Red Blood Cells Flashcards
1
Q
Anemia
A
decreased RBC mass
2
Q
Symptoms of anemia
A
fatigue, dizzy, poor concentration, pallor, SOB, dyspnea, tachycardia, palpitations, weakness
3
Q
Symptoms of iron overload
A
vertigo, bronze skin, arthritis, hair loss, memory loss, high liver enzymes, heart degeneration, diabetes
4
Q
Retic index <2
A
decreased production
5
Q
Retic index >2
A
increased destruction
6
Q
MCV in microcytic anemia
A
< 80
7
Q
Microcytic anemia differential
A
"TICS" Thalassemia Iron deficiency Chronic disease Sideoblastic
8
Q
Anemia of chronic disease causes
A
autoimmune SLE, chronic infection, immunodeficient
chronic inflammatory illness: inflam interferes with iron uptake
9
Q
Normocytic MCV range
A
80-100
10
Q
Macrocytic MCV
A
> 100
11
Q
Iron deficiency smear
A
hypochromic, pencil cells, micro
12
Q
Causes of iron deficiency
A
- GI bleed
- heavy menses
- GI malignancy
- Malabsorption (celiac)
- dietary intake
13
Q
Thalassemia demographic
A
mediterranean, african
14
Q
Thalassemia smear
A
target RBCs, micro
15
Q
Beta thal minor
A
1 gene, minor anemia, no treatment needed
16
Q
Beta thal intermedia/major
A
both genes
severe microcytic anemia with low HCT
bone marrow expansion, need tx
17
Q
thalassemia treatment
A
transfusions with deferoxamine to chelate iron
18
Q
thalassemia diagnosis
A
hemoglobin electrophoresis
19
Q
Alpha thal
A
one- fine
two- still fine
three- Hg H disease, need transfusions
four- fatal in utero
20
Q
sideroblastic anemia cause
A
cant incorporate Fe into Heme
- nutritional deficiency (Copper, Zinc, B6)
- chronic alchoholism
- lead poisoning
21
Q
Sideroblastic anemia smear/BM shows
A
sideroblasts on BM, basophilic stipplings, pappenheimer bodies on smear
22
Q
Sideroblastic anemia treatment
A
chelation therapy for lead
nutrition replacement
detox alcohol
23
Q
Sickle cell genetics
A
autosomal recessive beta globin single base pair mutation
Glu–> Val
SC is Glu–> Lys
24
Q
Sickle Cell manifestations
A
ichemia reperfusion free Hg release vascular injury thrombosis susceptibility to infection
25
Sickle cell- just the trait
chronic pain
CV collapse under stress
spleen infarction
renal papillary necrosis
26
Sickle cell treatment
1. hyroxyurea- fetal Hg, reduced pain, inc survival
2. Transfusions- simple or exchange
3. BM/SC transplant-curative
27
Indications for transfusion in sickle cell
stroke, acute chest syndrome, splenic sequestration, hepatic issue, symptomatic anemia
*watch: iron overload, infection, alloimmunization*
28
Sickle Cell: infection
more susceptible to capsules
pneumo, staph, h flu, menigococus, salmonella
osteomyelitis
29
Acute chest syndrome
sickle cell
| pneumonia, lung sickling (sm ves occlusion), thromboembolism (lg ves occlusion), chest wall sickling, bronchospasm
30
Sickle cell: stroke
continuously @ risk
screen cranial flow
look for moya moya
exchange transfusions and revascularization
31
Aplastic Crisis
sickle cell
caused by parovirus B19--> anemia, low retics, not making anything
transfuse ASAP
32
Sickle cell diagnosis
Hg electrophoresis
33
Compensated Hemolytic Anemia vs non-compensated
Hemolysis with adequate increase in RBC production (reticulocytes) vs. without
34
Hemoglobinuria vs hematuria
Hg molecules in urine vs. bloody urine
35
Intravascular hemolysis
Red cell destruction with arteries , veins, or capillaries
SEVERE: pain, fever, jaundice, renal damage
IgM mediated
Sometimes mechanical force
36
Extravascular hemolysis
Red cells consumed by macrophages after being sequestered in spleen
MILD: slow decrease in Hg, low grade fever, slow developing jaundice
IgG mediated
37
What lab indications are seen in intravascular hemolysis?
