Flashcards in Hematology Deck (153)
What is a Neutrophil?
The phagocyte (has anti-microbials, most abundant)
What is a Eosinophil?
The parasite destroyer, allergy inducer
What is a Basophil?
The Allergy Helper (IgE receptor=> histamine release)
What is a Monocyte?
The Destroyer=> MP (hydrolytic enzymes, coffee-bean nucleus)
What is a Lymphocyte?
The Warrior=>T, B, NK cells
What is a Platelet?
The Clotter (no nuclei, smallest cells)
What is a Blast?
Baby Hematopoietic cell
What is a Band?
What does high WBC and high PMNs tell you?
What does high WBC and <5% blasts tell you?
Leukemoid reaction, seen in burn patients (extreme demargination looks like leukemia)
What does high WBC and > 5% blasts tell you?
What does high WBC and bands tell you?
Left shift=> have infection
What does high WBC and B cells tell you?
What diseases have high eosinophils?
Addisons disease (no cortisol -> relative eosinophilia
Collagen vascular disease
What diseases have high monocytes (>15%)?
Syphilis: chancre, rash, warts
TB: hemoptysis, night sweats
EBV: teenager sick for a month
Listeria: baby who is sick
Salmonella: food poisoning
What do high retics (>1%) tell you?
RBC being destroyed peripherally
What do low retics tell you?
Bone marrow not working right (decrease production)
What is Poikilocytosis?
What is Anisocytosis?
What is the RBC lifespan?
What is the platelet lifespan?
What does -penia tell you?
Low levels (usually due to virus or drugs)
What does -cytosis tell you?
What soes -cythemia tell you?
What is the difference between plasma and serum?
Serum:no RBC or fibrinogen
What is Chronic Granulomatous Disease?
NADPH oxidase deficiency -> recurrent Staph/Aspergillus infections (Nitroblue Tetrazolium stain negative)
What does MPO deficiency cause?
Catalase + infections
What is Chediak Higashi?
Lazy lysosome syndrome: lysosomes are slow to fuse around bacteria
What organ can make RBCs if the longbones are damaged?
Spleen => splenomegaly
What causes a shift to the right in the Hb curve?
"All CADETs face right"
How does CO poison Hb?
Competitive inhibitor of O2 on Hb => cherry red lips, pinkish skin hue
How does Cyanide poison Hb?
Non competitive inhibitor of O2 on Hb => almond breath
What is MetHb?
Hb w/ Fe+3
What is Acute Intermittent Porphyria?
^Porphyrin, urine delta-ALA, porphobilinogen => abdominal pain, neuropathy, red urine
What is Porphyria Cutanea Tarda?
Sunlight=> skin blisters w/porphyrin deposits,
Woods lamp= orange-pink
What is Erythrocytic Protoporphyria?
Porphyria cutanea tarda in a baby
What is Sickle cell disease?
Homozygous HbS: (BGlut6->Val) vaso-occlusion, necrosis, dactylitis (painful fingers/toes) at 6mo, protects against malaria
What is Sickle cell trait?
Heterozygous HbS => painless hematuria, sickle with extreme hypoxia (can't be a pilot, fireman, diver)
What is Hb C disease?
(BGlu6->Lys), still charged => no sickling
What is alpha-thalassemia?
2 deletions "trait": Microcytic anemia
3 deletions: Hemolytic anemia, Hb H=B4
4 deletions: hydrops fetalis, Hb Bart= Gamma 4
What is B thalassemia?
1 deletion "B minor": ^HbA2 and HbF
2 deletions "trait/intermedia/major": only HbA2, and HbF => hypoxia at 6 months
What is Cooley's anemia?
See w/B thalassemia major (o HbA=>excess RBC production); baby making blood from everywhere=> frontal bossing hepatosplenomegaly, long extremities
What is Virchow's triad?
Thrombosis risk factors:
1) Turbulent blood flow "slow"
3)Vessel wall damage "escapes"
What does acute hypoxia cause?
Shortness of breath
What does chronic hypoxia cause?
Clubbing of fingers/toes
What is intravascular hemolysis?
RBC destroyed in blood vv. -> low haptoglobin (bind free floating Hb)
What is extravascular hemolysis?
