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Med Lab Exam 3 > RBC Disorders > Flashcards

RBC Disorders Flashcards

1
Q

Erythropoiesis requirements (3):

A
  1. Intact marrow function
  2. Sufficient erythropoietin
  3. Nutrients for HgB synthesis and cell division
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2
Q

T/F Anemia results when red cell production does not keep up with red cell loss.

A

True

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3
Q

Retic count indicates what?

A

Bone marrow’s response to anemia

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4
Q

Retic response to:

Lack of component essential to produce hemoglobin

A

Normal/low absolute reticulocyte count (reticulocytopenia)

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5
Q

Retic response to:

Marrow injury or replacement by malignant cells

A

Normal/low absolute reticulocyte count (reticulocytopenia)

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6
Q

Retic response to:

Reduced RBC lifespan due to destruction

A

High absolute reticulate count (reticulocytosis)

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7
Q

Define Anemia

A

decrease in RBC count, HGB, and/or HCT values as compared to normal for age and sex

functionally defined as tissue hypoxia

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8
Q

True Anemia

A

decreased RBC mass and normal plasma volume

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9
Q

Pseudo or Dilutional Anemia

A

normal RBC mass and increased plasma volume

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10
Q

T/F NRBC# correlates with severity of anemia.

A

True

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11
Q

Methods of Anemia Classification

A

Morphologic: based on MCV - microcytic, macrocytic, normocytic
Pathophysiologic: divided using two main causes
1. decreased delivery - retic count low
2. increased loss or RBC from blood - retic count high but not high enough

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12
Q

Microcytic, Normal/Low Retic Anemias

A

Iron Dificiency
Thalassemia Syndromes
Sideroblastic Lead Poisoning
Anemia of Chronic Disease

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13
Q

Macrocytic, Normal/Low Retic Anemias

A

Vitamin B12 Deficiency

Folic Acid Deficiency

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14
Q

Normocytic, Normal/Low Retic Anemias

A

Aplastic Anemia
Renal Disease
Anemia of Chronic Disease

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15
Q

Normocytic, High Retic Anemias

A

Hereditary and acquired hemolytic anemia

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16
Q

T/F in aplastic anemia, WBC & PLT counts are increased.

A

False - WBC and PLT are low in aplastic anemia

Elevated or normal in most other anemias

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17
Q

Lab Investigation of Anemia

A

CBC, Differential, Retic Count

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18
Q

HgB Electrophoresis

A

quantitates normal and abnormal Hgb types

useful for: thalassemias and Hgb S disorders

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19
Q

Iron Tests help identify the cause of ____cytic anemia.
A) Macro
B) Norma
C) Micro

A

C) microcytic anemias

or detect iron overload

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20
Q

Serum iron level measures:

A

amount of iron bound to transferrin

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21
Q

Total iron binding capacity (TIBC) is a _______ measure of the amount of ________ protein in the serum.

A

indirect, transferrin

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22
Q

Serum ferritin indirectly reflects:

A

storage of iron in tissues

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23
Q

Iron Test Results:
Low Iron
High TIBC
Low Ferritin

A

Iron Deficient State

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24
Q

Iron Test Results:
High Iron
Low TIBC
High Ferritin

A

Iron Overload

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25
Q

Iron Test Results:
Low Iron
Low TIBC
High/Normal Ferritin

A

Inflammation

Transferrin (- ) APR, levels decreased in inflammation

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26
Q

Vitamin B12 and Folate help identify the cause of ___cytic anemia.
A) macro
B) normo
C) micro

A

A) Macro

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27
Q

What does a direct anti globulin test (DAT) or Coomb’s test detect? What type of anemia is it used for identifying?

A

Detects antibody and/or complement coated red cells

Used for: immune hemolytic anemias

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28
Q

You ordered are RBC destruction test. What becomes depleted in RBC destruction?

