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Haematology > Week 1: Anemias > Flashcards

Week 1: Anemias Flashcards

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1
Q

What are 4 things that cannot be detected by hematology analyzers?

A
  1. Bands - not counted
  2. Blasts - Counted as lymph or mono
  3. Red cell fragments - counted as platelets
  4. Platelet clumps - false thrombocytopenia
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2
Q

What is needed to reduce Methemoglobin?

A

Cytochrime b5 Reductase

NADH

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3
Q

What happens when RBCs don’t neutralize ROS?

A
  1. SH groups on proteins becomes cross linked to S-S –> Denature or precipitate Hgb 2. Fe is oxidized and cant carry O2 (Methemoglobin)
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4
Q

What is Anisocytosis? Poikilocytosis?

A

Variation in size

Variation in shape

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5
Q

A normal hemoglobin content appears grossly as what?

A

Central pallor 1/3 of total diameter of RBC

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6
Q

What are signs of rapid RBC regeneration?

A 
Basophilic 
Stippled (dotted) 
Nucleated 
Howell-Jolly bodies 
Cabot Rings
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7
Q

What element is needed for cellular respiration?

A

Fe

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8
Q

How many grams of iron are in the body? In Hgb? As storage (ferritin, hemosiderin)?

A

3.5 g in body
2g in Hgb
1g in storage

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9
Q

oxidation and genetic defects in hgb structure can result in ______.

A

precipitation of Hgb

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10
Q

What causes bite cells?

A

ppt’d (oxidized) Hg –> tissue-based phagocytes nom the RBC to try to fix the oxidized area

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11
Q

What is hematocrit (HCT)?

A

(Red cell volume)/(Entire blood volume)

[think of the sedimented RBC at the bottom of test tube]

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12
Q

Is Hgb or hematocrit a better measurement?

A

Hgb - according to Strom the Storm

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13
Q

What chemical is used in a [Hgb] test? Reticulocyte?

A

Cyanide

Methylene Blue - binds residual mRNA

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14
Q

What do you measure in direct current Coulter Chamber conductivity? Alternating?

A

Direct: peak number - cell count // peak height - cell volume :: cell type

Indirect: peak height only - cell complexity :: lobulated nuclei

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15
Q

What can a high Immature Platelet Fraction (IPF) indicate?

A

Thrombocytopenia - even if its due to reduced platelet production

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16
Q

What is the formula for mean cell hgb (MCH)? Mean cell Hgb concentration (MCHC)?

A

Hgb/RBC = MCH

Hgb/Hct = MCHC

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17
Q

What are 4 things that cannot be detected by hematology analyzers?

A
  1. Bands - not counted
  2. Blasts - Counted as lymph or mono
  3. Red cell fragments - counted as platelets
  4. Platelet clumps - false/artifactual thrombocytopenia
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18
Q

If a person loses 2.5 liters of blood, how many mgs of iron have they lost?

A

2,500mg Fe

1ml=1mg

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19
Q

Testing ferritin shows what? Solubility? Primary location in body?

A

Amount of Fe in storage

H2O solubility

Liver and spleen

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20
Q

Is ferritin or hemosiderin more readily mobilized/used?

A

Ferritin - Water soluble

Hemosiderin is not water soluble

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21
Q

What is the labile iron pool? How many mgs are in it?

A

Iron leaving plasma for interstitial and intracellular space

80-90mg

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22
Q

What iron storage molecule is the most metabolically active? Which one is the smallest iron storage pool?

A

Transferrin - 10x daily turnover

same same - 3 mg

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23
Q

Where is apotransferrin synthesized?

A

liver

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24
Q

How much of transferrin is iron saturated? Where is transferrin found in the body?

