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91 Cards in this Set
- Front
- Back
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CBC
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WBC, RBC, Plt, Hb, HCT, WBC diff, RBC morphology, Calculated indicies (MCV, MCHC, MCH, RDW)
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Hemoglobin determination
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cyanmethemoglobin method: reducing Fe in Hb from ferrous to ferric w/K ferricyanide and K cyanide.
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Reticulocyte Count
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New Methylene Blue stain mixed w/EDTA blood sit for 10 min. Count 1000 rbcs; norm Retic count= 0.5-1.5%
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Reticulocyte Production Index
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Shift retics ejected from marrow early in anemia, retain reticulum up to 2.5 days. RPI corrects retic count for and allows an accurate assessment of erythropoeisis in marrow.
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RPI calculation
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(%retics x actual Hct)/maturation time
RPI<2indicates inadequate response>3 indicates adequate response |
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things that increase your ESR
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Abnormal plasma proteins fibrinogen, beta globulins, immunoglobulins, can lead to rouleaux and faster sedimentation
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Normal ESR values
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children- <10mm/hr
men- <15 mm/hr women- <20 mm/hr |
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Diseases with Elevated ESR
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multiple myeloma, pelvic inflammatory disease, rheumatic fever, severe anemia
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Rule of 3
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RBC count x 3=Hb
Hb x 3=HCT |
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Red Cell Indicies
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MCV=vol of avg RBC=(Hct x 10)/RBC count
MCH=mean corpuscular Hb=(Hb x 10)/RBC MCHC=mean corpuscular Hb conc= (Hb x 100)/Hct |
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Red Cell Indicies in classification of Anemias
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hypochromic MCHC < 32 g/dl
normochromic MCHC 32-27 g/dl Hyperchromic-due to abnormal shape Microcytic MCV <80 fL Normocytic MCV 80-100 fL Macrocytic MCV >100 fL |
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Granulocyte locations
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Bone marrow, circulation, adhered to vessel walls, and in the tissues
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Granulocyte Fxns
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Phgocytosis and pinocytosis, oxidative killing (granules contain peroxide, myeloperoxidase, superoxide), degradation and detoxification of phagocytosed materials
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Eosinophils granule characteristics
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eosinophil granules contain major basic protein, acid phosphtase, arylsulfatase, peroxidase, phospholipase, B-glucaronidase, cathepsin effective against parasites
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Basophil granules characteristics
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granules contain heparin, chondroitin sulfate, histamine
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Granulocyte Development stages
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Myeloblast, Normal Promyelocyte, Normal Myelocyte, Normal Metamyelocyte, Normal Band, Neutrophil
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Myeloblast
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fine, evenly distributed chromatin, several nucleoli, non-granular basophilic cytoplasm; <1% of marrow cells
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Promyelocyte
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distinct primary azurophilic granules, indistinct nucleoli, coarsening chromatin
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Myelocyte
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secondary neutrophilic granules, dawn of neutrophilia, round to oval nucleus with flattened side, N/C ratio 1:1, no nucleoli
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Metamyelocyte
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indented nucleus, clumped chromatin, 13-22% norm marrow diff
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Left Shift
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appearance of immature forms of neutrophils in the peripheral blood
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Cytokines in development of Platelets
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Meg-CSF generated in bone marrow in response to low megakaryocyte mass
TPO generated by liver and kidney in response to demand for platelets IL-3 differentiates stem cells IL-6, IL-11 promote endoreplication |
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Maturation Stages of Megakaryoctye
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Megakaryoblast-looks like sml lymphocyte
Promegakaryocyte- 20-80 um cell, no nuclear lobes N:C 4:1 to 1:1 Basophilic megakaryocyte-2,4,8 lobed nucleus N:C 1:1 to 1:12 Megakaryocyte-mature, shedding platelets Platelets-150-450x10^3/ul 7-10 days in periph circulation |
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Normal value for Platelet Size
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giant platelet= >6.5 um
Normal platelets ~1-4um lg platelets=4-6.5 um |
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Spleen fxn in Platelet storage
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30% of platelets stored; when depleted from spleen thrombopoietin in the kidney, liver and spleen is made
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Platelet adherence
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1st step in aggregation; GPlb binds thrombin, GPllb-llla binds fibrinogen, GPlb/V/lX binds von willebrand factor
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Monocyte development stages
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monoblast, promonocyte, blood monocyte, free and fixed tissue macrophage
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Monocyte characteristics
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chromatin is lacy with clumps, ground glass appearance in cytoplasm, sml blue pink or lav granules,phagocytic vacuoles, <15% in diff is normal, normally largest WBC
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Monocyte contents
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transport proteins, inflammatory agents, coagulation factors, complement proteins, cytokines
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Macrophage fxn
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size varies 15-85 um, shape is variable due to motility, vacuolated cytoplasm, pseudopods
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Site for bone marrow collection in children
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anteriomedial surface of the tibia
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Site for bone marrow collection in adults
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Posterior superior iliac spine, anterior iliact crest
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Indications for bone marrow analysis
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multilineage abnormalities, circulating blasts (xcept in infants) pancytopenia (xcept when marrow is being suppressed), staging H and non H lymphoma and carcinoma
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Bone Marrow Collection Procedure
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patient may be sedated, site is clean with iodine and draped, local anesthetic, 3 mm cut with scalpel blade, bone cavity is penetrated, stylet is removed and replaced with 10 mm syringe, 1.5 ml marrow and sinusoidal blood is aspirated
