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Blood and Immunology Flashcards

1
Q

DDx microcytic anemia (3)

A
  1. Iron deficiency, 2. Thalassemia, 3. Chronic inflammation
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2
Q

Normocytic anemia DDx

A

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

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3
Q

Macrocytic anemia DDx

A

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

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4
Q

Risk factors for Hodgkin lymphoma

A

EBV, immunosupression/HIV, autoimmune diseases

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5
Q

signs of acute hemolytic transfusion reaction

A

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

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6
Q

Signs of hemolysis on labs

A

Low haptoglobin and high LDH

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7
Q

Delayed hemolytic transfusion reaction causes hemolysis where?

A

Extravascular hemolysis in the reticuloendothelial system (spleen)

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8
Q

Reticuloendothelial system organ is

A

Spleen

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9
Q

Preventing hemolytic disease of the fetus

A

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

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10
Q

Neonatal Alloimmune thrombocytopenia mechanism

A

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

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11
Q

Transfusion related acute lung injury (TRALI)

A

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

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12
Q

Transfuse if Hgb is less than

A

70

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13
Q

How many platelets in a donor pack

A

30x10^10

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14
Q

Shelf life of platelets

A

7 days

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15
Q

Female donor plasma is used to make

A

Albumin and IvIg

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16
Q

Male plasma is used for

A

Transfusion, cryosupernatant, cryoprecipitate

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17
Q

INR threshold for transfusion

A

INR 1.6

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18
Q

Immune mediated transfusion complications

A

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

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19
Q

Non immune mediated hazards of transfusion

A

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

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20
Q

Pattern recognition receptors are a component of which immune system

A

Innate immune system

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21
Q

B and T cells are associated with which type of immunity

A

Adaptive

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22
Q

Antigen receptor type on B cells

A

Ig

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23
Q

Central tolerance immune system happens in

A

Thymus and bone marrow

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24
Q

Autoantibodies associated with rheumatoid arthritis

A

Rheumatoid factor, antibodies against citrullinated protein antigens (ACPA)

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25
Q

MHC presents the antigen to

A

T cell receptors

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26
Q

CD28 is located in

A

The T cell

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27
Q

HLA-B27 is associated with

A

Ankylosing spondylitis

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28
Q

Kawasaki disease is a

A

Medium vessel vasculitis affecting children

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29
Q

In SLE, autoantibodies are to

A

The cell nucleus

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30
Q

SLE arthritis is

A

Non erosive in a distribution like rheumatoid arthritis

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31
Q

SLE manifestations (renal)

A

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

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32
Q

CNS manifestations neurologic

A

Stroke, vasculitis, seizures, psychosis

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33
Q

Hematologic disorders of SLE

A

Hemolytic anemia, leukopenia, thrombocytopenia

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34
Q

Autoantibodies specific to SLE

A

Anti-dsDNA

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35
Q

ANA+ in what % of SLE cases

A

> 95%

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36
Q

The presentation of SLE is

A

Heterogenous - some kind of antibodies, and inflammation

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37
Q

Drug classes used to treat SLE include

A

Antimalarials, corticosteroids, immunosuppressants, and biologicals

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38
Q

SLE stands for

A

Systemic lupus erythematosus

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39
Q

Type I hypersensitivity is how fast?

A

Immediate

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40
Q

Type I hypersensitivity mediated with Ig…what?

A

IgE

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41
Q

Allergic reactions are usually which type of hypersensitity

A

Type I, IgE mediated q

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42
Q

Type II hypersensitivity involves which Ig?

A

IgM or IgG

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43
Q

Thrombocytopenia and hemolytic anemia are which type of hypersensitivity

A

Type II

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44
Q

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

45
Q

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

A

Type IV hypersensitivity

46
Q

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

47
Q

Sjogrens occurs secondary to

A

RA, SLE, Scleroderma, myositis

48
Q

Sjogrens on bloodwork

A

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

49
Q

In cryoglobulinemia, autoantibodies

A

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

50
Q

Malignancy in Sjogrens

A

44x fold increased risk for lymphoma, usually MALT

51
Q

MALT stands for

A

Mucosa associated lymphoid tissue

52
Q

Localized scleroderma presents s

A

Morphea and linear scleroderma

53
Q

Raynaud’s phenomenon is

A

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

54
Q

Raynauds is common in what demographic?

A

Young women

55
Q

Raynauds - what lifestyle changes for treatment? What medication?

A

Stop smoking, keep warm. Treat medically with vasodilator.

