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Path SJSM > Anemia & thrombo (crash cards) > Flashcards

Anemia & thrombo (crash cards) Flashcards

1
Q

Anemia:

Low iron
Low ferritin
Low RBC #
Low Hb
Low reticulocyte index
High TIBC
Microcytic & hypochromic

A

Iron deficiency anemia

Other symptoms:
- Koilonychia
- Pica
- Fatigue/weakness
- Pallor
- Plummer Vinson synd
(iron def anemia, esophageal webs, dysphagia)

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2
Q

Commonly causes what type of anemia?

  • diet
  • menorrhagia
  • peptic ulcers
  • tape worms
  • colon cancer
  • Pregnancy
  • Breast fed only babies
A

Iron deficiency anemia

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3
Q

Anemia:

Low iron
Low TIBC
High ferritin

A

Anemia of chronic disease

Other signs:
- Increased hepcidin

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4
Q

Anemia:

High RBC #
High basophils, neutrophils, & platelets
Low EPO
Normal SaO2

A

Polycythemia vera

Other signs:
- Hepatosplenomegaly
- Erythromelalgia
- Budd-Chiari syndrome
- Thrombotic episodes
- Aquagenic pruritus

Other lab signs:
- High megakaryocyte count
- Hypercellular bone marrow with fibrosis

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5
Q

Mutated hyperactive Jak2 kinase causes

A

Polycythemia vera

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6
Q

Anemia:

High EPO
High RBC #
High RBC mass
Normal plasma vol
Low SaO2

A

Secondary appropriate Polycythemia

Causes:
- High altitude dwellers
- Right-Left shunts (cardiac malformations or ventilation defects)
- Smoking

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7
Q

Anemia:

High EPO
High RBC #
High RBC mass
Normal SaO2
Normal plasma vol

A

Secondary inappropriate Polycythemia

Causes:
Paraneoplastic EPO production from cancers (renal, liver, cerebellar)

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8
Q

Anemia:

Low Hb (below 10)
Low EPO
Normocytic Normochromic

A

Anemia of chronic renal failure

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9
Q

Anemia:

High RBC #
a-globin deletion
Microcytic

A

Alpha thalassemia

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10
Q

Anemia cells:

Spherocytes

A

Hereditary spherocytosis &
Immune hemolytic anemia

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11
Q

Anemia cells:

Macro-ovalocytes & hypersegmented PMN;s

A

Megaloblastic anemias (B12, Folate, & Orotic aciduria)

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12
Q

Anemia cells:

Target cells

A

HbC disease
&
Thalassemias

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13
Q

Anemia cells:

Sickled cells

A

HbSC disease
&
Sickle cell disease

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14
Q

Anemia cells:

Iron granules

A

Sideroblastic anemia
&
Lead poisoning

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15
Q

Anemia cells:

Howell-Jolly bodies

A

Sickle cell disease

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16
Q

Anemia cells:

Basophilic stippling

A

Sideroblastic anemia
&
Thalassemia

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17
Q

Anemia cells:

Heinz bodies
Bite cells
Blister cells

A

G6PD deficiency anemia

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18
Q

Alpha thalassemia’s:

Minima

A

asymptomatic

1 a-globin deletion

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19
Q

Alpha thalassemia’s:

Minor

A

2 deleted a-globin’s
Cis (Asians)
Trans (Afro amer)

mild microcytic & hypochromic anemia

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20
Q

Alpha thalassemia’s:

Major

A

3 deletions of a-globin’s

Excess B-globin causes mod-severe microcytic hypochromic anemia

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21
Q

Alpha thalassemia’s:

Hydrops fetalis (Barts disease)

A

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)

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22
Q

Anemias:

Microcytic
Hypochromic
High HbF
High HbA2

A

Beta Thalassemia

Common in AA & Mediterranean people

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23
Q

Beta Thalassemia:

  • Point mutation in splicing of intro & Promoter region
  • Low B-globin production
  • High HbA2
A

