Hematology Flashcards
What is a neutrophil?
The Phagocyte
(Has anti-microbials, most abundant)
What is an Eosinophil?
The Parasite Destroyer
Also, an allergy inducer
What is a Basophil?
The Allergy Helper
(IgE receptor => histamine release)
What is a Monocyte?
The Destroyer = the MP
(Hydrolytic enzymes, coffee-bean nucleus)
What is a Lymphocyte?
The Warrior
= T, B, NK cells
What is a Platelet?
The Clotter
(No nuclei, smallest cells)
What is a Blast?
Baby hematopoietic cell
What is a Band?
Baby neutrophil
What does high WBC and high PMNs tell you?
Stress demargination
What does high WBC and <5% blasts tell you?
Leukemoid reaction
Seen in burn patients
(Extreme demargination, looks like leukemia)
What does high WBC and >5% blasts tell you?
Leukemia
What does high WBC and bands tell you?
Left shift => infection present
Hat does high WBC and B cells tell you?
Bacterial infection
What diseases have high eosinophils?
NAACP
- Neoplasm (lymphoma)
- Allergy/Asthma
- Addison’s disease (no cortisol -> relative eosinophilia)
- collagen vascular disease
- parasites
What disease have high monocytes? (>15%)
“STELS”
- syphilis: chancre, rash, warts
- TB: hemoptysis, night sweats
- EBV: teenager sick for a month
- Listeria: baby who is sick
- Salmonella: food
What do high reticulocytes (>1%) tell you?
RBC being destroyed peripherally
What is poikilocytosis?
Different shapes
What is anisocytosis?
Different sizes
What is the RBC lifespan?
120 days
What is the platelet lifespan?
7 days
What does “-penia” tell you?
Low levels
(Usually d/t virus or drugs)
What does “-cytosis” tell you?
High levels
What does “-cythemia” tell you?
High levels
What is the difference between plasma and serum?
Plasma: no RBC
Serum: no RBC or fibrinogen
What is a Chronic granulomatous disease?
NADPH oxidase deficiency
-> recurrent Staph/Aspergillus infections
(Nitro blue Tetrazolium stain negative)
What does MPO deficiency cause?
Catalase pos infections
What is Chediak-Higashi?
Lazy leukocyte syndrome
(Lysosomes are slow to fuse around bacteria)
What organ can make RBCs if the long bones are damaged?
Spleen
(Leading to splenomegaly)
What causes a shift to the right in the Hb curve?
“all CADETs face right”
- elevated CO2
- Acid/Altitude (= low pH)
- elevated 2,3-Dpg
- Exercise
- Temp
How does CO poison Hb?
Competitive inhibitor of O2 on Hb
Cherry-red lips
Pinkish skin hue
How does cyanide poison Hb?
Non-competitive inhibitor of O2 on Hb
Almond breath
What is MetHb?
Hb w/ Fe3+
What is acute intermittent porphyria?
Elevated porphyrin
Elevated urine d-ALA
Elevated porphobilinogen
Abdominal pain
Neuropathy
Red urine
What is porphyria cutanea tarda?
D/t sunlight
Skin blisters w/ porphyrin deposits
Wood’s
What is erythrocytic protoporphyria?
Porphyria cutanea tarda in a baby
What is sickle cell disease?
Homozygous HbS (beta chain mutation at position 6: Glu -> Val)
Vaso-occlusion
Necrosis
Dactylitis (painful fingers/toes) at 6 mo
Protects against malaria
What is Sickle cell trait?
Heterozygous HbS
Painless hematuria
Sickle with extreme hypoxia
(Cannot be pilot, fireman, diver)
What is HbC disease?
Hb mutation in beta chain at position 6 (Glu -> Lys)
Still charged => no sickling
What is alpha thalassemia?
