Anemia & thrombo (crash cards) Flashcards
Anemia:
Low iron
Low ferritin
Low RBC #
Low Hb
Low reticulocyte index
High TIBC
Microcytic & hypochromic
Iron deficiency anemia
Other symptoms:
- Koilonychia
- Pica
- Fatigue/weakness
- Pallor
- Plummer Vinson synd
(iron def anemia, esophageal webs, dysphagia)
Commonly causes what type of anemia?
- diet
- menorrhagia
- peptic ulcers
- tape worms
- colon cancer
- Pregnancy
- Breast fed only babies
Iron deficiency anemia
Anemia:
Low iron
Low TIBC
High ferritin
Anemia of chronic disease
Other signs:
- Increased hepcidin
Anemia:
High RBC #
High basophils, neutrophils, & platelets
Low EPO
Normal SaO2
Polycythemia vera
Other signs:
- Hepatosplenomegaly
- Erythromelalgia
- Budd-Chiari syndrome
- Thrombotic episodes
- Aquagenic pruritus
Other lab signs:
- High megakaryocyte count
- Hypercellular bone marrow with fibrosis
Mutated hyperactive Jak2 kinase causes
Polycythemia vera
Anemia:
High EPO
High RBC #
High RBC mass
Normal plasma vol
Low SaO2
Secondary appropriate Polycythemia
Causes:
- High altitude dwellers
- Right-Left shunts (cardiac malformations or ventilation defects)
- Smoking
Anemia:
High EPO
High RBC #
High RBC mass
Normal SaO2
Normal plasma vol
Secondary inappropriate Polycythemia
Causes:
Paraneoplastic EPO production from cancers (renal, liver, cerebellar)
Anemia:
Low Hb (below 10)
Low EPO
Normocytic Normochromic
Anemia of chronic renal failure
Anemia:
High RBC #
a-globin deletion
Microcytic
Alpha thalassemia
Anemia cells:
Spherocytes
Hereditary spherocytosis &
Immune hemolytic anemia
Anemia cells:
Macro-ovalocytes & hypersegmented PMN;s
Megaloblastic anemias (B12, Folate, & Orotic aciduria)
Anemia cells:
Target cells
HbC disease
&
Thalassemias
Anemia cells:
Sickled cells
HbSC disease
&
Sickle cell disease
Anemia cells:
Iron granules
Sideroblastic anemia
&
Lead poisoning
Anemia cells:
Howell-Jolly bodies
Sickle cell disease
Anemia cells:
Basophilic stippling
Sideroblastic anemia
&
Thalassemia
Anemia cells:
Heinz bodies
Bite cells
Blister cells
G6PD deficiency anemia
Alpha thalassemia’s:
Minima
asymptomatic
1 a-globin deletion
Alpha thalassemia’s:
Minor
2 deleted a-globin’s
Cis (Asians)
Trans (Afro amer)
mild microcytic & hypochromic anemia
Alpha thalassemia’s:
Major
3 deletions of a-globin’s
Excess B-globin causes mod-severe microcytic hypochromic anemia
Alpha thalassemia’s:
Hydrops fetalis (Barts disease)
All a-globin’s are deleted causing y-globin excess (aka HbBart Hb) which has a high affinity for O2 hogging it from tissues.
Severe tissue hypoxia = death (in utero or immediately post birth)
Anemias:
Microcytic
Hypochromic
High HbF
High HbA2
Beta Thalassemia
Common in AA & Mediterranean people
Beta Thalassemia:
- Point mutation in splicing of intro & Promoter region
- Low B-globin production
- High HbA2
B-thalassemia minor
Heterozygote:
Mild microcytic hypochromic anemia
Beta Thalassemia:
- Point mutation in splicing of exon & Chain terminator
- High HbF
- High HbA2
- Target cells
B-Thalassemia Major
Homozygote: No b-globin
- Severe microcytic & hypochromic anemia
- Aniso poikilocytosis (need rec. blood transfusions)
- Crew-cut skull
- Chipmunk face
- Hepatosplenomegaly
- Sequestration crisis (B19 parvovirus)
Anemia:
High iron
High ferritin
Low/Normal TIBC
Microcytic hypochromic
Basophilic stippling
Lead poisoning
Signs:
- Burton lines (on gingivae & metaphysis of long bones)
- Encephalopathy
- Colic
- Sideroblastic anemia
Anemia:
High Homocysteine
Normal methylmalonic acid
Low Folate
Macrocytic
Folate def megaloblastic anemia
Other signs:
- Hypersegmented PMN’s
- Glossitis
- Hemolytic anemia
Causes:
- diet (no leafy greens)
- chronic alcohol abuse
- malabsorption
- Pregnancy
- drugs
(methotrexate, trimethoprim, & phenytoin)
Anemia:
High Homocysteine
High Methylmalonic acid
Neurological symptoms
positive schillings test
