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Clinical Pathology > Normo/Normo, Macro, & hemolytic > Flashcards

Normo/Normo, Macro, & hemolytic Flashcards

1
Q

What are the 4 causes of deficient erythropoieisis?

A

Renal Disease (any kidney damage)
Hypothyroidism (endocrine failure)
Aplastic Anemia
Myelophithisc

ACD can present as normo/normo as well as Micro/hypo

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2
Q

Decreased O2 need–> decreased ??? –> Decreased Basal Metabolism–> Decreased ???

A

EPO
RBC production

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3
Q

List causes of chronic kidney disease

A

Diabetes mellitus
Chronic Hypertension
Glomerulus Nephritis
Polycystic Kidney Disease
Recurrent Kidney Infection

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4
Q

Kidney excretory failure means it does not perform what two functions?

A

EPO secretion
Urine production

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5
Q

What do these symptoms indicate?
Edema & fluid build up
hypertension
fatigue
decrease urine output
increase in urination frequency
muscle cramping

A

Renal insufficiency

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6
Q

What will a CBC show of someone with kidney damage/renal insufficency?

A

Anemia
Normo/Normo
PBS= Echinocytes

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7
Q

What are the expected UA results of someone with renal damage?

A

Proteinuria

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8
Q

What additional tests can you run for someone that has expected kidney damage?

A

Kidney Function Test
Refer to Nephrologist for Renal Imaging

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9
Q

How can hypothyroidism cause a Normo/Normo anemia?

A

Decreased T4–> Decreased T3= decreased metabolism–> decreased O2 requirement–> decreased EPO output–> decreased RBC production

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10
Q

How can hypothyroidism cause a Hypo/Micro anemia?

A

Hypothyroid causes heavy menses–> chronic blood loss–> decreased iron ferritin–> decreased Iron serum–> IDA

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11
Q

How can hypothyroidism cause a Macrocytic anemia?

A

Decreased metabolism due to low T4 & T3–> decreased function of parietal cells–> decreased I.F. & decreased stomach acid–> decreased absorption of B12–> leads to decreased B12 deficiency= Macro.

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12
Q

What are the symptoms of Hypothyroidism? (7)

A

Fatigue
Brain fog
Increased sensitivity to cold
Constipation
Weight gain
Weakness
Thinning of out 1/3 of eyebrow

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13
Q

Since hypothyroidism can result in 3 different anemias what additional tests can be performed to diagnose it?

A

Thyroid Panel (determine function)
Iron panel
Serum B12 (can pair with a RBC folate test as well)

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14
Q

Patient with confirmed hypothyroidism has a macrocytic anemia from a B12 deficency. Best way to treat the patient?

A

Hormonal therapy. Correct the primary disease to treat the secondary disease as well.

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15
Q

What is the term for all of the tissue cells in the bone marrow has decreased production?

A

Panhypoplasia

(pancytopenia & hypocellular bone marrow)

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16
Q

What are the etiological causes of Aplastic Anemia?

A

Idiopathic
Drugs
Viral (immunocompromised)
Toxic exposure- glues, pesticides
Immune disorders
Congenital- Fanconi Anemia
Radiation treatment

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17
Q

What is the congenital cause of aplastic anemia called?

A

Fanconi Anemia- congenital failure of marrow

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18
Q

Which anemia has an increased susceptibilty to infections?

A

Aplastic anemia (decreased WBCs)

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19
Q

Aplastic anemia has an issue with bleeding tendencies due to?

A

Decreased platelets

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20
Q

What are the CBC findings of aplastic anemia?

A

Normo/Normo Anemia
Leukopenia of less than 1500 WBC
Neutropenia (all WBCs down)

Low reticulocyte count
Hypocellularity on bone marrow biopsy

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21
Q

Treatment for aplastic anemia?

A

Bone Marrow Transplant
(often refractory)

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22
Q

What are the 4 etiological causes of myelophthisic anemia?

A

Carcinoma metastasizing to bone marrow from primary tumor
Myelofibrosis
Myeloproliferative conditions
Osteopetrosis

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23
Q

What is myelofibrosis?

