Hematopathology - Schoenwald Flashcards
Anemia is a ______ in RBC count and erythrocytosis is a ________ in RBC count. (Not going into super detail on this lecture because we did a lot of this in clin med, feel free to add stuff)
decrease increase
Name 3 mechanisms of anemia.
- Blood loss
- Decreased RBC production
- Increased RBC destruction
What is a reticulocyte?
Immature RBC
What are schistocytes?
RBC fragments
What is erythroblastosis fetalis?
It is an Rh factor incompatibility between mother and fetus leading to anemia due to increased destruction of RBCs.
People with paroxysmal nocturnal hemoglobinuria have acquired a defect in what gene?
Phosphatidylinositol class A (PIG-A)
What two organs remove RBCs from circulation?
Spleen and liver
An increase in unconjugated bilirubin levels is associated with what clinical findings?
Jaundice and gallstones
Name 2 conditions associated with spherocytes
hereditary spherocytosis
immune hemolysis
Name 2 conditions associated with schistocytes
TTP
HUS
(also, having a mechanical valve)
What type of conditions should be associated with target cells?
Hemoglobinopathies (thalassemia)
What condition is associated with teardrops?
Myelofibrosis
What is a rouleaux and what is one condition they are commonly seen in?
“stacking of coins” - RBCs are stacked together.
Common in multiple myeloma
Which thalassemia is more worrisome, alpha or beta thalassemia?
Beta
A patient with alpha thalassemia, with a loss of 3 copies of the alpha globulin chain gene will have which of the following?
a) the patient will be stillborn
b) the patient will have marked anemia
c) the patient will be a carrier for alpha thalassemia
d) the patient with be asymptomatic with a low MCV
b)the patient will have marked anemia
What patient population is most commonly diagnosed with beta thalassemia?
Patients of Mediterranean descent
T/F? Patients with beta thalassemia minor usually require blood transfusions
False - patients with beta thalassemia major usually require blood transfusions.
There are ____ copies of alpha globulin and ____ copies of beta globulin. This is important for classifying thalassemias
4 alpha, 2 beta
you have a patient who is asymptomatic but their labs exhibited a low MCV. Upon further investigation they have a loss of 2 of the alpha globulin chains. this is characteristic of what disease
alpha thalassemia
a complete loss of the hemoglobin protein is what disease?
Beta thalassemia
Beta thalassemia major is usually seen at 6 months of age due to the loss of _____ which transitions into ____
Hgb F (fetal) and it transitions into Hgb A (adult)
a characteristic lab finding of thalassemia minor is a disproportionate _____ and _____
a. MCV/ MHC
b. MCHC/ MCH
c. Hgb/ MCV
d. Hgb/ MCH
c. Hgb/ MCV (10/55)
labs of thalassemia: ____MCV ____Hgb anisocytosis Poikilocytosis
decreased MCV Decreased hgb
what is hepcidin and how does it play a role in anemia of chronic disease
it is a protein that is key regulator of the entry of iron into circulation. it impairs the release of iron from storage. therefor there will be elevated levels of iron in storage and decrease levels of iron in the serum.
Levels of ferratin, iron, TIBC, transferrin in IDA
a. increased, increased, decreased, decreased
b. decreased, decreased, increased, increased
c. decreased, increased, increased, increased
d. decreased, decreased, increased, decreased
d. decreased, decreased, increased, decreased
Transferrin is usually _____ related to TIBC
a. inversely
b. directly
c. not
d. the two are the same
a. TIBC and transferrin are inversely related
one way to differentiate between B12 deficiency and folate deficiency is_______
Elevated homocysteine and methyl-malonic acid with B12 deficiency. Also B12 deficiency has neuro deficits that you don’t get with folate deficiency.
you have a patient that has some paralysis in their left arm. You’ve done every workup you can think of for a stroke and they are negative. Finally you get the blood work back and they are deficient in an important substance that causes an anemia. This substance is____
A. folate
B. B12
C. Copper
D. iron
b. B12. folate will not cause iron deficiencies. This paralysis is from spinal cord lesions caused by b12 deficiency
your patient who has B12 deficiency has a condition that creates antibodies against the parietal cells in the stomach. This is called_____
pernicious anemia
its a strange day in the ER and you have yet another case of B12 deficiency. This patient really likes sushi and eats it often. You suspect that his B12 deficiency is from ________.
