Exam 2 Flashcards by Jim connelly

How are anemias classified according to cause?

Increased red cell destruction= hemolytic

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According to morphology?

Macrocytic Normochromic- means they’re not low in iron
Microcytic Hypocromic
Normocytic Normochromic-both normal
(No such thing as “hyperchromic”)

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What are the symptoms of anemia

Weak, pallored, shortness of breath, hypotension (low BP), fatigue, increased cardiac output, syncope

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Given the values for the red blood cell indices, suggest a possible diagnosis in the following
situations
increased MCV ⁭ MCHC Normal

B12 Def (PA)
Folate def
Liver PA
Alcholism

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Given the values for the red blood cell indices, suggest a possible diagnosis in the following
situations
MCV & MCHC Normal

Aplastic anemia… EVERYTHING ELSE

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Given the values for the red blood cell indices, suggest a possible diagnosis in the following
situations
MCV ↓ MCHC ↓

IDA (iron defficency)
Thalassemia
Sideroblastic Anemica
Pb poisoning

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What is the peripheral blood picture in vitamin B12 and folate deficiency?

oval
macrocitic
hypercegs
Pancytosemia

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What do you see in the bone marrow? In vitamin b12 def and folate def

megaloblast
giant bands
precursor cells

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What deficiency diseases cause megaloblastic erythropoiesis and what cellular consituents are
affected?

Vitamin B12 & Folic Acid

Affects DNA & RNA

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What specifically causes pernicious anemia?

Lack of intrinsic factor

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What main clinical manifestation distinguishes vitamin B12 deficiency from folic acid
deficiency

Pernicious anemia. Clinical manifestation is neurological symptoms relating to the myelin sheath.

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What conditions can produce non-megaloblastic macrocytic anemia?

Alcoholism and liver disease are most common. Also hypothyroidism

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What poikilocytes are often seen in liver disease

round macrocytes, target cells, acanthrocytes

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What parameters are decreased in aplastic anemia and what bone marrow precursor cells are
decreased?

All precursor cells decreased, all cells decreased.

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What is the peripheral blood picture in aplastic anemia and what would the reticulocyte count
be expected to be?

normocytic normochromic cells- no signs of increased red cell formation
decreased bone marrow

Retic= decreased

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What are the most common causes of aplastic anemia?

Chemical exposure: Benzene and chloramphenicol

Radiation

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Name several causes of myelophthisic anemia

Leukemia, Lymphomas, Multiple myeloma, Metastatic Carcinoma

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What poikilocyte is especially associated with the above condition because it indicates
extramedullary hematopoiesis

Tear drop cells

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What is the blood picture in chronic renal disease?

Normocytic

normochromic-burr cells, helmet cells

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What is the main cause of anemia due to renal disease and to what kidney function test is the
anemia frequently proportional

Failure of kidney to produce erythropoietin.

Decreased EPO, BUN.

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What are the characteristics of anemia due to chronic disorders?

Often start out normocytic normochromic but then as condition continues become microcytic hyperchromic. Increased anemia, Increased BUN. Can look similar to Fe deficiency (Fe stores increased, serum Fe decreased, TIBC normal).

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What is the common characteristic of ALL hemolytic anemias

Increased RBC destruction

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What type of RBC abnormality results in hereditary spherocytosis and how does it affect the
shape and osmotic fragility of the RBC?

Membrane abnormality-causes cell to be more permeable to sodium; makes them small and round rather than biconcave; and osmotic fragility is increased

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What biochemical pathway involves the enzyme glucose-6-phosphate dehydrogenase
(G-6-P-D)?

HMP shunt- to protect red cell (hemoglobin) from oxidation

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What usually precipitates a hemolytic crisis in G-6-P-D deficiency?

Exposure to oxidizing drugs

What RBC inclusions does this deficiency produce?g-6-p-d

Heinz bodies

What is the most unusual characteristic laboratory finding in ABO erythroblastosis of the newborn? In AIHA?

