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USMLE Pathoma > Anemia & thrombo (crash cards) > Flashcards

Anemia & thrombo (crash cards) Flashcards

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USMLE® Step 1 flashcards
1
Q

Iron deficiency anemia

Pathology:

Symptoms/Signs:

A

Path:
Microcytic & hypochromic anemia with:
Low iron
Low ferritin
High TIBC

Signs:
- 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 of chronic disease

Pathology:

Symptoms/Signs:

A

Anemia due to a chronic condition with:
Low iron
Low TIBC
High ferritin

Signs:
- Increased hepcidin

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4
Q

Polycythemia vera

Pathology:

Symptoms/Signs:

A

A JAK 2 kinase mutation resulting in More RBC’s but low EPO & normal SaO2 resulting in hypocellular and fibrotic bone marrow

Signs:
- Hepatosplenomegaly
- Erythromelalgia
- Budd-Chiari syndrome
- Thrombotic episodes
- Aquagenic pruritus

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5
Q

Secondary appropriate Polycythemia

Pathology/Causes:

A

Path:
More RBC’s with high EPO but Low SaO2 seen in high altitude dwellers, Smokers, or people with right to left shunts

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6
Q

Secondary inappropriate Polycythemia

Pathology/Causes:

A

Paraneoplastic EPO production from cancers (renal, liver, cerebellar) that results in high EPO, RBC’s but normal SaO2

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7
Q

Anemia of chronic renal failure

A

Path:
Normocytic & normochromic anemia from renal failure that causes low Hb (<10) & low EPO

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8
Q

Alpha thalassemia

Pathology:

A

Path:
a-globin deletion results in microcytic anemia with high levels of RBC’s

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9
Q

Anemia cells:

Spherocytes

A

Hereditary spherocytosis &
Immune hemolytic anemia

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10
Q

Anemia cells:

Macro-ovalocytes & hypersegmented PMN;s

A

Megaloblastic anemias (B12, Folate, & Orotic aciduria)

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11
Q

Anemia cells:

Target cells

A

HbC disease
&
Thalassemias

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12
Q

Anemia cells:

Sickled cells

A

HbSC disease
&
Sickle cell disease

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13
Q

Anemia cells:

Iron granules

A

Sideroblastic anemia
&
Lead poisoning

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14
Q

Anemia cells:

Howell-Jolly bodies

A

Sickle cell disease

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15
Q

Anemia cells:

Basophilic stippling

A

Sideroblastic anemia
&
Thalassemia

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16
Q

Anemia cells:

Heinz bodies
Bite cells
Blister cells

A

G6PD deficiency anemia

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17
Q

Alpha thalassemia’s:

Minima

A

asymptomatic

1 a-globin deletion

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18
Q

Alpha thalassemia’s:

Minor

A

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

mild microcytic & hypochromic anemia

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19
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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20
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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21
Q

Anemias:

Microcytic
Hypochromic
High HbF
High HbA2

A

Beta Thalassemia

Common in AA & Mediterranean people

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22
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

23
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)
24
Q

Lead poisoning

Pathology:

Symptoms/Sign:

A

Lead poisoning results in microcytic-hypochromic & sideroblastic anemia with high levels iron, ferritin but with low or normal TIBC

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

25
Q

Folate def megaloblastic anemia

Pathology:

Symptoms:

Causes:

A

Folate deficiency results in high homocysteine levels resulting in folate levels (normal methylmalonic acid)

Signs:
- Hyper segmented PMN’s
- Glossitis
- Hemolytic anemia

Causes:
- diet (no leafy greens)
- chronic alcohol abuse
- malabsorption
- Pregnancy
- drugs
(methotrexate, trimethoprim, & phenytoin)

26
Q

B12 deficiency megaloblastic anemia

Pathology:

Symptoms/Signs:

Causes:

A

B12 deficiency causes megaloblastic anemia with high homocysteine and methylmalonic acid levels

