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lab 1 Flashcards

1
Q

CBC
Decreased RBC
decreased hgb
MCV normal
Slide review reveals nucleated (young) RBCs
Retic count is ordered additionally to CBC
Supravital stain

A

Acute blood loss anemia

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2
Q

Due to trauma, surgery, GI bleeding

Normocytic, normochromic anemia with increased reticulocytes

A

Acute blood loss anemia

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3
Q

Microcytic, hypochromic anemia

A

Iron deficiency anemia

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4
Q 
CBC
Decreased RBC
Decreased HGB
Low MCV
Add- on testing? Iron studies
A

Iron deficiency anemia

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5
Q

Microcytic, hypochromic anemia
Usually a normal RBC count relative to level of anemia
Target cells, basophilic stippling often present, normal RDW
Definitive diagnosis with hemoglobin electrophoresis

A

Thallasemia

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6
Q

Thallasemias are a group of hereditary anemias where there is deficient production of alpha or beta hgb.
Alpha thallasemia major, alpha thallasemia minor
Beta thallasemia major, beta thallasemia minor
Patients with life-long microcytic anemia
unresponsive to Fe therapy

A

Thallasemia

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7
Q

Worse morphology with normal iron

A

Thallasemia

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8
Q

Spherocytes=

A

RBCs lacking central pallor

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9
Q

How to confirm Spherocytes?

A

osmotic fragility test

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10
Q

> 25 % of RBCs with elliptocyte/ovalocyte morphology to distinguish from other conditions

A

Hereditary elliptocytosis

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11
Q

Ususally normocytic, normochromic but may be microcytic

Lab findings: Low reticulocyte count, normal to increased ferritin and iron stores, decreased serum iron.

A

Anemia of chronic disease

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12
Q

Increased reticulocyte count

High serum bilirubin levels from increased RBC destruction

A

Hemolytic anemia

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13
Q

: hereditary hemoglobinopathies, G6PD deficiency, sickle cell

A

Intrinsic

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14
Q

autoimmune destruction, heart valves, burns

A

Extrinsic

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15
Q

Cold induced Hemolytic

A

IgM mediated

usually only a problem for laboratory testing (blood banking)

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16
Q

Warm Hemolytic

A

IgG mediated: extravascular hemolysis by splenic macrophages
Majority of AIHA, Reacts at body temp
Peripheral blood: NRBCs, schistocytes, spherocytes, increased retics
Direct antiglobulin test (DAT)
Patients serum reacts with screening cells

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17
Q

Hemolytic disease of newborn

A

Determine amount of fetomaternal hemorrhage with Kleihaour-Betke test

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18
Q

Kleihaour-Betke test

A

Hemolytic disease of newborn

Determine amount of fetomaternal hemorrhage with

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19
Q

Vasculature capable of shredding RBCs via formation of fibrin/clot within vessels
Labs: schistocytes on peripheral smear
High LDH and bilirubin
DIC: disseminated intravascular coagulation
TTP: thrombotic thrombocytopenic purpura
HELLP: hemolysis, elevated liver enzymes, low platelets

A

Microangionpathic hemolytic anemia

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20
Q

Most common RBC enzyme disorder

Requires Requires supravital stain for visualization

A

G6PD deficiency

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21
Q

Heinz bodies removed by spleen producing

A

bite cells

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22
Q

G6PD deficiency def. Diagnosis

A

Definitive diagnosis by demonstrating decreased enzyme activity or by identifying genetic abnormality with PCR

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23
Q

Megaloblastic anemia: abnormal cell development
Nuclear-cytoplasmic synchrony- defects in all cell types
Macrocytic anemia (MCV >100)
Macroovalocytes, hypersegmented PMNs, macroplatelets

A

Folate deficiency

24
Q

Megaloblastic
Macrocytic anemia
Serum b12 level

A

B12 deficinency

25
Q

Microcytic hypochromic anemia
Basophilic stippling of RBCs (precipitate of RNA, mitochondria)
S/Sx: abdominal pain, cognitive impairment, irritability
Acute onset: vomiting, seizures, AMS

