Term
what blood cell is:
anuclear
agranular
biconcave
7-8 microns diameter
area of central pallor should be about 1/3 of diameter |
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Definition
|
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Term
What blood cell is:
anuclear
granular
2-4 micron diamter
seals openings in vascular tree |
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Definition
|
|
Term
What blood cell is:
round-irregular nucleus
6-15 micrometers
adaptive immunity |
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Definition
|
|
Term
what blood cell is:
bead shaped nucleus
"cerebroform nucleus"
12-20 micrometers
3 functions:
phagocytes, antigen presenting cells, immune system regulator to produce cytokines |
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Definition
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Term
what blood cell is:
lobes nucleus (2-3)
cytoplasm full of large eosinophilic granules
12-15 microns
function:
IgE mediated reactions
anti-parasitic
full of histamine granules |
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Definition
|
|
Term
cytoplasm full of grandules
dark purple/blue
functions:
allergic reactions, anaphylaxis |
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Definition
|
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Term
What blood cell is:
3-5 lobed nucleus
granular cytoplasm (small granules)
12-15 micron diameter
function:
innate immunity
eat and kill bacteria and fungi |
|
Definition
Neutrophils
(PMN, bands, segs) |
|
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Term
Order the following developmental stages from myeloblasts to neutrophis/eosinophils/basophils.
metamyelocyte
promyeloctye
myelocyte
myeloblast
neutrophil/eosinophil/basophil
band |
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Definition
myeloblast
promyeloctye
myelocyte
metamyelocyte
band
neutrophil/eosinophil/basophil |
|
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Term
| red marrow vs. yellow marrow |
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Definition
red marrow = actively producing blood cells. Transitions to yellow marrow over time, starting with extremities.
yellow marrow = inactive fat filled |
|
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Term
What type of cell is identified by the cell surface markers:
CD34
kit
Thy
no CD38
no Lin |
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Definition
|
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Term
Match which type of differentiation is driven by which factor.
CFU-Meg
G-CSF
GM-CSF
EPO
Erythrocyte, Monocyte, Granulocyte, and Thrombocyte differentiation |
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Definition
Erythrocyte differentiation -- EPO
Granulocyte differentiation -- G-CSF
Monocyte differentiation -- GM-CSF
Thrombocyte differentiation -- CFU-Meg |
|
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Term
| What differentiated blood cells are still proliferative? |
|
Definition
|
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Term
| Which blood cells are granular and which are agranular? |
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Definition
Granular:
basophil, eosinophil, neutrophil (PMN, band, seg)
Agranular:
monocyte
lymphocyte
erythrocyte |
|
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Term
Which blood cells are anuclear?
segmented nucleus? |
|
Definition
anuclear?
thrombocyte
erythrocyte
segmented?
neutrophil (PMN)
bean shaped?
monocyte |
|
|
Term
| List platelet differentiation precursors. |
|
Definition
Megakaryoblast
Promegakaryocyte
Mature Megakaryocyte
Breaks off peices of cytoplasm --> platelet |
|
|
Term
| What are the 4 broad categories of pathology that effect marrow function? |
|
Definition
iatrogenic : radiation, chemotheraputic agents
clonal hemopathies : AML, MDS
malignancies : lymphoma, myelomas, metastatic lesion
aplastic anemia |
|
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Term
| What are the 4 causes of increased neutrophil counts? |
|
Definition
1. G-CSF - increased differentiation
2. Neoplasms
3. Splenectomy - no destruction
4. Inflammatory states - increased margination causes increased production? |
|
|
Term
Describe Heme synthesis
RDS and regulation! |
|
Definition
Steps 1, 6-8 in mitochondria
Steps 2-5 in cytosol
RDS is step 1, ALA synthase.
In bone marrow: increased by Iron
In liver: increased by Barbituates and drugs, decreased by glucose and heme.
