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fundamentals 2 > Hemolytic Anemia > Flashcards

Hemolytic Anemia Flashcards

1
Q

intravascular hemolysis

A

RBC ruptures in circulation

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2
Q

extravascular hemolysis

A

RBC rupture happens outside of circulation

most commonly in the spleen

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3
Q

How is heme degraded?

A

broken down in spleen to biliverdin and unconjugated bilirubin

*unconjugated bilirubin then goes to liver

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4
Q

haptoglobin in intra/extravascular hemolysis

A

intra: decreased because haptoglobin binds to free heme sites

extra: normal

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5
Q

LDH in intra/extravascular hemolysis

A

may be elevated in both

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6
Q

indirect bilirubin in intra/extravascular hemolysis

A

unconjugated bilirubin can be elevated in both

see more elevation in extravascular hemolysis

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7
Q

why does intravascular hemolysis not contributed to indirect bilirubin as much?

A

only small amounts of heme bound to haptoglobin will be recycled to bilirubin

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8
Q

Hepatosplenomegaly and lymphadenopathy indicate …

A

extravascular hemolysis

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9
Q

Urine dip for heme in intra/extravascular hemolysis

A

intra: positive for heme in urine

extra: no

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10
Q

urine dip for RBC in intra/extravascular hemolysis

A

usually negative in all hemolysis

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11
Q

DAT / direct coombs

A

indicates if hemolysis is immune-mediated or not

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12
Q

DAT vs. IAT

A

DAT tests immunoglobin or complement directly on RBC

IAT tests for red cell antibodies in patient’s serum

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13
Q

warm immune hemolytic anemia

A

+DAT

IgG mediated

most complete treatment is splenectomy

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14
Q

what can acute spherocytes indicate?

A

acute hemolytic anemia

not hereditary

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15
Q

hereditary spherocytosis vs. autoimmune anemia

A

look at DAT / coombs test

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16
Q

hereditary spherocytosis

A

spherocytes cannot traverse through spleen sinusoids in times of inflammation

RBCs are damaged in the spleen

leads to RBC breakdown / anemia

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17
Q

Inheritance pattern of G6PD def.

A

X-linked

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18
Q

Pathophysiology of G6PD Def.

A

pentose phosphate shunt cannot regenerate NADPH which is needed for formation of glutathionine

therefore, cannot overcome oxidative challenges

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19
Q

Is hereditary spherocytosis intra or extravascular?

A

extravascular

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20
Q

is autoimmune hemolysis intravascular or extravascular?

A

IgG = extravascular

IgM = intravascular

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21
Q

is G6PD def. intra or extravascular?

A

mostly intravascular

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22
Q

is sickle cell intra or extravascular?

A

both

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23
Q

is a-thalassemia intra or extravascular?

A

seems to be more extravascular

definitely intramedullary

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24
Q

what symptom is associated with elevated bilirubin?

A

jaundice

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25
Q

what can a hypersegmented neutrophil indicate?

A

folate def. or B12 def

26
Q

how can you differentiate between B12 and folate def?

A

only B12 def presents with neuro symptoms

27
Q

list 5 hypoproliferative anemias

A

anemia of inflammation

B12 + folate def

lead toxicity

aplastic anemia

iron deficiency anemia

28
Q

what indicates a hypoproliferative anemia?

A

low retic

29
Q

Hemochromatosis

A

iron overload

30
Q

how can you determine between iron def. anemia and anemia of inflammation?

A

anemia of inflammation will have LOW TIBC (don’t want iron)

iron def. anemia will have high TIBC (trying to bind the little amounts of iron)

31
Q

what is similar about anemia of inflammation and iron deficiency anemia

A

both have low Fe

anemia of inflammation has low Fe to limit iron in blood

32
Q

when is ferritin low

A

iron deficiency anemia

33
Q

percent iron saturation in iron def. anemia

A

low

34
Q

TIBC stands for

A

total iron binding capacity

35
Q

Hemoccult

A

tells you if you have blood in stool

indicates bleeding somewhere in GI tract

36
Q

megaloblastic anemia

A

very large red blood cells

decrease in the number of RBCs

37
Q

difference between megaloblastic anemia and macrocytic anemia

A

megaloblastic anemia is a type of macrocytic anemia

megaloblastic anemia occurs during B12 def.

38
Q

lead toxicity leads to …

A

hypoproliferative anemia

39
Q

elevated platelet indicates …

A

inflammation

40
Q

how can you treat immune-mediated hemolysis?

A

steroid

steroids are quick acting immunosuppressants

41
Q

Spherocytes with agglutination are seen in …

A

autoimmune hemolytic anemia

42
Q

uniform spherocytes are seen in …

A

hereditary spherocytosis

43
Q

heinz bodies and bite cells are seen in ….

A

G6PD def

44
Q

schistostocytes are seen in

A

HUS

45
Q

basophilic stippling is seen in

A

iron deficiency and lead toxicity

46
Q

How do you calculate ANC?

A

WBC * (neutrophil% + band%)

47
Q

How do you calculate ALC?

A

WBC * leukocyte%

48
Q

How can you determine neutropenia?

A

calculate the ANC

49
Q

List lab values for mild, moderate and high-risk neutropenia

A

mild: <750 ANC (cell/mm)

moderate: < 500 ANC (cell/mm)

high: <100 ANC (cells/mm)

50
Q

leukocytosis

A

HIGH white blood cell count

indicates immune response (secondary cause)

can indicate leukemia (primary cause)

51
Q

leukopenia

A

LOW white blood cell count

can be caused by aplastic anemia

can also be caused by chemotherapy and other things

52
Q

aplastic anemia

A

cannot produce enough new blood cells

53
Q

What happens at ANC < 750?

A

risk for bacterial infection rises

54
Q

Bloody diarrhea can be associated with which type of anemia?

A

HUS

mediated by shiga-like toxin

55
Q

bone marrow of aplastic anemia

A

acellular bone marrow

56
Q

Difference between ITP and aplastic anemia

A

in ITP only platelet count is low

in aplastic anemia, everything is low

57
Q

what is the only treatment for Fanconi anemia?

A

stem cell transplant

58
Q

4 categories of pantocytopenia

A

1) loss of stem cells (fanconi, DNA damage, autoimmune)
2) marrow replacement
3) bone marrow suppression
4) peripheral destruction of cells

59
Q

What can cause bone marrow replacement?

A

mylofibrosis or cancer like leukemia

60
Q

What can cause loss of stem cells?

A

Fanconi, autoimmune disorder, or acquired expsoure

61
Q

what can cause bone marrow suppression?

A

drugs or viruses

fundamentals 2 (30 decks)

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