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Pathophysiology 321 Exam > Erythrocyte Disorders) > Flashcards

Erythrocyte Disorders) Flashcards

1
Q

In a CBC:

RBC measures

Hemoglobin measures

Hematocrit measures

MCV measures

MCHC measures

A

RBC = # of red blood cells

Hemoglobin = Amount of hemoglobin in blood (Red color, oxygen carrying)

Hematocrit = Percent of volume that RBCs take up in blood

MCV = Average volume (size) of red blood cells
–>Microcytic, normocytic, Macrocytic

MCHC = Concentration of hemoglobin in an average red blood cell
–> Hypochromic, Normochromic

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2
Q

Anemias are defined on the basis of….

A

Cell Size (MCV) and amount of Hgb (MCH)

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3
Q

If MCV is less than the lower limit of normal it is what type of anemia?

Normal Range?

Greater than the upper limit?

A

Microcytic Anemia

Normocytic Anemia

Macrocytic Anemia

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4
Q

If MCH is less than the lower limit of normal, it is what type of anemia?

If MCH is within the normal range?

A

Hypochromic Anemia

Normochromic Anemia

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5
Q

An means

Emia means

A 
An = Without
Emia = blood
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6
Q

This is defined as a reduction in HEMOGLOBIN concentration in circulating blood, resulting in tissue hypoxia due to lack of oxygen-carrying capacity of blood

A

Anemia

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7
Q

Symptoms of this illness include pale skin and mucous membranes, jaundice (if hemolytic), Tachycardia, Breathlessness, Dizziness, and Fatigue

A

Anemia

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8
Q

There are three ways to become anemic…

A

Lose Blood

Destroy Too Much Blood (hemolysis)

Make Too Little Blood

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9
Q

Hemolysis (anemia) can happen for 2 reasons

A

Extracorpuscular

Intracorpuscular

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10
Q

When the cause of anemia is losing blood, it is what type of anemia?

When the cause is destruction of too much blood, it is what type of anemia?

When the cause is making too little blood, it is what type of anemia?

A

Blood loss (hemorrhage)

Hemolytic

Bone marrow suppression/nutritional deficiencies

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11
Q

The etiology of blood loss anemia is traumatic, acute blood loss NOT > 20%

At first the hemoglobin level is normal. After 2-3 days, we see what (have ribosomal RNA, and no nucleus)?

Chronic Blood loss is different, and due to…

A

Reticulocytes

Iron Deficiency Anemia

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12
Q

Hemolytic anemia is due to decreased red cell lifespan. It can be chronic or acute.

This type is inherited and due to red cell defects

This type is aquired

A

Intracorpuscular

Extracorpuscular

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13
Q

In hemolytic anemia, increased bilirubin, increased LDH, and decreased haptoglobin are signs of….

A

Destruction

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14
Q

In hemolytic anemia, increased reticulocytes and nucleated red cells in blood are signs of….

A

Production (of red cells?)

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15
Q

This extracorpuscular cause of hemolytic anemia is due to physical trauma to red cells, schistocytes (fibrin strands that shred RBCs), and triangulocytes. It is important to find out why it is occurring

A

Microangiopathic Hemolytic Anemia

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16
Q

The causes of this illness include:

Artificial Heart Valves
Malignancy
Obstetric Complications
Sepsis
Trauma
A

Microangiopathic Hemolytic Anemia

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17
Q

This type of anemia is characterized by IgG, the spleen, and spherocytes

A

Warm Autoimmune Hemolytic Anemia (Warm AIHA)

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18
Q

This type of anemia is characterized by IgM, complement, intravascular hemolysis, and agglutination

A

Cold Autoimmune Hemolytic Anemia (Cold AIHA)

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19
Q

This is the most common form of AIHA

_____ antibodies bind to RBCs best at 37 degree body temperature (98.6F)

What occurs in the spleen?

