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Heme/Onc by Minnie: AH Update > 242/243: Intro to CBC, Approach to Anemias, Anemia CBL > Flashcards

242/243: Intro to CBC, Approach to Anemias, Anemia CBL Flashcards

1
Q

RBC characteristic associated with autoimmune hemolysis

A

Spherocyte (Dark RBC with no central pallor)

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2
Q

What is the next diagnostic step when RBC agglutination is found on a blood smear?

A

Warm up the sample, look again

(And probably run labs again to get accurate values for RBC count, MCV)

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3
Q

What could result in a falsely high RBC count? (2)

A

Marked leukocytosis (WBCs contribute more than expected)

Giant platelets (Platelets counted as RBCs)

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4
Q

Describe the RBC morphology in iron deficiency anemia

A

Microcytic, hypochromic anemia

Cells are little and pale

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5
Q

What shape will RBCs be if there is excess RBC membrane relative to the its volume?

A

Target cells

  • Macro target cells: liver disease*
  • Micro target cells: Hemoglobinopathy (thalassemia, HbgE, HgbC)*
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6
Q

What is the finding indicated by the arrows?

What is the DDx? (3)

A

Spherocytes

  • Hereditary spherocytosis
  • Autoimmune hemolytic anemia
  • Burns
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7
Q

RBC characteristic associated with hereditary elliptocytosis

A

Ovalocyte

Also associated with B12/folate deficiency, iron deficiency

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8
Q

Are symptoms of orthostatic hypotension, headache, and tachycardia more likely with acute or chronic anemia?

A

Acute

No time for compensatory mechanisms to develop -> more symptoms

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9
Q

A patient with sickle cell disease has this finding

What does it indicate?

A

Splenic failure

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10
Q

List 4 clinical scenarios in which you would see increased numbers of immature RBCs on a peripheral blood smear

A
  • Newborns (<5 days old)
  • Brisk hemolysis
  • Myelodysplasia
  • Extramedullary hematopoiesis (blood cells being made outside of the bone marrow, seen in myelofibrosis)
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11
Q

Intravascular hemolysis will cause red blood cells to be what shape?

A

Schistocytes

Caused by microangiopathic hemolytic anemias

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12
Q

What could result in a falsely low RBC count? (3)

A

RBC agglutination (Multiple RBCs counted as one)

Microcytosis (RBCs too small to be counted)

Rouleaux formation (myeloma, inflammatory disorders)

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13
Q

What does mean corpuscular hemoglobin (MCH) measure?

A

The amount of hemoglobin in each RBC

Vs MCHC, which measures hemoglobin concentration in a given volume of packed RBCs

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14
Q

What does mean corpuscular Hb concentration (MCHC) measure?

A

Hemoglobin concentration in a given volume of packed RBCs

Vs. MCH, which measures amount of hemoglobin per RBC

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15
Q

What could cause a falsely low platelet count? (3)

A

Clotted sample

Platelet clumping

Frequent giant platelets

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16
Q

What does MCV measure?

A

Mean corpuscular volume

Average red blood cell size (volume)

Determines whether anemia is macrocytic (folate, B12, liver disease) or microcytic (iron deficiency, lead)

17
Q

List 6 clinical scenarios that would cause RBCs to turn into “spur cells” (acanthocytes)

A

Anorexia

Severe nutritional deficiency

Both acanthocytes and echinocytes: hemolytic anemia, liver disease, hypothryoidism, post-splenectomy, abetalipoproteinemia, Lipid disorder

18
Q

What is the finding indicated by the arrows?

What is the DDx? (2)

A

Schistocytes

  • Mechanical shear
  • MAHA (microangiopathic hemolytic anemia)
    • DIC
    • HUS
    • TTP
    • HELLP
19
Q

What could cause falsely high hemoglobin? (4)

A

Anything that increases turbidity of the sample

Hyperlipidemia

Hyperbilirubinemia

High protein

Marked leukocytosis

Hemoglobin measured spectrophotometrically; anything that makes the sample cloudier = less light = interpreted as more hemoglobin

20
Q

What does hematocrit (HCT) measure?

A

Volume of RBCs / blood volume

(Basically, the percentage of blood made up by the actual cells)

21
Q

How will the hemoglobin/oxygen dissociation curve change as a result of anemia?

A

Right shift=decreased affinity=increased P50

  • Via increased 2,3 bisphosphoglycerate
  • Allows existing RBCs to offload more oxygen to tissues to try to meet oxygen demands

2,3 BPG is the same thing as 2,3 DPG bc why not ¯_(ツ)_/¯

22
Q

RBC characteristic associated with myelofibrosis

A

Teardrop cell

23
Q

What defines anemia?

A

Decreased number of circulating red blood cells

24
Q

RBC characteristic associated with microangiopathic hemolytic anemia

A

Schistocytes

25
Q

What is the morphology finding indicated by the arrows?

What is the DDx? (4)

A

Hypochromic, microcytic, increased RDW

  • Iron deficiency anemia
  • Thalassemia
  • Lead poisoning
  • Anemia of chronic disease
26
Q

What is the MOA of RBC agglutionation?

A

IgM antibodies against RBCs

  • One IgM antibody can bind 5 RBCs -> Clumping
27
Q

RBC characteristic associated with G6PD deficiency

A

Bite cell

(G6PD causes Heinz body hemolysis, results in bite cells)

28
Q

List 4 compensatory mechanisms for anemia

A
  • Increased cardiac output
    • Tachycardia
  • Altered blood flow
    • Maintain O2 delivery to most important organs
  • Increased EPO
  • Increased 2,3-Bisphosphoglycerate
    • Causes RBC to have less affinity for O2
    • -> Right shift, allows more O2 offloading to tissues per RBC
29
Q

When is splenectomy indicated in sickle cell disease?

A

1 or more episodes of hyper-splenism

30
Q

How do bite cells form?

A
  • Heinz bodies form in cells susceptible to oxidative damage
  • When the RBCs try to filter through the basement membrane, Heinz bodies get stuck
  • The rest of the cell moves on, leaving a “bite” where the Heinz body got left behind
  • G6PD deficiency
31
Q

What does red cell distribution width (RDW) measure?

A

Degree of variation of RBC

Lots of variation = high RDW

32
Q

RBC characteristic associated with iron deficiency anemia

A

Hypochromic, microcytic

May see ovalocytes

Also associated with thalassemia

33
Q

What could cause falsely high MCV? (3)

A

RBC agglutination

Hyperglycemia

More young RBCs

34
Q

List 3 components of the initial laboratory evaluation for anemia

A

CBC

Reticulocyte count

Peripheral blood smear

35
Q

How would you describe the RBCs? What is the most likely diagnosis?

A

Microcytic, hypochromic

Iron deficiency anemia

36
Q

What’s the best interpretation of the CBC results?

A

Possible thalassemia

Cells are small. Everything else normal.

37
Q

This is a peripheral blood smear from a newborn girl who has jaundice and increased bilirubin. What is the possible cause?

A

Immune mediated hemolysis

The smear shows spherocytes.

38
Q

What would you expect of the oxygen dissociation curve and EPO levels of someone with severe anemia?

A

EPO is increased

Curve is shifted to the right (decrease affinity, oxygen released more easily)

Heme/Onc by Minnie: AH Update (36 decks)

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