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Course 1 (Blood and Guts) > Blood > Flashcards

Blood Flashcards

1
Q

What conditions are associated with the type of cell shown?

A

None - this is a smear of normal RBCs

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2
Q

What conditions are associated with the morphology of the cell point out in the image?

A

Spherocytes - due to loss of membrane

  • Hereditary spherocytosis, immune hemolytic anemia, post-transfusion
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3
Q

What conditions are associated with the cell in the image?

A

Elliptocytes

  • Hereditary elliptocytosis, megaloblastic anemia, myelofibrosis, iron deficiency anemia, myelodysplastic syndrome
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4
Q

What conditions are associated with the cell shown below?

A

Schistocytes - occur due to traumatic disruption of membrane, shearing of cell

  • Microangiopathic hemolytic anemia (HUS, TTP, DIC, preeclampsia, HELLP, malignant HTN), vasculitis, glomerulonephritis, prosthetic heart valve
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5
Q

What conditions are associated with the elongated cell shown below?

A

Sickle Cell - due to polymerization of hemoglobin S

  • Sickle cell disorders: HbSC, HbSS
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6
Q

What conditions are associated with the cell in the image?

A

Target cells

  • Liver disease, hemoglobin SC, thalassemia, Fe deficiency, asplenia
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7
Q

What conditions are associated with the cell shown in the image?

A

Tear drop cell

  • Myelofibrosis, thalassemia major, megaloblastic anemia
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8
Q

What conditions are associated with the cells shown below?

A

Burr cells

  • Uremia, HUS, burns, cardiopulmonary bypass, post-transfusion, storage artifact
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9
Q

What conditions are associated with the finding in the image?

A

Rouleaux formation - due to increased plasma concentration of high molecular weight proteins

  • Pregnancy (most common cause; due to physiological increase in fibrinogen)
  • Inflammatory conditions: due to polyclonal immunoglobulins
  • Plasma cell dyscrasia: due to monoclonal paraproteinemia ex. multiple myeloma, macroglobulinemia
  • Storage artifact
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10
Q

What conditions are associated with the finding in the image?

A

Nucleated RBC

  • Hyperplastic erythropoiesis (seen in hypoxia, hemolytic anemia), BM infiltration disorders, MPNs (Myelofibrosis)
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11
Q

What conditions are associated with the finding in the image?

A

Heinz Bodies

  • G6PD deficiency, thalassemia, unstable hemoglobins
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12
Q

What conditions are associated with the finding in the image?

A

Howell Jolly Bodies

  • Post-splenectomy, hyposplenism (sickle cell dx), neonates, megaloblastic anemia
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13
Q

What conditions are associated with the finding in the image below?

A

Basophillic stippling

  • Thalassemia, heavy metal (Pb, Zn, Ag, Hg) poisoning, megaloblastic anemia
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14
Q

What is the differential diagnosis for a microcytic anemia?

A

Think: TAIL

T = Thalassemia

A = Anemia of Chronic Disease

I = Iron deficiency

L = Lead poisoning

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15
Q

What are the 3 broad mechanisms for iron deficiency?

A
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16
Q

Iron deficiency from blood loss in pts over 40 yrs (or younger males) is ___________ until proven otherwise.

A

colon cancer

17
Q

A 30 yr old F complains of increasing fatigue of 3 months duration. She is otherwise healthy, with no PMHx. She has had chronic complaints of occasional loose stools, and almost daily bloating. Her wt is steady. She is not a vegetarian and is on no medications, including NSAIDs. She describes a 28 day menstrual cycle, with heavy bleeding for two days and lighter bleeding for another three days. She has no history of black stools or bright red blood per rectum. Both her paretns were born in N. Ireland and are alive and well, with no FHx of colon cancer or celiac disease. PE: BP 120/80, HR 90, pale, “spoon nails”, otherwise normal. Initial laboratory tests reveal: Hb 80 g/L, a normal WBC count, differential and platelets. PBS: microcytic, hypochromic RBCs.

What do you think are the potential etiologies of her anemia?

A

Microcytic Anemia

  • Menstruating female - blood loss
  • Loose stools, daily bloating - potential celiac disease, anemia could be due to malabsorption
18
Q

A 30 yr old F complains of increasing fatigue of 3 months duration. She is otherwise healthy, with no PMHx. She has had chronic complaints of occasional loose stools, and almost daily bloating. Her wt is steady. She is not a vegetarian and is on no medications, including NSAIDs. She describes a 28 day menstrual cycle, with heavy bleeding for two days and lighter bleeding for another three days. She has no history of black stools or bright red blood per rectum. Both her paretns were born in N. Ireland and are alive and well, with no FHx of colon cancer or celiac disease. PE: BP 120/80, HR 90, pale, “spoon nails”, otherwise normal. Initial laboratory tests reveal: Hb 80 g/L, a normal WBC count, differential and platelets. PBS: microcytic, hypochromic RBCs.

A tTG is orderd and returns negative. What is your diagnosis?

A

Iron deficiency anemia likely due to menstruation.

19
Q

What are the essentials of celiac disease? What are some complications?

