Pathology: 2Nd Quarter 2Nd Year 1St Week

Front 1

Anemia lowers the oxygen-carrying capacity of the blood, causing 5 signs of hypoxemia;

Back 1

1. Increased cardiac output
2. increased respiratory rate
3. Shunting of blood to vitals--pale skin
4. Decreased Hb O2 affinity which releases more O2 to tissues
5. Increased erythropoietin

Front 2

Clinical signs of anemia:

Back 2

Tachycardia
Shortness of breath
Systolic flow murmer
Fatigability
Faintness
Angina in elderly
Dyspnea on exertion

Front 3

Describe "Hematocrit" or HCT

Back 3

Percentage of whole blood occupied by RBCs. Numerically 3x Hb.

Front 4

Who has more red cells, males or females, and what hormone is this related to?

Back 4

Males, testosterone

Front 5

What are the primary RBC measurements?

Back 5

RBC count, Hematocrit (HCT), and Hemoglobin concentration (Hb).

Front 6

Name the classical indices (2 clinically useful ratios)

Back 6

Mean corpuscular volume=average size
Mean corpuscular Hgb concentration=Hb concentration per RBC.

Front 7

What is the equation for MCV?

Back 7

Hct/RBC x 10, refers to average size. Normal=87 FL

Front 8

What is the equation for MCHC?

Back 8

Hgb/Hct x 100, refers to paleness of cell. Normal=34 GM/DL

Front 9

What does RDW refer to?

Back 9

Red cell distribution width, or the variation of size (anisocytosis) and shape (poikilocytosis), or variation in volume.
<15% is normal.

Front 10

Microcytosis (low MCV) with high RDW diagnoses what disease?

Back 10

Iron deficiency

Front 11

Microcytosis (low MCV) with normal RDW diagnoses what disease?

Back 11

Thalassemia

Front 12

A red cell that has lost its nucleous is referred to as what?

Back 12

Reticulocyte

Front 13

Describe a reticulocyte under Wright-Giemsa stain and reticulocyte stain.

Back 13

Wright-Giemsa--bluish
Reticulocyte stain--precipitates RNA, blue with darker clusters.

Front 14

How long is the reticulocyte in the marrow before it enters the bloodstream?

Back 14

Two days

Front 15

How long is the reticulocyte in the blood before it loses the stainable RNA and becomes mature?

Back 15

Twenty-four hours

Front 16

Hypoxia of what organ increases EP synthesis?

Back 16

Kidney

Front 17

Chronic renal failure affects EP how?

Back 17

Decreases it, leading to anemia. Can be treated with synthetic EP.

Front 18

How long to RBCs live, and what happens to them?

Back 18

120 days, and they are phagocytized by macrophages in marrow and spleen at rate of 1% per day.

Front 19

The equation for the absolute reticulocyte count:

Back 19

raw reticulocyte ratio times the red cell count in x10^3/uL

Front 20

When diagnosing anemia, the reticulocyte count determines between what two categories of disease?

Back 20

Failure of production (low count)
Failure of Survival (high count)

Front 21

Mean corpuscular volume is useful for diagnosing what type of failure?

Back 21

Marrow failure

Front 22

Specific red cell shapes are useful for diagnosing what type of failure?

Back 22

Failure of RBC survival

Front 23

Name the four mechanisms for anemia.

Back 23

Blood loss from bleeding
Failure of red blood survival or hemolysis
Decreased production: lack of precursors
Cecreased production: ineffective erythropoiesis in spite of adequate marrow precursors.

Front 24

Describe reticulocyte count in the first 48 hours, and then 5 days after hemorrhage.

Back 24

Normal for the first two days, rises, and peaks at days 5-7.

Front 25

Describe the hemoglobin/hematocrit levels during the first 12 hours after hemorrhage.

Back 25

Normal unless fluids are given.

Front 26

Reticulocytosis occurs when the body increases red cell production how many fold?

Back 26

4-fold increase.

Front 27

Extrinsic damage to normal red cells occurs through which three major mechanisms?

Back 27

Physical destruction
Hypersplenism
Immune hemolytic anemia--antibodies

Front 28

What are mechanisms of physical extrinsic damage to normal RBCs?

Back 28

Burns, chemicals, distilled water.
Infections
Damaged/artificial heart valves
DIC

Front 29

Describe what physical damage hypersplenism does to RBCs?

