FINAL Flashcards by Jim connelly

What test is the most reliable assessment of the effective erythroid activity of the bone marrow?

retic count

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What conditions (including parasitic infections) produce a macrocytic/normochromic picture

Ovalocytes: Pernicious Anemia, Hemophilia B, folate deficiency, B12 deficiency
Round macrocytes: Liver disease, alcoholism

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What conditions (including parasitic infections) produce a Microcytic/hypochromic blood picture?

Thalassemia, Cooley’s Anemia, iron deficiency, sideroblastic anemia, Pb poisoning, hookworm infection

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What are the typical findings (including RBC, WBC and platelets) in pernicious anemia (or vitamin B12 deficiency)

Pancytopenia, oval macrocytes, hypersegs (shift to right)

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What is the Schilling test and what body fluid is used for the test?

The Schilling test is an indirect measure of intrinsic factor. Pernicious Anemia: Intake of radioactive B12, look for it in urine. Not in urine indicates lack of intrinsic factor and no B12 absorption in intestines.

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What are macropolycytes

large cells with 5-7 lobes in nucleus. They are larger than hypersegs.

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What portion of the red blood cell is damaged leading to the formation of burr cells and thorn cells?

membrane

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What are the distinguishing characteristics of hereditary ovalocytosis?

Ovalocytes are seen. It does not need bone marrow to confirm. It is a cell membrane abnormality.

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What is the most unusual and significant finding in patients suffering from AIHA

Positive Direct Coombs (Positive DAT)

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What poikilocyte is associated with ABO HDN?

With extramedullary hematopoiesis?

Spherocytes

- teardrop cells

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What are the laboratory findings in PCH

+ Direct Coombs, + Donath Lansteiner, symptoms after exposure to cold.

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What are the hemoglobin electrophoresis results in sickle cell anemia?

Has Hgb S,F

No Hgb A.

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What hemoglobin is insoluble in reducing agents such as sodium dithionite and sodium metabisufite

Hgb S

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Which chain of the hemoglobin molecule is abnormal in hemoglobin C disease, sickle cell anemia, and thalassemia major?

Beta chain

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What does the PBS of a patient with sickle cell trait usually show?

Occasional target cells

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What does the PBS of a patient with IDA show

Pale, microcytic/ hypochromic cells

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What are the serum iron and TIBC results in IDA?

decreased iron

increased TIBC

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What is the specific cause of thalassemia?

decreased rate of synthesis of either Alpha or Beta chain

inherited not normal

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What is another name for homozygous alpha thalassemia?

Heterozygous alpha thalassemia?

Bart’s Disease

- Hemoglobin H Disease

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What causes relative polyycthemia?

stress, dehydration, severe burns, plasma volume is decreased

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What are the typical laboratory findings in acute leukemia:

Auer rods and a positive peroxidase stain:

anemia, thrombocytopenia, young cells

- AML

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What type of leukemia is indicated by the following:

Positive periodic acid-Schiff(PAS) stain:

ALL

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What type of leukemia is indicated by the following:

Positive chloroacetate esterase staind:

AMML

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What type of leukemia is indicated by the following:

presence of myelomonocyes:

Naegli’s or AMML

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What type of leukemia is indicated by the following: | presence of the Philadelphia chromosome

CML

What type of leukemia is indicated by the following: | “hypermature lymphs” and smudge cells

CLL

What type of leukemia is indicated by the following: | extreme thrombocytosis

CML

What type of leukemia is indicated by the following: | increased incidence of bleeding disorders (i.e. DIC)

APL

What leukemia is most frequently seen in patients over the age of 50?

CLL

What type of cells might be expected to be found in the bone marrow of a leukemic patient?

same cells as in PBS (acute = blasts, CML = all stages of granulocytes) except IM

What is the “end stage” of DiGuglielmo’s syndrome

AML

What condition would be described as acute granulocytopenia?

severe neutropenia

What are the laboratory findings in Hodgkin’s disease

Increased Eos (Leukomoid reaction with eosinophilia), decreased lymphs, Reed Sternberg cell

What are the laboratory findings in multiple myeloma

occasional plasma cell, Bence Jones protein, rouleaux, increased sed rate

What is the L.E. factor?

anti-nucleoprotein | IgG antibody

How is a Downey cell described?

Atypical lymph in IM- scalloping around RBC, blue at edges | AKA Reactive Lymphocyte

What disease is indicated by a positive ANA?

SLE (Lupus)

With what conditions is a decreased LAP associated?

CML, AML, increased Leukomoid reactions

What are the causes of bleeding?

trauma, decreased clotting factor synthesis, DIC, increased utilization of clotting factors, genetic defects

What is the immediate response to vessel injury?

vasocontriction

What comprises the initial plug in the wall of an injured vessel?

platelets

What is meant by platelet adhesion

sticks to surfaces

What is meant by Platelet aggregation

platelets stick to each other

Which platelet factor is most instrumental in the clotting process?

Factor 3

Intrinsic factors

XII XI IX VIII X V II I 12 11 9 8 10 5 2 1 (NOT 7)

Extrinsic factors

VII X V II I | 7 10 5 2 1

Factors in common

X V II I | 10 5 2 1

Vitamin K dependent factors

II VII IX X | 2 7 9 10

Which factor NOT made in the liver is increased in liver disease?