Vit B6 is a cofactor, and is most commonly depleted by isoniazid therapy.
key regulation and ALA synthase (1), ALA dehydratase (2), and Ferrochelatase (8)
enzymes:
1. ALA synthetase
2. ALA dehydratase
3. PB deaminase
4. Uroporphyrinogen III synthase
5. UP III decarboxylase
6. CP III oxidase
7. Protoporphyrin III oxidase
8. Ferrochelatase |
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
|
Definition
|
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Term
| 3 pieces of evidence that bone marrow is in distress (and therefore causing anemia) |
|
Definition
1. Decreased platelets / WBC
2. immature cells on peripheral smear, like nucleated RBCs
3. Tear drop RBCs on peripheral smear |
|
|
Term
| What stimulates EPO (erythropoietin) production? |
|
Definition
hypoxemia
severe anemia
left-shifted oxygen binding curvbe
high altitude |
|
|
Term
What is the formula for the corrected Retic count?
Why?
What happens in Polychromasia? |
|
Definition
Corrected retic = Hct/45 * retic%
45 represents the normal hematocrit
The percentage is falsely elevated in anemia
** in Polychromasia, polychromatic RBCs (even less mature than retics) appear due to very brisk hemolytic anemia. Need to half the "corrected retic" to correct the retic |
|
|
Term
| What should the corrected retic be in response to anemia? |
|
Definition
| corrected retic should be over 3%, demonstrating effective erythropoesis. |
|
|
Term
What are the defining levels of Anemia in Children, Men, Women and Pregnant Women?
vs. Fetal Hemoglobin? |
|
Definition
Pregnant Women < 11 g/dL
Women < 12.5 g/dL
Men < 13.5 g/dL
They have testosterone to increase erythropoiesis and don't have cyclical bleeding.
Children < 11.5 g/dL
Their oxygen binding curves are more right-shifted, meaning they give oxygen up to tissues more easily (bc they have higher BPG from higher phosophorus). So oxygen delivery is sufficient at lower Hct.
Newborns have Hct around 18.5 g/dL.
Fetal Hemoglobin (2alpha, 2 gamma) has a left shifted oxygen binding curve, which stimulates erythropoeitin synthesis, which increases Hb, Hct, and RBC. |
|
|
Term
| MCHC in microcytic anemias vs in spherocytosis |
|
Definition
MCHC is low in microcytic anemias
high in spherocytosis |
|
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Term
|
Definition
| RBCs have no mitochondria, so they get their ATP from anaerobic glycolysis, producing lactic acid. Lactic acid is converted into glucose in the liver by gluconeogenesis, sending glucose back to the RBCs. |
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Term
|
Definition
| In spleen where splenic macrophages phagocytose senescent RBCs. They degreade heme to unconjugated bilirubin. |
|
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Term
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Definition
| Anti-oxidant that neutralized hydrogen peroxide. |
|
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Term
| Methemoglobin reductase pathway |
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Definition
| in RBCs, this reductase pathway reduces iron (Fe3+, methemoglobin) to ferrous (Fe2+)so that heme can bind O2. |
|
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Term
Ferritin.
Where is it synthesized.
How is it regulated. |
|
Definition
Synthesized in bone marrow macrophages. Stores iron in the bone marrow macrophages.
Directly correlates with serum iron levels.
Synthesis is increased in response to inflammation (due to interleukin 1 and TNF alpha). Inflammation makes your body want to store iron in macrophages to keep it away from the potential bacterial infection, since bacteria thrive off iron.
Levels decrease in iron deficiency, increase in anemia of chronic disease and iron overload disease.
Hemosiderin is the insoluble degradation product of ferritin. |
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Term
Serum iron.
What does it respresent?
What is the normal level? |
|
Definition
Represents iron bound to transferrin.
Normal level is 100 microg/dL
Levels decrease in iron deficiency and anemia of chronic disease, increase in iron overload disease |
|
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Term
Serum TIBC (total Iron binding capacity)
What does it represent.
What is its normal level.
How does it related to ferritin. |
|
Definition
essentially the same as the concentration of transferrin.
Normal level is 300 microg/dL.
