Blood Labs Flashcards
Describe the lab findings and 3 basic causes of iron deficiency
Also, what are the other anemia’s associated with a low MCV?
- Lab findings* Low MCV, low ferritin (unless inflammatory process), low serum Fe, high TIBC, low hemoglobin
- Other anemia’s with low MCV*
ACD (would have low TIBC and high ferritin) , thal, lead poisoning, Hb E hemoglobinopathy, siderblastic anemia
Causes
Bleeding, malabsorption, intake
Autoimmune hemolytic anemia
- Etiology?
- Symptoms?
- Findings on CBC/smear?
- Etiology*
- In*fections, drugs, CLL, lymphomas, idiopathic, other autoimmune diseases (ex. SLE)
- Symptoms*
The triad of hemolytic anemia - jaundice, anemia, and chronic splenomegaly
Findings on CBC/smear
Spherocytes, positive DAT, IgG positive, C3 positive
IF cold agglutination –> clumping of cells due to IgM, Rx is predisone or stay in warm temperatures (IgG neg, C3 pos)
Macrocytic anemia
- Etiology?
- Symptoms?
- Peripheral and lab tests findings
Etiology
Folate or B12 deficiency, hemolytic anemia - add other causes
Symptoms (thal on different cards)
General anemia symptoms –> neurological symptoms
Peripheral and Blood findings
High MMA/Homocysteine = B12, High homo only, could be folate
Hypersegmented neutrophils for folate and B12, macrocytic cells!
Name the diseases that causes MAHA and the findings on peripheral blood
Microangiopathic hemolytic anemia
Etiology
Thromcytic thrombocytopenia purpura (Ab to ADAMTS-13), hemolytic uremic syndrome (shiga toxin), disseminated intravascular coagulation (bleeding +/- thrombosis), extreme hypertension, HELLP
Smear findings
Helmet cells, schistocytes, polychromasia, low platelets
Sickle cell anemia
- Etiology
- Symptoms/Complications
- Tests and findings
- Treatment
Etiology
Autosomal recessive, two copies of Sickling hemoglobin gene –> HbS replaces all of the HbA. Heterzygotes are typically asymptomatic and resistant to malaria (but can show minor symptoms with very low oxygen or severe dehydration)
Symptoms
Various pain vaso-occulsive crises: acute chest syndrome, limb pain and abdo pain, dactilytis (sausage fingers due to inflam) and priapism (presistent painful erection)
Jaundice: hemolytic anemia (usually normocytic)
stroke: thrombi
infections from encapsulated organisms (N. menigititis, H. Influenza, Strep. Pneumo: patients usually have hyposplenism from repeated infarctions of spleen
Tests and findings
Howell jolly bodies and target cells (because of hyposplenism)
Sickle cells (under stress = metabolic acidosis, dehydration, and low O2 levels)
Hb electrophoresis or HPLC
Treatment
Avoid dehyration, O2 stress, acidosis
Hydroxerea to increase HbF
Exchange transfusion to give more HbA to replace HbS
Name two red cell membrane associated diseases and their findings on peripheral smear
- Hereditary elliptocytosis
- Elliptocytes on the smear, symptoms range from mild to severe anemia requiring splenectomy
- Anemia, splenomegaly and jaundice
- Hereditary Spherocytosis
- Looks exactly like autoimmune hemolytic anemia, spherocytes (circular, no pallor) on the smear.
- Also has a wide range of hemolytic anemia symptoms
Name the 4 reasons you would see reticulocytosis AND what that looks like on peripheral smear
- Bleeding
- Hemolysis
- Iron therapy
- Erythropoetin
You would see retics on smear (slighlty larger) and blue in color (polychromasia)
What causes basophilic stippling on a smear?
Lead poisoning
Basophilic stippling looks like little basophil granules on the periphery of an erythrocyte. It also causes a microcytic anemia. Treatment? Stop the lead!!!! Or chelation if severe. Diagnosis is serum lead.
Describe the clinical manifestations of malaria and the findings on the peripheral blood smear
Clinical
Anemia, rigors, jaundice, hemolytic anemia, fevers (cyclic shaking chills, sweating every 2 days)
Smear
See malarial organisms in the RBCs, stained small blue, sorta translucent like
List the findings on peripheral blood for someone with G6PD deficiency
- Heinz Bodies (denatured Hb on oxidative rxn –> looks like a blue dot on the actual periphery of an RBC
- Bite cells (macrophage has literaly taken a bite out of an RBC to remove the heinz body)
X-linked, shows up during oxidative stress. anti-malarials will cause the manifestations, so will other medications, fava beans, and infections
Alpha thalassemia findings on smear and genetics
Findings
HbH inclusions on RBCs
