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29 Cards in this Set
- Front
- Back
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Which of the following causes spurious increased MCV?
A. Rouleaux formation B. Increase in Reticulocyte [] C. Chronic lymphocyte leukemia D. Autoantibody production, hyperglobulinemia, cold agglutinins |
All of them!
A. Rouleaux formation - clumping, group recognized as one cell B. Increase in Reticulocyte [] -immature reticulocytes are larger than mature RBC C. Chronic lymphocyte leukemia - the machine counts all cells not just RBC, thus if there are a lot of WBC, numbers become significant |
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Macrocytes are divides into either what shapes?
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OVAL (megaloblastic)
ROUND (non-megaloblastic) |
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Cause of Oval macrocytosis
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- DNA replication problem resulting in nuclear/cytoplasmic asyynchory -> gigantism of all proliferating cells
- ineffective erythropoiesis results from high rates of BM cell dealth in a setting of marrow HYPERcellularity |
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in Folate/B12 deficiency , you see what kind of PMN.
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hypersegmented PMNs.
(oval macrocytosis) |
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in Myelodysplaisa, you see what kind of PMN.
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HYPOsegmented PMNs/
(oval macrocytosis) |
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Dx with the following lab result:
- normal MCHC (normochromic) - MCH increased - MCV > 100 or normal (w/ concenrrent iron deficiency) - anisocytosis (RDW high) - reticulocyte count low - neutorphils left shift, larger than normal - may see pancytopenia |
Megaloblastic Anemia
-pancytopenia means reduction of everything (RBC, WBC, platelets) |
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the only anemia with ALL 3 cell lines involved
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Megaloblastic Anemia
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Triad of oval macrocytes, Howell-Jolly bodies, and hypersegmented neutrophils is seen in
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Megaloblastic Anemia
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Tetrahydrofolate is the active form of ____.
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Folate.
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defective DNA synthesis by blocking dUMP to dTMP occurs in what deficiency
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Folate defiency
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possible causes of folate deficiency
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1. Dietary
2. Pregancy 3. Hemolytic anemia 4. malabsorption 5. Drugs ( oral contraceptives, long term anticoagulatns, pehnobarbitol) |
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Recommended allowance of folic acid
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200ug/day
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Timeline for folate deficiency
- serum folate decreae - hypersegmented neutorphils (first sign) - anemia (last sign) |
- serum folate decrease (2 wks)
- hypersegmented neutorphils (first sign) 11 wks - anemia (last sign) - 20 wks |
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B12 (Cobalamin) deficiency blocks what in DNA synthesis
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blocks syntheiss of methionine because folate is trapped in n-methyl THFform
(functional folate deficiency) |
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How long can a copious amount of B12 be stored?
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2- 6 years,
meaning dietary deficiency is unlikely. |
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Achlorhydria or partial gastrectomy due to tx for obesity can cause abnormal gastric envrionment and what deficiency?
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B12 deficiency
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Pernious anemia is
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anemia due to deficient intrinsic factor, due to destruction of parietal epithelial cells by autoantibodies, malabsorption syndromes, pancreatic insufficiency or surgial removal
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B12 binds with R-binding proteins in ___
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stomach
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IF is released from what cell in stomach
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parietal cell
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what term referes to megaloblastic anemia due to absence of IF secondary to gastric atrophy?
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Pernicious anemia
- It frequently occurs with other autoimmune diseases such as SLE, graves, or hashimotos, |
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What is the most common cuase of B12 deficiency?
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Pernicious anemia
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What happens to B12-R-protein complex in Duodenum?
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Pancreatic protease releases B12 (eats up R-binding protein) and bound to IF
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Where is the IF recepto located in the GI system?
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Terminal ileum
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2 ways to have pernicious anemia
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1. cann't form IF-B12 complexes
2. IF-B12 complex can't bind in the ileum |
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Elevated homocysteine may indicate
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B12 & folate deficiency
homocystein to methionine (needed for conversion from n-methyl THF to active THF) |
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If less than <7% on Schilling test part I but normal in part II, what does it suggest?
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Pernicious Anemia
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If its low on both part I and part II, what could it be?
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baterial overgrowth (should go down with antibiotics)
or Ileal dysfunction |
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Macrocytic anemia without Megaloblastosis characteristics
( just see answers) |
- round
- no hypersegmented PMN - absence of glossitis and neuropathy |
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Metabolic Inhibitors that affect proliferating cells including hematopoietic cells would cause what kind of anemia?
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Macrocytic Anemia with Megaloblastosis
examples of the durgs include chemotherpaeutic and antiretrovirals |
