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haematology > Week 1: Anemias > Flashcards

Week 1: Anemias Flashcards

1
Q

What are 4 things that cannot be detected by hematology analyzers?

A
  1. Bands - not counted
  2. Blasts - Counted as lymph or mono
  3. Red cell fragments - counted as platelets
  4. Platelet clumps - false thrombocytopenia
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2
Q

What is needed to reduce Methemoglobin?

A

Cytochrime b5 Reductase

NADH

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3
Q

What happens when RBCs don’t neutralize ROS?

A
  1. SH groups on proteins becomes cross linked to S-S –> Denature or precipitate Hgb 2. Fe is oxidized and cant carry O2 (Methemoglobin)
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4
Q

What is Anisocytosis? Poikilocytosis?

A

Variation in size

Variation in shape

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5
Q

A normal hemoglobin content appears grossly as what?

A

Central pallor 1/3 of total diameter of RBC

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6
Q

What are signs of rapid RBC regeneration?

A 
Basophilic 
Stippled (dotted) 
Nucleated 
Howell-Jolly bodies 
Cabot Rings
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7
Q

What element is needed for cellular respiration?

A

Fe

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8
Q

How many grams of iron are in the body? In Hgb? As storage (ferritin, hemosiderin)?

A

3.5 g in body
2g in Hgb
1g in storage

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9
Q

oxidation and genetic defects in hgb structure can result in ______.

A

precipitation of Hgb

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10
Q

What causes bite cells?

A

ppt’d (oxidized) Hg –> tissue-based phagocytes nom the RBC to try to fix the oxidized area

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11
Q

What is hematocrit (HCT)?

A

(Red cell volume)/(Entire blood volume)

[think of the sedimented RBC at the bottom of test tube]

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12
Q

Is Hgb or hematocrit a better measurement?

A

Hgb - according to Strom the Storm

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13
Q

What chemical is used in a [Hgb] test? Reticulocyte?

A

Cyanide

Methylene Blue - binds residual mRNA

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14
Q

What do you measure in direct current Coulter Chamber conductivity? Alternating?

A

Direct: peak number - cell count // peak height - cell volume :: cell type

Indirect: peak height only - cell complexity :: lobulated nuclei

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15
Q

What can a high Immature Platelet Fraction (IPF) indicate?

A

Thrombocytopenia - even if its due to reduced platelet production

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16
Q

What is the formula for mean cell hgb (MCH)? Mean cell Hgb concentration (MCHC)?

A

Hgb/RBC = MCH

Hgb/Hct = MCHC

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17
Q

What are 4 things that cannot be detected by hematology analyzers?

A
  1. Bands - not counted
  2. Blasts - Counted as lymph or mono
  3. Red cell fragments - counted as platelets
  4. Platelet clumps - false/artifactual thrombocytopenia
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18
Q

If a person loses 2.5 liters of blood, how many mgs of iron have they lost?

A

2,500mg Fe

1ml=1mg

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19
Q

Testing ferritin shows what? Solubility? Primary location in body?

A

Amount of Fe in storage

H2O solubility

Liver and spleen

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20
Q

Is ferritin or hemosiderin more readily mobilized/used?

A

Ferritin - Water soluble

Hemosiderin is not water soluble

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21
Q

What is the labile iron pool? How many mgs are in it?

A

Iron leaving plasma for interstitial and intracellular space

80-90mg

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22
Q

What iron storage molecule is the most metabolically active? Which one is the smallest iron storage pool?

A

Transferrin - 10x daily turnover

same same - 3 mg

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23
Q

Where is apotransferrin synthesized?

A

liver

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24
Q

How much of transferrin is iron saturated? Where is transferrin found in the body?

A

1/3

plasma

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25
Q

What are the minimum daily amounts of iron for children? infants? Men and post-men women? Young women? Preggers?

A

The question is in order of need. These are amounts absorbed (ingested = absorbed*10)

Children - .5
Infants - 1
Men, post-menopause - 1

Young women - 2
Preggers - 3

:: need to eat 10x the amount of Fe that you need to absorb

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26
Q

What is transferrin’s job?

A

to carry protein in the plasma

27
Q

What is the function of ferroportin?

A

Puts iron into plasma

Regulates

  1. Iron from mom to fetus
  2. Iron from intestines to plasma/bloodstream
  3. Iron out of macros
28
Q

What is the function of hepcidin?

A

Negative regulator of iron - by degrading ferroportin

  1. Inhibits iron to plasma from recycled RBCs
  2. Inhibits duodenal iron absorption
  3. Inihibits hepatocytes that store iron
29
Q

What factors affect non-heme iron absorption?

A

Increase: Reducing agents (ascorbic acid, gastric acid)

Decrease: Insoluble complexes (phytates, phosphates, grains, egg yolk) // chelators (Turkish clay) // Inhibit or compete for absorption (tea, tannins, Ca)

30
Q

What are 4 factors outside GI that increase iron absorption?

A
  1. Hypoxia
  2. Anemia
  3. Low Fe stores
  4. High erythropoesis
31
Q

Who gets iron deficient in the US?

A

The wee tots

bc people and cow milk is low in Fe

32
Q

Old surgery (billroth) to treat peptic ulcers can result in ______. Why?

A

Fe deficiency

snip out the proximal duodenum with the stomach, stomach sutures continue to bleed

33
Q

What causes non-tropical sprue? Symptoms? Treatment?