Free Hg detectable in serum and urine (hemoglobinemia or Uria)
Increased LDH
Increased total bilirubin
Decreased haptoglobin
38
Haptoglobin
Binds free Hg
39
What are lab indications for extravascular hemolysis?
No free Hg in serum or urine
Mildly increased LDH
Slight increase in bilirubin
Haptoglobin unchanged
40
Congenital hemolytic anemia: Hemoglobin
Thalassemia and sickle and Hg C disease
41
Congenital hemolytic anemia: membrane defect
Hereditary spherocytosis
| Hereditary elliptocytosis
42
Congenital hemolytic anemia: Metabolism defect
G-6-PD
| Pyruvate Kinase
43
What is an autoimmune hemolytic anemia?
Immune system attacks it own red cells as foreign and forms autoantibody- marked for destruction in the spleen
44
Warm vs cold autoimmune hemolytic anemia
Warm: high temp, extravascular hemolysis, IgG, CLL NHL SLE
Cold: cold temp, intravascular hemolysis, IgM, mycoplasma and mononucleosis, more SEVERE
45
What does Coombs test measure?
Person's RBC agglutinate to anti human Ab
46
What is an alloimmune hemolytic anemia?
Antibody based immune attack against foreign RBC antigens
- Hemolytic transfusion reactions-ABO non-ABO
- Hemolytic disease of the newborn- Rh neg mom
47
Hemolytic disease of the newborn
Mom is Rh neg and attacks Rh positive baby in her second pregnancy once she has developed anti + antibodies- cross placenta and destroys fetal RBCs
48
Hydrophobic fetalis presentation and consequences
Massive anemia of fetus
Congestive heart failure
Oran hypoperfusion
Organ damage and death
49
What causes microangiopathic hemolytic anemia?
Fibrin strands
(In small vessels with fibrin strand clots, intracellular RBCs get sheared going through them)
Seen in DIC TTP HUS
50
What are common culprits in infectious anemia?
Malaria and babesia
RBC are loses trying to clear infected RBCs
Resolves with abx
51
What protects you from congenital anemias in the first 8 months of life, and is the reason they often go undetected early on?
Fetal Hg
52
How do sickle cells sickle?
Hg SS polymerizes into a long tube AFTER it goes into circulation and is deoxygenated- locked in
53
Clinical presentation of vaso-occlusive crisis
-sudden onset of severe bone pain
- infection or high temperature
-abdominal pain
-priapism
Lasting hours to days
54
Acute chest syndrome can escalate to
Acute respiratory distress syndrome- form of damage to alveoli in lungs that prevents oxygen transport to blood
55
What is meant by the term "functional asplenia"?
Spleen goes infarct
Increased risk for infections with encapsulated
Need penicillin prophylaxis
See Howell-jolly bodies on smear
56
Hereditary spherocytosis: Disorder of RBC _________ results in ______ RBCs. This causes them to be _______, hence causing
Structural proteins
Spherical
Taken up by the spleen
Chronic anemia and splenomegaly
57
Spherocytes on smear differential
Autoimmune hemolytic anemia
Difference: spherocytosis is inherited, autoimmune is acquired
Also look for Ab
58
What causes G6PD deficiency and why?
Fava beans and sulfa drugs
Without the enzyme you accumulate oxygen radicals that cause a severe hemolytic anemia
-This is X linked, so men only
59
What is sneaky about anemia caused by blood loss trauma?
When you do labs, HCT and Hg may show up normal since they represent values based on total blood volume. Show up as normocytic
60
Why does renal failure anemia occur?
