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Pathology > RBC Disorders > Flashcards

RBC Disorders Flashcards

1
Q

1) Source of erythropoietin
2) Formation of granulocytes and monocytes
3) Commonest site bone marrow taken
4) Distinguish b/w IDA & Thalessemia trait
5) Formation of platelets require
6) Drug given to anti cancer patient in anemia
7) Recombinant GM-CSF & G-CSF
8) Recombinant IL-11

A

1) Peritubular cells of kidney
2) GM-CSF & G-CSF
3) In adults - post sup iliac spine
In child - Tibia
4) Mentzer index for IDA >13 & Thalessemia <13
5) IL-11
6) Darbopoeitin
7) Sargramostin & Filgrastim
8) Oprelvekin

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2
Q

1) Formation of platelets require
2) Drug given to anti cancer patient in anemia
3) Recombinant GM-CSF & G-CSF
4) Recombinant IL-11
5) RDW
6) Anemia diagnosis criteria

A

1) IL-11
2) Darbopoeitin
3) Sargramostin & Filgrastim
4) Oprelvekin
5) Variation in size of RBCs (anisocytosis)
11.5-14.5
6) Male -13 g/dl
Female - 12 g/dl
Pregnant female - 11 g/dl

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3
Q

1) First cell having appearance of Hb
2) Routine staining appearance of Hb
3) Last stage in development of nucleated RBC
4) Reticulocyte Normal range & stain
5) Reticulocyte is called
6) Maintains shape of RBC
7) MCV
8) MCH
9) MCHC

A

1) Erythroblast
2) Intermediate normoblast
3) Late normoblast
4) 0.5-2% & supravital stain - new methylene blue
5) Poorman bone marrow aspirate
6) Spectrin
7) 80-100 femtolitres
8) Hb inside RBC 27-32 picograms
9) 34-37 g/dl ; <34 - anemia

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4
Q

Examples of microcytic RBCs

A 
<80 FL
Sideroblastic anemia 
Iron deficiency anemia (MC)
Thalessemia 
Anemia of chronic disease 
Lead poisoning
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5
Q

Examples of macrocytic RBCs

A 
>100 FL 
Liver disease 
Hypothyroidism 
Megaloblast (B12, folate def.; Methotrexate)
Cell changes
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6
Q

Findings in hemolytic anemia

A 
Anemia 
Serum LDH inc
Unconjugated bilirubin & jaundice
Free Hb (toxic) release attach to Haptoglobin
Dec. in haptoglobin 
Hemoglobinemia & hemoglobinuria
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7
Q

Hemoglobinuria causes

A 
Altered color of urine
Acute tubular necrosis 
Renal hemosiderosis
Inc. in bone marrow activity causes decrease in M:E ratio 
Reticulocytosis
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8
Q

Myeloid: Erythroid ratio

A

Normal 3:1

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9
Q

CHRONIC hemolytic anemia causes

A

Unconjuagted bilirubin + Calcium salts = pigment gallstones

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10
Q

Jaundice + anemia + alteration in urine color

Jaundice + anemia + alteration in urine color + heaptosplenomegaly

A

Intravaacular hemolytic anemia

Extravascular hemolytic anemia

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11
Q

Intracorpuscular hemolytic anemia

Extracorpuscular hemolytic anemia

A

Inherited - Hereditary Spherocytosis, G6PD def., Thalessemia, sickle cell anemia

Acquired - PNH

Non immune - Clostridium infection , lead poisoning

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12
Q

1) Which form of iron is utilised for absorption?
2) Receptor
3) Site of absorption
4) Transporter on basal surface responsible for bringing iron inside body
5) Factors responsible for iron absorption
6) Factors causing IDA

A

1) Ferrous form Fe2+
2) DMT -1
3) Duodenum
4) Ferroportin
5) Vit C as Ascorbic acid, HCL,Amino acids , sugar
6) Chronic disease iron deficiency renal disease

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13
Q

Factors decreasing iron absorption

A

Phytate present in Vegetables
Carbonate
Tetracycline **

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14
Q

1) Plasma protein transporting iron inside blood
2) 1 molecule of this protein transports how many iron molecules
3) TIBC
4) % saturation Tf
5) Serum iron

A

1) Transferrin
2) 2
3) 360 mg/dl
4) 33%
5) 120 mg/dl

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15
Q

1) Iron storage form
2) This is getting converted into
3) Calculate 2) level with ____ stain

A

1) Ferritin
2) Hemosiderin
3) Prussian blue called Pearls reaction

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16
Q

1) Iron deficiency
2) Changes in blood picture - iron profile changes
3) Gold standard for diagnosis
4) Blood test shows

A

1) Koilonychia, pica, pallor, dyspnea, palpitations
2) serum ferritin dec.
Transferrin saturation dec.
Serum iron dec.
TIBC inc.*****
3) Bone marrow examination
4) dec. Hb, MCV MCH MCHC all dec.
RDW inc. (pencil shaped RBC)
Target cell
Microcytic hypochromic anemia
Anisocytosis
Poikilocytosis
Free protoporphrin inc.

