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136 Cards in this Set
- Front
- Back
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Increased erythrocyte fragility
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hereditary spherocytosis - hemolytic jaundice and others
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osmotic fragility
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hereditary spherocytosis - hemolytic jaundice and others
Increased erythrocyte fragility |
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Decreased erythrocyte fragility
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obstructive jaundice
thalassemia SS anemia Iron deficiency anemia polycythemia vera |
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Heinz bodies
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G6PD deficiency - methemoglobulinemia -
splenectomized patients. Dutch, French, German descent |
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Drugs that induce Heinz bodies/stress G6PD
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SNAAL:
Sulfa Antimalarials Antipyretics & analgesics Nitrofurans Large Dose Vit K |
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Methemoglobunemia antidote
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is methylene blue
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Sudan black stain - positive
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acute granulocytic leukemia (AML)
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sudan black stain - negative
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acute lymphocytic leukemia
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Hypersegmented neutrophils and large platelets
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megloblastic anemia
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Low leukocyte alkaline phosphatase
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think CML - low lap score
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Immature blast
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leukemia
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Spherocytes
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immune hemolysis
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Microangiopathic hemolysis
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schistocytes, erythrocyte fragmentation
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Sickle cell
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SSA
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Tear drops and nucleated RBC
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myelofibrosis and marrow infiltration
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Target cells central
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thalassemia
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target cells peripheral
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liver disease
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Iron deficiency looks like
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pencil shaped deformities, microcytic, hypochromic
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hemolytic anemia - 3 characteristics
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1. increased unconjugated bilirubin
2. increased reticulocyte 3. decreased haptoglobin |
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reticulocytes are...
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early immature RBCs that still have RNA.
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reticulocytes should be evaluated...
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in non-acute anemia as the normal physiologic response of healthy normal bone marrow
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birth jaundice
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pathological jaundice
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"bite cells" of RBC
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enzyme defects
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G6PD deficiency or use of oxidation drugs =
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Heinz bodies
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Howell-Jolly bodies
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megloblastic anemia, SS anemia, hemolytic anemia, hyposplenism and splenectomy
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erythrocyte membrane problem
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spherocytes or elliptocytes; increased fragility
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sickle cell anemia with osteomyelitis
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salmonella is #1 pathogen
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central red cell targeting
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thalassemia
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peripheral red cell targeting
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liver disease
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bone marrow finding of erythroid hyperplasia is typical finding of...
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anemia where bone marrow is responding to increased need
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microcytic hypochromic anemia is hallmark of
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Hb synthesis problem
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Number one cause of microcytic anemia?
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Iron deficiency
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Most common cause of Fe deficient anemia?
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Blood loss. Most common cause in premenopausal female is menstruation
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Most common B12 deficiency
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B12 anemia
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Antiphospholipid syndrome (associated with SLE)
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Thrombotic
Triad = destructive thrombocytopenia, recurrent thrombosis, fetal loss |
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Antiphospholipid syndrome dx by
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lupus anticoagulant, anticardiolipin antibody
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Antiphospholipid syndrome tx with... (4)
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warfarin, LMWH, ASA or other antiplatelet
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Spur cells =
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acanthocytes
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Spur cells occur in
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liver disease
malnutrition malabsorption asplenia A beta lipiproteinemia |
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Triad of HUS
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thrombocytopenia
microangiopathic hemolytic anemia renal failure |
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Fanconi anemia
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congenital aplastic anemia
renal hypoplasia skin hyperpigmentation |
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Basophilic stippling - think...
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lead poisoning! (heavy metal intoxication + thalassemia)
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CHF =
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Doxorubin (Adriamycin)
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Causes of eosinophilia
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NAACP
Neoplasm Asthma Allergic Rxn Collagen vascular disease Parasites/helminth |
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What do liver enzymes look like in alcohol-related disease?
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AST>ALT (hitting the S-auce too much)
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ALL occurs in __________ and the TOC is _________.
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ALL occurs in kids and the TOC is chemo. (#1 cause of chemo in children = ALL)
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First line tx w/ aplastic anemia + AML in young patients =
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bone marrow transplant
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Hereditary spherocytosis is the only condition causing:
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hyperchromic anemia
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Myeloplastic disorders have:
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decreased RBC production but normal cells
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Myeloplastic disorders - suppressed ___________ by _______.
