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Flashcards in Midterm RBC Review Deck (87):
1

What stimulates RBC production?

EPO from kidney

2

Hemoglobin has what two parts

Heme protein + 2 pairs of globin chains

3

Heme has what two parts

Iron + protoporphryin

4

HbA is 95% and has what chains

Alpha and beta

5

HbA2 is 3.5% and has what chains

Alpha and delta

6

HbF is 1.0% and has what chains

alpha and gamma

7

Anemia definition

Decreased red blood cell mass

8

Normal HCT to HB ratio?

3:1

9

Anemia special title

Most common RBC abnormality

10

What is reticulocytosis

Increase in reticulocytes signaling marrow response to anemia

11

What is polychromasia

New immature RBC's made in response to anemia are bigger and blue

12

Two GI losses causing anemia and their patient type

1. Peptic Ulcer: Adult males
2. GI Neoplasm: Elderly

13

One GYN loss causing anemia and patient type

Woman with menorrhagia

14

Intravascular sees decrease in what two proteins

Hemopexin and Haptobloin due to binding Iron

15

Extravascular hemolysis is done by what two things?

1. Spleen
2. Liver macrophages

16

What are the Hb and HCT level changes in extravascular hemolysis?

None

17

Intravascular hemolysis due to mechanical causes include?

Microangiopathic hemolytic anemias
Mechanical heart valves

18

What is the principal finding in microangiopathic hemolytic anemias

Schistocytes

19

Three types of microangiopathic hemolytic anemias?

1. Disseminated Intravascular coagulation
2. Hemolytic uremic syndrome
3. Thrombotic thrombocytopenic purpura

20

Three things elevated in DIC only?
Common patient type

D-dimer
PTT
PT

Pregnant

21

Hemolytic uremic syndrome is what age?
Cause?

Children
Toxin damage

22

Thrombotic thrombocytopenic purpura is due to what?
Patient type?

Adams 13 mutation
Young women

23

Microangiopathic hemolytic anemias have what common cause?

Lumen narrows and injures RBC's causing them to lyse and form schistocytes

24

Hereditary spherocytosis
Heredity
Ethnic group
2 proteins affected
Mechanism of path
Characteristic cell shape
One sequelae to know
Diagnose how?
Treatment?
Result of treatment

Autosomal Dominant
Scandinavians
Ankyrin and Spectrin
Lose parts of membrane over time and become sphere
Spherical
Cholelithiasis
Osmotic fragility
Splenomegaly
Howell Jolly Bodies

25

G6PD deficiency
What does G6PD normally make
Function of this product
Heredity
Moderate version ethnicity
Severe version ethnicity
Causes (3)
Typical histo finding in cells
Typical cell shape

NADPH
Reduces glutathione to protect against ROS
Recessive X-linked
African = moderate
Mediterranean = Severe
Antimalarials, Sulfonamides, Fava beans
Heinz bodies
Bite cells

26

Paroxysmal nocturnal hemoglobinuria
Congenital or acquired
Mutated gene
Loss of what proteins
Result of lost proteins
Most common cause of death
LAP score
Timing of hemolysis

Acquired
X-linked PIGA gene mutation
Loss of GPI proteins so no CD55/DAF or CD59/MIRL
Complement binds to RBC's at night and lyses them.
THrombosis
Decreased
Episodic at night

27

Immune hemolytic anemias definitive tests (2)

1. Positive antiglobulin test (DAT)
2. Direct Coomb's test

28

Alloimmune hemolytic anemia definition

Make Ab's against foreign RBC's

29

3 times alloimmune occurs

1. Immediate transfusion reaction
2. Delayed transfusion reaction
3. Hemolytic disease of newborn

30

Immediate transfusion reaction
Type of hemolysis
Antibody type

Intravascular
Preformed ABO IgM antibodies

31

Delayed transfusion reaction
Type of hemolysis
Timing
Antibody type

Extravascular
4-6 days after transfusion
IgG Ab's against RBC's

32

Hemolytic disease of newborn
Antibody type
Type of hemolysis
Treatment
What to do before birth
Most common situation

IgG against RBC's of newborn
Extravascular
Treat with Rhogam
Plasmapheresis
Mom's Anti-D Ab's against Fetal D antigen

33

Warm AIHA
Antibody
Temperature
Primary or secondary
Secondary causes (2)
Hemolysis type
RBC shape

IgG
37 degrees
Primary 50%
RE neoplasm or Collagen vascular disease
Extravascular
Spherocytes

34

Cold AIHA
Antibody
Temperature
Normal Cold Auto Ab's

IgM
4 degrees
Auto Ab's: Anti-I, Anti-H, Anti-IH

35

Acute gold agglutinin AIHA
secondary to what?

Mycoplasma

36

Cold agglutinin syndrome
Secondary to:
Common presentation
Specific antibody
Lab test:

Infection or lymph neoplasm
Elderly guy with lymphoma
Anti-I
DAT+

37

Paroxysmal COld hemoglobinuria
Common presentation
Specific AutoAb
Lab test
Name of this antibody:

Children with viral infection
Autohemolysin
Biphasic IgG Ab with Anti-P specificty
Donath-landsteiner antibody

38

Drug induced hemolytic anemia
Antibody
Two drug types

IgG
1. antigenic drugs
2. Alpha-methyldopa

39

Sickle Cell geography

Africa and Mediterranean

40

Hemoglobin C location

West Africa

41

Hemoglobin E location

SE asia

42

Beta Thalassemia
Characteristic cell
Characteristic intracellular sign
Clinical features (2)

Target cells
Basophilic stippling
Crewcut X-ray
WIdened facial bones

43

Beta minor hemoglobin change

Higher HgbA2

44

Beta major hemoglobin change

Absent HgbA and Increased HbF

45

How to distinguish between Beta minor and Fe deficiency?

