final exam Flashcards
what test is the most reliable assessment of the effective erythroid activity of the bone marrow?
retic count
what conditions (including parasitic infections) produce a macrocytic/normochromic picture?
D. Latum infections
ovalocytes: pernicious anemia
b12 deficiency
liver disease
what conditions (including parasitic infections) produce a microcytic/hypochromic blood picture?
Thalassemia ( Cooley's anemia) iron deficiency sideroblastic anemia Pb poisoning hookworm infection
what are the typical findings (including RBC, WBC, and platelets) in pernicious anemia (vitamin b12 deficiency)?
pancytopenia
oval macrocytes
hypersegs (shift to right)
BM: megaloblasts, WBC precursors
what is the Schilling test anew hat body fluid is used for the test?
The schilling test is an indirect measure of intrinsic factor.
Pernicious Anemia: intake of radioactive b12. LOOK FOR IT IN URINE
if not in urine indicates lack of intrinsic factor and no b12 absorption in intestines
what are macropolycytes?
large cells with 5-7 lobes in nucleus
LARGER THEN HYPERSEGS
what portion of the red blood cell is damaged leading to the formation of burr cells and thorn cells?
cell membrane
what are the distinguishing characteristics of hereditary ovalocytosis
normal central pallor
ovalocytes
don’t need BM to confirm and is a cell membrane abnormality
what is the most unusual and significant finding in patients suffering from AIHA
positive direct coombs (DAT)
what poikilocyte is associated with ABO HDN
spherocytes
what poikilocyte is associated with extremedullary hematopoiesis
teardrop cells
what are the laboratory findings in PCH
= sugar water test and hams test
+ DAT
+ donate landsteiner (which is an ab)
symptoms after exposure to cold
what are the hemoglobin electrophoresis results in sickle cell anemia?
has Hgb S, F
no Hgb A
what hemoglobin is insoluble in reducing agents such as sodium dithionite and sodium metabisulfite?
Hgb S
which chain of the hemoglobin molecule is abnormal in Hgb C disease, sickle cell anemia, and thalassemia major?
beta chain
what does the PBS of a patient with sickle cell trait usually have?
target cells
everything else is normal
what does the PBS of a patient with IDA show?
pale microcytic hypochromic cells
what are the serum ion and TIBC results in IDA?
decreased iron
increased TIBC
what its he specific cause of thalassemia
decreased rate of synthesis of either alpha or beta chain inherited not normal
what is another name for homozygous alpha thalassemia?
barts disease
what is another name for heterozygous alpha thalassemia?
Hemoglobin H disease
what causes relative polycythemia
increased erythropoietin stress dehydration severe burns plasma volume is decreased
what are the typical laboratory findings in acute leukemia?
anemia
thrombocytopenia
normal plt. and RBC are not consistent with acute leukemia
young cells
what type of leukemia is indicated by auer rods and a positive peroxidase stain?
AML
what type of leukemia is indicated by positive PAS (periodic acid-schiff) stain?
ALL
what type of leukemia is indicated by positive chloroacetate esterase stain? (specific)
AMoL (schilling’s)
what type of leukemia is indicated by presence of myelomonocytes
AMML ( Naegli’s)
what type of leukemia is indicated by presence of philadelphia chromosome?
CML
what type of leukemia is indicated by hypermature lymphs and smudge cells?
CLL
what type of leukemia is indicated by extreme thrombocytosis?
CML
what type of leukemia is indicated by increased incidence of bleeding disorders (i.e DIC)
APL
what leukemia is most frequently seen in patients over the age of 50?
CLL
what type of cells might be expected to be found in bone marrow of a leukemic patient?
same cells as in PBS
(acute = blasts
CML = all stages of granulocytes)
what is the end stage of Diguglielmo’s syndrome?
AML
what condition would be described as acute granulocytopenia?
severe neutropenia
agranulocytosis
what are the laboratory findings in Hodgkin’s disease?
increased monos
increased eos (leukomoid reacting with eosinophilia)
decreased lymphs
reed sternberg cells
what are the laboratory findings multiple myeloma?
rouleaux
occasional plasma cell
bence jones protein
increased sed rate
what is the L.E. factor?
IgG antibody
how is a downey cell described?
scalloping around RBC
blue at edges
AKA reactive lymphs
what disease is indicated by a positive ANA?
SLE (lupus)
with what conditions is a decreased LAP associated?
CML
AML
increased leukomoid reactions
what are the causes of bleeding?
trauma
decreased clotting factor synthesis
DIC
genetic defects
what is the immediate response to vessel injury?
vasoconstriction
what compromises the initial plug in the wall of an injured vessel?
platelets
what is meant by platelet adhesion?
sticks to surfaces
what is meant by platelet aggregation?
platelets stick to each other
which platelet factor is most instrumental in the clotting process
factor 3
factor VIII
hemophilia A
factor IX
hemophilia B
christmas factor
Factor X
stuart prower
Factor XI
plasma thromboplastin anticedient
Factor XII
Hageman’s Factor
intrinsic factors
12 11 9 8 10 5 2 1
extrinsic factors
7 10 5 2 1
factors in common of intrinsic and extrinsic
10 5 2 1
Vitamn K dependent factors
2 7 9 10
which factor NOT made in the liver is increased in liver disease?