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suppressed hematopoiesis by toxin
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If you see Pelger-Huet anomaly look for
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basophilic stipling
ringed sideroblast |
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Myeloproliferative disorders are those that have an:
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over production of one or more cell types. Mildly dysplastic cells - "preleukemia"
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Myelofibrosis
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abnormal hematopoiesis; replacement in marrow of fibrous tissue; massive splenomegaly
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Aplastic anemia has:
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hypoplastic bone marrow;
pancytopenia, decreased WBCs, anemia, decreased platelets |
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ALL is _____% of childhood leukemia
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90%
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ALL is _______ type of leukemia
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agranular
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AML is ____% of adult leukemia
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90%
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AML has _______
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Auer rods
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Philadelphia chromosome is chromosome #
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9, 22
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95% of CML cases have what?
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presence of Philadelphia chromosome
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In ALL, the Philadelphia chromosome indicates what?
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poor prognosis
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In CML, lack of the Philadelphia chromosome indicates what?
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poor prognosis
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In leukemia, a long term cure connotes with
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5 years disease free
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The "no's" of multiple myeloma
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No fever
No increased alk phos No splenomegaly |
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RBC in Rouleax
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Waldenstrom macroglobulinemia
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If there is a bone marrow dry tap,
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1. myelofibrosis
2. hairy cell leukemia (also + tap stain) |
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Increased leukocyte alkaline phosphatase (LAP score):
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polycythemia
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decreased leukocyte alkaline phosphatase (LAP) score
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CML
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Acid phosphatase is increase in:
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prostate CA, prostatic surgery, trauma
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Acid phosphatase has:
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excessive platelet destruction (ITP); found rarely in bone disease
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Alkaline phosphatase indicates:
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increased Ca deposition in the bone (hyperPTH)
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Increased Alk Phos may be elevated in what 8 conditions?
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Paget's disease (aka Oseitis deformans)
Osteoblastic bone tumor Osteomalacia Rickets Pregnancy Biliary obstruction/liver disease Children increased thyroid |
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Paget's disease is a disease of
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older people. Skeletal disease. Hypertrophied & thickened long bones; deformity of flat bones
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elevated AFP may indicated:
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"MESH"
hepatoma embryonal cancer malignant teratoma - chest/mediastinal tumor spina bifida (if found in mom's serum) |
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B12 is increased in
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leukemia, polycythemia vera
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B12 is decreased in
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pernicious anemia, malabsorption of pregnancy
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Total bilirubin is increased in
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hepatic damage, biliary obstruction, hemolysis and fasting
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Direct bilirubin (conjugated) is increased in:
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excretory obstruction (stone, gallbladder, tumor, stricture)
Drug induced cholestasis Dubin Johnson Rotor syndrome |
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Dubin Johnson =
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inherited bile metabolism defect, asymptomatic but mild intermittent jaundice
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Rotor syndrome =
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benign hyperbilirubinemia, autosomal recessive jaundice with normal liver value except increased direct bilirubin
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Indirect bilirubin increase with:
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any hemolytic anemia - transfusion tx, sickle cell
Gilbert's Physiological jaundice of newborn Crigler-Najjar syndrome |
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Crigler Najjar syndrome =
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familial form of hyperbilirubinemia;
brain damage as a result of bilirubin on the brain; autosomal recessive indirect bilirubin |
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Bleeding time normal limits -
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2.5 - 10 minutes
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At ____ minutes, stop a bleeding time test
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15
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Increased bleeding time (5)
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1. Thrombocytopenia - PLT <50K
2. Von Willebrand's disease 3. defective platelet fxn 4. Collagen abnormalities 5. Prolonged steroids |
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What might be the only sign of von Willebrand disease?
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increased bleeding time
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When is there defective platelet fxn leading to increased bleeding time?
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WHen there has been ASA/NSAID ingestion, uremia, liver disease
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Corrected calcium =
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0.8 (normal albumin - measured) + reported Ca
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#1 cause of inpatient hypercalcemia?
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mets
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#1 cause of outpatient hypercalcemia?
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hyperparathyroidism
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CEA elevation may indicate:
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CA of colon, pancreas, lung, stomach
Also increased in smokers |
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Coombs Test Direct which is normal is:
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negative (uses erythrocytes coated with antibodies)
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Coombs Test Direct which is positive is:
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indicative of autoimmune hemolytic anemia;
hemolytic transfusion reaction; drug sensitization; hemolytic disease of newborn |
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Drug sensitization that results in a + Coombs test is usually from what drugs?
