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Pathology 2 > Quiz 4: Hematopathology > Flashcards

Quiz 4: Hematopathology Flashcards

1
Q

Anemia is characterized by low oxygen transport capacity of the blood due to … (4)

A

blood loss, impaired RBC production, increased RBC destruction, a combination of all these things

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2
Q

Anemia can be due to what 2 categories?

A

Excessive blood loss (hemorrhage or hemolysis) or failure of blood production

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3
Q

Decreased oxygenation of the renal JGA cells triggers the production of what?

A

EPO

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4
Q

With acute blood loss, … blood loss allows for recycling of the Fe contained in the blood

A

internal

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5
Q

Immediately after acute blood loss, peripheral smear usually appears…

A

normal– normal size (normocytic), normal color (normochormic)

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6
Q

What is polychromasia?

A

RBC’s are released prematurely, leading to bone marrow stress.

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7
Q

Reticulocytes are usually (smaller/larger) than mature RBCs

A

larger

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8
Q

Chronic blood loss causes anemia only if… (2)

A

rate of loss exceeds the capacity of the marrow to restore adequate numbers of RBCs; iron stores are depleted such that inadequate hemoglobin is available.

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9
Q

Chronic blood loss is usually due to what (3) organ systems?

A

GI, Gyn, GU

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10
Q

What is a hemolytic anemia?

A

RBCs are prematurely destroyed

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11
Q

Hemolytic anemias are characterized by… (3)

A

shortened RBC life span, Hgb breakdown products accumulate, increase in BM erythropoiesis

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12
Q

What organ is the site of RBC destruction in the majority of hemolytic anemias?

A

Spleen

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13
Q

What are the 2 types of hemolytic anemais?

A

Intravascular (within the blood vessels); extravascular (hemolysis in the spleen)

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14
Q

A peripheral blood smear with numerous fragmented RBCs– “helmet” cells or “schistocytes” is indicative of what?

A

intravascular hemolysis

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15
Q

Intravascular hemolysis is a result of:

A

mechanical trauma, antibody fixation, toxic injury to the RBCs

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16
Q

What are 2 examples of extravascular hemolysis?

A

sickle cell anemia and hereditary spherocytosis

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17
Q

In extrinsic hemolytic anemias, Abs are usually what class?

A

IgG

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18
Q

Intrinsic hemolytic anemias are … while intrinsic hemolytic anemias are …

A

acquired; congenital

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19
Q

Intrinsic hemolytic anemiaas are divided into what 3 groups?

A

abnormal hemoglobin, abnormal RBC metabolism, abnormal hemoglobin synthesis

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20
Q

What condition is the prototype of abnormal hemoglobin disorders?

A

Sickle cell anemia

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21
Q

sickle cells are formed dt

A

low pH, low oxygen tension

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22
Q

why does sickling occur more readily in acidic tissues?

A

low pH reduces oxygen’s affinity for hemoglobin

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23
Q

What is MCHC?

A

Mean corpuscular hemoglobin concentration– concentration of Hgb per cell.

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24
Q

Intracellular dehydration (increases/decreases) MCHC, facilitating sickling and vascular occulsion

A

increases

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25
Q

What is AIHA?

A

Autoimmunie hemolytic anemias

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26
Q

What test(s) are used to diagnose AIHA?

A

Coombs and indirect Coombs antiglobulin

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27
Q

What is the most common form of AIHA?

A

Warm Ab AIHA

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28
Q

AIHA is (extrinsic/intrinsic)

A

extrinsic

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29
Q

Half of warm Ab AIHA are… and half are …

A

idopathic; secondary to SLE, Rx, or neoplastic dzs ie lymphoma

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30
Q

What is Cold Agglutinin AIHA caused by?

A

IgM Abs that bind and agglutinate RBCs at low temps (0-4C)

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31
Q

Peripheral smears of extrinsic hemolytic anemias resulting from RBC trauma show…

A

schistocytes, burr cells, helmet cells

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32
Q

What 2 conditions are the only conditions that cause major clinical problems associated with hemolysis?

A

TTP and HUS

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33
Q

what are (5) anemias of diminished erythropoiesis?

