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Blood Flashcards

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1
Q

RBCs lifespan = ____ days

A

120

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2
Q

RBCs are removed by ________

A

macrophages of spleen, liver, and bone marrow

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3
Q

Which part of a RBC is recycled?

A

Iron in Hb

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4
Q

What is Hematopoiesis? What is formed?

A

Formation of blood or all types of blood cells
MUST KNOW EVERYTHING BELOW RED LINE IN PIC

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5
Q

Thrombocytes =

A

PLTs

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6
Q

Platelets are membrane bound cell fragments resulting from fragmented _______

A

Megakaryocytes

Red Bone Marrow -> Myeloid Stem Cell -> Megakaryocytes -> Platelets

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7
Q

Platelet formation is regulated by _____

A

Thrombopoietin

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8
Q

PLTs last for

A

8-10 days

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9
Q

Which 3 factors do PLTs secrete, causing local PLT aggregation, Vasoconstriction, and Blood coagulation?

A
  • Thromboxame A
  • Serotonin
  • Thromboplastin
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10
Q

Platelets:
- Clinically significant bleeding is usu <___K.
- Trauma or Sx = ____K

A
  • usu <10K
  • Trauma or Sx = 50K
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11
Q

List the abundance of Plasma Proteins from Greatest -> Least

A
  1. Albumin
  2. B-Globulin
  3. Y-Globulin (antibodies_)
  4. A2-Globulin
  5. Fibrinogen
  6. A1-Globulin
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12
Q

Causes of Erythrocythemia

A

Conditions CAUSING low O2
- Heart Dz (CHD, HF)
- Congenital hemoglobinopathies
- High Altitude
- COPD, lung DOs
- Sleep Apnea
- Smoking

Performance Enhancing Drugs
- Anabolic Steroids, EPO
- Blood Doping (transfusions)
- Kidney CA/Transplants (incr EPO)

Bone Marrow Overproduction
- Polycythemia Vera and Myeloproliferative DOs

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13
Q

Causes of Anemia (low RBCs)

A

Underproduction
- Iron deficiency (MC)
- Vit B12 / Folate Deficiency
- Bone Marrow Dz (Leukemia, Myelofibrosis)

Excessive Destruction
- Fragmentation d/t mechanical issues
- Sickle Cell Anemia
- Autoimmune hemolytic anemia
- Hereditary Spherocytosis

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14
Q

Hereditary Spherocytosis
- Inheritance pattern
- SS
- Tx

A
  • Autosomal Dominant
  • SS: pale, fatigue, hemolytic anemia, jaundice, gallstones, +/- big spleen, short stature, delayed puberty, skeletal abnormalities
  • Tx: Splenectomy, RBC transfusions, Folic acid supplementation, cholecystectomy
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15
Q

Removing which 2 organs are Tx options for Hereditary Spherocytosis

A

Spleen
Gallbladder

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16
Q

_____ Supplements may help Hereditary Spherocytosis

A

Folic Acid

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17
Q

Hereditary Spherocytosis inheritance pattern

A

Austosomal Dominant

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18
Q

Causes of HIGH and LOW Hgb/Hct

A
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19
Q

What causes a HIGH Reticulocyte Ct?

A
  • HEMOLYTIC ANEMIA
  • ACUTE BLOOD LOSS
  • Transfusions
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20
Q

Causes of LOW Retic Ct

A
  • APLASTIC ANEMIA
  • BONE MARROW SUPPRESSION (drug, toxin, virus)
  • Pure red cell aplasia
  • Bone marrow infiltration (leukemia, lymphoma, carcinoma)
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21
Q

Causes of Normal Retic Ct

A
  • IRON DEFICIENCY ANEMIA
  • ANEMIA OF CHRONIC DZ
  • CHRONIC RENAL FAILURE
  • Megaloblastic anemia
  • Myelodysplasia
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22
Q

List 3 hypochromic microcytic anemias

A
  • Iron deficiency anemia
  • Thalassemia
  • Anemia of chronic dz
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23
Q

Sources of error in manual cell counts

A
  • in wedge-pushed smears, WBCs tend to gather at the edges, so must scan entire slide
  • poor smear prep/stain
  • small sample size 100200 cells
  • CV is felt to be 5-10%
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24
Q

Normal HgB values
- Men?
- Women?
- Children?
- Newborn?

