Blood

Question 1

Macrocytic

Answer 1

Size

Folic acid
B12 deficiency
Liver disease
Alcohol
Drugs

Question 2

Normocytic

Answer 2

Hemolytic
Chronic renal disease
Aplastic anemia

Question 3

Microcytic

Answer 3

Iron deficiency
Thalassemia

Question 4

Macrocytic/ normochronmic

Answer 4

Pernicious anemia
Folate deficiency

Question 5

Microcytic/ hypochromic

Answer 5

Iron definecy
Sideroblastic anemia
Thalassemia

Question 6

Normocytic/ normochromic

Answer 6

Aplastic
Postthemorrhagic
Hemolytic
Sickle cell anemia
Chronic illness

Question 7

Iron defiance anemia pathophysiology

Answer 7

Plasma iron is not soluable. Needs ferritin and transferrin (proteins) to bind iron to make iron from F2 2+ (toxic) to Fe 3+

Question 8

Iron defiency S&S, diagnosis, treatment

Answer 8

Symptoms starts when iron 70-80g/L

S&S: tired, weak, SOB, pale skin; then later: brittle nail, spoon shaped, gloss it is (tongue is red and smooth).

Diagnosis: 1. transferrin saturation (serum iron/ TIBC): TIBC> 71.6umol/L. 2. Use iron supplement that increase hgb 10-20g/l.

Others help to diagnose: low ferritin, high RDW (red cell distribution width)

Trouble to diagnosis: earlier stage all BWs are normal

Treatment:
1st line: food (meat, fish, poultry; orange juice); vitamin C helps iron uptake

2nd: iron sulfate

Question 9

Pernicious anemia

Prevalannce
S&S

Answer 9

Vitamin B12 deficiency

Rare in people< 30yr old
Caused by: lack of intrinsic factor (enzyme for B12 absorption in gut)
S&S: affect nerve; weak, fatigue, parenthesis, liver enlargement, pallor, glossitis

Diagnose: elevated MCV (cytic)

Treatment:
1st line: food (liver, fortified cereal, fish, dairy)
2nd line: oral: 1-2 mg OD x 2 weeks, then 1mg/week

Question 10

Aplastic anemia

Answer 10

Cause: caused by abnormal production of all RBC due to problem with bond marrow. Could be radiation, chemo, toxin, drugs, pregnancy.

Result: abnormal RBC cause pancytopenia, leads to bleeding, infection

Question 11

Thalassemia

Answer 11

Hereditary disorder of hemoglobin synthesis; type of hypoproliferative anemia

S&S: spleenomegaly; hepatosplenomegaly, jaundice, pallor

Treatment: mild does not need treatment
Severe: need regular transfusion and folate supplement

Question 12

Sickle cells anemia

Definition
S&S
Treatment

Answer 12

definition: abnormal hemoglobin leads to chronic hemolytic anemia

They have abnormal Hgb. When they get stressed (e.g. exercise). Then RBC becomes a shape that get clog in vessel and block supply to organs. —> this can cause significant damage to endothelium.

S&S: tends to have infection, common S&S: pain in back, ribs, limbs. Risk for stroke

Treatment: primary prevention (hydroxyurea reduce number of crisis)and treat complication (reduce pain, hydration)

Question 13

Sideroblastic anemia

Answer 13

Bone marrow can’t make normal RBC. RBC that is lack of iron inside even normal amount of iron

Question 14

Von Willebrand disease

Answer 14

Von Willebrand is a thing that helps platelet stick together when person bleeds

Lack of Von Willebrand cause the person to have clot problem

Question 15

Erythropoiesis

Answer 15

Low O2 stimulate kidney to produce erythropoietin, that trigger RBC production @ bone marrow

Question 16

Platelet formation

Answer 16

Platelet are formed and released from precursor cells called megakaryocytes within the bone marrow

Question 17

Clotting cascade

Answer 17

1: circulation activate coagulation factors
2. Form thrombin
Last: thrombin makes fibrinogen into fibrin–> fibrin is clot formation

Question 18

Normal MCV

Answer 18

80-100 fL

MCV is RBC’s size

Question 19

Normal MCHC

Answer 19

Colour (Hgb concentration in a given packed red blood cells)

320-370g/L

Question 20

Reticulocyte
Red cell distribution width; if elevated?

Answer 20

Reticulocyte: fro bone marrow: indicate % of circulationg RBC, takes 1-2 days to become mature

Red cell distribution width: indicate different sizes of RBC; if elevated: B12 deficiency, folic acid def, hemolysis, iron def

Question 21

Hgb

Answer 21

Part of reed blood cell

120-175 g/L

Question 22

WBC

Answer 22

3.3-11

Question 23

Platelet

Answer 23

140-450

Question 24

Hct

Answer 24

Measure % of RBC in blood

31-53

Question 25

WBC differential

Neutrophil
Eosinophil
Basophil
Monocytes
Lymphocyte

Answer 25

Question 26

PT

Definition
What does it measure
Normal range

Answer 26

Prothrombin time

A measure of extrinsic and common pathway (tissue caused clotting)

Normal: 11-16 sec

Question 27

INR

Answer 27

International normalized ratio

A gold standard measure for oral coagulants (e.g. warfarin)

Normal: 2-3 (if on anticoagulant); >4.9 is critical; normal patient not on anticoagulant INR is usually 1

Question 28

PTT

Answer 28

Partial Thromboplastin time

Measure: intrinsic pathway

Normal: 25-32 sec

Question 29

Fibrinogen assay

Answer 29

Amount of fibrinogen available (fibrinogen is a immature, precursor of fibrin)

Question 30

Intrinsic pathway vs extrinsic pathway

Answer 30

Extrinsic pathway: triggered by tissue damage

Intrinsic pathway: trauma to blood cells; or exposure blood to collagen

Question 31

Clotting pathway

Answer 31

Question 32

3 drug classic that affecting clot

Answer 32

1. Platelet inhibitor (platelet forms clot): block cyclooxygenase (enzyme needed to make arachidonic acid into prostaglandin, thromboxane- make platelet adhesion). E.g. aspirin
2. Anticoagulants: heparin (binds to antithrombin III–> cause inactivate clotting factor); warfarin (vitamin K antagonist) (vitamin K is a factor made from gut to micro flora to promote clotting)
3. Antiplatelet agent: plavix: binds to ADP receptor, prevent platelet adhesion: good: doesn’t need INR monitor; bad: risk for severe bleeding, neutropenia
4. Thrombolytics: tPA activator (tissue plasminogen): activate plasminogen bound to fibrin (cause fibrin degration); or streptokinase (convert free plasminogen into active plasm); plasminogen–> fibrin degration

Question 33

How long does it take for warfarin to max effect

Answer 33

8-14 days