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clinical pathology > normo/normo, macro, & hemolytic anemia > Flashcards

normo/normo, macro, & hemolytic anemia Flashcards

1
Q

what is the etiologic category for normochromic normocytic anemia?

A

deficient erythropoiesis

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2
Q

what is the DDx for normochromic normocytic anemia?

A

renal disease, hypothyroidism, aplastic, myelophthisic

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3
Q

what conditions may cause normo/normo anemia due to renal disease?

A

diabetes, HTN, glomerulonephritis, polycystic kidney disease, recurrent kidney infection

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4
Q

what are the clinical findings for normo/normo anemia due to renal disease?

A

decrease urine output, increased urine frequency, muscle cramping, HTN

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5
Q

what are the CBC findings for renal disease?

A

normochromic normocytic anemia

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6
Q

what cells are seen on a PBS for renal disease?

A

echimocytes

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7
Q

what UA findings are consistent with renal disease?

A

proteinuria

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8
Q

what other tests would be ordered to confirm renal disease?

A

kidney function test, renal imaging

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9
Q

what is the proper management for renal disease?

A

treat underlying disease, refer to nephrologist

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10
Q

what is the mechanism behind hypothyroidism leading to normo/normo anemia?

A

decrease T3/T4 –> decrease metabolism –> decrease oxygen requirement –> decrease EPO –> decrease RBC

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11
Q

what is the mechanism behind hypothyroidism leading to hypo/micro anemia?

A

hypothyroidism –> heavy menses –> blood loss –> IDA

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12
Q

what is the mechanism behind hypothyroidism leading to macrocytic anemia?

A

decrease metabolism –> parietal cells, decrease IF –> decrease stomach acid –> decrease absorption of B12

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13
Q

what are clinical findings seen with hypothyroidism?

A

sensitivity to cold, weight gain, brain fog, thinning of outer 1/3 of eyebrow

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14
Q

what are the CBC findings with hypothyroidism?

A

anemia (normo/normo, hypo/micro, macro)

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15
Q

what other tests would be ordered to confirm hypothyroidism?

A

thyroid panel, iron panel, serum B12/folate

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16
Q

what is the proper management for hypothyroidism?

A

hormone therapy, refer to endocrinologist

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17
Q

what is panhypoplasia?

A

decrease is ALL blood lines; RBCs, WBCs, and plts

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18
Q

what is the etiology behind aplastic anemia?

A

idiopathic, drugs, toxin exposure, radiation therapy, viral

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19
Q

what are clinical findings of aplastic anemia?

A

increased susceptibility to infections, hemorrhagic difficulties

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20
Q

what are CBC findings consistent with aplastic anemia?

A

normo/normo anemia, leukopenia with neutropenia (<1500), thrombocytopenia (<70,000)

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21
Q

what other tests could be ordered to confirm aplastic anemia?

A

reticulocyte count (decreased), bone marrow biopsy

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22
Q

what is the proper management for aplastic anemia?

A

bone marrow transplant

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23
Q

what is the etiology behind myelophthisic anemia?

A

carcinoma metastasizing to bone marrow from primary tumor (breast, lung, kidney, prostate, thyroid, adrenal)
myelofibrosis (PCV)
myeloproliferative conditions (multiple myeloma, leukemias, lymphomas)
osteopetrosis

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24
Q

what are clinical findings for myelophthisic anemia?

A

general s/s of anemia, hepatomegaly, splenomegaly

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25
Q

what are CBC findings in myelophthisic anemia?

A

normo/normo anemia

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26
Q

what cells would appear on PBS with myelophthisic anemia?

A

nucleated RBCs (teardrop cells), immature WBCs

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27
Q

what other lab findings are consistent with myelophthisic anemia?

A

reticulocytosis, polychromatophilia

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28
Q

what etiologic category does macrocytic anemia belong to?

A

deficient erythropoiesis

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29
Q

what is the DDx for macrocytic anemia?

A

B12/folate deficiency

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30
Q

what causes macrocytic anemia?

A

defective DNA synthesis (RNA synthesis continues)

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31
Q

which cell lines are affected in macrocytic anemia?