A

Cause: Gluten :: immuno damage to villus epithelial cells in small intestines

Symptoms: diarrhea, steatorrhea, weight loss, low Fe absorption

Treatment: stop eating gluten - kill yourself

34
Q

Tropical sprue. What is seen? Results? Treatment?

A

Overgrown coliforms in jejunum

Results: enterotoxin :: fluid secretion //
low folic acid, cobalamin (B12), fat absorption

Treatment: Tetracycline x 2mo + folic acid and maybe some B12

35
Q

What effect does turkish, egyptian, and iranian clay have on iron?

A

It chelates it when it gets in the food supply

36
Q

What are the 6 common causes of GI bleeding in the US?

A
  1. Peptic Ulcer
  2. Hiatal Hernia (stomach through diaphragm)
  3. Chronic Gastritis
  4. Hemerrhoids
  5. Bleeding post surgery
  6. GI cancer
37
Q

What is are the two most common causes of GI bleeding in infants?

A
  1. Milk allergy - boil milk

2. Meckel’s Diverticulum

38
Q

What is Meckel’s Diverticulum?

A

developmental :: babies are born this way

gastric tissues are wrongly in small intestine –> produce HCl –> born Fe-def

39
Q

What are 5 less common causes of iron deficiency?

A
  1. Resp. bleeding
  2. Intravasc. Hemolysis (RBC lyse in vessel)
  3. Chronic Renal Dialysis
  4. Donating blood
  5. Factitious bleeding (fucking weird)
40
Q

How much iron is lost to sick-nasty period blood every month? Crapping out a baby? Feeding the baby you just crapped out?

A

20-30 mg

150-200 mg

30 mg

41
Q

What is a common cause of GI bleeding in 3rd world countries?

A

Hookworm

gets in through unbroken skin, causes “ground itch”

42
Q

What disease presents with green pallor, breathlessness, palpitations, ankle edema, emotional disturbances, depression….?

A

Chlorosis

[think of young, green, Victorian girls]

43
Q

What are the symptoms of chlorosis?

A 
Green Pallor
Breathlessness
Ankle edema
GI probs
Emotional probs
Green Pallor
Breathlessness
Ankle edema
GI probs
Emotional probs
Green Pallor
Breathlessness
Ankle edema
GI probs
Emotional probs
Green Pallor
Breathlessness
Ankle edema
GI probs
Emotional probs
44
Q

What problem presents with fatigue, headaches and parasthesis, irritability, decreased exercise tolerance, burning tongue, and picca?

A

Iron deficiency

45
Q

What are the symptoms of iron deficiency? physical findings?

A 
Fatigue
Headaches and parasthesis (tingling/prickling sensation)
Irritability
Low exercise tolerance
Burning tongue
Picca

Pallor
Glossitis
Stomatitis
Angular Chelitis (sore at corner of mouth)

46
Q

What is koilonychia?

A

concave brittle nails

due to long term iron deficiency

47
Q

Iron deficiency causes what change in the following lab values:

WBC, Hmt, MCV, RDW, Platelets, Retic count

A 
WBC - normal
Hmt - Low
MCV - low
RDW - high
Platelets - high
Retic - low
48
Q

What is RDW?

A

RBC distribution width

aka the variability in red blood cell size

49
Q

What are the normal and iron deficient levels of serum markers:

TIBC, Serum Iron, % saturation, Serum Ferritin

A

TIBC: 280-230, 350
Serum Iron: 45-134, 28
% Sat: 30, <10?

50
Q

What is TIBC?

A

total iron binding capacity

aka measurement of the blood’s capacity to bind iron with transferrin

51
Q

What is the normal range of TIBC? Iron deficient level?

A

280-230 ug/ml

350 ug/L

52
Q

What is the normal range of serum iron? Iron deficient?

A

45-134 ug/ml

28 ug/ml

53
Q

What is the normal % sat. of iron? Iron deficient?

A

30%

<16%

54
Q

What is the normal range of serum ferritin for men and women? Iron deficient?

A

Men: 20-280 ng/ml
Women: 10 - 175 ng/ml

Deficient: <10 ng/ml

55
Q

What are the effects of high erythropoesis and iron deficiency on hepcidin?

A

both suppress hepcidin

:: more ferroportin :: more Fe from gut and release from iron stores

56
Q

What effect does infection have on TIBC and total serum iron? hepcidin?

A

It lowers both

It increases hepcidin levels

57
Q

What is the effect on hepcidin during chronic infection/inflammation? result?

A

increases hepcidin

:: decreased ferroportin :: low gut absorption and uptake from storage

58
Q

What are the indications for parenteral iron?

A
  1. Malabsorption
  2. Intolerance
  3. Uncooperative pt or unable to care for self
59
Q

What is iron dextran?

A

IM injection
Peaks at 10 days
Colors skin and painful - not popular

60
Q

What are some adverse effects of IV iron? What is the one that is particularly concerning?

A

Thrombophlebitis
Arthralgia and Fever
Hypotension and Bradycardia
Barfing up a storm

Anaphylaxis!!! (<1%)

61
Q

NOT by morphology

How are pluripotent stem cells ID’d?

A

NOT by morphology

CD34 (may be 38)??

62
Q

How are BFUs and CFUs defined?

A

Responsiveness to growth factors - cant tell them apart by looking

63
Q

What is treated with TPO? EPO?

A

Thrombocytopenia

64
Q

G-CSF stimulates production of what cell?

A

Neutrophil

haematology (5 decks)

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