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Patho II > Hematology > Flashcards

Hematology Flashcards

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1
Q

The percentage of blood that is cells (RBCs, WBCs, platelets)

A

Hematocrit

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2
Q

Functions of RBCs:

A

Transport Hgb
Transport oxygen & CO2
Acid-base buffer

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3
Q

Assesses shape of cell. Normal = _____

A

MCV; 90-95 mcm3

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4
Q

RBCs have a life span of ____

A

120 days

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5
Q

Released from kidneys (90%) and liver (10%) in response to hypoxemia & regulates RBC production

A

Erythropoietin

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6
Q

RBCs require ___ & ___ for maturation

A

Vit B12 & folic acid

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7
Q

Reduced erythropoietin response in:

A

Infections, AIDS, hypothyroidism, & renal dz

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8
Q

Intracellular iron is stored in protein-iron complexes such as ___ & ___ while circulating iron is loosely bound to the transport protein ____ - carrier protein

A

Ferritin & hemosiderin;

Transferrin

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9
Q

Where is the major site of iron absorption? What promotes it?

A

Duodenum & proximal jejunum;

HCl

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10
Q

Two iron binding sites;
Responsible for pink color of plasma
1/3 of sites are occupied, TIBC = 300, 30% saturation, 100

A

Transferrin

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11
Q

30% of total iron “storage iron”

A

Ferritin

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12
Q

Water insoluble. Can cause deposit is in tissue causing multiple organ failure

A

Hemosiderin

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13
Q

Conditions of defective heme synthesis that leads to the accumulation and increased excretion of heme precursors

A

Porphyria

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14
Q

S/sx of porphyria

A

Abd pain, N/v
Tachycardia, sustained HTN
Muscular weakness
Seizures

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15
Q

What 2 meds are contraindicated in porphyria’s?

A

Barbiturates & benzos

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16
Q 
Painful abdomen
Pink urine
Polyneuropathy
Psychological disturbance
Precipitated by drugs
A

Acute intermittent porphyria

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17
Q

Most common porphyria

Blisters & photosensitivity

A

Porphyria cutanea tarda

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18
Q

Anemia consists of a Hgb < ___ & Hct of ___ for women. Hgb < ___ and Hct ___ in men

A
  1. 5 & 36% (women)

12. 5 & 40% (men)

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19
Q

“Small pale cells” MCV <80
High TIBC, ⬇️ ferritin, ⬇️ serum iron
Bone marrow with absent iron stores

A

Microcytic hypochromic cells

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20
Q

Tx for iron deficiency anemia (microcytic hypochromic anemia)

A

Give iron; packed RBCs (⬆️ reticulocytes within 7-10 days and Hgb)

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21
Q

Low TIBC, ⬆️ ferritin, ⬇️ serum iron

Impaired utilization of iron & diminished response to erythropoietin

A

Anemia of chronic dz

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22
Q

Accelerated erythropoiesis- young RBCs
Defective DNA synthesis d/t folate or vit B12 deficiency
MCV > 100

A

Macrocytic anemia

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23
Q

Where is B12 absorbed? Stored?

A

Terminal ileum; stored in liver for 3-4 years

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24
Q

If anemia corrects with IF -> _____;

