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hematology > exam 2 > Flashcards

exam 2 Flashcards

1
Q

How are anemias classified according to cause?

A

Increased red cell destruction= hemolytic

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2
Q

How are anemias classified according to morphology?

A

Macrocytic Normochromic- means they’re not low in iron
Microcytic Hypocromic
Normocytic Normochromic-both normal
(No such thing as “hyperchromic”)

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3
Q

What are the symptoms of anemia?

A

Weak, , hypotension (low BP), fatigue, syncope

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4
Q

Given the values for the red blood cell indices, suggest a possible diagnosis in the following situations:

Increased MCV Normal MCHC

A

Macrocytic Anemias; liver disease, B12 deficiency, Folate deficiency, Pernicious anemias, alcoholism

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5
Q

Given the values for the red blood cell indices, suggest a possible diagnosis in the following situations:

MCV and MCHC Normal

A

hemoglobinopathies

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6
Q

MCV Decreased MCHC Decreased

A

Microcytic- Iron def anemia, Sideroblastic anemia, thalassemia, lead poisoning

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7
Q

What is the peripheral blood picture in vitamin B12 and folate deficiency?

A

Pancytosemia - all cells decreased

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8
Q

What do you see in the bone marrow with the peripheral blood picture in Vitamin B12 and folate deficiency?

A

Giant bands, precursor cells, megaloblasts

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9
Q

What deficiency diseases cause megaloblastic erythropoiesis

A

Vitamin B12 & Folic Acid

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10
Q

what cellular components are affected in megaloblastic erythropoiesis

A

Affects DNA & RNA

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11
Q

What specifically causes pernicious anemia?

A

Lack of intrinsic factor

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12
Q

What main clinical manifestation distinguishes Vitamin B12 deficiency from folic acid deficiency?

A

Pernicious anemia. Clinical manifestation is neurological symptoms relating to the myelin sheath.

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13
Q

What conditions can produce non-megaloblastic macrocytic anemia?

A

Alcoholism
liver disease
hypothyroidism.

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14
Q

What poikilocytes are often seen in liver disease?

A

round macrocytes, target cells,

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15
Q

What parameters are decreased in aplastic anemia and what bone marrow precursor cells are decreased?

A

All precursor cells decreased, all cells decreased.

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16
Q

What is the peripheral blood picture in aplastic anemia

A

normocytic normochromic cells- no signs of increased red cell formation
decreased bone marrow

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17
Q

what would the reticulocyte count be expected to be in aplastic anemia?

A

Retic= decreased

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18
Q

What are the most common causes of aplastic anemia?

A

Chemical exposure: Benzene and chloramphenicol
Radiation
drugs

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19
Q

Name several causes of myelophthisic anemia?

A

Leukemia, Lymphomas, Multiple myeloma, MetastaticCarcinoma

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20
Q

What poikilocyte is especially associated with myelophthisic anemia because it indicates extramedullary hematopoiesis?

A

Tear drop cells

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21
Q

What is the blood picture in chronic renal disease?

A

Normocytic normochromic-burr cells, helmet cells, schistocytes

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22
Q

What is the main cause of anemia due to renal disease

A

Failure of kidney to produce erythropoietin.

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23
Q

to what kidney function test is the anemia frequently proportional? (anemia due to renal disease)

A

BUN.

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24
Q

What are the characteristics of anemia due to chronic disorders?

A

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).

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25
Q

What is the common characteristic of ALL hemolytic anemias?

A

Increased RBC destruction

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26
Q

What type of RBC abnormality results in hereditary spherocytosis

A

Membrane abnormality-causes cell to be more permeable to sodium;

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27
Q

how does spherocytosis affect the shape and osmotic fragility of the RBC

A

makes them small and round rather than biconcave; and osmotic fragility is increased

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28
Q

What biochemical pathway involves the enzyme glucose-6-phosphate dehydrogenase(G-6-P-D)?

A

HMP shunt- to protect red cell (hemoglobin) from oxidation

hexosmonophosphate

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29
Q

What usually precipitates a hemolytic crisis in G-6-P-D deficiency?

A

Exposure to oxidizing drugs

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30
Q

What RBC inclusions does this deficiency produce?

A

Heinz bodies

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31
Q

What is the most unusual characteristic laboratory finding in ABO erythroblastosis of the newborn?

A

Spherocytes

32
Q

what is the most unusual characteristic laboratory finding in AIHA

A

Positive Direct Coombs Test- extremely unusual in adult

33
Q

How do PCH and PNH differ?

A

PCH: is extrinsic- have an antibody. Extracorpuscular defect.
PNH: intrinsic, acquired, sensitive to complement

34
Q

In which condition is the Donath-Landsteiner antibody found?