A
  • Men 13.5-17.5
  • Women 12-15.5
  • Children 11-13
  • Newborn 17-22

Highest in neonates
Lower in kids and women

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25
HCT = ___X Hemoglobin
3
26
Norm HCT - Men? - Women?
- Men 40-54% - Women 36-48%
27
Sickle cell trait vs Sickle cell disease?
Trait = 1 gene for sickle Hb Disease = 2 genes for sickle Hb
28
What are the 4 major RBC indices?
* MCV = Mean Corpuscular Volume (calculated) * MCH = Mean Corpuscular Hemoglobin (calculated) * MCHC = Mean Corpuscular Hemoglobin Concentration (calculated) * RDW = Red Cell distribution Width (Measured)
29
Poss reasons for a FALSE HIGH and LOW MCH
*False highs or lows d/t automated analyzer error * **FALSE HIGH** * High WBC >50K * Suprisingly high Hgb with a "low" RBC Ct **FALSE LOW** - Suprisingly LOW Hgb with a "High" RBC ct
30
RBC Shape change = RBC Size change =
shape change = Poikilocytosis size change = anisocytosis
31
What DOs cause RBC agglutination
- Cold hemagglutination Dz - Paroxysmal cold hemoglobinuria ## Footnote NO WARM AGGLUTINATION
32
What causes Rouleaux RBCs?
- Hyperproteinemias -> Multiple Myeloma, Waldenstrom's macroglobulinemia - Chronic inflammatory DOz - some Lymphomas
33
Why is RDW valuable?
* helps with anemia Dx * can be used to flag smalpes that may need peripheral smear exam ## Footnote HIGH RDW is seen with red cell fragmentation, agglutination, or dimorphic cells
34
Causes of a HIGH MCHC
- Incr Spherocytosis - Autoimmune Hemolytic Anemia - Homozygous Sickle Cell or Hgb C Dz
35
List which of the following causes HIGH vs LOW MCHC: - Agglutination - Clotted Sample - HIGH WBC - Hyperglycemia
- HIGH MCHC = Aautoagglutination, Clotted sample - LOW MCHC = HIGH WBC, Hyperglycemia
36
RBC Ct are lower in which groups? | M? F? Peds?
Women Children
37
Things are measured by the ______ method
Coulter ## Footnote Sizing and counting particles is based on measurable changes in electrical impedance produced by nonconductive particles suspended in an electrolyte. A small opening (aperture) between electrodes is the sensing zone through which suspended particles pass.
38
RBC ct are measured at what unit
uL
39
Hyperchromia = MCHC >____% - Causes?
36 - Hemolytic anemias d/t burns - spherocytosis
40
Causes of Hypochromic anemia
41
Polychromatophile =
grey-blue in color and usu larger than the normal RBC
42
Polychromatophile Causes
**Conditions with bone marrow stimulation** - Acute and chronic hemorrhage - Recovery from a nutritional deficiency anemia
43
Causes of Target Cells (Codocytes)
- Liver Dz (high bad cholesterol) - Hemoglobinpathies - Thalassemia ## Footnote Incr in RBC surface membrane Bell shaped in free flow Excess membrane cholesterol and decr Hgb
44
Causes of Spherocytes
- Hereditary Spherocytosis - Autoimmune hemolytic anemias and other
45
Causes of Stomatocytes
- Hereditary stomatocytosis - Hemolytic anemias - Alcoholic cirrhosis - Acute alcoholism - Rh null Dz (mutation in the Rh30 and RhAg genes)
46
Causes of Ovalocytes
- Myelodysplastic syndrome - Thalassemic syndromes - Megaloblastic process (Macrocyte)
47
Causes of Elliptocytes
- Iron deficiency anemia - Hereditary Elliptocytosis - Idiopathic myelofibrosis
48
Are ovalocytes or Elliptocytes egg-shaped?
Ovalocytes = Egg shape Elliptocytes = Pencil shape
49
Causes of true burr cells (echinocyes)
- Uremia - Heart Dz - Stomach CA
50
Hereditary cause for Acanthocytes
Abetaliprotenemia
51
Causes of dacrocytes (tear drop cells)
