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Patho II > Hematology > Flashcards

Hematology Flashcards

1
Q

The percentage of blood that is cells (RBCs, WBCs, platelets)

A

Hematocrit

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2
Q

Functions of RBCs:

A

Transport Hgb
Transport oxygen & CO2
Acid-base buffer

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3
Q

Assesses shape of cell. Normal = _____

A

MCV; 90-95 mcm3

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4
Q

RBCs have a life span of ____

A

120 days

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5
Q

Released from kidneys (90%) and liver (10%) in response to hypoxemia & regulates RBC production

A

Erythropoietin

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6
Q

RBCs require ___ & ___ for maturation

A

Vit B12 & folic acid

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7
Q

Reduced erythropoietin response in:

A

Infections, AIDS, hypothyroidism, & renal dz

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8
Q

Intracellular iron is stored in protein-iron complexes such as ___ & ___ while circulating iron is loosely bound to the transport protein ____ - carrier protein

A

Ferritin & hemosiderin;

Transferrin

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9
Q

Where is the major site of iron absorption? What promotes it?

A

Duodenum & proximal jejunum;

HCl

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10
Q

Two iron binding sites;
Responsible for pink color of plasma
1/3 of sites are occupied, TIBC = 300, 30% saturation, 100

A

Transferrin

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11
Q

30% of total iron “storage iron”

A

Ferritin

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12
Q

Water insoluble. Can cause deposit is in tissue causing multiple organ failure

A

Hemosiderin

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13
Q

Conditions of defective heme synthesis that leads to the accumulation and increased excretion of heme precursors

A

Porphyria

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14
Q

S/sx of porphyria

A

Abd pain, N/v
Tachycardia, sustained HTN
Muscular weakness
Seizures

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15
Q

What 2 meds are contraindicated in porphyria’s?

A

Barbiturates & benzos

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16
Q 
Painful abdomen
Pink urine
Polyneuropathy
Psychological disturbance
Precipitated by drugs
A

Acute intermittent porphyria

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17
Q

Most common porphyria

Blisters & photosensitivity

A

Porphyria cutanea tarda

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18
Q

Anemia consists of a Hgb < ___ & Hct of ___ for women. Hgb < ___ and Hct ___ in men

A
  1. 5 & 36% (women)

12. 5 & 40% (men)

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19
Q

“Small pale cells” MCV <80
High TIBC, ⬇️ ferritin, ⬇️ serum iron
Bone marrow with absent iron stores

A

Microcytic hypochromic cells

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20
Q

Tx for iron deficiency anemia (microcytic hypochromic anemia)

A

Give iron; packed RBCs (⬆️ reticulocytes within 7-10 days and Hgb)

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21
Q

Low TIBC, ⬆️ ferritin, ⬇️ serum iron

Impaired utilization of iron & diminished response to erythropoietin

A

Anemia of chronic dz

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22
Q

Accelerated erythropoiesis- young RBCs
Defective DNA synthesis d/t folate or vit B12 deficiency
MCV > 100

A

Macrocytic anemia

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23
Q

Where is B12 absorbed? Stored?

A

Terminal ileum; stored in liver for 3-4 years

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24
Q

If anemia corrects with IF -> _____;

If corrects with antibiotics -> ______

A

Schilling test; pernicious anemia; bacterial overgrowth

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25
Q

MCC of B12 deficiency
Atropic gastritis -> No IF
Antibodies to parietal cells or IF
Increase risk of gastric cancer

A

Pernicious anemia (lack of IF)

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26
Q

Dietary deficiency “tea and toast diet” MCC;
Common in alcoholics
Malabsorption - sprue; increased need-pregnancy
Defective DNA & RNA synthesis

A

Folate deficiency

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27
Q

Hallmark of megaloblastic anemia

A

Hypersegmented polys/neutrophils; 6+ lobes

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28
Q

Neurological-paresthesias, ataxia d/t demyelination

Cerebral and psychiatric manifestation; UMN lesion signs, dementia, incontinence, impotence

A

B12 deficiency

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29
Q

Why should folic acid alone NEVER be given in macrocytic anemia?

A

Bc it will fix the anemia but exaggerate neurological signs and symptoms
Give combo of folic acid & B12 for life

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30
Q

Low urinary excretion (<5%) of labeled vit B12 =?

A

Absorption defect of vit B12 (+ schilling’s test)

Repeat test with IF -> should get high urinary excretion

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31
Q

What keeps RBCs in shape

A

Spectrin

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32
Q

Acanthocytosis

A

Change in shape “spiny” RBCs

33
Q

Most common enzyme deficiency disorder; 1% of African Americans, x-linked, reduce glutathione level

A

G6PD deficiency

34
Q

What two drugs cause cyanide toxicity in G6PD deficiency?

A

Nitroprusside & prilocaine

35
Q

Which drugs lead to a hemolytic crisis in G6PD deficiency?

