Hertz CIS Flashcards
koilonychia
spoon shaped nails seen in iron deficiency
RDW measures?
red cell distribution width– the differences in the red cell sizes
red cell normal, HG low, what do we think?
a thalassemia
how to look at the hemogram
- RBC/ Hgb to look at an anemia
- MCV– are we normo, micro, or macrocytic?
- RDW- variation in size.
- Retic count
Why are MCH and MCHC kind of worthless?
they are calculated values, don’t add a whole lot.
When they’re low, the color is low.
THe MCHC is only good in hereditary spherocytosis, when it is elevated. Dead giveaway.
skier hits tree, bleeding into abdomen
hemoglobin normal to start, begins to drop
retic stays normal until about 8 days later, rises as hemoblogen gets under 10 g
colon cancer
chronic blood loss. retic would be up, hypochromic microcytic anemia. MCV would be like 70. Lower MCV more likeiron deficiency.
Female with post-menopausal bleeding
anemia of chronic blood loss
endometrial cancer
extravascular hemolysis triad
jaundice, splenomegaly, reticulocytosis
Haptoglobin
when red cells get popped or hemolyzed (intravascular), haptoglobin picks up the hemoglobin. (alpha 2).
normal MCHC values
33-34
Holly Jowell bodies happen when?
splenectomy nonfunctional spleen when small, stiff RBCs (old) Sickle cell (due to autosplenectomy)
G6PD
HEinz bodies, bite cells
mediterranean is the worst, don’t make any
negative is ok, just diminished.
BOTH intravascular and extravascular hemolysis
wait 2 weeks to test because the G6PD problem cells will be gone for a while (the old ones)
Sickle Cell. What does the C type do?
inhibits polymerization, sort of stabilizes the sickle cell and ends up being a milder version than sickle trait
the balance of thalassemia genes
4 alphas
2 betas
In beta thalassemia we are making
more alpha than beta
aaaa BB (normal) aaaa Bb (minor) aaaa bb (major)
alpha thalassemias
missing 1- silent carrier
missing 2- trait
missing 3- H
missing 4- Hydrrops
target cells mean
hemonglobinopathies like- thalassemia
soccer ball cells
hemoglobin H- high affinity (hangs on to oxygen)
hemosiderin around the kidney tubules
chronic anemia, normochromic, normocytic
PNH
test to make sure? flow cytometry
deficiency of CD59
downey cells
active T cells (seen in mono)
causes agglutination
autoimmune diseases DATs?
warm agglutination
Ig G
(no blood transfusions are compatible)
acute disease DAT?
cold agglutination
Ig M
zero retics, what would we need to think?
folate or B12 deficiency
think even more if you see hypersegmented neutrophils
asynchrony in folate/ B12 deficiency
nucleus doesn’t develop well but the cytoplasm does
4 things that can cause B12 deficiency
Sjogrens
atrophic gastritis
lack of pancreatic amylase
Crohn’s disease
fish tapeworm loves B12
pencil cells mean
iron deficiency anemia
3 chronic diseases
infections
autoimmune
neoplasms
primary hemochromatosis
the ferroportin is always open, too much iron always comes in.
secondary hemochromatosis
particularly happens in thalassemia
can’t make good marrow, –> gut tries to absorb as much iron as possible
WBC and platelets low. What do we ask?
what do you do for a living or what drugs?
e.g. bone marrow suppression from lead
dacryocytes come from
myelophthystic process (space occupying lesion)
stuff that leads to myellophthystic stuff
granulomas
cancer
renal disease (?)
renal cell carcinoma makes
EPO! –> erythrocytosis
hepatocellular and
cerebellar hemangioblastomas can also do this
