Essential Hematology Part 1 Flashcards
ID this cell and name a marker
Myeloblast
Myeloperoxidase
ID morphology of these RBCs and mention 3 causes when you find these types of RBC
Microcytic Hypochromic RBC
+ Anisocytosis
Increased central pallor
Diet
Chronic Bleeding- Peptic ulcers, colonic neoplasms, dysfunctional uterine bleeding
Mention the changes seen in the following indices in the haematological disease shown in the image:
TIBC:
Transferrin Saturation:
Marrow Iron:
Haemoglobin A2:
TIBC: High/elevated
Transferrin Saturation: decreased
Marrow Iron: decreased
Haemoglobin A2: Normal (low in Beta- thal.)
A 54-year-old hospitalised patient developed minor fatigue on exertion. He has been hospitalised for the past 4 months due to his COPD. On physical examination, there are no remarkable findings. Laboratory studies show haemoglobin of 11.7 g/dL, hematocrit of 34.8%, MCV of 73 μm3, platelet count of 315,000/mm3, and WBC count of 8035/mm3. Which of the following is the most sensitive and cost-effective test that the physician should order to help to determine the cause of these findings?
A Bone marrow biopsy
B Hemoglobin electrophoresis
C Serum ferritin
D Serum haptoglobin
E Serum iron
F Serum transferrin
Serum ferritin
Key: hospitalised patient developed minor fatigue on exertion. He has been hospitalised for the past 4 months due to his COPD
The serum iron concentration or transferrin level by itself gives no indication of iron stores because in anemia of chronic disease, the patient’s iron level can be normal to low, and the transferrin levels also can be normal to low, but iron stores are increased.
A patient with chronic anemia and splenomegaly since birth. RBC morphology is shown in the figure.
Diagnose the RBC morphology.
Spherocytes
A patient with chronic anemia and splenomegaly since birth (autosomal dominant). RBC morphology is shown in the figure.
Diagnose the disease and cause of this change.
Hereditary Spherocytosis
Deficiency of spectrin deficiency
A patient with hemolytic anaemia, presented with huge splenomegaly.
A biopsy of the spleen would show the cells as below.
Diagnosis?
These are megakaryocytes.
Myeloid metaplasia
When do you observe myeloid metaplasia
Excessive hemolysis
A 3-year-old boy has a poor appetite and is underweight for his age and height. Physical examination shows hepatosplenomegaly. The hemoglobin concentration is 6 g/dL, and the peripheral blood smear shows severely hypochromic and microcytic RBCs. The total serum iron level is normal, and the reticulocyte count is 10%. A radiograph of the skull shows maxillofacial deformities and expanded marrow spaces. Which of the following is the most likely cause of this child’s illness?
A Imbalance in α-globin and β-globin chain production
B Increased fragility of erythrocyte membranes
C Reduced synthesis of hemoglobin F
D Relative deficiency of vitamin B12
E Sequestration of iron in reticuloendothelial cells
Imbalance in α-globin and β-globin chain production
This patient has β-thalassemia major. In this condition, there is a severe reduction in the synthesis of β-globin chains without impairment of α-globin synthesis. The free, unpaired α-globin chains form aggregates that precipitate within normoblasts and cause them to undergo apoptosis. The death of RBC precursors in the bone marrow is called “ineffective erythropoiesis.” Not only does this cause anemia, but it also increases the absorption of dietary iron, giving rise to iron overload, which results in hemochromatosis with infiltrative cardiomyopathy, hepatic cirrhosis, and “bronze diabetes” from pancreatic islet dysfunction
Why is spleen like as shown Sickle cell anemia?
Vasooccultion by sickled cells=infarction=fibrosis
In sickle cell anemia, the cumulative ischemic damage to the spleen results in autosplenectomy, leaving behind a small fibrotic remnant of this organ. The impaired splenic function and resultant inability to clear bacteria from the bloodstream can occur early in childhood, leading to risk for infection with encapsulated bacterial organisms
Which infections are common is a patient with splenectomy or loss of spleen function?
