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RBC Disorders Flashcards

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1
Q

1) Source of erythropoietin
2) Formation of granulocytes and monocytes
3) Commonest site bone marrow taken
4) Distinguish b/w IDA & Thalessemia trait
5) Formation of platelets require
6) Drug given to anti cancer patient in anemia
7) Recombinant GM-CSF & G-CSF
8) Recombinant IL-11

A

1) Peritubular cells of kidney
2) GM-CSF & G-CSF
3) In adults - post sup iliac spine
In child - Tibia
4) Mentzer index for IDA >13 & Thalessemia <13
5) IL-11
6) Darbopoeitin
7) Sargramostin & Filgrastim
8) Oprelvekin

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2
Q

1) Formation of platelets require
2) Drug given to anti cancer patient in anemia
3) Recombinant GM-CSF & G-CSF
4) Recombinant IL-11
5) RDW
6) Anemia diagnosis criteria

A

1) IL-11
2) Darbopoeitin
3) Sargramostin & Filgrastim
4) Oprelvekin
5) Variation in size of RBCs (anisocytosis)
11.5-14.5
6) Male -13 g/dl
Female - 12 g/dl
Pregnant female - 11 g/dl

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3
Q

1) First cell having appearance of Hb
2) Routine staining appearance of Hb
3) Last stage in development of nucleated RBC
4) Reticulocyte Normal range & stain
5) Reticulocyte is called
6) Maintains shape of RBC
7) MCV
8) MCH
9) MCHC

A

1) Erythroblast
2) Intermediate normoblast
3) Late normoblast
4) 0.5-2% & supravital stain - new methylene blue
5) Poorman bone marrow aspirate
6) Spectrin
7) 80-100 femtolitres
8) Hb inside RBC 27-32 picograms
9) 34-37 g/dl ; <34 - anemia

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4
Q

Examples of microcytic RBCs

A 
<80 FL
Sideroblastic anemia 
Iron deficiency anemia (MC)
Thalessemia 
Anemia of chronic disease 
Lead poisoning
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5
Q

Examples of macrocytic RBCs

A 
>100 FL 
Liver disease 
Hypothyroidism 
Megaloblast (B12, folate def.; Methotrexate)
Cell changes
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6
Q

Findings in hemolytic anemia

A 
Anemia 
Serum LDH inc
Unconjugated bilirubin & jaundice
Free Hb (toxic) release attach to Haptoglobin
Dec. in haptoglobin 
Hemoglobinemia & hemoglobinuria
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7
Q

Hemoglobinuria causes

A 
Altered color of urine
Acute tubular necrosis 
Renal hemosiderosis
Inc. in bone marrow activity causes decrease in M:E ratio 
Reticulocytosis
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8
Q

Myeloid: Erythroid ratio

A

Normal 3:1

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9
Q

CHRONIC hemolytic anemia causes

A

Unconjuagted bilirubin + Calcium salts = pigment gallstones

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10
Q

Jaundice + anemia + alteration in urine color

Jaundice + anemia + alteration in urine color + heaptosplenomegaly

A

Intravaacular hemolytic anemia

Extravascular hemolytic anemia

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11
Q

Intracorpuscular hemolytic anemia

Extracorpuscular hemolytic anemia

A

Inherited - Hereditary Spherocytosis, G6PD def., Thalessemia, sickle cell anemia

Acquired - PNH

Non immune - Clostridium infection , lead poisoning

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12
Q

1) Which form of iron is utilised for absorption?
2) Receptor
3) Site of absorption
4) Transporter on basal surface responsible for bringing iron inside body
5) Factors responsible for iron absorption
6) Factors causing IDA

A

1) Ferrous form Fe2+
2) DMT -1
3) Duodenum
4) Ferroportin
5) Vit C as Ascorbic acid, HCL,Amino acids , sugar
6) Chronic disease iron deficiency renal disease

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13
Q

Factors decreasing iron absorption

A

Phytate present in Vegetables
Carbonate
Tetracycline **

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14
Q

1) Plasma protein transporting iron inside blood
2) 1 molecule of this protein transports how many iron molecules
3) TIBC
4) % saturation Tf
5) Serum iron

A

1) Transferrin
2) 2
3) 360 mg/dl
4) 33%
5) 120 mg/dl

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15
Q

1) Iron storage form
2) This is getting converted into
3) Calculate 2) level with ____ stain

A

1) Ferritin
2) Hemosiderin
3) Prussian blue called Pearls reaction

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16
Q

1) Iron deficiency
2) Changes in blood picture - iron profile changes
3) Gold standard for diagnosis
4) Blood test shows

A

1) Koilonychia, pica, pallor, dyspnea, palpitations
2) serum ferritin dec.
Transferrin saturation dec.
Serum iron dec.
TIBC inc.*****
3) Bone marrow examination
4) dec. Hb, MCV MCH MCHC all dec.
RDW inc. (pencil shaped RBC)
Target cell
Microcytic hypochromic anemia
Anisocytosis
Poikilocytosis
Free protoporphrin inc.

