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68 Cards in this Set
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Difference b/w anti AB antibodies and anti Rh antibodies?
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Rh antibodies are IgG (cross placenta)
AB antibodies are IgM (do not cross placenta) |
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Macrovalocytes seen in?
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Megaloblastic anemia (also hypersegmented PMN's), and marrow failure
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Helmet cells, schistocytes seen in?
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DIC, TTP/HUS, traumatic hemolysis
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Bite cell seen in?
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G6PD deficiency
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Teardrop cell seen in?
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Myeloid metaplasia w/myelofibrosis
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Acanthocytes (spur cells) seen in?
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Spiny appearance in liver disease and abetalipoproteinemia
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Target cell seen in?
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HbC disease
Asplenia Liver disease Thalassemia |
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Burr cells seen in?
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TTP/HUS
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Basophilic stippling seen in?
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Thalassemias
Anemias of chronic disease Iron deficiency Lead poisoning |
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Heinz bodies
(a) etiology (b) seen in? |
(a) oxidation of iron from ferrous to ferric leads to denatured Hgb precipitation and damage to RBC membrane; forms bite cells
(b) alpha thalassemia, G6PD deficiency |
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Howell Jolly bodies
(a) etiology (b) seen in? |
(a) basophilic nuclear remnants found in RBC's
(b) hypo/asplenic patients |
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Etiologies of microcytic, hypochromic anemias (MCV<80)
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Iron deficiency
Thalassemias Lead poisoning Some sideroblastic anemias |
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Differential feature b/w iron deficiency and thalassemia hypochromic, microcytic anemias
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In thallassemia you have increased # of microcytes
IN iron deficiency you have decreased # of microcytes |
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Etiologies of macrocytic anemias (MCV>100)
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Megabloblastic (vitB12/folate deficiency)
Drugs that block DNA synthesis (sulfa drugs, phenytoin, AZT) |
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Decr serum haptoglobin
Incr serum LDH indicate? |
RBC hemolysis
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Abdominal pain
Pink urine Polyneuropathy Psychological disturbances Precipitated by drugs |
Porphyria
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Lead poison effect on heme synthesis
(a) enzyme(s) inhibited (b) accumulated substrate in urine |
(a) ferrocheletase; ALA dehydratase
(b) coproporphyrin & ALA |
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Acute intermittent porphyria
(a) enzyme inhibited (b) accumulated substrate in urine |
(a) uroporphyrinogen I sunthase
(b) prophobilinogen and gamma ALA |
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Porphyria cutanea tarda
(a) enzyme inhibited (b) accumulated substrate in urine |
(a) uroporphyrinogen decarboxylase
(b) uroporphyrin |
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Acute intermittent porphyria presentation (inheritence)
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Autosomal Dominant
Episodic expression Abd pain anxiety/confu/paranoia Muscle weakness Port wine urine in some patients NO photosensitivity |
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Porphyria cutanea Tarda presentation
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Photosensitivity
Skin inflammation and blistering Cirrhosis often associated |
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Lead poisoning presentation
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Microcytic sideroblastic anemia
Basophilic stippling HA, nausea, memory loss, abd pain, diarrhea Lead lines in gums Neuropathy (claw hand, wrist drop) |
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Ferritin
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Primary iron storage protein of body
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Transferrin
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Transport iron in blood
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Haptoglobin
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Binds free heme in blood
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Iron deficiency
(a) serum iron (b) transferrin/RIBC (indirectly measures transferrin) (c) ferritin (d) % transferrin sat (serum Fe/TIBC) |
(a) serum iron: low (primary)
(b) transferrin/TIBC (indirectly measures transferrin): incr (c) ferritin: low (d) % transferrin sat (serum Fe/TIBC): very low |
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Chronic disease
(a) serum iron (b) transferrin/TIBC (indirectly measures transferrin) (c) ferritin (d) % transferrin sat (serum Fe/TIBC) |
(a) serum iron: low
(b) transferrin/TIBC (indirectly measures transferrin): low (c) ferritin: high (primarily) (d) % transferrin sat (serum Fe/TIBC): nml |
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Hemochromatosis
(a) serum iron (b) transferrin/TIBC (indirectly measures transferrin) (c) ferritin (d) % transferrin sat (serum Fe/TIBC) |
(a) serum iron: high (primary)
(b) transferrin/TIBC (indirectly measures transferrin): low (c) ferritin: high (d) % transferrin sat (serum Fe/TIBC): very high |
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Pregnancy/OCP use
(a) serum iron (b) transferrin/TIBC (indirectly measures transferrin) (c) ferritin (d) % transferrin sat (serum Fe/TIBC) |
(a) serum iron: nml
(b) transferrin/TIBC (indirectly measures transferrin): high (primary) (c) ferritin: nml (d) % transferrin sat (serum Fe/TIBC): low |
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Aplastic anemia
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Pancytopenia
Due to failure or destruction of multipotent myeloid stem cells |
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Etiologies of aplastic anemia
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Radiation
Benzene Chloramephnicol Alkylating agents Antimetabolites Viruses (B19, EBV, HIV) Fanconie's anemia (inherited defect in DNA repair) Idiopathic May follow acute heptatitis |
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Symptoms of aplastic anemia
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Fatigue
Malaise Pallor Purpura Mucosal bleeding Petechiae Infection |
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Pathologic features of aplastic anemia
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Pancytopenia w/normal cell morphology, hypocellular bone marrow w/fatty infiltration. Diagnose with bone marrow biopsy
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Treatment of aplastic anemia
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Withdrawal of offending agent.