macrocytic
B12 deficiency megaloblastic anemia
Other signs:
- Hypersegmented PMN’s
- Glossitis
- Neurological symptoms
Causes:
- Pernicious anemia
- Malabsorption
- Veganism (diet)
- Pancreatic insufficiency
- Gastrectomy
- Tape worm
Anemia:
Orotic acid in urine
Macrocytic
Orotic aciduria
Orotic acid can’t be converted into UMP (UMP synthase def)
Signs:
- Developmental delay
- No hyperammonemia
- Glossitis
- Megaloblastic anemia
- Fait to thrive
Anemia:
High MCHC
High LDH
High unconjugated bilirubin
Low mean fluorescence 5 EMA test
High fragility (osmotic fragility test)
Hereditary spherocytosis
AUTO DOM, defect in SPECTRIN & ankyrin, band 3, protein 4.2
Other signs:
- Extravascular hemolysis
- Splenomegaly
- Pigmented gallstones
- Aplastic crisis
Anemia:
Bite cells
Heinz bodies
Blister cells
Hemolysis
G6PD deficiency
X-REC
Other signs:
- Back pain
- Hemoglobinuria (2-3 say post oxidative stress)
Triggers:
- FAVA beans
- Sulfa drugs
- Antimalaria
Anemia:
Negative Coombs test
Negative CD55/59 on flow cytometry
Hemolytic anemia
Paroxysmal nocturnal hemoglobinuria
Mutated PIGA (increases compliment mediated intravascular hemolysis) by impairing GPI anchor for CD55/59
Other signs:
- Pancytopenia
- Venous thrombosis
- Budd Chiari syndrome
- Hemoglobinuria
Anemia:
Low Hb
High 2,3 BPG
Burr cells
Pyruvate kinase deficiency
AUTO REC, leads to low ATP and rigid RBCs
Other signs:
- Extravascular hemolysis
- Hemolytic anemia of a newborn
Anemia:
Low HbA
High HbF
High HbS
Sickled RBCs
Sickle cell disease
A point mutation to the 6th codon of B-globin gene to replace Glutamate with valine causing Sickling leading to intra/extra-vascular hemolysis
Sickle cell disease:
HbSS
Low HbA
High HbS
High EPO
crew-cut skull
Chipmunk face
Osteomyelitis (salmonella)
Aplastic crisis (B19 parvo)
Sequestration crisis
Autosplenectomy (Howell-jolly bodies)
Hematuria
Avascular necrosis
Vaso-occlusive crisis
- dactylitis
- Priapism
- Acute chest syn (chlamydia & mycoplasma kids & atypical pneumonia adults)
Anemia:
Hemoglobin crystals in RBC’s
Target cells
High HbC
Low HbA
Extravascular hemolysis
HbC disease
A mutation in the 6th codon of B-globin to replace glutamate with lysine causing production of abnormal HbC
Anemia:
Low iron
Low TIBC
High ferritin
Normocytic
Normochromic
Anemia of chronic disease
Inflammatory mediators TNF & IL-6 cause liver to release more hepcidin to “hide” the body’s iron (liver & macrophages) & reduce its absorption so iron chelators (inflammatory orgs or siderophores can’t use it)
Triggers:
- Chronic infection
- Neoplastic disorders
- Chronic kidney disease
- Diseases like SLE or RA
Anemia:
Low reticulocyte #
High EPO
Aplastic anemia
Failed or destroyed hematopoietic stem cells leading to hypocellular bone marrow with fat globules
Causes:
- Fanconi anemia (bone marrow failure)
- Viruses (EBV mono, HIV, Hep A, B, C)
- Idiopathic
- Drugs (Benzene & Chloramphenicol)
Anemias:
Low reticulocyte #
High EPO
Pancytopenia
Fatigue/malaise
Purpura
Mucosal bleeding
Petechiae
Infection
Aplastic anemia
Anemia:
Normocytic & Normochromic
Spherocytes
Positive Coombs (Agglutinated RBCs)
Formed IgG’s vs RBCs
Autoimmune hemolytic anemia with warm Ab IgG
Chronic anemia with extravascular hemolysis that can be triggered by SLE.
Triggers:
- SLE
- a-methyldopa
- B-lactams
Anemia:
Normocytic & Normochromic
Spherocytes
Positive Coombs (Agglutinated RBCs)
Formed IgM’s vs RBCs
Autoimmune hemolytic anemia with warm Ab IgM
Acute hemolytic anemia with compliment fixation
Signs:
- RBC agglutination
- Extravascular hemolysis during cold (toes, hands, ears)
Triggers:
- Post mycoplasma pneumoniae & EBV (mono) infections
Coagulation disorders:
Deficient factor VIII (8)
Prolonged PTT
Normal PT
Hemophilia A
X REC
Other signs
- Soft tissue hematomas
- Severe Hemarthropathy (blood in knee joint !)