Made in the Liver. Increased in response to low ferritin stores. |
|
|
Term
| What is iron saturation = |
|
Definition
= (serum iron/ TIBC) * 100%
normally 33%
(100/300) |
|
|
Term
What types of globin chains make up each of the following.
HbA
HbA2
HbF |
|
Definition
HbA -- 2 alpha, 2 beta
HbA2 -- 2alpha, 2delta
HbF -- 2alpha, 2gamma |
|
|
Term
| How does iron get absorbed? |
|
Definition
Duodenum, absorb 10% of iron from diet. Only absorb reduced form (ferrous Fe2+) as from red meat, not ferric Fe3+.
Gastric acid frees iron from food.
Ascorbic acid reduces Fe3+ to the absorbable Fe2+.
HFE (hemochromatosis) gene regulates (increases) transferrin endocytosis to absorb iron in intestinal cells. |
|
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Term
| What antibodies can pass through the placenta? |
|
Definition
|
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Term
| Typing vs Screening blood |
|
Definition
Typing is direct and Screening is indirect. Both find the patients antibody status (blood type).
Typing uses whole blood from the patient and anti-AB antibodys on a slide, look for agglutination.
Screening uses only patients serum (containing antibodies) and a sample of donor RBC with a known antigen, then look for agglutination. |
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|
Term
What is FFP?
(a type of blood transfusion)
When do you use it? |
|
Definition
Acellular. Coagulation factors plus fibrinogen. No RBC antigens, but still lots of antibody in the plasma that can react with a host.
This is not virally inactivated.
Use:
DIC
liver disease
dilutional coagulopathy
urgent warfarin reversal |
|
|
Term
What is Cryoprecipitate?
(a type of blood transfusion)
When do you use it? |
|
Definition
The cold insoluble remnant of thawed FFP.
Acellular. Full of FVIII, FXIII, fibrinogen, fibronectin, vWF.
Use:
hypofibrinogenemeia
FXIII deficiency |
|
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Term
Leukoreduction.
What is it?
Uses? |
|
Definition
Removing WBCs from blood.
uses:
Reduces febrile transfusion reactions because its the WBCs that produce cytokines. Give WBCs is like giving a cytokine bolus.
Reduces viral transmission, like CMV.
Prevents HLA immunization of recipient (ie. will have reaction to this HLA type in future).
problems:
cost |
|
|
Term
Irradiation (for blood transfusion).
What is it?
Uses? |
|
Definition
Gamma irradiation. Prevent CD8 T cells in the blood from being able to proliferate. This reduces the shelf life of the blood and so is only done for people at risk of GVHD.
Uses:
Prevents graft versus host disease (GVHD), which is fatal in about 80% of cases. At risk patients:
- immunodeficiencies
- newborns (esp with erythrobastosis fetalis)
- recipients of intrauterine transfusions, hematopoietic stem cells, blood products from relatives, HLA-selected platelets (homogenous)
Problems:
Reduces shelf life of blood products because causes potassium to leak from the cells. |
|
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Term
Washing (for blood transfusion).
What is it?
Uses? |
|
Definition
Removes plasma proteins and antibodies from blood products. Removes potassium that has leaked from platelet units.
Uses:
Neonatal alloimmune thrombocytopenia - Removes PLA-1 antibodies from maternal platelet donations.
Patients with IgA deficiency
Patients with history of anaphylactic reactions to blood products.
Problems:
Once washed, must be used within 24 hours or sterility will be lost. |
|
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Term
Volume reduction (for blood transfusion).
What is it?
Uses? |
|
Definition
To transfuse a lot of platelets with very little plasma volume.
Use:
apheresis units with volume overloaded patients
problem:
up to half of the product is lost because this is done by centrifuging
neonatal and pediatric populations |
|
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Term
Phenotypic Matching (for blood transfusion).
What is it?