Back 29

Cirrhosis, lymphoma, and leukemia trap and destroy RBCs in enlarged spleen--can lead to tear-drop shaped cells.

Front 30

Three mechanisms of Immune hemolytic anemia's extrinsic damage to RBCs?

Back 30

Autoimmune disease
Blood transfusion--allo-abs in plasma of recipient attack donor red cells
Pregnancy--maternal Abs attack red cells in fetus.

Front 31

Coombs Reagent is what?

Back 31

Rabbit Ab against human immunoglobulins. Any red cell with human Abs will be agglutinated by adding Coombs reagent.

Front 32

Describe Direct Coombs test (DCT)

Back 32

Detects human anti-red cell antibodies on patient's rbcs.

Front 33

Describe Indirect Coombs test (ICT)

Back 33

Detects human anti-red cell antibodies in patients plasma/serum.

Front 34

Name two inherited membrane defects of RBCs.

Back 34

Spherocytosis
Ovalocytosis

Front 35

Name an acquired membrane defect of RBCs

Back 35

Paroxysmal nocturnal hemoglobinuria (PNH). Increases complement-mediated lysis of blood cells.

Front 36

What test is important for the diagnosis of defective hemoglobin?

Back 36

Hemoglobin electrophoresis

Front 37

In what two diseases will you find defective hemoglobin?

Back 37

Thalassemia and Hemoglobinopathy.

Front 38

Describe the effects of the mutation causing Thalassemia.

Back 38

Descreased synthesis of hemoglobin chain, either alpha or beta chains. Will result in the excess of the other, which precipitates out and destroys RBCs by phagocytosis.

Front 39

Describe the effects of the mutation causing Hemoglobinopathy.

Back 39

Change to one or more of the amino acids of a hemoglobin chain. Results in decreased solubility, crystalized Hb alters RBC shape and membrane causing vascular occlusion and phagocytic destruction of red cell.

Front 40

Defective RBC enzymes result in what reaction? What disease does this occur in?

Back 40

Leads ot degredation of hemoglobin and forms precipitates which cause phagocytosis.
Seen in G-6-PD deficiency (H2O2 "burns" hemoglobin"

Front 41

Decreased production due to ineffective erythropoiesis causes RBC destruction where?

Back 41

In the marrow.

Front 42

Ineffective erythropoiesis: iron deficiency looks like what?

Back 42

Defective red cells from lack of iron, causes microcytosis.

Front 43

Ineffective erythropoiesis: anemia of chronic disease looks like what?

Back 43

Chronic inflammation causes macrophages to hoard iron and keep it from erythroblasts. Looks like normocytic anemia but can be severe enough to cause microcytosis.

Front 44

Megaloblastic anemia due to ineffective erythropoiesis looks like what?

Back 44

Defective red cells, neutrophils, and megakaryocytes from lack of B12, Folate. Causes deficiency of thymidine and inhibits nuclear replication. Looks like macrocytosis (skips divisions)

Front 45

95% of megaloblastic anemias are caused by what two deficiencies?

Back 45

Vitamin B12 or folate deficiencies.

Front 46

A peripheral smear of blood in megaloblastic anemia has the following characteristics;

Back 46

Hypersegmented neutrophilic granulocytes
Macrocytes
Thrombocytopenia
Neuropenia

Front 47

Bone marrow in megaloblastic anemias has the following characteristics;

Back 47

Hypercellular
Looks like puffed rice--parachromatin
Nuclear/cytoplasmic ansynchrony--nucleus is primitive but cytoplasm matures

Front 48

Four causes of macrocytosis other than B12 and folate deficiences;

Back 48

Myxedema
Liver disease
Reticulocytosis of any cause
Aplastic anemia

Front 49

What is the primary cause of B12 deficiency in the Western world?

Back 49

malabosrption

Front 50

How is B12 obtained by humans?

Back 50

Ingestion of animal products

Front 51

How long do B12 stores last in the human body?

Back 51

3-4 years

Front 52

What is the typical body store for B12 in humans?

Back 52

2 mg

Front 53

B12 cannot be absorbed in the intestin unless it is linked to what? Where does this come from?

Back 53

Intrinsic factor, obtained from parietal cells in the stomach.

Front 54

Where does the B12--Intrinsic factor complex attach and absorb?

Back 54

Receptors in the ileum

Front 55

What two things are required for the attaching of the B12--IF complex to the ileum?

Back 55

Ca++ and a neutral pH