Newborn? Spherocytes AIHA? Positive Direct Coombs Test- extremely unusual in adult

How do PCH and PNH differ

PCH: is extrinsic- have an antibody. Extracorpuscular defect. PNH: intrinsic, acquired, sensitive to complement

In which condition is the Donath-Landsteiner antibody found?

PCH

What is the difference between an intrinsic (intracorpuscular defect)and an extrinsic (extracorpuscular) defect

Intrinsic: Something in the cell (genetic) is causing hemolysis Extrinsic: Something outside the cell is causing the hemolysis

What RBC abnormality is responsible for the formation of burr cells and thorn cells?

Membrane abnormalities

What globin chains are found in the following hemoglobins? - A2 - F - H - Bart's - Gower-1 - Gover-2

``` A2: 2 alpha and 2 delta F: 2 alpha and 2 gamma H: 4 Beta Bart's: 4 Gamma Gower-1:Epsilon Gower-2: Zeta ```

Which ones are present only during embryonic development?

Epsilon and Zeta

What is the major hemoglobin of the newborn?

What hemoglobin is insoluble when reduced

What hemoglobin is resistant to alkali?

What are the normal mobilities of hemoglobins A, C, F, and S on hemoglobin electrophoresis at pH 8.6

C-crawls, S-slow, F-fast, A-accelerates faster than fast

What is poikilocyte is the “common denominator” of peripheral blood smears of patients with hereditary hemoglobinopathies

Target Cells

What is the specific amino acid substitution in hemoglobin S? In hemoglobin C?

Valine substitutes in for Glutamic acid on # 6 position for S Lysine at same position for C only on beta chain

What are the clinical manifestations of sickle cell anemia

Frequent crises like aplastic and thrombotic crises, osteomyelitis, sickled cells, decreased osmotic fragility

What is the best test to use to differentiate sickle cell anemia and sickle cell trait?

Hg Electrophoresis

What does the peripheral blood smear usually show in sickle cell trait

Occasional Target Cell

What are the characteristics of Hemoglobin C disease?

Target cells, rod shaped crystals, envelope cells, mild hemolytic anemia

Hemoglobin SC disease

SC crystals, positive tube solubility test, some sickle cells but not usually and not numerous

Why does the hemoglobin combination of S and D create a problem in the laboratory diagnosis of hemoglobinopathies

Migrate together, alkaline pH S & D migrate together, further testing

What does the peripheral blood smear usually show in IDA?

Microcytic hyperchromic

What does the serum iron and TIBC show?

Serum iron-decreased | TIBC- increased

Chlorosis

Green coloration of skin in hypochromic anemia

Favism

G6 PD deficiency

Koilonychia

spoon shaped nails found in iron deficency

Pica syndrome

Eating weird stuff

What are some causes of IDA

Chronic bleeding, hookworm infection, menstrual problems, bleeding ulcers

What is the specific cause of the thalassemias?

Decreased rate of synthesis of either the alpha or beta chain.

What is another name for beta thalassemia

Cooley's Anemia, Mediterranean anemia.

What hemoglobins are increased in thalassemia major?

Can't make beta chain- increases A2(alpha 2 and delta 2) and F(alpha 2 and gamma 2)

Barts Disease

Homozygous alpha thalassemia

Cooley's trait

Beta thalassemia minor

Fanconi's anemia

Congenital Aplastic Anemia

Hemoglobin H disease

Heterozygous alpha thalassemia

What are the characteristics of sideroblastic anemia?

Microcytic hypochromic, increased iron stores, increased ringed sideroblast

What is the RBC inclusion most frequently associated with lead poisoning

Basophilic Stippling

What blood cell parameters are increased in polycythemia vera

All are increased; plasma volume= normal

What is the cause of secondary polycythemia

Overproduction of erythropoetin

What parameters are increased in this condition

Red cell parameters

How do hemachromatosis and hemosiderosis differ?

Stress, dehydration, burns

What are some possible causes of relative polycythemia?

Both involve deposition of excess iron. Hemosiderosis is in the normal cells of the liver, spleen. Hemochromatosis is deposited in functional cells where they shouldn't be placed causing tissue damage. (Tissue damage is the most important to remember here)