Rbcs

Front 1

causes of microcytic anemia, lab findings

Back 1

low MCV, low rbc or low hgb
Iron deficiency anemia
– Anemia of chronic disease
– Thalessemia
– Sideroblastic anemia
"Anemia that ITSy"

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lab findings in megaloblastic anemia

Back 2

low Hgb or low rbc, high mcv (>100)

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calc of mcv

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hct/rbc (rbc in fl=1 um3)

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cal of mch

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mean corp hem - hb/rbc
hem content of avg rbc (pg)

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calc of mchc

Back 5

mean corpuscular hemoglobin concentration =HB/HCT
Hemoglobin concentration within circulating RBCs (g/dL)

Front 6

mech of anemia of chronic dz

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In anemia of chronic inflammation, iron cannot exit the macrophage.
Hepcidin blocks ferroportin in the macrophage so the iron can’t get out.

Front 7

mech of sideroblastic anemia

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Iron can become trapped in the mitochondia of rbc

Front 8

mech of thal

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no globin chains
Iron makes it to heme synthesis, but globin chains are not made, so hemoblobin is not
formed

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iron defic anemia lab findings

Back 9

lower Fe
increased Tf
lower % sat,
lower ferritin,
increased Tf-R

Front 10

iron stores in anemia of chronic dz

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increased ferritin
reduced Tf
nl tr receptor
lower % sat

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causes of sideroblastic anemia

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Alcohol, most common
– erythroid specific ALA-synthase
(x-linked)
– MDS/RARS
– Drugs
– Toxins (lead, zinc)

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lab findings in sideroblastic anemia

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increased Fe in rbc precursors and in serum, inc ferritin,
nl TIBC, nl/low MCV
Decreased pyridoxine

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causes of megaloblastic anemia

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- B12 deficiency
– Folate deficiency
– MDS
– Congenital dyserythropoietic anemia (types I, III, IV)
– Hereditary orotic aciduria
– Lesch-Nyhan syndrome

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macrocytic anemias that are not megaloblastic

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Alcohol
– Liver disease
– Aplastic anemia
– Hypothyroid

(round shaped - not ovoid)

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peripheral smear findings for megaloblastic anemia

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Macroovalocytes
• Hypersegmented PMNs

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bone marrow findings for megaloblastic anemia

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Hypercellular
• Nuclear cytoplasmic
dyssynchrony
• Giant myelocytes
• Dysplasia

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acanthocytes

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heretidary abetalipproteinemia
cirrhosis
hepatorenal failure
anorexia
chronic starvation

Front 18

where is Hb constant spring found and what can it be heterozygotic with

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SE asian, with a-thal 1

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beta+ means

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reduced production of beta chains

Front 20

lab findings in b thal minor

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mild anemia, reduced MCV, reduced MCH (increased A2 and F)

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beta thal major electrophoresis (if bo)

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if b0: 5-10% A2, 90% F

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electrophoresis in sickle cell dz

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90-95% S
1-3% A2
5-10% F

Front 23

where is aa messed up in Hb C

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same place as sickle cell but different substitution

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homozygotes for Hb C

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mild anemia, indirect hyperbilirubinemia, reduced MCV but increased MCHC
90-955 C
1-7% F

Front 25

what is HbE

Back 25

southeast asion, change in position 26, mild microcytic

hz: 60-70 hb A, 30% E
homo: 90% E, 3-5% A2 and 1-5% F

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findings on AIM hemolytic anemia peripheral smear

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dense microspherocytes with no central pallor and polychromasia

Front 27

findings on peripheral smear of oxidant hemolysis

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bite cells, blisters
heinz bodies with supravital stains

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schistocytes, burr cells, helmet cells s/o

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microangiopathic hemolytic anemia

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peripheral smear on HbH

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recall: alpha thal with three missing globin chains)
target cells, microcytic cells and hypochromic cells

Front 30

peripheral smear on alpha thal trait

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only mild microcytic, occ targets

Front 31

basophilic stippling in younger polychromatophilic cells

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lead

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best test to id m7

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glycoprotein IIIa (CD61)

Front 33

what

Back 33

b12 deficiency -

Front 34

folate in b12/folate deficiency

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folate lowered in rbcs for b12 defii
folate lowered in serum for folate defi

Front 35

falsely low serum folate

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pregnancy, myeloma,
haptocorrin deficiency

Front 36

in pernicious anemia, which is more specific and which is more sensitive

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anti-intrinsic factor antibodies
– most specific, but insensitive (50 - 75% +)
• anti-parietal cell antibodies
– More sensitive, but less specific

Front 37

what is the retic index

Back 37

retic ct x hct/nl hct

Front 38

what is RPI

Back 38

retic ct/maturation correction

Front 39

causes of intravascular hemolysis

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MAHA( DIC, TTP, HUS)
• PNH
• PCH
• Malignant hyptertension
• Abnormal heart valve
schistocytes appear

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causes of extravascular hemolysis

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G6PD deficiency
• Hereditary Spherocytosis
• Hereditary Elliptocytosis
• Hemoglobinopathy
• Thalassemia
• Pyruvate kinase deficiency

spherocytes

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red cell defects

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Hereditary spherocytosis
• Hereditary elliptocytosis
• Southeast Asian ovalocytosis
• Stomatocytosis

Front 42

two causes of spherocytes

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HS (anykrin mutation is most common)
aiha

Front 43

causes of elliptocytosis

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-HE (Abnormal spectrin α or β, protein 4.1)
Hereditary pyropoikilocytosis (essentially a
severe form of HE)
cf to cigar shaped rbcs

