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42 Cards in this Set
- Front
- Back
CBC test:
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-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 |
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These have what type of morphology?
-Chronic disease -hemoglobinopathy -iron deficiency -lead poisoning -80% of sideroblastic anemia -thalaassemia |
Microcytic/Hypochromatic
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-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
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-Acute blood loss
-aplastic anemia -cancer -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) -myelofibrosis -sickle cell disease |
Normochromic Normocytic
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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
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Stromal pathway
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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
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Free hemoglobin pathway
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-(+) DAT, IAT
-Low serum haptoglobin -bilirubinemia -hemoglobinuria -bleeding from DIC -Renal shutdown |
Test results showing hemolysis
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Primary, malignant, too many of the cells but predominantly shown as red cell disease
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Polycythemia Vera
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Can be in response to a hormone (like erithropoietin), disease, severe pulminary disease
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Secondary polycythemia
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Decrease in amount of plasma, but not increase in amount of cells
-dehydration - causes hematocrit to rise -pregnancy - spurious |
Relative Polycythemia
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What type of anemia?
Hypersplenism increased volume |
Relative anemia
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What type of anemia?
sideroblastic anemia renal disease pure red cell aplasia marrow infiltraion |
Decreased production
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What type of anemia?
Abnormal hemoglobin Enzyme defects Autoimmune disease Mechanical Membrane defects other etc. |
Increased destruction
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Schistocytes + thrombocytopenia = ?
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Thrombotic thrombocytopenia purpura (TTP)
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implies immunologic destruction of the cells where the spleen has taken off Ab coated membrane , which creates more surface area
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Sphrocytosis
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Megaloblastic + Hypersegmentation is diagnostic of ?
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B12 or Folate deficiency
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Primary hemostatic plug does not form in this
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Thrombocytopenia
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Primary hemostatic plug forms but no fibrin (missing clotting factor)
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Clotting disorders
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Hallmark of thrombocytopenia
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Petichiae, nonblanchable rash on feet
- two endothelial cells contract revealing the basement membrane, not enough platelets to cover opening hwere RBCs seep out. |
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Four D's of quantitative thrombocytopenia
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Decreased production
Dilution Distribution Destruction increased |
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What type of disorders?
Acquired - drug induced, myeloproliferative, uremia Congenital - Bernard Soulier's disease, Storage Pool Disease |
Qualitative platelet disorder
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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
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Autoimmune disease, Ab produced against your own platelets
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Idiopathic thrombocytopenic purpura
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Thrombocytopenia and schistocytosis, mental status altered, renal failure, fever, clotting in microvasculature - (RBCs sliced by fibrin strands), platelet consumption
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Thrombotic thrombocytopenic purpura
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-chronic myeloid leukemia
-polycythemia vera -essential thrombocythemia myelofibrosis -chronic myelomonocytic leukemia |
Myeloproliferative disorders
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Location of bone marrow aspirate and biopsy for evaluation of WBC disorder
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Posterior and superior iliac crest
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Young malignant cells predominate in this WBC disorder
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acute lymphoblastic/myeloblastic leukemia (ALL/AML)
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Mature malignant cells predominate in this WBC disorder
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Chronic lymphocytic leukemia (CLL)
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Same disease, only cells died out and replaced by fibrotic tissue
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CML vs. myelofibrosis
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Hairy cell leukemia (HCL) is classified under what type of leukemia?
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Chronic leukemia
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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
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What type of disorders
Myeloproliferative disorder, chronic myeloid leukemia, polycythemia rubra vera, essential thrombocythemia, myelofibrosis with myeloid metaplasia |
Myeloproliferative disorders
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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
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Mature lymphocytes in blood
Which disorder? |
Chronic lymphocitic leukemia
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History is not sufficient for the evaluation of this disease
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Coagulopathy
-normal workup for sugic patient to minimize bleeding |
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If these two are absent: hypercoagulable state - thrombosis
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Protein C
Protein S |
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Morphologic analysis
immuno-phenotyping of cell surface markers cytogenetics molecular genetics micro-array technology |
Future approaches in understandng medicine
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Amyloid, circulating anticoagulants, DIC, fibrinolysis, liver disease, SLE, Vit K Def, medicaiton induced (aspirin)
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Acquired coagulopathy
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Factor defic, dys-fibrinogenemia, Fletcher trait, Fitzgeral trait, Von Willenbrand's disease
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Congenital coagulopathy
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Name the myeloproliferative disorder:
Increased platelets, megakaryocytes |
essential thrombocythemia myelofibrosis
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Name the myeloproliferative disorder:
Increased monocytes |
chronic myelomonocytic leukemia
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Is history sufficient for evaluating hypercoaguability?
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NO!
CBC/smear PT, INR, PTT Platelet count (coagulopathy screen) |