FINALS - ANEMIA P2 Flashcards
Anemia due to mechanical extracorpuscular abnormality
- Microangiopathic hemolytic anemia (MAHA)
thrombotic thrombocytopenic purpura
hemolytic uremic syndrome (HUS) - Traumatic cardiac hemolytic anemia
is a group of clinical disorders characterized by RBC fragmentation
in the circulation resulting in intravascular hemolysis
Microangiopathic hemolytic anemia (MAHA)
Microangiopathic hemolytic anemia (MAHA)
fragmentation occurs as a result of:
RBCs passing through fibrin deposits inside the lumen of
arterioles and capillaries
damaged epithelium and vessel walls
Lab findings of Microangiopathic hemolytic anemia (MAHA)
anemia (low hgb, hct), presence of
schistocytes
MAHA is characterized by schistocytes or also called as
helmet cell
4 Disorders/conditions of MAHA:
Thrombotic thrombocytopenic purpura (TTP)
Hemolytic uremic syndrome (HUS)
Disseminated Intravascular coagulation (DIC)
hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)
is rare and potentially fatal characterized by disseminated
thrombotic occlusions of the microcirculation.
Thrombotic thrombocytopenic purpura (TTP)
Ecchymosis largest
purpura - 2nd to the largest
petechiae - 3rd
true or false
true
caused by deposition of microthrombi that contain platelets
and von Willebrand factor in arterioles and capillaries of many
organs can be found commonly in adults and can be seen also in children
but rare
thrombi - clots
von willebrand factor - adhesion
Thrombotic thrombocytopenic purpura (TTP)
Hemolytic uremic syndrome (HUS)
severe microangiopathic anemia caused by E. coli serotype ___
0:157 H7
Hemolytic uremic syndrome (HUS) difference to TTP
same thrombocytopenia (dec platelets)
both chance of bleeding
renal failure is only for HUS
causes of Hemolytic uremic syndrome (HUS)
renal failure
thrombocytopenia (dec platelets)
mucocutaneous hemorrhage
Lab findings of HUS
schistocytes, gastroenteritis (bloody diarrhea,
develops after 1-3 days), affected and kidney
Characterized by a widespread activation of the hemostatic
system, once it was activated it results into fibrin and thrombi
formation, kaya merong pagbara
Disseminated Intravascular coagulation (DIC)
is Disseminated Intravascular coagulation (DIC) as well a secondary complication?
yes
a condition of MAHA that is a very serious complication during pregnancy
hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)
anemia is caused by injury and fragmentation RBCs exposed to high shear stresses on a foreign surface during cardiac surgery
Traumatic cardiac hemolytic anemia/ Macrovascular
hemoglobinuria
Lab findings of Traumatic cardiac hemolytic anemia/ Macrovascular
hemoglobinuria
presence of schistocytes, inc. reticulocytes, dec.
platelets, inc. LDH (Lactate dehydrogenase is an enzyme found in
nearly all living cells
cardiac surgery nagkakaron ng hemolysis, magiging normal after the surgery
Traumatic cardiac hemolytic anemia/ Macrovascular
hemoglobinuria
MARCH HEMOGLOBINURIA is also known as
Sports anemia
Sports anemia, wherein there is a destruction of RBC due to
o Extreme Training
o Marching for many hours
Laboratory findings of
MARCH HEMOGLOBINURIA
o Destruction of RBC/Schistocytes
o Decrease Hct and Hgb
o Macrocytic: Tea colored urine
o Increase in Retics
ANEMIA DUE TO INFECTIONS
- malaria
- Babesiosis
- Bartonellosis (Carrion disease)
- Erlichiosis
Acute, chronic or recurrent febrile protozoan infection
transmitted by the bite of the female Anopheles
mosquito.
malaria
Can cause anemia by the rupture of infected cells at the
end of the asexual cycle
Malaria
Amount of hemolysis is related to the number of RBC
parasitized by the plasmodium
Malaria
Medication for malaria
quinine
Laboratory findings of Malaria
i. Decrease survival rate of RBC (Does not
reach 120 days)
ii. Spherocytosis
An uncommon hemolytic disorder caused by protozoan
babesia microti
Babesiosis
It can the transmitted either from deer, mice to humans
by vector (Ixodes dammini) or blood transfusion
Babesiosis
Babesiosis treatement
Clindamycin
Caused by B. bacilliformis transmitted by the sandfly
Bartonellosis (Carrion disease)
Two clinical stages of Bartonellosis (Carrion disease)
Oroya fever
Veruga pernuana
Oroya fever AKA ___
Autoimmune hemolytic
anemia or AHA
Veruga pernuana has a clinical manifestation of
Blisters
Swelling to the highest level
Diagnosis for Bartonellosis (Carrion disease)
Blood culture
Disease caused by a small intracellular bacateria, ehlichia transmitted by ticks to humans
Erlichiosis
LABORATORY TEST OF ANEMIA DUE TO INFECTION
- CBC
- Peripheral smear
Species of malarial parasite - Reticulocyte count increases because of lysis
- Serological test
ANEMIA DUE TO CHEMICAL AND PHYSIAL AGENTS
- Drugs and chemicals
- Venom
- Thermal injury
Caused by oxidative denaturation of hemoglobin
leading to the formation of:
i. Methemoglobin
ii. Sulfhemoglobin
iii. Heinz bodiess and chemicals
Example of Drugs and chemicals
i. Naphthalene (Moth balls)
ii. Dapsone (for leprosy)
iii. Arsenic, copper, lead (for intravascular
hemolysis)
Venom will cause
lysis
Brown recluse spider (loxoscheles reclusa)
venom
Third 3rd degree burns
Damage to RBC circulating in he involved skin and
tissues leading to hemolysis
third injury
H.