A

PCH

35
Q

What is the difference between an intrinsic (intracorpuscular defect) and an extrinsic (extracorpuscular) defect?

A

Intrinsic: Something in the cell (genetic) is causing hemolysis
Extrinsic: Something outside the cell is causing the hemolysis

36
Q

What RBC abnormality is responsible for the formation of burr cells and thorn cells?

A

Membrane abnormalities

37
Q

what globin chains are found in A2

A

2 alpha and 2 beta

38
Q

what globin chains are found in F

A

2 alpha and 2 gamma

39
Q

what globin chains are found in H

A

4 beta

40
Q

what globin chains are found in BARTS

A

4 gamma

41
Q

what globin chains are found in gower-1

A

epsilon

42
Q

what globin chains are found in gower-2

A

zeta

43
Q

Which ones are present only during embryonic development?

A

Epsilon and Zeta

44
Q

What is the major hemoglobin of the newborn?

A

F

45
Q

What hemoglobin is insoluble when reduced?

A

S

46
Q

What hemoglobin is resistant to alkali?

A

F

47
Q

What are the normal mobilities of hemoglobins A,C,F,S on hemoglobin electrophoresis at pH 8.6?

A

C-crawls, S-slow, F-fast, A-accelerates faster than fast

48
Q

What is poikilocyte is the “common denominator” of peripheral blood smears of patients with hereditary hemoglobinpathies?

A

Target Cells

49
Q

What is the specific amino acid substitution in hemoglobin S?

A

Valine substitutes in for Glutamic acid on # 6 position on alpha chain

50
Q

what is the specific amino acid substitution in hemoglobin C

A

lysine substitutes for glutamic acid on 6 position in beta chain

51
Q

What are the clinical manifestations of sickle cell anemia?

A

Frequent crises like aplastic and thrombotic crises, osteomyelitis, sickled cells, decreased osmotic fragility

52
Q

What is the best test to use to differentiate sickle cell anemia and sickle cell trait?

A

Hg Electrophoresis

53
Q

What does the peripheral blood smear usually show in sickle cell trait?

A

Occasional Target Cell

54
Q

What are the characteristics of Hemoglobin C disease?

A

Target cells, rod shaped crystals, envelope cells, mild hemolytic anemia

55
Q

Hemoglobin SC disease?

A

SC crystals (WASHINGTON MONUMENT) , positive tube solubility test, some sickle cells

56
Q

Why does the hemoglobin combinations of S and D create a problem in the lab diagnosis of hemoglobinpathies?

A

Migrate together, alkaline pH S & D migrate together, further testing

57
Q

What does the peripheral blood smear usually show in IDA?

A

Microcytic hypochromic
Polychromasia
NRBC

58
Q

What does the serum iron and TIBC show in IDA

A

Serum iron-decreased

TIBC- increased

59
Q

Define: Chlorosis

A

Green coloration of skin in hypochromic anemia

60
Q

Define: Favism

A

G6 PD deficiency

61
Q

Define: Koilonychia

A

spoon shaped nails found in iron deficency

62
Q

Define: Pica Syndrome

A

Eating weird stuff

63
Q

What are some causes of IDA?

A

Chronic bleeding, hookworm infection, menstrual problems, bleeding ulcers

64
Q

What is the specific causes of the thalassemias?

A

Decreased rate of synthesis of either the alpha or beta chain. Abnormal one can’t keep up level of synthesis. So normal A could not be made

65
Q

What is another name for beta thalassemia?

A

Cooley’s Anemia, Mediterranean anemia.

66
Q

What hemoglobins are increased in thalassemia major? Why are they increased?

A

Can’t make beta chain- increases A2(alpha 2 and delta 2) and F(alpha 2 and gamma 2)

67
Q

Define: Bart’s disease

A

Homozygous alpha thalassemia

68
Q

Define: Cooley’s Trait

A

Beta thalassemia minor

69
Q

Define: Fanconi’s anemia

A

Congenital Aplastic Anemia

70
Q

Define: Hemoglobin H disease

A

Heterozygous alpha thalassemia

71
Q

What are the characteristics of sideroblastic anemia?

A

Microcytic hypochromic, increased iron stores, increased ringed sideroblast

72
Q

What is the RBC inclusion most frequently associated with lead poisoning?

A

Basophilic Stippling

73
Q

What blood cell parameters are increased in polycythemia vera?

A

WBC
RBC
Platelets

74
Q

What is the cause of secondary polycythemia?

A

Overproduction of erythropoetin

75
Q

What parameters are increased in secondary polycythemia ?

A

Increased HGB
Increased HCT
Increased RBC count

76
Q

How do hemachromatosis and hemosiderosis differ?

A

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)

77
Q

What are some possible causes of relative polycythemia

A

Severe burns
Severe stress
Dehydration

hematology (9 decks)

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