Blood and Immunology Flashcards by Becca Nicole

DDx microcytic anemia (3)

Iron deficiency, 2. Thalassemia, 3. Chronic inflammation

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Normocytic anemia DDx

Blood loss, immune hemolytic, spherocytosis, sickle cell, renal disease

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Macrocytic anemia DDx

Folate def, B12 def, liver disease, hypothyroid, neoplasms, aplastic anemia,

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Risk factors for Hodgkin lymphoma

EBV, immunosupression/HIV, autoimmune diseases

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signs of acute hemolytic transfusion reaction

Fever, hemoglobinuria, hypotension, DIV, evidence of hemolysis, complement activation

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Signs of hemolysis on labs

Low haptoglobin and high LDH

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Delayed hemolytic transfusion reaction causes hemolysis where?

Extravascular hemolysis in the reticuloendothelial system (spleen)

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Reticuloendothelial system organ is

Spleen

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Preventing hemolytic disease of the fetus

Give rh immune globulin to d negative moms before they form antibodies

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Neonatal Alloimmune thrombocytopenia mechanism

Antibodies vs platelet antigens in fetus leading to severe bleeding complications at time of delivery

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Transfusion related acute lung injury (TRALI)

Antibody mediated reaction from donor units that activate neutrophils in the recipient causing inflammatory damage to the lungs

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Transfuse if Hgb is less than

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How many platelets in a donor pack

30x10^10

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Shelf life of platelets

7 days

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Female donor plasma is used to make

Albumin and IvIg

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Male plasma is used for

Transfusion, cryosupernatant, cryoprecipitate

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INR threshold for transfusion

INR 1.6

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Immune mediated transfusion complications

Hemolytic, febrile/allergic, TRALI, PTP, TA-GVHD, alloimmunization

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Non immune mediated hazards of transfusion

Sepsis, non-immune hemolysis, mistransfusion, TACO, coagulopathic complications, iron overload

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Pattern recognition receptors are a component of which immune system

Innate immune system

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B and T cells are associated with which type of immunity

Adaptive

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Antigen receptor type on B cells

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Central tolerance immune system happens in

Thymus and bone marrow

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Autoantibodies associated with rheumatoid arthritis

Rheumatoid factor, antibodies against citrullinated protein antigens (ACPA)

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MHC presents the antigen to

T cell receptors

CD28 is located in

The T cell

HLA-B27 is associated with

Ankylosing spondylitis

Kawasaki disease is a

Medium vessel vasculitis affecting children

In SLE, autoantibodies are to

The cell nucleus

SLE arthritis is

Non erosive in a distribution like rheumatoid arthritis

SLE manifestations (renal)

Lupus nephritis: persistent proteinuria, cell casts, hematuria, pyuria, hypertension, increased creatinine

CNS manifestations neurologic

Stroke, vasculitis, seizures, psychosis

Hematologic disorders of SLE

Hemolytic anemia, leukopenia, thrombocytopenia

Autoantibodies specific to SLE

Anti-dsDNA

ANA+ in what % of SLE cases

>95%

The presentation of SLE is

Heterogenous - some kind of antibodies, and inflammation

Drug classes used to treat SLE include

Antimalarials, corticosteroids, immunosuppressants, and biologicals

SLE stands for

Systemic lupus erythematosus

Type I hypersensitivity is how fast?

Immediate

Type I hypersensitivity mediated with Ig...what?

IgE

Allergic reactions are usually which type of hypersensitity

Type I, IgE mediated q

Type II hypersensitivity involves which Ig?

IgM or IgG

Thrombocytopenia and hemolytic anemia are which type of hypersensitivity

Type II

Immune complexes depositing in vascular beds is what type of hypersensitivity reaction

Type III

Which type of hypersensitivity reactions are T cell activation and involve induction of inflammation through macrophages and inflammatory cytokines like TNF

Type IV hypersensitivity

Which type of hypersensitivity for rheumatoid arthritis, multiple sclerosis, and IBD, type I diabetes

Type IV

Sjogrens occurs secondary to

RA, SLE, Scleroderma, myositis

Sjogrens on bloodwork

ANA+, anti-Ro or anti-La, RF+, anemia of chronic disease

In cryoglobulinemia, autoantibodies

Precipitate at low temperatures and cause vasculitis in the small vessels by IC deposition

Malignancy in Sjogrens

44x fold increased risk for lymphoma, usually MALT

MALT stands for

Mucosa associated lymphoid tissue

Localized scleroderma presents s

Morphea and linear scleroderma

Raynaud’s phenomenon is

Exaggerated vasoconstrictive response to cold or stress leading to colour change in digits

Raynauds is common in what demographic?

