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104 Cards in this Set
- Front
- Back
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source of energy for erythrocytes?
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glucose (90% anaerobically degraded to lactate; 10% by HMP shunt)
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densely basophilic granules containing heparin, histamine & other vasoactive amines, and leukotrienes (LTD-4)
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basophil
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where are mast cells found?
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tissue
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cells that mediate allergic reaction?
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mast cells and basophils
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What prevents mast cell degranulation?
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cromolyn sodium
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cells that defend against helminthic and protozoan infections?
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eosinophils
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causes of eosinophilia?
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"NAACP:
neoplastic, asthma, allergic processes, collagen vascular diseases, parasites" |
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when are hypersegmented neutrophils seen?
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vitamin B12 deficiecncy and Folate deficiency
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Which cells contain large, spherical, azurophilic primary granules that contain hydrolytic enzymes, lysozyme, myeloperoxidase, and lactoferrin
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neutrophils
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kidney-shaped nucleus; extensive 'frosted glass' cytoplasm; differentiates into macrophages in tissues
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monocyte
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off-center nucleus, clock-face chromatin distribution, abundant RER and well-developed Golgi
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plasma cell
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multiple myeloma is what type of neoplasm?
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plasma cell
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which cells are the main inducers of the primary antibody response?
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dendritic cells
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what is the role of tPA?
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generates plasmin, which cleaves fibrin
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what does PTT measure?
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intrinsic pathway
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what does PT measure?
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extrinsic pathway - factors II, V, VII, X
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what initiates the intrinsic pathway?
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factor XII
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what initiates the extrinsic pathway?
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factor VII
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what do proteins C and S inactivate?
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Va and VIIIa; dependent on vitamin K
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waht does antithrombin III inactivate?
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thrombin, IXa, Xa, XIa; activated by heparin
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what usually has more prognostic value - stage or grade?
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stage
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degree of cellular differentiation based on histologic appearance of tumor?
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grade
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degree of localization/spread based on site and size of primary lesion, spread to regional lymph nodes, presence of metastases, etc.
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stage (S-spread)
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macro-ovalocytes are seen in what?
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megaloblastic anemia (also hypersegmented PMNs), marrow failure
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helmet cells and schistocytes are seen when?
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DIC, traumatic hemolysis
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teardrop cells are seen when?
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myeloid metaplasia with myelofibrosis
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acanthocytes are seen when
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spiny appearance in abetalipoproteinemia
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when are target cells seen?
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HALT: HbC disease, asplenia, liver disease, thalassemia
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what are poikilocytes & when are they seen?
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nonuniform shapes in TTP/HUS, microvascular damge, DIC
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when are Burr cells seen?
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TTP/HUS
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etiologies of microcytic, hypochromic anemia?
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iron deficiency, thalassemias, lead poisoning, sideroblastic anemias
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etiologies of macrocytic anemia?
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megaloblastic - vitamin B12/folate deficiency
drugs that block DNA synthesis (e.g. sulfa drugs, phenytoin, AZT) marked reticulocytosis (bigger than mature RBCS) |
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causes of normocytic, normochromic anemia?
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acute hemorrhage, enzyme defects (G6PD, PK), RBC membrane defects (e.g. hereditary spherocytosis), bone marrow disorders (aplastic anemia, leukemia), hemoglobinopathies (sickle cell), anemia of chronic disease, AI hemolytic anemia
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what do decreased serum haptoglobin and increased serum LDH indicate?
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RBC hemolysis
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causes of aplastic anemia?
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radiation, benzene, chloramphenicol, alkylating agents, antimetabolites, viral agents (parvovirus B19, EBV, HIV), Fanconi's anemia, idiopathic; may follow acute hepatitis
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symptoms of aplastic anemia?
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fatigue, malaise, pallor, purpura, mucosal bleeding, petechiae, infection
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pancytopenia with normal cell morphology, hypocellular bone marrow with fatty infiltration.
What is the diagnosis? |
aplastic anemia
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what is the HbS mutation?
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single AA replacement in beta chain - substitution of normal glutamic acid with valine
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therapies for sickle cell anemia?