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Bone marrow samples
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aspirate: cell types, proportions of cell types, iron stores
core biopsy: archiecture of focal lesions, spicules |
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Bone marrow biopsy
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helpful for diagnosis of leukemias, myelofibrosis, neoplasia, granulomatous disease
core sample expelled by stylet into formalin fixative and sent to histology for tissue processing |
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Shifts in Marrow cellularity from infancy to adulthood
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at birth granulocyte precursors predominate, w/in 1 month lymphoid cells predominate, lymphoid cells make up ~1/3 of marrow cells up to 3 yrs of age and decrease gradually, in adults lymphocytes are randomly throughout marrow 5-15%
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Differential cell count of Bone Marrow Smear
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myeloid/erythroid normal ratio is 1.5:1 to 3.3:1
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special tests for bone marrow smear
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FISH, cytogenetic or karyotype studies, flow cytometry, iron staining, bacterial or fungal cultures
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MCV calculation
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mean corpuscular volume=(Hct x 10)/RBC count
normal 80-100 fL |
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MCH definition and calculation
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mean corpuscular hemoglobin=(Hb x 10)/ RBC count
normal 28-32 pg |
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MCHC definition and calculation
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mean corpuscular hemoglobin concentration=(Hb x 100)/Hct
normal 32-37 g/dl |
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RDW significance and normal value
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an index of the variation in cell volume within the red cell population
normal 11.5-14.5% |
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Classification of Severity for Anemia
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mild-hemoglobin >10 g/dL
moderate-hemoglobin 7-10 g/dL severe-hemoglobin <7 g/dL |
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Laboratory Diagnosis of Anemia
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retic count, periph blood smear, bone marrow exam, urinalysis, fecal occult blood, ova and parasite exam, direct antiglobulin test, hemoglobin electrophoresis
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Corrected Reticulocyte Count
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assesses RBC production in bone marrow, normal 0.5-1.5% in adults
(%retics x hematocrit)/normal Hct |
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Iron Deficiency Anemia
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nutritional deficiency or blood loss, inadequate production of hemoglobin, hypochromic, microcytic, RDW high
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Megaloblastic Anemia
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vitamin B12 or folate deficiency, malabsorption, RDW high, hypersegmented neutrophils, target cells
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Anemia of Chronic Disease
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Microcytic, hypochromic, RDW is normal, does not respond to iron therapy, treated with erythropoietin
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Hemolytic anemia
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intrinsic cell defects, extrinsic cell defects, elevated retic count, usually normocytic, normochromic
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Functional Iron
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70% in Hb form, 5% myoglobin form and carries O2 to the tissues
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Storage Iron forms
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Hemosiderin, ferritin, transferrin (25%)
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Dietary Iron
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10-20 mg/day in avg Amer diet
1-2 mg/day are absorbed chelators can affect absorption |
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Iron Deficiency Anemia stages
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Depletion of Iron stores: ferritin and hemosiderin, Hb normal
Depletion of Transport Iron: transferrin, Hb normal Functional Iron Depletion: all stores and functional plus low Hb level |
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Sideroblastic Anemia
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inadequate heme w/adequate or excessive iron, ringed sideroblasts in bone marrow, hereditary and acquired forms
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Anemia of Chronic Disease
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lactoferrin, high levels of acute phase reactants (CRP, ferritin, cytokines, hepcidin), high ESR affect iron usage and erythropoiesis
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Hereditary forms of Sideroblastic Anemia
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x-linked and autosomal
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Acquired forms of Sideroblastic Anemia
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secondary sideroblastic anemia-alcohol, lead, drugs
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Lead poisoning
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interferes with porphyrin synthesis: ALA accumulates, iron and protophorphrin IX accumulate, basophilic stippling
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Basophilic Stippling
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appears as round, dark-blue granules in RBCs=ribosomes and mitochondria
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Hereditary Hemachromatosis
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mutant MHC class 1 gene single aa mutation, mutant HFE protein does not bind TFr so iron continues to be stored even when cells are overloaded
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Diagnosis of HH
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causes of organ damage include elevated AST, ALT, decrease albumin, elevated serum iron, ferritin and transferrin saturation
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Absorption of Vit B12
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bound to haptocorrin in saliva, released by trypsin in small intestine, bound to intrinsic factor, int factor required for absorption by ileal cells
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Impaired Absorption of Vit B12
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trypsin deficiency due to chronic pancreatic disease, lack of intrinsic factor, competition of vit from intestinal organisms
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Pernicious Anemia
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vit B12 deficiency caused by autoimmune attack on gastric parietal cells by achlorhydria and Abs to parietal cells and to intrinsic factor
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Lab diagnosis of pernicious anemia
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CBC: pancytopenia, decreased Hb and Hct, high MCV, high RDW and MCH, MCHC is usually normal
RBC morphology: oval macrocytes, target cells, and teardrops, anisocytosis, no polychromasia, decrease in reticulocytes Hypersegmented neutrophils 5+ lobes Bilirubin and lactate dehydrogenase both elevated |
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Schilling Test for Pernicious Anemia
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phase 1: patient is given labeled CobaltB12, if radioactivity in urine no PA is present.