A

Polycythemia Vera elevating all cell lineages but leads to bone marrow replacement by scar tissue

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24
Q

What are 4 examples of myeloproliferative conditions?

A

Multiple myeloma, Leukemias, Lymphoma, Hodgkin’s

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25
Q

What condition results from increased bone deposition taking up bone marrow space?

A

Osteopetrosis

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26
Q

Myelophthisic anemia has 3 sets of symptoms. What are they?

A

Symptoms of Anemia
Symptoms of Underlying disease
Hepatomegaly & Splenomegaly

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27
Q

What lab findings indicate Myelophthisic anemia?

A

Normo/Normo anemia
Nucleated RBCs (due to increased production rate)
Reticulocytosis
Polychromatophilia (blue-ish RBCs)
Tear drop RBCs on PBS

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28
Q

What is the term for blue tinted RBCs?

A

Polychromatophilia

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29
Q

Why are the RBCs on a PBS for Myelophthisic anemia tear drop shaped?

A

Due to lack of space and squeezing the RBCs

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30
Q

What is significant about WBCs in a macrocytic anemia? What is this an early indicator for?

A

Hypersegmented Neutrophils; B9/B12 deficiency

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31
Q

What “bucket” does megaloblastic/Macrocytic anemias fit in?

A

Decreased production

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32
Q

How long is B12 stored in the liver?

A

5-6 years

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33
Q

What does B12 do to folic acid?

A

Reduces to Folate

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34
Q

B12 is important for?

A

Myelin synthesis

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35
Q

There are 3 systems that make tissues rapidly that are most affected by B12 deficiency. What are they?

A

GI tract
Hematopoetic system
Neuro system

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36
Q

How long could a B12 deficiency take to develop after a gastrectomy/gastric bypass? Why does this happen?

A

3-6 years due to liver storage.
Happens due to decreased intrinsic factor= less B12 absorbed

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37
Q

What are the 3 causes to deficient intrinsic factor?

A

Gastrectomy/Gastric Bypass
Myxedema (hypothyroidism)
Pernicious Anemia (Most Common)

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38
Q

What is Pernicious Anemia?

A

auto immune attack on intrinsic factor and/or parietal cells leading to B12 deficiency

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39
Q

What is Myxedema?

A

Severe Hypothyroidism

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40
Q

What does Myxedema cause?

A

Decreased in parietal cells & chief cells= decreased I.F. & stomach acid= less B12 absorption

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41
Q

What group should be supplementing B12 in their chosen diet?

A

Strict Vegans

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42
Q

What GI syndromes lead to B12 malabsorption syndromes?

A

Celiac Disease
Crohn’s disease
SIBO (small Intestinal Bacterial Overgrowth)
Chronic pancreatitis or pancreatic cancer

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43
Q

Why could you see discoloration of the skin (mild jaundice) in a B12 deficiency?

A

Megaloblast cells get destroyed at a higher rate.
Macrocytic blood cells are not as flexible/strong leading to increased free bilirubin

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44
Q

What are the 3 patient presentation categories for B12 deficiency anemia?

A

Hematopoetic
Gastrointestinal
Neurological

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45
Q

What are hematopoetic signs in patient presentation?

A

Anemia (any signs)
Discoloration of the skin

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46
Q

What are the gastrointestinal patient presenations for B12 deficency?

A

Glossitis- sore, “beefy red” tongue
Weight loss (digestive issues)
Anorexia (digestive complaint)
Constipation w/ diarrhea
Poorly localized abdominal pain

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47
Q

What is typically the 1st presentation & the MC complaint of B12 def?

A

Neurological- numbness/tingle in BIL hands & feet that moves proximal as it progresses

Can progress to DWC= loss of vibratory & position sense and ataxia

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48
Q

What do you expect to see on a neuro exam for B12 Def?