A

Warm AIHA

IgG

Splenomegaly

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20
Q

In Warm AIHA, these RBCs are formed from nibbling by macrophages (Kupfer cells) causing loss of membrane, leading to a spherical shape

A

Spherocytes

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21
Q

This is the less common AIHA

_____ antibody binds to RBCs at 0-4 degrees celsius, in the ears, hands, and toes in cold weather

It causes extravascular hemolysis via membrane attack complexes in what organs? (2)

A

Cold AIHA

IgM

Spleen and Liver

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22
Q

In cold AIHA, this is binding of IgM that causes cross linking of red cells, and sludging of blood

What can it ultimately lead to?

A

Agglutination

Raynaud’s Phenomenon

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23
Q

This is a test for AIHAs, it can detect the antibodies on RBCs using blood samples

A

Direct Coombs Test/Direct Antiglobulin Test

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24
Q

A determination of warm AIHA is positive for what?

A determination of cold AIHA is positive for what?

A

IgG

Compliment

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25
Q

Warm AIHA can be secondary to 2 things

It can also be induced by:

A

Lymphoproliferative Disorder and Autoimmune Disease

Drugs

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26
Q

Cold AIHA can be secondary to 2 things

A

Infection and Lymphoproliferative Disorder

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27
Q

What is found in the blood film of warm AIHA

Cold AIHA?

A

Warm: Spherocytes

Cold: Agglutination

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28
Q

This is an intracorpuscular anemia characterized by QUALITATIVE defect in hemoglobin (aka hemoglobinopathy)

A

Sickle Cell Anemia

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29
Q

This intracorpuscular anemia is characterized by a single AA substitution in the beta chain of hemoglobin

It can be heterozygous or homozygous, which has worse prognosis?

It creates these cells which are fragile (burst easily), and they get stuck in vessels

A

Sickle Cell Anemia

Homozygous

Sickle Cells

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30
Q

In sickle cell anemia, what kind of mutation occurs in the Beta chain gene, leading to abnormal beta chains?

The cell will aggregate and polymerize upon deoxygenation. They get stuck in vessels and are fragile.

A

Point Mutation (valine substituted for glutamate)

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31
Q

Sickle Cell Anemia is more prominent in what ethnic group?

It’s severity is variable

A

Blacks

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32
Q

What 3 things does sickle cell disease cause?

Treatment includes preventing triggers, vaccinating, and blood transfusion

A

Chronic Hemolysis, vaso-occlusive disease, and increased infections

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33
Q

This intracorpuscular anemia is a hereditary QUANTITATIVE defect in Hb. Not enough alpha or beta chains can be made. It has variable disease severity

A

Thalassemia

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34
Q

What type of anemia is thalassemia?

A

Hypochromic, microcytic with increased RBC and target cells

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35
Q

This blood disease causes tons of spherocytes with a spectrin defect.

What cures it?

A

Hereditary Spherocytosis

Splenectomy

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36
Q

Hereditary Spherocytosis is autosomal ______

It causes a defect in the RBC membrane due to a mutation in ______, a membrane protein

A

Dominant

Spectrin

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37
Q

Hereditary Spherocytosis causes spheroidal erythrocytes called ______ that are more vulnerable to sequestration/destruction by the spleen

On smears, red cells lack normal central pallor

Also, splenomegaly (enlargement of spleen)

A

Spherocytes

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38
Q

40-50% of patients with hereditary spherocytosis experience _____

A

Gall stones (cholelithiasis)

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39
Q

Glucose-6-Phosphate Dehydrogenase Deficiency causes increased ______ which cause cell lysis

Related to exposure to what kind of drug?

G6PD is self limiting

A

Peroxides

Oxidative Drug

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40
Q

What cells develop in G6PD due to removal of Heinz bodies?

A

Bite Cells

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41
Q

In G6PD, some patients are asymptomatic

Other have _____________ hemolysis triggered by broad beans (favism-Africa), drugs (antibiotics, aspirin, infections)

It resolves spontaneously

A

Episodic hemolysis

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42
Q

Look at chart on the role of G6PD on slide 62 related to pentose phosphate pathway

A

!