A

ALL (anemia, leukopenia, thrombocytopenia)

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32
Q

which cells would appear on a PBS with macrocytic anemia?

A

hypersegmented neutrophils

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33
Q

how long is B12 stored in the liver?

A

5-6 years

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34
Q

why is B12 important?

A

needed for DNA synthesis and myelin synthesis

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35
Q

what conditions could lead to deficiency in intrinsic factor leading to B12 deficiency?

A

gastrectomy, myxedema, pernicious anemia

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36
Q

what are malabsorption conditions that could lead to B12 deficiency?

A

celiac disease, crohns disease, SIBO, pancreatitis

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37
Q

why might strict vegans become B12 deficient?

A

inadequate intake of B12 (B12 is found in meat)

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38
Q

what are hematopoietic clinical findings seen in B12 deficiency?

A

mild jaundice, “lemon-colored” skin

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39
Q

what are GI clinical findings in B12 deficiency?

A

glossitis (beefy red tongue), sore tongue, weight loss, anorexia, diffuse abdominal pain

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40
Q

what are neurological clinical findings in B12 deficiency?

A

loss of vibratory and position sense, ataxia (DWC), spasticity, Babinski sign

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41
Q

what are the CBC findings consistent with B12 deficiency?

A

macrocytic anemia, increased RDW, mild leukopenia, mild thrombocytopenia

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42
Q

what cells would be seen on a PBS in B12 deficiency anemia?

A

hypersegmented neutrophils

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43
Q

what are other tests and their findings that would help confirm B12 deficiency anemia?

A

increased bilirubin, increased LDH, decreased serum B12, auto-antibody test to IF and parietal cells, increased MMA

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44
Q

what is the proper management for B12 deficiency anemia?

A

eat meats, B12 injections, oral B12

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45
Q

what can taking folic acid without B12 do in patients with a B12 or pernicious anemia?

A

make signs and symptoms more severe and sudden

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46
Q

why is folate important?

A

used in synthesis of purines and pyrimidines

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47
Q

what foods contain folate?

A

vegetables, yeast, liver, mushrooms

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48
Q

where is folate absorbed in the body?

A

duodenum, jejunum

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49
Q

what is the etiology behind folate deficiency anemia?

A

deficient dietary intake (elderly, alcoholics)
chronic liver disease
increased requirements (pregnant/lactation)

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50
Q

what are clinical findings consistent with folate deficiency anemia?

A

general s/s of anemia, GI disturbances, NO neurological deficits

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51
Q

what are the CBC findings consistent with folate deficiency anemia?

A

macrocytic anemia, increased RDW, mild leukopenia, mild thrombocytopenia

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52
Q

what cells would be found on a PBS with folate deficiency anemia?

A

hypersegmented neutrophils

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53
Q

what other lab test would confirm folate deficiency anemia?

A

RBC folate

54
Q

what is the proper management for folate deficiency anemia?

A

active folate supplementation

55
Q

why does increased RBC destruction anemia occur?

A

shortened RBC lifespan, hemolysis; bone marrow production cannot keep up

56
Q

what are general clinical findings for increased RBC destruction anemia?

A

pallor, jaundice, scleral icterus, gallstones

57
Q

what are the extra labs and their findings for hemolytic anemia?

A

increased LDH, increased unconjugated bilirubin, increased reticulocyte count, decreased haptoglobin

58
Q

what etiologic category does intrinsic RBC defects anemia belong to?

A

increased RBC destruction (hemolytic)

59
Q

which type of anemia is due to red cell membrane alterations?

A

hereditary spherocytosis

60
Q

what is the etiology behind hereditary spherocytosis?

A

defect in RBC membrane leading to formation of spherocytes which are destroyed by the spleen

61
Q

what are the CBC findings consistent with hereditary spherocytosis?

A

mild to moderate anemia, increase in MCHC

62
Q

which cells would be seen on a PBS in hereditary spherocytosis?

A

spherocytes

63
Q

which other test would confirm hereditary spherocytosis?