Immunesuppressive regiments Allogeneic BMT RBC and platelet transfusion GCSF, GM CSF |
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Myelophthisic anemia
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Displacement of hematopoietic bone marrow by infiltrating tumor
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Mutation in sickle cell anemia
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Valine fro glutaminc acid in position 6 of beta chain of Hgb
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Sickel trait manifestations
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40% have a sickle crisis in extreme conditions (low oxygen or dehydration)
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Sickle prep
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Blood sample treated with a reducing agent (sickled cells may be seen)
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Diagnosis of sickle cell anemia
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Hgb electrophoresis
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Advantage of heterozygotes (sickle trait)
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Protective against falciparum malaria
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Complications of sickle cell anemia patients
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Aplastic crisis (parvovirus B19)
Autosplenectomy Incr risk of encapsulated organism Salmonella osteomyelitis Painful crisis Renal papillary necrosis Splenic sequestration |
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Therapies for sickle cell anemia
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Hydroxyurea (incr HgbF)
Bone marrow transplant |
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"crew cut" skull on x ray seen in? why?
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Sickle cell anemia and thallasemia
Due to marrow expansion from incr erythropoiesis |
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HbC disease
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Different beta chain mutation; patients w/HbC or HbSC have a milder disease than HbSS patients
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Defect in alpha thalassemia
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Defect in 1 to 4 alpha globin genes
Alpha globin is underproduced w/nocompensatory incr in any of the other chains |
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1 deleted alpha globin chain mutation
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Silent carrier
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2 deleted alpha globin chain mutation
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Alpha thal trait
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3 deleted alpha globin chain mutation
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HbH disease; hemolysis and anemia
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4 deleted alpha globin chain mutation
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Hydrops fetalis (bart Hb); intrauterine death
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Alpha thalassemia is prevalent where geographically?
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Asia and africa
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Defect and result in beta thalassemia
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Mutations in splicing sites and promoter sequences for beta globin gene
Excess of alpha chains causes Hgb aggregates (insoluble) Intra and extramedullary hemolysis Extramedullary hematopoiesis |
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HbS/beta thal
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Mild to moderate sickle disease dependeing on amnt of beta globin production
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Treatment of beta thal major
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Severe anemia requiring blood transfussions
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Complications of beta thal major
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Heart failure due to secondary hemochromatosis
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Hemolytic anemia: hemoglobinuria indicates?
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Intravascular hemolysis
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Hemolytic anemia: jaundice indicates?
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Extravascular hemolysis
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Warm agglutinin hemolytic anemia
(a) mechanism (b) etiologies |
(a) IgG autoimmune hemolytic anemia; accelerated RBC destruction in liver Kupffer cells and spleen)
(b) SLE, CLL, certain drugs (alpha methyl dopa) |
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Cold agglutinin hemolytic anemia
(a) mechanism (b) etiologies |
(a) acute anemia triggered by cold; IgM antibodies against RBC
(b) mycoplasma, mononucleosis, idiopathic, lymphoma |
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Hereditary spherocytosis defect
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Ankyrin, band 3.1 or spectrin defectl; cause RBCs to be less pliable and vulnerable to destruction in the spleen
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MCHC and RDW in hereditary spherocytosis
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Increased
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Symptoms of hereditary spherocytosis
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Anemia, jaundice, splenomegaly, cholelithiasis
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Treatment of hereditary spherocytosis
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Splenectomy
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Presplenectomy smear for hereditary spherocytosis
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Cells lacking central pallor; reticulocytosis
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Postsplenectomy smear
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More spherocytes and Howel Jowel bodies
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Paroxysmal nocturnal hemoglobinuria cause (defect)
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Intravascular hemolysis due to memraben defect; incr sensitivity of RBC to lytic activity of complemement (impaired synth of GPI anchor/decay accelerating factor in RBC membrane).
See hemosiderin in urine |
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G6PD deficiency defect (inheritence)
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XL defect of hexose monophsophate shunt enzyme
Decreased regeneration of NADPH (and thus glutathione) Older cells unable to tolerate oxidative stress |
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Cause of G6PD related anemia
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Drugs (sulfa, quinine, nitrofurantoin)
Infections (particularly viral) Certain foods (fava beans) |
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Smear in G6PD deficiency
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Reticulocytosis and Heinz bodies (Hgb degradation products)
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