Normocytic Anemia

Question 1

Corrected Reticulocyte Count

Answer 1

Multiply RC by Hct/45
If greater than 3%, indicates good marrow response and peripheral destruction
If less than, suggests poor marrow response and underproduction

Question 2

Aplastic Anemia

Answer 2

Failure or destruction of myeloid stem cells, often from Radiation or Fanconi anemia, resulting in pancytopenia and hypocellular bone marrow with fatty infiltration

Question 3

Lab Findings in Intravascular (2), Extravascular (1), and Both Hemolysis

Answer 3

Both: Increased LDH
IV: Decreased haptoglobin, a Hb scavenger in the blood. Used up. Also hemosiderinuria bc renal tubular cells pick up Hb and break it down to Fe. (also hemoglobinuria and stuff)
EV: Increased unconjugated bilirubin which can cause jaundice

Question 4

Hereditary Spherocytosis (cause, RBCs, dx, complications, treatment and note)

Answer 4

Defect in proteins of RBC skeleton/PM like spectrin, ankyrin, band 3
Small, round RBCs with no central pallor (increased MHC, increased RDW)
Diagnose by osmotic fragility test (lyse more easily in saline solutions)
Splenomegaly, aplastic crisis from Parvovirus
Treat with splenectomy which will lead to Howell-Jolly bodies

Question 5

Sickle Cell Substitution and Precipitants

Answer 5

Substition of glutamic acid with valine on Beta chain

Hypoxia and dehydration precipitates (as well as acidosis)

Question 6

Sickle Cell 6 Complications and 1 Presentation

Answer 6

Crew cut on skull from marrow expansion
Aplastic crisis - Parvovirus
Splenic sequestration leading to wedge shaped infarct
From that, autosplenectomy leading to susceptibility to encapsulated organisms
SALMONELLA osteomyelitis
Painful crises (vaso-occlusive) like dactylitis
Renal papillary necrosis

Question 7

Sickle Cell Treatment

Answer 7

Hydroxyurea (increases HbF)

Question 8

Hemoglobin C

Answer 8

Glutamic acid replaced with lysine. Just crystals, not sickle, although can have kind of a mild sickle like disease with HbSC heterozygotes

Question 9

Paroxysmal Noctural Hemoglobinuria (what it is, dx, at risk for)

Answer 9

Acquired hematopoeitic stem cell lack of GPI anchor for a protective protein causes complement-mediated RBC lysis, leading to hemoglobinuria/emia especially in morning
Diagnose because missing CD55/59 on flow cytometry (and negative Ham’s test). (Coombs negative)
Increased incidence of AML

Question 10

G6PD Deficiency (what it is, smear)

Answer 10

XL Recessive, can’t make glutathione so RBCs susceptible to oxidative stress (sulfa drugs, antimalarials, infections, fava beans)
Oxidation of Fe and denaturing of Hb causes Heinz bodies and subsequently bite cells
Also get back pain from kidney damage after stress bc nephrotoxic

Question 11

Pyruvate Kinase Deficiency

Answer 11

Hemolytic anemia of newborn because AR defect in pyruvate kinase causes decreased ATP and rigid RBCs

Question 12

Warm Agglutinin AIHA (Ig, temperature, 3 causes)

Answer 12

IgG
SLE, CLL, some drugs like alpha-methyldopa (also maybe EBV)
At body temp so don’t need a precipitate

Question 13

Cold Agglutinin AIHA (Ig, temperature, 3 causes)

Answer 13

IgM
Triggered by cold, especially circulation in cold extremities causing
CLL, Mycoplasma pneumonia, Mononucleosis (EBV)

Question 14

Direct vs. Indirect Coombs Test (method, use)

Answer 14

anti-Ig RBCs added to patient’s blood vs. normal RBCs added to patient’s serum
Used for conditions (it seems, including after transfusion) vs. screening blood for transfusions

Question 15

Micro vs. Macroangiopathic Anemia

Answer 15

Micro is through narrowed vessel lumina like DIC/TPP HUS/SLE, malignant hypertension vs. past something larger/mechanical like prosthetic heart valves or aortic stenosis

Question 16

2 Infections that Can Cause Hemolysis

Answer 16

Malaria and Babesia