Pneumococcus, Meningococcus
The impaired splenic function and resultant inability to clear bacteria from the bloodstream can occur early in childhood, leading to risk for infection with encapsulated bacterial organisms
In which condition a patient’s bone marrow will look like the image?
Aplastic Anemia
AKA- Hypocellular marrow
Replacement of marrow by fat occurs in aplastic anemia, which is characterized by pancytopenia. Many cases are idiopathic, although some can follow toxic exposures to chemotherapy drugs or to chemicals, such as benzene. Some cases may follow viral hepatitis infections. An intrinsic defect in stem cells, or T lymphocyte suppression of stem cells, can play a role in the development of aplastic anemia.
A 44-year-old woman has a 2-week history of multiple ecchymoses on her extremities after only minor trauma. She also reports feeling extremely weak. Over the previous 24 hours, she has developed a severe cough productive of yellowish sputum.
Laboratory studies show hemoglobin, 7.2 g/dL; hematocrit, 21.4%; MCV, 88 μm3; platelet count, 35,000/mm3; and WBC count, 1400/mm3 with 20% segmented neutrophils, 1% bands, 66% lymphocytes, and 13% monocytes. The reticulocyte count is 0.1%.
Diagnose the blood picture= CBC.
Pancytopenia
A 23-year-old woman in her 25th week of pregnancy has felt no fetal movement for the past 3 days. Three weeks later, she still has not given birth and suddenly develops dyspnea with cyanosis. On physical examination, her temperature is 37° C, pulse is 106/min, respirations are 23/min, and blood pressure is 80/40 mm Hg. She has large ecchymoses over the skin of her entire body. A stool sample is positive for occult blood. Laboratory studies show an elevated prothrombin time and partial thromboplastin time. The platelet count is decreased, plasma fibrinogen is markedly decreased, and fibrin split products are detected. A blood culture is negative. Which of the following is the most likely cause of her bleeding diathesis?
A Consumption of coagulation factors
B Defects in platelet aggregation
C Increased vascular fragility
D Reduced production of platelets
E Toxic injury to the endothelium
Consumption of coagulation factors
The presence of thrombocytopenia, increased prothrombin and partial thromboplastin times, and fibrin split products, and the low fibrinogen concentration all suggest disseminated intravascular coagulation (DIC)
A 9-year-old boy has developed prominent bruises on his extremities over the past week. On physical examination, he has ecchymoses and petechiae on his arms and legs. Laboratory studies show hemoglobin, 13.8 g/dL; hematocrit, 41.9%; MCV, 93 μm3; platelet count, 11,300/mm3; and WBC count, 7720/mm3. He had respiratory syncytial virus pneumonia 3 weeks ago. His condition improves with corticosteroid therapy. Which of the following abnormalities is most likely to cause his hemorrhagic diathesis?
A Antiplatelet antibodies
B Bone marrow aplasia
C Glycoprotein IIb/IIIa dysfunction
D Vitamin C deficiency
E Von Willebrand factor metalloproteinase deficiency
A Antiplatelet antibodies
Mention why these RBCs have shapes like this–?
Structurally abnormal Hb S – on deoxygenation polymerization = gelation or crystallization
Mechanism of organ damage this condition (see image)
Crystallization → Rigid sickle Shape- → microvascular obstruction → ischemic tissue damage + ↑ removing in the spleen = splenic fibrosis; aka-“autosplenectomy“
Why do you get low hematocrit in the disease that shows the cells below in the blood?
Immune helolytic destruction of RBC by IgG
Please examine the image. This patient is undergoing B12 therapy.
These two graphs illustrate how haemoglobin and reticulocyte levels will change during the course of B12 therapy in a case of B12 deficiency.
Which line depicts Hemoglobin and which one is for reticulocytes?
Red- Hemoglobin
Blue: reticulocytes (the level picks between days 7-8)
