Heme Flashcards
Along with homocysteine, what levels can be elevated with vitamin B12 deficiency?
Methylmalonic acid levels
Besides elevated MCV, what else can be elevated with folate deficiency?
Homocysteine levels
Blister cells or bite cells on peripheral smear are most often seen with what condition?
Glucose 6 phosphate dehydrogenase deficiency (G6PD)
Bleeding disorder with GpIb deficiency?
Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor)
Name the four main causes of microcytic anemia.
Thalassemia, Iron deficiency, Anemia of chronic disease, Sideroblastic anemia (mnemonic TICS)
What are the most common vitamin K dependent clotting factors?
Factors II, VII, IX, and X
Patient is found to have a Pelger-Huet anomaly and hyposegmented neutrophils. What condition does this patient likely have?
Myelodysplastic syndrome
What condition is often associated with hypersegmented neutrophils?
Vitamin B12 deficiency
What hematologic condition is often associated with restless leg syndrome?
Iron deficiency anemia
What hematological condition is caused by a membrane defect of spectrin deficiency?
Hereditary spherocytosis
What is the earliest lab value to increase after repleting iron in patients with iron deficiency anemia?
Reticulocyte count
Rapid fire assoc:Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
Anaphylaxis following blood transfusion Dx?
IgA deficiency
Autosplenectomy (fibrosis and shrinkage) associated w/what dz?
Sickle cell disease (hemoglobin SS dz)
Rapid fire txt: Heparin reversal
Protamine sulfate
Rapid fire assoc:Monoclonal antibody spike. 3 things.
-Multiple myeloma (usually IgG or IgA)
-Monoclonal gammopathy of undetermined significance (MGUS consequence of aging)
Waldenström (M protein= IgM) macroglobulinemia
-Primary amyloidosis
dabigatran bleeding reversal agent?
Idracizumab or prothrombin complex concentrate
Painful blue fingers/toes, hemolytic anemia
Cold agglutination disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)
Rapid fire assoc: Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)
Mucosal bleeding and prolonged bleeding time
Glanzmann thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)
Rapid fire assoc:Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Rapid fire assoc:Hair on end” (“Crew cut”) appearance on x-ray
β-thalassemia, sickle cell disease (marrow expansion)
Rapid fire assoc: basophilic stippling on RBCs
Lead poisoning or sideroblastic anemia
Rapid fire assoc: Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
What is the simplest test to differentiate anemia of chronic disease from iron deficiency?
Total iron-binding capacity (TIBC)
What mutation is often associated with polycythemia vera?
JAK2 mutation
Athlete with polycythemia Dx?
Secondary to erythropoietin injection (blood doping)
Which antibody is associated with cold agglutinin hemolytic anemia?
IgM
If mixing study corrects PT or PTT, what would this indicate?
Indicates a factor deficiency.
Myelodysplasia w/5q and w/out 5q txt?
Lenalidomide, azacitidine
What are the 2 most common causes of spherocytosis?
Auto immune hemolytic anaemia & hereditary spherocytosis
How do you differentiate
Auto immune hemolytic anaemia & hereditary spherocytosis?
Direct anti globulin test (coombs). DAT is negative in HS patients
How do you confirm the diagnosis of hereditary spherocytosis?
Eosin 5 maleimide binding (flow cytometry) or acidified glycerol lysis test
How do you treat hereditary spherocytosis?
Rbc transfusion for symptomatic anemia, folic acid supplementation, splenectomy for severe cases
What are the 3 main diseases that patients with polycythemia Vera are at risk of developing?
Thrombotic events, post polycythemia myelofibrosis, acute myeloid leukaemia/Myelodysplastic syndrome
Abdominal pain, constipation, dark urine, hyponatraemia, peripheral neuropathy, neuropsychiatric manifestations suggest what diagnosis?
Acute intermittent porphyria
What is the dx test and treatment for Acute intermittent porphyria?
Elevated urinary porphobilinogen (PBG) during attack. Glucose loading and intravenous hemin
What is the most common long term adverse effect of external beam radiation for prostate cancer?
Sexual dysfunction
