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Hematologic Disorders > Anemias and Coagulation > Flashcards

Anemias and Coagulation Flashcards

1
Q

Where does the common coagulation cascade begin?

A

Factor X activation

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2
Q

What does PT measure?

A

Extrinsic + common pathway

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3
Q

What does PTT measure?

A

Intrinsic + common pathway

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4
Q

Where does the intrinsic pathway begin?

A

Factor XII

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5
Q

Where does the extrinsic pathway begin?

A

Factor VII activation by tissular factor

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6
Q

Heparin function in coagulation

A

Inhibit Xa

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7
Q

Primary hemostasis disorders are caused by _______ dysfunction

A

Platelet

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8
Q

Secondary hemostasis disorders are caused by ________ dysfunction

A

Coagulation

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9
Q

Primary hemostasis disorders manifestations

A

Mucous membrane bleeding
- Epistaxis
- Bleeding gums
- GI bleeding

Cutaneous:
- Petechiae
- Purpura
- Ecchymoses
- Easy bruising

  • Menorrhagia
  • Prolonged bleeding, but it STOPS
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10
Q

Secondary hemostasis disorders manifestations

A

Deep tissue bleeding
- Hemarthrosis
- Hematomas

Large, palpable ecchymoses
>80% male

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11
Q

Splenomegaly’s effect on platelets

A

Platelet sequestration of 90%

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12
Q

Mechanisms of failure of platelet production

A

Selective megakaryocytic depletion by drug or virus

Bone marrow failure

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13
Q

Mechanisms of increased platelet consumption (6)

A
  • ITP
  • TTP
  • UHS
  • Infections (HIV, protozoa, H.pylori, malaria)
  • Post-transfusion (10 days)
  • Drug-induced (heparin)
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14
Q

Glanzmann’s disease

A

Primary aggregation of platelet failure because of IIb/IIIA deficiency

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15
Q

Bernard-Soulier sx

A

Large platelets without GPIb and defective adhesion

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16
Q

Half-life of platelets

A

7 days

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17
Q

Anti-platelet drugs

A

Aspirin
Clopidogrel
Dipyridamole

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18
Q

Platelet and coagulation disorders that cause microangiopathic hemolytic anemia

A

DIC
TTP

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19
Q

Hemophilia A

A

Factor VIII deficiency
- Joints and soft tissue bleeding
- Painful hemarthroses and muscle hematomas
- Pressure = necrosis
- Pseudotumors

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20
Q

Abnormal test in Hemophilia A

A

PTT
Factor VIII clotting assay

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21
Q

Hemophilia B

A

Factor IX deficiency
Abnormal PTT

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22
Q

Von Willebrand Disease

A
  • Decreased platelet ADHESION
  • Premature VIII destruction
  • Type 1 is partial deficiency, most common
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23
Q

Abnormal tests in Von Willebrand’s disease

A
  • Elevated PTT
  • PFA-100
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24
Q

