Hematology 3% Flashcards
Multiple myeloma shows ____ RBCs.
Rouleaux formation d/t increase plasma proteins
B12 and Folate deficiency presents as (macro/micro)cytic anemia and ____.
MACROcytic anemia
hypersegmented neutrophils
Heinz bodies =
Seen in ____
denatured Hgb in cells
Thalassemias (alpha thalassemia intermedia)
G6PD Deficiency
Howell-Jolly Bodies seen in ____.
Splenectomized pts
Target cells seen in ___.
Sickle cell disease
Thalassemia
Hgb SC
Severe Fe deficiency
Asplenia
Liver disease
Echinocytes (a.k.a. ____) seen in ____ (3)
Burr cells
Uremia *
Pyruvate kinase deficiency
Hypophosphatemia
Acanthocytes (a.k.a. ___) seen in ____ (5)
Spur cells
Liver disease (ETOHic cirrhosis) Post splenectomy Thalaseemia Autoimmune Hemolytic Anemia Renal Disease
Reticulocytosis =
Seen when ___
Immature RBC
Increased blood loss
Increased RBC destruction (hemolytic anemia)
Fe deficiency anemia
(increase/decrease) serum Fe
(increase/decrease) ferritin
(increase/decrease) TIBC
decrease serum Fe
decrease ferritin
INCREASE TIBC
Anemia of Chronic Disease (increase/decrease) serum Fe (increase/decrease) ferritin (increase/decrease) TIBC (increase/decrease) Haptoglobin (increase/decrease) CRP (increase/decrease) Hepcidin
- decrease serum Fe
- INCREASE ferritin
- DECREASE TIBC
- Increase Haptoglobin = binds free hemoglobin reducing iron availability for microbes
- Increase CRP
- Increase Hepcidin = prevent iron release from macrophages –> reducing iron availability for microbes
Low reticulocytes seen in ____
Fe, B12, Folate deficiencies
Anemia of chronic disease
High reticulocytes seen in ____
Blood loss
Hemolytic anemias
Indirect hyperbilirubinemia is associated with ___.
Direct hyperbilirubinemia is associated with ___.
Indirect: Jaundice
Direct: dark urine b/c water soluable
Hemolytic anemia: (increase/decrease) reticulocytes (increase/decrease) LDH (increase/decrease) indirect bilirubin (increase/decrease) haptoglobin
Increase reticulocytes
Increase LDH = enzyme in RBCs –> RBC destruction –> increase LDH
Increase indirect bilirubin
DECREASE Haptoglobin = increase RBC destruction –> increased free Hgb –> haptoglobin binds to free Hgb –> haptoglobin stores used up
Alpha Thalassemia:
Hgb ratio
Normal Hgb ratios of HgbA, A2 and F
Beta Thalassemia:
Hgb ratio
Decreased HgbA
Increased HgbA2
Increased HbgF
T/F: TTP and HUS can be distinguished via abnormal coag labs (prolonged PT and PTT).
False. Both have normal coags, can’t be distinguished via labs.
Prolonged PT and PTT seen in Disseminated Intravascular Coagulation (DIC)
TTP presentation
Thrombocytopenia Hemolytic anemia Kidney damage Neuro sx** Fevers**
HUS presentation
Thrombocytopenia
Hemolytic anemia
Kidney damage
“Dark urine worse in AM”
Paroxysmal nocturnal hemoglobinuria
Schilling test used to diagnose ____.
Other findings (3)
Pernicious Anemia (B12 deficiency)
+ Intrinsic factor ab
Parietal cell ab
Increased gastrin levels
B12 is absorbed in ____
Folate is absorbed in ___
B12: ileum
Folate: jejunum
Watch for signs of ____ when giving B12 replacement
HYPOkalemia
T/F: Folate deficiency causes pallor, glossitis, stomatitis and neurologic sx (peripheral neuropathy, spinal cord demyelination** and degeneration)
False. B12 causes neurological symptoms, NOT folate. Otherwise, both present similarly.
Neurologic sx of B12 deficiency: peripheral neuropathy, ataxia, weakness, vibratory, sensory and proprioception deficits, DECREASED DTR
T/F: Replacing folate in pts w/ B12 deficiency will correct anemia but worsen neuro sx.
True
Microcytic anemia w/ normal/increased Fe or no response to Fe tx =
Thalassemia
HgbA =
HgbA2 =
HgbF =
HgbA = aabb
HgbA2 = aadd
HgbF =aagg
a= alpha b= beta d= delta g = gamma
What type of thalassemia?
- normal Hgb ratio
- Increased HgbA2, increased HgbF, decreased HgbA
- Increased HgbA2, increased HgbF (90%), little or no HgbA
- Alpha thalassemia (mior, intermedia, major)
- Beta thalassemia minor
- Beta thalassemia major (Cooley’s)
Hgb Barts seen in ___
alpha thalassemia major (Hydrops fetalis)
=gamma tetramers
Associated w/ stillbirth, or death soon after
Deferoxamine
Iron chelating agents
Tx of severe anemia, Apha/beta thalassemia major
Pts with beta-thalassemia major will become symptomatic at age ___.
6 months (when HgbF declines)
Plummer Vinson syndrome =
Dysphagia + esophageal webs + atrophic glossitis + Fe deficiency
Anemia of chronic disease: (macro/normo/micro)chromic (macro/normo/micro)cytic anemia
Tx:
Normochromic, normocytic anemia
Tx: Erythropoietin-alpha
G6PD Deficiency: Peripheral smear shows \_\_\_\_ Labs: (increased/decreased) reticulocytes (increased/decreased) (indirect/direct) bilirubin (increased/decreased) haptoglobin
Schistocytes
Heinz bodies
Increased reticulocytes
Increased indirect bilirubin
Decreased haptoglobin
Sickle cell disease dx:
Hemoglobin electrophoresis
Peripheral smear
Increased HgbF, HgbS, NO HgbA
Target cells, sickled erythrocytes, Howell-Jolly bodies (functional asplenia)