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43
Q

G6PD deficient cells die in part due to reduced ______, oxidants attack hemoglobin bonds

This causes heme to break away from globin, globin denatures and sticks to the RBC membrane, forming ______

This organ bites out Heinz bodies, leading to bite cells?

A

GSH

Heinz Body

Spleen

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44
Q

Anemia associated with making too little blood has too few building blocks, like this type

Or it can be due to too few erythroblasts, like this type

Or there could be not enough room, like this type

A

Iron Deficiency Anemia

Aplastic Anemia

Myelophthlistic Anemia

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45
Q

The most important cause of iron deficiency anemia is

A

GI Bleeding

46
Q

What category of anemia is iron deficiency anemia?

It’s a symptom, not a disease! Must find cause.

A

Microcytic, hypochromic anemia

47
Q

This is a symptom of iron deficiency anemia, tongue inflammation/loss of papilla

A

Atrophic Glossitis

48
Q

There are 3 causes of iron deficiency

A

Decreased iron intake (bad diet, bad absorption)
Increased iron loss (GI bleeding, menstrual cycle, hemorrhage)
Increased iron requirement (pregnancy)

49
Q

Anemia caused by infections (osteomyelitis, endocarditis), inflammation (immune disorders like RA), and malignancy are anemias of chronic disease. Iron metabolism may be disturbed. It is usually mild anemia. What type of anemia is it?

A

Normochromic, normocytic

50
Q

These are anemias of defective DNA synthesis, and has nuclear/cytoplasmic asynchrony

It is caused by a decrease in these molecules, associated with pernicious/folate anemia

A

Megaloblastic anemia

B12/Folate

51
Q

What type of anemia is a megaloblastic anemia?

A

Macrocytic, hyperchromic

52
Q

Vitamin B12 is needed to make..

A

DNA! (Megaloblastic anemias)

53
Q

Anemias of Chronic Diseases are caused by,..

Iron metabolism is disturbed

What are the RBCs under the microscope?

Is anemia mild or severe?

A

Infections
Inflammation
Malignancy

Normochromic, normocytic

Mild

54
Q

Megaloblastic anemia is initially caused by retarded _____ synthesis

Which leads to impaired ____ synthesis

Which leads to cells that look like what?

A

DNA

RNA

Big cells, with immature nucleus and mature cytoplasm

55
Q

This can occur with megaloblastic anemia, and includes tongue swelling and loss of papilla (discussed earlier as well)

A

Atrophic Glossitis

56
Q

This type of anemia is characterized by pancytopenia (deficiency of all three cellular components of the blood), empty marrow, and idiopathic etiology

A

Aplastic Anemia

57
Q

There are 5 potential causes of aplastic anemia

A 
Idiopathic
Drugs
Viruses
Pregnancy
Fanconi Anemia
58
Q

This red blood cell disorders causes RBCs to be released from marrow in excess quantities. It has an unknown cause.

A

Polycythemia

59
Q

Polycythemia is caused by hyperplasia of what?

A

Erythroid Precursors

60
Q

In polycythemia, increased MCV/ viscosity leads to….

What disease develops?

A

Organ Congestion

Leukemia

61
Q

This anemia is when there is not enough room

A

Myelophthisic Anemia

62
Q

What is the cause of myelophtisic Anemia?

Associated with anemia and thrombocytopenia

A

Extensive inflitration of marrow by a tumor/lesion

metastatic breast, lung, or prostate cancer, and advanced TB

63
Q

Right heart failure leads to what?

A

Congestion of peripheral tissues which leads to liver and tract congestion, as well as edema and ascites

64
Q

Left heart failure leads to what?

A

Decreased cardiac output (leads to activity intolerance and signs of decreased tissue perfusion)

Pulmonary congestion

65
Q

When left heart failure leads to pulmonary congestion, what occurs?

A

Impaired gas exchange and pulmonary edema (look at diagram with heart on it)

66
Q

Cyanosis and pulmonary edema (dyspnea) are consequences of failure on which side of the heart?

A

Left

67
Q

Hepatomegaly, jugular venous distention, splenomegaly, ascites, and peripheral edema are consequences of failure on which side of the heart?