- Idiopathic myelofibrosis - Thalassemia - Drug-induced heinz-body formation
52
Cause of Drepanocytes
- polymerization of Hgb ## Footnote crescent or sickled shaped cells . projections at ends
53
Cause of blister cells
- G6PD Deficiency - Oxidation or fragmentation injury
54
Causes of Howell-Jolly Bodies
- Splenectomy - Asplenia - Severe megaloblastic anemia - Severe hemolytic anemia
55
Causes of Heinz bodies
* G6PD deficiency * NADPH deficiency * Chronic Liver Dz * Alpha Thalassemia * Asplenism
56
Causes of Pappenheimer Bodies
* Splenectomy * Hemolytic Anemia * Sideroblastic Anemia * Megaloblastic Anemias * Hemoglobinopathies
57
Causes of Cabot Rings ## Footnote Looped rings within RBC cytoplasm +/- "beads on a string" Microtubular remnants of mitotic tubules from mitosis
* Myelodysplastic Syndrome * Megaloblastic Anemia | abnormality in RBC prod
58
What are the inclusions in these inclusion bodies? - Howel-Jolly bodies? - Heinz bodies? - Pappenheimer bodies? - Hgb H inclusions? - Basophilic stippling?
- Howel-Jolly bodies = DNA - Heinz bodies = Hgb - Pappenheimer bodies = Iron deposits - Hgb H inclusions = Hgb - Basophilic stippling = Ribosomes
59
Which inclusion bodies are seen after post-splenectomy
Howell-Jolly bodies
60
_______ cells are seen in G6PD deficiency and are cells in which a Heinz Body has been removed
Helmet
61
Howell-Jolly bodies vs Heinz bodies
- Howell-Jolly bodies are seen with supravital stain and can be found throughout the cell - Heinz bodies are basophilic, seen on Wright's Stain smears, and are found at the periphery of the cell
62
Causes of Basophilic Stippling - Coarse? - Fine? ## Footnote accumulations of RNA and Ribosomes AKA Puntate Basophilia
**COARSE = Impaired Hgb synthesis** - Megaloblastic and other severe anemias - Thalassemia - Lead poisoning **FINE** - Incr RBC prod - Incr polychromatophilia
63
SS of PLT Associated Bleeding?
- skin cut bleeding CAN be controlled by pressure - Spon bleeding into the skin (petechiae, purpura, ecchymoses) - Bleeding into mucus membranes (bloody nose, GI bleed, Intraretinal, Intracranial)
64
____ is a contractile protein that is a major part of PLT cytoplasm
Thrombosthenin
65
Do mammals have nucleated PLTs?
NO!!! but other animals do
66
- Normal PLT Ct = - BAD = < ____ - ____ K
- Norm = 150-350K per mm3 (uL) of blood - BAD = < 10-40K
67
* Old PLTs are destroyed by the _____ * Extra PLTs are stored in the _____
SPLEEN (BOTH)
68
3 As of Primary Hemostasis (PLT Plug)
Adhesion Activation Aggregration
69
* Arterial clotting is primarily done by _____ * Venous clotting is primarily done by _____
- Arterial = PLT - Venous = Fibrin
70
Causes of Thrombocytopenia | (LOW PLT)
- ITP -> idiopathic, drugs, Onyalai (acquired) - Familial Thrombocytopenia - Thrombotic Thrombocytopenic Purpura - HELPP Syndrome - HUS - Aplastic Anemia - Chemo - **Transfusions** - Hepatic Dysfn, Familial Nonhemolytic jaundice - **Splenomegaly (Gaucher's Dz)** - **Gilbert's Syndrome** - **Babesiosis (tick parasite)** - **Dengue Virus (Mosquitos)**
71
Causes of Thrombo-cytosis/cythemia | HIGH PLT
**Reactive** - **Chronic Infx/Inflammation** - Malignancy - Hyposplenism - Iron Deficiency - Acute blood loss **Myeloproliferative DOs** - **Essential thrombocytosis** - **Polycythemia Vera** Other myeloid neoplasms Congenital
72
Causes of Thrombocytopathy | Dysfunctional PLTs
73
Drugs affecting PLT Fn
74
Taking ____ before Aspirin will prevent the irreversible inhibition of cyclooxygenase-1