56
Q

Vasodilator classes for raynauds treatment (3)

A

CCB, ARBs, nitrates

57
Q

Lab work in scleroderma

A

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

58
Q

Treating scleroderma

A

Treat specific organ manifestations

59
Q

What is elevated in polymyositis

A

CK, CPK, 50% ANA +

60
Q

Dermatomyositis has a characteristic rash consisting of

A

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

61
Q

Palpable purpura is

A

Non blanching, palpable, lower extremity predominant

62
Q

Lab work glomerulonephritis

A

High creatinine, proteinuria, RBC casts

63
Q

Mononeuritis multiplex

A

Ischemia of vessels supplying nerves leads to periopheral nerve damage

64
Q

Large vessel vasculitis includes

A

Takayasu’s arteritis, giant cell arteritis

65
Q

Stenosis of the aorta and major branches is called

A

Takayasu’s arteritis

66
Q

GCA affects people aged

A

Older than 50

67
Q

Jaw claudication in GCA is due to

A

Ischemia of the muscles of mastication

68
Q

Vision changes in GCA due to

A

Retinal artery occlusion

69
Q

Treatment of GCA is with

A

High dose steroids, and low dose ASA

70
Q

Areas affected by polymyagia rheumatica

A

Pectoral and pelvic girdles

71
Q

Bloodwork for polymyalgia rheumatica

A

High ESR CRP, anemia of chronic disease

72
Q

Treating polymyalgia rheumatica

A

Low dose steroids

73
Q

What antibody has high specificity for GPA

A

C-ANCA (vs PR-3)

74
Q

Churg strauss syndrome is also known as

A

Eosinophilic granulomatosis with polyangitits

75
Q

Characteristic of Eosinophilic granulomatosis with polyangiitis

A

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

76
Q

When is eosinophilic granulomatosis with polyangitis typically diagnosed?

77
Q

Signs of IgA deficiency

A

Typically asymptomatic, though recurrent bacterial sinopulmonary infections can occur

78
Q

Severe combined immunodeficiency usually results from

A

X linked mutations

79
Q

Signs of severe combined immunodeficiency

A

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

80
Q

Treating severe combined immmunodeficiency

A

Hematopoetic stem cell transplant

81
Q

Typical presentation of myasthenia gravis

A

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

82
Q

MG is caused by

A

Autoantibodies directed against nicotinic AcH receptors at the NMJ

83
Q

Achalasia occurs due to

A

The desecration of Neurons within the myenteric plexus

84
Q

MS is characterized by

A

Inflammatory demyelination of axons in the CNS

85
Q

Acute urticaria is caused by

A

Mast cell activation in the superficial dermis

86
Q

Initial management of acute urticaria includes

A

Second generation H1 blocker eg. Cetirizine

87
Q

Photosensitive rash along with multisystemic symptoms is suspicious for

88
Q

ANA assay is highly sensitive for

89
Q

How do you test for SLE

90
Q

High reticulocyte count anemia is usually due to

A

Acute bleeding or hemolysis

91
Q

The most common nutritional deficiency in infants is

A

Iron deficiency

92
Q

In thalassemia the iron and ferritin levels are

A

Normal or high

93
Q

In thalassemia, reticulocytes and total bilirubin count is

A

Increased due to hemolysis

94
Q

TSAT is calculated by

A

serum iron / TIBC

95
Q

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

A

Megaloblastic anemia

96
Q

High MCV, high MCH, normal hemoglobin

A

Megaloblastic anemia

97
Q

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

A

Hereditary spherocytosis

98
Q

Hemophilia A has absent or low factor

99
Q

Hemophilia B has low or absent factor

100
Q

Phenytoin can cause what kind of anemia?

A

Megaloblastic anemia due to folic acid deficiency

101
Q

Patients on phenytoin should be supplemented with

A

Folic acid

102
Q

Medications that commonly cause megaloblastic anemia include

A

Methotrexate, TMP, phenytoin

103
Q

Risk factors for MS

A

Female, Caucasian, low vitamin D levels, smoking

104
Q

Vitamin deficiency that can lead to pancytopenia with normal coagulation studies

A

Vitamin B12 deficiency

105
Q

Treating stroke in sickle cell disease

A

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

106
Q

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

A

Antiplatelet agents

107
Q

Allergic contact dermatitis is which type of hypersensitivity reaction?

A

Type IV, cell mediated

108
Q

Treating allergic contact dermatitis

A

Topical corticosteroids and avoidance of the allergen

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