EPO production is decreased, causing normocytic anemia over time. EPO injection helps HCT/Hg
61
Two causes of macrocytic anemia
B12 and folate deficiency
62
B12 deficiency hallmarks
Macrocytic anemia
Levels <200
PERIPHERAL NEUROPATHY
63
Top 4 causes of B12 deficiency
1. Liver disease (alcoholism)
2. Diet (vegan)
3. Pernicious anemia (autoimmune impairment of gut absorption)
4. GI surgery- malabsorption
64
What symptoms is missing in folate deficiency?
Neuropathy
65
Top 3 causes of folate deficiency
1. Liver disease
2. Diet
3. Pregnancy (higher consumption)
66
This strange increase can be seen in iron deficiency anemia because they have the same precursor- might be making these instead of RBCs
Platelets
67
In anemia of chronic disease, inflammation can also interfere with what?
Uptake of iron via hepcidin
68
3 effects of EPO
1. Inc rate of RBC precursor division
2. Inc rate of Fe incorporation
3. Inc rate of reticulocytes entry into blood
69
What are you lacking in aplastic anemia?
Low number of erythroid precursors- pancytopenia with teardrop RBCs
70
What is pernicious anemia?
Autoimmune disorder when Abs are produced against parietal cells of the stomach so intrinsic factor cant be produced.
71
Shilling test
For B12 deficiency anemia- looks at radiolabeled cobalmin in urine
72
Iron is absorbed in the ________ while it is ultimately stored in ______ and _______.
Duodenum
| Bone marrow, ferritin
73
Clinical definition of iron deficiency anemia (values)
Ferritin <10 (normal 20-250 in men and 10-200 in women)
OR absent BM stores
74
In anemia of chronic disease, _________ is high while _______ is low.
Ferritin
| TIBC
75
In ACD, why is TIBC low and ferritin high?
YOu have the transferrin bound by iron already but cant deliver it to the RBCs
76
What does LDH tell us?
It is energy metabolism enzyme of the RBC so it is elevated in hemolytic anemia states
77
Why is cold AIHA more severe?
IgM and complement mediated
78
Basophilic stipplings are seen in
BASte the ox TAIL
Thalassemias,
Anemia of chronic disease,
Iron deficiency,
Lead poisoning
79
Target cells are seen in
HALT
HgC disease
Asplenia
Liver disease
Thalassemia
80
Lab levels in anemia of chronic disease
Low iron, low TIBC, high ferritin
81
What is aplastic anemia
Destruction of myeloid stem cells- low number of precursors
82
What causes aplastic anemia?
1. Radiation and drugs
2. Viral agents (parvovirus, EBV, HIV, HCV)
3. Franconi's anemia (DNA repair)
4. Idiopathic, immune mediated
83
G6PD deficiency smear
Heinz bodies and bite cells
84
Pyruvate kinase deficiency
Autosomal recessive
Defect causes less ATP and rigid RBCS
Hemolytic anemia in a newborn
85
Paroxysmal nocturnal hemoglobinuria
Complement mediated RBC lysis, urine hemosiderin and thrombosis
86
Microangiopathic anemia
RBC are damaged when passing through obstructed/ narrow vessel
DIC
TTP
HUS
SLE
Schistocytes
87
Macroangiopathic anemia
Prosthetic heart valves and aortic stenosis cause d/t mechanical destruction
Schistocytes
88
Factor deficiencies and lab values seen in hemophilia A and B
Prolonged PTT due to factor 8, 9 deficiency, respectively
89
Thrombotic thrombocytopenic purpura
Low platelets
Deficient ADAMTS 13 leads to less degradation of vWF
Presents: large vWF multimers, inc platelet aggregation and thrombosis
90
DIC pneumonic
STOP Making New Thrombi
```
Sepsis
Trauma
Obstetric complication
Pancreatitis
Malignancy
Nephrotic syndrome
Transfusion
```
91
DIC in simple terms
Widespread activation of clotting leads to a deficiency in clotting factors which creates a bleeding state
