Heme Flashcards
Apt with chronic alcoholism presents with HA, chills, nausea, and dizziness and notes he has been home in his apartment a lot with a gas heater. What abn finding would be on his hgb dissociation curve?
Carbon monoxide poisoning
Decrease in oxygen carrying capacity of hgb
Tx - 100% Oxygen or hyperbaric therapy
Pt presents with hemiparesis, recent history of gum bleeding, LUQ pain, Platelet count 900,000.
Essential thrombocytosis - platelet overproduction
Epistaxis, thrombosis, burising, bleeding, erythromelalgia (buring and redness in hands and fee)
Tx - hydroxyurea - inhibits ribonucleotide reductase preventing dNTP formation
Hodgkin lymphoma is associated with which viral infection?
Epstein Barr (EBV) dsDNA linear
INR increases when warfarin concentration is too
high.
High INR = hypocoaguable
IE when a CYP450 inhibitor is added to the pt regimen (isoniazid, cimetidine, quinidine, quinolones, spironolactone, macrolide, amiodarone, dapsone, ketoconazle
A pt with G6PD deficiency has deficiency in which molecule after taking certain medications (primaquine, sulfonamides, nitrofurantoins) or fava beans?
NADPH (reduced by G6PD)
Pt T cells have a multilobulated nucleus in “cloverleaf” cells. Skin lesions, hepatosplenomegaly, lymphadenopathy.
Adult T cell leukemia
Human T cell leukemia virus (HTLV-1) - rapidly progressive. Death in months
Transplant recipient presents with itching over his palms and soles and recent diarrhea. Maculopapular rash over neck, shoulder, palms, and soles. Elevated ALT/AST alk phos
Acute graft vs host dz
Triad of dermatitis, hepatitis, gastroenteritis
Donor lymphocytes react against host MHC
Occurs weeks after transplantation
In what order do organs begin hematopoiesis during development?
- Yolk sac (3-8 wks)
- Liver (6 wks - birth)
- Spleen (10-28 wks)
- Bone Marrow (~18 wks gestation)
A pt with severe sepsis develops DIC. what changes will be seen in her RBCs?
microangiopathic hemolytic anemia
Schistocytes
A 65 y/o pt has been experiencing pain exacerbation associated with OA for a week and has been brought to the ED with disorientation and lethargy. He is presenting with respiratory alkalosis and anion gap acidosis. What did he over dose on?
Aspiring (salicylate) tox
Would have ringing in the ears prior to disorientation
Combined resp alkalosis and anion gap acidosis
Other AEs = GI discomfort and bleeding
Tx - admin bicarb to alkalinize the urine and promote excretion
What is the result of warfarin exposure in utero?
hemorrhage causing scaring of the organs (optic atrophy, Dandy-walker, developmental delay)
A pt with iron deficiency anemia will have what finding on her labs for: Ferrittin, Iron-binding capacity, MCV
Low Ferrittin, MCV
High Iron binding capacity
What is ferritin?
Binds free iron and stores it intracellularly. Count directly correlates with total body levels of iron
What is give to a pt presenting acutely with a fib to protect from thrombosis? And what is given if they are over anti-coagulated?
Heparin (potentiates antithrombin)
Correct overdose with Protamine sulfate, a cationic molecule that binds the negatively charged heparin
Which drug binds directly to IIb/IIIa on activated platelets to prevent aggregation?
Abciximab
Binds IIb/IIIa to prevent fibrinogen from binding and interfering with aggregation. Used in acute coronary syndrome and angioplasty
Inheritance pattern for G6PD deficiency
X-linked
exposure to oxidant drug -> production of peroxides and free radicals -> GSH (glutathione) absorbs this radicals but fails to regenerate with G6PD is absent because NADPH becomes depleted
In follicular lymphoma these is overexpression of bcl-2. What is its function?
antagonist of apoptosis by preventing cytochrome c from binding APAF
Pt presents with chronic fatigue, pale conjunctivae, decreased cap refill, wide gait, mild parathsia, low hgb, low hct, high MCV, high platelet
Megaloblastic anemia due to B12 deficiency
smear would show macrocytic hypersegmented PMNs and large oval shaped erythrocytes
How do you distinguish folate deficiency from B12?
Time of onset, folate occurs in months. B12 takes years
Following a mono infection a college student presents with fatigue, scleral icterus, cervical lymphadenopathy and splenomegaly. Finger tips are purple. Low hgb, high reticulocyte, + heterophile testing. Dx?
IgM-mediated hemolytic anemia (cold agglutin)
Manifests shortly after EBV, acute HIV, mycoplasma, leukemia
heterophile test = sens and spec to cold agglutins
pt presents with RLQ pain, diarrhea, fever x 10 years. Low hgb, large MCV. Hypersegmented PMNs and oval macrocytes on smear. Dx?
Crohn’s dz
Decreased abs of B12 causing megaloblastic anemia
Elevated methylmalonic acid level b/c B12 is an essential cofactor to convert it to succinyl-CoA
Pt presents with anemia, jaundice, and splenomegaly with spheroids on smear
Hereditary spherocytosis
defect in cytoskeletal proteins (ankyrin, band 3, spectrin)
Tx - splenectomy
A college student reports seeing blood in her urine but only first thing in the morning
Paroxysmal nocturnal hemoglobinuria (PNH)
abn PIG-A gene which produces the glycophosphatidylinositol (GPI) anchors on the cell surface
Without these anchors, MAC complexes attach to the RBC and cause hemolytic anemia
hematuria happens all day but most noticable in the morning because urine is concentrated
When do you see the Taut form of hemoglobin?
It is the deoxygenated form, low oxygen affinity, favors offloading. See it in the venous system.
Relaxed form has greater oxygen affinity