Hematology III Flashcards
How many different blood group systems are there?
How many antigens within these systems?
30
600+
What are 2 most important blood group systems?
ABO
Rhesus
T/F
The ABO system is protein based
False
*Sugar based
What is the most common blood type in the US?
Least common?
O+ (37%)
AB- (0.6%)
If type O has both A and B antibodies, why is it the universal donor?
The amount is low
*Recipients antibodies matter more
Type A blood group has what antibodies?
Anti-B
Type O blood group has what antibodies?
Anti A and Anti B
How many Rh blood groups are there?
How many are common?
around 50
5 common
What is the most important Rh blood group?
Group D
*Determines Rh- or Rh+
What does Rh positive mean?
Rh negative?
Rhesus D positive
Rhesus D negative
What blood group is the Universal Donor?
Universal Receiver?
O-
AB+
Why is the Rh blood grouping important?
High immunogenicity
What is another highly immunogenic peptide blood antigen?
not as much as Rh though
Kell
either K+ or K-
Name 2 blood groups that have two types of antigens.
Duffy (Fy)
Fy (a+,b+) Fy (a+,b-) Fy (a-,b+) Fy (a-,b-)
Lewis
(a+,b+) (a+,b-) (a-,b+) (a-,b-)
Name 5 blood group systems not including ABO and Rh.
Kell Duffy Lewis Kidd Ss
Instead of whole anti-coagulated blood, name 5 components blood is processed into.
RBC's WBC's Platelets Fresh frozen plasma Heat-treated plasma
Broadly, what are 5 detrimental transfusion reactions that can occur?
Hemolytic Non-hemolytic Allergic Volume overload Bacterial transfer
What causes Hemolytic transfusion reaction?
What are 2 consequences?
Antigen-antibody rxn
Severe/fatal intravascular hemolysis
Kidney failure
What causes non-hemolytic rxns as a result of blood transfusions?
Cytokines
*from damaged blood products
T/F
Non-hemolytic blood transfer reactions are often fatal
False
mostly benign
What an an allergic transfer rxn cause?
Rashes, itching
*usually benign
What could volume overload of a blood transfusion cause?
Pulmonary edema
What can bacterial transfer in blood transfusions cause?
Endotoxemia
Septicemia
*potentially fatal
What 3 tests are used in transfusion medicine?
Blood grouping (ABO and Rh)
Antibody screen
Cross-Match
What disease can Rh+ babies be born with?
If mother has antibodies
Hemolytic Disease of the Newborn
HDN
How is HDN prevented?
Drug binds fetal RBC agglutinogens
*immune system never stimulated
Physicians give out Rh immune globulin throughout pregnancy if…
Mother Rh-
Father Rh+
What are the drugs (2) that prevent HDN?
RhoGAM
Gamulin
T/F
Anemia can be a reduction in Hemoglobin concentration, hematocrit, or RBC count
True
What demographic is often affected by mild anemia?
Younger patients
What 3 specific deficiencies can cause anemia?
Iron
B12
Folate
T/F
TB, lupus, rheumatoid arthritis, AIHA (acquired autoimmune hemolytic anemia) all cause anemia
True
What is the most common cause of anemia worldwide?
Iron deficiency
What are 2 results of Iron deficiency at the level of the cell?
Microcytic (decreased MCV)
Hypochromic (MCH & MCHC decreased)
How do Fe deficient RBC’s appear on a blood smear?
Pale
Smaller Cells
Pencilling
What gets Fe from intestinal cell into the blood?
Transferrin
What gets Fe from the liver to the spleen?
Ferritin
What are 4 causes of Iron deficiency?
Blood loss
Decreased Fe absorption (drugs, GI)
Dietary
Increased Fe requirements (growth)
B12 deficiency produce RBC’s that are…
Macrocytic
elevated MCV
What are large RBC’s sometimes called?
Megaloblasts
“Magaloblastic Anemia”
*B12 deficiency
How does B12 deficiency result in larger RBC’s?
B12 needed for Mitotis
Delay in division results in larger cells
What is required to absorb B12?
Location?
Intrinsic Factor (IF) Stomach
Lack of B12 because of IF dearth is called…
Pernicious Anemia
What 2 cells are attacked in a dearth of Intrinsic Factor?
What causes this?
Intrinsic Factor cells
Parietal Cells
*Autoimmune
What causes chronic atrophic gastritis?
Autoimmune attack on Intrinsic Factor and Parietal Cells in stomach
T/F
Folate deficiency increases MCV
True
*Macrocytic just like B12 deficiency and same pathway
T/F
Folate requires Intrinsic Factor to be absorbed
False
4 things that cause Folate deficiency:
Poor nutrition
Increased requirements (pregnancy)
Malabsorption
Drugs
Large amounts of blood loss will do what to the heart rate and what to the blood pressure?
Increase Heart Rate
Lower Blood Pressure
T/F
Blood counts taken after large blood loss are abnormal.
False
*concentrations same until plasma replaced
If blood is Normocytic, what remains normal?
MCV
Why does Chronic Kidney Failure cause anemia?
No EPO
What is the pathophysiology in hemolytic anemias?
RBC’s destroyed faster than normal
T/F
Hemolytic anemias can be acquired or inherited
True
What is an example of an acquired hemolytic anemia?