A

⬇️ position sense
⬇️ Vibratory sense
abnormal reflex
ataxia
(+) Babinski sign
extremity numbness
hypoalgesia “sock & glove”

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49
Q

List the 5 MC physical exam findings of B12 Def. anemia

A

Weight loss
Glossitis
Hepatomegaly/Splenomegaly
Skin pigmentation change (mild jaundice)
Anemia symptoms

50
Q

CBC shows=
Anemia= Macrocytic
Anisocytosis= ⬆️ RDW
Mild Leukopenia
Mild Thrombocytopenia
PBS= Hyper-segmented neutrophils
What could this be?

A

B12 deficiency anemia
B9 deficiency anemia

51
Q

What would the chem panel for B12 def. anemia look like?

A

⬆️ Serum bilirubin- Unconjugated (will NOT show up on UA)
⬆️ LDH isoenzyme 1 (found IN RBCs)

52
Q

What special tests should you run to confirm B12 Deficiency anemia?

A

Serum B12
Follow up w/ Auto-antibody test for I.F. & Parietal Cell antibodies
MMA test- WNL B12 and ⬆️ MMA shows B12 is not being used by the body

53
Q

What does the timeline for B12 Tx look like?

A

Hematologic correction- 6 weeks
Neural improvement- can take up to 18 months
Retest Serum B12 every 1-2 month post high dosing Tx. MMA as well to see it is being utilized

54
Q

What is the precaution with folic acid Tx?

A

Folic acid treatment without B12 in patients who have pernicious anemia is contraindicated. Can cover up early symptoms and/or make neuro symptoms worse

55
Q

What is the function of Folic acid?

A

Needed for synthesis of purines & pyrimidines aka DNA maturation

56
Q

Where is B9 absrobed?

A

Duodenum & jejunum

57
Q

What is the ONE test that will differentiate Folic Acid deficiency from B12 deficiency?

A

RBC Folate Level= Would be ⬇️ & serum B12 would be WNL

58
Q

What groups are at risk for folate def?

A

Deficient dietary intake- “tea & toasters” or Chronic Alcoholics
Chronic Liver Disease
Increased requirements- Pregnancy & lactation

59
Q

MC cause of B9 def?

A

Pregnancy & lactation

60
Q

What are the symptoms of B9 def? What is the one symptom that B9 does NOT share with B12?

A

Anemia Sx’s
Gi disturbance
Does NOT have neuro deficits

61
Q

This is your CBC panel=
Anemia= Macrocytic
Anisocytosis= ⬆️ RDW
Mild Leukopenia
Mild Thrombocytopenia
PBS= Hyper-segmented neutrophils, Macrocytes.

You think it is B12 or B9 deficiency. What tests are you using to decide between the two?

A

Serum B12
RBC folate

62
Q

How are you treating B9 def?

A

Active Folate (5-MTHF)
400-1000 mg/day
1-3 months, then retest

400-800mcg/day for pregnancy through lactation

63
Q

What does hemolytic anemia mean?

A

Shortened RBC lifespan,
hemolysis,
Bone marrow production can not keep up

64
Q

What 3 clinical findings can occur with hemolytic anemias?

A

Jaundice
splenomegaly
hepatomegaly

65
Q

What lab tests should be run for all hemolytic anemias?

A

LDH levels
Serum Unconjugated bilirubin
Serum Haptoglobin
Reticulocyte count

66
Q

What are the 4 genetic categories of hemolysis due to intrinsic RBC defects?

A

Hereditary spherocytosis
G6PD defects
Sickle Cell anemia
Thalassemia

67
Q

Congenital issue with the extracellular matrix of RBCs that results in it not being able to maintain a biconcave shape

A

Hereditary Spherocytosis

68
Q

What is this?
CBC=
Mild/Moderate Anemia
Hb not below 8g/dL
MCHC ⬆️ (unique to this anemia)

PBS= Spherocytes

A

Hereditary Spherocytosis

69
Q

What test is used to confirm Spherocytosis?

A

Osmotic Fragility Test= will be ⬆️

70
Q

How do you manage Spherocytosis?

