Blood Flashcards
RBCs lifespan = ____ days
120
RBCs are removed by ________
macrophages of spleen, liver, and bone marrow
Which part of a RBC is recycled?
Iron in Hb
What is Hematopoiesis? What is formed?
Formation of blood or all types of blood cells
MUST KNOW EVERYTHING BELOW RED LINE IN PIC
Thrombocytes =
PLTs
Platelets are membrane bound cell fragments resulting from fragmented _______
Megakaryocytes
Red Bone Marrow -> Myeloid Stem Cell -> Megakaryocytes -> Platelets
Platelet formation is regulated by _____
Thrombopoietin
PLTs last for
8-10 days
Which 3 factors do PLTs secrete, causing local PLT aggregation, Vasoconstriction, and Blood coagulation?
- Thromboxame A
- Serotonin
- Thromboplastin
Platelets:
- Clinically significant bleeding is usu <___K.
- Trauma or Sx = ____K
- usu <10K
- Trauma or Sx = 50K
List the abundance of Plasma Proteins from Greatest -> Least
- Albumin
- B-Globulin
- Y-Globulin (antibodies_)
- A2-Globulin
- Fibrinogen
- A1-Globulin
Causes of Erythrocythemia
Conditions CAUSING low O2
- Heart Dz (CHD, HF)
- Congenital hemoglobinopathies
- High Altitude
- COPD, lung DOs
- Sleep Apnea
- Smoking
Performance Enhancing Drugs
- Anabolic Steroids, EPO
- Blood Doping (transfusions)
- Kidney CA/Transplants (incr EPO)
Bone Marrow Overproduction
- Polycythemia Vera and Myeloproliferative DOs
Causes of Anemia (low RBCs)
Underproduction
- Iron deficiency (MC)
- Vit B12 / Folate Deficiency
- Bone Marrow Dz (Leukemia, Myelofibrosis)
Excessive Destruction
- Fragmentation d/t mechanical issues
- Sickle Cell Anemia
- Autoimmune hemolytic anemia
- Hereditary Spherocytosis
Hereditary Spherocytosis
- Inheritance pattern
- SS
- Tx
- Autosomal Dominant
- SS: pale, fatigue, hemolytic anemia, jaundice, gallstones, +/- big spleen, short stature, delayed puberty, skeletal abnormalities
- Tx: Splenectomy, RBC transfusions, Folic acid supplementation, cholecystectomy
Removing which 2 organs are Tx options for Hereditary Spherocytosis
Spleen
Gallbladder
_____ Supplements may help Hereditary Spherocytosis
Folic Acid
Hereditary Spherocytosis inheritance pattern
Austosomal Dominant
Causes of HIGH and LOW Hgb/Hct
What causes a HIGH Reticulocyte Ct?
- HEMOLYTIC ANEMIA
- ACUTE BLOOD LOSS
- Transfusions
Causes of LOW Retic Ct
- APLASTIC ANEMIA
- BONE MARROW SUPPRESSION (drug, toxin, virus)
- Pure red cell aplasia
- Bone marrow infiltration (leukemia, lymphoma, carcinoma)
Causes of Normal Retic Ct
- IRON DEFICIENCY ANEMIA
- ANEMIA OF CHRONIC DZ
- CHRONIC RENAL FAILURE
- Megaloblastic anemia
- Myelodysplasia
List 3 hypochromic microcytic anemias
- Iron deficiency anemia
- Thalassemia
- Anemia of chronic dz
Sources of error in manual cell counts
- in wedge-pushed smears, WBCs tend to gather at the edges, so must scan entire slide
- poor smear prep/stain
- small sample size 100200 cells
- CV is felt to be 5-10%
Normal HgB values
- Men?
- Women?
- Children?
- Newborn?
- Men 13.5-17.5
- Women 12-15.5
- Children 11-13
- Newborn 17-22
Highest in neonates
Lower in kids and women
HCT = ___X Hemoglobin
3
Norm HCT
- Men?
- Women?
- Men 40-54%
- Women 36-48%
Sickle cell trait vs Sickle cell disease?