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17
Q

Most sensitive indicator of IDA
Rx for children
Rx for adult

A

Serum ferritin
Antihelminthic like Albendazole
Fe supplement like ferrous sulphate Fe2+

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18
Q

When parenteral iron is given

A

Oral iron is not tolerated
Iron dextran & iron sorbitol citrate
Given by ‘Z’ tract technique

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19
Q

1) Anemia of chronic dis which interleukin secreted & its action on bone marrow & liver
2) Rx

A

1) IL-6 ==> dec. erythropoietin
Normocytic normochromic anemia
serum ferritin inc.**
Transferrin saturation dec.
Serum iron dec.
TIBC dec.

Hepcidin - Inhibit metabolism of iron
Causes microcytic hypochromic anemia

2) Treat primary cause

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20
Q

1) Vit B12 is also called
2) Vit B12 absorbed in
3) Stomach secretes
4) What causes B12 & IF attachment

A

1) Cyanacobalmin containing cobalt
2) Absorbed in ileum****
3) Pepsin & Intrinsic factor
4) Pancreatic enzymes

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21
Q

Causes of dec. absorption of B12

A 
Vegans and alcoholics 
Surgery 
Pernicious anemia (Oral B12 not efficient )
Pancreatic insufficiency 
Bacterial overgrowth syndrome 
Iliacdisease
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22
Q