AIHA
Acquired Autoimmune Hemolytic Anemia
- often pts have short lives
- *Attack on RBC’s own antigens
Hereditary anemias are all…
Hemolytic
In what 3 areas can the pathophysiology of inherited anemias that decrease RBC lifespan occur?
RBC membrane (spherocytosis, eliptocytosis) RBC enzymes (G6DP) Hemoglobin (sickle cell, thalassemias)
What 4 gene defects can lead to Hereditary spherocytosis?
Spectrin
Ankyrin
Band 3 protein
Protein 4.2
An elevation in what 2 tests suggests Hereditary Spherocytosis?
MCHC (mean cell Hb conc)
RDW (red cell distribution width)
Under a microscope, what will Hereditary Spherocytosis look like?
Round (no pale center)
Darker (from higher MCHC)
T/F
Hereditary Spherocytosis and Elliptocytosis have defects in the same genes.
True
What does Hereditary Elliptocytosis look like under slide?
Kind of like pencilling, with other dark round cells
What test can detect Spherocytosis and Elliptocytosis?
Osmotic Fragility Test
What does the MCF (mean corpuscular fragility) test?
50% lysis in NaCl solution
Compared to healthy RBC’s, when do spherocytes and elliptocytes lyse in an osmotic fragility test (as solution becomes more hypotonic)?
Lyse more readily than RBC’s
What is the most common enzymatic disorder of RBC’s in humans worldwide (affects 400 million)?
What type of disorder is it?
Glucose-6-Phosphate Dehydrogenase Deficiency
X-linked
What does Glc-6-P dehydrogenase do for the RBC?
obtain NADPH via PPP
What is the function of NADPH in the RBC?
maintains Reduced Glutathione
What does Glc-6-P dehydrogenase deficiency cause in the RBC?
Hemolytic Anemia
*without Glutathione in reduced form membrane becomes unstable
What 2 morphologically distinct cells can be visible in a Glc-6-P dehydrogenase deficiency under a microscope?
Heinz Bodies (Olives) - cluster of denatured hemoglobin
Bite Cells
- Spleen removal of Heinz Bodies
What mutation results in sickle cell?
Point mutation in Beta-globin
What specific AA is affected in Sickle Cell?
Replace with what?
AA number six
Glu replaced with Val
The defective Hemoglobin seen in Sickle Cell is know as:
Hemoglobin S (HbS)
In sickle cell, when do RBC’s elongate?
Reduced Oxygenation
What leads to Sickle Cell Crisis?
RBC change shape (low Oxygen)
Vascular occlusion
The hemoglobin disorders are know as…
Thalassemias
What is diminished or absent in Thallasemias?
Globin Chains (one or more)
What causes chronic hemolysis in Thalassemias?
Globin chain excess (due to precipitation within RBC’s)
*due to inability to use chains/unbalanced production
T/F
Thallasemias and Sickle cell occur in pretty much the same areas.
True
How are Thalassemias classified?
Gene affected
alpha, etc
In Thalassemia, RBC’s are both…
Microcytic and Hypochromic
What does Leukemia mean?
“white blood”
Where does the cancer occur in Leukemias?
WBC precursors
What 2 types of forms does leukemia take?
Acute and Chronic
Why do patients tend to have reduced number of RBC’s and megakaryocytes?
Progressive bone marrow failure
What is the most common acute Leukemia affecting adults?
incidence increases with age
AML - Acute Myeloid Leukemia
What is the Myeloid Line?
Neutrophils
Eosinophils
Basophils
5 underlying causes of symptoms in AML:
reduced RBC's reduced WBC's reduced platelets leukemic cells in bones (pain) Hyperviscosity (resp./neuro problems)
What leukemia is most common in childhood and peaks in incidence around 2-5?
Acute Lymphoblastic Leukemia
ALL
What line is affected in ALL?
Lymphoid
(B, T, Nk cells)
*symptoms similar to AML
What generally treatable leukemia has a mutation that leads to transcription with high tyrosinase kinase activity?
(affects adults between 40-60)
Chronic Myeloid Leukemia
CML
What is the chromosomal defect called in CML and where is it found?
Philadelphia chromosome
Translocation of 9 and 22
What are the 3 phases of CML?
Chronic
Accelerated
Blast Crisis
What would cause left side pain in the chronic phase of CML?
Spleen
What is the most common adult leukemia in Western societies that peaks between 60-80?
What is the male:female ratio?
Chronic lymphoblastic leukemia
(CLL)
2:1
How does a Lymphoma differ from Leukemia?
Solid tumor masses
*usually originate in lymphoid tissues like nodes, spleen, etc.
What has a more serious prognosis, Hodgkins or non-Hodgkins?
Non-Hodgkins
What type of cells are present in Hodgkin’s Lymphoma?
Reed-Sternberg
“popcorn”
T/F
itchy skin, night sweats, unexplained weight loss, enlarged nodes, splenomegaly, hepatomegaly are all symptoms of Non-Hodkin’s lymphoma
False.
these are Hodgkin’s
*although both present similarly
What are Reed-Sternberg “popcorn” cells?
B-lymphocytes that no longer produce antibodies
T/F
Both Hodgkin’s and non-Hodgkin’s lymphomas have unknown causes.
True