A

1/3

plasma

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25
What are the minimum daily amounts of iron for children? infants? Men and post-men women? Young women? Preggers?
The question is in order of need. These are amounts absorbed (ingested = absorbed*10) Children - .5 Infants - 1 Men, post-menopause - 1 Young women - 2 Preggers - 3 :: need to eat 10x the amount of Fe that you need to absorb
26
What is transferrin's job?
to carry protein in the plasma
27
What is the function of ferroportin?
Puts iron into plasma Regulates 1. Iron from mom to fetus 2. Iron from intestines to plasma/bloodstream 3. Iron out of macros
28
What is the function of hepcidin?
Negative regulator of iron - by degrading ferroportin 1. Inhibits iron to plasma from recycled RBCs 2. Inhibits duodenal iron absorption 3. Inihibits hepatocytes that store iron
29
What factors affect non-heme iron absorption?
Increase: Reducing agents (ascorbic acid, gastric acid) Decrease: Insoluble complexes (phytates, phosphates, grains, egg yolk) // chelators (Turkish clay) // Inhibit or compete for absorption (tea, tannins, Ca)
30
What are 4 factors outside GI that increase iron absorption?
1. Hypoxia 2. Anemia 3. Low Fe stores 4. High erythropoesis
31
Who gets iron deficient in the US?
The wee tots bc people and cow milk is low in Fe
32
Old surgery (billroth) to treat peptic ulcers can result in ______. Why?
Fe deficiency snip out the proximal duodenum with the stomach, stomach sutures continue to bleed
33
What causes non-tropical sprue? Symptoms? Treatment?
Cause: Gluten :: immuno damage to villus epithelial cells in small intestines Symptoms: diarrhea, steatorrhea, weight loss, low Fe absorption Treatment: stop eating gluten - kill yourself
34
Tropical sprue. What is seen? Results? Treatment?
Overgrown coliforms in jejunum Results: enterotoxin :: fluid secretion // low folic acid, cobalamin (B12), fat absorption Treatment: Tetracycline x 2mo + folic acid and maybe some B12
35
What effect does turkish, egyptian, and iranian clay have on iron?
It chelates it when it gets in the food supply
36
What are the 6 common causes of GI bleeding in the US?
1. Peptic Ulcer 2. Hiatal Hernia (stomach through diaphragm) 3. Chronic Gastritis 4. Hemerrhoids 5. Bleeding post surgery 6. GI cancer
37
What is are the two most common causes of GI bleeding in infants?
1. Milk allergy - boil milk | 2. Meckel's Diverticulum
38
What is Meckel's Diverticulum?
developmental :: babies are born this way gastric tissues are wrongly in small intestine --> produce HCl --> born Fe-def
39
What are 5 less common causes of iron deficiency?
1. Resp. bleeding 2. Intravasc. Hemolysis (RBC lyse in vessel) 3. Chronic Renal Dialysis 4. Donating blood 5. Factitious bleeding (fucking weird)
40
How much iron is lost to sick-nasty period blood every month? Crapping out a baby? Feeding the baby you just crapped out?
20-30 mg 150-200 mg 30 mg
41
What is a common cause of GI bleeding in 3rd world countries?
Hookworm gets in through unbroken skin, causes "ground itch"
42
What disease presents with green pallor, breathlessness, palpitations, ankle edema, emotional disturbances, depression....?
Chlorosis [think of young, green, Victorian girls]
43
What are the symptoms of chlorosis?
``` Green Pallor Breathlessness Ankle edema GI probs Emotional probs Green Pallor Breathlessness Ankle edema GI probs Emotional probs Green Pallor Breathlessness Ankle edema GI probs Emotional probs ``` ``` Green Pallor Breathlessness Ankle edema GI probs Emotional probs ```
44
What problem presents with fatigue, headaches and parasthesis, irritability, decreased exercise tolerance, burning tongue, and picca?
Iron deficiency
45
What are the symptoms of iron deficiency? physical findings?
``` Fatigue Headaches and parasthesis (tingling/prickling sensation) Irritability Low exercise tolerance Burning tongue Picca ``` Pallor Glossitis Stomatitis Angular Chelitis (sore at corner of mouth)
46
What is koilonychia?
concave brittle nails due to long term iron deficiency
47
Iron deficiency causes what change in the following lab values: WBC, Hmt, MCV, RDW, Platelets, Retic count
``` WBC - normal Hmt - Low MCV - low RDW - high Platelets - high Retic - low ```
48
What is RDW?
RBC distribution width aka the variability in red blood cell size
49
What are the normal and iron deficient levels of serum markers: TIBC, Serum Iron, % saturation, Serum Ferritin
TIBC: 280-230, 350 Serum Iron: 45-134, 28 % Sat: 30, <10?
50
What is TIBC?
total iron binding capacity aka measurement of the blood's capacity to bind iron with transferrin
51
What is the normal range of TIBC? Iron deficient level?
280-230 ug/ml 350 ug/L
52
What is the normal range of serum iron? Iron deficient?
45-134 ug/ml 28 ug/ml
53
What is the normal % sat. of iron? Iron deficient?
30% <16%
54
What is the normal range of serum ferritin for men and women? Iron deficient?
Men: 20-280 ng/ml Women: 10 - 175 ng/ml Deficient: <10 ng/ml
55
What are the effects of high erythropoesis and iron deficiency on hepcidin?
both suppress hepcidin :: more ferroportin :: more Fe from gut and release from iron stores
56
What effect does infection have on TIBC and total serum iron? hepcidin?
It lowers both It increases hepcidin levels
57
What is the effect on hepcidin during chronic infection/inflammation? result?
increases hepcidin :: decreased ferroportin :: low gut absorption and uptake from storage
58
What are the indications for parenteral iron?
1. Malabsorption 2. Intolerance 3. Uncooperative pt or unable to care for self
59
What is iron dextran?
IM injection Peaks at 10 days Colors skin and painful - not popular
60
What are some adverse effects of IV iron? What is the one that is particularly concerning?
Thrombophlebitis Arthralgia and Fever Hypotension and Bradycardia Barfing up a storm Anaphylaxis!!! (<1%)
61
NOT by morphology How are pluripotent stem cells ID'd?
NOT by morphology CD34 (may be 38)??
62
How are BFUs and CFUs defined?
Responsiveness to growth factors - cant tell them apart by looking
63
What is treated with TPO? EPO?
Thrombocytopenia
64
G-CSF stimulates production of what cell?
Neutrophil

Haematology (5 decks)

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