heme Flashcards
lymphoid cells
B lymphocytes, T lymphocytes, NK cells
usual exclusion criteria for HCT
age (>70 years old), uncontrolled infection, cardiac, pulmonary, liver or renal dysfunction, and/or psychosocial variables.
medical conditions that predispose people to bleeding
hypothyroidism cancer liver disease kidney disease connective tissue disease
When do you use cryoprecipitate?
severe hypofibrinogenemia, usually arising as a consequence of disseminated intravascular coagulation (DIC) or liver failure
what is the reversal agent for dabigatran?
Idarucizumab
IVIG side effect profile
numerous adverse effects, including anaphylaxis, serum sickness, kidney failure, hypertension, and headache
what is cryoprecipitate?
manufactured from fresh frozen plasma and contains fibrinogen in a more concentrated form.
only clotting factor not produced in the liver
factor VIII
normal PT
11 to 13 seconds
normal PTT
25 to 35 seconds
inherited thrombophilias
factor V leiden (50%) protein C deficiency protein S deficiency antithrombin deficiency prothrombin gene mutation
Indications for thrombophilia workup
At least one first degree relative with documented VTE before the age of 45 years
Younger than 45
Recurrent thrombosis
Thrombosis in multiple venous sites or in unusual vascular beds (eg, portal, hepatic, mesenteric, or cerebral veins)
acronym for malignancies associated with polycythemia
PHUCK Pheo Hepatoma Uterine leiomyoma Cerebellar something Kidneys
Conditions where you see spherocytes
All hemolytic anemias to some degree
ONLY spherocytes in warm AIHA
hereditary
target cells seen in
1) thalassemias
2) liver disease
3) some other condition?
only indication for hypertransfusion in sickle cell
stroke
indication for transfusion in SCD
1) surgery, transfuse to hgb to 10
2) Acute chest syndrome
3) Stroke
4) severe, symptomatic anemia
how many lobes can a neutrophil have
5 or 6 (confirm)
saturation threshold where you should worry about hereditary hemochromatosis
45%
conditions where you commonly see high iron
Liver disease (NAFLD) HLH
best screening test for hemochromatosis
transferrin saturation
rouleaux formations
are giant. don’t overcall it.
ITP physiology
increased platelet destruction + *decreased production
why do patients with liver disease have low platelets
Multi factorial — reduced TPO levels + portal hypertension
2 meds that cause cobalamin deficiency
1) metformin
2) PPIs
what happens when you correct b12 deficiency with folic acid
corrects anemia but not neurologic stuff
vitamin k dependent clotting factors
factors II, VII, IX, X, proteins C and S
PT measures what pathway in coagulation cascade
extrinsic
PTT measures what pathway in coagulation cascade
intrinsic
warfarin mechanism
Works by blocking an enzyme called vitamin K epoxide reductase that reactivates vitamin K1. Without sufficient active vitamin K1, clotting factors II, VII, IX, and X have decreased clotting ability. The anticlotting protein C and protein S are also inhibited but to a lesser degree.
DIC labs
PT/PTT + d-dimer + fibrinogen
what is d-dimer a measure of
fibrinolysis
what is von willebrand factor
protein that binds to factor VIII and is important in platelet adhesion to wound sites.
general threshold for transfusing cryoprecipitate
Fibrinogen <100
components of FFP
- All of the clotting factors,
- fibrinogen (400 to 900 mg/unit),
- plasma proteins (particularly albumin)
- physiological anticoagulants (protein C, protein S, antithrombin, tissue factor pathway inhibitor) - added anticoagulants
FFP preparation
FFP is commonly thawed in a water bath over 20 to 30 minutes.
