Hematology part 2 DIT - part 1 in endo Flashcards
protein responsible for the flexibility of RBCs
Spectrin
Anisocytosis
RBCs of varying size
Poikilocytosis
RBCs of varying shape
erythrocytosis
same thing as polycythemia
Life span of a RBC
120 days
Incompatible blood transfusion is due to what type of process
symptoms?
Type II HTN
hemolysis
renal failure
shock
death
erythroblastosis fettles is due to
prevented by? timeline of treatment (3)
mothers(Rho-) IgG antibodies crossing the placental and attacking the fetus’s Rho + RBCs
->anemia, jaundice-> kernicterus, hydrops fetalis, intrauterine death
Give RhoGram (IgGs that mask presence of Rho + RBCs) Give at: -28 wks - any traumatic event - w/in 3 days of delivery
acanthocytes are?
Seen when? (2)
irregularly spiked RBCs (vs regularly spiked RBCs in echinocytes)
liver disease
abetalipoproetinemia
Liver disease see what 2 changes to the RBCs
acanthocytes
target cells
Basophilic stippling of the RBCs indicates what (3)
Lead poisoning*
Thalassemia
anemia of chronic disease
Bite cells are seen in
G6PD deficiency - Macrophages removing oxydized hemoglobin (heinz bodies)
Elliptocytes are?
seen in
pencil shaped cells
hereditary elliptocytosis
schistocytes are?
seen in (3)
cut up RBCs
Due to DIC, TTP/HUS, trauma (metal heart valve)
sideroblasts are?
differ from ringed siderblasts how?
nucleated RBC precursor w/ granules of iron surrounding the mitochondria in the bone marrow - NORMAL
ringed sideroblasts is due to a disorder in heme synthesis -> excess iron granules that circle the nucleus (can lead to anemia
Causes of ringed sideroblasts (4)
lead poisoning
drugs
genetic conditions
myelodysplastic syndromes
Sherocytes commonly seen in
hereditary spherocytosis
teardrop cells seen in
bone marrow infiltration; like myelofibrosis (squeezed out)
Target cells are seen in ((4)
THAL
Thalessemia
Hemaglobin C disease
Asplenia (sickle cell or post surgery)
Liver disease
Heinz bodies are?
oxidation of heme in the RBCs in G6PD deficiency -> benatured hemoglobin precipitates
Can be “bite out”
Howell jolly bodies are seen?
nucleated RBCs that are normally removed by the spleen
Seen in apslenic patients
Asplenic patients you may see(2)
howell jolly bodies
Target cells
HbA composition
normal adult hemoglobin - 97%
2 alpha
2beta
HbA2 composition
2 % of normal Hgb
2 alpha
2 delta
HbF composition
2 alpha
2 gamma chains
higher affinity for oxygen, less affinity for 2,3 DPG (allows placental transfer)
HbS composition
sickle cells
2 alpha
2 beta (glu -> valine)
HbC composition
hemoglobin C
2 alpha
2 beta (glu -> lys)
Hb barts composition
Severe thalassemia
no alpha
4 gamma
HbH compostion
Severe thalassemia
4 beta
no alpha
Fetal erythropeies occurs where (4)
timeline
young liver synthesizes blood
Yolk sac - 3-8 weeks
Liver* 6-birth
Spleen 15-30 wks
Bone marrow 22 wks - adult
Late adolesent/ adult erythropeisis occurs where specifically (3)
axilla skeleton
- vertebra
- pelvis
- ribs
Early childhood erthyropoeisis occurs where specifically?
flat and long bones
-sternum, pelvis, ribs, cranial bones, vertebra, long bones
Lead poisoning interferes w/ these 2 enzymes
see what build up?
ferrochelatase
-protoporphyrin in the urine
aminolevulinic dehydratase (ALA dehydratase) - aminolevulinic acid
can be given to inhibit porphyries and stop heme synthesis(2)
glucose and heme
induces heme synthesis
rate limiting step
alchohol, barbituates, seizure drugs, rifampin, metoclopramide
aminolevulinic acid synthase
acute intermittent porphyria is due to a defect in what enzyme
presents as (5)
pophobilinogen deamninase
Acute abdomen; acute neuropathy (heme substrates are neurotoxic)
Painful abdomen port wine -colored urine polyneuropathy psychological disturbances precipitated by drugs
patient’s started on metclopramide for GERD and begins to have a painful abdomen, and dark urine, also polyneuropathy and agitation
acute intermittent porphyria due to issues w. porphobilinogen deaminase
build up of porphoblinogen Painful abdomen port wine -colored urine polyneuropathy psychological disturbances precipitated by drugs -alchohol, barbituates, seizure drugs, rifampin, metoclopramide
Porphyria cutanea tarda presents as ?
Due to defect where?
Most common - think of a homeless man
- blistering cutaneous photosensitivity
- hypertrichosis
- increase in ALT/AST
- tea color during
- facial hyperpigmentation
Associated w/ Hep C and alcoholism
defect in uroporphyrinogen decarboxylase
Presentation of lead poisoning?