A

Celiac Disease - The Essentials

  • Abnormal small bowel mucosa (blunted villi) - characteristic changes
  • Permanent intolerance to gluten-containg grains
  • An auto-immune, multi-system disorder
    • DQ genes create receptors to which gluten peptides tightly bind
    • Activates T lymphocytes = cytokins = tissue damage = stimulate B cells = Abs = autoimmune process
  • Diagnosis: anti-tTG and duodenal biopsy, only order HLA DQ2/DQ8 if it is a difficult case
  • Treatment: life long gluten free diet
  • Complications: Anemia (iron, B12/folate infrequently), Osteoporosis (Vit D, Ca), Malnutrition (growth retardation), Increased risk of cancer (lymphoma, GI malignancies)
20
Q

A 34 yr old M complains of fatigue and lethargy. He has occasionally stumbled when walking, especially in the dark. He has a known history of Crohn’s disease, requiring two previous resections totalling 80 cm of terminal ileum (no colonic involvement). His last surgery was 2 yrs ago and other than loose stools 3x/day, controlled by cholestyramine, he is in clincal remission. His wt has been steady and his appetite has been good. He has one meat containing meal daily. His on no medications besides the cholestyramine. PE: mild pallor, HR 100, BP 140/70. He has decreased vibration and position sense in his toes and ankles. His spleen is not palpable. Initial laboratory results are: Hb 65 g/L, WBC 3.2 x 109/L with a normal differential, platelets 100 x 109/L. The MCV is 120 fl and reticulocyte count is 1%.

What is the cause of his neurological symptoms?

A

The neurological symptoms are likely due to a vitamin B12 deficiency.

B12 Deficiency Clinical Features

Neurological

  • Cerebral (common, reversible with B12 therapy): confusion, delirium, dementia
  • Cranial nerves (rare): optic atrophy
  • Cord (irreversible damage)
    • Subactue combined degeneration: decreased vibration sense, proprioception and 2-pt discrimination, spastic weakness, hyperactive reflexes
  • Peripheral neuropathy (variable reversibility): usually symmetrical, affecting lower limbs more than upper limbs
21
Q

A 34 yr old M complains of fatigue and lethargy. He has occasionally stumbled when walking, especially in the dark. He has a known history of Crohn’s disease, requiring two previous resections totalling 80 cm of terminal ileum (no colonic involvement). His last surgery was 2 yrs ago and other than loose stools 3x/day, controlled by cholestyramine, he is in clincal remission. His wt has been steady and his appetite has been good. He has one meat containing meal daily. His on no medications besides the cholestyramine. PE: mild pallor, HR 100, BP 140/70. He has decreased vibration and position sense in his toes and ankles. His spleen is not palpable. Initial laboratory results are: Hb 65 g/L, WBC 3.2 x 109/L with a normal differential, platelets 100 x 109/L. The MCV is 120 fl and reticulocyte count is 1%.

What is the cause of his low platelet count and low WBC count?

A

Severe B12 deficiency can result in a low platelet and WBC count.

22
Q

How do vitamin B12 and Folate deficiency lead to their hematologic manifestations?

A

B12/Folate Deficiency

  • Erythroblasts require folate and B12 for proliferation during differentiation
  • Deficiency inhibits purine and thymidylate synthesis, impairs DNA synthesis and causes erythroblast apoptosis, resulting in anemia from ineffective erythropoiesis
    • Hyper segmented neutrophils
23
Q

What drug is associated with folate deficiency?

A

Methotrexate

24
Q

What is the pathogenesis of Anemia of Chronic Disease?

A
25
Q

What are the common (general) clinical features of thalassemia?

A

Thalassemia

  • Autosomal recessive
  • Mediterranean
  • Hypochromic, microcytic anemia
  • Clinical manifestations etc. are dependent on specific gene and number of alleles involved
26
Q

A 23 yr old Mediterranean F is found to have a mild anemia at the time of her first visit to a new doctor. She is 2 mths pregnant. She has never been ill but remembers being given iron pills when she was 8 yrs old when her Hb was low at a regular check up. PE: normal pregnancy, no abnormal findings. Hb 105 g/L, WBC 6 x 109/L with normal differential, and platelet count of 100 x 109/L. PBS: hypochromic, microcytic RBCs and her MCV is 60 fL. Ferritin is 60 (normal).

What is at the top of your differential diagnosis?

A

Mediterranean, normal ferritin makes iron deficiency less likely, this is likely trait thalassemia.

27
Q

A 23 yr old Mediterranean F is found to have a mild anemia at the time of her first visit to a new doctor. She is 2 mths pregnant. She has never been ill but remembers being given iron pills when she was 8 yrs old when her Hb was low at a regular check up. PE: normal pregnancy, no abnormal findings. Hb 105 g/L, WBC 6 x 109/L with normal differential, and platelet count of 100 x 109/L. PBS: hypochromic, microcytic RBCs and her MCV is 60 fL. Ferritin is 60 (normal). Her HbA2 is 4.5% and her husband’s HbA2 is 5%. What are the potential genotypes of their child?

A

Both parents are likely Beta thalassemia trait. The child could be normal (25%), Beta thalassemia trait (50%), or Beta thalassemia majory (25%).

Course 1 (Blood and Guts) (17 decks)

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