B-thalassemia minor

Heterozygote:
Mild microcytic hypochromic anemia

24
Q

Beta Thalassemia:

  • Point mutation in splicing of exon & Chain terminator
  • High HbF
  • High HbA2
  • Target cells
A

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)
25
Q

Anemia:

High iron
High ferritin
Low/Normal TIBC
Microcytic hypochromic
Basophilic stippling

A

Lead poisoning

Signs:
- Burton lines (on gingivae & metaphysis of long bones)
- Encephalopathy
- Colic
- Sideroblastic anemia

26
Q

Anemia:

High Homocysteine
Normal methylmalonic acid
Low Folate
Macrocytic

A

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)

27
Q

Anemia:

High Homocysteine
High Methylmalonic acid
Neurological symptoms
positive schillings test
macrocytic

A

B12 deficiency megaloblastic anemia

Other signs:
- Hypersegmented PMN’s
- Glossitis
- Neurological symptoms

Causes:
- Pernicious anemia
- Malabsorption
- Veganism (diet)
- Pancreatic insufficiency
- Gastrectomy
- Tape worm

28
Q

Anemia:

Orotic acid in urine
Macrocytic

A

Orotic aciduria

Orotic acid can’t be converted into UMP (UMP synthase def)

Signs:
- Developmental delay
- No hyperammonemia
- Glossitis
- Megaloblastic anemia
- Fait to thrive

29
Q

Anemia:

High MCHC
High LDH
High unconjugated bilirubin
Low mean fluorescence 5 EMA test
High fragility (osmotic fragility test)

A

Hereditary spherocytosis

AUTO DOM, defect in SPECTRIN & ankyrin, band 3, protein 4.2

Other signs:
- Extravascular hemolysis
- Splenomegaly
- Pigmented gallstones
- Aplastic crisis

30
Q

Anemia:

Bite cells
Heinz bodies
Blister cells
Hemolysis

A

G6PD deficiency

X-REC

Other signs:
- Back pain
- Hemoglobinuria (2-3 say post oxidative stress)

Triggers:
- FAVA beans
- Sulfa drugs
- Antimalaria

31
Q

Anemia:

Negative Coombs test
Negative CD55/59 on flow cytometry
Hemolytic anemia

A

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

32
Q

Anemia:

Low Hb
High 2,3 BPG
Burr cells

A

Pyruvate kinase deficiency

AUTO REC, leads to low ATP and rigid RBCs

Other signs:
- Extravascular hemolysis
- Hemolytic anemia of a newborn

33
Q

Anemia:

Low HbA
High HbF
High HbS
Sickled RBCs

A

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

34
Q

Sickle cell disease:

HbSS
Low HbA
High HbS
High EPO

A

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)

35
Q

Anemia:

Hemoglobin crystals in RBC’s
Target cells
High HbC
Low HbA
Extravascular hemolysis

A

HbC disease

A mutation in the 6th codon of B-globin to replace glutamate with lysine causing production of abnormal HbC

36
Q

Anemia:

Low iron
Low TIBC
High ferritin
Normocytic
Normochromic

A

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

37
Q

Anemia:

Low reticulocyte #
High EPO

A

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)

38
Q

Anemias:

Low reticulocyte #
High EPO
Pancytopenia
Fatigue/malaise
Purpura
Mucosal bleeding
Petechiae
Infection

A

Aplastic anemia

39
Q

Anemia:

Normocytic & Normochromic
Spherocytes
Positive Coombs (Agglutinated RBCs)
Formed IgG’s vs RBCs

A

Autoimmune hemolytic anemia with warm Ab IgG

Chronic anemia with extravascular hemolysis that can be triggered by SLE.

