Midterm RBC Review Flashcards
1
Q
What stimulates RBC production?
A
EPO from kidney
2
Q
Hemoglobin has what two parts
A
Heme protein + 2 pairs of globin chains
3
Q
Heme has what two parts
A
Iron + protoporphryin
4
Q
HbA is 95% and has what chains
A
Alpha and beta
5
Q
HbA2 is 3.5% and has what chains
A
Alpha and delta
6
Q
HbF is 1.0% and has what chains
A
alpha and gamma
7
Q
Anemia definition
A
Decreased red blood cell mass
8
Q
Normal HCT to HB ratio?
A
3:1
9
Q
Anemia special title
A
Most common RBC abnormality
10
Q
What is reticulocytosis
A
Increase in reticulocytes signaling marrow response to anemia
11
Q
What is polychromasia
A
New immature RBC’s made in response to anemia are bigger and blue
12
Q
Two GI losses causing anemia and their patient type
A
- Peptic Ulcer: Adult males
2. GI Neoplasm: Elderly
13
Q
One GYN loss causing anemia and patient type
A
Woman with menorrhagia
14
Q
Intravascular sees decrease in what two proteins
A
Hemopexin and Haptobloin due to binding Iron
15
Q
Extravascular hemolysis is done by what two things?
A
- Spleen
2. Liver macrophages
16
Q
What are the Hb and HCT level changes in extravascular hemolysis?
A
None
17
Q
Intravascular hemolysis due to mechanical causes include?
A
Microangiopathic hemolytic anemias
Mechanical heart valves
18
Q
What is the principal finding in microangiopathic hemolytic anemias
A
Schistocytes
19
Q
Three types of microangiopathic hemolytic anemias?
A
- Disseminated Intravascular coagulation
- Hemolytic uremic syndrome
- Thrombotic thrombocytopenic purpura
20
Q
Three things elevated in DIC only?
Common patient type
A
D-dimer
PTT
PT
Pregnant
21
Q
Hemolytic uremic syndrome is what age?
Cause?
A
Children
Toxin damage
22
Q
Thrombotic thrombocytopenic purpura is due to what?
Patient type?
A
Adams 13 mutation
Young women
23
Q
Microangiopathic hemolytic anemias have what common cause?
A
Lumen narrows and injures RBC’s causing them to lyse and form schistocytes
24
Q
Hereditary spherocytosis Heredity Ethnic group 2 proteins affected Mechanism of path Characteristic cell shape One sequelae to know Diagnose how? Treatment? Result of treatment
A
Autosomal Dominant Scandinavians Ankyrin and Spectrin Lose parts of membrane over time and become sphere Spherical Cholelithiasis Osmotic fragility Splenomegaly Howell Jolly Bodies
25
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G6PD deficiency
What does G6PD normally make
Function of this product
Heredity
Moderate version ethnicity
Severe version ethnicity
Causes (3)
Typical histo finding in cells
Typical cell shape
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NADPH
Reduces glutathione to protect against ROS
Recessive X-linked
African = moderate
Mediterranean = Severe
Antimalarials, Sulfonamides, Fava beans
Heinz bodies
Bite cells
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26
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Paroxysmal nocturnal hemoglobinuria
Congenital or acquired
Mutated gene
Loss of what proteins
Result of lost proteins
Most common cause of death
LAP score
Timing of hemolysis
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Acquired
X-linked PIGA gene mutation
Loss of GPI proteins so no CD55/DAF or CD59/MIRL
Complement binds to RBC's at night and lyses them.
THrombosis
Decreased
Episodic at night
27
Immune hemolytic anemias definitive tests (2)
1. Positive antiglobulin test (DAT)
| 2. Direct Coomb's test
28
Alloimmune hemolytic anemia definition
Make Ab's against foreign RBC's
29
3 times alloimmune occurs
1. Immediate transfusion reaction
2. Delayed transfusion reaction
3. Hemolytic disease of newborn
30
Immediate transfusion reaction
Type of hemolysis
Antibody type
Intravascular
| Preformed ABO IgM antibodies
31
Delayed transfusion reaction
Type of hemolysis
Timing
Antibody type
Extravascular
4-6 days after transfusion
IgG Ab's against RBC's
32
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Hemolytic disease of newborn
Antibody type
Type of hemolysis
Treatment
What to do before birth
Most common situation
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IgG against RBC's of newborn
Extravascular
Treat with Rhogam
Plasmapheresis
Mom's Anti-D Ab's against Fetal D antigen
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33
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Warm AIHA
Antibody
Temperature
Primary or secondary
Secondary causes (2)
Hemolysis type
RBC shape
```
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IgG
37 degrees
Primary 50%
RE neoplasm or Collagen vascular disease
Extravascular
Spherocytes
```
34
Cold AIHA
Antibody
Temperature
Normal Cold Auto Ab's
IgM
4 degrees
Auto Ab's: Anti-I, Anti-H, Anti-IH
35
Acute gold agglutinin AIHA
| secondary to what?
Mycoplasma
36
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Cold agglutinin syndrome
Secondary to:
Common presentation
Specific antibody
Lab test:
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Infection or lymph neoplasm
Elderly guy with lymphoma
Anti-I
DAT+
37
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Paroxysmal COld hemoglobinuria
Common presentation
Specific AutoAb
Lab test
Name of this antibody:
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Children with viral infection
Autohemolysin
Biphasic IgG Ab with Anti-P specificty
Donath-landsteiner antibody
38
Drug induced hemolytic anemia
Antibody
Two drug types
IgG
1. antigenic drugs
2. Alpha-methyldopa
39
Sickle Cell geography
Africa and Mediterranean
40
Hemoglobin C location
West Africa
41
Hemoglobin E location
SE asia
42
Beta Thalassemia
Characteristic cell
Characteristic intracellular sign
Clinical features (2)
Target cells
Basophilic stippling
Crewcut X-ray
WIdened facial bones
43
Beta minor hemoglobin change
Higher HgbA2
44
Beta major hemoglobin change
Absent HgbA and Increased HbF
45
How to distinguish between Beta minor and Fe deficiency?
