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Flashcards in Haematology Deck (17):
1

True or False?
Alcohol is a very common cause of macrocytosis, with or without anemia

True

2

What cells can be typically seen on a peripheral blood smear of a pt. with alcoholism?

stomatocytes
-erythrocytes with a slit-like central pallor --> coffee beans/kissing lips appearance

3

What is the commonest anemia worldwide

iron defeiciency anemia

4

Outline the iron cycle

-closed loop involving circulating transferrin, erythroid BM, circulating erythrocytes and reticuloendothelial macrophages
-small amount of iron is absorbed/lost through intestinal mucosa
-excess iron is stored in liver, muscle, etc

5

What happens to serum iron, transferrin, TIBC, %saturation and serum ferritin in iron deficiency anemia?

serum iron --> low
transferrin --> high
TIBC --> high
%saturation --> low
serum ferritin --> low (low iron stores)

6

What happens to serum iron, transferrin, TIBC, %saturation and serum ferritin in ACD?

serum iron --> low
transferrin --> normal/low
TIBC --> low
%saturation --> low
serum ferritin --> normal/high

7

How does ACD cause anemia?

Chronic disease causes increased inflamm. cytokines and acute phase protein --> hepcidin
-inhibition of EPO release and bone marrow response to EPO --> decr. RBC production
-hepcidin inhibits iron absorption from intestine and inhibits iron release from storage sites (macrophages/reticuloendothelial system)
-normal stores BUT inadequate delivery to BM

8

What is an important investigation when suspecting megaloblastic anemia (despite FBC/blood smear)?

folate/B12 levels

9

What is an important investigation when suspecting IDA (despite FBC/blood smear)?

iron studies

10

When would you typically see echinocytes (burr cells)?

anemia in chronic renal failure

11

How can hypothyroidism cause anemia?

-absence of thyroid hormone can cause BM suppression
-hypercholesterolemia --> macrocytosis
-menorrhagia --> IDA
-assoc. pernicious anemia (also autoimmune)
-folate poorly absorbed from GIT --> macrocytic anemia

12

What is the difference in EPO levels between primary and secondary polycythemia?

primary --> decreased EPO due to suppression by increased RBCs

secondary --> increased EPO (compensatory due to chronic hypoxemia - smoking, altitude, etc)

13

What molecular biology test can be used to distinguish between primary and secondary polycythemia?

JAK2 mutation --> present in primary (MPD)

14

What is spurious polycythemia?

occurs in dehydration when there is a decrease in plasma volume

15

How does heparin prevent coagulation?

attaches to ATIII (antithrombin 3) to form a complex which inhibits the action of thrombin, FIX, FX

16

When would you see Howell-Jolly bodies?

-post-splenectomy
-thalassemia
-liver disease

17

When do you see rouleaux formation?

conditions that cause a markedly increased ESR:
-multiple myeloma
-TB
-malignancy
-temporal arteritis