A

Haptoglobin

Bilirubin, plasma hemoglobin, LD level, urine urobilnogen and urine hemoglobin all increase

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29
Q

Anemias due to impaired Hgb synthesis are _____cytic:
A) macro
B) normo
C) micro

A

C) Microcytic

Anemias due to impaired Hgb synthesis: iron deficiency, anemia of chronic disease, thalassemia and sideroblastic anemia

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30
Q

Iron Deficiency Anemia Causes

A

chronic blood loss - GI bleeding or menstrual loss

increased need or decreased intake - pregnancy, kids, females, elderly

31
Q

Progressive depletion of body iron stores:

A

Iron Deficiency Anemia

decreased serum iron, increased TIBC, decreased stores

32
Q

Iron Deficiency Anemia Symptoms

A

brittle hair and nails
pica
glossitis - red beefy tongue
ovalocytes

33
Q

Inability to use iron and decreased response to EPO:

A

Anemia of Chronic Disease

decreased serum iron, decreased TIBC, normal or increased serum ferritin

34
Q

Anemia of Chronic Disease Causes

A

persistant infection

chronic inflammatory or colagen disorders (RA, SLE), malignant disease (carcinoma)

35
Q

Inherited decrease in alpha or beta globin chain production needed for Hgb A

A

Thalassemia

36
Q

Epidemiology of Thalassemia

A

Greek/Italian (beta)
Asian (alpha)
African (both)

37
Q

Major Thalassemia

A

conditions are severe, Hgb A is absent

requires lifelong transfusions or results in death

38
Q

Minor Thalassemia

A

conditions are mild, common
target cells, increased Hgb A2 level (beta)
differs from iron deficiency - normal iron test

39
Q

Protoporphyrin block leads to iron overload (increased serum iron, decreased TIBC, increased serum ferritin)

A

Sideroblastic Anemia

40
Q

Primary Sideroblastic Anemia

A

cause unknown, irreversible

ex: myelodysplastic syndrome (order bone marrow exam)

41
Q

Secondary Sideroblastic Anemia

A

lead poisoning, alcohol, anti-TB drugs
results in neurological dysfunction
tests show basophilic stippling

42
Q

Anemias due to impaired DNA synthesis are _____cytic:
A) macro
B) normo
C) micro

A

A) Macrocytic
Megaloblastic - Pernicious Anemia; Malnutrition
Non-Megaloblastic - Liver

43
Q

Vitamin B12 Deficiency Causes

A 
Malabsorption
Pernicious Anemia (antibodies to IF/parietal cells)
44
Q

Folate Deficiency Causes

A

Dietary Deficiency
Increased Need - pregnancy, hemolytic anemias
Drug Induces - anti-folate chemo drugs

45
Q

Anemia due to decreased production

A

Aplastic Anemia - decreased production of ALL cell lines by the bone marrow (low retic count); caused by injury to bone marrow stem cells/environment

46
Q

Aplastic Anemia Signs and Symptoms

A

Pancytopenia - low WBC w/ neutropenia, low RBC/HGB, low PLT

symptoms of bleeding or infection

47
Q

Anemia due to increased destruction

A

Hemolytic anemia
severity depends on rate of hemolysis AND
degree of bone marrow compensatory response
destruction > production (retics cannot keep up)

48
Q

Schistocytes, spherocytes and target cells can be found in:

A

Hemolytic Anemia

49
Q

Inherited production of a structurally abnormal Hgb type, amino acid substitution in beta glob in chain -> variant HgbA

A

Hemoglobin S disorders
Sickle Cell Trait - heterozygote, asymptomatic, no anemia, no sickle cells, problems with hypoxia
Sickle Cell Disease - homozygote, symptomatic, sickle cell anemia when oxygen removed, avoid infection, hypoxia, dehydration

50
Q

Hereditary spherocytosis

A

inherited RBC membrane defect

tx: splenectomy to increase RBC survival

51
Q

G-6-PD deficiency

A

inherited lack of G-6-PD enzyme needed to protect red cells from oxidative injury
problems when exposed to oxidative agents (primaquine, sulfa drugs, infection) -> schistocytes, spherocytes
common in African, Mediterranean, Asian Ancestries

52
Q

Describe immune hemolytic anemias and how they are detected.

A

RBC directed antibody binds to red cell = lysis
Anemia w/ spherocytes, schistocytes
detected: positive direct anti globulin test (DAT)

53
Q

What are examples of organisms that can cause hemolytic anemias?