Trait = 1 gene for sickle Hb
Disease = 2 genes for sickle Hb
What are the 4 major RBC indices?
- MCV = Mean Corpuscular Volume (calculated)
- MCH = Mean Corpuscular Hemoglobin (calculated)
- MCHC = Mean Corpuscular Hemoglobin Concentration (calculated)
- RDW = Red Cell distribution Width (Measured)
Poss reasons for a FALSE HIGH and LOW MCH
*False highs or lows d/t automated analyzer error *
FALSE HIGH
* High WBC >50K
* Suprisingly high Hgb with a “low” RBC Ct
FALSE LOW
- Suprisingly LOW Hgb with a “High” RBC ct
RBC Shape change =
RBC Size change =
shape change = Poikilocytosis
size change = anisocytosis
What DOs cause RBC agglutination
- Cold hemagglutination Dz
- Paroxysmal cold hemoglobinuria
NO WARM AGGLUTINATION
What causes Rouleaux RBCs?
- Hyperproteinemias -> Multiple Myeloma, Waldenstrom’s macroglobulinemia
- Chronic inflammatory DOz
- some Lymphomas
Why is RDW valuable?
- helps with anemia Dx
- can be used to flag smalpes that may need peripheral smear exam
HIGH RDW is seen with red cell fragmentation, agglutination, or dimorphic cells
Causes of a HIGH MCHC
- Incr Spherocytosis
- Autoimmune Hemolytic Anemia
- Homozygous Sickle Cell or Hgb C Dz
List which of the following causes HIGH vs LOW MCHC:
- Agglutination
- Clotted Sample
- HIGH WBC
- Hyperglycemia
- HIGH MCHC = Aautoagglutination, Clotted sample
- LOW MCHC = HIGH WBC, Hyperglycemia
RBC Ct are lower in which groups?
M? F? Peds?
Women
Children
Things are measured by the ______ method
Coulter
Sizing and counting particles is based on measurable changes in electrical impedance produced by nonconductive particles suspended in an electrolyte. A small opening (aperture) between electrodes is the sensing zone through which suspended particles pass.
RBC ct are measured at what unit
uL
Hyperchromia = MCHC >____%
- Causes?
36
- Hemolytic anemias d/t burns
- spherocytosis
Causes of Hypochromic anemia
Polychromatophile =
grey-blue in color and usu larger than the normal RBC
Polychromatophile Causes
Conditions with bone marrow stimulation
- Acute and chronic hemorrhage
- Recovery from a nutritional deficiency anemia
Causes of Target Cells (Codocytes)
- Liver Dz (high bad cholesterol)
- Hemoglobinpathies
- Thalassemia
Incr in RBC surface membrane
Bell shaped in free flow
Excess membrane cholesterol and decr Hgb
Causes of Spherocytes
- Hereditary Spherocytosis
- Autoimmune hemolytic anemias and other
Causes of Stomatocytes
- Hereditary stomatocytosis
- Hemolytic anemias
- Alcoholic cirrhosis
- Acute alcoholism
- Rh null Dz (mutation in the Rh30 and RhAg genes)
Causes of Ovalocytes
- Myelodysplastic syndrome
- Thalassemic syndromes
- Megaloblastic process (Macrocyte)
Causes of Elliptocytes
- Iron deficiency anemia
- Hereditary Elliptocytosis
- Idiopathic myelofibrosis
Are ovalocytes or Elliptocytes egg-shaped?