Young women

Raynauds - what lifestyle changes for treatment? What medication?

Stop smoking, keep warm. Treat medically with vasodilator.

Vasodilator classes for raynauds treatment (3)

CCB, ARBs, nitrates

Lab work in scleroderma

ANA+ in 50-80%, anticentrometere + 80%, frequently anemic

Treating scleroderma

Treat specific organ manifestations

What is elevated in polymyositis

CK, CPK, 50% ANA +

Dermatomyositis has a characteristic rash consisting of

Gottren’s papules, heliotrope rash, shawl sign, nailfold capillary changes

Palpable purpura is

Non blanching, palpable, lower extremity predominant

Lab work glomerulonephritis

High creatinine, proteinuria, RBC casts

Mononeuritis multiplex

Ischemia of vessels supplying nerves leads to periopheral nerve damage

Large vessel vasculitis includes

Takayasu’s arteritis, giant cell arteritis

Stenosis of the aorta and major branches is called

Takayasu’s arteritis

GCA affects people aged

Older than 50

Jaw claudication in GCA is due to

Ischemia of the muscles of mastication

Vision changes in GCA due to

Retinal artery occlusion

Treatment of GCA is with

High dose steroids, and low dose ASA

Areas affected by polymyagia rheumatica

Pectoral and pelvic girdles

Bloodwork for polymyalgia rheumatica

High ESR CRP, anemia of chronic disease

Treating polymyalgia rheumatica

Low dose steroids

What antibody has high specificity for GPA

C-ANCA (vs PR-3)

Churg strauss syndrome is also known as

Eosinophilic granulomatosis with polyangitits

Characteristic of Eosinophilic granulomatosis with polyangiitis

Systemic vasculitis with chronic rhinosinusitis, nasal polyps, asthma, and prominent eosinophilia

When is eosinophilic granulomatosis with polyangitis typically diagnosed?

Adulthood

Signs of IgA deficiency

Typically asymptomatic, though recurrent bacterial sinopulmonary infections can occur

Severe combined immunodeficiency usually results from

X linked mutations

Signs of severe combined immunodeficiency

Recurrent severe infections, poor growth, chronic diarrhea, death by 12 months without stem cell transplant

Treating severe combined immmunodeficiency

Hematopoetic stem cell transplant

Typical presentation of myasthenia gravis

Fluctuating, fatiguable muscle weakness that worsens with repetitive motion and improves with rest

MG is caused by

Autoantibodies directed against nicotinic AcH receptors at the NMJ

Achalasia occurs due to

The desecration of Neurons within the myenteric plexus

MS is characterized by

Inflammatory demyelination of axons in the CNS

Acute urticaria is caused by

Mast cell activation in the superficial dermis

Initial management of acute urticaria includes

Second generation H1 blocker eg. Cetirizine

Photosensitive rash along with multisystemic symptoms is suspicious for

SLE

ANA assay is highly sensitive for

SLE

How do you test for SLE

ANA assay

High reticulocyte count anemia is usually due to

Acute bleeding or hemolysis

The most common nutritional deficiency in infants is

Iron deficiency

In thalassemia the iron and ferritin levels are

Normal or high

In thalassemia, reticulocytes and total bilirubin count is

Increased due to hemolysis

TSAT is calculated by

serum iron / TIBC

What type of anemia is caused by folate and vitamin b12 deficiency

Megaloblastic anemia

High MCV, high MCH, normal hemoglobin

Megaloblastic anemia

Inherited defect in RBC membrane that presents with hemolytic anemia, jaundice, splenomegaly

Hereditary spherocytosis

Hemophilia A has absent or low factor

VIII 8

Hemophilia B has low or absent factor

IX 9

Phenytoin can cause what kind of anemia?

Megaloblastic anemia due to folic acid deficiency

Patients on phenytoin should be supplemented with

Folic acid

Medications that commonly cause megaloblastic anemia include

Methotrexate, TMP, phenytoin

Risk factors for MS

Female, Caucasian, low vitamin D levels, smoking

Vitamin deficiency that can lead to pancytopenia with normal coagulation studies

Vitamin B12 deficiency

Treating stroke in sickle cell disease

Exchange transfusion - increases carrying capacity, improves hyper-viscosity, limits further occlusion

What kind of anti coagulant is appropriate for treating patients with ischemic stroke due to atherosclerosis, small vessel disease, or thromboembolism?

Antiplatelet agents

Allergic contact dermatitis is which type of hypersensitivity reaction?

Type IV, cell mediated

Treating allergic contact dermatitis

Topical corticosteroids and avoidance of the allergen