Diphyllobathrium latum infection (fish tapeworm)
alcoholics are prone to ____ deficiency
folate
aplastic anemia is due to absence of ____ in bone marrow
a. reticulocytes
b. leukocytes
c. Hemoglobin
d. RBCs
d. RBCs
Labs:
Haptoglobin: decreased
Unconjugated bilirubin: increased
LDH: markedly increased urine is brown (due to hemosiderin and hemoglobin)
Intravascular hemolysis
in extravascular hemolysis the RBC are broken down in:
a. spleen
b. Liver
c. blood vessels
d. A and B
d. the RBCs are broken down in the liver and the spleen.
what is haptoglobin
glycoproteins produced by the liver. They are very powerful free hemoglobin binding proteins. Haptoglobin decreases with hemolytic anemia because liver is unable to rapidly compensate to make more haptoglobin.
Indirect coombs testing tests the ______ for antibodies where in direct coombs the _____is tested for antibodies
serum, RBC
ABO tranfusion reaction is mediated by which antibodiy?
a. IgA
b. IgM
c. IgG
d. IgE
b. IgM causes acute renal failure
Blood type O has which antigens?
a. A
b. B
c. none
d. A,B
c. none
None ABO tranfusion reaction is mediated by which antibody?
a. IgA
b. IgM
c. IgG
d. IgE
c. IgG causes jaundice
Mothers with a ____ RH factor have to get Rhogam injections throughout pregnancy, every pregnancy
negative
In warm auto immune anemia, direct coombs will be ____
postive
In cold autoimmune anemia direct coombs will be ______
negative
In hereditary spherocytosis there is a defect in the cytoskeleton of the RBC. The RBC gets caught in the spleen. A cure fo rthe disease is _____
a. transfusion
b. spleenectomy
c. no cure
d. iron supplimentation
b. spleenectomy
In paroxysmal nocturnal hemoglobinuria, red cells are more prone to lysis by ___________.
In paroxysmal nocturnal hemoglobinuria, red cells are more prone to lysis by complement (because complement-regulating proteins CD55 and CD59 are deficient).
Paroxysmal nocturnal hemoglobinuria can result in ___________________________.
Paroxysmal nocturnal hemoglobinuria can result in venous thrombosis in hepatic portal, mesenteric, and cerebral veins.
T/F: Vitamin B12 deficiency causes hypersegmented neutrophils on CBC due to incorrect maturation of DNA.
True
T/F: Pts with aplastic anemia will often have splenomegaly
False. No splenomegaly.
Indirect bilirubin, AKA __________
Unconjugated bilirubin
Direct bilirubin, AKA __________
Conjugated bilirubin
ABO transfucion reaction has (intravascular/extravascular) hemolysis, whereas non-ABO transfusion reaction has (intravascular/extravascular) hemolysis.
ABO transfucion reaction has intravascular hemolysis, whereas non-ABO transfusion reaction has extravascular hemolysis.
Pts with sickle cell anemia have “sticky” hemoglobin due to _______ substitution for _________ in Beta globin chain.
Pts with sickle cell anemia have “sticky” hemoglobin due to valine substitution for glutamic acid in Beta globin chain.
G6PD: microscopy will show _______ and ________
Heinz bodies and Bite cells
Which type of anemia is this describing: RBC unable to regenerate glutathione, which normally helps to reduce oxidized substances
G6PD deficiency
Clinical findings of red faces, headaches, and hgb >60%, indicative of….
Polycythemia