Ovalocytes = Egg shape
Elliptocytes = Pencil shape
Causes of true burr cells (echinocyes)
- Uremia
- Heart Dz
- Stomach CA
Hereditary cause for Acanthocytes
Abetaliprotenemia
Causes of dacrocytes (tear drop cells)
- Idiopathic myelofibrosis
- Thalassemia
- Drug-induced heinz-body formation
Cause of Drepanocytes
- polymerization of Hgb
crescent or sickled shaped cells . projections at ends
Cause of blister cells
- G6PD Deficiency
- Oxidation or fragmentation injury
Causes of Howell-Jolly Bodies
- Splenectomy
- Asplenia
- Severe megaloblastic anemia
- Severe hemolytic anemia
Causes of Heinz bodies
- G6PD deficiency
- NADPH deficiency
- Chronic Liver Dz
- Alpha Thalassemia
- Asplenism
Causes of Pappenheimer Bodies
- Splenectomy
- Hemolytic Anemia
- Sideroblastic Anemia
- Megaloblastic Anemias
- Hemoglobinopathies
Causes of Cabot Rings
Looped rings within RBC cytoplasm
+/- “beads on a string”
Microtubular remnants of mitotic tubules from mitosis
- Myelodysplastic Syndrome
- Megaloblastic Anemia
abnormality in RBC prod
What are the inclusions in these inclusion bodies?
- Howel-Jolly bodies?
- Heinz bodies?
- Pappenheimer bodies?
- Hgb H inclusions?
- Basophilic stippling?
- Howel-Jolly bodies = DNA
- Heinz bodies = Hgb
- Pappenheimer bodies = Iron deposits
- Hgb H inclusions = Hgb
- Basophilic stippling = Ribosomes
Which inclusion bodies are seen after post-splenectomy
Howell-Jolly bodies
_______ cells are seen in G6PD deficiency and are cells in which a Heinz Body has been removed
Helmet
Howell-Jolly bodies vs Heinz bodies
- Howell-Jolly bodies are seen with supravital stain and can be found throughout the cell
- Heinz bodies are basophilic, seen on Wright’s Stain smears, and are found at the periphery of the cell
Causes of Basophilic Stippling
- Coarse?
- Fine?
accumulations of RNA and Ribosomes
AKA Puntate Basophilia
COARSE = Impaired Hgb synthesis
- Megaloblastic and other severe anemias
- Thalassemia
- Lead poisoning
FINE
- Incr RBC prod
- Incr polychromatophilia
SS of PLT Associated Bleeding?
- skin cut bleeding CAN be controlled by pressure
- Spon bleeding into the skin (petechiae, purpura, ecchymoses)
- Bleeding into mucus membranes (bloody nose, GI bleed, Intraretinal, Intracranial)
____ is a contractile protein that is a major part of PLT cytoplasm
Thrombosthenin
Do mammals have nucleated PLTs?
NO!!!
but other animals do
- Normal PLT Ct =
- BAD = < ____ - ____ K
- Norm = 150-350K per mm3 (uL) of blood
- BAD = < 10-40K
- Old PLTs are destroyed by the _____
- Extra PLTs are stored in the _____
SPLEEN (BOTH)
3 As of Primary Hemostasis (PLT Plug)
Adhesion
Activation
Aggregration
- Arterial clotting is primarily done by _____
- Venous clotting is primarily done by _____
- Arterial = PLT
- Venous = Fibrin
Causes of Thrombocytopenia
(LOW PLT)
- ITP -> idiopathic, drugs, Onyalai (acquired)
- Familial Thrombocytopenia
- Thrombotic Thrombocytopenic Purpura
- HELPP Syndrome
- HUS
- Aplastic Anemia
- Chemo
- Transfusions
- Hepatic Dysfn, Familial Nonhemolytic jaundice
- Splenomegaly (Gaucher’s Dz)
- Gilbert’s Syndrome
- Babesiosis (tick parasite)
- Dengue Virus (Mosquitos)
Causes of Thrombo-cytosis/cythemia
HIGH PLT
Reactive
- Chronic Infx/Inflammation
- Malignancy
- Hyposplenism
- Iron Deficiency
- Acute blood loss
Myeloproliferative DOs
- Essential thrombocytosis
- Polycythemia Vera
Other myeloid neoplasms
Congenital
Causes of Thrombocytopathy
Dysfunctional PLTs
Drugs affecting PLT Fn
Taking ____ before Aspirin will prevent the irreversible inhibition of cyclooxygenase-1
Ibuprofen
2 NSAIDs that affect PLT Fn
Aspirin
Ibuprofen
- Drugs that SUPPRESS PLT Fn?