RBC destroyed in spleen (problem w/RBC membrane) => splenomegaly
What enzyme need lead (Pb)?
delta- ALA dehydrase
What does EDTA bind?
What disease has a smooth philthrum?
Fetal alcohol syndrome
What disease has a long philthrum?
What disease has a sausage digits?
Pseudo-hypoparathyroidism, psoriatic arthritis
What disease has 6 fingers?
What disease has 2 joined thumbs?
What disease has painful fingers?
Sickle cell disease
What are the Microcytic Hypochromic anemias?
Anemia of chronic disease
^ TIBC, menses, GI bleed, koilonychia
Anemia of Chronic Disease
decrease Delta-ALA synthase, blood transfusions
AA, Asians, (Chromosome 16 deletion)
Mediterraneans (Chromosome 11 point mutation)
decrease delta-ALA dehydrogenase, decrease ferrochelatase, x-ray blue line, eating old paint chips
What are the Megaloblastic Anemias?
Vit B12 deficiency
Vit B12 deficiency
Tapeworms, vegans, type A gastritis, pernicious anemia
old food, glossitis
Fetal alcohol syndrome: smooth philthrum, stuff doesn't grow
What are the Intravascular Hemolytic Anemias?
Sulfa drugs, moth balls, fava beans, sudden drop in Hb
Mononucleosis, mycoplasma infections, RBC agglutination
What are the Extravascular Hemolytic anemias?
Paroxysmal cold autoimmune
Sickle cell anemia
Defective spherin or ankyrin, + osmotic fragility test
Anti-Rh Ab, dapsone, PTU, anti-malarias, sulfa drugs
Paroxysmal cold autoimmune
Bleeds after cold expossure, Donath-Landsteiner Ab
Sickle Cell Anemia
Crew haircut x-ray, avascular necrosis of femur, short fingers
What are the Production Anemias?
No RBCs, 2-joined thumbs
Pancytopenia, autoimmune, benzene, AZT, CAM, radiation
What is the Basophilic Stippling?
Lots of immature cells, ^mRNA (Pb poisoning)
What is a Bite cell=Basket cell?
Unstable Hb inclusions (G6-PD deficiency)
What is a Burr cell=Echinocyte?
Pyruvate kinase deficiency, Liver dz, Post-splenectomy
What is Cabot's ring body?
Vit B12 deficiency, Pb poisoning
What is a Doehle body?
PMN leukocytosis (infection, steroids, tumor)
What is a Drepanocyte?
Sickle cell anemia
What is a Helmet cell?
Fragmented RBC (Hemolysis: DIC, HUS, TTP)
Whats a Heinz body?
Hb precipitates and sticks to cell membranes (G-6PD deficiency)
What is a Howell-Jolly body?
Spleen or bone marrow should have removed nuclei fragments (hemolytic anemia, spleen trauma, cancer)
What is a Pappenheimer body?
Fe ppt inside cell (sideroblastic anemia)
What is a Pencil Cell=Cigar cell?
Fe deficiency anemia
What is a Rouleaux formation?
What is a Schistocyte?
Broken RBC (DIC, artificial heart valves)
What is a Sideroblast?
Macrophages pregnant w/Fe (genetic or multiple transfusions)
What is a Spherocyte?
What is a Spur cell= Acanthocyte?
Lipid bilayer dz
What is a Stomatocyte?
What is a target cell=codocyte?
Less Hb (Thallasemias or Fe deficiency)
What is a tear drop cell = dandrocyte?
RBCs squeezed out of marrow (hemolytic anemia. bone marrow cancer)
What is a clotting cascade?
How you stop bleeding
What do platelet problems cause?
bleeding from skin and mucosa
What do clotting problems cause?
bleeding into cavities
What causes increased PTT and bleeding time?
von Willebrand disease and Lupus
What is Bernard-Soulier?
baby w/bleeding from skin and mucosa, big platelets (low GP1b)
What is Glanzmann's?
baby w/ bleeding from skin and mucosa (low GP2b3a)
How does Factor 1 deficiency present?
Unbilical stump bleeding (1st time baby has to stabilize a clot)
What is Factor V Leiden?