A

Sulfa, aspirin, penicillin, streptomycin, quinidine, methylene blue
“Stop Asking Penny Strep Questions about Meth”

36
Q

_____ is used to distinguish b/w immune vs non immune mediated RBC hemolysis

A

Direct Coomb’s test

37
Q

In sickle cell anemia, ____ substitutes with ____ in the 6th position of the Beta hgb chain (HbS)

A

Valine; glutamine

38
Q

Painful leg ulcers, hematuria, necrosis of spleen “autosplenectomy”, require vaccination against pneumococci salmonella, priapism, cor pulmonale

A

Sickle cell anemia

39
Q

Why does someone with sickle cell anemia have resistance to malaria?

A

Malaria parasite needs a health RBC to stay in and replicate

40
Q

Prevention of sickle cell crisis

A

Hydration, O2 (low PO2 triggers sickling 30-40mmHg) maintain high CO, avoid stasis

41
Q

Tx for sickle cell crisis

A

Hydroxyurea

42
Q

Pancytopenia characterized by sever anemia, neutropenia, thrombocytopenia caused by failure or destruction of myeloid (bone marrow) stem cells - “dry tap”

A

Aplastic anemia

43
Q

Tx of thalassemia

A

Packed RBCs & folic acid

44
Q

What 3 steps occur rapidly after injury?

A
  1. Vascular spasm to prevent blood loss
  2. Platelet plug formation
  3. Coagulation: formation of clot
45
Q

Once attached, platelets are “activated” and release: ? These chemicals recruit more platelet s (+ve fb)

A

Serotonin, ADP, thromboxane A2, & platelet activating factor

46
Q

____ Aggregates platelets, ____ Inhibits aggregation

A

Thromboxane A2; Prostacyclins (PGI2)

47
Q

Inhibit Phospholipase A2 -> inhibition of TXA2 synthesis

A

Steroids

48
Q

Inhibit COX 1 and COX2

A

NSAIDs

49
Q

Inhibits lipooxigenase

A

Zileuton (Zyflo)

50
Q

vWF receptor

A

GP Ib

51
Q

Converts fibrinogen to fibrin

A

Thrombin

52
Q

How does acetaminophen alter platelet function?

A

No effect

53
Q

Inhibit ADP induced fibrinogen aggregation of platelets (anti-ADP)

A

Ticlopidine & clopidogrel

54
Q

Increases cAMP that prevents platelet aggregation

A

Dipyridamole (persantine)

55
Q

Cap & block the fibrinogen receptors on platelets -> no linking -> no aggregation (antifibrinogen receptor GPIIb/IIIa)

A

Abciximab, tirofiban, eptifibatide

56
Q

What are the functions of vWF?

A

Helping attachment of platelets on interior endothelium & providing a ride for factor VIII

57
Q

What is the function of fibrinogen (factor I)?

A

Cross-linking chain b/w two platelets (the GPIIb/IIIa receptors)

58
Q

What is the function of GPIb?

A

Links platelets to vWF

59
Q

What is the function of GPIIb/IIIa?

A

Provides cross link when active with the fibrinogen bridge

60
Q

Measures platelet function

A

Bleeding time (within 4-5 min bleeding should stop)

61
Q

Prolonged BT despite normal platelet count, prolonged PTT

A

Von willebran’s dz

62
Q

Tx for von willebrand’s dz

A

DDAVP 1st line
Cryoprecipitate is rich in factor VIII:vWF
Estrogen & OCP

63
Q

All factors are synthesized in the liver EXCEPT

A

vWF, factor IV (Ca), factor III (tissue factor;thromboplastin), & factor VIII

64
Q

What are the vit K dependent factors?

A

II, VII, IX, X (1972), protein S & C

65
Q

_____ binds the fibrin strands tightly together and strengthens and stabilizes the clots

A

XIIIa

66
Q

PT & INR assess the _______ pathway; PTT & ACT assess the _______ pathway

A

Extrinsic; intrinsic

67
Q

Extrinsic factors

A

Tissue factor III, & factor VII

68
Q

Intrinsic factors

A

XII, XI, IX

69
Q

______ is rapid & explosive in nature (15 sec) while ____ is slower (2-6 min) with Mandy components

A

Extrinsic pathway; intrinsic pathway

70
Q

Prolonged PTT with normal BT (normal platelets)

A

Hemophilia A

71
Q

Hemophilia A tx

A

FFP & cryo

Factor VIII replacement

72
Q

Depletion of coagulation factors and platelets “global consumption”

A

Disseminated intravascular coagulation

73
Q

Contains all clotting factors except platelets

A

FFP

74
Q

Rich in I, VIII, vWF, & XIII

A

Cryo

75
Q

How long does it take to correct the effect of warfarin aft d/c?

A

5 days

76
Q

Present in basophil and mast cells

A

Heparin

77
Q

What would cause someone to be unresponsive to heparin? Tx?

A

Antithrombin III deficiency (d/t cirrhosis & nephrotic syndrome)
FFP that contains AT3

78
Q

LMWH inhibits which factor?

A

Xa

79
Q

Prevent breakdown of fibrin by preventing displacing the plasmin from fibrin

A

EACA, Amicar

Patho II (11 decks)

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