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17
Q

Most sensitive indicator of IDA
Rx for children
Rx for adult

A

Serum ferritin
Antihelminthic like Albendazole
Fe supplement like ferrous sulphate Fe2+

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18
Q

When parenteral iron is given

A

Oral iron is not tolerated
Iron dextran & iron sorbitol citrate
Given by ‘Z’ tract technique

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19
Q

1) Anemia of chronic dis which interleukin secreted & its action on bone marrow & liver
2) Rx

A

1) IL-6 ==> dec. erythropoietin
Normocytic normochromic anemia
serum ferritin inc.**
Transferrin saturation dec.
Serum iron dec.
TIBC dec.

Hepcidin - Inhibit metabolism of iron
Causes microcytic hypochromic anemia

2) Treat primary cause

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20
Q

1) Vit B12 is also called
2) Vit B12 absorbed in
3) Stomach secretes
4) What causes B12 & IF attachment

A

1) Cyanacobalmin containing cobalt
2) Absorbed in ileum****
3) Pepsin & Intrinsic factor
4) Pancreatic enzymes

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21
Q

Causes of dec. absorption of B12

A 
Vegans and alcoholics 
Surgery 
Pernicious anemia (Oral B12 not efficient )
Pancreatic insufficiency 
Bacterial overgrowth syndrome 
Iliacdisease
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22
Q

Reaction of 1 carbon transfer

A

B12 and FA
Homocysteine——-> Methionine

DNA synthesis B12

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23
Q

Increased homocysteine

A

Thrombosis

Atherosclerosis

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24
Q

B12 reaction only

A

Methylmalonyl CoA—–> Succinyl CoA required for myelin

Neurological deficits

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25
Q

Increased methylmalonyl

A

Methylmaloniemia

Methylmaloneuria

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26
Q

Bone marrow studies in B12 deficiency

A

Pancytopenia (ineffective erythropoeisis)

RBCs : Macrocytic = Megaloblast, oval shape= Macrovaloblasts
Howell Jolly bodies, Cabot rings

WBCs : Hypersegmented neutrophils

Platelets : Abnormal megakaryocytes

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27
Q

GIT findings in B12 deficiency

Neurological symptoms

A

Mucosal atrophy
Tongue : smooth appearance

Paraesthesia 
Tingling sensation 
CNS : spinal cord involvement 
Dorsal column more commonly affected
Sub Acute Combined Degeneration = SACD
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28
Q

Blood studies shows what in B12 deficiency

A

Hb dec.
MCV inc.
MCHC NORMAL****

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29
Q

Schilling test

A

Not useful for diagnosis of B12

Dons for differentiating causes of absorption

30
Q

Infection causing B12 deficiency

A

Fish tapeworm = Diphyllobothrum latum

31
Q

Pernicious anemia

Treatment

A

Autoantibodies + auto reactive T-cell against parietal cells

Dec. IF

Type 2 Hypersensitivity reaction

Cause intestinal metaplasia in fundus of stomach

Parenteral B12 (IM)

32
Q

B12 parenteral is given in

A

Pernicious anemia

CYANIDE POISONING *****

33
Q

Increase in MCHC occurs only in

A

Hereditary spherocytosis

34
Q

Sickle cell trait relation with falciparum

A

Protective

Any kind of Hbpathy & G6PD deficiency is protective

35
Q

1) Folate is absorbed in
2) Most active form of folic acid
3) Diagnosis

A

1) Jejunum

2) Methyl THF—–> THF
which is useful for

Methylene THF —-> DHF forms dTMP useful for DNA synthesis

3) RBC folate levels which do not fluctuate

36
Q

Folate trap

A

Due to B12 deficiency in form of Methyl THF

37
Q

Causes of secondary folate deficiency

A

Alcohol
Phenytoin
Methotrexate inhibits DHF reductase

    DHF reductase  DHF------------------>THF
38
Q

Megaloblastic anemia but no neurological symptoms

A

Folate deficiency

39
Q

Histidine metabolism

A

FA
Histidine —-> FiGLU——-> Glutamate

FiGLU in urine

40
Q

Folate in pregnancy

A

Prior to conception so as to avoid neural tube defects such as spina bifida

41
Q

Hereditary spherocytosis

Rx

A 
AD 
Ankyrin is defective 
Jaundice Anemia Splenomegaly
Anisocytosis & hyperchromic spherocytes 
Microspherocytes 
Loss of central pallor of RBC

MCV dec.
MCH Normal
MCHC inc.

Elective splenectomy
Higher chance of infection- capsulated org.