1 deletion: normal
2 deletions “trait”: microcytic anemia
3 deletions: hemolytic anemia, HbH (= 4 beta chains)
4 deletions: hydrops fetalis, HbBart (= 4 gamma chains)
What is beta thalassemia?
1 deletion = “beta minor” = HbA2 + HbF
2 deletions = “trait/intermedia/major” = only HbA2 and HbF => hypoxia at 6 mo
What is Cooley’s anemia?
See w/ beta-thalassemia major (no HbA => excess RBC production)
Baby making blood from everywhere
=> frontal bossing, hepatosplenomegaly, long extremities
What is Virchow’s triad?
Thrombosis risk factors:
- turbulent blood flow “slow”
- hypercoaguable “sticky”
- vessel wall damage “escapes”
What does acute hypoxia cause?
Shortness of breath
What does chronic hypoxia cause?
Clubbing of fingers/toes
What is intravascular hemolysis?
RBC destroyed in blood vv.
-> low haptoglobin
What is extravascular hemolysis?
RBC destroyed in spleen (problem w/ RBC membrane)
=> splenomegaly
What enzymes need lead (Pb)?
d-ALA dehydratase
Ferrochelatase
What does EDTA bind?
Any heavy metals with 2+ charge
(Lead, Iron, Calcium, Magnesium)
What disease has a smooth philtrum?
Fetal alcohol syndrome
What disease has a long philtrum?
William’s Syndrome
(Deletion on chromosome 7)
What disease has sausage digits?
Pseudo-hypoparathyroidism
Psoriatic arthritis
What disease has 6 fingers?
Trisomy 13
(Patau Syndrome)
What disease has 2-jointed thumbs?
Diamond-Blackfan
What disease has painful fingers?
(= “dactylitis”)
Sickle cell disease
What are the Microcytic Hypochromic anemias?
“FASTT LEAD”
- Fe deficiency = elev TIBC, menses, GI bleed, koilonychia
- Anemia of chronic disease = decr TIBC
- Sideroblastic anemia = decr d-ALA synthase, blood transfusions
- alpha-Thalassemia = AA, Asians (Chr 16 deletion)
- beta-Thalassemia = Mediterraneans (Chr 11 point mutation)
- Lead poisoning = decr d-ALA dehydratase, decr ferrochelatase, blue line on x-ray, eating old paint chips
What are the megaloblastic anemias?
Vit B12 deficiency
Folate deficiency
Alcohol
Megaloblastic anemia:
Vit B12 deficiency
d/t tapeworms, vegans, Type A gastritis, pernicious anemia
Megaloblastic anemia:
Folate deficiency
d/t old food, glossitis
Megaloblastic anemia:
Alcohol
Seen w/ fetal alcohol syndrome
- smooth philtrum
- stuff doesn’t grow
What are the Intravascular Hemolytic anemias?
G6PD deficiency
Cold autoimmune
Problem w/ IgM
Intravascular Hemolytic anemia:
G6PD deficiency
d/t sulfa drugs, moth balls, fava beans
See a sudden drop in Hb
Intravascular Hemolytic anemia:
Cold autoimmune
Seen with:
- mononucleosis
- mycoplasma infections
- RBC agglutination
What are the Extravascular Hemolytic anemias?
Spherocytosis
Warm autoimmune
Paroxysmal cold autoimmune
Sickle cell anemia
Problem w/ IgG
Extravascular Hemolytic anemia:
Spherocytosis
Defective spherin or ankyrin
Pos osmotic fragility test
Extravascular Hemolytic anemia:
Warm autoimmune
Anti-Rh Ab
Dapsone
PTU
Anti-malarials
Sulfa drugs
Extravascular Hemolytic anemia:
Paroxysmal cold autoimmune
Bleeds after cold exposure
Donath-Landsteiner Ab
Extravascular Hemolytic anemia:
Sickle cell anemia
Crew haircut on X-ray
Avascular necrosis of femur
Short fingers
What are the Production Anemias?