- Easy bruising
Coagulation disorders:
Deficient factor IX (9)
Prolonged PTT
Normal PT
Hemophilia B
X REC
Coagulation disorders:
Deficient factor XI (11)
Prolonged PTT
Normal PT
Hemophilia C
AUTO REC
Vitamins:
Prolonged PT
Prolonged PTT
Normal bleeding time
Deficient factors II(2), VII(7), IX (9), X (10), proteins C & S
Vitamin K deficiency
Platelet disorders:
Def GPIb
Prolonged bleeding time
Normal/low platelet #
Abnormal ristocetin test (no agglutination)
Bernard-Soulier syndrome
Aka giant platelet disorder
Signs:
-Giant platelets with poor adhesion
- Menometrorrhagia (irreg/long period)
- Mucus membrane bleeding
- Petechia
- Epistaxis
- Gingival hemorrhages
-
Platelet disorders:
Deficient GPIIb/IIIa
Normal platelet #
Prolonged bleeding time
No platelet clumping
Glanzmann syndrome
Deficient agglutination causing poor platelet plug formation
Signs:
- Petechiae (face)
- Subconjunctival hemorrhages (crying)
- Mucocutaneous & gingival hemorrhages
- Epistaxis
- Post circumcision bleeding
Platelet disorders:
Formed antibodies (IgG’s) against GPIIb/IIIa
Low platelet #
Low CBC
Prolonged bleeding time
High Megakaryocytes
Immune Thrombocytopenia
IgG Antibodies against GPIIb/IIIa cause destruction of platelets in the spleen (splenic macrophages) & can cross the placental if mom is preggos
Signs:
- Purpura
- Ecchymosis
- Petechiae
- Epistaxis
- Menorrhagia
- Gingival bleeding
Thrombotic microangiopathies:
High platelet adhesion/aggregation
High LDH
High CK
High indirect bilirubin
Normal PT & PTT
Low Platelet #
Low Hb
Low Haptoglobin
Schistocytes
Thrombotic Thrombocytopenic Purpura (TTP)
Usually adult women
Deficient ADAMTS13 (vWF metalloprotease) leads to a build up of vWF multimers which cleave RBC’s
Signs:
- Triad
1. Thrombocytopenia
2. Microangiopathic hemolytic anemia
3. Acute kidney injury
- Fever
- Neurological symptoms
- Hemoglobinuria
- Petechiae
- Purpura
- Mucosal bleeding
Thrombotic microangiopathies:
Normal PT
Normal PTT
High LDH
High CK
High indirect bilirubin
Hemolytic uremic syndrome
Due to E.coli 0157:H7 Shiga toxin infection
Sign:
- Thrombocytopenia
- Microangiopathic hemolytic anemia
- Acute kidney injury
-
Mixed Platelet & Coagulation disorders:
Normal platelet #
Normal PT
Prolonged Bleeding time
Prolonged/normal PTT
Low vWF
No aggregation with ristocetin factor (agglutination with added vWF)
Von Willebrand Disease
AUTO DOM
Intrinsic path coagulation deficiency in vWF causing increase in bleeding time & poor platelet plug
Deficient vWF protein/function & factor VIII
Type 1 vWF
Normal vWF levels with missense mutations causing multimers leads to microangiopathic hemolytic anemia
vWF Type 2
Mixed Platelet & Coagulation disorders:
Prolonged Bleeding time
High PTT
High PT
Low platelet #
Low fibrinogen
Low factors V & VIII
Schistocytes
Disseminated Intravascular Coagulation
Deficient widespread clotting activation leads to a deficiency in clotting factors
Hereditary Thrombophilia’s (Hypercoagulable states):
Normal PT
Normal PTT (Decreased PTT with large dose of heparin)
Renal failure
Antithrombin deficiency
Acquired from renal failure or nephrotic syndrome
Antithrombin is lost in the urine leading to less inhibition of coagulation factors IIa & Xa
Hereditary Thrombophilia’s (Hypercoagulable states):
Mutated factor V in prothrombin gene
Factor V Leiden
mutation swaps glutamine with arginine so factor V becomes more resistant to protein C cleavage
Signs:
- DVTs
- Cerebral vein thrombosis
- Recurrent abortions
- Increased prothrombin levels
Hereditary Thrombophilia’s (Hypercoagulable states):
Deficient protein C & S leads to
Hypercoagulability
the body can’t inactivate factors Va or VIIIa causing increased risk of warfarin- induced skin lesions
Hereditary Thrombophilia’s (Hypercoagulable states):
High prothrombin
High plasma volume
High venous clot formation
Prothrombin G20210A point mutation in the 3’ untranslated region causing an increase in prothrombin production leading to a hypercoagulable state