A

Blood Transfusions
Splenectomy

71
Q

What does G6PD cause?

A

⬆️ Reactive Oxygen Species (⬆️ cell damage)
Heinz Bodies (darkened areas on RBC)
Bite Cells (macrophages attacking the Heinz Bodies)

72
Q

Why is G6PD Def Anemia more common in males?

A

it is an X-linked abnormality

73
Q

When does G6PD anemia start?

A

Normal life until “triggered”=
Certain drugs
Certain chemicals
Infections- Viral & bacterial
Stressors
FAVA BEANS

74
Q

What are the clinical findings of G6PD anemia?

A

Any anemia, jaundice, & hepat/splenomegaly
Difficulty fighting infections due to neutrophil involvement

75
Q

What does the following lab findings indicate?
CBC- Moderate anemia
PBS- Bite cells

A

G6PD anemia

76
Q

What are the 2 types of Sickle Cell Anemia?

A

Homozygous (inherit 2 bad genes)= sickle cell anemia
Heterozygous (inherit 1 bad gene)= sickle cell trait

77
Q

Why is Sickle Cell Trait not as serious as Sickle Cell Anemia?

A

SCT is usually asymptomatic w/o anemia. There is not enough of an abnormality in the Hb of SCT to create sickle cells so there is far less risk

78
Q

What causes issues with Sickle Cell Trait?

A

Exertional Sickling=
caused by intense physical activity
dehydration
Low O2/High Alt

79
Q

What causes sickle cell anemia?

A

Beta chains of Hb not synthesized correctly

80
Q

What are the normal levels of Hb A, Hb F, & Hb A2?

A

HbA= 95-98% of Hb
HbF= 2-3%. Larger percentage until 6 months.
HbA2= 0-1%

81
Q

What chains make up each Hb?

A

HbA= 2 alphas, 2 Betas
HbF= 2 alphas, 2 Gammas
HbA2= 2 alphas, 2 deltas

82
Q

Why is the substitution for Valine in place of Glutamic Acid what causes Sickle Cell Hb and the sickle shape?

A

Valine is hydroPHOBIC
Glutamic Acid is hydroPHILIC

83
Q

What complications can sickle cells cause?

A

Odd shape, rigidity causes Increased blood viscosity
Stasis
Obstruction of arterioles and capillaries
Ischemia
Fragile= increased hemolysis

84
Q

What are the steps to a vaso-occlusive crisis?

A

Vascular occlusion –> tissue hypoxia–> tissue necrosis–> pain

*Tissue necrosis can cause ulcers**

85
Q

What are symptoms of vaso-occlusive crisis?

A

Symmetrical painful swelling of hands & feet
increased infection risk
Painful bones, joints, abdomen, back, & viscera

86
Q

What are the CBC results for someone in SCT/SCA crisis?

A

Moderate to severe anemia
RBC indicies WNL
Leukocytosis
Thrombocytosis

PBS= Sickle cells

87
Q

What test seems odd to be decreased in SCA but is possible due to the function of the RBCs?

A

Decreased ESR= Sickle cells can NOT form a rouleaux/stack due to shape

88
Q

What special tests are used to Dx Sickle Cell Anemia/Trait?

A

Hb electrophoresis

89
Q

What would the Hb Electrophoresis test results be for SCA & SCT?

A

SCA= 80-100% Hb S, no Hb A
SCT= 20-40% Hb S, 60-80% Hb A (still producing Beta Chains, just not as effectively)

90
Q

What percentage needs to be hit for HB S to present as an anemia?

A

60% or more Hb S

91
Q

What screening test is used for Hb S?

A

Sodium metabisulfite reduction test aka SickleDex Test

92
Q

When do crises in SCA typically start?

A

1-2 years old

93
Q

Thalassemia fits into what two categories of anemia?

A

Hypo/Micro
Hemolytic

94
Q

What is Thalassemia?