Uses? |
|
Definition
Make sure donor RBCs are lacking the same minor antigens that the recipient is lacking: C, E, K
uses:
Sickle cell patients to prevent alloimmunization to minor antigens. |
|
|
Term
Risks of Blood transfusions:
List Infectious diseases that can be transfused with blood transfusions and how we screen for them. |
|
Definition
HBV - surface antigen test only bc uncommon in US, window of 40-60 days
HCV - Nucleic acid test bc common (1%), window of 10-30 days
HIV-1 - Nucleic acid test, window 9-10 days
HTLV1/11 (causes adult T-cell leukemia/lymphoma)
Syphilis
CMV (lives in lymphocytes, most common infection from transfusion) - we only screen some units and save them for immunosupressed patients
also consider:
West Nile Virus - minipool Nucleic acid test bc rare (test 100 at once)
Malaria - no effective screen, just history
Babesiosis - no effective screen, just history (tickborne protozoa replicates in RBCs)
vCJD - only history if have been to UK/Europe (same prion as mad cow, death within 7-38 months) |
|
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Term
| Describe Folate absorption. |
|
Definition
In jejunum. Comes in Fresh fruits/veges. Cooking denatures it. Yay vegans!
Intestinal conjugase converts digested polyglutamates to monoglutamates, which can then be absorbed in the jejunum.
Need 50 microg/day, diet usually 700 but only absorb 10%. Liver stores a 3-4 month supply.
Absorption inhbited by:
- alcohol (and release from liver)
- OCPs
- phenytoin (inhibits intestinal conjugase)
- Celiac disease
- Bacterial overgrowth
Due to post-absorption processing, Folate levels reduced by:
- 5-FU
- Methotrexate, trimethoprim, sulfamethoxazole |
|
|
Term
|
Definition
Damages endothelial cells leading to thrombosis. Leads to strokes, etc.
Most commonly elevated in US due to folate deficiency. Normally Vit B12 transfers a methyl group to homocysteine to produce methionine.
Elevated by both B12 and folate deficiency. |
|
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Term
| What does folate deficiency in a mother due to an unborn fetus? |
|
Definition
| Increases risk of open neural tube defects. This is from deficient folate PRIOR TO CONCEPTION and in first month of gestation. |
|
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Term
Reduced Neutrophil count.
How does it impair the immune system?
Why infection are common?
What will decrease neutrophil count? |
|
Definition
Impairs:
Can't fight extracellular pathogens as well.
Infections:
Bacterial pathogens, even those less virulent
Fungi : Candida
Opportunistic Molds : Aspergillus
Etiology:
Cytotoxic drugs
Acute leukemia
Chronic granulomatous dz
Chediak-Higashi syndrome |
|
|
Term
Reduced Cell-Mediated immunity (T-cells).
How does it impair the immune system?
Why infection are common?
What will decrease T cells? |
|
Definition
Impairs:
Can't fight intracellular pathogens as well.
Infections:
Any organism with an intracellular phase.
Mycobacteria
Listeria
Cryptococcus
Toxoplasmosis
Pneumocystis
Etiology:
HIV
Glucocorticoids (steroids)
immunosuppression for organ transplant
lymphomas (esp. Hodgkin's disease)
PCP
Mycobacteria
Toxoplasmosis
Strongyloides |
|
|
Term
Reduced Humoral Immunity (B cells / antibodies).
How does it impair the immune system?
Why infection are common?
What will decrease B cell count? |
|
Definition
Impairs:
Can't fight extracellular encapsulated pathogens.
(Less complement and macrophage activation)
Infections:
encapsulated bacteria like S. pneumoniae, H. influenzae, N. meningitidis
Etiology:
Splenectomy
Multiple myeloma
Immunodeficiency
X-linked agammaglobinemia |
|
|
Term
What pathogen do you need to consider if patient:
Has been exposed to grasses / hay |
|
Definition
|
|
Term
What pathogen do you need to consider if patient:
Has been exposed to animals |
|
Definition
salmonella
toxopasmosis
bartonella |
|
|
Term
What pathogen do you need to consider if patient:
Has been exposed to children (eeekk!) |
|
Definition
Viruses like
CMV
adenovirus
parvovirus |
|
|
Term
What pathogen do you need to consider if patient:
Has been exposed to sex. |
|
Definition
|
|
Term
|
Definition
High retic count > 75000
Corrected retic > 3%
High non-conjugated (indirect) bilirubin
High LDH (lactic dehydrogenase, in RBCs)
Low haptoglobins (binds free hemoglobin, now all occupied) - esp in intravascular
Usually normocytic MCV = 80-94
*though intravascular may lead to microcytic
Hemosiderosis - systemic iron deposition
Increase urine urobilinogen |
|
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Term
|
Definition
| decreases when free serum Hb increases during intravascular hemolysis. It attaches to free Hb. |
|
|
Term
Hemosiderinuria
and
Hemosiderosis |
|
Definition
Hemosiderin is the insoluble degradation product of ferritin / Iron.