A

Right

68
Q

This is a major health problem affecting 25% of the population, it is asymptomatic until late. It contributes to coronary artery disease, stroke, cardiac hypertrophy, and heart failure

A

Hypertension

69
Q

What is the cause/mechanism of hypertension?

A

Depends, but largely unknown (idiopathic)

70
Q

What is the clinical measure of hypertension?

A

> 140/90

71
Q

This is idiopathic hypertension, and comprises 95% of hypertension cases

A

Essential Hypertension

72
Q

This hypertension comprises 5% of hypertension cases

A

Secondary Hypertension

73
Q

This is the classification for BP > 180/120

A

Malignant Hypertension

74
Q

This is hypertension that is urgent (180/110) or is an emergency (with end organ damage)

A

Hypertensive Crisis

75
Q

What are the boundaries for classification of hypertension?

A

Normal
>120 and >80

Pre-hypertensive
120-139 or 80-89

Stage I
140-159 or 90-99

Stage II
greater than or equal to 160, or greater than or equal to 100

76
Q

White essential hypertension is idiopathic, it may be related to:

Reduced ______ excretion

______ disease

______ factors

_____ factors

A

Sodium Excretion
Vascular Disease
Genetic Factors
Environmental Factors (Drug, EtOH)

77
Q

Essential hypertension accelerates what condition?

It potentiates what 2 conditions?

A

Atherogenesis

Aortic Dissection and Stroke

78
Q

Essential hypertension causes small blood vessels to narrow, especially in this organ

It hardens the arteries, leading to either:

Benign hypertension, called

Severe Hypertension, called

A

Kidneys

Hyaline Arteriosclerosis

Hyperplastic arteriosclerosis

79
Q

This is defined as normal, clot free blood flow that is able to form a hemostatic plug if there is vascular injury

A

Hemostasis

80
Q

This is the pathological counterpart of hemostasis, the formation of a blood clot within a vessel

A

Thrombosis

81
Q

This is a solid mass of coagulated blood inside an uninjured vessel in the cardiovascular system (or after a relatively minor injury

It may be life saving or life threatening, clotting stops bleeding but can block a blood vesse

A

Thrombosis

82
Q

This is an intravascular solid, liquid, or gaseous mass carried by the blood to a site distant from its point of origin

What do they mostly derive from?

A

Embolism

Thrombuses (this process is called thromboembolism)

83
Q

Eventually, emboli lodge in vessels that are too small.

This type of embolism causes necrosis of downstream tissue (infarction)

This type of embolism causes hypoxia, hypotension, right sided heart failure

A

Systemic Embolization

Pulmonary Embolization

84
Q

This is the term for venous emboli that eventuall block pulmonary arteries, leading to death.

Most are small and silent

A

Pulmonary Thromboembolism

85
Q

Pulmonary thromboembolisms originate 95% of the time from?

A

Deep Vein Thrombosis (thrombi in deep leg)

86
Q

This is an arterial emboli

80% arise from ____________ Thrombi

Final resting place depends upon their point of origin

75% or the time it ends up here

10% of the time it ends up here

A

Systemic Thromboembolism

Intracardiac Mural Thrombi

Lower extremities (75%)

CNS (10%)

87
Q

When an infarct occurs in a myocardial location is called

A

Coagulative Necrosis

88
Q

When an infarct occurs in a cerebral location it is called

A

Liquefactive Necrosis

89
Q

When an infarct occurs in the pulmonary system, it is called this and associated with this disease

A

Caseous Necrosis

TB

90
Q

When an infarct occurs in the bowels it is called

A

Liquefactive Necrosis

91
Q

When an infarct occurs in the distal extremities, it is called

A

Gangrenous Necrosis

92
Q

This is a retroviral disease of the lentivirus family and is characterized by a depletion of CD4+ T-lymphocytes and profound immunosuppression

A

AIDS

93
Q

How many people are infected with AIDS in the US?

In Africa?

When were the peak number of deaths in

A

1 million

23 million

1995 (it’s been declining since)

94
Q

Transmission of AIDS occurs via

What percent of it occurs in male-male sex?