42
Q

Grave of RBC

CORDS OF BILLROTH

A

Spleen

43
Q

Spherical RBCs seen in

A

Autoimmune hemolytic anemia and not spherocytosis

44
Q

Osmotic fragility test also called as

A

Pink test

RBCs placed in Hypotonic solution
Increased in spherocytosis
Decreased in sickle cell disease

45
Q

Increased bone marrow activity in spherocytosis

A

Increased erythroid precursor

46
Q

G6PD deficiency

G6PD Mediterranean

A

X LR

Self limiting hemolysis
Prevents oxidative damage to RBC

                      G6PD Glucose 6 PO4----> 6 phospogluconate

Forms NADPH—-> Reduced glutathione

In Mediterranean form, Blister cells seen

Coombs negative

47
Q

Oxidative stress

A

Hb denaturation —> HEINZ BODY (intracellular inclusion)
Crystal violet stain

Intravascular & extravascular hemolysis

BITE CELLS in peripheral smear
BLISTER CELLS

48
Q

Etilogy of oxidative stress

A

Fava beans
Infections
SULPHONAMIDES NITROFURANTOIN
ANTI MALARIAL DRUGS (primaquine)

49
Q

Sickle cell anemia

A

AR
Point mutation at 6 beta globin chain
Valine instead of GLUTAMIC ACID
Polymerisation of deoxygenated Hb

BetaS

Hypoxia & dehydration
RBC sticky & trapped into spleen

Sickle cell trait & disease —HbS

Extravascular hemolytic anemia

50
Q

Irreversible sickling

A

Micro vascular occlusion

Bones : Dactylitis ; Hand foot syndrome, avascular necrosis of femur **
Vertebral column : cord fish vertebra
H shaped vertebra , fish mouth vertebra
Skull: Crew cut appearance= hair on end
Osteomyelitis : Salmonella & staph aureus

Skin : non healing ulcer in lower limb
Penis : Priapism
Lungs : acute chest syndrome
Kidneys : papillary necrosis also in DM, hyposthenuria

51
Q

Sickle cell anemia changes in spleen

A

Spleen :

Early : Congestive splenomegaly
GANDY GAMMA BODY

Late : Autosplenectomy

52
Q

ESR in sickle cell

A

Dec. ESR

Dithionite metabisulfite removes O2

53
Q

Distinguish sickle cell trait & disease

A

HPLC gives % of HbS & HbA

Hb electrophoresis

54
Q

Complications in sickle cell

A

Vaso-occlusion crisis

Sequestration crisis

55
Q

Drug in sickle cell

A

Hydroxyurea
Inc. HbF
Used as anti cancer drug

56
Q

Factors responsible for sickling

A

HbS
Dehydration & deoxygenation
Acidosis
Infections

57
Q

Intake of primaquine acts as a trigger for hemolysis in

A

G6PD deficiency

58
Q

Banana like finding in smear

A

Plasmodium falciparum causing malaria

59
Q

Hereditary spherocytosis

A

Due to chronic hemolysis, pigmented stones are formed in gallbladder

Howell Jolly bodies seen

60
Q

Hereditary elliptocytosis

A

Polymerisation of spectrum molecules

61
Q

Spherocytosis is seen in

A 
Hereditary spherocytosis 
Autoimmune hemolytic anemia 
Hemolytic disease of newborn 
Post transfusion
Heinz body hemolytic anemia (G6PD def.)
Water dilution hemolysis 
Fragmentation hemolysis (burns, mechanical trauma)
62
Q

Gene deletion

Gene mutation

A

Alpha Thalessemia Chr.16
4 genes

Beta Thalessemia (MC) Chr.11
2 genes
63
Q

Beta zero beta zero

A

AR

Thalessemia major

Transfusion dependent Thalessemia

Iron overload

64
Q

Alpha chain precipitation

A

Direct damage to normoblasts

Extravascular hemolysis

Causing anemia
Jaundice hepatosplenomegaly

65
Q

Thalessemia features

A

Extra medullary hematopoeisis due to increased erythropoietin

Chimpanzeee chipmunk like fancies

Microcytic hypochromic anemia
Target cells
Basophilic stippling

HLPC shows :
HbF elevated in major
HbA2 elevated in minor >3.5 g/dl

66
Q

Test for BETA Thalessemia

A

Nestrof test —> screening test

HbA2 inc.

67
Q

ALPHA Thalessemia

A

Beta 4 tetramer = HbH
Has too much affinity for O2
Hypoxia

Fetal : Gamma 4 tetramer = Barts Hb
Hydrops fetalis

68
Q

Autoimmune hemolytic anemia

A

Type 2 hypersensitivity

Direct Coombs test

Warm : IgG&raquo_space; IgA
Idiopathic, SLE, rheumatoid arthritis, CLL, ALPHA METHYLDOPA

Cold : IgM&raquo_space; IgG
INFECTIOUS MONONUCLEOSIS, Mycoplasma , malgnancies (Walden storm macroglobulinemia)

69
Q

Agglutination of RBC

A

IgM

70
Q

Paroxysmal Cold Hemoglobinuria in child

A

IgG

Attached at 4 degrees & activates at 37degrees

Altered color of urine at cold temp.

Biphasic antibidy = Donath Landsteiner Ab

Intravascular hemolysis

71
Q

Aplastic anaemia caused by drugs

A

Chlorpromazine
Allopurinol
Diclofenac

Pathology (2 decks)

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