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hydroxyurea (increases HbF), bone marrow transplant
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what percent of blacks carry the Hb trait? what percent have the disease?
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8%, 0.2%
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crew cut on skull x-ray?
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sickle cell anemia, thalassemias - due to marrow expansion from increased erythropoeisis
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what is the defect in beta thalassemia minor? major?
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minor - heterozygote - beta chain is underproduced
major - homozygote - beta chain is absent |
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why does cardiac failure occur in thalassemia?
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secondary hemochromatosis
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patient has marked erythrocytosis, moderate increase in granulocytes and platelets, splenomegaly, decreased EPO.
What is the diagnosis? |
polycythemia vera
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labs in anemia of chronic disease?
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decreased TIBC, increased ferritin, low serum iron
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findings in hemolytic anemia?
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increased serum unconjugated bilirubin, increased reticulocytes (marrow compensating for anemia)
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test for Autoimmune hemolytic anemia?
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Coombs positive
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chronic anemia seen in SLE, CLL, or with certain drugs (e.g. alpha methyldopa)
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warm agglutinin (IgG)
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describe the direct Coombs' test
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anti-Ig Ab added to patient's RBCs agglutinate if RBCs are coated with Ig
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Describe the indirect Coombs' test
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normal RBCs added to patient's serum agglutinate if serum has anti-RBC surface Ig
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microvascular hemolysis seen in DIC, TTP/HUS, SLE, or malignant hypertension describes what disease?
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microangiopathic anemia
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what is seen on blood smear in microangiopathic anemia?
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schistocytes (helmet cells)
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what is increased in paroxysmal nocturnal hemoglobinuria?
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urine hemosiderin
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activation of coagulation cascade leading to microthrombi and global consumption of platelets, fibrin, and coagulation factors
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DIC
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lab findings in DIC?
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increased PT, PTT, fibrin split products (D dimers); decreased platelet count
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what is seen on blood smear in DIC?
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helmet-shaped cells and schistocytes
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antiplatelet antibodies coating and damaging platelets, increased megakaryocytes, children
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ITP
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hyaline microthrombi in small vessels, helmet cells and schistocytes, neurologic abnormalities and renal insufficiency.
What is the diagnosis? |
TTP
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microhemorrhage - mucous membrane bleeding, epistaxis, petechiae, purpura, increased bleeding time. What is the underlying defect and differential diagnosis?
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platelet abnormalities - ITP, TTP, DIC, aplastic anemia, drugs (e.g. immunosuppressive agents)
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factor VIII deficiency
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hemophilia A
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factor IX deficiency
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hemophilia B
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describe von Willebrand's disease
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mild; most common bleeding disorder; deficiency of vWF - defect of platelet adhesion and decreased factor VIII survival
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macrohemorrhage - hemarthroses (bleeding into joints), easy bruising, increased PT, PTT. What is the category of disease and differential diagnosis?
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coagulation factor deficiencies; Hemophilia A, Hemophilia B, von Willebrand's disease
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Bernard-Soulier disease?
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defect of platelet adhesion (decreased GP Ib) - prolonged bleeding time and decreased platelets
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Glanzmann's thrombasthenia
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defect of platelet aGgregation - decreased GP IIb-IIIa - prolonged bleeding time
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decresed platelet count, increased bleeding time with normal PT and PTT. Diagnosis?
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thrombocytopenia
or Bernard Soulier's |
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lab findings in hemophilia A or B?
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normal platelet count, bleeding time, PT, increased PTT
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increased bleeding time and increased PTT
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von Willebrand's disease
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findings in DIC
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decreased platelet count, increased bleeding time, PT, and PTT
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PT measures what?
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extrinsic pathway - factors, II, V, VII, X
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PTT measures what?
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intrinsic pathway - all factors except VII
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What are common complications associated with Sickle Cell Disease?
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aplastic crisis (e.g. from parvovirus B19), autosplenectomy (occurs by 20 y/o), salmonella osteomyelitis, renal papillary necrosis, splenic sequestration crisis
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What are common causes of DIC?