A

Lead poisoning

26
Q

Increased RBC

Hgb >18.5 g/dL in males, Hbg > 16.5 in females

A

erythrocytosis

27
Q

erythrocytosis Dx:

A

must directly measure RBC mass and perform bone marrow bx

Tx: therapeutic phlebotomy

28
Q

Measured in lab by partial thromboplastin time (PTT)

Monitor herparin/lovenox therapy

A

Intrinsic pathway

29
Q

VII and tissue factor
Measured in lab by prothrombin time (PT/INR)
Monitor Coumadin therapy

A

Extrinsic pathway

30
Q

I, II, V, X

A

Common pathway: thrombin activates fibrinogen to fibrin

31
Q

mutation making factor V resistant to protein C degradation causing hypercoagulable state

A

Factor V Leiden:

32
Q

Antithrombin

Anticoagulant properties greatly increased by

A

heparin

33
Q

fibrinolysis Major enzyme is

A

palsmin

34
Q

Fibrinogen cleaves clot into specific fibrin degredation products (FDPs):

A

d-dimer

35
Q

Measures PLT function in vivo- measures amount of time for patient to stop bleeding from a superficial cut

A

Bleeding time

Normal: 1-9min

36
Q

Test PLT ability to aggregate in vitro in presence of different reagents- identify qualitative PLT disorders

A

Platelet Aggregation test

37
Q

Measures clot formation by extrinsic pathway

INR: algorithm to reduce variability in PT between labs

A

PT: prothrombin time

38
Q

Measures clot formation via intrinsic pathway

A

PTT: partial thromboplastin time

39
Q

Measures conversion of fibrinogen to fibrin

A

Thrombin time

40
Q

Factor VIII deficiency
Dx: prolonged PTT w/ normal PT
Factor assay will show decreased factor VIII

A

Hemophilia A

41
Q

Deficiency of factor IX

Prolonged PTT w/ normal PT

A

Hemophilia B

42
Q

Needed by hepatic cells to produce factors II, VII, IX, X

A

Vitamin K deficiency

43
Q

MC d/t infection (10-20% incidence in gram neg sepsis)

A

Disseminated intravascular coagulation:DIC

44
Q

Acute: sudden onset severe bleeding
HELLP: hemolysis, elevated liver enzymes, low PLTs in peripartum women

A

Disseminated intravascular coagulation:DIC

45
Q

Thrombocytopenia, PT & PTT ↑, fibrinogen ↓, D-dimer +

Schistocytes on peripheral smear

A

Disseminated intravascular coagulation:DIC

46
Q

Decreased PLTs on CBC, normal coag studies

A

Immune thrombocytopenic purpura (ITP)

47
Q

PLT count decrease by >50% after exposure to heparin is diagnostic

A

Heparin-induced thrombocytopenia

48
Q

Thrombocytopenia within 5-10 days of heparin tx

Less common with LMWH

A

Heparin-induced thrombocytopenia

49
Q

Persistently elevated PLT count with increased megakaryocytes in BM

A

Essential thrombocythemia

50
Q

Most common inherited bleeding disorder

A

Von Willebrand Disease

51
Q

Ristocetin cofactor assay: assess PLT ability to aggregate in presence of ristocetin
Early sx: easy bleeding/bruising in childhood.

A

Von Willebrand Disease

52
Q

MC inherited cause of hypercoagulability (3% of population)

A

Factor V Leiden

53
Q

Point mutation in factor V, making it resistant to degradation by protein C

A

Factor V Leiden
Testing clot based: inability of activated protein C (APC) to prolong clotting time
Confirmatory test with PCR (polymerase chain reaction) to look for specific abnormality in patient DNA

54
Q

Labs: same as microangiopathic hemolytic anemia
Schistocytes, reticulocytes, LDH increased, bili increased
Tx: plasma exchange

A

Thrombotic thrombocytopenic purpura

55
Q

Triad
Thrombocytopenia with generalized purpura
Microangiopathic hemolytic anmeia w/ jaundice
Neuro sx: weakness, dysphasia, HA, seizures…
Pentad: add fever and renal dysfunction

A

Thrombotic thrombocytopenic purpura

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