Term
| What are the precursors for RBC's, thrombocytes, neutrophils, eosinophils, basophils, macrophages, mast cells, natural killer cells, T cells, B cells and plasma cells? |
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Definition
| RBC = erythroblast. Thrombocyte = megakaryoblast. Neutrophil, Eosinophils, Macrophage and Basophil = myeloid stem cell. Mast cell = Basophil. Natural Killer cells, T cells and B cells = lymphoid cell. Plasma cell = B cells. |
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Term
| What is the precursor to all cells? |
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Definition
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Term
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Definition
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Term
| What is EPO? Where is it produced? What triggers its release? |
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Definition
| Glycoprotein that directly stimulates RBC formation. Produced by kidneys & liver. Triggered by a decrease in RBCs, iron deficiency or a decrease in O2. |
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Term
| What is the average life span of a RBC? |
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Definition
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Term
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Definition
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Term
| What is the definition of anemia? |
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Definition
| decrease in # of RBCs or a decrease in RBC function. |
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Term
| Do dialysis patients have EPO? |
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Definition
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Term
| What kind of anemia involves the destruction of stem cells? |
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Definition
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Term
| What kind of anemia results from vitamin B12 and folate deficiencies? |
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Definition
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Term
| What anemia is characterized by the inability to produce globulin chains? |
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Definition
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Term
| What type of anemia results from depleted Fe stores? |
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Definition
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Term
| What kind of anemia is characterized by the inability to incorporate stored iron to make heme? |
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Definition
| Anemia of chronic disease |
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Term
| How long does it take reticulocytes to lose their DNA and become mature RBCs? |
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Definition
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Term
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Definition
| an abnormal variation in size between RBCs. |
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Term
| What is micro and macrocytosis? |
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Definition
Microcytosis: cell size < 6µm
Macrocytosis: cell size > 8µm |
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Term
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Definition
| Hypochromia: cells with ↓ conc of Hb |
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Term
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Definition
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Term
| What are spherocytosis, sickle cells, target cells and schistocytes? |
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Definition
Spherocytosis: spherical, w/o pale centers.
Sickle cells: crescent shaped cells.
Target cells: dark center & periphery with a clear ring in between (look like a bullseye).
Schistocytes: fragmented, irregularly contracted cells. |
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Term
| How many O2 molecules are carried on oxyhemoglobin? |
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Definition
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Term
| How do WBCs travel out of the blood vessels? What signals them to go to a certain area? |
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Definition
| travel out of the blood vessels (diapedesis). Move in amoeboid motion by positive chemotaxis (follow a chemical trail of damaged cells or other leukocytes) to an area of infection. |
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Term
| Which WBCs are the granulocytes? agranulocytes? |
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Definition
| Granulocytes are neutrophils, eosinophils and basophils. Agranulocytes are lymphocytes and monocytes. |
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Term
| Describe the function of neutrophils, eosinophils and basophils. |
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Definition
Neutrophil (PMN)- phagocytize bacteria.
Eosinophil – kill parasitic worms and implicated in allergy/asthma
Basophile – release histamine |
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Term
| What are the functions of the agranulocytes, (lymphocytes and monocytes)? |
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Definition
Lymphocyte - mount immune response via direct attack or antibodies.
Monocyte - phagocytosis, they become macrophages in tissues. |
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Term
| What are band cells? What do they signify? |
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Definition
| They are immature Neutrophils and signify infection or cancer. |
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Term
| What is included in a CBC? |
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Definition
includes: Hgb/Hct
RBC count
RBC indices
WBC count
WBC differential
platelet count
reticulocyte count |
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Term
| What is Hgb? Norms for males and females? |
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Definition
measure of total amt Hgb in peripheral blood. Reflects # RBCs in blood.
norms: males 14-18 g/dl
females 12-16 g/dl |
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Term
| What is Hct? Norms for males and females? |
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Definition
(AKA packed cell vol) measure of % of the total blood vol that is made up of RBCs (height after centrifuge)
norm: males 42-52%
females 37-47% |
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Term
| What does a reticulocyte count measure? Norms? |
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Definition
| Bone marrow function. norm: adult/child 0.5-2% of RBCs |
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Term
| What does a Reticulocyte index tell us? Normal value? |
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Definition
| Determines if retic count indicates an appropriate erythropoietic response from RBC marrow. Normal value = 1.0 |
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Term
What is the MCV (Mean Corpuscular Volume)?