Vitamin K deficiency affected factors

A

II
VII
IX
X
Proteins C and S

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25
Abnormal tests in vitamin K deficiency
Prolonged PT and PTT
26
Abnormal tests in DIC (4)
- Decreased platelets - Decreased fibrinogen - Increased PT - Increased D-dimers
27
DIC mechanisms
Increased thrombin activity + plasmin = fibrinogen and factor depletion
28
MCV normal values
80-100 fL
29
Hb normal values
13.5 - 17.5 g/dL male 12-16 g/dL female
30
MCH normal values
25.4 - 34.6 pg/cell
31
Reticulocyte count normal value (%)
0.5 - 1.5%
32
Hematocrit normal values
41 - 53% males 36 - 46% females
33
Iron deficiency anemia iron values
Decreased: - Serum iron - Ferritin Increased: - Iron-binding capacity TIBC
34
Normal iron values (serum, ferritin, binding capacity)
Serum iron: 10 - 30 mmol/L Serum ferritin: 40 - 340 mg/L ; 14 - 150 mg/L Iron-binding capacity: 40 - 70 mmol/L
35
Anisocytosis
Size variation
36
Poikilocytosis
Shape variation
37
Iron form absorbed by enterocytes
Fe2+ = ferric
38
Iron form in the bloodstream
Fe3+ = ferrous
39
Platelet normal levels
150,000-450,000
40
ITP effects
IgG remove platelets in 7-10 days or hours Increase in megakaryocytes GPIIb/IIIa or GPIb antibodies Children post-vax or chicken pox or mono infection
41
ITP treatment
Corticosteroids IVIG Immunosuppression Rituximab Splenectomy if <30,000
42
TTP characteristics
- Familial or acquired - Metalloprotease deficiency, breaks vWF multimers Microvascular thrombosis = less platelets, hemolytic anemia, fever, renal, neuro, increase LDH, schistocytosis
43
_____ (PT/PTT) is used as a vigilant for heparin
PTT
44
When is PT abnormal? Options: TTP, hemophilia A, hemophilia B, Von Willebrand disease, vit K deficiency, DIC
- Vit K deficiency - DIC
45
When is PTT abnormal Options: TTP, hemophilia A, hemophilia B, Von Willebrand disease, vit K deficiency, DIC
- Hemophilia A - Hemophilia B - Von Willebrand disease - Vit K deficiency - DIC
46
In which diseases are MACROCYTES seen?
Liver disease Alcoholism Megaloblastic anemia (B12 or folate deficiency)
47
In which diseases are TARGET CELLS seen?
Iron deficiency Thalassemia Liver disease Hemoglobinopathies Splenectomy
48
In which diseases are STOMATOCYTES seen?
“Mouth cells” Liver disease Alcoholism Hemolytic anemias
49
In which diseases are PENCIL CELLS seen?
Iron defficiency
50
In which diseases are ECHINOCYTES seen?
“Burr cells” Liver disease Splenectomy Uremia Pyruvate kinase deficiency
51
In which diseases are SPHEROCYTES seen?
Hereditary Autoimmmune hemolytic anemia Septicemia Blood transfusion reaction
52
In which diseases are RBC FRAGMENTS seen?
DIC Microangiopathy HUS TTP
53
In which diseases are SCHISTOCYTES seen?
Microangiopathic hemolytic anemia Mechanical damage
54
In which diseases are DACROCYTES seen?
Myelofibrosis Thalassemia Splenomegaly
55
In which diseases are SICKLE CELLS seen?
Sickle cell anemia Hypoxia
56
Hepcidin function
Inhibits Fe release from MQ and ECs
57
Iron deficiency anemia clinical
- Glossitis - Angular stomatitis - Koilonychia - Dysphagia - Pica - Irritable children
58
Iron deficiency anemia causes (4)
- Blood loss - Demand increase: infancy and adolescence, pregnancy, lactation, menstruation >80mL - Gluten enteropathy, gastrectomy, atrophic gastritis - Poor diet (rare)
59
How long does it take to replenish iron storage?
At least 6 months Increase 2 g/dl every 3 weeks
60
Anemia of chronic disorders iron labs
Decreased: - Iron - Iron-binding capacity TIBC - Reticulocytes Increased: - Ferritin
61
RBC in anemia of chronic disorders
Normo normo
62
Anemia of chronic disorders pathogenesis
More HEPCIDIN = less release of iron - Ferroportin degradation Or less RBC lifespan NON PROGRESSIVE, relates to disease severity
63
Sideroblastic anemia
Iron granules not randomly distributed, ringed
64
Lead poisoning and anemia
Inhibition of heme and globin synthesis Hypochromatic, hemolytic Ring sideroblasts Increased free protoporphin
65
Anemias classified by size
Micro: - Iron def. - Thalassemia Normo: - Chronic disease - Blood loss - Hemolytic Macro: - Folate or B12 def. - Liver disease
66
Megaloblastic vs non megaloblastic anemia
Megaloblastic: defective DNA synthesis, hypersegmented neutrophils, B12/folate def. Non: liver disease, hemolytic, cytotoxicity, etc.
67
Labs in megaloblastic anemia
Decrease: - Reticulocytes - WBC Increase: - Unconjugated bilirrubin - LDH
68
Why is B12/cobalamine necessary?
It binds to cubilin or amnionless —> endocytosis of IF-B12 at ileum Transcobalamins —> bone marrow Aids in DNA synthesis
69
Megaloblatic anemia clinical findings
Typical anemia symptoms +: - Purpura - Vitiligo - Infertility - Peripheral neuropathy - Gastritis - Depression, psychosis
70
What is pernicious anemia?
Lack of B12 - Gastric atrophy - Decreased IF - Increased gastrin
71
Folate deficiency causes
- Malnutrition: chronic alcoholism - Malabsorption: enteropathy - Increased requirement: pregnancy, hemolytic anemia - Meds: anticonvulsants, barbiturates, sulfonamides, methotrexate, phenytoin, TMP
72
Bone marrow in hemolytic anemia
Hyperplasic
73
Lab findings in hemolytic anemia
Increased: - Reticulocytes - Serum bilirrubin - Urine Urobilinogen - LDH - Cholesterol NO serum haptoglobins - Hemoglobinemia - Hemoglobinuria - Hemosiderinuria - Methamalbuminemia
74
Hereditary causes of hemolytic anemia (5)
- Spherocytosis AD can’t pass through spleen - Elliptocytosis - G6P dehydrogenase def. XL = oxidative stress (asymptomatic, females with malaria resistance) - Glutathione def. = prickle cells, like G6P - Hemoglobin synthesis —> sickle cell anemia (b-globin)
75
Acquired hemolytic anemia (5)
- Autoimmune: keep warm to avoid - Alloimmune - ABO and Rh - Drug: penicillin, rifampicine, methyldopa - Others: fragmentation, march hemoglobinuria, infections, chemical, physical, secondary - Paroxysmal nocturnal hemoglobinura XL = less GPI
76
Hemolytic anemia clinical manifestations (6)
- Typical - Splenomegaly - Dark urine - Ankle ulcers - Aplastic crises - parvovirus - Pigment gallstones
77
Sickle cell anemia crisis (4)
- Vaso-occlusive: infection, acidosis, dehydration = bone infarcts with severe pain hands and feet, lung & spleen - Visceral: blood pooling/sequestration in chest, liver, spleen - Aplastic: parvovirus or folate def. Less reticulocytes - Hemolytic: increase in reticulocytes, painful
78
Sickle cell clinical manifestations are typical for hemolytic anemias + ______ (7)
- Lower leg ulcers = local ischemia - Pulmonary HTA - Tricuspid regurgitation - Retinopathy - Kidney papillary necrosis - Nocturnal enuresis - Osteomyelitis
79
What type of hemoglobin do patients with sickle cell anemia have?
F
80
Sickle cell anemia treatment (7)
- Avoidance - Folic acid - Nutrition, vaccines, penicillin - Crisis: rest, warm, hydration, analgesia - Transfusions - Hydroxycarbamide increases HbF - Stem cell transplant

Hematologic Disorders (6 decks)

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