Blood Flashcards
(104 cards)
When do palmar creases loses their pink color?
Hg below 4 g/dL
What symptom is an under-appreciated manifestation of severe anemia?
Shortness of breath
When can anemia precipitate dramatic symptoms?
Circulation already compromised from vascular disease
What conditions can lead to anemia with a low MCV in a man?
GI bleed
Celiac sprue
Thalassemia (very low MCV)
What should you think about with newly unusually heavy menses?
Thrombocytopenia, hypothyroidism
What unusual manifestation may be seen in iron deficiency anemia?
Pagophagia: compulsive for ice or iced drinks (a form of pica)
(Seen especially in women and children with iron-deficiency anemia)
What lab finding may be seen in hemolysis?
- Elevated indirect bilirubin
- Low serum haptoglobin
- Increased plasma lactate dehydrogenase (LDH)
- Spherocytes on peripheral smear
What is haptoglobin, and how is it affected in hemolytic anemia?
Haptoglobin: plasma protein that binds free hemoglobin and causes it to be sequestered in the spleen
Decreased in hemolytic anemia, as more Hg is released into plasma, which is bound by haptoglobin and cleared.
(Decrease may be small in autoimmune hemolytic anemia because hemolysis occurs primarily in the spleen).
What nutrient needs to be supplemented in hemolytic anemia?
Folate (can become deficient due to rapid turnover in bone marrow to make up for hemolysis)
What types of cells are seen on smear in microangiopathic hemolytic anemia?
What are some main elements on the differential diagnosis for this type of anemia?
What is the mechanism of hemolysis?
Smear: Schistocytes and helmet cells
Causes:
- Thrombotic thrombocytopenic purpura (TTP)
- Disseminated intravascular coagulation (DIC)
- Malignant hypertension
Mechanism: Shearing of RBC (and damaging platelets) due to fibrin strands deposited in small arterioles, which results from activation of the coagulation cascade
(Can result from anything leading to widespread endothelial injury, including drugs, infection, and fibrinoid necrosis due to malignant HTN)
What type of cardiac disease can lead to hemolysis?
Dysfunctional valve disease (heavily calcified or artificial valves)
(Called Waring Blender syndrome)
What types of diseases can show autoimmune hemolytic anemia?
- Lymphoproliferative diseases
2. Collagen vascular diseases (especially SLE)
What type of hemolytic anemia shows a relatively small decrease in haptoglobin?
Autoimmune hemolytic anemia
(Hemolysis occurs primarily in spleen, so little hemoglobin released into blood, so there is little for serum haptoglobin to bind to).
What type of hemolysis has “warm” antibodies? What type of Ig is this? Where does hemolysis occur?
How about “cold” antibodies?
Warm:
- Seen in autoimmune hemolytic anemia.
- Mainly IgG
- Hemolysis occurs in spleen (and RES)
Cold:
- Associated with certain infections (e.g. mycoplasma pneumonia, mono)
- Mainly IgM
- Hemolysis occurs in cold-exposed areas of circulation
What is a common cause of hemolytic anemia combined with immune thrombocytopenia (ITP) in younger patients? Older patients?
Younger: SLE
Older: Lymphoproliferative disorder
(This combination is called “Evans syndrome)
What is suggested by hemolytic anemia in associated with leukopenia, thrombocytopenia, and venous thrombosis?
Paroxysmal nocturnal hemolgobinurea
(In PND, acquired defects in hematopoietic stem cells means these cells are more sensitive to complement, leading to intravascular hemolysis and hemoglobinuria)
Where does venous thrombosus tend to occur in PNH?
What is a potential mechanism?
Intra-abdominal vessels (including portal and hepatic veins)
Complement against platelets may make them prone to aggregration
What are common causes of drug-induced hemolytic anemias?
- Penicillin
- Cephalosporins
- Methyldopa (for HTN)
- Quinine
- Sulfonamides (e.g. TMP-SMX, sulfadiazene (for Toxo), sulfasalazine (for RA), zonisamide (antiepileptic))
What causes a delayed hemolytic transfusion reaction?
Antibody response against minor antigens (e.g. Kidd, Duffy, Kell) that may lead to extravascular immune hemolysis days-to-weeks after transfusion.
What reactions does B12 catalyze?
- 5-methyltetrahydrofolate to tetrahydrofolate (the active form)
- Homocysteine to methionine
- Methylmalonic acid to succinic acid
Other than macrocytosis, what else is seen on blood smear in megaloblastic anemia?
Multisegmental polymorphonuclear leukocytes (PMNs)
The delayed maturation seen in RBCs also affects granulocytes
In what condition can a non-megaloblastic macrocytosis be seen?
Hypothyroidism
What are some causes of B12 deficiency?
- Long-standing strict veganism
- Pernicious anemia (lack of intrinsic fracture production due to autoimmune destruction of parietal cells)
- Ileal disease (e.g. Crohn’s, celiac) or resection
- Gastrectomy / gastric bypass
- Small intestinal bacterial overgrowth (SIBO, due to bacteria competing for B12)
What lab changes are seen in B12 deficiency?
Which is the most reliable test?
Decreased B12, elevated MMA, elevated homocysteine
Elevated MMA is the most reliable test