Anemias caused by Bld loss + RBC lysis (Pt2)

Question 1

Describe Acute Blood loss

Answer 1

Acute: pt rbc’s may not be indicative of loss, plasma is lost at same rate as blood/no time to respond by retaining fluid

Question 2

Describe Chronic Blood loss

Answer 2

has decreased HCT/rbc counts with fluid retention

Question 3

Describe Relative Anemia
How does pt appear?
Total ability?
What is decreased?

Causes:

Answer 3

pt appears anemic with an increased plasma
total RBC mass/O2 carrying ability uneffected
HCT/HGB decreased

Causes: pregnancy/hyperproteinemia/Massive IV/infusions

Question 4

Indicators of RBC destruction? (hemolysis)

Answer 4

Increased bilirubin/LDH
Increased Iron/Hemosiderin (and urine)
Dec haptoglobin
schistocytes

Question 5

Indicators of RBC production?

Answer 5

erythrohyperplasia
increased RPI

Question 6

COOMBS DAT test
increased destruction/production
what is a Positive

What is a negative?

Answer 6

+ —> Ab mediated, immune hemolytic anemia

• —> peripheral blood smear

Question 7

Intrinsic abnormalities causing rbc destruction

Answer 7

non-immune

Question 8

What are the 4 groups of rbc membrane defects

Answer 8

Hereditary Spherocytosis (HS)
Hereditary Elliptocytosis (HE) (HPP/SE/SOA)
Hered. Stomatocytosis
Hereditary Xerocytosis

Question 9

What is the vertical spectrin ankryn defect anemia?

What is the horizontal defects?

Answer 9

Vertical: HS

Horizontal: HE/HPP

Question 10

Describe Hereditary Spherocytosis (HS)
RBC membrane
hemolysis ranges?

Answer 10

vertical spectrin ank. defect
Rbc’s lose membrane/low surface area/vol ratio/hemolyzed in spleen
Silent carrier to severe

Question 11

What is the Presentation for HS?
Lab findings?
Hemolysis
DAT
Folic acid
MCV/MCHC
Retics/RDW

Answer 11

Presentations - jaundice, splenomegaly, anemia
Splenectomy resolves symptoms but defects persists

Lab: Extravascular Hemolysis
DAT -
Folic acid decreased (looks megaloblastic)
MCV dec
MCHC increased
Retics increased
RDW increased

Question 12

Describe Osmotic Fragility

Answer 12

rbc placed in HYPOtonic solution, water drawn intracellular by osmosis
Rbc becomes more spherical/lyse (release HgB)

Spherocytes = increased fragility

Question 13

T/F by-concave cells can take on more water

Answer 13

true

Question 14

What is the normal rbc fragility

Answer 14

normal rbc lyse at .45% complete at 100%

Question 15

T/F: use heprin tubes to dilute your sample (saline to water)

Answer 15

true

Question 16

What is the calculation for % hemolysis

Answer 16

O.D sample/O.D of water x 100

Question 17

What is the hereditary spherocytosis % hemolysis

Answer 17

.65 close to isotonic solution

Question 18

Describe Hered. Elliptocytosis (HE)
defects in what
(micro….)
diff types linked?

Answer 18

alpha/beta chain spectrin ank defect, effects rbc deformability, failure to return to normal disc shape (microvasculature)
severity varies
DIFF TYPES LINKED TO DIFF BLOOD GROUPS

Question 19

Lab findings of HE

Answer 19

elliptocytes
MCV norm to high
MCHC norm
Osmotic fragillity norm
some rbcs might be heat sensitive

Question 20

What is Hereditary spherocytic HE

Answer 20

rare hybrid of HE/HS

Question 21

Describe Southeast Asian ovalocytosis (SAO)

Answer 21

south asia/cape pop of south africa (against malaria)
spoon shaped ovalocytes/transverse bar avoids central pallor
treat w splenomectomy

Question 22

Describe Pyropoikilocytosis
What kind of spectrin defects
what mutation
subtype of
thermal instability
what are most pts?

Answer 22

alpha/beta spectrin mutation/decrease synth of alpha spectrin
Subtype of HE/severe hem. anemia
Thermal Instability - heated to 45deg - fragment (norm at 49deg)
most pts are black
(face abnorm/gallbladder/growth retard)

Question 23

Lab findings of Pyropoikilocytosis
MCV
MCHC
rbc shapes?
Bizzare?

Answer 23

MCV dec
MCHC incr
Elliptocytes
Spherocytes
Bizzare micro poik- rbc budding/fragments

Question 24

Describe hereditary stomatocytosis
most pt def. in what
failure of
increased?

Answer 24

most pts deficient in stomatin
-membrane protein (theorized to regulate channel)
Failure of NaK pump
increased H2O in cells

Question 25

Lab findings of Hereditary stomatocytosis
MCV
MCHC
cells
Increased?
What decreased?

Answer 25

MCV increased
MCHC decreased
stomatocytes
Increased osmotic fragility
2,3 BPG decreased (inc affinity for O2)

Question 26

Describe Hereditary Xerocytosis
cells defect in what
what do cells look like?

Lab findings?
MCV
MCHC
Types of cells
2,3 BPG?
Osm fragility?

Answer 26

cells lose K+ due to unknown rbc perm. defect
cells are dehydrated
“Puddle cells”

MCV increased (macro)
MCHC inc
Stomatocytes
target cells
2,3 BPG dec (less aff for O2)
dec Osmotic fragility

Question 27

Describe Acanthocytosis
abnormal what
shapes?

Causes?
A
L
M
C
V

Answer 27

abnormal membrane lipids - inc cholesterol
shape defect not present in young rbcs
phospholipids

Causes: Abetalipoprotenima (Hereditary)
liver disease
malnutrition
certain bld groups
Vit E def

Question 28

Describe Anemia of liver disease

Lab findings?

Answer 28

cholesterol/lipids increased

Lab:
target cells
macro/ROUND
acanthocytes
hemolysis

Question 29

Anemia of Alcholism

Answer 29

hemolytic/megaloblastic anemias
megaloblastic folate defect (poor diet/ethanol/folate)

Ethanol - toxic effect on rbc precursors, cellularity/morph