Reaction of 1 carbon transfer

A

B12 and FA
Homocysteine——-> Methionine

DNA synthesis B12

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23
Q

Increased homocysteine

A

Thrombosis

Atherosclerosis

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24
Q

B12 reaction only

A

Methylmalonyl CoA—–> Succinyl CoA required for myelin

Neurological deficits

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25
Increased methylmalonyl
Methylmaloniemia | Methylmaloneuria
26
Bone marrow studies in B12 deficiency
Pancytopenia (ineffective erythropoeisis) RBCs : Macrocytic = Megaloblast, oval shape= Macrovaloblasts Howell Jolly bodies, Cabot rings WBCs : Hypersegmented neutrophils Platelets : Abnormal megakaryocytes
27
GIT findings in B12 deficiency Neurological symptoms
Mucosal atrophy Tongue : smooth appearance ``` Paraesthesia Tingling sensation CNS : spinal cord involvement Dorsal column more commonly affected Sub Acute Combined Degeneration = SACD ```
28
Blood studies shows what in B12 deficiency
Hb dec. MCV inc. MCHC NORMAL******
29
Schilling test
Not useful for diagnosis of B12 | Dons for differentiating causes of absorption
30
Infection causing B12 deficiency
Fish tapeworm = Diphyllobothrum latum
31
Pernicious anemia | Treatment
Autoantibodies + auto reactive T-cell against parietal cells Dec. IF Type 2 Hypersensitivity reaction Cause intestinal metaplasia in fundus of stomach Parenteral B12 (IM)
32
B12 parenteral is given in
Pernicious anemia | CYANIDE POISONING *****
33
Increase in MCHC occurs only in
Hereditary spherocytosis
34
Sickle cell trait relation with falciparum
Protective Any kind of Hbpathy & G6PD deficiency is protective
35
1) Folate is absorbed in 2) Most active form of folic acid 3) Diagnosis
1) Jejunum 2) Methyl THF-----> THF which is useful for Methylene THF ----> DHF forms dTMP useful for DNA synthesis 3) RBC folate levels which do not fluctuate
36
Folate trap
Due to B12 deficiency in form of Methyl THF
37
Causes of secondary folate deficiency
Alcohol Phenytoin Methotrexate inhibits DHF reductase DHF reductase DHF------------------>THF
38
Megaloblastic anemia but no neurological symptoms
Folate deficiency
39
Histidine metabolism
FA Histidine ----> FiGLU-------> Glutamate FiGLU in urine
40
Folate in pregnancy
Prior to conception so as to avoid neural tube defects such as spina bifida
41
Hereditary spherocytosis | Rx
``` AD Ankyrin is defective Jaundice Anemia Splenomegaly Anisocytosis & hyperchromic spherocytes Microspherocytes Loss of central pallor of RBC ``` MCV dec. MCH Normal MCHC inc. Elective splenectomy Higher chance of infection- capsulated org.
42
Grave of RBC | CORDS OF BILLROTH
Spleen
43
Spherical RBCs seen in
Autoimmune hemolytic anemia and not spherocytosis
44
Osmotic fragility test also called as
Pink test RBCs placed in Hypotonic solution Increased in spherocytosis Decreased in sickle cell disease
45
Increased bone marrow activity in spherocytosis
Increased erythroid precursor
46
G6PD deficiency | G6PD Mediterranean
X LR Self limiting hemolysis Prevents oxidative damage to RBC G6PD Glucose 6 PO4----> 6 phospogluconate Forms NADPH----> Reduced glutathione In Mediterranean form, Blister cells seen Coombs negative
47
Oxidative stress
Hb denaturation ---> HEINZ BODY (intracellular inclusion) Crystal violet stain Intravascular & extravascular hemolysis BITE CELLS in peripheral smear BLISTER CELLS
48
Etilogy of oxidative stress
Fava beans Infections SULPHONAMIDES NITROFURANTOIN ANTI MALARIAL DRUGS (primaquine)
49
Sickle cell anemia
AR Point mutation at 6 beta globin chain Valine instead of GLUTAMIC ACID Polymerisation of deoxygenated Hb BetaS Hypoxia & dehydration RBC sticky & trapped into spleen Sickle cell trait & disease ---HbS Extravascular hemolytic anemia
50
Irreversible sickling
Micro vascular occlusion Bones : Dactylitis ; Hand foot syndrome, avascular necrosis of femur ** Vertebral column : cord fish vertebra H shaped vertebra , fish mouth vertebra Skull: Crew cut appearance= hair on end Osteomyelitis : Salmonella & staph aureus Skin : non healing ulcer in lower limb Penis : Priapism Lungs : acute chest syndrome Kidneys : papillary necrosis also in DM, hyposthenuria
51
Sickle cell anemia changes in spleen
Spleen : Early : Congestive splenomegaly GANDY GAMMA BODY Late : Autosplenectomy
52
ESR in sickle cell
Dec. ESR Dithionite metabisulfite removes O2
53
Distinguish sickle cell trait & disease
HPLC gives % of HbS & HbA Hb electrophoresis
54
Complications in sickle cell
Vaso-occlusion crisis | Sequestration crisis
55
Drug in sickle cell
Hydroxyurea Inc. HbF Used as anti cancer drug
56
Factors responsible for sickling
HbS Dehydration & deoxygenation Acidosis Infections
57
Intake of primaquine acts as a trigger for hemolysis in
G6PD deficiency
58
Banana like finding in smear
Plasmodium falciparum causing malaria
59
Hereditary spherocytosis
Due to chronic hemolysis, pigmented stones are formed in gallbladder Howell Jolly bodies seen
60
Hereditary elliptocytosis
Polymerisation of spectrum molecules
61
Spherocytosis is seen in
``` Hereditary spherocytosis Autoimmune hemolytic anemia Hemolytic disease of newborn Post transfusion Heinz body hemolytic anemia (G6PD def.) Water dilution hemolysis Fragmentation hemolysis (burns, mechanical trauma) ```
62
Gene deletion | Gene mutation
Alpha Thalessemia Chr.16 4 genes ``` Beta Thalessemia (MC) Chr.11 2 genes ```
63
Beta zero beta zero
AR Thalessemia major Transfusion dependent Thalessemia Iron overload
64
Alpha chain precipitation
Direct damage to normoblasts Extravascular hemolysis Causing anemia Jaundice hepatosplenomegaly
65
Thalessemia features
Extra medullary hematopoeisis due to increased erythropoietin Chimpanzeee chipmunk like fancies Microcytic hypochromic anemia Target cells Basophilic stippling HLPC shows : HbF elevated in major HbA2 elevated in minor >3.5 g/dl
66
Test for BETA Thalessemia
Nestrof test ---> screening test HbA2 inc.
67
ALPHA Thalessemia
Beta 4 tetramer = HbH Has too much affinity for O2 Hypoxia Fetal : Gamma 4 tetramer = Barts Hb Hydrops fetalis
68
Autoimmune hemolytic anemia
Type 2 hypersensitivity Direct Coombs test Warm : IgG >> IgA Idiopathic, SLE, rheumatoid arthritis, CLL, ALPHA METHYLDOPA Cold : IgM >> IgG INFECTIOUS MONONUCLEOSIS, Mycoplasma , malgnancies (Walden storm macroglobulinemia)
69
Agglutination of RBC
IgM
70
Paroxysmal Cold Hemoglobinuria in child
IgG Attached at 4 degrees & activates at 37degrees Altered color of urine at cold temp. Biphasic antibidy = Donath Landsteiner Ab Intravascular hemolysis
71
Aplastic anaemia caused by drugs
Chlorpromazine Allopurinol Diclofenac

Pathology (2 decks)

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