- Drugs that STIMULATE PLT Fn
SUPPRESS
* Aspirin
* Clopidrogel
* Cilostazol
* Ticlopidine
* Ticagrelor
* Prasugrel
STIMULATE
- Thrombopoietin mimics
- Desmopressin
- Factor VIIa
What is Samter’s Triad?
*** AERD = Aspirin-Exacerbated Respiratory Dz **
* Rhinosinusitis, Asthma
* NSAID Intolerance
* used to be known as Samter’s Triad
* ACQUIRED DO OF PLT ADHESION
Which coagulation factors are known by name?
4 of them
- Factor I = Fibrinogen
- Factor II = Prothrombin
- Factor III = Tissue Factor, Thromboplastin
- Factor IV = Calcium
PLT Ct Sources of ERROR
- Both Automated and Manual Counts -> Improper collection, slightly clotted sample
- Automated Counts -> PLT clumping, Presence of RBC fragments, Presence of Microcytes
- Blood smear evaluation will reveal the presence of the problems causing issues in the automated count
If PLT ct and bleeding time is NORMAL, what else could the cause of bleeding problem?
PLT Fn
bleeding time detects issues with vessel wall/SQ tissue
PTT will NOT detect a factor ____ defect, bc it’s not in the intrinsic pathway
VII
Bleeding tests
- PLT Ct
- Bleeding time
- PT/INR
- PTT
- +/- Factor ____ assays
XIII (13)
Stabilizes the fibrin mass
Deficiency -> unstbale clots
Fibrin dissolves into Urea W/O XIII
- ______ Anticoagulant throws off PTT data
- ______ Anticoagulant throws off PT data
Lupus Anticoagulant = PTT wrong
Citrate Anticoagulant = PT wrong
Which bleeding tests does Heparin interfere with?
- PT
- PTT
- Thrombin Time
Abnormal Bleeding Time may be d/t
thrombocytopenia
order a PLT Ct -> if norm -> prob is either vessel wall/SQ tissue issue or PLT Fn.
Order a bleeding time to determine if vessel wall/SQ tissue issue
Normal Thrombin time
<22 sec (~ 14-16sec)
Condition?
- PT: LONG
- PTT: Norm
- Thrombin Time: Norm
- PLT Ct: Norm
- Factor VII
- deficiency early oral anticoagulation
Condition?
- PT: Norm
- PTT: LONG
- Thrombin Time: Norm
- PLT Ct: Norm
- Circulating anticoagulants
- VonWillebrand Dz
- Factor VIII:C, IX, XI, XII deficiency
- Perkallikrein
- HMWK
Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: Norm
- PLT Ct: Norm
- Vit K Deficiency
- Oral anticoagulant
- FActor V, VII, X, II Deficiency
Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: LONG
- PLT Ct: Norm
- Fibrinogen defiicency
- Liver Dz
- Heparin
- Hyperfibrinolysis
Condition?
- PT: Norm
- PTT: Norm
- Thrombin Time: Norm
- PLT Ct: LOW
Thrombocytopenia
Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: Norm
- PLT Ct: LOW
- Liver Dz
- Massive Transfusion
Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: LONG
- PLT Ct: LOW
- ACUTE Liver Dz
- DIC
Plasmin cleaves fibrin -> ______
Major degradation product
D-Dimer (Fibrin DDimer)
Norm Fibrin = <500 ng/mL
Norm D-Dimer = <250 ng/mL
Clinical uses for D-Dimer
4 of them
- DVT
- PE
- DIC
- Primary Hyperfibrinolysis
- ____ out of 30 blood groups are considered clinically significant
- List the grps
- They are known to cause which 2 conditions?
**9 grps **
- ABO
- Rhesus (Rh)
- Kell
- Kidd
- Duffy
- MNS
- P
- Lewis
- Lutheran
2 Conditions
- Hemolytic Transfusion Rxns (HTR)
- Hemolytic Dz of the fetus and Newborn (HDFN)
Is blood type O autosomal dominant or recessive?
