Fang

Question 1

Reticulocyte count

Answer 1

• Marker of EFFECTIVE ERYTHROPOIESIS
  
  • Bone marrow response to anemia
  • newly released RBCs from Bone marrow
    
    • stained via methylene blue
• Normal is BELOW 3% (.5 to 1.5%)
• % count is FALSELY INCREASED in anemia

Question 2

morphology of normal RBC

Answer 2

• RBCs show minimal anisocytosis (size) and poikilocytosis (shape) and only MILD variations in hemoglobinization

Question 3

causes of microcytic anemia

Answer 3

MCV < 80fL

• IRON DEFICIENCY (most common)
• Anemia of chronic disease (ACD)
• Thalassemia
• Sideroblastic anemia (least common)

Question 4

Lab tests in microcytic anemias

Answer 4

• Serum iron
• Serum total iron binding capacity (TIBC)
• SERUM FERRITIN –> circulating fraction of storage iron –> SINGLE BEST TEST FOR IRON STUDIES
• Hb electrophoresis –> gold standar for diagnosising mild Beta-thalassemia

Question 5

classification of Immune hemolytic anemias

Answer 5

• Drug-induced
• Auto-immune
  
  • Most common type of immune hemolytic aneimia; F>M
    
    • SLE –> most common cause
• Allo-immune
  
  • Hemolytic transfusion reaction
  • Hemolytic disease of newborn

Question 6

Direct coombs test vs Indirect coombs test

Answer 6

• Direct coombs test –> use patient RBC
  
  • deterimine whether patients with hemolysis have an immune etiology
• Indirect coombs test –> use patient serum
  
  • identify clinically significant red cell allantibodies that are important in choosing campatible blood products

Question 7

Diagnosis of anemia

Answer 7

• Practical = low Hb or low Hematocrit
• sign of underlying disease rather than a specific diagnosis

Question 8

Anemia due to increased blood loss

Answer 8

• Acute = trauma
• Chronic
  
  • Lesion of gastrointestinal tract
  • Gynecological disturbances

Question 9

Polychromasia

Answer 9

• alteration of the color of the RBC
• it is a sign of cellular immaturity
• the polychromatic RBCs are characterized by their LARGE SIZE and their BLUSIH HUE due their content in RNA

Question 10

SPherocytes

Answer 10

Hereditary spherocytosis

autoimmune hemolytic anemia

(Hyperchomatic –> no biconcave

Question 11

Schistocyte

Answer 11

Microangiopathic hemolytic anemia (DIC, TTP, HUS)

other hemolytic anemias

(looks like a piece broke off)

Question 12

Basophilic stippling

Answer 12

also called punctuate basophilia

Pathology = coarse smaller purple dots in RBC

causes = severe anemia caused by lead poisoning, severe infection, drug exposure, alcoholism

Question 13

Howell-Jolly body**

Answer 13

• are red cell inclusions which are residual nuclear fragments
• H-J is purple dot which is much larger than basophilic stippling
• MAY be seen in
  
  • hemolysis
  • megaloblastic anemia
  • post-splenectomy
    
    • absence of spleen

Question 14

Pathogenesis of microcytic anemias

Answer 14

DEFECT in syntheisis of Hb (Hb= heme + globin chains)

• Defects in heme synthesis
  
  • iron deficiency
  • anemia of chronic disease
  • sideroblstic anemias
• defects in synthesis of globin chains (alpha/beta)
  
  • alpha and beta thalassemias

Question 15

Macrocytic anemia Causes

Answer 15

• MCV > 100 fL
• Causes
  
  • Vit B12/folate deficiency
  • ALCOHOL USE
  • LIVER DISEASE
  • Hypothydroidism

Question 16

Pathogenesis of macrocytic anemia

Answer 16

• Defective DNA synthesis
  
  • B12/folate defiicency
• Increased RBC membrane
  
  • from lipid alterations associated with alchohol use

Question 17

Describe anemia due to acute blood loss

Answer 17

• If pt survives
  
  • intravascular shift of water from interstitial fluid compartment
    
    • HEMODILATION –> LOW PCV
      
      • reduced oxygen –> stimulates erythropoietin production
        
        • reticulocytes appear in peripheral blood loss after 5 days