Heme Flashcards
Rouleaux Formation
RBCs stick together like “stack of coins” due to increase plasma proteins
Disease: Multiple Myeloma
Auto Agglutination
Clumping of RBCs due to IgM auto-antibodies coating the surface of RBCs
Diseases: Cold agglutinin autoimmune hemolytic anemia
Howell-Jolly Bodies
Small dense basophilic RBC inclusions (usually removed by the spleen)
Diseases:
- Decreased splenic function: autosplenectomy (ie sickle cell disease)
- Severe hemolytic anemia, megaloblastic anemia
Hemolytic Cells
Bite Cells: bite-like deformity due to phagocyte removal of denatured Hgb
-Thalassemia, G6PD deficiency
Schistocytes: Fragmented RBCs
-Hemolytic anemia
Keratocytes: Helmet shaped RBCs; mechanical RBC damage in small vessels
Basophilic stippling
-Coarse blue granules in RBCs evenly distributed throughout the RBC
Diseases: Sideroblastic anemia; Thalassemias
Echinocytes
“Burr Cells”
RBCs w/ numerous, small, evenly spaced projections due to abnormal cell membrane
Disease: Uremia
Acanthocytes
“Spur Cells”
Few large spiny, irregular projections on the RBC membrane
Diseases: Liver dz, post splenectomy, thalassemia, autoimmune hemolytic anemia, renal dz
Target Cells (Condocytes)
HYPOchromic RBC w/ round area of central pigment “target-shaped”
Diseases:
- Sickle Cell
- Thalassemia
- Severe Fe deficiency
Hypersegmented neutrophils
Neutrophils w/ >5 lobes
Diseases: B12 & Folate deficiencies
Auer Rods
Acute Myelogenous Leukemia (AML)
Reed-Sternberg Cells
Hodgkin Lymphoma
MCC of anemia worldwide
Iron deficiency anemia
MCC of iron deficiency anemia in the US
Chronic blood loss
- excessive menstruation
- occult GI bleed (colon cancer)
MCC of iron deficiency anemia worldwide
Decreased absorption
-Diet
Iron deficiency anemia patho
Decreased RBC production due to lack of iron & decreased iron stores (decreased ferritin)
Iron deficiency anemia clinical manifestations
- fatigue, weakness, dyspnea, irritability, anorexia
- Pagophagia: craving for ice
- Pica: appetite for non-food substance
PE: koilonychia, angular cheilitis, tachycardia, glossitis, pallor
Iron deficiency anemia lab findings
- Microcytic Hypochromic anemia classic
- Increased RDW
- DECREASED ferritin, INCREASED TIBC, decreased transferrin saturation
Iron deficiency anemia management
Iron replacement w/ Ferrous sulfate
How to increase iron absorption
Take iron replacement w/ Vitamin C (ascorbic acid) w/ water or orange juice on an empty stomach
Clinical manifestations of lead poisoning
Ataxia, fatigue, learning disabilities, difficulty concentrating, peripheral neuropathy (wrist or foot drop)
Intermittent abdominal pain, vomiting, loss of appetite, constipation
Lead poisoning diagnosis/ lab values
Serum lead levels >10 mcg/dL
Peripheral smear: microcytic hypochromic anemia w/ basophilic stippling.
Ringed sideroblasts in the bone marrow
“Lead lines” on x-rays
Lead poisoning management
Removal of source of lead
Succimer first-line as inpatient (oral chelation)
Idiopathic bone marrow failure
Aplastic anemia
Aplastic anemia classically caused by what toxin?
Benzene
Pancytopenia w/ bone marrow hypocellularity
Aplastic anemia
Clinical manifestations aplastic anemia/ pancytopenia
Easy bruising, bleeding, frequent infections, fatigue
-Thrombocytopenia: mucocutaneous bleeding
Most accurate test for aplastic anemia/ pancytopenia
Bone marrow biopsy
-hypocellular, fatty bone marrow
Diagnosis of exclusion if bone marrow biopsy failure
Initial treatment of choice for aplastic anemia/ pancytopenia
Supportive management
Treatment of choice for sever aplastic anemia/ pancytopenia in otherwise healthy pt <50 yrs
Allogenic hematopoietic stem call transplantation
X-linked recessive disorder common in African American males
G6PD deficiency
In G6PD deficiency, denatured hemoglobin precipitated as ____
Heinz bodies
Exacerbating factors for G6PD deficiency
- Infections (MCC)
- Fava beans
- Medications: oxidative drugs (dapsone, primaquine, nitrofurantoin)
Peripheral smear diagnosis for G6PD
Normocytic hemolytic anemia during crisis
- schistocytes (bite or fragmented cells)
- Heinz bodies hallmark
Causes of Hemolytic anemia
- G6PD deficiency
- Sickle cell disease
- TTP
- HUS
- DIC
Lab findings hemolytic anemia
- INCREASED reticulocyte count
- INCREASED unconjugated (indirect) bilirubin
- DECREASED haptoglobin
- INCREASED LDH