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Anemia & thrombo (crash cards) Flashcards

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1
Q

Anemia:

Low iron
Low ferritin
Low RBC #
Low Hb
Low reticulocyte index
High TIBC
Microcytic & hypochromic

A

Iron deficiency anemia

Other symptoms:
- Koilonychia
- Pica
- Fatigue/weakness
- Pallor
- Plummer Vinson synd
(iron def anemia, esophageal webs, dysphagia)

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2
Q

Commonly causes what type of anemia?

  • diet
  • menorrhagia
  • peptic ulcers
  • tape worms
  • colon cancer
  • Pregnancy
  • Breast fed only babies
A

Iron deficiency anemia

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3
Q

Anemia:

Low iron
Low TIBC
High ferritin

A

Anemia of chronic disease

Other signs:
- Increased hepcidin

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4
Q

Anemia:

High RBC #
High basophils, neutrophils, & platelets
Low EPO
Normal SaO2

A

Polycythemia vera

Other signs:
- Hepatosplenomegaly
- Erythromelalgia
- Budd-Chiari syndrome
- Thrombotic episodes
- Aquagenic pruritus

Other lab signs:
- High megakaryocyte count
- Hypercellular bone marrow with fibrosis

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5
Q

Mutated hyperactive Jak2 kinase causes

A

Polycythemia vera

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6
Q

Anemia:

High EPO
High RBC #
High RBC mass
Normal plasma vol
Low SaO2

A

Secondary appropriate Polycythemia

Causes:
- High altitude dwellers
- Right-Left shunts (cardiac malformations or ventilation defects)
- Smoking

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7
Q

Anemia:

High EPO
High RBC #
High RBC mass
Normal SaO2
Normal plasma vol

A

Secondary inappropriate Polycythemia

Causes:
Paraneoplastic EPO production from cancers (renal, liver, cerebellar)

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8
Q

Anemia:

Low Hb (below 10)
Low EPO
Normocytic Normochromic

A

Anemia of chronic renal failure

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9
Q

Anemia:

High RBC #
a-globin deletion
Microcytic

A

Alpha thalassemia

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10
Q

Anemia cells:

Spherocytes

A

Hereditary spherocytosis &
Immune hemolytic anemia

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11
Q

Anemia cells:

Macro-ovalocytes & hypersegmented PMN;s

A

Megaloblastic anemias (B12, Folate, & Orotic aciduria)

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12
Q

Anemia cells:

Target cells

A

HbC disease
&
Thalassemias

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13
Q

Anemia cells:

Sickled cells

A

HbSC disease
&
Sickle cell disease

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14
Q

Anemia cells:

Iron granules

A

Sideroblastic anemia
&
Lead poisoning

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15
Q

Anemia cells:

Howell-Jolly bodies

A

Sickle cell disease

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16
Q

Anemia cells:

Basophilic stippling

A

Sideroblastic anemia
&
Thalassemia

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17
Q

Anemia cells:

Heinz bodies
Bite cells
Blister cells

A

G6PD deficiency anemia

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18
Q

Alpha thalassemia’s:

Minima

A

asymptomatic

1 a-globin deletion

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19
Q

Alpha thalassemia’s:

Minor

A

2 deleted a-globin’s
Cis (Asians)
Trans (Afro amer)

mild microcytic & hypochromic anemia

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20
Q

Alpha thalassemia’s:

Major

A

3 deletions of a-globin’s

Excess B-globin causes mod-severe microcytic hypochromic anemia

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21
Q

Alpha thalassemia’s:

Hydrops fetalis (Barts disease)

A

All a-globin’s are deleted causing y-globin excess (aka HbBart Hb) which has a high affinity for O2 hogging it from tissues.

Severe tissue hypoxia = death (in utero or immediately post birth)

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22
Q

Anemias:

Microcytic
Hypochromic
High HbF
High HbA2

A

Beta Thalassemia

Common in AA & Mediterranean people

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23
Q

Beta Thalassemia:

  • Point mutation in splicing of intro & Promoter region
  • Low B-globin production
  • High HbA2
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A

B-thalassemia minor

Heterozygote:
Mild microcytic hypochromic anemia

24
Q

Beta Thalassemia:

  • Point mutation in splicing of exon & Chain terminator
  • High HbF
  • High HbA2
  • Target cells
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A