VIII (8)

Labile factors

V VIII | 5 & 8

Adsorbed plasma factors

V VIII XI XII (I) | 5 8 11 12 (1)

Aged serum factors

VII IX X XI XII (II) | 7 9 10 11 12 (2)

Factors which have an enzymatically active form

NOT 5 8

Components of thromboplastin

Activated factor X platelet factor 3 Calcium Factor V

End result of Stage I

Plasma thromboplastin

. End result of Stage II

thrombin

End result of Stage III

fibrin

Substance which initiates the extrinsic system

tissue factor 3 | + thromboplastin

Substance which initiates the intrinsic system

platelet factor 3, Plasma Factor XII (12), contact with exposed collagen (NOT by Tissue Factor III!)

Precursor of thrombin

prothrombin

Substance which converts fibrinogen to fibrin

thrombin

Activated substance responsible for clot lysis

plasmin (activated)

Final end products of the breakdown of fibrin and of fibrinogen

frag 1E | 2 D frag

Components which are depleted in DIC

I V VIII | platelet factor 3

Factor deficiency that would be incompatible with life

IV (calcium)

Principle of the coagulyzer (or MLA)

formation of clot changes ocular density of light detected by photoelectric cell

Principle of the Fibrometer

completion of electrical circuit due to formation of clot

Know the principle and the normal values for the various coagulation tests: Tourniquet test

capillary fragility

Know the principle and the normal values for the various coagulation tests: Thrombin time

availability of fibrinogen | 15-20 sec

Know the principle and the normal values for the various coagulation tests: Lee-White clotting time (use)

monitoring heparin therapy, detect intrinsic defects

Know the principle and the normal values for the various coagulation tests: Prothrombin consumption test

Measures amount of prothrombin remaining in serum after clotting

Know the principle and the normal values for the various coagulation tests: Fibrinogen (normal values)

200-400 mg/dl

Know the principle and the normal values for the various coagulation tests: Clot retraction (factors which influence it)

fibrinogen level, platelet count, thrombosthenin VI Platelet function test only if fibrinogen level is normal, normal platelet count, thombosthenin produced by platelets is present. (Normal HCT?)

Know the principle and the normal values for the various coagulation tests: PT (What deficiency is it especially sensitive to?)

deficiency in factor VII

Know the principle and the normal values for the various coagulation tests: PTT (What abnormalities could be indicated by an PTT?)

liver disease Hemophilia A & B **Any intrinsic defect, no platelet abnormality. Cannot detect platelet abnormality

Know the principle and the normal values for the various coagulation tests: Plasma recalcification time

Amount of time required for a clot to form in plasma (add Ca to plasma, time to clot)

Know the principle and the normal values for the various coagulation tests: Stypven time (factor for which it is most useful for diagnosis of deficiency)

Russels viper venom - factor VII

Know the principle and the normal values for the various coagulation tests: Substitution testing(how to use adsorbed plasma & aged serum)

know what factors increase PT & PTT

Know the principle and the normal values for the various coagulation tests: Euglobulin lysis (use)

fibrinolysis measure

Know the principle and the normal values for the various coagulation tests: ThromboWellco test (especially normal values)

If agglutination occurs: in 1:5 dilution but not in 1:20: FDP >1040 in neither:

Know the principle and the normal values for the various coagulation tests: TGT (use of adsorbed plasma & aged serum)

Thromboplastin generation time Know factors for increased not factor 7

Know the principle and the normal values for the various coagulation tests: 5 M urea test (what factor does it detect?)

only factor 13

Know the principle and the normal values for the various coagulation tests: Tests useful in the diagnosis of DIC

jbleeding time, abnormal PT/PTT, fibrinolysis, 1,5,8 platelets

Know the principle and the normal values for the various coagulation tests: Effect of asprin on testing (esp. BT and Saltzman glass bead test)

increased BT, abnormal glass bead test

Know the characteristics and laboratory results for the following diseases: Hemophilia A

Deficiency of VIII sex-linked recessive increased PTT (NOT PT)

Know the characteristics and laboratory results for the following diseases: Hemophilia B

Christmas disease Deficiency of factor IX Increased PTT Clinically cannot be distinguished from Hemophilia A

Know the characteristics and laboratory results for the following diseases: VonWillebrand’s disease

increased PTT, abnormal bleeding time (Factor VIII def) | Bleeding time distinguishes Hem A from VonWillebrands

Know the characteristics and laboratory results for the following diseases: ITP

due to anti-platelet Ab, increased bleeding time, decreased platelets, pinpoint hemorrhages petechiae BM increased megacaryocytes

Know the characteristics and laboratory results for the following diseases: Glanzmann’s thrombasthenia

Defect in platelet aggregation - abnormal platelet function

Know the characteristics and laboratory results for the following diseases: Hereditary telangiectasia

vascular defect

Know the characteristics and laboratory results for the following diseases: Parahemophilia

factor V def

What is the mode of action of the common anticoagulants coumadin and heparin? What tests are used to monitor them?

Coumadin: anti-Vitamin K heparin: neutralized/inactivates thrombin - coumadin: PT heparin: PTT

What level (expressed as a percentage of normal) must be reached for a clotting factor to cause an abnormality in coagulation?

30-40% | norm 50-150%

What is anti-thrombin III?

Heparin cofactor needs anti-thrombin to be bound, wouldn't work without it

Name a test that will distinguish between primary and secondary fibrinolysis.

D-Dimer

What factors are removed when plasma is adsorbed?

vitamin K dependent factors II VII IX X

What reagents can be used to prepare adsorbed plasma?

barium sulfate or aluminum hydroxide

What is viscous metamorphosis?

irreversible aggregation of platelets | 1st aggregation is reversible 2nd is irreversible

What plasminogen activators are now being used to treat heart attack and stroke victims?

streptokinase, urokinase, TPA if stroke within 4hrs