Ibuprofen
75
2 NSAIDs that affect PLT Fn
Aspirin Ibuprofen
76
- Drugs that SUPPRESS PLT Fn? - Drugs that STIMULATE PLT Fn
**SUPPRESS** * Aspirin * Clopidrogel * Cilostazol * Ticlopidine * Ticagrelor * Prasugrel **STIMULATE** - Thrombopoietin mimics - Desmopressin - Factor VIIa
77
What is Samter's Triad?
*** AERD = Aspirin-Exacerbated Respiratory Dz ** * Rhinosinusitis, Asthma * NSAID Intolerance * used to be known as Samter's Triad * **ACQUIRED DO OF PLT ADHESION**
78
Which coagulation factors are known by name? | 4 of them
- Factor I = Fibrinogen - Factor II = Prothrombin - Factor III = Tissue Factor, Thromboplastin - Factor IV = Calcium
79
PLT Ct Sources of ERROR
* Both Automated and Manual Counts -> Improper collection, slightly clotted sample * Automated Counts -> PLT clumping, Presence of RBC fragments, Presence of Microcytes * Blood smear evaluation will reveal the presence of the problems causing issues in the automated count
80
If PLT ct and bleeding time is NORMAL, what else could the cause of bleeding problem?
PLT Fn ## Footnote bleeding time detects issues with vessel wall/SQ tissue
81
PTT will NOT detect a factor ____ defect, bc it's not in the intrinsic pathway
VII
82
Bleeding tests - PLT Ct - Bleeding time - PT/INR - PTT - +/- Factor ____ assays
XIII (13) ## Footnote Stabilizes the fibrin mass Deficiency -> unstbale clots Fibrin dissolves into Urea W/O XIII
83
- ______ Anticoagulant throws off PTT data - ______ Anticoagulant throws off PT data
Lupus Anticoagulant = PTT wrong Citrate Anticoagulant = PT wrong
84
Which bleeding tests does Heparin interfere with?
- PT - PTT - Thrombin Time
85
Abnormal Bleeding Time may be d/t
thrombocytopenia ## Footnote order a PLT Ct -> if norm -> prob is either vessel wall/SQ tissue issue or PLT Fn. Order a bleeding time to determine if vessel wall/SQ tissue issue
86
Normal Thrombin time
<22 sec (~ 14-16sec)
87
Condition? - PT: LONG - PTT: Norm - Thrombin Time: Norm - PLT Ct: Norm
- Factor VII - deficiency early oral anticoagulation
88
Condition? - PT: Norm - PTT: LONG - Thrombin Time: Norm - PLT Ct: Norm
- Circulating anticoagulants - VonWillebrand Dz - Factor VIII:C, IX, XI, XII deficiency - Perkallikrein - HMWK
89
Condition? - PT: LONG - PTT: LONG - Thrombin Time: Norm - PLT Ct: Norm
- Vit K Deficiency - Oral anticoagulant - FActor V, VII, X, II Deficiency
90
Condition? - PT: LONG - PTT: LONG - Thrombin Time: LONG - PLT Ct: Norm
- Fibrinogen defiicency - Liver Dz - Heparin - Hyperfibrinolysis
91
Condition? - PT: Norm - PTT: Norm - Thrombin Time: Norm - PLT Ct: LOW
Thrombocytopenia
92
Condition? - PT: LONG - PTT: LONG - Thrombin Time: Norm - PLT Ct: LOW
- Liver Dz - Massive Transfusion
93
Condition? - PT: LONG - PTT: LONG - Thrombin Time: LONG - PLT Ct: LOW
- ACUTE Liver Dz - DIC
94
Plasmin cleaves fibrin -> ______ | Major degradation product
D-Dimer (Fibrin DDimer) ## Footnote Norm Fibrin = <500 ng/mL Norm D-Dimer = <250 ng/mL
95
Clinical uses for D-Dimer | 4 of them
- DVT - PE - DIC - Primary Hyperfibrinolysis
96
- ____ out of 30 blood groups are considered clinically significant - List the grps - They are known to cause which 2 conditions?
**9 grps ** - ABO - Rhesus (Rh) - Kell - Kidd - Duffy - MNS - P - Lewis - Lutheran **2 Conditions** - Hemolytic Transfusion Rxns (HTR) - Hemolytic Dz of the fetus and Newborn (HDFN)
97
Is blood type O autosomal dominant or recessive?
RECESSIVE ## Footnote AO = A phenotype OO = O Phenotype