B-Thalassemia Major

Homozygote: No b-globin

  • Severe microcytic & hypochromic anemia
  • Aniso poikilocytosis (need rec. blood transfusions)
  • Crew-cut skull
  • Chipmunk face
  • Hepatosplenomegaly
  • Sequestration crisis (B19 parvovirus)
25
Anemia: High iron High ferritin Low/Normal TIBC Microcytic hypochromic Basophilic stippling
Lead poisoning Signs: - Burton lines (on gingivae & metaphysis of long bones) - Encephalopathy - Colic - Sideroblastic anemia
26
Anemia: High Homocysteine Normal methylmalonic acid Low Folate Macrocytic
Folate def megaloblastic anemia Other signs: - Hypersegmented PMN's - Glossitis - Hemolytic anemia Causes: - diet (no leafy greens) - chronic alcohol abuse - malabsorption - Pregnancy - drugs (methotrexate, trimethoprim, & phenytoin)
27
Anemia: High Homocysteine High Methylmalonic acid Neurological symptoms positive schillings test macrocytic
B12 deficiency megaloblastic anemia Other signs: - Hypersegmented PMN's - Glossitis - Neurological symptoms Causes: - Pernicious anemia - Malabsorption - Veganism (diet) - Pancreatic insufficiency - Gastrectomy - Tape worm
28
Anemia: Orotic acid in urine Macrocytic
Orotic aciduria Orotic acid can't be converted into UMP (UMP synthase def) Signs: - Developmental delay - No hyperammonemia - Glossitis - Megaloblastic anemia - Fait to thrive
29
Anemia: High MCHC High LDH High unconjugated bilirubin Low mean fluorescence 5 EMA test High fragility (osmotic fragility test)
Hereditary spherocytosis AUTO DOM, defect in SPECTRIN & ankyrin, band 3, protein 4.2 Other signs: - Extravascular hemolysis - Splenomegaly - Pigmented gallstones - Aplastic crisis
30
Anemia: Bite cells Heinz bodies Blister cells Hemolysis
G6PD deficiency X-REC Other signs: - Back pain - Hemoglobinuria (2-3 say post oxidative stress) Triggers: - FAVA beans - Sulfa drugs - Antimalaria
31
Anemia: Negative Coombs test Negative CD55/59 on flow cytometry Hemolytic anemia
Paroxysmal nocturnal hemoglobinuria Mutated PIGA (increases compliment mediated intravascular hemolysis) by impairing GPI anchor for CD55/59 Other signs: - Pancytopenia - Venous thrombosis - Budd Chiari syndrome - Hemoglobinuria
32
Anemia: Low Hb High 2,3 BPG Burr cells
Pyruvate kinase deficiency AUTO REC, leads to low ATP and rigid RBCs Other signs: - Extravascular hemolysis - Hemolytic anemia of a newborn
33
Anemia: Low HbA High HbF High HbS Sickled RBCs
Sickle cell disease A point mutation to the 6th codon of B-globin gene to replace Glutamate with valine causing Sickling leading to intra/extra-vascular hemolysis
34
Sickle cell disease: HbSS Low HbA High HbS High EPO
crew-cut skull Chipmunk face Osteomyelitis (salmonella) Aplastic crisis (B19 parvo) Sequestration crisis Autosplenectomy (Howell-jolly bodies) Hematuria Avascular necrosis Vaso-occlusive crisis - dactylitis - Priapism - Acute chest syn (chlamydia & mycoplasma kids & atypical pneumonia adults)
35
Anemia: Hemoglobin crystals in RBC's Target cells High HbC Low HbA Extravascular hemolysis
HbC disease A mutation in the 6th codon of B-globin to replace glutamate with lysine causing production of abnormal HbC
36
Anemia: Low iron Low TIBC High ferritin Normocytic Normochromic
Anemia of chronic disease Inflammatory mediators TNF & IL-6 cause liver to release more hepcidin to "hide" the body's iron (liver & macrophages) & reduce its absorption so iron chelators (inflammatory orgs or siderophores can't use it) Triggers: - Chronic infection - Neoplastic disorders - Chronic kidney disease - Diseases like SLE or RA
37
Anemia: Low reticulocyte # High EPO
Aplastic anemia Failed or destroyed hematopoietic stem cells leading to hypocellular bone marrow with fat globules Causes: - Fanconi anemia (bone marrow failure) - Viruses (EBV mono, HIV, Hep A, B, C) - Idiopathic - Drugs (Benzene & Chloramphenicol)
38
Anemias: Low reticulocyte # High EPO Pancytopenia Fatigue/malaise Purpura Mucosal bleeding Petechiae Infection
Aplastic anemia
39
Anemia: Normocytic & Normochromic Spherocytes Positive Coombs (Agglutinated RBCs) Formed IgG's vs RBCs
Autoimmune hemolytic anemia with warm Ab IgG Chronic anemia with extravascular hemolysis that can be triggered by SLE. Triggers: - SLE - a-methyldopa - B-lactams
40
Anemia: Normocytic & Normochromic Spherocytes Positive Coombs (Agglutinated RBCs) Formed IgM's vs RBCs