A

genetic disorder that affects the RATE of adult Hb synthesis

95
Q

Aka Cooley’s Anemia
Transfusions necessary to sustain life

A

B-Thalassemia Major

96
Q

two bad copies of the gene, more severe.
Defective production rates of β-globin polypeptide
Leads to both decreased Hb production and excessive hemolysis

A

β-Thalassemia Major

97
Q

Severe anemia
Jaundice- rate of destruction ⬆️
Splenomegaly
Hemolytic facies – maxillary hypertrophy, prominent forehead, can also have failure to thrive due to anemia
What is this?

A

β-Thalassemia Major

98
Q

What CBC would β-Thalassemia Major have? PBS?

A

CBC= Severe Anemia w/⬆️RBC Count (yes, weird)
PBS= Target Cells

99
Q

What special tests are used to Dx Thalassemia Major? What would you see?

A

Hb ELP (electrophoresis);
Significant reduction in Hb A w/ >50% of Hb F to compensate (up-regulation of Hb A2)

100
Q

How do you treat thalassemia Major?

A

Transfusions to push Hb >9.3
Folate supplements
Treat infection quickly
Splenectomy
Iron MANAGEMENT- not supplements, avoid iron rich foods

101
Q

β-Thalassemia Minor is frequently misdiagnosed as?

A

IDA

102
Q

why does β-Thalassemia Minor usually go unnoticed?

A

asymptomatic or mild anemia
(certain stressors can change this)

103
Q

What is this?
Mild anemia
Hb is typically >10
⬇️MCV/MCH/MCHC
RDW= WNL, can see a slight ⬆️ RDW at times
Slight ⬆️ RBC count

A

β-Thalassemia Minor

Anemia with an increased RBC count is unique to thalassemia conditions

104
Q

what would a PBS of β-Thalassemia Minor look like?

A

Hypo/Micro RBCs
Possible= Target cell RBCs

105
Q

What 3 special tests can you use to determine Thalassemia Minor?

A

Reticulocytosis count
Hb ELP
Calculate Mentzer index

106
Q

How do you calc Mentzer index? What do the results mean?

A

MCV/RBC count
>13 IDA
<13 Thalassemia

107
Q

How do you Tx Thalassemia Minor?

A

No Tx, live healthy, minimize stress

108
Q

What does Thalassemia Minor look like on an iron panel?

A

WNL iron panel

its not an iron issue, its Hb Rate. Iron supplements can make them worse

109
Q

Traumatic Hemolytic Anemia results from?

A

physical trauma

110
Q

What are the lab findings for Traumatic Hemolytic Anemia?

A

anemia, ⬇️ MCV, ⬆️ RDW
PBS Schistocytes

111
Q

The AKA for Traumatic Hemolytic Anemia is?

A

microangiopathic anemia

112
Q

Transfusion of incompatible blood types results in?

A

Isoimmune hemolytic anemia

113
Q

What are the 2 causes of hemolytic diseases in newborns?

A

ABO incompatibility
Rh Incompatibility

114
Q

What are the lab findings for Isoimmune anemia?

A

CBC:
Anemia
Elevation of unconjugated bilirubin
Special tests:
Coomb’s test (direct anti-globin test aka DAT)
Will be + in our immune mediated hemolytic anemias

115
Q

Acquired anemia induced by binding autoantibodies to RBC membrane is called?

A

Autoimmune hemolytic anemia (AIHA)

116
Q

Two types of AIHA are?

A

Warm (IgG antibody)
Cold (IgM antibody)

117
Q

Warm AIHA is which antibody and common with what?

A

IgG antibody
common with other autoimmune conditions

118
Q

Cold AIHA is caused by and common in? What antibody?

A

Cold exposure, MC in elderly, acrocyanosis, Raynaud’s; IgM antibody

119
Q

What are the risk factors for AIHA?

A

Autoimmune disorders
Prior blood transfusion
Malignancy
Medications

120
Q

What test will be positive with Warm or Cold AIHA?

A

Direct Coombs Test (DAT- Direct Antiglobulin Test)

121
Q

What kind of anemia will be seen with AIHA?

A

Normo/Normo

Clinical Pathology (9 decks)

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