A

Malarial parasites

Clostridial toxins

54
Q

Disseminated Intravascular Coagulation (DIC)

A

widespread clotting triggered by sepsis, OB complications

clotting factors and platelets consumed in formation of fibrin in micro-vessels . . . bleeding

55
Q

Hemolytic Uremic Syndrome

A

E. coli toxins cause fibrin clots, damage kidney . . . failure

56
Q

Examples of conditions that can cause fragmentation anemias:

A

Disseminated intravascular coagulation (DIC)
Hemolytic Uremic Syndrome (HUS)
Artificial Heart Valve
Extensive Thermal Burns

57
Q

define Polycythemia

A

increase in RBC count, HGB and/or HCT values

58
Q

Primary versus Secondary Polycythemia

A

Primary: malignant, low EPO level
Secondary: secondary to hypoxia, increased EPO to stimulate RBC to compensate for heart or lung disease or high altitudes

59
Q

Pseudo Polycythemia

A

normal RBC mass and decreased plasma volume

plasma loss caused by severe dehydration . . . prolonged diarrhea or vomiting, thermal burns

60
Q

What type of iron state are you in? ↑ Fe, ↓ TIBC, ↑ ferritin, ↑ % saturation

A

Iron overload state

61
Q

What would these results mean? ↓ Fe, ↓ TIBC, ↑ ferritin

A

Chronic inflammation

62
Q

What iron state are you in: ↓ Fe, ↑ TIBC, ↓ferritin, ↓ % saturation

A

Iron deficient state

63
Q

An accelerated retic response by the bone marrow (i.e., reticulocytosis) would be expected in
which of the following conditions?
a. Severe renal disease requiring dialysis – Low EPO
b. Hereditary and acquired hemolytic anemias
c. Following corrective therapy for a deficiency
d. a and b
e. b and c

A

e

64
Q

You are evaluating a patient with a microcytic anemia. The HGB is 9.0 g/dl, MCV 65.2 fl, with
a low retic count and microcytic red cells reported. Which of the following tests would provide
valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination

A

a

65
Q

You are evaluating a patient with a macrocytic anemia. The HGB is 9.0 g/dl, MCV 115.5 fl,
with a low retic count and macrocytic red cells reported. Which of the following tests would
provide valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination

A

b

66
Q

You are evaluating a patient with a normocytic anemia. The HGB is 7.0 g/dl, MCV 90.2 fl,
with normal WBC and PLT counts, a high retic count, and many damaged red cells called
schistocytes reported. Which of the following tests would provide valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination

A

c

67
Q

You are evaluating a patient with a normocytic anemia. The HGB is 7.0 g/dl, MCV 89.0 fl, with
very low WBC and PLT counts, a low retic count, but no damaged red cells reported. Which of
the following tests would provide valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination

A

d

68
Q

Pallor and symptoms of hypoxia would explain/correlate with which of the following CBC
results?
a. WBC count of 25,000/ul
b. Hemoglobin value of 6.0 g/dl
c. Platelet count of 25,000/cmm
Marked decreased platelet counts are associated with bleeding symptoms

A

b

69
Q

Which of the following test results suggest that a normocytic anemia is the result of a
hemolytic process rather than bone marrow failure?
a. High retic count, high haptoglobin level, high LD level, and high bilirubin level
b. High retic count, low haptoglobin level, high LD level, and high bilirubin level
c. Low retic count, low haptoglobin level, high LD level, and high bilirubin level
d. Low retic count, high haptoglobin level, high LD level, and high bilirubin level

A

b

70
Q

A recent post-surgical patient has an MCV of 105.0 fl and a Retic count of 8.0%. The most
likely explanation for the patient’s elevated MCV result is that:
a. A folic acid deficiency has developed
b. A marked reticulocyte response occurred following acute blood loss
c. Chronic loss of blood occurred during the month before surgery

A

b

71
Q

Which of the following are considered typical findings for a normal newborn?

a. Macrocytic red cells and MCV of 110.1 fl
b. 8 nucleated red cells per differential
c. High RBC count and HGB value of 19.0 g/dl
d. All of the findings are usual for newborns

A

d

72
Q

A 60 year old female with a 6 month history of Lupus has complaints of increasing fatigue and
shortness of breath. You suspect anemia of chronic disease has developed. Which of the
following sets of lab data support your suspicion?
a. Hgb 9.5 g/dl, ESR 90 mm/hr, low serum iron, low TIBC, and high serum ferritin
b. Hgb 7.0 g/dl, ESR 15 mm/hr, low serum iron, high TIBC, and low serum ferritin
c. Hgb 9.0 g/dl, ESR 60 mm/hr, low serum iron, high TIBC, and high serum ferritin

A

a

73
Q

You are evaluating a 40 year old woman who has been vomiting for the past 3 days. Her
hemoglobin is 17.9 g/dl and hematocrit is 54.0%. These findings suggest:
a. Dilutional/pseudo anemia due to increased plasma volume
b. Pseudo polycythemia due to severe dehydration with plasma loss
c. True polycythemia secondary to pulmonary disease

A

b

Med Lab Exam 3 (7 decks)

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