A

Megaloblastic anemia, iron deficiency anemia, anemia of chronic dz, anemia of renal failure, marrow stem cell failure

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34
Q

What are the keynotes of megaloblastic anemia?

A

Impaired DNA synthesis and distinctive morphological changes in the blood and bone marrow

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35
Q

What are the 4 most common causes of megaloblastic anemia?

A

B-12 deficiency; Folic acid deficiency; hyperthyroidism, pregnancy, disseminated cancer; inadequate diet and alcoholism

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36
Q

what is the morphology of megaloblastic anemia?

A

increased RBC size, increased MCV, normochromia, anisocytosis; hypersegmented nuclei of neuts and eos.; low reticulocytes, nucleated RBC’s;hypercellular marrow with increased numbers of all types myeloid precursors

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37
Q

Coabalamine and folate are coenzymes required for the synthesis of what?

A

thymidine

38
Q

Reduced thymidine results in what?

A

DNA synthesis is diminished and macrocytosis and ineffective erythropoiesis in erythroid precursors

39
Q

In megaloblastic anemias, what is unaffected so cytoplasmic maturation is normal, leading to nuclear/cytoplasmic asynchrony?

A

RNA synthesis

40
Q

Pernicious anemia is a chronic illness of impaired absorption of vit B-12 dt a lack of what?

A

Intrinsic factor

41
Q

Adult form of pernicious anemia is a result of what?

A

auto-reactive T-cell response

42
Q

An autoreactive T-cell response initiates what?

A

Gastric mucosal injury, triggering formation of autoantibodies, which then cause gastric mucosal destruction

43
Q

There are 3 types of ab’s found in pernicious anemia. Type I does what?

A

Blocks binding of B-12 to IF

44
Q

There are 3 types of ab’s found in pernicious anemia. Type II does what?

A

prevents binding of IF-B-12 complex to its ileal receptor

45
Q

There are 3 types of ab’s found in pernicious anemia. Type III does what?

A

Binds to the proton pump are are found in up to 50% of elderly pts with chronic gastritis

46
Q

Which ab’s occur in 90% of pts with pernicious anemia compared to only 5% of healthy adults?

A

Anti-parietal cell ab’s

47
Q

Pts with pernicious anemia have a 2 to 3 fold increase incidence of what?

A

gastric carcinoma

48
Q

Pernicious anemia often coexists with what other anemia? Why?

A

Iron deficiency; achorhydria prevents solubilization of dietary ferric iron from foodstuffs

49
Q

How is pernicious anemia diagnosed?

A

endoscopy directed biopsy of gastric mucosa showing depleted parietal cells

50
Q

Neurological symptoms and findings may be present in the absence of anemia dt B-12 deficiency in which patients?

A

Patients taking folate or on a high folate diet

51
Q

What are the primary diagnostic features of B-12 deficiency?

A

low serum or RBC B-12 level; low hgb, hct, RBC counts; MCV elevated; decreased wbc and platelet count; increased serum homocysteine and methylmalonic acid levels; mild jaundice; inability to absorb B-12 supplements

52
Q

Continual dietary supply of what vitamin is needed because it is not stored in the body in large amounts?

A

Folic acid

53
Q

Which medications interfere with the absorption of folic acid?

A

dilantin, lithium, sulfasalazine, oral contraceptives

54
Q

RBCs in folate deficiency are abnormally (large/small) in the blood

A

large (megalocytes)

55
Q

RBCs in folate deficiency are abnormally (large/small) in the bone marrow

A

large (megaloblasts)

56
Q

What are the primary diagnostic findings of folate deficiency?

A

RBS abnormally large in blood and bone marrow (megalocytes, megaloblasts); hypersegmented neuts; decreased folate levels in serum or RBC; elevate homocysteine in serum

57
Q

What are 3 primary causes of folate deficiency?

A

decreaesd intake, increased requirements, impaired use

58
Q

Unlike B-12 deficiency, folate deficient pts do NOT exhibit what?

A

neurologic complications associated with myelin loss in nerves of the posterior column

59
Q

What might mask the diagnosis of combined B-12 and folic acid deficiency?

A

pt with folic acid replacement

60
Q

What is the most common nutritional disorder in the world?

