Exam2 Flashcards
How is anemia classified according to cause?
Increased red cell destruction is hemolytic
How is anemia classified according to morphology?
macrocytic normochromic anemia means they are low on iron,, normocytic normochromic anemia both are normal, microcytic hypo chromic anemia
What are the symptoms of anemia?
weak, pallored, shortness of breath, hypotension, fatigue, increased cardiac output, syncope
Diagnoses of increased MCV and normal MCHC
liver disease, B12 deficiency, folate deficiency, pernicious anemias, alcoholism
Diagnosis of normal MCV and MCHC
aplastic anemia, thyroid deficient hemoglobinopathies, hemolytic anemias
Diagnoses of decreased MCV and MCHC
iron deficiency anemia, sideroblastic anemia, thalassemia, lead poisoning
What is the peripheral blood picture in vitamin B12 and folate deficiency?
pancytopenia, oval macrocytes, hypersegs
What does pancytopenia mean?
all cells decreased
What do you see in the bone marrow picture in vitamin B12 and folate deficiency?
giant bands, megaloblasts, M:E ratio lower
What deficiency disease causes megaloblastic erythropoiesis?
vitamin B12 and folic acid
What cellular constituents are affected in megaloblastic erythropoiesis?
DNA and RNA
What specifically causes pernicious anemia?
lack of intrinsic factor
What main clinical manifestation distinguishes vitamin B12 deficiency from folic acid deficiency?
neurological symptomes relating to the myelin sheath
What conditions can produce non-megaloblastic macrocytic anemia?
alcoholism and liver disease, round macrocytes
What poikilocytes are often seen in liver disease?
round macrocytes, target cells, acanthocytes
What parameters are decreased in aplastic anemia?
all precursor cells
What bone marrow precursor cells are decreased in aplastic anemia?
all cells
What is the peripheral blood picture in aplastic anemia?
normocytic normochromic cells; no signs of increased red cell formation decreased bone marrow; no Howell-Jolly bodies, no Heinz bodies, no NRBCs
What would the reticulocyte count be expected to be in aplastic anemia?
decreased
What are the most common causes of aplastic anemia?
chemical exposure (benzene and chlorophenicol) and radiation
Name several causes of myelophthisic anemia.
metastatic carcinoma, multiple myeloma, leukemia, lymphoma
What poikilocyte is especially associated with myelophthisic anemia because it indicates extramedullary hematopoiesis?
tear drop cells
What is the blood picture in chronic renal disease?
normocytic/normochromic; burr cells, helmet cells, schistocytes
What is the main cause of anemia due to renal disease?
failure of erythropoietin production
What kidney function test is the anemia frequently proportional?
decreased EPO and BUN
What are the characteristics of anemia due to chronic disorders?
begins as normocytic/normochromic then becomes microcytic hyper chromic; can look similar to iron deficiency but iron stores are increased
What is the common characteristic of all hemolytic anemias?
increased RBC destruction
What type of RBC abnormality results in hereditary spherocytosis?
membrane abnormality
How does hereditary spherocytosis affect the shape and osmotic fragility of the RBC?
small and round rather than biconcave; osmotic fragility is increased
What biochemical pathway involves the enzyme glucose-6-phosphate dehydrogenase (G6PD)?
hexose monophosphate shunt (HMP)
What usually precipitates a hemolytic crisis in G6PD deficiency?
exposure to oxidizing drugs
What RBC inclusions does G6PD deficiency produce?
Heinz bodies
What makes up Heinz bodies?
denatured hemoglobin
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
What does AIHA stand for?
autoimmune hemolytic anemia
What are the characteristics of PCH?
extrinsic, have an antibody, extracorpuscular defect
What are the characteristics of PNH?
intrinsic, acquired, sensitive to complement, genetic, intracorpuscular defect
What does extracorpuscular defect mean?
extrinsic, outside of the RBC; something outside the cell is causing hemolysis
What does intracorpuscular defect mean?
intrinsic, inside of the RBC; something in the cells is causing hemolysis
In which condition is the Donath-Landsteiner antibody found?
PCH
What RBC abnormality is responsible for the formation of burr cells and thorn cells?
membrane abnormality
What globin chains are found in A2 hemoglobin?
2 alpha and 2 delta
What globin chains are found in F hemoglobin?
2 alpha and 2 gamma
What globin chains are found in H hemoglobin?
4 beta
What globin chains are found in Bart’s hemoglobin?
4 gamma
What globin chains are found in Gower 1 hemoglobin?
Epsilon
What globin chains are found in Gower 2 hemoglobin?
Zeta
Which hemoglobin chains 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 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?
valine substitues in for glutamic acid on #6 position on the beta chain
What is the specific amino acid substitution in hemoglobin C?
lysine substitues in for glutamic acid on #6 position on the beta chain
What are the clinical manifestation of sickle cell anemia?
frequent crises like plastic and thrombotic, sickled cells, decreased osmotic fragility
What is the best test to use to differentiate sickle cell anemia and sickle cell trait?
hemoglobin 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
What are the characteristics of hemoglobin SC disease?
SC crystals, positive tube solubility test, some sickle cells
Why does the hemoglobin combination of S and D create a problem in the lab diagnosis of hemoglobinopathies?
the migrate together in an alkaline pH (8.6)
What does the peripheral blood smear usually show in IDA?
microcytic hyperchromic
What does IDA stand for?
iron deficiency anemia
What does the serum iron and TIBC show in IDA?
serum iron decreased and TIBC increased
What is chlorosis?
green coloration of skin
What is favism?
G6PD deficiency
What is koilonychia?
spoon shaped nails found in iron deficiency
What is pica syndrome?
eating weird stuff
What are some causes of IDA?
chronic bleeding, hookworm infections, 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?
A2 and F
Why are the A2 and F increased in thalassemia major?
can’t make beta chain
What is Bart’s disease?
homozygous alpha thalassemia
What is Cooley’s trait?
beta thalassemia minor
What is Fanconi’s anemia?
Congenital aplastic anemia
What is 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 erythropoietin
What parameters are increased in secondary polycythemia?
red cell parameters
What are some possible causes of relative polycythemia?
stress, dehydration, burns, decreased plasma volume
Describe hemachromatosis.
excess iron deposited in functional cells where they should not be placed causing tissue damage
Describe hemosiderosis.
excess iron in the normal cells of the liver and spleen
What is increased MCV and normal MCHC classified as?
macrocytic/normochromic
What is decreased MCV and MCHC classified as?
microcytic/hypochromic