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methyldopa, levodopa, cephalothin
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erythroblastosis fetalis AKA hydrops fetalis has what 4 signs
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anemia
jaundice hepatosplenomegaly general edema |
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Coombs Test Indirect uses _____ that contains _________
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serum that contains antibody
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Coombs test indirect that is normal is:
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negative
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Coombs test indirect that is abnormal is:
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positive - isoimmunization from previous transfusion
incompatible blood due to negligence |
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Fibrin degradation products WNL =
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< 5mg/ml
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fibrin degradation products increase...
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with any thrombosed embolic condition - DVT, MI, PE, DIC
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Fibrinogen normal limits
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150-450 mg/dL
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Decreased fibrinogen is...
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-congenital
- DIC - Surgery - prostate, open heart - Neoplastic and hematological conditions - acute severe bleeding - burns "BC SAND" |
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Fibrinogen in DIC is secondary to a ____________ such as ________ or ______________.
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OB catastrophe... such as
- Amniotic fluid emboli or Placenta abruption |
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Folic acid decreased
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1. massive cellular growth (cancer)
2. Hemolytic anemia 3. Megaloblastic anemia 4. Malabsorption 5. Sickle cell anemia |
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Haptoglobin - decreased in...
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hemolysis
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Transferrin increased in...
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iron deficiency
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Transferrin decreased in...
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poor nutrition, chronic & acute inflammation
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Iron increased in (4)
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1. Hemachromatosis
2. Hemosiderosis secondary to increased iron intake 3. Excess destruction or decreased production of erythrocytes 4. Liver necrosis |
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Iron decreased in (4)
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1. IDA
2. nephrosis 3. loss of iron binding proteins 4. normochromic anemia of chronic disease infections |
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TIBC =
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total iron binding capacity
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Increased TIBC
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acute & chronic blood loss
Iron deficiency anemia Hepatitis |
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Decreased TIBC
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anemia of infection and chronic diseases - cirrhosis, nephrosis, hemochromatosis
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PTT or aPTT
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partial thromboplastin time
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Increased PTT with the use of...
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Heparin
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With an increased PTT, where is the defect?
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Intrinsic clotting factors - I, II, V, VIII, IX, X, XI, XII
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antidote to reverse heparin?
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protamine
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PT is elevated with:
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increased warfarin,
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PT is decreased with:
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VItamin K, poor fat absorption, liver disease, antibiotics, cephalosporins
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PT elevated through what pathway?
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extrinsic and common pathway - I, II, V, VI, X
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Antidote for warfarin
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increased Vitamin K
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Thrombin time increased with: (3)
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systemic heparin,
DIC, congenital absent fibrinogen |
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Thrombin time is increased with
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systemic heparin
DIC congenital absent fibrinogen |
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leukocytosis occurs in acute infections in which the degree of increase of white cells depends on what 4 things?
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1. infection severity
2. patient's resistance 3. patient's age 4. marrow efficiency & reserve |
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What are causes of leukocytosis?
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1. hemorrhage
2. trauma/tissue injury 3. malignant disease (esp. GI, liver, bone, mets) 4. toxins (like uremia, coma, eclampsia) 5. drugs - chloroform, ether, quinine, adrenaline 6. serum sickness 7. circulatory disease 8. tissue necrosis |
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Leukopenia is a decrease of WBC to:
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below 4000
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Leukopenia occurs during and following what disease/conditions (3)?
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1. viral infection
2. hypersplenism 3. bone marrow depression |
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In leukopenia, bone marrow depression occurs due to: (9)
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1. drugs
2. heavy metals 3. radiation 4. agranulocytosis 5. acute leukemia 6. pernicious & aplastic anemia 7. multiple myeloma 8. alcoholism 9. diabetes |
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What is the hemolytic disease of newborn?
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erythroblastosis fetalis
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normal platelet count =
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150,000 - 300,000
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At a platelet count of < 10,000 there is a risk of:
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spontaneous bleeding
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What causes decreased platelet production?
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1. viral infection
2. marrow infiltration 3. drugs |
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What causes increased platelet destruction?
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1. viral infections
2. ITP 3. TTP 4. DIC 5. HUS 7. drugs |
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What are the 4 main causes of decreased platelets (thrombocytopenia)?
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1. decreased production
2. increased destruction 3. splenic sequestration 4. loss of platelets |
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What occurs in pseudothrombocytopenia?
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platelets aggregate but not truly decreased in number
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What causes thrombocytosis?
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1. inflammation
2. malignancy 3. PCV 4. can also be associated with hemorrhage or thrombosis |