Spherocytosis
Type of inheritance:
Abnormal Autosomal
Physical feature of H.
Spherocytosis
Physical feature:
Enlargement of the spleen
Jaundice
Anemia
Clinical findings of H.
Spherocytosis
Assymptomatic to severe type
Rbc become spherocytosis
75% autosomal dominant
25% autosomal non-dominant
Defects of H.
Spherocytosis
ANK1 or Ankyrin and
Alpha and beta spectrin
Protein 4.2
H.
elliptocytosis is also known as
Hereditary ovalocytosis
Type of inheritance of H.
elliptocytosis
Autosomal dominant
Physical Feature of H.
elliptocytosis
Splenomegaly
Neonatal jaundice
Clinical findings of H.
elliptocytosis
90% cases asymptomatic
10% moderate to severe type of
anemia (must be managed with
blood transfusion and
splenectomy)
Defects in H.
elliptocytosis
Spectrin
Protein 4.1
Alpha or beta spectrin
seen in PS of pyropoikilocytosis
micropyropoikilocytosis and fragmentation
of RBC
Very sensitive to heat
Type of inheritance of H, pyropoikilocytosis
Autosomal recessive
Defects in H , pyropoikilocytosis
Spectrin
Alpha or beta spectrin
Type of inheritance: H.
stomatocytosis
Autosomal recessive
H.
stomatocytosis is known as
Hereditary hydrocytosis
H. stomatocytosis is caused by
Increase in sodium and
decrease in potassium
Due to increased permeability of
the membrane
H.
acanthocytosis is caused by
Caused by absence of beta-lipoprotein
H. acanthocytosis Associated with ____
condition
Abeta;lipoproteinemia
Type of inheritance: H.
acanthocytosis
Autosomal recessive
Result from heme suppression and lack
Rh antigen in the RBC membranes
RH null disease
Type of inheritance of RH null
Autosomal recessive
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Also known as ___
Marchiafava-micheli syndrome
Rare chronic defect in RBC membrane considered to be sleep
related hemoglobinuria
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Etiology of PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
UNKNOWN
Lahat ng cells natin dito very sensitive to lysis by complement
causing chronic intravascular hemolysis
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Red cells are sensitive to low pH of plasma and occurs during
depressed respiration while sleeping, caused by retention of CO2
resulting in acidosis
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Major problem dito walang ___
C55 CD55 CD59
hemolysis in PAROXYSMAL NOCTURNAL HEMOGLOBINURIA is called as
Intravascular hemolysis
in PNH
Kapag nagkaroon na ng intravascular hemolysis that’s the time na
magkakaroon na tayo ng hemoglobinuria and hemosidinuria
___ it is a yellowish brown crystal that can be found in urine
Hemosidinuria
Special tests for Paroxysmal nocturnal hemoglobin
Ham’s Test/Ham’s Acidified Serum Test
Sugar Water Test/Sucrose Hemolysis
Crosby’s thrombin test
Cobra-venom test
Heat Resistance Test
Insulin Test
two common test for PNH
Ham’s Test/Ham’s Acidified Serum Test
Sugar Water Test/Sucrose Hemolysis
screening test for PNH
Sugar Water Test/Sucrose Hemolysis
most common metabolic disorder of RBCs involving the
HMP (aerobic glycolysis) involving hexose
monophosphate
G6PD Deficiency
most common metabolic disorder of RBCs involving the EMP
(anaerobic glycolysis)
Pyruvate Kinase Deficiency
lack of ATP
decreased erythrocytes deformability that reduces the lifespan of
RBC
Pyruvate Kinase Deficiency
Laboratory findings of
Pyruvate Kinase Deficiency
o Fluorescent Spot Test (+)
o Quantitative assay of PK (dec.)
o ↑ Reticulocyte count
also known as sickle cell disease or drepanocytosis
Sickle Cell Anemia
inherited defect that results in abnormal structure of one of
the globin chains of the hemoglobin molecule caused by genetic
mutations.
Hemoglobinopathy - Globin abnormality
Hemoglobinopathy - Globin abnormality
most common in ethnic population from
Africa, the Mediterranean
basin and Southeast Asia
homozygous Hb S disease
Sickle Cell Anemia
the abnormality is due to substitution of valine for glutamic acid
in position 6 in the beta chain
Sickle Cell Anemia
distribution of Hgb is thru Hgb __
electrophoresis
Hgb distribution of Sickle cell anemia
o HgbA: 0%
o Hgb S: >80%)
o Hgb F:1-20%
o HgbA₂: 2-5%
