exam 2 Flashcards by whitney webb

How are anemias classified according to cause?

Increased red cell destruction= hemolytic

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How are anemias classified according to morphology?

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

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What are the symptoms of anemia?

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

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

Increased MCV Normal MCHC

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

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

MCV and MCHC Normal

hemoglobinopathies

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MCV Decreased MCHC Decreased

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

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

Pancytosemia - all cells decreased

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

Giant bands, precursor cells, megaloblasts

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What deficiency diseases cause megaloblastic erythropoiesis

Vitamin B12 & Folic Acid

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what cellular components are affected in megaloblastic erythropoiesis

Affects DNA & RNA

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What specifically causes pernicious anemia?

Lack of intrinsic factor

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

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

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What conditions can produce non-megaloblastic macrocytic anemia?

Alcoholism
liver disease
hypothyroidism.

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What poikilocytes are often seen in liver disease?

round macrocytes, target cells,

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

All precursor cells decreased, all cells decreased.

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What is the peripheral blood picture in aplastic anemia

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

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

Retic= decreased

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What are the most common causes of aplastic anemia?

Chemical exposure: Benzene and chloramphenicol
Radiation
drugs

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Name several causes of myelophthisic anemia?

Leukemia, Lymphomas, Multiple myeloma, MetastaticCarcinoma

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

Tear drop cells

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What is the blood picture in chronic renal disease?

Normocytic normochromic-burr cells, helmet cells, schistocytes

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What is the main cause of anemia due to renal disease

Failure of kidney to produce erythropoietin.

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

BUN.

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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).

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What is the common characteristic of ALL hemolytic anemias?

Increased RBC destruction

What type of RBC abnormality results in hereditary spherocytosis

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

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

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 | hexosmonophosphate

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

Exposure to oxidizing drugs

What RBC inclusions does this deficiency produce?

Heinz bodies

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

Spherocytes

what is the most unusual characteristic laboratory finding in 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 A2

2 alpha and 2 beta

what globin chains are found in F

2 alpha and 2 gamma

what globin chains are found in H

4 beta

what globin chains are found in BARTS

4 gamma

what globin chains are found in gower-1

epsilon

what globin chains are found in gower-2

zeta

Which ones are present only during embryonic development?

Epsilon and Zeta

What is the major hemoglobin of the newborn?

What hemoglobin is insoluble when reduced?

What hemoglobin is resistant to alkali?

What are the normal mobilities of hemoglobins A,C,F,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 hemoglobinpathies?

Target Cells

What is the specific amino acid substitution in hemoglobin S?

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

what is the specific amino acid substitution in hemoglobin C

lysine substitutes for glutamic acid on 6 position in 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 (WASHINGTON MONUMENT) , positive tube solubility test, some sickle cells

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

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

What does the peripheral blood smear usually show in IDA?

Microcytic hypochromic Polychromasia NRBC

What does the serum iron and TIBC show in IDA

Serum iron-decreased | TIBC- increased

Define: Chlorosis

Green coloration of skin in hypochromic anemia

Define: Favism

G6 PD deficiency

Define: Koilonychia

spoon shaped nails found in iron deficency

Define: Pica Syndrome

Eating weird stuff

What are some causes of IDA?

Chronic bleeding, hookworm infection, menstrual problems, bleeding ulcers

What is the specific causes of the thalassemias?

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

What is another name for beta thalassemia?

Cooley's Anemia, Mediterranean anemia.

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

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

Define: Bart's disease

Homozygous alpha thalassemia

Define: Cooley's Trait

Beta thalassemia minor

Define: Fanconi's anemia

Congenital Aplastic Anemia

Define: 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?

WBC RBC Platelets

What is the cause of secondary polycythemia?

Overproduction of erythropoetin

What parameters are increased in secondary polycythemia ?

Increased HGB Increased HCT Increased RBC count

How do hemachromatosis and hemosiderosis differ?

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)

What are some possible causes of relative polycythemia

Severe burns Severe stress Dehydration