Fe levels

46

Alpha thalassemia
4 betas forms what
4 gammas forms what

4 Betas: HbH
4 gammas: Hb Barts

47

Alpha thalassemia one gene deletion.
Only difference

Hb Barts at birth

48

Alpha thal two gene deletion
Only difference
The mutation that is far more severe and what ethnic group

Hb barts at birth

Cis mutation (same chromosome) causes hydrops fetalis in Asians

49

Three gene deletion alpha thal
Hb change?
Result?

Hemoglobin H disease (beta tetramers)

Extravascular hemolysis

50

Four gene deletion alpha thal

Hydrops fetalis with hemoglobin barts

51

How to determine alpha thal in lab? (3)

1. Target cells
2. Abnormal hemoglobins (barts and HbH)
3. Hemoglobin H inclusions with cresyl blue stain

52

Hemoglobin S
Inheritance
Mutation
Main population in US
Trait advantage
If infarction occurs what is result
One primary clinical finding

Autosomal recessive
Valine to glutamine on Beta globin chain
Blacks
Malaria protection
Autosplenectomy
Salmonella osteomyelitis

53

Sickle cell trait
Cell findings
Lab test
Hemoglobin changes

Target cells and sickle cells
Cloudy sickle solubility test
60% HbA and 40% HbS

54

Hemoglobin C
Main lab finding in disease
Hb change in Disease
Hb change in trait
Trait advantage

Hemoglobin C crystals
HbC 90% with increased HbF
HbA 60% and HbC 40%
Malaria protection

55

Hemoglobin E
Trait advantage
Trait hb levels
Disease hb levels

Protective against malaria
equal HbA and HbE
No HbA and 95% HbE

56

3 megaloblastic anemia causes

1. Vitamin B 12 deficiency
2. Folic acid deficiency
3. Methotrexate

57

First sign of defective DNA synthesis in megaloblastic?
Other cell finding later

Hypersegmented neutrophils

Oval macrocytes

58

Vitamin B 12 deficiency results in what symptoms? (2)

1. Glossitis
2. Subacute combined degeneration of spinal cord

59

Pernicious anemia
Path mech
Ethnic group

Auto antibodies against B-12-IF binding
Scandinavians

60

Common B 12 deficiency causes 3

1. Impaired absorption
2. Parasites
3. Removal of GI (gastrectomy or ileal)

61

Folate deficiency cause 3

Decreased intake
Impaired absorption
Blocked activation by Methotrexate

62

Only diet patient type to be concerned with B12 deficiency?

Vegans

63

Malabsorption symptoms make you think what anemia?

Folate deficiency

64

Neurologic symptoms make you think what anemia?

B12 deficiency

65

Schilling test
First part
Second part

Irradiated B 12 only
Irradiated B12 with Intrinsic factor

66

Methylmalonic acid increase, think what?

B12 deficiency

67

Iron is stored how

Ferritin

68

Iron is transferred how

Transferrin

69

Absorption of iron occurs where?
What regulates

Duodenum
Hepcidin

70

When is hepcidin made?
Function

When liver iron stores are high.
Block absorption

71

Most common cause of iron deficiency

Chronic blood loss

72

Iron deficiency symptoms? (3)

1. Koilonychias
2. Pica
3. Alopecia

73

Iron deficiency anemia iron studies
Serum iron
TIBC
Percent saturation
Ferritin

Serum iron: Decreases
TIBC increases
Percent saturated decreases
Ferritin decreases

74

Anemia of chronic disease
Common patient type
Serum iron
TIBC
Saturation
Ferritin
EPO

Hospitalized patients
Low serum iron
Low TIBC
Normal saturation
High ferritin
EPO low

75

Aplastic anemia
What cell lines involved
2 drug causes

Pancytopenia
Chloramphenicol and Dilantin

76

Pure red cell aplasia causes (4)

1. Drug/virus
2. Thymoma
3. Large granular lymphocytic leukemia
4. Autoimmune disorders

77

SIderoblastic anemias
Cell finding
Primary hereditary cause
Acquired primary cause
Secondary cause

Ringed sideroblasts (iron accumulating in mito)
Congenital sideroblastic anemia
Myelodysplastic disorder
Drugs like Tb and alcohol

78

Primary hemochromatosis
Inheritance
Defective gene
Chromosome
Main manifestation

Autosomal recessive
HFE gene
Chromosome 6
Adult bronze diabetes

79

Lead poisoning two main findings

Lead lines in bone and teeth
Basophilic stippling

80

Myelophthisic anemia
Main histo finding

Teardrop cells = Dacrocytes

81

Icterus suggests what

Hemolytic anemia

82

subacute combined degeneration suggests what

Pernicious anemia

83

Helmet cells/Schistocytes suggests what?

Hemolytic anemia

84

Target cell suggests what? (2)

1. Hemoglobinopathies
2. Iron deficient anemia

85

Heinz bodies suggest what?

G6PD deficiency

86

Basophilic stippling suggests what?

Lead poisoning or thalassemia

87

Location for bone marrow exam?

Posterior superior iliac spine