98
AB grp blood - antigens in RBC? - Antibodies in plasma?
- A & B antigens in RBC - NO Antibodies in plasma
99
O grp blood - Antigens in RBC? - Antibodies in plasma?
- NO antigens in RBC - A&B antibodies in plasma
100
____ blood grp antibodies are the only ones present in blood prior to any rxn or exposure
ABO
101
Hemolytic Dz of Fetus and Newborn (HDFN) is an autoimmune condition developing in a paripartum fetus when the ____ antibodies produced by mom crosses the placenta and attacks fetal RBCs
IgG
102
In hemolytic dz of fetus and newborn, are there HIGH or LOW erythroblasts in the fetal blood?
HIGH = "Erythroblastosis Fetalis"
103
Sickle Cell pts have HIGH levels of ____ antigens on their Sickles RBCs
Lu (Lutheran blood grp)
104
Blood Transfusion Indications
- Acute blood loss >20% of blood vol - Hgb <8 - Hgb <9 (Major Dz) - Hgb <10 (Autologous blood transfusion) - Hgb <11 (ventilator dependent)
105
Hgb transfusion factors
- Age and cardiovascular status - Anticipated additional blood loss - Arterial Oxygenation - Cardiac output - Oxygenation extraction ratio -
106
In antibody screens, which antibody is clinically significant? | IgM? IgG?
IgG
107
Major vs Minor blood Crossmatch
- Major = Donor Cell + Pt Serum - Minor = Pt cell + Donor serum/plasma
108
a Major cross-match is basically a(n) _____ Coombs Test | Direct? Indirect?
INDIRECT | Donor cell + Pt serum
109
The general rule is to transfuse RBC if Hgb <7. Does child with TOF and Hgb 8 with severe hypoxia need transfusion?
YES!!! Don't be shy with the transfusions since they have TOF and severe hypoxia, regardless of the general Hgb level rule
110
Who should be transfused first? - A. Transfuse plasma in a pt with INR 1.7 that is taking an anticoagulant for an invasive procedure - Child with TOF and Hgb 7
Child with TOF and Hgb 7
111
Contraindications to Autologous blood donations
- Infx, risk of sepsis - Scheduled Aortic Stenosis Sx - Active Sz DO - MI or CVA within 6mo - Significant Cardiac or pulm Dz - High grade LT main CAD - Cyanotic Heart Dz - Uncontrolled HTN
112
Average blood volumes - Preterm neonates? - Full-term neonates? - Infants? - Adult M? - Adult F?
- Preterm neonates = 95 mL/kg - Full-term neonates = 85 mL/kg - Infants = 80 mL/kg - Adult M = 75 mL/kg - Adult F = 65 mL/kg | M are thicker than F and babies are thickest of all
113
- 1 unit RBCs = incr [hgb] ____g/dL = incr HCT ____% - 10mL/kg RBCs = incr [hgb] ___g/dL = incr HCT ____%
- 1 unit RBCs = incr [hgb] 1 g/dL = incr HCT 3% - 10mL/kg RBCs = incr [hgb] 3 g/dL = incr HCT 10%
114
If pt needs to incr HCT from 24% -> 30%, how many units of blood will need to be transfused?
2 ## Footnote 1 unit blood = HCT incr 3%
115
Plasma Transfusion Indications
- INR >1.6 - Emergent Warfarin Reversal - Acute DIC - Microvascular bleeding during massive transfusion (≥ 1 blood volume) - Replacement fluid for Apheresis in thrombotic microangiopathies - Hereditary angioedema
116
PLT Transfusion Indications
117
Always transfuse if neonate PLT Ct < _____
20
118
Consider neonate PLT transfusion if PLT ct ___ - ____
20-30
119
Indications for neonate PLT transfusion if PLT Ct 30-50 &....
low birth wt in 1st week
120
When to transfuse cryoprecipitate
121
Acute vs Delayed Transfusion Rxns
122
It's best to ______ if taking Aspirin and need elective Sx
Wait 1.5 weeks to do Sx for PLT levels to normalize

Lab Medicine (1 decks)

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