Random Facts 2

Question 1

How to distinguish btwn Fe deficiency and thalassemia

Answer 1

Can be distinguished by the RDS

• both are microcytic anemias
• Fe deficiency: RBC in many stages => high RDW
• thalassemia will have less variation => lower RDW

Question 2

When is a Coombs test indicated?

Answer 2

When testing for hemolytic anemia

-differentiates immune vs. non-immune hemolytic anemia

Question 3

What are some causes of non-immune hemolytic anemia

Answer 3

Non-immune hemolytic anemia = negative Coombs test

Extracorpuscular defect = something outside the RBC destroying it
ex: artificial valve smashing RBCs

Intracorpuscular defect = something wrong w/ the RBC itself
ex: congenital spherocytosis

Question 4

Describe the mechanism of a direct Coombs test

Answer 4

Purpose = to see if there are antibodies on the surface of the pt’s RBC (testing for autoimmune hemolytic anemia)

-take washed pt’s RBC + Coombs’ reagent (antihumanized antibody) that will agglutinate if antibodies are present on the red cell’s surface

Question 5

Differentiate warm vs. cold antibody autoimmune hemolytic anemia

Answer 5

Warm up the sample and cool of the sample and see in which situation lysing increases

Warm (you warm up sample and lysing increases) means the process is IgG mediated

Cold (you cool down sample and lysing increases) mean the process is IgM/complement mediated

Question 6

What bacterial infection is associated w/ a cold induced hemolytic anemia?

Answer 6

Mycoplasma

Question 7

What is the most common congenital hypercoagulable defect?

Answer 7

factor V leiden

Question 8

Most abundant white cell in normal CBC

Answer 8

45-70% neutrophils (which = granulocytes, polys, and PMNs)

Question 9

What is erythroferrone?

(a) What cells produce it?
(b) Fxn

Answer 9

Erythroferrone = released by bone marrow cells to communicate w/ the GI tract indirectly thru the liver

• Bone marrow secretes ERFE when it receives a signal (ex: EPO) to rev up hematopoeisis
• ERFE then inhibits the liver’s secretion of hepcidin
• less hepcidin available to inhibit ferroportin on enterocyte membrane => more Fe absorbed from the gut

Question 10

Fanconi’s anemia

Answer 10

= genetic disorder of chromosomal instability due to mutation in DNA stress repair gene

=inherited bone marrow failure syndrome

Question 11

Dyskeratosis congenita

Answer 11

= inherited bone marrow failure syndrome

-disorder of telomere maintenance

Question 12

Lab findings in PNH

Answer 12

Indicative of intravascular hemolysis =>

hemoglobinuria, and free Hgb in the blood

Question 13

Treatment for PNH

Answer 13

Antibody against CD5 to prevent formation of complement membrane attack complex

Question 14

Most common presenting symptom of CML

Answer 14

Neutrophilia/Granulocytosis

-high white count w/ predominantly increased neutrophils

Question 15

Mechanism of disease in P. vera

Answer 15

JAK2 mutation => loss of autoinhibition of the JAK-STAT proliferation pathway

Question 16

Describe the spent phase of P. vera

Answer 16

Mimics myelofibrosis

Question 17

Mechanism of primary myelofibrosis

Answer 17

Platelet derived growth factors + TGF-beta act as fibrogenic growth factors that stimulate bone marrow fibroblast proliferation

Question 18

What pathology is associated w/ the following on peripheral smear:

Acanthocyte

Answer 18

= spurr cell

-indicative of liver disease

Question 19

What pathology is associated w/ the following on peripheral smear:

Dagmacute

Answer 19

= bite cell

• indicative of G6PD deficiency
• spleen basically takes a bite out of the RBC to make up for inability of cell to deal w/ oxidative stress

Question 20

What pathology is associated w/ the following on peripheral smear:

Elliptocyte

Answer 20

Hereditary elliptocytosis

-causes anemia b/c the spleen destroys

Question 21

What pathology is associated w/ the following on peripheral smear:

Ringed Sideroblast

Answer 21

Indicative of sideroblast anemia

-problem w/ protoporphyrin production => underproduction of heme

Question 22

What pathology is associated w/ the following on peripheral smear:

Schistocyte

Answer 22

= Helmet cell = fragmented cell

-associated w/ DIC, TTP, HUS, HELLP

Question 23

What pathology is associated w/ the following on peripheral smear:

Dacrocyte

Answer 23

= tear drop cell

-myelofibrosis

Question 24

What pathology is associated w/ the following on peripheral smear:

Target cell

Answer 24

HbC disease, asplenia, liver disease, thalassemia

‘HALT to the target’

Question 25

What pathology is associated w/ the following on peripheral smear:

Howell-Jolly bodies

Answer 25

= basophilic nuclear remnants in RBC that are usually removed by splenic macrophages

-indicative of functional hyposplenia or asplenia

Question 26

Common complications of CLL

Answer 26

Secondary malignancy and immune dysfunction

-b/c hypogammaglobulinemia and T cell dysregulation

Question 27

Small cleaved cells on bone marrow biopsy

Answer 27

Indicative of follicular lymphoma or diffuse lymphoma

Question 28

Most common subtype of Hodgkin’s lymphoma

Answer 28

HL = neoplasia of large B cell

-most common subtype = nodular sclerosing

Question 29

Rituximab

Answer 29

Monoclonal anti-CD20 antibody used in NHL (nonHodgkin’s lymphoma)