Signs:
- Hyper segmented PMN’s
- Glossitis
- Neurological symptoms
- +ve Schillings test

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

27
Q

Orotic aciduria

Pathology:

Symptoms/Signs:

A

Path:
UMP synthase deficiency that results in Orotic acid in the urine because it can’t be converted to UMP

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

28
Q

Anemia:
Hereditary spherocytosis

Pathology:
Signs:

“rbc’s look like PEAS”

A

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

Signs:
- Extravascular hemolysis
- Splenomegaly
- Pigmented gallstones
- Aplastic crisis

Optional
High MCHC
High LDH
High unconjugated bilirubin

29
Q

G6PD deficiency

Pathology:

Symptoms/Signs:

Causes:

A

Path:
X-REC condition that results in autoimmune hemolytic anemia

Signs:
- Back pain
- Hemoglobinuria (2-3 say post oxidative stress)
- Heinze bodies
- Bite cells
- Blister cells

Triggers:
- FAVA beans
- Sulfa drugs
- Antimalaria

30
Q

Paroxysmal nocturnal hemoglobinuria

Pathology:

Symptoms/Signs:

A

Path:
Mutated PIGA (increases compliment mediated intravascular hemolysis) causes impaired GPI anchoring for CD55/59 resulting in hemolytic anemia

Signs:
- Pancytopenia
- Venous thrombosis
- Budd Chiari syndrome
- Hemoglobinuria
- Negative Coombs test
- Negative CD55/59 on flow cytometry

31
Q

Pyruvate kinase deficiency

Pathology:

Symptoms/Signs:

A

Path:
Pyruvate kinase deficiency causes low ATP levels and rigid RBCs resulting in extravascular hemolysis & hemolytic anemia of a newborn

Signs:
Low Hb
High 2,3 BPG
Burr cells

32
Q

Sickle cell disease

Pathology:

Symptoms/Signs:

A

Path:
A point mutation to the 6th codon of B-globin gene to replace Glutamate with valine causing Sickling leading to intra/extra-vascular hemolysis

Signs:
Low HbA
High HbF
High HbS
Sickled RBCs

33
Q

HbC disease

Pathology:

Symptoms/Signs:

A

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

Signs:
Hemoglobin crystals in RBC’s
Target cells
High HbC
Low HbA

34
Q

Anemia of chronic disease

Pathology:

Symptoms/Signs:

Causes:

A

Path”
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)

Signs:
Low iron
Low TIBC
High ferritin
Normocytic
Normochromic

Triggers:
- Chronic infection
- Neoplastic disorders
- Chronic kidney disease
- Diseases like SLE or RA

35
Q

Aplastic anemia

Pathology:

Symptoms/Signs:

Causes:

A

Path:
Failed or destroyed hematopoietic stem cells leading to hypocellular bone marrow with fat globules

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

Causes:
- Fanconi anemia
- Viruses
(EBV mono, HIV, Hep A, B, C)
-Benzene & Chloramphenicol

36
Q

Autoimmune hemolytic anemia with warm Ab IgG

Pathology:

Symptoms/Signs:

Causes:

A

Path:
Chronic Normocytic/Normochromic anemia with extravascular hemolysis that can be triggered by SLE.

Signs:
Spherocytes
Positive Coombs (Agglutinated RBCs)
Formed IgG’s vs RBCs

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

37
Q

Autoimmune hemolytic anemia with warm Ab IgM

Pathology:

Symptoms/Signs:

Causes:

A

Path:
Acute Normocytic & Normochromic hemolytic anemia with compliment fixation

Signs:
- RBC agglutination
- Extravascular hemolysis during cold (toes, hands, ears)
- Spherocytes
- Positive Coombs (Agglutinated RBCs)
- Formed IgM’s vs RBCs

Triggers:
- Post mycoplasma pneumoniae & EBV (mono) infections

38
Q

Coagulation disorders:

Deficient factor VIII (8)
Prolonged PTT
Normal PT

“HESmophilia A”