cryoprecipitate contents
Fibrinogen – >150 mg of fibrinogen (range: 150 to 250 mg); half-life: 100 to 150 hours
Factor VIII – >80 international units (range: 80 to 150 units); half-life: 12 hours
Factor XIII – 50 to 75 units; half-life of 150 to 300 hours
Von Willebrand factor – 100 to 150 units; half-life: 24 hours
neutropenia definition
Neutropenia definitions:
neutropenia = ANC <1500
severe neutropenia = ANC <500
What you can’t use DOACs for
valvular AF
Anticoagulants approved for DVT prophylaxis after hip and knee surgery
1) rivaroxaban and apixaban
2) mechanical heart valves
why patients can be labile with VKA’s
1) Gastric bypass surgeries (ileal absorption)
2) Crohn’s (ileal absorption)
basophilic stippling
basophilic granules that are dispersed through the cytoplasm of erythrocytes in a peripheral blood smear.
what basophilic stippling suggests
problem with erythropoiesis
basophilic stippling causes
Thalassemia[2] (β-thalassemia Minor (i.e. Trait) & Major, and α-thalassemia, only when 3 gene loci defective: (--/-α)) Severe megaloblastic anemia Hemolytic anemia Sickle-cell anemia Pyrimidine 5' nucleotidase deficiency[3] Alcoholism[4] Myelodysplastic syndromes Sideroblastic anemia[5] Congenital dyserythropoietic anemia [6] Primary myelofibrosis Leukemia[7]
function of monocyte
largest type of leukocyte and can differentiate into macrophages and myeloid lineage dendritic cells.
atypical localization of immature precursors (ALIP)
atypically localized precursors (myeloblasts and promyelocytes) on bone marrow biopsy. In healthy humans, precursors are rare and are found localized near the endosteum, and consist of 1-2 cells. In some cases of myelodysplastic syndromes, immature precursors might be located in the intertrabecular region and occasionally aggregate as clusters of 3 ~ 5 cells.
hypercellularity definition in BMB
ratio of hematopoetic cells to marrow fat
what is MDS?
A heterogeneous group of malignant hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production and a variable risk of transformation to acute leukemia. It is a clonal process.
how FISH works
A molecular cytogenetic technique that uses fluorescent probes that bind to only those parts of a nucleic acid sequence with a high degree of sequence complementarity. It was developed by biomedical researchers in the early 1980s[1] to detect and localize the presence or absence of specific DNA sequences on chromosomes. Fluorescence microscopy can be used to find out where the fluorescent probe is bound to the chromosomes
what is a mutation?
Alteration of the nucleotide sequence of the genome of an organism.
diseases considered myeloproliferative neoplasms
CML Polycythemia vera Essential thrombocythemia Primary myelofibrosis Chronic neutrophilic leukemia Chronic eosinophilic leukemia (not otherwise specified) Mastocytosis
hemolysis labs
fractionated bilirubin + haptoglobin + reticulocyte count
2 things that can cause a rapid drop in RBCs
hemolysis + acute bleed
Deal with haptoglobin in diagnosis of hemolytic anemia
There’s a common conception that haptoglobin is a useless test because of low specificity but the problem is more so that because it’s an acute phase reactant, it may be elevated even if the patient is hemolyzing. So normal or elevated haptoglobin doesn’t rule out hemolysis. And I think it’s useful to order because the other tests like bilirubin and LDH are very nonspecific, that the combination of lab findings increases specificity.
lab features of MDS
Anemia with low retic count + leukopenia (50%) + varying degrees of thrombocytopenia (25%) + dysplastic cells on smear (≥10 percent of erythroid precursors, granulocytes, or megakaryocytes) + inappropriately low retic count + blasts <20
normal transferrin saturation
25 percent to 35 percent
normal transferrin level
170 to 370 mg/dl
Why does hypothyroidism predispose someone to bleeding
Decreased platelet number and function
Increased acquired Vw syndrome
Why do spherocytes form in hemolytic anemia? What is a spherocyte?
Cytoskeletal defect. FC region of antibody is recognized and grabbed onto by FC receptors found on monocytes and macrophages in the spleen. These cells will pick off portions of the red cell membrane, almost as if they are taking a bite. The loss of membrane causes the red blood cells to become spherocytes.
Function of a lymphocyte
subtypes of a white blood cell in a vertebrate’s immune system.[1] Lymphocytes include natural killer cells (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adaptive immunity), and B cells (for humoral, antibody-driven adaptive immunity).[2][3] They are the main type of cell found in lymph,
