Exam 2 Flashcards
How are anemias classified according to cause?
Increased red cell destruction= hemolytic
According to morphology?
Macrocytic Normochromic- means they’re not low in iron
Microcytic Hypocromic
Normocytic Normochromic-both normal
(No such thing as “hyperchromic”)
What are the symptoms of anemia
Weak, pallored, shortness of breath, hypotension (low BP), fatigue, increased cardiac output, syncope
Given the values for the red blood cell indices, suggest a possible diagnosis in the following
situations
increased MCV MCHC Normal
B12 Def (PA)
Folate def
Liver PA
Alcholism
Given the values for the red blood cell indices, suggest a possible diagnosis in the following
situations
MCV & MCHC Normal
Aplastic anemia… EVERYTHING ELSE
Given the values for the red blood cell indices, suggest a possible diagnosis in the following
situations
MCV ↓ MCHC ↓
IDA (iron defficency)
Thalassemia
Sideroblastic Anemica
Pb poisoning
What is the peripheral blood picture in vitamin B12 and folate deficiency?
oval
macrocitic
hypercegs
Pancytosemia
What do you see in the bone marrow? In vitamin b12 def and folate def
megaloblast
giant bands
precursor cells
What deficiency diseases cause megaloblastic erythropoiesis and what cellular consituents are
affected?
Vitamin B12 & Folic Acid
Affects DNA & RNA
What specifically causes pernicious anemia?
Lack of intrinsic factor
What main clinical manifestation distinguishes vitamin B12 deficiency from folic acid
deficiency
Pernicious anemia. Clinical manifestation is neurological symptoms relating to the myelin sheath.
What conditions can produce non-megaloblastic macrocytic anemia?
Alcoholism and liver disease are most common. Also hypothyroidism
What poikilocytes are often seen in liver disease
round macrocytes, target cells, acanthrocytes
What parameters are decreased in aplastic anemia and what bone marrow precursor cells are
decreased?
All precursor cells decreased, all cells decreased.
What is the peripheral blood picture in aplastic anemia and what would the reticulocyte count
be expected to be?
normocytic normochromic cells- no signs of increased red cell formation
decreased bone marrow
Retic= decreased
What are the most common causes of aplastic anemia?
Chemical exposure: Benzene and chloramphenicol
Radiation
Name several causes of myelophthisic anemia
Leukemia, Lymphomas, Multiple myeloma, Metastatic Carcinoma
What poikilocyte is especially associated with the above condition because it indicates
extramedullary hematopoiesis
Tear drop cells
What is the blood picture in chronic renal disease?
Normocytic
normochromic-burr cells, helmet cells
What is the main cause of anemia due to renal disease and to what kidney function test is the
anemia frequently proportional
Failure of kidney to produce erythropoietin.
Decreased EPO, BUN.
What are the characteristics of anemia due to chronic disorders?
Often start out normocytic normochromic but then as condition continues become microcytic hyperchromic. Increased anemia, Increased BUN. Can look similar to Fe deficiency (Fe stores increased, serum Fe decreased, TIBC normal).
What is the common characteristic of ALL hemolytic anemias
Increased RBC destruction
What type of RBC abnormality results in hereditary spherocytosis and how does it affect the
shape and osmotic fragility of the RBC?
Membrane abnormality-causes cell to be more permeable to sodium; makes them small and round rather than biconcave; and osmotic fragility is increased
What biochemical pathway involves the enzyme glucose-6-phosphate dehydrogenase
(G-6-P-D)?
HMP shunt- to protect red cell (hemoglobin) from oxidation
What usually precipitates a hemolytic crisis in G-6-P-D deficiency?
Exposure to oxidizing drugs
What RBC inclusions does this deficiency produce?g-6-p-d
Heinz bodies
What is the most unusual characteristic laboratory finding in ABO erythroblastosis of the
newborn?
In AIHA?
Newborn?
Spherocytes
AIHA?
Positive Direct Coombs Test- extremely unusual in adult
How do PCH and PNH differ
PCH: is extrinsic- have an antibody. Extracorpuscular defect.