Diamond-Blackfan
Aplastic anemia
Production anemias:
Diamond-Blackfan
No RBCs
2-jointed thumbs
Production anemias:
Aplastic anemias
Pancytopenia
Autoimmune
d/t benzene, AZT, CAM, radiation
What is basophilic stippling?
Lots of immature cells
Incr mRNA
d/t lead poisoning
What is a burr cell (=echinocyte)?
Seen in:
- Pyruvate kinase deficiency
- liver disease
- post-splenectomy
What is a Bite cell (= basket cell)?
Seen in:
- unstable Hb inclusions (such as G6PD deficiency)
What is Cabot’s ring body?
Seen in:
- vit B12 deficiency
- lead poisoning
What is a Doehle body?
Seen in:
PMN leukocytosis
- infection
- steroids
- tumor
What is a Drepanocyte?
Seen in:
Sickle cell anemia
What is a Helmet cell?
Fragmented RBC
Seen in: hemolysis
- DIC
- HUS
- TTP
What is a Heinz body?
Hb precipitates and sticks to cell membranes
Seen in G6PD deficiency
What is a Howell-Jolly body?
Spleen or bone marrow should have removed nuclei fragments
- hemolytic anemia
- spleen trauma
- cancer
What is a Pappenheimer body?
Iron precipitated inside cell
Seen in: sideroblastic anemia
What is a Pencil cell (= cigar cell)?
Seen in iron deficiency anemia
What is a Rouleaux formation associated with?
Multiple myeloma
What is a Schistocyte?
Broken RBC
Seen in: DIC & artificial heart valves
What is a sideroblast?
Macrophages pregnant w/ Fe
(d/t genetic or multiple transfusions)
What is a spherocyte?
Old RBC
What is a spur cell (=acanthocytes)?
RBCs covered in lipids
(High serum lipids)
What is a stomatocyte associated with?
Liver disease
What does a target cell (= codocyte) indicate?
Less Hb
- thalassemias
- Fe deficiency
What is a teardrop cell (= dacrocyte)?
RBCs squeezed out of bone marrow
Seen in hemolytic anemia, any diseases that make RBCs come out of bone marrow too fast)
What is the purpose of the clotting cascade?
How the body stops bleeding
What clotting factors use Vitamin K as a cofactor?
2, 7, 9, 10, protein C, protein S
What do platelet problems cause?
Bleeding from skin and mucosa
What do clotting factor problems cause?
Bleeding into cavities
What causes increased PTT and bleeding time?
Von Willebrand disease
Lupus
What is Bernard-Soulier?
Baby w/ bleeding from skin and mucosa
Big platelets
Low Gp 1b
What is Glanzmann’s?
Baby w/ bleeding from skin and mucosa
Low Gp 2b/3a
How does Factor 13 deficiency present?
Umbilical stump bleeding
(1st time baby has to stabilize a clot)
What is Factor V Leiden?
Protein C can’t break down Factor V
=> more clots
How does Von Willebrand disease present?
Heavy menstrual bleeding
Easy bruising
Petechiae
Bleeding of gums
Prolonged bleeding from minor injuries
What are the types of vWD?
Type 1 (AD): decr vWF production
Type 2 (AD): decr vWF production (pos Ristocetin aggregation test)
Type 3 (AR): no vWF
What is a hemophilia A?
Defective Factor VIII (<40% activity)
=> bleed into cavities (head, abdomen, etc.)
What is Hemophilia B?
Factor IX deficiency
=> bleed into joints (knee, etc.)
What diseases have low LAP?
CML
PNH
What has high LAP?
Leukemoid reaction
What is the difference between acute and chronic leukemias?
Acute
- started in bone marrow
- squeezes RBC out of marrow
Chronic
- started in periphery
- not constrained => will expand
What is the difference between myeloid and lymphoid leukemias?
