
Febrile non hem transfusion reaction is most common with
Platelet transfusions
155
How doe Transfusion related sepsis present
Signs/symptoms: Rapid onset high fever (often greater than 4oF/2C), Rigors (true shaking chills with rigidity), Abdominal cramping, nausea/vomiting, Hypotension/shock, DIC
Lab findings:
1) Discolored RBC product (+/-); contaminated RBCs may turn dark or purple
2) May have hemoglobinemia/uria (non-immune)
3) DAT negative
4) Gram stain positive in only half to 2/3 of proven cases!
- Remember to also culture associated IV fluids and consider that an indwelling IV catheter may be a source of contamination
5) Culture is proof positive (when same organism is cultured from both unit and recipient)
156
How does graft v host present
Patients present with:
a) Fever 7-10 days post-transfusion
b) Face/trunk rash that spreads to extremities
c) Mucositis, nausea/vomiting, watery diarrhea
d) Pancytopenia and subsequent marrow aplasia
- This is what leads to the fatal consequences, with most patients dying from overwhelming infections
157
What is the common culprit in Post transfusion purpura
Anti-HPA-1A
158
What is a major risk in chronically infused pts
Iron overload
159
What is the culprit in the pathology of TRALI
Neutrophils
160
What kind of blood collection can be used to treat Thrombotic Thrombocytopenic Purpura
Hemapheresis
161
What is hereditary elliptocytosis
Mutations in red cell membrane proteins spectrin, protein 4.1, or glycophorin C
Lab findings:
```
Very mild anemia that is compensated
Slight reticulocytosis
MCV: normal, slighty elevated
MCHC: normal
Decreased haptoglobin
Increase osmotic fragility
```
162
What is hereditary stomatocytosis
Marked increase in the passive permeability of sodium into the cell and potassium out of the cell. Defect greater for sodium permeability resulting in water influx and formation of hydroctyes
LAb findings:
```
Mild anemia
MCV: Elevated
MCHC: Decreased
Decreased haptoglobin
Increased osmotic fragility
```
163
What characterizes sickle cell
Characterized by production of HbS
Beta chain abnormality; Single amino acid substitution of valine for glutamic acid in the sixth position from the NH2-terminal end of the β chain