A

Hemophilia A

X REC

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

39
Q

Coagulation disorders:

Deficient factor IX (9)
Prolonged PTT
Normal PT

A

Hemophilia B

X REC

40
Q

Coagulation disorders:

Deficient factor XI (11)
Prolonged PTT
Normal PT

A

Hemophilia C

AUTO REC

41
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

42
Q

Bernard-Soulier syndrome

Pathology:

Symptoms/Signs:

A

Path:
Aka giant platelet disorder,
Def GPIb that results in giant platelets with poor adhesion & prolonging bleeding time

Signs:
- Menometrorrhagia
- Mucus membrane bleeding
- Petechia
- Epistaxis
- Gingival hemorrhages
- Normal/low platelet #
- Abnormal ristocetin test (no agglutination)

43
Q

Glanzmann syndrome

Pathology:

Symptoms/Signs:

A

Glanzmann syndrome

Deficient agglutination GPIIb/IIIa causing poor platelet plug formation (regardless of normal levels) this prolongs bleeding time

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

44
Q

Immune Thrombocytopenia

Pathology:

Symptoms/Signs:

“igG’s vs PlatElEts Makes Purpura”

A

Path:
IgG Antibodies against GPIIb/IIIa cause destruction of platelets in the spleen (splenic macrophages) & can cross the placental if mom is preggos resulting in low platelet & CBC counts & prolonging bleed time

Signs:
- Purpura
- Ecchymosis
- Petechiae
- Epistaxis
- Menorrhagia
- Gingival bleeding

45
Q

Thrombotic Thrombocytopenic Purpura (TTP)

Pathology:

Symptoms/Signs:

“Adam is MeATy & TPP”

A

PATH:
Usually adult women

Deficient ADAMTS13 (vWF metalloprotease) leads to a build up of vWF multimers which cleave RBC’s resulting in more platelet adhesion/aggregation (despite low platelet counts)

Signs:
- Triad
1. Thrombocytopenia
2. Microangiopathic hemolytic anemia
3. Acute kidney injury
- Fever
- Neurological symptoms
- Hemoglobinuria
- Petechiae
- Purpura
- Mucosal bleeding
4. Low Haptoglobin & Schistocytes

46
Q

Hemolytic uremic syndrome

Pathology:

Symptoms/Signs:

A

Path:
Due to E.coli 0157:H7 Shiga toxin infection causing microangiopathic hemolytic anemia

Sign:
- Thrombocytopenia
- Acute kidney injury
- Normal PT & PTT

47
Q

Von Willebrand Disease

Pathology:

Symptoms/Signs:

A

PATH:
AUTO DOM
Intrinsic path coagulation deficiency in vWF causing increase in bleeding time & poor platelet plug

Signs:
Low vWF
No aggregation with ristocetin factor (agglutination with added vWF)
Normal platelet levels but prolonged bleeding time

48
Q

Deficient vWF protein/function & factor VIII

A

Type 1 vWF

49
Q

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

A

vWF Type 2

50
Q

Disseminated Intravascular Coagulation

Pathology:

Symptoms/Signs:

A

Path:
Deficient widespread clotting activation leads to a deficiency in clotting factors

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

51
Q

Antithrombin deficiency

Pathology:

Symptoms/Signs:

A

Path:
Acquired from renal failure or nephrotic syndrome as the Antithrombin is lost in the urine leading to less inhibition of coagulation factors IIa & Xa

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

52
Q

Factor V Leiden

Pathology:

Symptoms/Signs:

A

Path:
Mutated factor V in prothrombin gene that swaps glutamine with arginine so factor V becomes more resistant to protein C cleavage

Signs:
- DVTs
- Cerebral vein thrombosis
- Recurrent abortions
- Increased prothrombin levels

53
Q

Prothrombin gene mutation (or Factor II mutation)

Pathology:

Symptoms/Signs:

A

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

Signs:
High prothrombin
High plasma volume
High venous clot formation

USMLE Pathoma (20 decks)

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