Norms? |
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Definition
| Volume of a single RBC. Norms = 82-98 um. |
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Term
| What is the best test to classify anemias? How does it classify them? |
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Definition
| MCV. Can be microcytic, normocytic or macrocytic. |
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Term
| What is the MCHC measure? Norms? What is its diagnostic value? |
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Definition
| Measures the average concentration of Hb in RBCs. Norm = 31-37 g/dl. It is used to monitor for anemia. |
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Term
| What is MCH? Norms? Diagnostic value? |
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Definition
| Amount of Hb per RBC. Norm = 30-34 pg/cell. It is used to diagnose severe anemia. |
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Term
| What does a WBC differential measure? Norms? |
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Definition
| Differential measures the % of each type of leukocyte in the sample. Norms = neutrophils (50-70%), lymphocytes (20-40%), monocytes (2-8%), eosinophils (1-4%) and basophils (0.5-1%). NeverLetMonkeysEatBananas |
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Term
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Definition
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Term
| What is leukocytosis and leukopenia? Causes of each? |
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Definition
Luekocytosis - ↑ in # WBCs
cause: infection, inflammation, tissue necrosis, leukemic neoplasia
Leukopenia - ↓ in # WBCs
cause: bone marrow failure |
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Term
| What is the average life span and normal values for platelets? |
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Definition
Life span is approx 10 days.
Norm = 150,000 – 300,000/mm3 |
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Term
| Where does B12, folate and iron deficiency cause anemia? |
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Definition
| In the bone marrow, it causes RBC defects. |
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Term
| What kinds of anemias are microcytic? |
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Definition
| iron deficiency, thalassemia, lead poisoning, hemorrhagic, hemolytic (transfusion rxn)and aplastic (red bone marrow destruction. |
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Term
| What kinds of anemias are normocytic? |
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Definition
| Chronic disease and malignancy |
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Term
| What kinds of anemias are macrocytic? |
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Definition
| B12 deficiency, folate deficiency, alcoholism, hypothyroidism, chronic liver disease with acute heme malignancies. |
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Term
| Important Hx questions for anemia? |
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Definition
| blood loss, fatigue, FHx of anemia, diet, PICA (ice cravings) or ASA/NSAID use. |
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Term
| Important PE checks for anemia? |
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Definition
| skin color, check the tongue and the mouth, nails, heart rate, heart murmurs and dyspnea. |
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Term
| Where is iron primarily absorbed? How does anemia, hypoxia, increased EPO and decreased iron stores affect iron absorption? How does inflammation and an increase in iron stores affect iron absorption? |
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Definition
| In the duodenum. They all increase iron absorption. Inflammation/increase in stores leads to a decreased absorption of iron. |
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Term
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Definition
| In the spleen and bone marrow. |
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Term
| What is the most common cause of microcytic anemia in children and women during childbearing years? |
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Definition
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Term
| In what state is iron transported? Stored? |
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Definition
| Transported as transferrin and stored as ferritin. |
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Term
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Definition
| Fingers are enlarged and spoon shaped due to chronic deoxygenation. |
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Term
| How are Hemoglobin and Hematocrit, serum iron and TIBC affected by iron deficiency anemia? |
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Definition
| H&H and serum iron are decreased and TIBC is increased. |
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Term
| What are the forms of iron given for Tx of iron deficiency anemia? |
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Definition
Oral - ferrous sulfate, ferrous gluconate, polysaccharide iron preps.
IV - iron-dextran for urgent replacement |
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Term
| What are some major causes of Hemolytic anemias? |
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Definition
| G6PD, Sickle cell, TTP (Thrombotic thrombocytopenic purpura), HUS (hemolytic-uremic syndrome), DIC (Disseminated intravascular coagulation) and autoimmune disease. |
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Term
| What are some major causes of autoimmune hemolytic anemia? Describe what happens. |
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Definition
| ABO incompatibility, transfusion rxn, thermal burns and drugs. The RBCs are coated with antibodies or compliment and the body attacks them. |
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Term
| Which antibodies are "warm" and which are "cold"? Which usually cause hemolytic anemia in the elderly? |
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Definition
IgG = “warm” antibodies.
IgM = “cold” antibodies.