Autoimmune hemolytic anemia with warm Ab IgM Acute hemolytic anemia with compliment fixation Signs: - RBC agglutination - Extravascular hemolysis during cold (toes, hands, ears) Triggers: - Post mycoplasma pneumoniae & EBV (mono) infections
41
Coagulation disorders: Deficient factor VIII (8) Prolonged PTT Normal PT
Hemophilia A X REC Other signs - Soft tissue hematomas - Severe Hemarthropathy (blood in knee joint !) - Easy bruising
42
Coagulation disorders: Deficient factor IX (9) Prolonged PTT Normal PT
Hemophilia B X REC
43
Coagulation disorders: Deficient factor XI (11) Prolonged PTT Normal PT
Hemophilia C AUTO REC
44
Vitamins: Prolonged PT Prolonged PTT Normal bleeding time Deficient factors II(2), VII(7), IX (9), X (10), proteins C & S
Vitamin K deficiency
45
Platelet disorders: Def GPIb Prolonged bleeding time Normal/low platelet # Abnormal ristocetin test (no agglutination)
Bernard-Soulier syndrome Aka giant platelet disorder Signs: -Giant platelets with poor adhesion - Menometrorrhagia (irreg/long period) - Mucus membrane bleeding - Petechia - Epistaxis - Gingival hemorrhages -
46
Platelet disorders: Deficient GPIIb/IIIa Normal platelet # Prolonged bleeding time No platelet clumping
Glanzmann syndrome Deficient agglutination causing poor platelet plug formation Signs: - Petechiae (face) - Subconjunctival hemorrhages (crying) - Mucocutaneous & gingival hemorrhages - Epistaxis - Post circumcision bleeding
47
Platelet disorders: Formed antibodies (IgG's) against GPIIb/IIIa Low platelet # Low CBC Prolonged bleeding time High Megakaryocytes
Immune Thrombocytopenia IgG Antibodies against GPIIb/IIIa cause destruction of platelets in the spleen (splenic macrophages) & can cross the placental if mom is preggos Signs: - Purpura - Ecchymosis - Petechiae - Epistaxis - Menorrhagia - Gingival bleeding
48
Thrombotic microangiopathies: High platelet adhesion/aggregation High LDH High CK High indirect bilirubin Normal PT & PTT Low Platelet # Low Hb Low Haptoglobin Schistocytes
Thrombotic Thrombocytopenic Purpura (TTP) Usually adult women Deficient ADAMTS13 (vWF metalloprotease) leads to a build up of vWF multimers which cleave RBC's Signs: - Triad 1. Thrombocytopenia 2. Microangiopathic hemolytic anemia 3. Acute kidney injury - Fever - Neurological symptoms - Hemoglobinuria - Petechiae - Purpura - Mucosal bleeding
49
Thrombotic microangiopathies: Normal PT Normal PTT High LDH High CK High indirect bilirubin
Hemolytic uremic syndrome Due to E.coli 0157:H7 Shiga toxin infection Sign: - Thrombocytopenia - Microangiopathic hemolytic anemia - Acute kidney injury -
50
Mixed Platelet & Coagulation disorders: Normal platelet # Normal PT Prolonged Bleeding time Prolonged/normal PTT Low vWF No aggregation with ristocetin factor (agglutination with added vWF)
Von Willebrand Disease AUTO DOM Intrinsic path coagulation deficiency in vWF causing increase in bleeding time & poor platelet plug
51
Deficient vWF protein/function & factor VIII
Type 1 vWF
52
Normal vWF levels with missense mutations causing multimers leads to microangiopathic hemolytic anemia
vWF Type 2
53
Mixed Platelet & Coagulation disorders: Prolonged Bleeding time High PTT High PT Low platelet # Low fibrinogen Low factors V & VIII Schistocytes
Disseminated Intravascular Coagulation Deficient widespread clotting activation leads to a deficiency in clotting factors
54
Hereditary Thrombophilia's (Hypercoagulable states): Normal PT Normal PTT (**Decreased PTT with large dose of heparin**) Renal failure
Antithrombin deficiency Acquired from renal failure or nephrotic syndrome Antithrombin is lost in the urine leading to less inhibition of coagulation factors IIa & Xa
55
Hereditary Thrombophilia's (Hypercoagulable states): Mutated factor V in prothrombin gene
Factor V Leiden mutation swaps glutamine with arginine so factor V becomes more resistant to protein C cleavage Signs: - DVTs - Cerebral vein thrombosis - Recurrent abortions - Increased prothrombin levels
56
Hereditary Thrombophilia's (Hypercoagulable states): Deficient protein C & S leads to
Hypercoagulability the body can't inactivate factors Va or VIIIa causing increased risk of warfarin- induced skin lesions
57
Hereditary Thrombophilia's (Hypercoagulable states): High prothrombin High plasma volume High venous clot formation
Prothrombin G20210A point mutation in the 3' untranslated region causing an increase in prothrombin production leading to a hypercoagulable state

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