Hematology + Oncology Flashcards
Give the associated pathology for the pathologic RBC: Ancanthocyte
Liver disease, abetalipoproteinemia (states of cholesterol dysregulation)
What is the “common name” for ancanthocytes?
Spur cells
Give the associated pathology for the pathologic RBC: Basophilic stippling
Anemia of chronic disease, alcohol abuse, lead poisoning, thalassemias
Give the associated pathology for the pathologic RBC: Bite cell
G6PD deficiency
Give the associated pathology for the pathologic RBC: Elliptocyte
Hereditary elliptocytosis
Give the associated pathology for the pathologic RBC: Macro-ovalocyte
Megaloblastic anemia (also hyper segmented PMNs), marrow failure
Give the associated pathology for the pathologic RBC: Ringed sideroblast
Sideroblastic anemia. Excess iron in mitochondria = pathologic
Give the associated pathology for the pathologic RBC: schistocyte, helmet cell
DIC, TTP/HUS, traumatic hemolysis (i.e mechanical heart valve prosthesis)
Give the associated pathology for the pathologic RBC: sickle cell
Sickle cell anemia
Give the associated pathology for the pathologic RBC: Spherocyte
Hereditary spherocytosis, autoimmune hemolysis
Give the associated pathology for the pathologic RBC: teardrop cell
bone marrow infiltration (e.g., myelofibrosis)
Give the associated pathology for the pathologic RBC: Target cell
HbC disease, Asplenia, Liver disease, Thalassemia
Explain the pathological process associated with Heinz bodies
Oxidation of hemoglobin sulfhydryl groups –>denatured hemoglobin precipitation and phagocytic damage to RBC membrane –> bite cells.
How can we visualize Heinz bodies?
crystal violet stain
Explain the pathological process associated with Howell-Jolly bodies
Basophilic nuclear remnants found in the RBCs.
Howell-Jolly bodies are usually removed from RBCs by splenic macrophages
List some pathologies associated with a finding of Howell-Jolly bodies
Functional hyposplenia
Asplenia
List some pathologies associated with a finding of Heinz Bodies
See in G6PD deficiency
Heinz body like inclusions are seen in alpha-thalassemia
What MCV value is consistent with microcytic anemias?
<80 fL
What MCV value is consistent with normocytic anemia?
80-100 fL
What MCV value is consistent with macrocytic anemia?
> 100 fL
How are normocytic anemias further divided?
normocytic anemias are either non-hemolytic or hemolytic
What is the reticulocyte count like in non-hemolytic normocytic anemias?
normal or decreased
What is the reticulocyte count like in hemolytic anemias?
increased
What pathologies lead to microcytic anemia? List 5
Iron Def (late) ACD (anemia of chronic disease) Thalassemias Lead poisoning Sideroblastic anemia
What pathologies lead to non-hemolytic normocytic anemia? List 4
ACD (anemia of chronic disease)
Aplastic anemia
Chronic kidney disease
Iron def (early)
How are normocytic hemolytic anemias categorized?
Into intrinsic/extrinsic variations
List 5 pathologies that end in intrinsic hemolytic anemia.
RBC membrane defect: hereditary spherocytosis
RBC enzyme deficiency: G6PD, pyruvate kinase
HbC defect
Paroxysmal noctural hemoglobinuria
Sickle cell anemia
List 4 pathologies that end in extrinsic hemolytic anemia.
Autoimmune disease
Microangiopathic
Macroangiopathic
Infections
How are macrocytic anemias divided?
Into either magloblastic or non-megaloblastic
List 3 pathologies that lead to megaloblastic macrocytic anemia.
Folate deficiency
B12 def
Orotic aciduria
List 3 pathologies that lead to non-megaloblastic macrocytic anemia.
Liver disease
Alcoholism
Reticulocytosis
What are the findings for microcytic, hypo chromic anemia secondary to iron deficiency?
Decreased Iron Increase total iron binding capacity Decreased ferritin fatigue conjunctival pallor May manifest as Plummer-Vinson syndrome
Describe plummer-vinson syndrome
Triad of:
Iron Def
Esophageal webs
Atrophic glossitis
What is alpha-thalassemia?
A defect leading to alpha-globin gene deletions that result in decreased alpha-globin syn
Which deletions do you see in alpha-thalassemia for the asian vs. african american population?
Cis = asian Trans = African
Describe findings associated with a 3 allele deletion in alpha-thalassemia
HbH disease.
Very little alpha-globulin
Excess B-globin forms B4 (HbH)
Describe the findings associated with a 1-2 allele deletion in alpha-thalassemia
no clinically significant anemia
Describe the findings associated with a 4 allele deletion in alpha-thalassemia
No alpha-globulin
Excess y-globulin forms Y4 (Hb Barts)
Incompatible with life (causes hydrous fetalis)
Describe microcytic, hypochromic anemia secondary to B-thalassemia
Point mutation in splice sites and promoter sequences –> decreased B-globin synthesis.
(Prevalent in mediterranean populations)
Describe the 3 findings associated with B-thalassemia minor (heterozygote)
- B chain is under produced
- usually asymptomatic
- diagnosis confirmed by increased HbA2 (>3.5%) on eletrophoresis
Describe the 3 findings associated with B-thalassemia major (homozygous)
- B-chain is absent –> severe anemia requiring blood transfusion (secondary hemochomatosis)
- marrow expansion –> skeletal deformaties. Chipmunk facies
- Extramedullary hematopoiesis (leads to hepatosplenomegaly). Increased risk of parvovirus B19-induced aplastic crisis
What significance does HbF play in infants?
HbF is protective in infants and disease doesn’t become symptomatic until 6 mo.
How does lead cause poisoning?
Lead inhibits ferrochelatase and ALA dehydratase –> decreased heme synthesis and increased RBC protoporphyrin.
Also inhibits rRNA degredation, causing RBCs to retain aggregates of rRNA (basophilic stippling)
List some signs of lead poisoning
- lead lines in the gingivae (burton lines) and on metaphases of long bones
- encephalopathy and erythrocyte basophilic stippling
- abdominal colic and sideroblastic anemia
- drops: wrist and foot
What is sideroblastic anemia?
defect in heme synthesis
hereditary: x-linked in gamma-ALA synthase gene
What findings are associated with sideroblastic anemia?
ringed sideroblasts (Fe+ laden mitochondria)
Increased Iron
Normal total iron binding capacity
increased ferritin
List some causes of sideroblastic anemia.
Genetic
Acquired (myelodysplastic syndromes)
Reversible: alcohol, lead, vitamin B6 deficiency, copper deficiency, isoniazid
restudy pages 384 onwards…
not making the rest of these freakin Q cards UGH!