Triggers:
- SLE
- a-methyldopa
- B-lactams

40
Q

Anemia:

Normocytic & Normochromic
Spherocytes
Positive Coombs (Agglutinated RBCs)
Formed IgM’s vs RBCs

A

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

41
Q

Coagulation disorders:

Deficient factor VIII (8)
Prolonged PTT
Normal PT

A

Hemophilia A

X REC

Other signs
- Soft tissue hematomas
- Severe Hemarthropathy (blood in knee joint !)
- Easy bruising

42
Q

Coagulation disorders:

Deficient factor IX (9)
Prolonged PTT
Normal PT

A

Hemophilia B

X REC

43
Q

Coagulation disorders:

Deficient factor XI (11)
Prolonged PTT
Normal PT

A

Hemophilia C

AUTO REC

44
Q

Vitamins:

Prolonged PT
Prolonged PTT
Normal bleeding time
Deficient factors II(2), VII(7), IX (9), X (10), proteins C & S

A

Vitamin K deficiency

45
Q

Platelet disorders:

Def GPIb
Prolonged bleeding time
Normal/low platelet #
Abnormal ristocetin test (no agglutination)

A

Bernard-Soulier syndrome

Aka giant platelet disorder

Signs:
-Giant platelets with poor adhesion
- Menometrorrhagia (irreg/long period)
- Mucus membrane bleeding
- Petechia
- Epistaxis
- Gingival hemorrhages
-

46
Q

Platelet disorders:

Deficient GPIIb/IIIa
Normal platelet #
Prolonged bleeding time
No platelet clumping

A

Glanzmann syndrome

Deficient agglutination causing poor platelet plug formation

Signs:
- Petechiae (face)
- Subconjunctival hemorrhages (crying)
- Mucocutaneous & gingival hemorrhages
- Epistaxis
- Post circumcision bleeding

47
Q

Platelet disorders:

Formed antibodies (IgG’s) against GPIIb/IIIa
Low platelet #
Low CBC
Prolonged bleeding time
High Megakaryocytes

A

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

48
Q

Thrombotic microangiopathies:

High platelet adhesion/aggregation
High LDH
High CK
High indirect bilirubin
Normal PT & PTT
Low Platelet #
Low Hb
Low Haptoglobin
Schistocytes

A

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

49
Q

Thrombotic microangiopathies:

Normal PT
Normal PTT
High LDH
High CK
High indirect bilirubin

A

Hemolytic uremic syndrome

Due to E.coli 0157:H7 Shiga toxin infection

Sign:
- Thrombocytopenia
- Microangiopathic hemolytic anemia
- Acute kidney injury
-

50
Q

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)

A

Von Willebrand Disease

AUTO DOM

Intrinsic path coagulation deficiency in vWF causing increase in bleeding time & poor platelet plug

51
Q

Deficient vWF protein/function & factor VIII

A

Type 1 vWF

52
Q

Normal vWF levels with missense mutations causing multimers leads to microangiopathic hemolytic anemia

A

vWF Type 2

53
Q

Mixed Platelet & Coagulation disorders:

Prolonged Bleeding time
High PTT
High PT
Low platelet #
Low fibrinogen
Low factors V & VIII
Schistocytes

A

Disseminated Intravascular Coagulation

Deficient widespread clotting activation leads to a deficiency in clotting factors

54
Q

Hereditary Thrombophilia’s (Hypercoagulable states):

Normal PT
Normal PTT (Decreased PTT with large dose of heparin)
Renal failure

A

Antithrombin deficiency

Acquired from renal failure or nephrotic syndrome

Antithrombin is lost in the urine leading to less inhibition of coagulation factors IIa & Xa

55
Q

Hereditary Thrombophilia’s (Hypercoagulable states):

Mutated factor V in prothrombin gene

A

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

56
Q

Hereditary Thrombophilia’s (Hypercoagulable states):

Deficient protein C & S leads to

A

Hypercoagulability

the body can’t inactivate factors Va or VIIIa causing increased risk of warfarin- induced skin lesions

57
Q

Hereditary Thrombophilia’s (Hypercoagulable states):

High prothrombin
High plasma volume
High venous clot formation

A

Prothrombin G20210A point mutation in the 3’ untranslated region causing an increase in prothrombin production leading to a hypercoagulable state

Path SJSM (26 decks)

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