Factor VIII (8)
labile factors
5 8
adsorbed plasma factors
5 8 11 12 (1)
aged serum
2 7 9 10 11 12
factors which don’t have an enzymatically active form
NOT 5 8
components of thromboplastin
activated factor X
platelet factor 3
calcium
factor V
end result of stage I
plasma thromboplastin
end result of stage II
thrombin
end of stage III
fibrin
substance which initiates the extrinsic system
tissue factor 3
tissue thromboplastin
substance which initiates the intrinsic system
platelet factor 3
precursor of thrombin
prothrombin
substance which converts fibrinogen to fibrin
thrombin
activated substance responsible for clot lysis
plasmin (activated)
final end products of the breakdown of fibrin and fibrinogen
frag 1E
2 D frag
components which are depleted in DIC
I V VIII
platelet factor 3
factor deficiency that would be incompatible with life
IV calcium
principle of the coagulyzer (or MLA)
formation of clot changes ocular density of light detected by photoelectric cell
principle of the fibrometer
completion of electrical circuit due to formation of clot
bleeding time (duke and ivy method)
Duke: earlobe 1-3 minutes
Ivy: forearm 1-7 minutes
tourniquet test
for capillary fragility
thrombin time
availability of fibrinogen (factor 1)
15-20 seconds
Lee-white clotting time (use)
monitoring heparin therapy, detect intrinsic defects
prothrombin consumption test (use)
measures amount of prothrombin remaining in serum after clotting
fibrinogen (normal values)
200-400 mg/dl
clot retraction (factors which influence it)
thrombosthenin VI
platelet function test only if fibrinogen level is normal, normal platelet count, thombosthenin produced by platelets is present. (normal HCT)
PT (what deficiency is it especially sensitive to)
deficiency in factor VII
PTT (what abnormalities could be indicated by an increased PTT)
liver disease
Hemophilia A & B
** any intrinsic defect, no platelet abnormality. cannot detect platelet abnormality
plasma recalcification time
amount of time required for a clot to form in plasma (add Ca to plasma, time to clot)
Stypven time (factor for which it is most useful for diagnosis of deficiency)
Russels Viper Venom - Factor VII
substitiution testing (how to use adsorbed plasma & aged serum)
know what factors increase PT AND PTT
Euglobulin lysis (use)
fibrinolysis measure
thrombowellco test (especially normal values)
If agglutination occurs:
in 1:5 dilution but not in 1:20:
FDP>1040
in neither:
TGT (use of adsorbed plasma and aged serum)
thromboplastin generation time
know factors for increased not factor 7
5 M urea test (what factor does it detect)
only factor 13
test useful in diagnosis of DIC
bleeding time, abnormal PT/PTT
fibrinolysis
1 5 8
platelets
effect of aspirin on testing (esp. BT and Saltzman glass bead test)
both prolonged
increased BT
abnormal decreased glass bead test
Hemophilia A
deficiency of VIII sex-linked recessive increased PTT (not PT)
Hemophilia B
christmas disease
deficiency of factor IX
increased PTT
clinically cannot be distinguished from Hemophilia A
VonWillebrand’s disease
increased PTT
increased bleeding time (factor VIII def)
bleeding time distinguishes Hem A from Von Willebrands
idiopathic thrombocytopenic purpura
due to anti-platelet Ab, increased bleeding time decreased platelets pinpoint hemorrhages petechiae BM increased megacaryocytes
Glanzmann’s thrombasthenia
platelets are functionally defective
Hereditary Telangiectasia
Vascular abnormality
Parahemophilia
Factor V def
what is the mode of action of the common anticoagulants coumadin and heparin
coumadin: anti-Vitamin K
heparin: neutralized/inactivated thrombin
what tests are used to monitor them?
coumadin: PT
heparin: PTT
what level (expressed as a percentage of normal) must be reached for a clotting factor to cause an abnormality in coagulation?
30-40%
norm 50-150%
what is anti-thrombin III
natural anticoagulant required for heparin to work
name a test that will distinguish between primary and secondary fibrinolysis
D-Dimer
what factors are removed when plasma is absorbed?
vitamin K dependant factors 2 7 9 10
BONUS
what reagents can be used to prepare adsorbed plasma
barium sulfate or aluminum hydroxide
what is viscous metamorphosis?
irreversible aggregation of platelets
1st aggregate is reversible
2nd is irreversible
what plasminogen activators are now being used to treat heart attack and stroke victims?
streptokinase
urokinase
TPA- tissue plasminogen activator