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STOP Making New Thrombi
Sepsis, Trauma, Obstetric complications, acute Pancreatitis, Malignancy, Nephrotic syndrome, Transfusion |
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What causes Paroxysmal Nocturnal Hemoglobinuria?
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Intravascular hemolysis due to membrane defect that increases sensitivity of RBCs to lytic activity of complement
(GPI anchor deficiency) |
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What is Cold agglutinin?
Where is it seen? |
IgM mediated acute anemia triggered by cold. Seen in M. pneumoniae infections or infectious mononucleosis
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What causes Hereditary Spherocytosis?
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intrinsic extravascular hemolysis due to defect in spectrin or ankyrin
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patient has increased MCHC, increased RDW, and RBCs with no central pallor. What is the diagnosis?
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Hereditary spherocytosis
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What cytokine activates macrophages?
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interferon gamma
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What proteins are expressed on the surface of dendritic cells?
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MHC II and Fc receptors
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Cytotoxic T lymphocytes are of which cluster designation and MHC complex?
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CD4 and MHC II
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Helper T cells are of which cluster designation and MHC complex?
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CD8 and MHC I
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Which are the vitamin K dependent factors?
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II, VII, IX, X and proteins C and S
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What activates protein C?
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Thrombomodulin (protein S is a cofactor)
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What is caused by a factor V Leiden mutation?
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resistance to activated protein C
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What do eosinophils produce?
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histaminase and aryl sulfatase
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When are bite cells seen?
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G6PD deficiency
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In what conditions would you see basophilic stippling?
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TAIL - Thalassemia, Anemia of chronic disease, Iron deficiency, Lead poisoning
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How do you distinguish between B12 and folate deficiencies clinically?
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B12 deficiencies have neurologic manifestations
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How do you diagnose aplastic anemia?
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Bone Marrow biopsy
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patient comes in with normal platelet count, normal bleeding time, normal PT and increased PTT. What is the diagnosis?
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Hemophilia A or B
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Patient presents with normal platelet count, increased bleeding time, normal PT and increased PTT. What is the diagnosis?
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von Willebrand's disease
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Patient has decreased platelet count, increased bleeding time, PT and PTT. What is the diagnosis?
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DIC
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patient has normal platelet count and bleeding time but increased PT and PTT. What is the diagnosis?
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Vitamin K deficiency
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patient has decreased platelet count and increased bleeding time with normal PT and PTT. What is the diagnosis and mechanism?
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Bernard-Soulier disease;
decreased GP Ib (platelet adhesion) |
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Patient has increased bleeding time and normal platelet count, PT and PTT. What is the diagnosis and mechanism?
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Glanzmann's thrombasthenia;
defect of GPIIb-IIIa (aggregation) |
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patient has decreased serum Iron, increased transferrin/TIBC, decreased Ferritin and decreased %transferrin saturation. What is the diagnosis?
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iron deficiency
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Patient has decreased serum iron, decreased transferrin/TIBC, increased ferritin and normal % transferrin saturation. What is the diagnosis?
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anemia of Chronic disease
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patient has normal serum iron, increased transferrin/TIBC, normal Ferritin and decreased % transferrin saturation. What is the diagnosis?
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Pregnancy/OCP use
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patient has increased serum iron, decreased transferrin/TIBC, increased Ferritin and markedly increased % transferrin saturation. What is the diagnosis?
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hemochromatosis
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What are the 3 steps of the formation of a platelet plug?
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1. Platelet adhesion to exposed BM
2. Aggregation 3. Swelling - ADP and Ca release to strengthen plug and induce fibrin deposition |
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How is platelet aggregation regulated in clot formation?
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1. TXA2 is released by platelets in induce aggregation
2. PGI2 and NO are released by endothelial cells to inhibit aggregation |
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PTT measures function of which clotting factors?
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all factors except VII (intrinsic pathway)
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PT measures function of which clotting factors?
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II, V, VII and X (extrinsic pathway)
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bilobed nucleus, densely basophilic granules containing heparin, histamine and other vasoactive amines and leukotrienes. found in blood. what is the cell?
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Basophil
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