Hemosiderinuria - brown urine
Renal tubules convert iron from serum Hb in hemolysis into hemosiderin, which is peed out. A sign of intravascular hemolysis.
Hemosiderosis
Deposition of iron around the body. Seen in severe hemolysis. |
|
|
Term
| What differentiates intravascular from extravascular hemolytic anemia? |
|
Definition
both
- high LDH
Intravascular
- Hemoglobinemia/Hemoglobinuria
- Hemosiderinuria
- low haptoglobin
eg.
paroxysmal nocturnal hemoglobinuria
mechanical destruction
microangiopathic anemia (DIC, TTP, HUS, HTN, HELLP)
Extravascular (phagocytosed by macrophages in spleen and liver)
-high unconjugated bilirubin --> jaundice and black gallstones.
eg.
hereditary spherocytosis
G6PD deficiency
sickle cell
pyruvate kinase deficiency |
|
|
Term
| Signs of an inherited hemolytic anemia |
|
Definition
neonatal jaundice
recurrent hepatitis
hyperbilirubinemia
"premature" gallstones (bilirubinate)
"premature" anemia, splenectomy
Family history of a hereditary hemolytic anemia
chronic or recurrent symptoms / pains |
|
|
Term
|
Definition
nuclear remnants in circulating RBCs
seen in peripheral smear in Sickle cell anemia and after splenectomy in Hereditary spherocytosis. |
|
|
Term
|
Definition
RBCs on peripheral smear that look like "helmet cells" - they have been cleaved by mechanical destruction intravascularly, as in microangiopathic anemia.
(DIC, TTP, HUS, SLE, malignant HTN, HELLP) |
|
|
Term
|
Definition
| Lead lines on gingivae as seen in lead poisoning. May be an indication of lead poisoning as the cause of a microcytic hypochromic anemia. |
|
|
Term
| elevated methylmalonic acid in a macrocytic anemia tells you what? |
|
Definition
| That the megaloblastic macrocytic anemia is caused by vit B12 deficiency, not folate deficiency. |
|
|
Term
Yeasts
vs.
Molds
vs.
Dimorphic Fungi
? |
|
Definition
Yeasts
eg. Candida, Cryptococcus
pseudohyphae (with narrowings)
Molds
eg. Aspergillus (common infection post stem cell transplant)
True hyphae - no narrowings
Dimorphic Fungi
eg. Histoplasma (Ohio/Mississippi river valley), Coccidiodomyces (West US)
Yeast in the heat (in body), mold in the cold |
|
|
Term
What cell is this?
Primary hemostasis, makes hemostatic plug
Dense granules of ADP and Ca
Alpha granules of vWF and fibrinogen |
|
Definition
|
|
Term
what do these terms mean:
anisocytosis
poikilocytosis |
|
Definition
size variation
shape variation |
|
|
Term
|
Definition
| vWF receptor on platelets |
|
|
Term
|
Definition
Fibrinogen receptor on platelets
increased by ADP |
|
|
Term
|
Definition
NAACP
neoplastic
asthma
allergy
collagen vascular disorder
parasites |
|
|
Term
| What normal cell has CD28, CD3, and CD4 |
|
Definition
|
|
Term
| What normal cell has CD28, CD3, and CD8 |
|
Definition
|
|
Term
| What normal cell has CD19 and CD20 |
|
Definition
|
|
Term
| What normal cell has CD14 and MHCII |
|
Definition
Macrophages
develop from monocytes in tissues from gamma-interferon exposure |
|
|
Term
| Where do you see hypersegmented neutrophils? |
|
Definition
Vit B12 deficiency
Folate deficiency |
|
|
Term
| Where do you see "crew cut skull"? |
|
Definition
Sickle Cell anemia
Major Beta Thalassemia
from marrow expansion |
|
|
Term
| WBC differential: List the WBCs in order of largest proportion to least. |
|
Definition
"Neutrophils Like Making Everything Better"
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils |
|
|
Term
What cells is this?