Protein C can't break down factor 5=> more clots
How does von Willerbrand Disease present?
Heavy menstrual bleeding
What are the types of VWD?
Type 1 (AD): decreases VWF production
Type 2(AD): decreases VWF activity (+Ristocetin aggregation test)
Type 3(AD): No VWF
What is Hemophilia A?
Defective factor 8 ( bleed into cavities (head, abdomen, etc)
What is Hemophilia B?
Factor 9 deficiency=> bleed into joints (knee, etc)
What diseases have low LAP?
What has high LAP?
What is the difference between acute and chronic leukemia?
Acute: started in bone marrow, squeezes RBC out of marrow
Chronic: started in periphery, not constrained => will expand
What is the difference between myeloid and lymphoid leukemias?
Myeloid: ^RBC, WBC, platelets, MP (decrease lymphoid cells) => bone marrow biopsy
Lymphoid: ^NK, T, B cells (decrease myeloid cells) => do lymph node biopsy
What defines ALL?
<15 y/o males, bone pain, PAS stain +, TdT +
What defines AML?
15-30 y/o males, Sudan Stain, Auer rods
What defines CML?
30-50 y/o females, t (9,22) "philadelphia chromosome", bcr-abl, decrease LAP
What defines CLL?
>50 y/o males w/lymphadnopathy, "soccer ball", nuclei, smudge cells
What defines Hodgkin's lymphoma?
EBV, may have Reed-Sternberg cells
What are the B cel Non-Hodgkins lymphomas?
Follicular: t(14,18), bcl-2
Burkitt: t(8,14), c-myc, starry sky MP
-American kids: abdominal mass
-African kids: jaw mass
What are the T cell Non-hodgkins lymphomas?
Mycosis Fungoides: total body rash
Sezary syndrome: cerebreform cells
What is Polycythemia Rubra Vera?
Hct>60%, decrease Epo, Budd-Chiari, plethora "pruritis after bathing"
What is Essential Thrombocythemia?
Very high platelets, stainable Fe, decrease c-mpl
What is Myelofibrosis?
Megakaryocytes, fibrotic marrow=> teardrop cells, extramedular hematopoiesis
What are plasma neoplasm?
Produces lots of Ab
What is Waldenstrom Macroglobulinemia?
What is Monoclonal Gammopathy of Undetermined Significance?
Old person w/ gamma spike
What is multiple myeloma?
Serum M prot (IgG), urine Bence-Jones protein, rouleaux, punched out lesions
What is Heavy Chain Disease?
What is Hystocytosis X?
Kid w/ eczema, skull lesions, diabetes insipidus, exophthalmos
What does the Coombs test tell you?
What does the direct Coombs tes tell you?
What is type and cross?
You know you can use that blood, save it for specific pt
What is type and match?
Type it and wait
What is forward typing?
Uses Ab to detect Ag " Fabulous"
What is backward typing?
Uses Ag to detect Ab
What does blood type A tell you?
Have the A antigen
What does blood type O tell you?
Have no antigens, universal donor
What does bloos type AB tell you?
Have both antigens, universal recipient
What does Rh + tell you?
Has D antigen
What does Rh- tell you?
Does not have D antigen
What is Hemolytic Disease of the Newborn?
Rh -Mom's placenta tears, 100 cc baby's blood sees Mom/produces Ab, attack fetus
What is RHOGAM?
When do you give RHOGAM?
1st dose: 28 wk gestation (of 2nd child)
2nd dose: 72 hrs post delivery (Rh + baby)
What is the most common transplant?
What is a Syngenic transplant?
Twin to twin
What is an Autograft?
Self to Self transplant
What is an Allograft?
Human to Human transplant
What is a Xenograft?
1 species to another species
What is a Hyperacute rejection?
within 12 hrs (preformed Ab)
What is Acute rejection?
4 days to years later (tcells, MP)
What is a Chronic rejection?
>7 days (fibroblast)
What is a Graft vs Host disease?
Bone marrow transplants reject (T k, MP)
What are Immunoprivileged sites?
No lymphatic flow=> no Ag=> easy to transplant (brain, cornea, thymus, testes)