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Hematology Exam 1 > Hemolytic Anemias > Flashcards

Hemolytic Anemias Flashcards

(101 cards)

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1
Q

IgG-coated RBCs interact with __ receptors on macrophages and that causes _____ hemolysis and formation of _____

A

Fc; extravascular; spherocytes

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2
Q

Bite cells are derived from ____ _____

A

Heinz bodies

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3
Q

In HA, the bone marrow expands due to increased erythropoiesis. What bones are likely to be expanded?

A

Skull, ribs, long bones

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4
Q

____ is released after lysis of any cell

A

LDH

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5
Q

What should be given to patients prior to splenectomy?

A

Vaccination against encapsulated organisms

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6
Q

What cells will you see in a blood smear of someone with hereditary spherocytosis?

A

Spherocytes

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7
Q

Is a splenectomy or corticosteroids effective in treating in cold agglutinin disease?

A

NO

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8
Q

In African variant of G6PD deficiency, will the old or new RBCs be more unstable?

A

The old

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9
Q

Complement-coated red cells can undergo ________ and ______ hemolysis

A

Intra and extravascular

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10
Q

Direct Coomb’s= DAT and this tests for ___ or ___ which are bound directly to RBC

A

IgG; C3

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11
Q

Heinz bodies are indicative of what deficiency?

A

G6PD

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12
Q

What is the rate limiting enzyme in the Pentose-phosphate shunt?

A

G6PD

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13
Q

Methemoglobin is capable/incapable of carrying O2 to tissues

A

incapable

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14
Q

Patients with hereditary spherocytosis get increasingly anemic and have abdominal pain during ____ infections

A

Mild

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15
Q

If you do a Coomb’s test and there is agglutination in the tube then the test is _____ for IgG or ___

A

Positive; C3

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16
Q

Can get infection with mycoplasma or mononucleosis and develop ________

A

Cold agglutinin disease that will resolve when the infection is cleared

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17
Q

Why can digital ischemia occur in a patient with in cold agglutinin disease?

A

IgM causes agglutination of the red cells and they cannot pass through the microvasculature and that causes ischemia and cyanosis

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18
Q

In AIHA, what are some clinical manifestations that will be seen?

A 
Splenomegaly
High reticulocytes
High LDH
High bilirubin
Low haptoglobin
Positive Coomb's test
Spherocytes
Can be elevated MCHC
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19
Q

In someone with G6PD deficiency, what are some oxidant agents to avoid?

A
  • Quinine
  • Sulfa drugs
  • Dapsone
  • Vitamin K
  • Fava Beans
  • Naphtha (moth balls)
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20
Q

What percentage of African American men have G6PD deficiency?

A

10-14%

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21
Q

In someone with the African variant of G6PD deficiency, the G6PD levels after a hemolytic will be normal/abnormal

A

Normal because the old cells that have lysed were deficient and the new cells are not

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22
Q

AIHA can be provoked by certain infections and induced by ___

A

drugs

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23
Q

Yellowing of sclera in the eyes is referred to as:

A

scleral icterus

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24
Q

Unconjugated/conjugated bilirubin is elevated in HA

A

Unconjugated

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25
Erythroid hyperplasia is characteristic of what kind of anemia?
Hemolytic; myeloid:erythroid ratio is usually 3:1 and in hyperplasia, the ratio is 1:10
26
Low G6PD results in low levels of glutathione and ____ which are necessary to protect Hb from oxidative damage
NADPH
27
An African American child that has come into the ER and has breath that smells of moth balls may be undergoing ____
hemolysis due to G6PD deficiency
28
A child with a deformed skull and high reticulocyte counts may be suffering from what consequence of B-thalassemia major?
Frontal bossing
29
When the reticulocyte count is close to 0, this is referred to as an/a _____ crisis
aplastic
30
In hereditary spherocytosis, the MCHC can be _______
Elevated
31
G6PD deficiency leads to hemoglobin conversion to ______ and the production of ____ bodies and the spleen pinches this off and overlying membrane and leaves a ____ cell
methemoglobin; Heinz; bite
32
Positive DAT for C3 and negative for IgG=
Cold agglutinin disease
33
Dapsone is used for treatment of _____ and prophylaxis for ___
Leprosy, PJP
34
A myeloid:erythroid ratio of 1:10 would indicate what?
Erythroid hyperplasia
35
A patient who has chronic hemolytic anemia presents with an acute drop in their baseline hemoglobin value. What is the likely diagnosis and what would you test for?
Aplastic crisis; check retic count and send in PCR for parvovirus
36
Fingertips, toes, and tip of nose are places where ___ binds red cells in cold agglutinin disease and then fixes ________
IgM; complement
37
Normal red cell lifespan
120 days
38
Increased osmotic fragility is a test for ______ _______
hereditary spherocytosis
39
C3-coated red cells interact with C3 receptors on ______ and this causes _______ hemolysis
Extravascular
40
Lipid microvesicles (blebs) form on the surface of the RBCs in hereditary spherocytosis and they are pinched off in the _____ by ______ and this is referred to as ________ hemolysis
spleen; macrophages; extravascular
41
Lactate dehydrogenase (LDH) is found in some/all cells
all
42
An adult with parvovirus infection may present with which 2 key clinical manifestations?
Fever and arthritis of the hands
43
The complement cascade may cause lysis of the cells and that leads to ______ hemolysis
Intravascular
44
Why is infection with parvovirus B19 so dangerous in patients with hemolytic anemia?
- parvovirus B19 suppresses bone marrow erythropoietic activity - patients with HA have RBCs that only last about 10 days and the virus may persist that long and suppress production of new RBCs so that leads to an aplastic crisis
45
End result of Hb breakdown is ______.
Bilirubin
46
Blister cells are seen in patents with what condition?
G6PD deficiency
47
Hereditary spherocytosis is caused by defects in the proteins of the membrane skeleton, usually _____
ankyrin
48
Macrophages remove damaged or red cells coated with _______
Antibodies
49
Haptoglobin is made in the _____ and has a half life of ____ days
liver; 14
50
_______ is a byproduct of heme breakdown and the elevated portion is _______
Bilirubin; unconjugated
51
Where is G6PD deficiency seen and why?
In Africa and the Mediterranean; some malarial resistance
52
If there are reduced levels of haptoglobin, what type of hemolysis is occurring?
Intravascular
53
In cold agglutinin disease, when IgM and complement fixed red cells travel to warm parts of the body, ____ falls off
IgM
54
White/red cells turn over more quickly are are more predominant in the marrow
White cells (myeloid)
55
Cold agglutinin disease may be associated with
lymphoproliferative disease
56
This type of anemia is characterized by decreased red cell lifespan
Hemolytic
57
______ _____ is the most common congenital defect leading to anemia
Hereditary spherocytosis
58
An increase in this biochemical breakdown product increases in HA patients
Bilirubin
59
Blister and ____ cells are present on peripheral blood smear of someone with G6PD deficiency
bite
60
What is the underlying problem of the RBCs in HA?
Destruction of RBCs
61
A Direct Coomb's test will be positive for C3 in patients with this disease
Cold agglutinin disease
62
Warm antibodies do not cause ______
agglutination
63
Will you likely see frontal bossing in mild HA?
No, mainly seen in severe HA (i.e. B-thalassemia)
64
How could you treat someone with hereditary spherocytosis?
Folate supplementation | Splenectomy
65
A child with parvovirus infection may present with which 2 key clinical manifestations?
Fever and rash; Fifth disease
66
What are some key clinical manifestations of someone with hemolytic anemia?
- Jaundice - Tea-colored urine - Pigmented gallstones - Ankle ulcers - Splenomegaly (generally)
67
Bilirubin normally passes through the _____ and is conjugated to glucoronide and is stored in the gallbladder before being released in the stool
liver
68
The ___ levels will increase in HA, but it is not very specific
LDH
69
If someone has HIV and want to start them on sulfa drugs or dapsone, what levels should you check first?
G6PD
70
Anaerobic glycolysis pathway in RBCs
Embden-Myerhof pathway
71
Quinine is used for
Anti-malaria treatment
72
In a reduced osmotic concentration a spherocyte will ___ while a normal red cell will not
Lyse
73
What is the inheritance pattern of hereditary spherocytosis?
Autosomal dominant
74
What are effective treatments for cold agglutinin disease?
Keep patient warm; Rituximab
75
What is the treatment for warm AIHA?
Immunosuppression mainly or transfusion if indicated and folate repletion
76
G6PD reduces/oxidizes hemoglobin
reduces
77
If someone with hereditary spherocytosis undergoes a splenectomy, the hemolysis will decrease, but what will stay the same?
The spherocytes are still there because it is a genetic defect in the membrane protein
78
In HA, the RDW should be increased/decreased
Increased
79
Which variant of G6PD deficiency is more severe: African or Mediterranean?
Mediterranean
80
_______ are used as the first line of treatment of AIHA and if it does not work, then may perform a splenectomy and/ or use ______
Corticosteroids (Prednisone); Rituximab
81
A positive Coomb's test=
Autoimmune Hemolytic Anemia (AIHA)
82
When haptoglobin binds to free hemoglobin, the half life increases/ decreases
Decreases; about 20 min
83
Hereditary spherocytosis affects mainly what ancestry?
1/5000 of European descent
84
AIHA can manifest as a primary disorder with no underlying problem or it can be complication of other diseases such as ____ or CLL or Non-Hodgkin's lymphoma
Lupus
85
Pentose-phosphate shunt starts with which molecule?
G-6-P
86
In Hereditary spherocytosis, there is a decrease in the ___, due to loss of membrane
MCV
87
G6PD deficiency is what inheritance pattern?
X-linked
88
In intravascular hemolysis, can see reduced ______, hemoglobinemia, ________, and hemosiderinuria
haptoglobin; hemoglobinuria
89
During intravascular hemolysis, red cells rupture within the ________ and that releases free _____ into circulation
vasculature; hemoglobin
90
Aerobic pathway used in RBCs
Pentose-phosphate shunt
91
MAHA characteristic cells found on smear are
Schistocytes
92
Cold antibodies cause _____
agglutination
93
Which Ig works best at <32C?
IgM
94
An increased number of reticulocytes produces a blood smear with a lot of ______
polychromasia
95
Reduced serum _________ is a sensitive marker for intravascular hemolysis
haptoglobin
96
Which Ig works best at 37C?
IgG
97
Macrophages in the spleen, liver, and marrow are a part of ________ hemolysis
Extravascular
98
In G6PD deficiency, hemolysis is triggered by ___ or infections
drugs
99
What supplement should patients with HA be given?
Folate due to rapid turnover of cells
100
In a solution with a tonicity of 0.85%, there will be/ won't be lysis occurring in someone with hereditary spherocytosis vs. someone who is normal
Will be --> test for osmotic fragility
101
Aplastic crisis occurs in patients with hemolytic anemia when they are infected with which pathogen?
Parvovirus B19

Hematology Exam 1 (16 decks)

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