IgM causes hemolytic in the elderly often post infection. |
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Term
| What will be some distinct charcateristics with hemolytic anemias on PE, labs and smear? |
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Definition
| jaundice, splenomegaly, increased bilirubin and spherocytes (dense RBCs without pale centers) on smear. |
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Term
| Briefly describe the difference between a Direct Coombs test and an Indirect one. |
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Definition
| Direct uses the patients blood to test their RBCs and indirect uses their serum to check for antibodies. |
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Term
| How will the lab results differ for warm vs. cold hemolytic anemia? |
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Definition
| Warm will have a + Coombs test (will have IgG on the RBC membrane) and cold will have a - Coombs test (negative for IgG, IgM, + for complement). |
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Term
| What is the MOA for Aplastic anemia? How do these look on CBC? |
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Definition
| Pluripotent stem cells in the bone marrow are injured. They can be microcytic or normocytic but will have Pancytopenia. |
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Term
| What are some S&S for Aplastic anemia? |
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Definition
| bleeding, eccymosis, petechiae, fatigue, pallor, lethargy, dyspnea,palpitations, tachycardia, murmurs, fever/chills and increased risk for infection. |
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Term
| What is needed to treat Aplastic anemia? What is a common complication of the treatment? |
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Definition
| A bone marrow transplant. 20-30% get severe graft vs host disease. |
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Term
| What kind of MCV anemia is B12 deficiency? What is it called if the deficiency comes from an inability to absorb vitamine B12? |
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Definition
| A macrocytic anemia. It is called pernicious anemia if the problem is with absorption and not diet. |
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Term
| What are some common causes of B12 deficiency anemia? |
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Definition
| vegetarian diet, post gastrectomy, and Crohn's disease. |
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Term
| What symptoms are present with Pernicious anemia but not folate deficiency that helps distinguish between the two? |
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Definition
| Pernicious will have symmetric paresthesias of the feet and hands. |
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Term
| How is Pernicious anemia diagnosed? |
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Definition
| By Schilling Test (radioisotopes of B12 are ingested and you watch for absorption or malabsorption). |
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Term
| How will Pernicious anemia appear on labs? Treatment for Pernicious anemia? |
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Definition
| pancytopenia, macrocytic and decreased folic acid. Treatment is IM B12 (cyanocobalmin) supplementation for life. |
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Term
| What kind of defects are seen with folate deficiency anemic pregnant mothers? What is it usually associated with? |
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Definition
| It is associated with neural tube defects in neonates and is usually associated with alcoholism. |
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Term
| What are some S&S of folate deficiency anemia? |
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Definition
| memory changes, irritability and personality changes but NO neurological changes (only B12 deficiency). |
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Term
| How is folate deficiency diagnosed on peripheral smear and serum testing? |
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Definition
| Macro-ovalocytes (large oval RBCs), hypersegmented PMNs (Neutrophils), Howell-Jolly bodies (small peices of DNA in RBCs), low folate levels and normal B12 levels. |
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Term
| What are some common folate sources? |
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Definition
| Dark leafy green veggies, okra, lentils, kidney beans and sunflower seeds. |
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Term
| What is the cause of Anemia of Chronic Disease? How will it look on MCV? |
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Definition
| It is due to a decrease in EPO production from chronic renal, liver, endocrine or thyroid failure or malignancies. It is normocytic on MCV. |
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Term
| What will Anemia of Chronic Disease appear on peripheral smear? CBC? What is the treatment? |
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Definition
| Hb and Hct will be decreased, RBCs will be deformed (Burr cells), MCV,MCH,MCHC are all normal, serum iron is normal and WBCs/platelets are normal. Treatment is recombinant human EPO. |
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Term
| Which anemias are inherited? |
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Definition
| G6PD anemia, sickle cell anemia and Thalassemia anemia. |
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Term
| What is the most common metabolic disease of the RBC? |
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Definition
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Term
| Describe G6PD anemia. What is the characteristic of G6PD seen on histology? |
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Definition
| It is an X-linked recessive disorder where they are missing the G6PD enzyme which damages RBC membranes and results in Heinz bodies (inclusions within red blood cells composed of denatured hemoglobin) and bite cells on histology. |
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Term
| What are the causes of acute G6PD anemia problems? |
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Definition
| The RBCs are more sensitive to oxidative stress and it is exacerbated by infection, drugs (ASA), and dietary (tell them to avoid red wine, legumes, blueberries and soy. |
