Patho Flashcards
Bm aspn site:
Needles:
Post sup iliac spine
Salah(side screw)
Kima
Which stage
Hgb 1 st detected in Electronic Microscope:
1 st in light microscope:
E.M> pronormoblast stage
L.M> interM/ polychromatophilic stage
Erythropoesis order (downwards)
Pronormoblast
Early NB( basophilic)
InterM Nb( polychromatic)
Late NB( orthochromic)
Reticulocyte
Erythrocyte
All blasts- nucleated occur in BM
All Cyte- no nucleus( reached blood already)- peripheral
Normal cbc
Mcv:
Mch
Mchc
Rdw
Ht/pCV
Ret
Mcv: 80-100 fl ( ind size of single rbc)
Mch: 27-32. ( ind hgb)
Mchc continues 32-37 ( hgb concn)
Rdw- 11-14. ( variation in sizes of group of rbc)
Ht/pCV-45%
Ret 0.5-2%
Corrected Ret= ret count* hb( pt)/ hb( normal)
PCV and ESR detd by
Both in wintrobes tube( smaller)
Only ESR in westergreen pipette( longer in length)
Stains
-Mc for blood smear( giemsa, leishman)
-For p falciparum- field stain
- For Ret- Methylene blue
- for Iron. Pearl stain/ prussian blue
- Sideroblastic A. Same above( papenheimer- multiple blue spots)
-for G6pd. Crystal violet( heinz bodies), H.E stain( bite cells)
Same
Iron studies
IDA. Aof CD. SBA. Thalassemia
S.Fe. L. L. H. L
Transferrin. L. L. H. N
Ferritin. L. H. L. N
TIBC. H. L. H
Imp
IDA opposite to SIderoBA
Always TIBC opp to ferritin
Inc in chr diseases- hepcidin - inhb release of iron, cause elevated ferritin, low seum levels
Iron in food is
Conv by.
Absorbed in
Transport in by
Storage as
Released out to blood by
Coverted back to —— by ——
Transport in blood binding to
Iron in food is. Fe 3+
Conv by. Cytb reductase to fe2+
Absorbed in Duodenum
Transport in by DMT( divalent transporter) only 2+ allowed
Storage as. Ferritin
Released out to blood by. Ferroportin
Coverted back to fe 2+—— by _ceruloplasmin, hephaestin
Transport in blood binding to transferrin
Hepcidin is in liver
Inc in chr disease anemia
Hepcidin inhibit. Ferroportin
Sideroblastic A affd is syn of:
Iron prof opp to
Which factors causes it
Smear:??
Bm ??
Protoporphrin
2 componenrs of hgb syn:
- Fe
2.protoporphrin
Formed by ALA enzymes- deficiency- dec proto P also-SideroBA
Iron P opp to that of IDA
Vit b6 def, alcohol, lead poisoning
Smear: Papenheimer bodies( multiple blue spots) - Prussian blue/pearl stain as iron is the one detected
BM: ringed sideroB
Macrocytic anemia Causes
FAT RBC D
F- fetus/ preg
A- alcohol
T- thyroid ( hypo)
R- Reticulocytosis( in bloodL/hemolysis) compnsn
B- b12/ b9 def
C- cirhhosis
D- drugs( cytoT, AntiE in -b9)
B 12 causes
B9 causes
Absorption locn
B12
1- gastritis type A/autoimmune- (ab to IF- low b12 absorption )
2- B. Overgrowth/ parasite ( fish tapeworm- D.latum)
3- orotic acuduria?
B9
-Pregnancy
-Anti E
-bowel D( celiac sprue)
-HypoT
-Aplastic A
-Chr LD
Iron- duodenum
B12- terminal ileum
B9- jejunum
C/F of b9, b12
( presn,
Analysis biochem)??
Smear?
Presn:
Hyperp of knuckles in both
Neurologic sx only in B12!!
( cobalamin def- dec myelin syn)- causes( SACd)
Blood A:
Inc MM co A ( methyl malonly)
Inc homicysteine
Dec succinyl coA
Smear:
-jolly bodies( single spot)- dna remnants
-Cabot rings- figure 8 shaped
- hyperSeg N(>= 6 lobes)
Also in asplenia( jolly, Cabot)
IVH vs EVH
IVH. EVH
Occur in blood. In liver, spleen
Hgb absent. Hgb low but present
Eg PNH, PCH?? Sicke CA, thalassemia, HSm
( p ag, I ag resp
G6 pd eg of both !!!
IVH( AntiM dx) and
EVH( enzyme def)
Cause,screening/confirm, mx:
HS -
G6 OD def
- HS- memb defect( ankyrin(AD»> spectrin(AR- more severe
Smear- smaller cells, spheric, hgb concn- absent pallor( spherocyte), inc mchc, rdw inc( both ret, spherocytes)
Scre- Osm FT (inc)
Confirm- EMA test( eosin maleimide test)
Tx- elective splenectomy- give 4 Vacc b4!!
- G6PD def
Smear- heinz bodies( crystal V stain), bite cells( HE stain)
Sc- fluorescent T, met Hgb test( just mugup)
Conf- G6pd enzyme assay
Tx
PNH( cause- ONLY ACQUIRED!!) -
PIGA gene affd,
GPI anchors absent>
low CD55(DAF)
Low CD59( MIRL)
SCA( glb defx) glu> val at B6 posn
Thalassemia( glb def)
Alpha- deletions
BetaT - mutations( sloucing/ frame shift), del( 619bp-)
Screening ? Dx? Tx?
- PNH
Scr- Ham acidification/ sucrose lysis/
gel card test( only used-imp)
[above line ind +, low line ind - ve CD markers]
Conf- (FLtests)
Flow cytometry- indirect detect cd markers
Flaer test - direct detect GPI anchors+-
Tx- ecluzimab
2.SCA
Smear: sickle shaped ( drepanocytes)
Skull- crewcut/hair on end
Vert- fish mouth vertebra
Finger- dactylitis
Spleen- Autospkenectomy(Vacc against 1- (yersinua .EnteroC)
Scr- sickling test/
using 2% sodium meta bi sulphite
Hgb electrophoresis( can diff trait/ disease)
HPLC gold std!!
Tx- hydroxyurea- induce HgF- inc oxy affinuty- dec sickling!!
- Thalassemua
Alpha-
Asymptomatic
Alpha trait(AA - -)
Alpha major( A- - -)-
-called Hb H/ golf ball on smear
- firm b tetramer
Hb barts. (- - - -) fetal death all other after birth!!
Form y tetramer!
Proteins of rbc memb and most predominant
1.Ankyrin
2.Spectrin- shape
In HS- both ankyrin/ spectrin( Aut R)
- The PreD protein is glycoprotein A but doesn’t undergo mutation important!!!
