Anemias caused by Bld loss + RBC lysis (Pt2) Flashcards

(29 cards)

1
Q

Describe Acute Blood loss

A

Acute: pt rbc’s may not be indicative of loss, plasma is lost at same rate as blood/no time to respond by retaining fluid

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2
Q

Describe Chronic Blood loss

A

has decreased HCT/rbc counts with fluid retention

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3
Q

Describe Relative Anemia
How does pt appear?
Total ability?
What is decreased?

Causes:

A

pt appears anemic with an increased plasma
total RBC mass/O2 carrying ability uneffected
HCT/HGB decreased

Causes: pregnancy/hyperproteinemia/Massive IV/infusions

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4
Q

Indicators of RBC destruction? (hemolysis)

A

Increased bilirubin/LDH
Increased Iron/Hemosiderin (and urine)
Dec haptoglobin
schistocytes

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5
Q

Indicators of RBC production?

A

erythrohyperplasia
increased RPI

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6
Q

COOMBS DAT test
increased destruction/production
what is a Positive

What is a negative?

A

+ —> Ab mediated, immune hemolytic anemia

  • —> peripheral blood smear
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7
Q

Intrinsic abnormalities causing rbc destruction

A

non-immune

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8
Q

What are the 4 groups of rbc membrane defects

A

Hereditary Spherocytosis (HS)
Hereditary Elliptocytosis (HE) (HPP/SE/SOA)
Hered. Stomatocytosis
Hereditary Xerocytosis

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9
Q

What is the vertical spectrin ankryn defect anemia?

What is the horizontal defects?

A

Vertical: HS

Horizontal: HE/HPP

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10
Q

Describe Hereditary Spherocytosis (HS)
RBC membrane
hemolysis ranges?

A

vertical spectrin ank. defect
Rbc’s lose membrane/low surface area/vol ratio/hemolyzed in spleen
Silent carrier to severe

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11
Q

What is the Presentation for HS?
Lab findings?
Hemolysis
DAT
Folic acid
MCV/MCHC
Retics/RDW

A

Presentations - jaundice, splenomegaly, anemia
Splenectomy resolves symptoms but defects persists

Lab: Extravascular Hemolysis
DAT -
Folic acid decreased (looks megaloblastic)
MCV dec
MCHC increased
Retics increased
RDW increased

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12
Q

Describe Osmotic Fragility

A

rbc placed in HYPOtonic solution, water drawn intracellular by osmosis
Rbc becomes more spherical/lyse (release HgB)

Spherocytes = increased fragility

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13
Q

T/F by-concave cells can take on more water

A

true

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14
Q

What is the normal rbc fragility

A

normal rbc lyse at .45% complete at 100%

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15
Q

T/F: use heprin tubes to dilute your sample (saline to water)

A

true

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16
Q

What is the calculation for % hemolysis

A

O.D sample/O.D of water x 100

17
Q

What is the hereditary spherocytosis % hemolysis

A

.65 close to isotonic solution

18
Q

Describe Hered. Elliptocytosis (HE)
defects in what
(micro….)
diff types linked?

A

alpha/beta chain spectrin ank defect, effects rbc deformability, failure to return to normal disc shape (microvasculature)
severity varies
DIFF TYPES LINKED TO DIFF BLOOD GROUPS

19
Q

Lab findings of HE

A

elliptocytes
MCV norm to high
MCHC norm
Osmotic fragillity norm
some rbcs might be heat sensitive

20
Q

What is Hereditary spherocytic HE

A

rare hybrid of HE/HS

21
Q

Describe Southeast Asian ovalocytosis (SAO)

A

south asia/cape pop of south africa (against malaria)
spoon shaped ovalocytes/transverse bar avoids central pallor
treat w splenomectomy

22
Q

Describe Pyropoikilocytosis
What kind of spectrin defects
what mutation
subtype of
thermal instability
what are most pts?

A

alpha/beta spectrin mutation/decrease synth of alpha spectrin
Subtype of HE/severe hem. anemia
Thermal Instability - heated to 45deg - fragment (norm at 49deg)
most pts are black
(face abnorm/gallbladder/growth retard)

23
Q

Lab findings of Pyropoikilocytosis
MCV
MCHC
rbc shapes?
Bizzare?

A

MCV dec
MCHC incr
Elliptocytes
Spherocytes
Bizzare micro poik- rbc budding/fragments

24
Q

Describe hereditary stomatocytosis
most pt def. in what
failure of
increased?

A

most pts deficient in stomatin
-membrane protein (theorized to regulate channel)
Failure of NaK pump
increased H2O in cells

25
Lab findings of Hereditary stomatocytosis MCV MCHC cells Increased? What decreased?
MCV increased MCHC decreased stomatocytes Increased osmotic fragility 2,3 BPG decreased (inc affinity for O2)
26
Describe Hereditary Xerocytosis cells defect in what what do cells look like? Lab findings? MCV MCHC Types of cells 2,3 BPG? Osm fragility?
cells lose K+ due to unknown rbc perm. defect cells are dehydrated "Puddle cells" MCV increased (macro) MCHC inc Stomatocytes target cells 2,3 BPG dec (less aff for O2) dec Osmotic fragility
27
Describe Acanthocytosis abnormal what shapes? Causes? A L M C V
abnormal membrane lipids - inc cholesterol shape defect not present in young rbcs phospholipids Causes: Abetalipoprotenima (Hereditary) liver disease malnutrition certain bld groups Vit E def
28
Describe Anemia of liver disease Lab findings?
cholesterol/lipids increased Lab: target cells macro/ROUND acanthocytes hemolysis
29
Anemia of Alcholism
hemolytic/megaloblastic anemias megaloblastic folate defect (poor diet/ethanol/folate) Ethanol - toxic effect on rbc precursors, cellularity/morph