A

increased osmotic fragility test

64
Q

what is the proper management for hereditary spherocytosis?

A

splenectomy, blood transfusions, folate supplementation, reduce stress

65
Q

which anemia is caused by disorders of red cell metabolism?

A

G6PD deficiency

66
Q

what is the etiology behind G6PD anemia?

A

x-linked genetic abnormality (MC in males)

67
Q

what are some possible triggers of G6PD anemia?

A

drugs, chemicals, infections, stressors, foods (fava beans)

68
Q

what are clinical findings consistent with G6PD anemia?

A

difficulty fighting infections, general s/s of anemia

69
Q

what is the CBC finding in G6PD anemia?

A

moderate anemia

70
Q

which cell would be found on a PBS in G6PD anemia?

A

bite cells

71
Q

which types of anemia are due to defective hemoglobin synthesis?

A

sickle cell, thalassemia

72
Q

is sickle cell anemia homozygous or heterozygous?

A

homozygous (more severe)

73
Q

is sickle cell trait homozygous or heterozygous?

A

heterozygous (excertional sickling)

74
Q

what is the molecular etiology behind sickle cell anemia?

A

normal Hb (HbA) has 2 alpha and 2 beta chains
Hb S has valine instead of glutamic acid
deoxygenated Hb S polymerizes and forms long rods = sickle shape

75
Q

what is the cellular etiology behind sickle cell anemia?

A

inflexible, prone to getting stuck in small vessels, fragile leading to hemolysis

76
Q

what is the clinical etiology behind sickle cell anemia?

A

chronic anemia and crises
vaso-occlusive crisis –> hypoxia –> necrosis –> pain

77
Q

at what age does HbF fade away and HbA take over?

A

after 6 months of age

78
Q

what are the s/s of vaso-occlusive crises

A

symmetrical painful swelling of hands and feet
increased infection risk
painful crises: bones, joints, abdomen, back, viscera

78
Q

what are the CBC findings for sickle cell anemia?

A

moderate to severe anemia, RBC indices usually normal, in crises: leukocytosis and thrombocytosis

78
Q

what are clinical findings seen in sickle cell anemia?

A

jaundice, pallor, fatigue

78
Q

what other tests would confirm sickle cell anemia?

A

decreased ESR, hemoglobin electrophoresis

78
Q

which cells would be found on a PBS in sickle cell anemia?

A

sickle cells

79
Q

what would be the Hb electrophoresis findings in sickle cell anemia?

A

80-100% Hb S, no HbA

80
Q

what would be the Hb electrophoresis findings in sickle cell trait?

A

20-40% Hb S, 60-80% Hb A

81
Q

what is the screening test for sickle cell anemia?

A

SickleDex (tests amount of Hb S)

82
Q

what is the prognosis for sickle cell anemia?

A

anemia is lifelong, crises start after 1-2 years, life expectancy is 40-50 years

83
Q

what does thalassemia do?

A

impacts the rate of synthesis of HbA; inadequate Hb and imbalanced accumulation of globin chains

84
Q

what is the morphological type of thalassemia?

A

hypochromic microcytic

85
Q

what is the etiologic category of thalassemia?

A

hemolytic anemia

86
Q

what is the difference between thalassemia minor and thalassemia major?

A

the severity of anemia (major is worse than minor)

87
Q

what is the etiology behind thalassemia minor?

A

heterozygous; defective rate of production of beta globin chains

88
Q

what are the clinical findings of thalassemia minor?

A

general s/s of anemia

89
Q

what are the CBC findings consistent with thalassemia minor?

A

mild anemia (>10), decreased MCV, MCH, MCHC, increased RBC count, normal RDW

90
Q

what cells would be seen on a PBS of thalassemia minor?

A

hypo/micro RBCS, maybe target cells

91
Q

what are the Hb electrophoresis findings for thalassemia minor?

A

increased HbA2, increased HbF, decreased HbA

92
Q

what is the best confirmatory test for thalassemia minor?

A

Hb electrophoresis

93
Q

how do you calculate the Mentzer index?

A

MCV/RBC count

94
Q

what would a Mentzer index of greater than 13 be indicative of?