RECESSIVE
AO = A phenotype
OO = O Phenotype
AB grp blood
- antigens in RBC?
- Antibodies in plasma?
- A & B antigens in RBC
- NO Antibodies in plasma
O grp blood
- Antigens in RBC?
- Antibodies in plasma?
- NO antigens in RBC
- A&B antibodies in plasma
____ blood grp antibodies are the only ones present in blood prior to any rxn or exposure
ABO
Hemolytic Dz of Fetus and Newborn (HDFN) is an autoimmune condition developing in a paripartum fetus when the ____ antibodies produced by mom crosses the placenta and attacks fetal RBCs
IgG
In hemolytic dz of fetus and newborn, are there HIGH or LOW erythroblasts in the fetal blood?
HIGH = “Erythroblastosis Fetalis”
Sickle Cell pts have HIGH levels of ____ antigens on their Sickles RBCs
Lu
(Lutheran blood grp)
Blood Transfusion Indications
- Acute blood loss >20% of blood vol
- Hgb <8
- Hgb <9 (Major Dz)
- Hgb <10 (Autologous blood transfusion)
- Hgb <11 (ventilator dependent)
Hgb transfusion factors
- Age and cardiovascular status
- Anticipated additional blood loss
- Arterial Oxygenation
- Cardiac output
- ## Oxygenation extraction ratio
In antibody screens, which antibody is clinically significant?
IgM? IgG?
IgG
Major vs Minor blood Crossmatch
- Major = Donor Cell + Pt Serum
- Minor = Pt cell + Donor serum/plasma
a Major cross-match is basically a(n) _____ Coombs Test
Direct? Indirect?
INDIRECT
Donor cell + Pt serum
The general rule is to transfuse RBC if Hgb <7. Does child with TOF and Hgb 8 with severe hypoxia need transfusion?
YES!!! Don’t be shy with the transfusions since they have TOF and severe hypoxia, regardless of the general Hgb level rule
Who should be transfused first?
- A. Transfuse plasma in a pt with INR 1.7 that is taking an anticoagulant for an invasive procedure
- Child with TOF and Hgb 7
Child with TOF and Hgb 7
Contraindications to Autologous blood donations
- Infx, risk of sepsis
- Scheduled Aortic Stenosis Sx
- Active Sz DO
- MI or CVA within 6mo
- Significant Cardiac or pulm Dz
- High grade LT main CAD
- Cyanotic Heart Dz
- Uncontrolled HTN
Average blood volumes
- Preterm neonates?
- Full-term neonates?
- Infants?
- Adult M?
- Adult F?
- Preterm neonates = 95 mL/kg
- Full-term neonates = 85 mL/kg
- Infants = 80 mL/kg
- Adult M = 75 mL/kg
- Adult F = 65 mL/kg
M are thicker than F and babies are thickest of all
- 1 unit RBCs = incr [hgb] ____g/dL = incr HCT ____%
- 10mL/kg RBCs = incr [hgb] ___g/dL = incr HCT ____%
- 1 unit RBCs = incr [hgb] 1 g/dL = incr HCT 3%
- 10mL/kg RBCs = incr [hgb] 3 g/dL = incr HCT 10%
If pt needs to incr HCT from 24% -> 30%, how many units of blood will need to be transfused?
2
1 unit blood = HCT incr 3%
Plasma Transfusion Indications
- INR >1.6
- Emergent Warfarin Reversal
- Acute DIC
- Microvascular bleeding during massive transfusion (≥ 1 blood volume)
- Replacement fluid for Apheresis in thrombotic microangiopathies
- Hereditary angioedema
PLT Transfusion Indications
Always transfuse if neonate PLT Ct < _____
20
Consider neonate PLT transfusion if PLT ct ___ - ____
20-30
Indications for neonate PLT transfusion if PLT Ct 30-50 &….
low birth wt in 1st week
When to transfuse cryoprecipitate
Acute vs Delayed Transfusion Rxns
It’s best to ______ if taking Aspirin and need elective Sx
Wait 1.5 weeks to do Sx for PLT levels to normalize