Myeloid
- elev RBC
- elev WBC
- elev platelets
- elev macrophages
- decr lymphocytes
=> do bone marrow biopsy
Lymphoid
- elev NK cells
- elev T cells
- elev B cells
- decr myeloid cells
=> do lymph node biopsy
What defines ALL?
<15 yo males
Bone pain
PAS stain positive
TdT stain positive
What defines AML?
15-30 yo males
Sudan stain
Auer rods
What defines CML?
30-50 yo females
t(9;22) “Philadelphia chromosome”
Bcr-abl
Decr LAP
What defines CLL?
> 50 yo males w/ lymphadenopathy
“Soccer ball” nuclei
Smudge cells
What defines Hodgkin’s lymphoma?
EBV
May have Reed-Sternberg cells
What are the B-cell Non-Hodgkin’s lymphomas?
Follicular
- t(14;18)
- bcl
Burkitt
- t(8;14)
- c-myc
- starry sky MP
- American kids: abdominal mass
- African kids: jaw mass
What are the T-cell Non-Hodgkin’s Lymphomas?
Mycosis fungoides
- total body rash
Sezary syndrome
- cerebreform nuclei
What is polycythemia Vera?
Hct >60%
Decr Erythropoietin
Seen with Budd Chiari
Plethoric “pruritus after bathing
What is essential thrombocythemia?
Very high platelets
Stainable Fe
Decr c-mpl
What are characteristics of myelofibrosis?
Megakaryocytes
Fibrotic marrow => teardrop cells
Extramedullary hematopoiesis
What are plasma cytomas?
Produce lots of Ab
What are manifestations of Waldenstrom macroglobulinemia?
IgM
Hyperviscous
How does monoclonal gammopathy of undetermined significance (MGUS) present?
Old person w/ gamma spike
What are manifestations of multiple myeloma?
Serum M protein (IgG)
Bence-Jones protein in urine
Rouleaux formation
Punched-out lesions
What is heavy chain disease?
Increased IgA
Infiltration of bowel wall
What are manifestations of histocytosis X?
Kid w/ eczema
Skull lesions
Diabetes insipidus
Exophthalmus
What does the Coombs test tell you?
Ab involved against RBC
What does the direct Coombs test tell you?
Ab on surface of RBCs => hemolytic anemias
What does the indirect Coombs test tell you?
Ab in serum
What is a “type and cross”?
So you know you can use that blood, and then save it for a specific patient
What is a “type and match”?
Type it, and then wait
What is forward typing?
“FABulous”
Uses Ab to detect Ag
What is backward typing?
Uses Ag to detect Ab
What does blood type A tell you?
Have the A antigen
What does blood type O tell you?
Have no antigens
Universal donor
What does blood type AB tell you?
Have both antigens
Universal recipient
What does Rh+ tell you?
Has D antigen
What does Rh- tell you?
Does not have D antigen
What is Hemolytic Disease of the Newborn?
Rh neg mother
Placenta tears => 100cc baby’s blood sees mom/produces Ab => attacks fetus
What is RHOGAM?
Anti-D IgG
When do you give RHOGAM?
1st dose: after delivery of 1st baby
2nd dose: week 28 of any subsequent pregnancy
What is the most common transplant?
Blood
What is a syngenic transplant?
Twin-to-twin
What is an autograft?
Self-to-self transplant
What is an allograft?
Human-to-human transplant
What is a xenograft?
1 species to another species
What is hyperacute rejection?
Within 12 hours (d/t preformed Ab)
What is acute rejection?
4 days to years later
(d/t T-cells and macrophages)
What is chronic rejection?
> 7 days
(See fibroblasts)
What is graft vs. host disease?
Bone marrow transplants reject
(d/t cytotoxic T cells, macrophages)
What are immunoprivileged sites?
No lymphatic flow
=> no Ag
=> easy to transplant (brain, cornea, thymus, testes)
What is INR?
Measured PT/Control PT
