RBC Anomalies Flashcards
Basis of morphological classification of anemia
MCV and MCHC
Identify the anemia:
Aplastic Anemia
Normocytic, normochromic with normal or decreased Reticulocyte count
Drug most frequently implicated in acquired aplastic anemia
Chloramphenicol
Identify the anemia:
Renal Disease
Normocytic, normochromic with normal or decreased Reticulocyte count
Most common of the inherited aplastic anemias
Fanconi Anemia
Identify the anemia:
G6PD deficiency
Normocytic, normochromic with high reticulocyte count
Classical symptoms associated with anemia
Fatigue and shortness of breath
Patients who experience pagophagia are usually associated with this type of anemia
Iron Deficiency Anemia
Patients with tachycardia may experience a rapid fall in _ concentration
Hemoglobin
Hemoglobin concentration of 7-10g/dL
Moderate Anemia
Hemoglobin concentration of <7g/dL
Sever Anemia
Tissue hypoxia triggers an (increased/decreased) 2,3-bisphosphoglycerate
Increased
The patient is found to be anemic. What is the next test that should be done?
Reticulocyte count
Microcytosis histogram
Shift to the left
Macrocytosis histogram
Shift to the right
Coefficient of variation of RBC volume expressed as a percentage
Red cell Distribution Width
Adult reference interval for the reticulocyte count
0.5.-2.5%
Newborn reference interval for the reticulocyte count
1.5-6%
MCV 53fL
RBC diameter: 5um
Microcytic anemia
Most common form of microcytic anemia
Iron Deficiency Anemia
Small cells with increased central pallor
Microcytic, hypochromic anemia
Associated conditions with Microcytic, Hypochromic anemia
TAILS
- Thalassemia
- Anemia of Chronic Inflammation
- Iron Deficiency Anemia
- Lead poisoning
- Sideroblastic anemia
Most common anemia among hospitalized patients
Anemia of chronic inflammation
Central feature of anemia of chronic inflammation
Sideropenia (low serum iron despite abundant iron body stores)
Anemia wherein incorporation of iron into porphyrin is prevented
Sideroblastic anemia (Iron: “Sider”)
Nucleated RBC precursor with cytoplasmic iron granules
a. Sideroblast
b. Siderocyte
Sideroblast
Anucleated RBC precursor with iron granules
a. Sideroblast
b. Siderocyte
Siderocyte
Anemia wherein iron is trapped in the mitochondria
Sideroblastic anemia
Hallmark of sideroblastic anemia
Ring sideroblasts (mitochondria loaded with iron)
Liver disease
Chronic alcoholism
Bone marrow failure
Macrocytic, normochromic nonmegaloblastic anemia
Pernicious anemia may cause deficiency in _
Vitamin B12
Characterized by the presence of antibodies in the parietal cells of the stomach and destroys the intrinsic factor
Pernicious anemia
Competition with this parasite may decrease Vitamin B12 absorption
D. latum
Infection of this parasite may decrease the intrinsic factor of the parietal cells in the stomach
H. pylori
It is the root cause of megaloblastic anemia
Impaired DNA Synthesis
Hypersegmentation of neutrophils (>6) is typically found in what anemia
Megaloblastic anemia
Macrocytic, normochromic anemia
Megaloblastic anemia and non-megaloblastic anemia
The characteristic shape of macrocytes in non-megaloblastic anemia
Round
The characteristic shape of macrocytes in megaloblastic anemia
Oval
Vitamin B12 is only obtained from
Animal sources
Three types of anemia based on the morphologic classification
- Normocytic, normochromic
- Microcytic, hypochromic
- Macrocytic, normochromic
Normocytic, normochromic anemias with normal or decreased reticulocyte count
- Aplastic anemia
2. Renal Disease
Donath-Landsteiner Hemolytic Anemia may also be called as
Paroxysmal cold Hemoglobinuria
Type of anemia in
- Paroxysmal nocturnal hemoglobinuria
- Paroxysmal cold hemoglobinuria
- Sickle Cell
- G6PD and PK deficiency
- Other hemolytic anemias
Normocytic, normochromic with increased reticulocyte count
Why? Extravascular/ Intravascular hemolysis is high in these conditions
Why is renal disease classified as normocytic, normochromic anemia with normal or reduced reticulocyte count?
Kidneys will not be able to produce EPO that will promote erythropoiesis
Impaired production of heme
Porphyrias
Lead poisoning is an example of what heme disorder
Acquired porphyria
Congenital Erythropoietic porphyria is deficient with what particular enzyme?
Uroporphyrinogen III synthase
The deficient enzyme in erythropoietic protoporphyria
Ferrochelatase
A gain of function of the ALA-synthase 2 enzyme may lead to
X-linked Erythropoietic Protoporphyria
A primary cause of porphyrias
Deficiencies in the heme biosynthetic pathway
Deposition of accumulated products in impaired heme synthesis may lead to
Photosensitivity
It is due to the differences in the arrangement of amino acids in the polypeptide chain
Hemoglobinopathies
Most common hemoglobinopathies
Beta-hemoglobinopathies
Two types of beta-hemoglobinopathies
- Homozygous beta-hemoglobinopathies
2. Heterozygous beta-hemoglobinopathies
Type of hemoglobinopathy where both beta genes are mutated
Homozygous beta-hemoglobinopathies
Genotype of Sickle cell disease
Hb SS
Genotype of Hb C disease
Hb CC
Genotype of Sickle cell trait
Hb AS
Genotype of Hb C trait
Hb AC
Identify the hemoglobinopathy: 6GLU–>VAL
Hb S
Identify the hemoglobinopathy: 6GLU–>LYS
Hb C
Identify the hemoglobinopathy: 26GLU–>LYS
Hb E
Hb M-Saskatoon, Hb M-Milwauee-1, Hb M-Milwaukee-2
M Hemoglobins (Associated with Methemoglobinemia and Cyanosis)
Hemoglobinopathies associated with Increased Oxygen affinity
Hiroshima, Rainier, Bethesda
Hemoglobinopathies associated with Decreased Oxygen affinity
Agenogi, Beth Israel, Yoshizuka
When does sickling happen in patients with sickle cell anemia?
After oxygen is released from the RBC
Difference of sickle cell trait and sickle cell disease
Disease: Copy of 2 altered hemoglobin (SS)
Train: Copy of 1 altered hemoglobin (AS)
Patients with sickle cell are resistant to what type of parasite?
P. vivax
Primary screening test to detect variant hemoglobins
Cellulose Acetate Electrophoresis
Confirmatory test for Hb S
Citrate Agar Electropheresis
Screening tests for Hemoglobin S
- Sodium metabisulfite
- Sodium dithionate tube test
- Cellulose Acetate
Two crystals related to Hb C
Hb SC crystals & Hb CC crystals
Characteristic of crystals in Hb SC
Washington Monument in the periphery
Characteristic of crystals in Hb CC
Bars of gold within the membrane