final exam Flashcards by whitney webb

what test is the most reliable assessment of the effective erythroid activity of the bone marrow?

retic count

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what conditions (including parasitic infections) produce a macrocytic/normochromic picture?

D. Latum infections
ovalocytes: pernicious anemia
b12 deficiency
liver disease

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what conditions (including parasitic infections) produce a microcytic/hypochromic blood picture?

Thalassemia ( Cooley's anemia) 
iron deficiency
sideroblastic anemia
Pb poisoning
hookworm infection

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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

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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

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what are macropolycytes?

large cells with 5-7 lobes in nucleus

LARGER THEN HYPERSEGS

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what portion of the red blood cell is damaged leading to the formation of burr cells and thorn cells?

cell membrane

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what are the distinguishing characteristics of hereditary ovalocytosis

normal central pallor
ovalocytes
don’t need BM to confirm and is a cell membrane abnormality

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what is the most unusual and significant finding in patients suffering from AIHA

positive direct coombs (DAT)

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what poikilocyte is associated with ABO HDN

spherocytes

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what poikilocyte is associated with extremedullary hematopoiesis

teardrop cells

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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

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what are the hemoglobin electrophoresis results in sickle cell anemia?

has Hgb S, F

no Hgb A

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what hemoglobin is insoluble in reducing agents such as sodium dithionite and sodium metabisulfite?

Hgb S

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which chain of the hemoglobin molecule is abnormal in Hgb C disease, sickle cell anemia, and thalassemia major?

beta chain

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what does the PBS of a patient with sickle cell trait usually have?

target cells

everything else is normal

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what does the PBS of a patient with IDA show?

pale microcytic hypochromic cells

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what are the serum ion and TIBC results in IDA?

decreased iron

increased TIBC

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what its he specific cause of thalassemia

decreased rate of synthesis of either alpha or beta chain inherited not normal

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what is another name for homozygous alpha thalassemia?

barts disease

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what is another name for heterozygous alpha thalassemia?

Hemoglobin H disease

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what causes relative polycythemia

increased erythropoietin
stress
dehydration
severe burns
plasma volume is decreased

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what are the typical laboratory findings in acute leukemia?

anemia
thrombocytopenia
normal plt. and RBC are not consistent with acute leukemia
young cells

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what type of leukemia is indicated by auer rods and a positive peroxidase stain?

AML

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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