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42 Cards in this Set

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CBC test:
-Hematocrit (HCT)

-Hemoglobin (Hgb)

-Red blood cell count (RBC)

-Red blood cell indicies

-White blood cell count (WBC)

-White blood cell types (Differential)

-Platelet count
These have what type of morphology?

-Chronic disease
-iron deficiency
-lead poisoning
-80% of sideroblastic anemia
-High reticulocyte count (prior hemolysis, prior hemorrhagew, treated B12 defic., treated folate defic.)

-Low reticulocyte count
(B12 defic., pernicious anemia, GI disease - malabsorption, DNA synthesis disease, liver disease, 20% of sideroblastic anemia)
Macrocytic anemia
-Acute blood loss
-aplastic anemia
-Chronic disease/infection/inflammation
-endocrine diseases
-hemolysis (burns, toxins, collagen vascular diseases, DIC, G6PD defic, hemoglobinopathies, hereditary spherocytosis, hypersplenism, immune mediated, paroxysmal nocturnal hemoglobinuria (PNH), prothetic heart valve damage, TTP, vasculitis)
-sickle cell disease
Normochromic Normocytic
If broken down hemoglobin enters this pathway, there may be a formation of immune complexes may lead to DIC and bleeding or accumulation in the kidneys causing renal failure
Stromal pathway
If broken down hemoglobin enters this pathway, it gets picked up by haptoglobin making a haptoglobin-hemoglobin complex, which gets destroyed by the reticuloendothelial cells. This leads to low serum haptoglobin, also an increase of hemoglobin in the urin
Free hemoglobin pathway
-(+) DAT, IAT
-Low serum haptoglobin
-bleeding from DIC
-Renal shutdown
Test results showing hemolysis
Primary, malignant, too many of the cells but predominantly shown as red cell disease
Polycythemia Vera
Can be in response to a hormone (like erithropoietin), disease, severe pulminary disease
Secondary polycythemia
Decrease in amount of plasma, but not increase in amount of cells

-dehydration - causes hematocrit to rise

-pregnancy - spurious
Relative Polycythemia
What type of anemia?

increased volume
Relative anemia
What type of anemia?

sideroblastic anemia
renal disease
pure red cell aplasia
marrow infiltraion
Decreased production
What type of anemia?

Abnormal hemoglobin
Enzyme defects
Autoimmune disease
Membrane defects
other etc.
Increased destruction
Schistocytes + thrombocytopenia = ?
Thrombotic thrombocytopenia purpura (TTP)
implies immunologic destruction of the cells where the spleen has taken off Ab coated membrane , which creates more surface area
Megaloblastic + Hypersegmentation is diagnostic of ?
B12 or Folate deficiency
Primary hemostatic plug does not form in this
Primary hemostatic plug forms but no fibrin (missing clotting factor)
Clotting disorders
Hallmark of thrombocytopenia
Petichiae, nonblanchable rash on feet

- two endothelial cells contract revealing the basement membrane, not enough platelets to cover opening hwere RBCs seep out.
Four D's of quantitative thrombocytopenia
Decreased production
Destruction increased
What type of disorders?

Acquired - drug induced, myeloproliferative, uremia
Congenital - Bernard Soulier's disease, Storage Pool Disease
Qualitative platelet disorder
May result in which Platelet disorder:

Aplastic anemia, congental, post chemo-therapy/radiation therapy, drug induced, paroxysmal nocturnal hemoglobinuria, marrow infultration, nutritional, viral
Thrombocytopenia - decreased production
Autoimmune disease, Ab produced against your own platelets
Idiopathic thrombocytopenic purpura
Thrombocytopenia and schistocytosis, mental status altered, renal failure, fever, clotting in microvasculature - (RBCs sliced by fibrin strands), platelet consumption
Thrombotic thrombocytopenic purpura
-chronic myeloid leukemia
-polycythemia vera
-essential thrombocythemia myelofibrosis
-chronic myelomonocytic leukemia
Myeloproliferative disorders
Location of bone marrow aspirate and biopsy for evaluation of WBC disorder
Posterior and superior iliac crest
Young malignant cells predominate in this WBC disorder
acute lymphoblastic/myeloblastic leukemia (ALL/AML)
Mature malignant cells predominate in this WBC disorder
Chronic lymphocytic leukemia (CLL)
Same disease, only cells died out and replaced by fibrotic tissue
CML vs. myelofibrosis
Hairy cell leukemia (HCL) is classified under what type of leukemia?
Chronic leukemia
What type of disorders

Refractory anemia, refractory anemia with ringed sideroblast, refractory with excess blasts, chronic myelomoncyitc leukemia, refractory anemia with excess blasts in transformation
Myelodysplastic syndromes
What type of disorders

Myeloproliferative disorder, chronic myeloid leukemia, polycythemia rubra vera, essential thrombocythemia, myelofibrosis with myeloid metaplasia
Myeloproliferative disorders
What type of disorder?

Multiple myeloma, light chain disease, heavy chain disease, benign monoclonal gammopathey, waldenstrom's macroglobulinemia, amyloidosis, plasmacytoma, plasma cell leukemia, monoclonal gammopahtey of undetermined significance
Plasma cell disorders
Mature lymphocytes in blood

Which disorder?
Chronic lymphocitic leukemia
History is not sufficient for the evaluation of this disease

-normal workup for sugic patient to minimize bleeding
If these two are absent: hypercoagulable state - thrombosis
Protein C

Protein S
Morphologic analysis
immuno-phenotyping of cell surface markers
molecular genetics
micro-array technology
Future approaches in understandng medicine
Amyloid, circulating anticoagulants, DIC, fibrinolysis, liver disease, SLE, Vit K Def, medicaiton induced (aspirin)
Acquired coagulopathy
Factor defic, dys-fibrinogenemia, Fletcher trait, Fitzgeral trait, Von Willenbrand's disease
Congenital coagulopathy
Name the myeloproliferative disorder:

Increased platelets, megakaryocytes
essential thrombocythemia myelofibrosis
Name the myeloproliferative disorder:

Increased monocytes
chronic myelomonocytic leukemia
Is history sufficient for evaluating hypercoaguability?

Platelet count
(coagulopathy screen)