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Term
| How is G6PD anemia diagnosed? |
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Definition
| By bite cells (cells that look like they have a bite taken out of them) and Heinz bodies (inclusions within red blood cells composed of denatured hemoglobin) on smear. |
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Term
| Describe Sickle Cell anemia. |
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Definition
| It is an autosomal recessive gene seen almost entirely in blacks and it involves a mutation of the beta chain of Hb that causes the RBCs to "sickle" under deoxygenated conditions. |
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Term
| Describe what happens in a sickle cell crisis. |
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Definition
| The sickled cells clog the capillaries and venules, leadign to tissue ischemia and acute pain and end organ damage. |
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Term
| What are some causes of an acute Sickle Cell exacerbation? |
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Definition
| cold weather, high altitude, dehydration, acidosis and hypoxemia. |
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Term
| What are some long term sequela of sickle cell anemia? |
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Definition
| splenomegaly, abnormal spleen function, renal failure, avascular necrosis of femoral head, strokes, retinopathies and priapism (painful erect penis/clitoris that will not return to its flaccid state) |
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Term
| How is sickle cell diagnosed based on blood smear? |
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Definition
| It will have anisocytosis, poikilocytosis, Howell-Jolly bodies and sickled cells on smear. |
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Term
| What is the treatment of choice for sickle cell anemia? |
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Definition
| stem cell transplant (curative) |
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Term
| Describe how Thalassemia leads to anemia. |
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Definition
| It is a genetically inherited disorder resulting in decreased or absent synthesis of alpha or beta globin chains of the hemoglobin molecule which results in abnormal RBCs that do not live as long and leads to anemia. |
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Term
| Where is Alpha-Thalassemia more common? Beta? What is the prominent feature of Thalassemia? |
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Definition
| Alpha = Asian origin. Beta = Mediterranean origin. Prominent feature is microcytosis out of proportion to the degree of anemia and it is hypochromic. |
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Term
| What is Hgb H and Bart's Hgb (hydrops fetalis)? |
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Definition
| Hgb H is in alpha-Thalassemia and only 2 of the 4 chains are deleted and results in mild anemia. Bart's Hgb is when all 4 chains are deleted and results in a stillborn child or one that dies within days. |
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Term
| How will alpha-Thalassemia appear on labs? Smear? How is it diagnosed? |
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Definition
| Hypochromic, microcytic, will have target cells on smear and there will be evidence of hemolysis. It is diagnosed by Hb electrophoresis. |
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Term
| How do you treat alpha-Thalassemia? Do you want to give them iron? |
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Definition
| Treat with folic acid supplements, do not give iron because the problem is incorporating the iron not an iron deficiency. |
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Term
| Describe Beta-Thalassemia minor. MCV and MCHC? How is it diagnosed? |
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Definition
| Occurs in people that are heterozygous for the B-Thalassemia gene, they are usually asymptomatic but the RBCs are hypochromic and microcytic. Diagnosis made by Hb electrophoresis. |
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Term
| Where is B-Thalassemia major common? AKA? When is the onset? S&S? |
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Definition
| Common in people of Mediterranean, Middle East, India, or Pakistani descent. It is also known as Cooley's anemia. The onset of symptoms is 4-6 months after birth when they switch from HgF to adult Hb. S&S = severe anemia, growth retardation, abnormal facies, pathologic fractures, osteopenia, bone deformities, splenomegaly and jaundice. |
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Term
| How is Beta-Thalassemia major treated? |
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Definition
| treated with chronic blood transfusions, bone marrow transplant and chelation therapy if iron gets too high. |
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Term
| What is Polycythemia Vera? |
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Definition
| A condition with an abnormally elevated Hgb or Hct that increases the blood viscosity. |
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Term
| How will Polycythemia appear on a smear? |
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Definition
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Term
| What could be some causes of polycythemia? |
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Definition
| dehydration, allergic reaction, chronic hypoxia or renal tumors (secrete too much EPO). |
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Term
| What are some Sx of polycythemia vera? At what Hgb concentration is the patient at risk for arterial/venous thrombosis and marked decrease in blood flow to vital organs? |
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Definition
| fatigue, headache, malaise and pruritis after bathing. Hgb > 20g/dl. |
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Term
| What is the treatment for Polycythemia Vera? |
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Definition
| Treatment is phlebotomy QD (once a day) or myelosuppressive drugs (Hydroxyurea). |
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Term
| What is the normal RBC count for men and women? |
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Definition
males: 4.3 – 5.7 x10³/µL
female: 3.8 – 5.1 x10³/µL |
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