PNH: intrinsic, acquired, sensitive to complement
In which condition is the Donath-Landsteiner antibody found?
PCH
What is the difference between an intrinsic (intracorpuscular defect)and an extrinsic
(extracorpuscular) defect
Intrinsic: Something in the cell (genetic) is causing hemolysis
Extrinsic: Something outside the cell is causing the hemolysis
What RBC abnormality is responsible for the formation of burr cells and thorn cells?
Membrane abnormalities
What globin chains are found in the following hemoglobins?
- A2
- F
- H
- Bart’s
- Gower-1
- Gover-2
A2: 2 alpha and 2 delta F: 2 alpha and 2 gamma H: 4 Beta Bart's: 4 Gamma Gower-1:Epsilon Gower-2: Zeta
Which ones are present only during embryonic development?
Epsilon and Zeta
What is the major hemoglobin of the newborn?
F
What hemoglobin is insoluble when reduced
S
What hemoglobin is resistant to alkali?
F
What are the normal mobilities of hemoglobins A, C, F, and S on hemoglobin electrophoresis
at pH 8.6
C-crawls,
S-slow,
F-fast,
A-accelerates faster than fast
What is poikilocyte is the “common denominator” of peripheral blood smears of patients with hereditary hemoglobinopathies
Target Cells
What is the specific amino acid substitution in hemoglobin S?
In hemoglobin C?
Valine substitutes in for Glutamic acid on # 6 position for S
Lysine at same position for C only on beta chain
What are the clinical manifestations of sickle cell anemia
Frequent crises like aplastic and thrombotic crises, osteomyelitis, sickled cells, decreased osmotic fragility
What is the best test to use to differentiate sickle cell anemia and sickle cell trait?
Hg Electrophoresis
What does the peripheral blood smear usually show in sickle cell trait
Occasional Target Cell
What are the characteristics of Hemoglobin C disease?
Target cells, rod shaped crystals, envelope cells, mild hemolytic anemia
Hemoglobin SC disease
SC crystals, positive tube solubility test, some sickle cells but not usually and not numerous
Why does the hemoglobin combination of S and D create a problem in the laboratory
diagnosis of hemoglobinopathies
Migrate together, alkaline pH S & D migrate together, further testing
What does the peripheral blood smear usually show in IDA?
Microcytic hyperchromic
What does the serum iron and TIBC show?
Serum iron-decreased
TIBC- increased
Chlorosis
Green coloration of skin in hypochromic anemia
Favism
G6 PD deficiency
Koilonychia
spoon shaped nails found in iron deficency
Pica syndrome
Eating weird stuff
What are some causes of IDA
Chronic bleeding, hookworm infection, menstrual problems, bleeding ulcers
What is the specific cause of the thalassemias?
Decreased rate of synthesis of either the alpha or beta chain.
What is another name for beta thalassemia
Cooley’s Anemia, Mediterranean anemia.
What hemoglobins are increased in thalassemia major?
Can’t make beta chain- increases A2(alpha 2 and delta 2) and F(alpha 2 and gamma 2)
Barts Disease
Homozygous alpha thalassemia
Cooley’s trait
Beta thalassemia minor
Fanconi’s anemia
Congenital Aplastic Anemia
Hemoglobin H disease
Heterozygous alpha thalassemia
What are the characteristics of sideroblastic anemia?
Microcytic hypochromic, increased iron stores, increased ringed sideroblast
What is the RBC inclusion most frequently associated with lead poisoning
Basophilic Stippling
What blood cell parameters are increased in polycythemia vera
All are increased; plasma volume= normal
What is the cause of secondary polycythemia
Overproduction of erythropoetin
What parameters are increased in this condition
Red cell parameters
How do hemachromatosis and hemosiderosis differ?
Stress, dehydration, burns
What are some possible causes of relative polycythemia?
Both involve deposition of excess iron. Hemosiderosis is in the normal cells of the liver, spleen. Hemochromatosis is deposited in functional cells where they shouldn’t be placed causing tissue damage.
(Tissue damage is the most important to remember here)