global ecephalopathy memory loss delirium mental deterioration colicky pain lead lines in gingiva and bone foor/wrist drop microcytic anemia basophilic stippling sideroblastic anemia
Causes of polycythemia (3)
Polycythemia vera
- monoclonal expansion due to abnormal stem cells
Chronic hypoxia
- Lung disease, congenital heart disease, high altitude
Secondary to ectopic production
- pheo
- renal cell
- hepatocellular carcinoma
- hemangioblastoma
60% of trisomy 21 babies are polycythemic
4 tumors that can lead to ectopic EPO -> polycythemia
pheo
renal cell
hepatocellular carcinoma
hemangioblastoma
what test can be used to diagnose beta thalassemia minor
hemoglobin electrophoresis
Lab values of thalassemia minor
Ferritin
TIBC
Serum Fe
All are normal
may see target cells in peripheral smear
microcytic anemia, swallowing difficulties and glossitis
Plummer Vinson Syndrome
Microcytic anemia and >3.5% HbA2 level
Thalassemia minor
Megaloblastic anemia not correctible with B12 or folate
orotic aciduria (w/o the hyper ammonia)
Microcytic anemia reversible by B6
sideroblastic anemia
HIV positive patient w/ macrocytic anemia
AZT; zidovudine
normocytic anemia and elevated creatine
chronic renal disease
Hypersegmented nuetraphils be suspicious of
Folate or B12 deficiency
Causes of hyposchromic, microcytic anemia(4)
Fe deficiency
Thalassemia
lead poisoning
Sideroblastic anemia
Iron deficiency can be due to? (3)
chronic bleeding - CA-
malnutrition/absorbtion
increased demand -pregnant
Lab findings w/ Fe deficiency
Serum Fe
Ferritin
Transferrin
TIBC
low Fe in serum
low Ferritin
Increased transferrin ( trying to mobilize limited stock)
Decreased TIBC (not saturated at all)
Alpha thalassemia presentation (4) due to?
4 copies of the gene inherited on chromosome 16
1 mutation - no anemia
2 mutations- alpha thalassemia trait, no anemia
3 mutations - anemia; HbH forms (4 globins beta)
4 mutations- hydrops fatilis w/ formation of Hb Barts (4 globins of gamma )
Populations at increased risk for alpha thalassemia
Africans - trans mutation
Asians - cyst mutation
beta thalasemia presentation (2)
2 genes at work
Minor - one gene mutated (heterozygote) -> asymptomatic usually
see increased HbA2 on Hb electrophoreses (with less beta, more delta glob ins produced)
Major - genes mutated -> severe anemia
- Needs blood transfusions -> hemochromatosis
- Marrow expansion, chipmunk facies
- increased HbF (2 alpha 2 gamma); can’t make any beta globin
- target cell
2 diseases w/ marrow expansion
crew cut appearance on X ray
Sickle cell and Beta thalassemia
Population at risk for beta thalassemia
Mediterranean
Sideroblastic anemia due to ?
defect in heme synthesis -> ringed sideroblasts ( iron laden macrophages)
- hereditary - X linked
- reversible: alcohol, lead, INH, Rifampin
Rx w/ pyridoxine
Anemia due to chronic disease lab values
Serum Fe
Ferritin
Transferrin
TIBC
Serum - low
Ferritin - high (acute phase reactant)
transferrin- decreased
TIBC - normal
Hemachromatosis lab values
Serum Fe
Ferritin
Transferrin
TIBC
Serum - High
Ferritin - High
Transferrin - Low (body senses a lot and doesn’t want to mob)
TIBC - High ( a lot of saturation)
Pregnancy and OCP - Fe lab values
Serum Fe
Ferritin
Transferrin
TIBC
Serum - normal
Ferritin - normal
Transferrin - increased w/ estrogen
TIBC - Lower w/ excess binding sites
Transferrin production ramped up
Sideroblastic anemia Fe lab values
Serum Fe
Ferritin
Transferrin
TIBC
Serum - Increased (not using the Fe w/ defect in heme synth)
Ferritin - normal or increased
Trasnferrin -decreased, senses high serum
TIBC - is thus increased
Meagloblastic macrocytic anemia causes ( 3)
Impaired DNa synth -> increasing cytoplasm w/ ineffective nucleus maturation
B12 deficiency
Folate deficiency
Orotic aciduria
Folate deficiency due to (4)
Presentation (4)
malnutrition
-alcoholic
malabsorbtion
antifolates
- methotexate
- trimethoprin
increased requirement
-pregnanat
Presents w/
- megaloblastic/macrocytic anemia
- hyper seg PMNs
- glossitis
- homocystinuria w/o MMA increase
B12 deficiency due to (5)
Presentation
inefficent uptake ( vegans) malabsorbtion - crohns pernicious anemia Diphyllobothrium datum PPIs
Hyperseg PMNs
glossitis
homocystinuria w/ increased MMA
Neuro symptoms (B12 used in myelin synth)
Which vitamin Def presents w/ neuro symptoms and megaloblastic anemia
B12 deficiency
- Neuro: Peripheral neuropathy, posterior columns, lateral corticospinal, dementia
need to be aware and not just give folic acid w/ megaloblastic anemia
Orotic acid in the urine and fatigued
Hyperammonia?
Megaloblastic macrocytic anemia due to deficiency in UMP syntase in the production of Pyrimidines
No hyper ammonia ( Ornithine transcarbonylase in urea cycle)
Cannot be cured w/ B12 or folate
Non megaloblastic - Macrocytic anemia causes ((3)
DNA synthesis is unimpaired
Liver disease Alcoholism - direct effect Drugs - 5 FU - AZT -hydroxyurea
Nonhemolytic normocytic anemia due to (3)
anemia of chronic disease
Aplastic anemia
Chronic kidney disease
Anemia due to chronic disease is due to what acute phase reactant pathology
an increase in hepcidin binds to ferroportin preventing the release of Fe out of macrophages
Aplastic anemia causes (4)
Radiation *
Viral: B19, EBV, HIV, HCV - especially if sickle cell
Fanconi’s Anemia - DNA repair defect
Idiopathic
-> pancytopenia