Hertz CIS

Question 1

koilonychia

Answer 1

spoon shaped nails seen in iron deficiency

Question 2

RDW measures?

Answer 2

red cell distribution width– the differences in the red cell sizes

Question 3

red cell normal, HG low, what do we think?

Answer 3

a thalassemia

Question 4

how to look at the hemogram

Answer 4

1. RBC/ Hgb to look at an anemia
2. MCV– are we normo, micro, or macrocytic?
3. RDW- variation in size.
4. Retic count

Question 5

Why are MCH and MCHC kind of worthless?

Answer 5

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.

Question 6

skier hits tree, bleeding into abdomen

Answer 6

hemoglobin normal to start, begins to drop

retic stays normal until about 8 days later, rises as hemoblogen gets under 10 g

Question 7

colon cancer

Answer 7

chronic blood loss. retic would be up, hypochromic microcytic anemia. MCV would be like 70. Lower MCV more likeiron deficiency.

Question 8

Female with post-menopausal bleeding

Answer 8

anemia of chronic blood loss

endometrial cancer

Question 9

extravascular hemolysis triad

Answer 9

jaundice, splenomegaly, reticulocytosis

Question 10

Haptoglobin

Answer 10

when red cells get popped or hemolyzed (intravascular), haptoglobin picks up the hemoglobin. (alpha 2).

Question 11

normal MCHC values

Answer 11

33-34

Question 12

Holly Jowell bodies happen when?

Answer 12

splenectomy
nonfunctional spleen when small, stiff RBCs (old)
Sickle cell (due to autosplenectomy)

Question 13

G6PD

Answer 13

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)

Question 14

Sickle Cell. What does the C type do?

Answer 14

inhibits polymerization, sort of stabilizes the sickle cell and ends up being a milder version than sickle trait

Question 15

the balance of thalassemia genes

Answer 15

4 alphas

2 betas

Question 16

In beta thalassemia we are making

Answer 16

more alpha than beta

aaaa BB (normal)
aaaa  Bb  (minor)
aaaa bb (major)

Question 17

alpha thalassemias

Answer 17

missing 1- silent carrier
missing 2- trait
missing 3- H
missing 4- Hydrrops

Question 18

target cells mean

Answer 18

hemonglobinopathies like- thalassemia

Question 19

soccer ball cells

Answer 19

hemoglobin H- high affinity (hangs on to oxygen)

Question 20

hemosiderin around the kidney tubules

chronic anemia, normochromic, normocytic

Answer 20

PNH

test to make sure? flow cytometry
deficiency of CD59

Question 21

downey cells

Answer 21

active T cells (seen in mono)

causes agglutination

Question 22

autoimmune diseases DATs?

Answer 22

warm agglutination
Ig G

(no blood transfusions are compatible)

Question 23

acute disease DAT?

Answer 23

cold agglutination

Ig M

Question 24

zero retics, what would we need to think?

Answer 24

folate or B12 deficiency

think even more if you see hypersegmented neutrophils

Question 25

asynchrony in folate/ B12 deficiency

Answer 25

nucleus doesn’t develop well but the cytoplasm does

Question 26

4 things that can cause B12 deficiency

Answer 26

Sjogrens
atrophic gastritis
lack of pancreatic amylase
Crohn’s disease

fish tapeworm loves B12

Question 27

pencil cells mean

Answer 27

iron deficiency anemia

Question 28

3 chronic diseases

Answer 28

infections
autoimmune
neoplasms

Question 29

primary hemochromatosis

Answer 29

the ferroportin is always open, too much iron always comes in.

Question 30

secondary hemochromatosis

Answer 30

particularly happens in thalassemia

can’t make good marrow, –> gut tries to absorb as much iron as possible

Question 31

WBC and platelets low. What do we ask?

Answer 31

what do you do for a living or what drugs?

e.g. bone marrow suppression from lead

Question 32

dacryocytes come from

Answer 32

myelophthystic process (space occupying lesion)

Question 33

stuff that leads to myellophthystic stuff

Answer 33

granulomas
cancer
renal disease (?)

Question 34

renal cell carcinoma makes

Answer 34

EPO! –> erythrocytosis

hepatocellular and
cerebellar hemangioblastomas can also do this