phase 2: if no B12 detected 1st time, patient is given labeled B12 with intrinsic factor |
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Treatment of Megaloblastic Anemia
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replace folate or vit B12, monitor reticulocyte response
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Causes of Bone Marrow Failure
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stem cell failure, viral infection, infiltration of marrow space, drugs, chemicals, radiation, infections, platelets can harbinger pancytopenia due to short life-span
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Aplastic anemia
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anemia resulting from failure of the bone marrow to produce adequate quantities of essential blood components, red cells, white cells and platelets
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Pancytopenia
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deficiency of all cell elements in the peripheral blood, can be caused by aplastic anemia
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Myelophthistic anemia
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disorder characterized by immature granulocytes and nucleated red blood cells in the periph blood
caused by replacement of normal marrow cells with abnormal cells |
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Diagnosis of Fanconi Anemia
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depends on finding chromosome breakage or crosslinking after incubation of periph blood lymphocytes w/depoxybutane or mitomycin-C
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Fanconi Anemia characteristics
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usually appears before age 12, smaller than avg stature, extreme fatigue, squamous cell carcinoma
lab findings: low white cell, red cell and or platelet count, acute myelogenous leukemia |
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Idiopathic Aplastic Anemia
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40-70% of aplastic anemias are idiophathic
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Causes of Secondary Aplastic Anemia
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viral causes Hep A and B, EBV, CMV, parvovirus
TB, Brucellosis, parasites radiation |
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Clinical and Laboratory Findings in Aplastic Anemia
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spleen is not enlarged, pancytopenia, normochromic, normocytic anemia, decreased reticulocytes, petechiae, bleeding gums nose or eyes due to decreased platelet counts
bacterial infections increased serum iron due to delayed clearance |
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Hypersplenism
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spleen becomes a hyperactive housecleaner removing good and bad cells
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Consumptive coagulopathies
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intravascular coagulation destroys cells
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myelophthistic
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leukemia, lymphoma, metastatic carcinoma, multiple myeloma, myelofibrosis
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Chronic Renal Disease
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waste product build-up damages kidney's erythropoeitin production
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Pure Red Cell Aplasia
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affects erythroid precursors only, associated with thymoma, females predominate 2:1
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Intrinsic Hemolytic Anemia
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inherited: membrane defects, enzyme defects (G6PD, pyruvate kinase), globin structure and or synthesis defects
Acquired: paroxysmal nocturnal hemoglobinuria |
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Extrinsic Hemolytic Anemia
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inherited: abetalipoproteinemia, red cells bind cholestrol
acquired: immunohemolytic, traumatic, infectious agents, chemical or thermal damage |
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Extravascular Hemolysis
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90% of normal RBC degradation occurs extravascularly; mononuclear phagocyte system=reticuloendothelial system
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Clinical Features of Hemolytic Anemia
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pallor, tachycardia, jaundice, crises, splenomegaly, choleithiasis
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Lab indicators of accelerated RBC destruction
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serum: elevated unconjugated bilirubin, elevated lactate dehydrogenase, decreased haptoglobin, hemoglobinemia
EDTA blood: decreased Hb and Hct, decreased RBCs, elevated retic count Urine: increased urobilinogen, free Hb and Hemosiderin |
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Diagnosis of Hemolytic Anemia
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lab tests much show both increased erythrocyte destruction and a compensatory increase in erythropoeisis
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Acanthocytosis
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severe liver disease, abetalipoproteinemia, anorexia nervosa, decreased activity of lecithin cholesterol acyltransferase
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Lab Tests to Differentiate Hemolytic Processes
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exam of smear for RBC morph, direct antiglobulin test, osmotic fragility, autohemolysis, Heinz body test, red cell enzymes, flow cytometry
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Heinz bodies
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precipitated denatured Hb formed bc of RBC enzyme (G6PD) deficiency or unstable Hb, not stained by Wright stain, stain with methyl violet or new methylene blue, supravital stains
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