Heterosexual contact?

IV Drug Use?

Blood Transfusion?

Parental Transmission to fetus/newborn?

A

Exchange of blood or bodily fluids

48%

34%

16%

1%

1%

95
Q

AIDS transmission is extremely low risk for dentists when protective barriers are worn

Seroconversion from a needle stick/exposure of nonintact skin from an HIV patient occurs at what percent per exposure?

For a patient with hepatitis it is…

A

0.3%

6-30%

96
Q

What is the structure of HIV?

A

RNA retrovirus

97
Q

How many strands of RNA are in the AIDS virus?

What core does it have?

What type of membrane does it have, where is it derived from, and what does it have in its surface

A

2 single strands

Viral protein core (p24)

Phospholipid bilayer derived from the host cell membrane and studded with gp120 and gp41

98
Q

HIV entry into host cells requires what molecule?

What envelope protein of the virus fuses with the CD4 cell membrane, binding the virion to the cell?

Which envelope protein inserts into the target membrane, fusing the virus with the cell?

The virus then enters what part of the host cell?

A

CD4

gp120

gp41

Cytoplasm

99
Q

In the progression of HIV infection, during initial infection, the first cells infected are ____________

This results in major depletion of lymphocytes

A

Mucosal Lymphoid tissue CD4+ T cells

100
Q

In the progression of HIV infections, during the acute phase (which is after initial infection), viral replication leads to _____ within days (about 3-6 weeks)

The host immune response is termed

A

Viremia

Acute HIV Syndrome

101
Q

This occurs during the acute phase of HIV infection, and is nonspecific symptoms of any virus like fever, sore throat, occurring between weeks 3-17

So viral load is low at 12 weeks

A

Acute HIV Syndrome

102
Q

During progression of HIV infection, during the chronic phase (after the acute phase), there is continued T cell depletion with new CD4 cells being made but unable to keep up with loss for several years

What occurs?

A

Asymptomatic or persistent lymphadenopathy

May have zoster or candida infection

103
Q

During this phase of progression of an HIV infection, the CD4 count is less than 500 cells/ul, fever is present for one month, and there is weight loss/fatigue

A

Crisis Phase

104
Q

During this phase of progression of HIV infection, the CD4 cell count is less than 200 cells/uL, leading to pneumonia/TB, opportunistic infections, malignancies, AIDS dementia

It occurs by how many years if left untreated?

A

AIDS

10 years (antiretrovirals have changed the course of the disease)

105
Q

Regarding cells affected by HIV, these are the first immune cells effected

Its count eventually declines, and this ratio declines as well

A

CD4+ Inducer T cells

Helper/suppressor ratio (CD4/CD8 ratio)

106
Q

These cells are affected by HIV becasue there is reduced response to specific antigens due to loss of stimulation from T-helper cells

A

B cells

107
Q

These cells affected by HIV are mucosal and capture the virus, transporting it to regional lymph nodes.

Follicular ones in the germinal centers of lymph nodes are important ______ of HIV

A

Dendritic Cells

Reservoirs

108
Q

These cells are affected in tissues by HIV, like CD4 T cells

Where specifically does this occur?

Why are they a good reservoir for HIV?

A

Monocytes/Macrophages

Brain and Lungs

They are resistant to the cytotoxic effects of HIV

109
Q

(AIDS malignancies) This used to be the most common AIDS tumor, but has decreased due to antiretroviral treatment

What areas does it affect

What virus causes it?

A

Kaposi Sarcoma

Mouth, skin, lungs

Herpes virus HHV-8

110
Q

This is the 2nd most common AIDS malignancy in patients

What virus plays a role?

Lymphoma of the _____ is considered an AIDS defining condition

A

Non-Hodgkin Lymphoma

EBV

Brain

111
Q

AIDS defining cancers (Kaposi, Lymphoma) are on the decrease due to antiretrovirals

Non AIDS defining cancers are increasing

A

Liver Cancer, Hodgkins lymphoma, Anal Cancer

Pathophysiology 321 Exam (4 decks)

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