IgE triggers degranulation
Degranulation is prevented by cromolyn sodium
Type 1 hypersensitivity
Granules contain histamine (vasodilate), heparin (anticoagulate by propogating antithrombin), and eosinophil chemotactic factors |
|
Definition
|
|
Term
|
Definition
spiny/spur RBC
liver dz
abetalipoproteinemia |
|
|
Term
|
Definition
"BASte the ox TAIL"
Thalassemias
Anemia of Chronic dz
Iron deficiency
Lead poisoning |
|
|
Term
|
Definition
|
|
Term
|
Definition
Megaloblastic anemia
Marrow failure |
|
|
Term
|
Definition
Helmet cell RBC
DIC
TTP/HUS
traumatic hemolysis |
|
|
Term
|
Definition
hereditary spherocytosis
Autoimmune hemolysis |
|
|
Term
|
Definition
Bone marrow infiltration
eg. myelofibrosis |
|
|
Term
|
Definition
"HALT said the hunter to his targer"
HbC dz
Asplenia
Liver dz
Thalassemias |
|
|
Term
|
Definition
denature Hb from oxidized iron
alpha thalassemia
G6PD d
--> bite cells |
|
|
Term
|
Definition
nucelar remnant in RBC, should be taken out by spleen
asplenia or functional hyposplenia
eg. sickle cell |
|
|
Term
List causes of Microcytic anemia
<80 |
|
Definition
problem with Hb:
"CLITS"
chronic dz
lead poisoning
iron deficiency
thalassemias
sideroblastic anemia |
|
|
Term
List Normocyteic anemias
low retic vs. high retic |
|
Definition
low retic "ALARM"
Aplastic
Leukemia
Anemia of CD
Renal failure
Myelofibrosis or Marrow failure
high retic "GASP"
G6PDd
Autoimmune
Sickle and Spherocyteosis
PNH |
|
|
Term
List normocytic anemias.
Nonhemolytic
vs.
Hemolytic intrinsic
vs.
Hemolytic extrinsic |
|
Definition
Nonhemolytic: (synth problem)
Anemia of CD (new onset)
Aplastic anemia
Kidney dz
Hemolytic - Intrinsic:
Hereditary spherocytosis
G6PD d
PK d
HbC
Sickle Cell
PNH
Elliptocytosis and Pyropoikilocytosis
Hemolytic - Extrinsic:
Autoimmune
Microangiopathic
Macroangiopathic
Infection
Hypersplenism
Hypophosphatemia |
|
|
Term
Macrocytic Anemias. list.
>100 |
|
Definition
Megaloblastic: (problem with DNA synth)
(Macro-ovalocytes!)
Vit B12 deficiency
Folate deficiency
NonMegaloblastic (target cells!)
Liver dz
Alcoholism
Hypothyroid
Reticulocytosis
Drgus |
|
|
Term
Intravascular Hemolysis vs. Extravascular Hemolysis
(signs) |
|
Definition
Intravascular
Low haptoglobin bc binds free Hb
Hb in urine
Extravascular
High UCB (indirect) --> jaundice |
|
|
Term
| Steps of Heme degradation to Bilirubin |
|
Definition
Heme ---(heme oxygenase)--> Bilverdin, Iron, CO, NADP
Bilverdin---(bilverdin reductase)-->Bilirubin, NADP
Bilirubin--> to liver in blood bound to albumin |
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