Exam 2 Flashcards
How are anemias classified according to cause?
increased red cell destruction/hemolytic
how are anemias classified according to morphology?
macrocytic normochromic ( not iron low) microcytic hypochromic normochromic/normocytic (both normal)
what are the symtoms of anemia?
weak pallored shortness in breath hypotension fatigue
MCV ^ MCHC normal
macrocytic anemia, pernicous anemia
liver disease, B12 deficiency, alcholism
MCV & MCHC normal
aplastic anemia-hemolytic
MCV decrease MCHC decrease
microcytic anemia (iron deficient anemia) siderblastic anemia, thlassemia, lea poisoning
what is the peripheral blood picture in vitamin B12 and folate deficiency?
pancytopemia
all cells decreased
ovalmacrocytes-WBCs look like hypersegs
what do you see in the bone marrow in vitamin B12 and folate deficiency?
giant bands, precursor cells, megaloblasts
ME ration decreased
what deficiency diseases cause megaloblastic erythroopoiesis and what cellular constituents are affected?
vitamin B12 and folic acid
affects DNA and RNA
What specifically causes pernicious anemia?
lack of intrinsic factor
what main clincal manifestation distinguishes vitamin B12 deficiency from folic acid deficiency?
pernicious anemia.
Clincal manifestation is neurological symptoms relating to the myelin sheath
what conditions can produce non-megaloblastic macrocytic anemia?
- alcholism and liver disease are most common
* hyperthyroidism associated with round macrocytes and target cells
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 amemia and what would the retic count be expected to be?
*normocytic normochoromic cells(no HJB, NRBCs ect)
increased red cell formation decreased bone marrow
*retic=decreased
what are the common causes of aplastic anemia?
chemical exposure (benzene and chloramphenicol) radiation and drugs
several causes of myleophtisic anemia
leukemia, lyphomas, multiple myeloma, metastatic carcinoma
what piokilocyte is associated with myleophtisic anemia because it indictes extramedullary hematopoiesis?
tear drop cells
what is the blood picture in chronic renal disease?
normocytic normochoromic, burr cells and 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 BUN and EPO
what are the characteristics of anemia due to chronic disorders?
- often start out as normocytic normochromic but as condition continues it becomes microcytic hyperchromic
- ^ anemia ^ BUN, looks similar to Fe deficiency
what is the common characteristic of ALL hemolytic anemias
increased RBC destruction
what type of RBC abnormality results in herditary spherocytosis and how does it affect the shape and osmotic fragility of the RBC?
- membrane abnormality causes cells to be more permeable to Na
- 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
what usually preciitates a hemolytic crisis in G-6-P-D deficiency?
exposure to oxidizing drugs
what RBC inclusions does this deficiency produce?
heinz bodies denatured hemoglobin
what is the most unusual characterisitic lab finding in ABO erythroblastosis of the newborn?
spherocytes
what is the most unusual characteristic lab finding in AIHA?
positive direct coombs test (extremely unusal in an adult)
How do PCH and PNH differ?
PCH: is extrinsic and have anitbody. Extracorpuscular defect (outside RBC)
PNH: intrinsic acquired, sensitive to complement (genetic and inside RBC)
in which condition is the Donath-Landsteiner antibody found?
PCH
What is the difference between an intrinsic (intracorpuscular defect) and and extrinsic (extracopuscular) defect?
- Intrinsic-something in the cell is causing hemolysis
* extrinsic-something outside the cells is causing hemolysis
what RBC abnormality is responsible for the formation of burr cells and thorn cells?
membrane abnormalities
which globin chain is present 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 specific amino acid substitution is in hemoglobin S?
valine substitutes in for glutamin acid on the #6 or beta chain
what specific amino acid substitution is in hemoglobin C?
lysine at the same time for c only on beta chain
What are the clinical manifestations of Hemoglobin C disease?
- frequent crises like aplastic and thrombotic
- sickled cells
- decreases osmotic fragility due to target cells
why does the hemoglobin combinaion of S and D create a problem in the lab diagnosis of hemoglobinopathies?
S and D migrate together
what does the peripheral blood smear usually show in IDA?
micorcytic hyperchromic
what doe the serum iron and TIBC show in a peripheral blood smear?
serum iron decrease
TIBC increased
green coloration of skin in hypochromic anemia
chlorosis
G-6-P-D deficiency
favism
spoon shaped nails found in iron deficiency
koilonychia
eating weird stuff
pica syndrome
what are some causes of IDA?
- chronic bleeding
- hookwork
- menstral problems
- bleeding ulcers
what is the specific cause of the thalassemias?
decreased rate of synthesis of either the alpha or beta chain. Abnormal one cant keep up level of synthsis, so normal Alpha chain could not be made
what is another name for beta thalassemia?
coolys anemia
meditterania anemia
what hemoglobins are increased in thalassemia major? Why are they increased?
F (alpha 2, gamma 2)
A2 (alpha 2, delta 2)
can not make the beta chain
homozygous alpha thalassemia
barts disease
beta thalassemia minor
cooleys trait
congenital aplastic anemia
fanconis anemia
heterozygous alpha thalassemia
Hemoglobin H disease
what are the characterisitcs of siderblastic anemia?
microcytic hypochromic
increased iron stores
increased ringed sideroblasts
what is the RBC inclusion most frequently associated with lead poisoning?
basophilic stippling
what blood cell parameters are increased in polycythemia vera?
all cells are increased
plasma volume is normal
what is the cause of secondary polycythemia?
over production of erythropoeitin
what parameters are increased in polycythemia?
red cell parameters
what are some possible causes of relative polycythemia?
stress
dehydration
burns
how do hemachromatosis and hemosiderosis differ?
both involve decomposition of excess iron. Hemosiderosis is in the normal cells of the liver/spleen. hemochromatosis is deposited in functional cells where they should not be placed causing TISSUE DAMAGE.
