Buzzwords - Hematology

Question 1

hemolytic anemia w/

Hgb S on hemoglobin electrophoresis

Answer 1

Sickle cell anemia

+ sickled cells on peripheral smear

Question 2

hemolytic anemia w/

microcytic anemia w/ normal/inc serum Fe or no response to Fe treatment

Answer 2

Thalassemia - assoc w/ severe anemia & abnormal smear for given hematocrit level

ALPHA: hgb electrophoresis w/ NORMAL HGB RATIOS of HgbA, A2, F (diagnosis of exclusion since smear normal)

BETA: hgb electrophoresis DEC HgbA, INC HgbF

Question 3

hemolytic anemia w/

EPISODIC hemolytic anemia associated w/ SULFA DRUGS, FAVA BEANS, INFECTIONS

Answer 3

G6PD DEFICIENCY

Question 4

hemolytic anemia w/

microspherocytes, COOMBS NEGATIVE

Answer 4

hereditary spherocytosis

Question 5

hemolytic anemia w/

microspherocytes, COOMBS POSITIVE

Answer 5

autoimmune hemolytic anemia

Question 6

hemolytic anemia w/
normal coags
thrombocytopenia, hemolytic anemia, kidney damage, NEURO SX, FEVER

Answer 6

TTP

Question 7

hemolytic anemia w/
normal coags
thrombocytopenia, hemolytic anemia & KIDNEY DAMAGE

Answer 7

hemolytic uremic syndrome (HUS)

• mc seen in children (esp w/ diarrhea prodrome)
• higher assoc w/ kidney damage than TTP, doesn’t classically have fever or neuro sx

Question 8

hemolytic anemia w/ 
abnormal coags (prolonged PT + PTT)

Answer 8

disseminated intravascular coagulation (DIC)

Question 9

hemolytic anemia w/ 
dark urine (worse in mornings)

Answer 9

paryoxysmal nocturnal hemoglobinuria

Question 10

peripheral smear: rouleaux formation

Answer 10

• RBC stick as “STACK OF COINS” due to inc plasma proteins (like immunoglobulins or fibrinogen)
• inc density of them stuck causes them to settle in tube faster –> INC ESR

MULTIPLE MYELOMA (high protein)
INFECTIONS (acute/chronic - have high fibrinogen)

Question 11

peripheral smear: auto agglutination

Answer 11

• CLUMPING OF RBC due to IgM auto-antibodies coating surface of RBC lead to inc RBC destruction by macrophages
• cold IgM Ab agglutinins are reactive at colder temps (28-31 C)

COLD AGGLUTININ AUTOIMMUNE HEMOLYTIC ANEMIA (mycoplasma pneumonia, EBV)
Cryoglobulinemia
Ag-Ab reaction if blood type not matched

Question 12

peripheral smear: HOWELL-JOLLY BODIES

Answer 12

-small dense basophilic RBC inclusions (usually removed by spleen)

DECREASED SPLENIC FX: autosplenectomy (ex. sickle cell), post splenectomy
SEVERE HEMOLYTIC ANEMIA, MEGALOBLASTIC ANEMIA

Question 13

peripheral smear: hemolytic cells - BITE CELLS

Answer 13

-bite-like deformity due to phagocyte removal of denatured Hgb

THALASSEMIA
G6PD DEFICIENCY

Question 14

peripheral smear: hemolytic cells - SHISTOCYTES

Answer 14

-fragmented RBC

HEMOLYTIC ANEMIAS
MICROANGIOPATHIC DZ

Question 15

peripheral smear: hemolytic cells - KERATOCYTES

Answer 15

-“helmet-shaped” RBCs –> mechanical RBC damage in small vessels

microangiopathic dz like TTP, HUS, DIC, PROSTHETIC VALVES

Question 16

peripheral smear: BASOPHILIC STIPPLING

Answer 16

-course blue granules in RBC (residual RNA) - looks like reticulocytes but STIPPLING EVENLY DISTRIBUTED

SIDEROBLASTIC ANEMIA
HEAVY METAL POISONING (LEAD)
THALASSEMIAS
myelodysplasia, chronic alcohol abuse

Question 17

peripheral smear: ECHINOCYTES “BURR CELLS”

Answer 17

-RBCs w/ numerous, small, evenly spaced projections due to abnormal cell membrane

UREMIA
pyruvate kinase deficiency
hypophosphatemia

Question 18

peripheral smear: ACANTHOCYTES “SPUR CELLS”

Answer 18

-Few, large, spiny, irregular projections on the RBC membrane

Liver Dz
Post Splenectomy
Thalassemia
Autoimmune Hemolytic Anemia
Renal Dz

Question 19

peripheral smear: TARGET CELLS (Codocytes) & SPHEROCYTES

Answer 19

TARGET CELL: hypochromic RBC w/ round area of central pigment “target-shaped”

• seen if there is excess of cell membrane relative to hgb
• HEMOGLOBINOPATHIES: SICKLE CELL, THALASSEMIA, sev Fe deficiency, asplenia, liver dz

SPHEROCYTES: usually associated w/ hyperchromia (often w/ microcytosis)

• HEREDITARY SPHEROCYTOSIS
• WARM AUTOIMMUNE HEMOLYTIC ANEMIA

Question 20

peripheral smear: HYPERSEGMENTED NEUTROPHILS

Answer 20

-neutrophils w/ >5 lobes

B12 & FOLATE DEFICIENCIES

Question 21

peripheral smear: AUER RODS

Answer 21

ACUTE MYELOGENOUS LEUKEMIA (AML)

Question 22

peripheral smear: REED-STERNBERG CELL “OWL EYE APPEARANCE”

Answer 22

HODGKIN LYMPHOMA

Question 23

plummer-vinson syndrome

Answer 23

dysphagia, esophageal webs, atrophic glossitis, Fe deficiency

Question 24

thrombocytopenia

Answer 24

low platelet count

Question 25

prolonged PT

Answer 25

VIT K DEFICIENCY ( WARFARIN) | DIC

Question 26

prolonged PTT

Answer 26

HEMOPHILIAS VON WILLEBRAND DISEASE DIC

Question 27

prolonged bleeding time

Answer 27

THROMBOCYTOPENIA VON WILLEBRAND DZ, ESP W/ ASA DIC

Question 28

BM biopsy: DUTCHER BODIES

Answer 28

waldenstrom macroglobulinemia

Question 29

thrombocytopenia sx

Answer 29

``` MUCOCUTANEOUS BLEEDING PETECHIAE small, superficial bruising BLEED AFTER MINOR CUTS IMMEDIATE BLEEDING AFTER SURGERY ```

Question 30

factor deficiency sx (ex hemophilias)

Answer 30

``` DEEP BLEEDING (joint, muscles) petechiae uncommon LARGE HEMATOMAS (not small bruises) unusual bleeding after small cuts DELAYED BLEED AFTER SURGERY ```

Question 31

SMUDGE CELLS

Answer 31

CLL | MC LEUKEMIA IN ADULTS

Question 32

METALLIC OR BRONZE SKIN --> "BRONZE DIABETES"

Answer 32

hereditary hemochromatosis | -increased Fe absorption and deposition into organs