Front 44

cause of stomatocyte

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Hereditary stomatocytosis
– Autosomal dominant
– Defect in Na/K permeability of rbc membrane
• Alcohol and liver disease
• Rh null disease

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where see heinz bodies

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Seen in G6PD deficiency, unstable Hb, α thal (Hb
Barts, Hb H)

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what is Flourescent spot test,

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NADPH flouresces, lost in G6PD deficency)

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transmission of G6PD

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x linked

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settings for echinocyte

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Pyruvate kinase deficiency
• air drying
renal disease
burns

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setting for acanthocyte

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spur cell
Liver disease
• Post splenecomy
• McCloud syndrome
• Abetalipoproteinemia (Mutated microsomal
triglyceride transfer protein cannot absorb fat from food)

Front 50

two examples of unstable hb and effect on peripheral smear

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Hb Zürich, Hemoblobin H disease
(see heinz bodies)

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high O2 affinity hb

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Hb Chesapeake

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name an ex methb

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Methemoglobins, iron is in the Fe3+ ferric state, not Fe2+ ferrous (HbM Boston)

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alkaline agar for hb

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alkaline Cellulose acetate pH 8.5,
a fat santa claus (+ at A)

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acid agar for hb

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Citrate Agar pH 6.0, acid gel
for a safe christmas

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globin chain in A2

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delta

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globin chain in F

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gamma

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what runs with Hb S on alk gel

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Hb D, Hb G, Hb Lepore, india and hasharon

SDGL

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what runs with C on alk gel

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A2, HbE and HbO run with Hb C on alk gel
“A CEO”

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what runs with A on acid gel

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D, A2, G, E, N, I, H, Lepore
all run with Hb A on acid gel

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ultra fast moving on alk gel

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NIH Barts

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ultra slow on acid gel

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constant spring

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what is Dithionite solubility test

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turbidity in sickle cell (cant see lines)

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cancer that sickle cell patients are at increased risk fo

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renal medullary ca

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sickling test, who sickles

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Metabisulfate sickling test - add agent, look for sickling
SS, SA (alpha thal and sickle) and Hb C Harlem

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another name for target cells

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codocytes

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osmotic fragility in codocyte

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increased (too much membrane)

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target cells seen in

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HbC, HbE, HbS
• Liver disease
• Hyperlipidemia
• Thalessemia

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what are thal indices

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Thalessemia indices
– Microcytic (MCV <75), erthrocytosis (RBC >5.5 x 1012)

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what hb shows thal indices

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Hb E

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golf ball inclusions on supravital dye

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hb H

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b thal major sx

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Cooley’s anemia, severe, transfusion dependant

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b thal major peripheral smear

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Anisopoikilocytosis, nucleated rbcs, target cells, tear drop cells
• basophilic stippling

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flow for pnh

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CD55, CD59, CD16, CD66, CD14
detects loss of GPI linked proteins

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hams test principle

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acid urine causes hemolysis in PNH patients; heat resolves this (cuz kill complement)

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criteria for aplastic anemia

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absolute neutrophil count < 500/ml
– Platelets < 20 x 109/l
– Reticulocytes < 1%
– BM cellularity < 25%

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what settings does this arise

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basophilic stippling
lead poisoning
pyrimidine 5’ nucleotidase deficency
MDS, infxn,
sideroblastic anemia

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what are howell jolly bodies made of

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DNA

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where do howell jolly bodies occur

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Seen in MDS, post splenectomy, sickle cell anemia,

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what are pappenheimer bodies

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iron
post-splenectomy/asplenia
- iron overload

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what, where

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cabot ring
Ring shaped inclusion
• Can look like 8
• Microtubule
• Remnants of mitotic spindle
• Seen in megaloblastic
anemia, CDA and lead
poisoning

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effect of autoagglutination on rbc indices

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CBC incorrect values
– ↓RBC count
– ↑ MCV

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Stomatocytosis assoc with

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Rh null disease

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Spherocytes assoc with

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autoimmune hemolytic anemia

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Target cells + Hb C crystals

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= Hgb CC

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when might you transfuse someone with scd

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to avoid stroke

Front 86

what's a false neg for g6pd

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a recent hemolytic episode

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common finding in hemolytic anemia (in lab)

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Hemolytic anemia, low Hgb A1C levels

Front 88

PNH mutations of

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GPI proteins

Front 89

unique fx of P malariae on peripheral smear

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Plasmodium malariae, band form lacks stippling,

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triad of PNH

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hemolytic anemia, pancytopenia and thrombosis

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decreased Lap score

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CML and PNH

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what is cause and what is result of pnh thrombosis

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cause: lack of CD59 on plts
result: budd-chiari

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how is hemolysis caused in PNH

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activation of complement alternate pathway (C3b) - not classic C1, C4, C2

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what are downey cells

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Cd8 t cells

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what is 5q - syndrome

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5q-syndrome is characterized by macrocytic anemia often thrombocytosis, erythroblastopenia, megakaryocyte hyperplasia with nuclear hypolobation and an isolated interstitial deletion of chromosome 5. The 5q- syndrome is found predominantly in females of advanced age.

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three causes of petechiae with normal coag

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- vit c def
- miningococcemia
- CRF - depressing plt fxn

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marked splenomegaly (5 associations)

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CML
myelofibrosis with myeloid hyperplasia
Gaucher
Kala-azar (visceral leishmaniasis)
Hairy cell leukemia
(mild forms with mono)

Front 98

mech of pml dic

Back 98

release of granules/auer rods triggering coag cascade