A

IDA

95
Q

what would a Mentzer index of less than 13 be indicative of?

A

Thalassemia minor

96
Q

what is the proper management for thalassemia minor?

A

live healthy, avoid stress

97
Q

what is another name for thalassemia major?

A

Cooley’s anemia

98
Q

what is the etiology behind thalassemia major?

A

homozygous, defective rate of beta globin polypeptide

99
Q

what are the clinical findings seen in thalassemia major?

A

jaundice, splenomegaly, hemolytic facies (maxillary hypertrophy, prominent forehead)

100
Q

what are the CBC findings for thalassemia major?

A

severe anemia, increased RBC count

101
Q

which cells would be seen on a PBS for thalassemia major?

A

target cells

102
Q

what are the Hb electrophoresis findings for thalassemia major?

A

little to no HbA, increased HbF (>50%), increased HbA2

103
Q

why would HbF and HbA2 be increased in thalassemia major?

A

there is no beta chain

104
Q

what is the proper management/prognosis for thalassemia major?

A

regular transfusions, folate supplementation, splenectomy, iron management

105
Q

why is iron management important with thalassemia major?

A

an overload of iron causes morbidity and mortality

106
Q

what is the DDx for intrinsic RBC defects?

A

hereditary spherocytosis, G6PD deficiency, sickle cell, thalassemia

107
Q

which etiologic category does extrinsic RBC defects belong to?

A

hemolytic

108
Q

what is the DDx for extrinsic RBC defects?

A

traumatic hemolytic anemia, hemolysis due to infectious agents, anemia due to immunologic abnormalities (isoimmune & autoimmune)

109
Q

what is another name for traumatic hemolytic anemia?

A

microangiopathic anemia

110
Q

what is the etiology behind traumatic hemolytic anemia?

A

march hemoglobinuria, karate, bongo playing, prosthetic heart valves

111
Q

what are the CBC findings consistent with traumatic hemolytic anemia?

A

decrease MCV, increased RDW, anemia

112
Q

which cells would be found on a PBS of traumatic hemolytic anemia?

A

schistocytes

113
Q

what is the etiology behind hemolysis due to infectious agents?

A

malaria
bacterial toxins (clostridium perfringens, streptococcus, meningococcus)

114
Q

what are the lab findings for hemolysis due to infectious agents?

A

hemolytic anemia

115
Q

what is the etiology behind anemia due to immunologic abnormalities: isoimmune?

A

transfusion of incompatible blood, hemolytic disease of newborn

116
Q

what are the 2 possibilities when it comes to incompatible blood?

A

ABO incompatibility: mom has incompatible blood type with baby
Rh incompatibility: more severe, less common

117
Q

what are clinical findings in isoimmune abnormalities?

A

anemic newborn, jaundice

118
Q

how do you tell the difference between pathological and physiological jaundice?

A

pathological: 1st 24 hrs after birth
physiological: after 24 hrs after birth

119
Q

what is the special test to confirm isoimmune abnormalities causing anemia?

A

coombs’ test (direct antiglobin test)

120
Q

what is the etiology behind anemia due to immunologic abnormalities: autoimmune?

A

acquired anemia induced by auto-antibodies binding to RBC membrane

121
Q

how is anemia due to autoimmune abnormalities defined?

A

by maximum binding temperature

122
Q

what antibody is associated with warm tempertature?

A

IgG

123
Q

what type of patient would have warm antibody autoimmune hemolytic anemia?

A

a patient who has other autoimmune conditions

124
Q

what antibody is associated with cold temperature?

A

IgM

125
Q

what type of patient would present with cold antibody autoimmune hemolytic anemia?

A

elderly, acrocyanosis, or raynaud’s phenomenon

126
Q

what are risk factors for autoimmune hemolytic anemia?

A

malignancy (esp lymphomas)
autoimmune disorders (warm, IgG)
medications
prior blood transfusions

127
Q

what special test is done to confirm autoimmune hemolytic anemia?

A

direct coombs’
warm: IgG
cold: IgM

clinical pathology (6 decks)

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