If corrects with antibiotics -> ______

A

Schilling test; pernicious anemia; bacterial overgrowth

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25
MCC of B12 deficiency Atropic gastritis -> No IF Antibodies to parietal cells or IF Increase risk of gastric cancer
Pernicious anemia (lack of IF)
26
Dietary deficiency “tea and toast diet” MCC; Common in alcoholics Malabsorption - sprue; increased need-pregnancy Defective DNA & RNA synthesis
Folate deficiency
27
Hallmark of megaloblastic anemia
Hypersegmented polys/neutrophils; 6+ lobes
28
Neurological-paresthesias, ataxia d/t demyelination | Cerebral and psychiatric manifestation; UMN lesion signs, dementia, incontinence, impotence
B12 deficiency
29
Why should folic acid alone NEVER be given in macrocytic anemia?
Bc it will fix the anemia but exaggerate neurological signs and symptoms Give combo of folic acid & B12 for life
30
Low urinary excretion (<5%) of labeled vit B12 =?
Absorption defect of vit B12 (+ schilling’s test) | Repeat test with IF -> should get high urinary excretion
31
What keeps RBCs in shape
Spectrin
32
Acanthocytosis
Change in shape “spiny” RBCs
33
Most common enzyme deficiency disorder; 1% of African Americans, x-linked, reduce glutathione level
G6PD deficiency
34
What two drugs cause cyanide toxicity in G6PD deficiency?
Nitroprusside & prilocaine
35
Which drugs lead to a hemolytic crisis in G6PD deficiency?
Sulfa, aspirin, penicillin, streptomycin, quinidine, methylene blue “Stop Asking Penny Strep Questions about Meth”
36
_____ is used to distinguish b/w immune vs non immune mediated RBC hemolysis
Direct Coomb’s test
37
In sickle cell anemia, ____ substitutes with ____ in the 6th position of the Beta hgb chain (HbS)
Valine; glutamine
38
Painful leg ulcers, hematuria, necrosis of spleen “autosplenectomy”, require vaccination against pneumococci salmonella, priapism, cor pulmonale
Sickle cell anemia
39
Why does someone with sickle cell anemia have resistance to malaria?
Malaria parasite needs a health RBC to stay in and replicate
40
Prevention of sickle cell crisis
Hydration, O2 (low PO2 triggers sickling 30-40mmHg) maintain high CO, avoid stasis
41
Tx for sickle cell crisis
Hydroxyurea
42
Pancytopenia characterized by sever anemia, neutropenia, thrombocytopenia caused by failure or destruction of myeloid (bone marrow) stem cells - “dry tap”
Aplastic anemia
43
Tx of thalassemia
Packed RBCs & folic acid
44
What 3 steps occur rapidly after injury?
1. Vascular spasm to prevent blood loss 2. Platelet plug formation 3. Coagulation: formation of clot
45
Once attached, platelets are “activated” and release: ? These chemicals recruit more platelet s (+ve fb)
Serotonin, ADP, thromboxane A2, & platelet activating factor
46
____ Aggregates platelets, ____ Inhibits aggregation
Thromboxane A2; Prostacyclins (PGI2)
47
Inhibit Phospholipase A2 -> inhibition of TXA2 synthesis
Steroids
48
Inhibit COX 1 and COX2
NSAIDs
49
Inhibits lipooxigenase
Zileuton (Zyflo)
50
vWF receptor
GP Ib
51
Converts fibrinogen to fibrin
Thrombin
52
How does acetaminophen alter platelet function?
No effect
53
Inhibit ADP induced fibrinogen aggregation of platelets (anti-ADP)
Ticlopidine & clopidogrel
54
Increases cAMP that prevents platelet aggregation
Dipyridamole (persantine)
55
Cap & block the fibrinogen receptors on platelets -> no linking -> no aggregation (antifibrinogen receptor GPIIb/IIIa)
Abciximab, tirofiban, eptifibatide
56
What are the functions of vWF?
Helping attachment of platelets on interior endothelium & providing a ride for factor VIII
57
What is the function of fibrinogen (factor I)?
Cross-linking chain b/w two platelets (the GPIIb/IIIa receptors)
58
What is the function of GPIb?
Links platelets to vWF
59
What is the function of GPIIb/IIIa?
Provides cross link when active with the fibrinogen bridge
60
Measures platelet function
Bleeding time (within 4-5 min bleeding should stop)
61
Prolonged BT despite normal platelet count, prolonged PTT
Von willebran’s dz
62
Tx for von willebrand’s dz
DDAVP 1st line Cryoprecipitate is rich in factor VIII:vWF Estrogen & OCP
63
All factors are synthesized in the liver EXCEPT
vWF, factor IV (Ca), factor III (tissue factor;thromboplastin), & factor VIII
64
What are the vit K dependent factors?
II, VII, IX, X (1972), protein S & C
65
_____ binds the fibrin strands tightly together and strengthens and stabilizes the clots
XIIIa
66
PT & INR assess the _______ pathway; PTT & ACT assess the _______ pathway
Extrinsic; intrinsic
67
Extrinsic factors
Tissue factor III, & factor VII
68
Intrinsic factors
XII, XI, IX
69
______ is rapid & explosive in nature (15 sec) while ____ is slower (2-6 min) with Mandy components
Extrinsic pathway; intrinsic pathway
70
Prolonged PTT with normal BT (normal platelets)
Hemophilia A
71
Hemophilia A tx
FFP & cryo | Factor VIII replacement
72
Depletion of coagulation factors and platelets “global consumption”
Disseminated intravascular coagulation
73
Contains all clotting factors except platelets
FFP
74
Rich in I, VIII, vWF, & XIII
Cryo
75
How long does it take to correct the effect of warfarin aft d/c?
5 days
76
Present in basophil and mast cells
Heparin
77
What would cause someone to be unresponsive to heparin? Tx?
Antithrombin III deficiency (d/t cirrhosis & nephrotic syndrome) FFP that contains AT3
78
LMWH inhibits which factor?
Xa
79
Prevent breakdown of fibrin by preventing displacing the plasmin from fibrin
EACA, Amicar

Patho II (11 decks)

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