Fe levels
46
Alpha thalassemia
4 betas forms what
4 gammas forms what
4 Betas: HbH
| 4 gammas: Hb Barts
47
Alpha thalassemia one gene deletion.
| Only difference
Hb Barts at birth
48
Alpha thal two gene deletion
Only difference
The mutation that is far more severe and what ethnic group
Hb barts at birth
Cis mutation (same chromosome) causes hydrops fetalis in Asians
49
Three gene deletion alpha thal
Hb change?
Result?
Hemoglobin H disease (beta tetramers)
Extravascular hemolysis
50
Four gene deletion alpha thal
Hydrops fetalis with hemoglobin barts
51
How to determine alpha thal in lab? (3)
1. Target cells
2. Abnormal hemoglobins (barts and HbH)
3. Hemoglobin H inclusions with cresyl blue stain
52
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Hemoglobin S
Inheritance
Mutation
Main population in US
Trait advantage
If infarction occurs what is result
One primary clinical finding
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Autosomal recessive
Valine to glutamine on Beta globin chain
Blacks
Malaria protection
Autosplenectomy
Salmonella osteomyelitis
```
53
Sickle cell trait
Cell findings
Lab test
Hemoglobin changes
Target cells and sickle cells
Cloudy sickle solubility test
60% HbA and 40% HbS
54
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Hemoglobin C
Main lab finding in disease
Hb change in Disease
Hb change in trait
Trait advantage
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Hemoglobin C crystals
HbC 90% with increased HbF
HbA 60% and HbC 40%
Malaria protection
55
Hemoglobin E
Trait advantage
Trait hb levels
Disease hb levels
Protective against malaria
equal HbA and HbE
No HbA and 95% HbE
56
3 megaloblastic anemia causes
1. Vitamin B 12 deficiency
2. Folic acid deficiency
3. Methotrexate
57
First sign of defective DNA synthesis in megaloblastic?
| Other cell finding later
Hypersegmented neutrophils
Oval macrocytes
58
Vitamin B 12 deficiency results in what symptoms? (2)
1. Glossitis
| 2. Subacute combined degeneration of spinal cord
59
Pernicious anemia
Path mech
Ethnic group
Auto antibodies against B-12-IF binding
| Scandinavians
60
Common B 12 deficiency causes 3
1. Impaired absorption
2. Parasites
3. Removal of GI (gastrectomy or ileal)
61
Folate deficiency cause 3
Decreased intake
Impaired absorption
Blocked activation by Methotrexate
62
Only diet patient type to be concerned with B12 deficiency?
Vegans
63
Malabsorption symptoms make you think what anemia?
Folate deficiency
64
Neurologic symptoms make you think what anemia?
B12 deficiency
65
Schilling test
First part
Second part
Irradiated B 12 only
| Irradiated B12 with Intrinsic factor
66
Methylmalonic acid increase, think what?
B12 deficiency
67
Iron is stored how
Ferritin
68
Iron is transferred how
Transferrin
69
Absorption of iron occurs where?
| What regulates
Duodenum
| Hepcidin
70
When is hepcidin made?
| Function
When liver iron stores are high.
| Block absorption
71
Most common cause of iron deficiency
Chronic blood loss
72
Iron deficiency symptoms? (3)
1. Koilonychias
2. Pica
3. Alopecia
73
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Iron deficiency anemia iron studies
Serum iron
TIBC
Percent saturation
Ferritin
```
Serum iron: Decreases
TIBC increases
Percent saturated decreases
Ferritin decreases
74
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Anemia of chronic disease
Common patient type
Serum iron
TIBC
Saturation
Ferritin
EPO
```
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Hospitalized patients
Low serum iron
Low TIBC
Normal saturation
High ferritin
EPO low
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75
Aplastic anemia
What cell lines involved
2 drug causes
Pancytopenia
| Chloramphenicol and Dilantin
76
Pure red cell aplasia causes (4)
1. Drug/virus
2. Thymoma
3. Large granular lymphocytic leukemia
4. Autoimmune disorders
77
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SIderoblastic anemias
Cell finding
Primary hereditary cause
Acquired primary cause
Secondary cause
```
Ringed sideroblasts (iron accumulating in mito)
Congenital sideroblastic anemia
Myelodysplastic disorder
Drugs like Tb and alcohol
78
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Primary hemochromatosis
Inheritance
Defective gene
Chromosome
Main manifestation
```
Autosomal recessive
HFE gene
Chromosome 6
Adult bronze diabetes
79
Lead poisoning two main findings
Lead lines in bone and teeth
| Basophilic stippling
80
Myelophthisic anemia
| Main histo finding
Teardrop cells = Dacrocytes
81
Icterus suggests what
Hemolytic anemia
82
subacute combined degeneration suggests what
Pernicious anemia
83
Helmet cells/Schistocytes suggests what?
Hemolytic anemia
84
Target cell suggests what? (2)
1. Hemoglobinopathies
| 2. Iron deficient anemia
85
Heinz bodies suggest what?
G6PD deficiency
86
Basophilic stippling suggests what?
Lead poisoning or thalassemia
87
Location for bone marrow exam?
Posterior superior iliac spine