A

Iron deficiency anemia

61
Q

What are 4 causes of iron deficient anemia?

A

dietary lack, impaired absorption, increased requirement, chronic blood loss

62
Q

Dietary lack of iron is most common where?

A

Developing world.

63
Q

Why is the lack of iron most common in the developing world?

A

Vegetarian diet

64
Q

Dietary lack of iron occurs most often in what populations?

A

Elderly, infants, children, poor

65
Q

Impaired absorption of iron is found in what conditions?

A

Celiac dz, chronic diarrhea, other czs of malabsorption

66
Q

What are 3 examples of dietary substances that inhibit the absorption of nonheme iron?

A

phytates, tannins, phosphates

67
Q

What form of iron comes from animal products?

A

Heme form

68
Q

What is the most common cause of iron deficiency anemia in the western world?

A

chronic blood loss

69
Q

Iron deficiency induces a … and … anemia

A

microcytic, hypochromic

70
Q

When does iron deficiency anemia appear?

A

iron stores are completely depleted, low serum iron, low serum ferritin, low transferrin saturation

71
Q

What does the PB of iron deficiency anemia look like?

A

microcytic, hypochromic RBCs with central zone of pallor and poikilocytosis– small, elongated red cells aka pencil, cigar cells, or elliptocytes

72
Q

What is diagnostically significant in iron deficient anemia?

A

disappearance of stainable iron from mononuclear phagocytic cells in the marrow

73
Q

What are the 3 C’s of anemia of chronic disease?

A

Chronic infections, connective tissue disease, cancer

74
Q

ACD (unlike IDA) is characterized by what?

A

Low iron levels and low TIBC, with normal or even elevated ferratin levels

75
Q

ACD generally presents as…

A

normocytic, normochromic anemia

76
Q

Aplastic anemia is a BM failure syndrome characterized by what 2 things?

A

PB Pancytopenia, BM hypoplasia

77
Q

What is the morphology of aplastic anemia?

A

BM is largely devoid of hematopoietic elements, shows largely fat cells, fibrous stroma, scattered or clustered foci of lymphocytes and plasma cells remain

78
Q

What is aplastic anemia?

A

failure of the pluripotent stem cells to produce RBCs, WBCs, and mgakaryocytes

79
Q

What are the major causes of morbidity and mortality from aplastic anemia?

A

Infection and bleeding

80
Q

With aplastic anemia, thrombocytopenia may present as…

A

mucosal and gingival bleeding or petechial rashes

81
Q

With aplastic anemia, neutropenia may manifest as…

A

overt infections, recurrent infections, or mouth and pharyngeal ulcerations

82
Q

WBC disorders are classified into what 2 categories?

A

Proliferative and leukopenias

83
Q

What are the 2 types of proliferative WBC disorders?

A

reactive and neoplastic

84
Q

Leukopenia is an (increase/decrease) in leukocytes?

A

decrease

85
Q

Proliferative WBC disorders are an (increase/decrease) in leukocytes?

A

increase

86
Q

Which type of proliferative WBC disorders are less common and more clinically important?

A

neoplastic

87
Q

Leukopenia is usually dt a decrease in what?

A

Neutrophils

88
Q

What is agranulocytosis?

A

marked reduction in neutrophil count with increased susceptibility to infections

89
Q

What is the pathogenesis of neutropenia?

A

Decreased/ineffective neutro production; removal of neutros from circulation

90
Q

Decreased production of leukocytes can be caused by: (4)

A

Suppression of myeloid stem cells (aplastic anemia, infiltrative marrow d/o’s –tumors, granulomatous dz); Drug suppression of granulocytic precursors; Defective precursors in marrow (megaloblastic anemia, myelodysplastic syndromes); Genetic defects (Kostmann syndrome)

91
Q

Increased removal of neutrophils can be caused by: (3)

A

Immune mediated injury (SLE, drugs); Splenic sequestration (increased destruction dt enlargement of the spleen); Increased peripheral utilization (overwhelming infxns)

92
Q

Which myeloid stem cell can go on to become a WBC?

A

myeloblast

Pathology 2 (2 decks)

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