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Question 1

Intravascular hemolysis occurs in 4 conditions:

Answer 1

Mnemonic: STIG

Incompatible blood transfusion
Sickle cell anemia
G6PD deficiency
TTP & DIC

(Thrombotic thrombocytopenic purpura (TTP) and Disseminated intravascular coagulation (DIC))

Question 2

Extravascular hemolysis occurs in 3 conditions:

Answer 2

HAT

1. Hereditary spherocytosis
2. Autommine diseases
3. Thalassemia

Question 3

Intravascular hemolysis is mediated by “_____ antibodies”
Extravascular hemolysis is mediated by “______ antibodies”

Answer 3

Intravascular hemolysis is mediated by “IgM antibodies”
Extravascular hemolysis is mediated by “IgG antibodies”

Question 4

Which of these antibodies will mostly be involved in blood transfusion reactions?
IgG
IgM
IgE
IgD
IgA

Answer 4

Answer: B

(BCZ intravascular hemolysis is always mediated by IgM antibodies, and in blood transfusion, there might be incompatible blood transfusion نقل الدم بالخطأ)

Question 5

These three main types of hemolytic anemia, Membrane Defect (Spherocytosis), Enzyme Defect (G6PD Deficiency), Hemoglobin Defect (thalassemia) are all types of _________ hemolysis.

Answer 5

EXTRAVASCULAR hemolysis.

Question 6

Spherocytes/ elipocytes have abnormal _______ RBCS

Answer 6

Spherocytes/ elipocytes have abnormal shaped RBCS

Question 7

If abnormal RBC shape, then it is “Extravascular hemolysis”

Answer 7

If abnormal RBC shape, then it is “Extravascular hemolysis”

(Bc of hereditary spehrocytosis/ellyptocytosis)

Question 8

Shnu il farg bain hereditary spherocytosis & autoimmune hemolytic anemia?

Answer 8

Hereditary spherocytosis:

Autosomal dominant congenital disease (Since birth)
Spherocytes in blood smear
Negative coomb’s test ( a test to detect autoantibodies)
50% of cases have pigmented gall stones
It could be complicated to hemolytic crisis by infections
It could be complicate to aplastic crisis by Parvovirus

Autoimmune hemolytic anemia:

Affects mostly women at their 20’s/30’s
Spherocytes in blood smear
POSTIVE COOMB’s test (Detects autoantibodies against RBCs)

Question 9

Exam Question:
a middle aged previously healthy female presented with normocytic anemia and jaundice, cbc shows, low Hb, low MCH, and high reticulocytes, PBS shows spherocytosis, what is the condition?

A) Hereditary spherocytosis
B) Immune mediated hemolysis

Answer 9

Answer: B (bcz they said she was previously healthy)

Question 10

If someone ate fava beans (فلافل، فول ، حمص), and he has G6PD Deficiency, he will suffer from symptoms of?

Answer 10

hemolytic anemia

يعني بالحالة الطبيعية مافيه شي، اول ما ياكل فول او فلافل، تبدأ الاعراض تطلع “مثال عليه لون البول يصير بني”

Question 11

Enzyme Defect (G6PD Deficiency) is one of the causes of ectravascular hemolytic anemia, what kind of disease is it?
(Dominant? Recessive? Autosomal?)

Answer 11

X-linked recessive disease

Question 12

In a blood smear of a person with G6PD deficiency, we will see?

Answer 12

1- Bite cells
2- Heinz bodies
3- Blister cells

Question 13

What causes symptoms of hemolytic anemia in a person with G6 PD deficiency and why?

Answer 13

1. Fava beans
2. Antibiotics
3. Infections
   All will lead to oxidative stress in the body, and we know that G6PD is important to reduce “Reactive oxygen species”

(G6PD Deficiency + Fava beans ——-> Oxidative stress ——-> Hemolytic anemia)

Question 14

what is thalassemia?

Answer 14

Thalassemia is a Congenital disease, in which there is Defect in hemoglobin structure.

Question 15

Characteristics of thalassemia?

Answer 15

1. Frontal bossing
2. Hair like appearance on x ray
3. Dental mal-occlusion
4. Prominent facial bones
5. Splenomegaly (BCZ extravascular hemolysis)

Question 16

The previous two pictures are characteristics of thalassemia, but why does the patient have “bossing of the frontal bone” and Hair like appearance?

Answer 16

BCZ in thalassemia, the patient has very severe hemolysis of RBCs, so the bone marrow will grow and expand trying to compensate

Question 17

Thalassemia patients don’t have enough RBCs, so they MUST have ___________________

Answer 17

Thalassemia patients don’t have enough RBCs, so they MUST have FREQUENT BLOOD TRANSFUSION

Question 18

what is the complication of frequent blood transfusion for a patient with thalassemia?

Answer 18

Iron overload

That is why thalassemia patients, when they go to hospital for blood transfusion, the doctor prescribes iron chelating therapy to get rid of the excess iron in body

Question 19

Symptoms of sickle cell anemia only occur when?

Answer 19

Symptoms of Sickle cell anemia only occurs when there is low Oxygen

Question 20

The hemoglobin of Sickle cell anemia is called?

Answer 20

“Hemoglobin S” (HbS)

Question 21

How does sickle cell anemia occur?

Answer 21

bcz of point mutation in one of amino acids
SO, we will have the amino acid “Valine” Replaces the original amino acid “Glutamine”
So valine is found instead of glutamine will give “HbS”

Question 22

Why does HbS travel slower than the normal Hemoglobin in electrophoresis?

Answer 22

Bcz HbS has “Less charges” than the normal hemoglobin

Question 23

In sickle cell anemia, a patient obviously has microvascular occlusion bc of its shape, what does that lead to?

Answer 23

It cuts off blood supply to the spleen, leg

1. Spleen atrophy
2. Leg ulcers
3. Gallstones

Question 24

What would you expect to see in a female with sickle cell anemia suffering from a vaso- occlusive crisis?
A) Schistocytes
B) Howell jolly bodies
C) helmet cells
D) blister cells
E) spherocytes

Answer 24

B) Howell jolly bodies