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54 Cards in this Set

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formula for calculating corrected reticulocyte count
corrected reticulocyte count = (actual Hct/45) x reticulocyte count. 45 = normal Hct
Corrected reticulocyte count at or above 3% and rct ct below 3%
above 3% = effective erythropoeisis; below 3% poor bone marrow response to anemia
Extramedullary hematopoiesis
liver and spleen: pathogenesis = intrinsic bone marrow dz (myelofibrosis); accelerated erythropoiesis (severe hemolysis in sickle cell dz (radiograph shows "hair on end" appearance)
anemia in pregnancy
not a "true anemia" = plasma volume is x2 > than RBC mass (dilutional effect)
MCV values for micro/macrocytic anemias
microcytic (<80um3)
normocytic (80-100um3) macrocytic (>100um3)
(average volume of RBCs)
dec MCHC (mean corpuscular hemoglobin concentration)
dec: decreased synth of Hb (microcytic anemias) --> central area of pallor greater than nl.
inc MCHC
correlates with presence of spherical RBCs (hereitary sperocytosis); no central area of pallor
RDW (RBC distribution width)
variation in size of RBCs in peripheral blood = anisocytosis
inc RDW
RBCs not uniform in size; iron deficiency = only microcytic anemia with an increased RDW due to a mix of normocytic and microcytic RBCs
end product of heme degradation in macrophage
unconjugated bilirubin
serum TIBC
concentration of transferrin (inc transferrin and TIBC present in iron deficiency) (dec in transferring and TIBC in ACD and iron overload dz)
Iron saturation (%)
represents the percentage of sites on transferrin occupied by iron
Microcytic anemias
Iron deficiency, anemia of chronic Dz, thalassemia (a and b), sideroblastic anemia. MCV <80 = defects in the synthesis of Hb (heme+globin chains)
Macrocytic anemias
folate def; vit B12 (cobalamin) deficiency
what are HbH and Hb Bart and what are they assoc w?
HbH = 4 B Hb chains; Hb Bart = 4 gamma chains (incompat w/ life) assoc w/ alpha thal
Beta thal minor (B/B+) v. B-thal major (Cooley's anemia; B0/B0)
Beta thal minor = mild microcytic anemia; mild protective effect against malaria, dec HbA; Beta thal major = severe hemolytic anemia; inc unconj bilirubin; no syth of HbA
Sideroblastic anemia
defect in heme sythesis in the mitochondria; ringed sideroblasts; alochol MCC = a mitochondrial toxin; B6 def (isoniazid therapy)
histo of lead poisoning
ringed sideroblasts and coarse basophilic stippling (Pb denatures enzymes = Ferrochelatase, Aminolevulinic acid, Ribonuclease)
Fanconi's syndrome
lead poisoning --> renal tubule damage: proximal renal tubular acidosis, aminoaciduria, phosphaturia, glucosuria
phenytoin and anemia
Phenytoin inhibits intestinal conjugase - inhibits folate absorbtion --> pernicious anemia (macrocytic)
Alcohol and oral contraceptives and anemia
reabsorption of folate inhib -> macrocytic anemia
homocysteine and folate deficiency
deficiency of folate is most common cause of inc serum homocysteine in US. Homocysteine damages endothelial cells leading to vessel thrombosis.
Most sensitive test for B12 def
inc methylmalonic acid
Pancytopenia, oval macrocytes, hyperseg neutrophils
B12 or folate def
pernicious anemia
lack of IF
what test is used to localize B12 def
Schilling test
dec maternal intake folate:
inc risk for NT defects
Normocytic anemias
acute blood loss, early iron def, anemia of chronic disease, chronic renal failure
Anemia of chronic renal failure
Hemolytic anemias: intrinsic and extrinsic
intrinsic - defect in RBC (membrane def, abn Hb, enzyme def)
extrinsic - outside RBC (stenotic aortic valve, immune destruction)
Extravascular hemolysis - macrophage phagocytosis, unconjugated hyperbilirubinemia
RBCs coated by AgG w or w/o C3b, abn shaped RBCs; inc LDH from hemolyzed RBCs
Intravascular hemolysis
enzyme def (def of G6PD), mechanical damage (aortic valve), - hemosiderinuria (renal tubules convert iron in Hb to hemosiderin); dec haptoglobin, inc LDH
Hereditary Spherocytosis
intrinsic defect, extravasc hemolysis; mut in ankyrin in cell membrane; inc RBC osmotic fragility
Hereditary elliptocytosis
defective spectrin and band 4.1
Paroxysmal nocturnal hemoglobinuria
mutation in multipotent myeloid stem cell - loss of anchor for decay accelerating factor (normally, DAF neutralizes complement attached to RBCs, Neutrophils, platelets. Intrinsic defect, intravascular hemolysis (occurs at night becauseresp acidosis enhances complement attachment to these cells)
Sickle cell anemia
intrinsic defect, extravascular hemolysis; sickle cell trait (HbAS) - no anemia
prevents sickling of cells
painful swelling of hands and feet in infants due to bone infarcts in sickle cell
Howell-Jolly bodies
sign of splenic dysfunction - in HbSS - autosplenectomy by age 2 - spleen fibrosed and diminished in size in young adults
Sickle cell susceptibility
to encapsulated bacteria
Heinz bodies and bite cells
G6PD deficiency; intrinsic defect, intravascular hemolysis
G6PD deficiency
no glutathoine, which usu neutralizes hydrogen peroxide --> oxidizes Hb --> heinz bodies --> in spleen - removes heinz body = bite cell
RBCs with thorny projections (echinocytes)
Pyruvate kinase deficiency
most common cause of autoimmune hemolytic anemia
warm AIHA v Cold AIHA
warm - IgG, cold - IgM
Coombs' test (DAT)
most important marker of immune hemolytic anemia
Achlorhydria, anti-intrinsic factor, antiparietal cell abs, inc incidence of gastric carcinoma
pernicious anemia - autoimmune gastritis - failure of production of IF
lemon-yellow skin color, somatitis, glossitis, demyelination of posterior and lateral cell columns
pernicious anemia
Abnormal Schillings test not correcte by IF
intestinal malabsorption - Crohns dz, blind loops syndrome, and giant tapeworm infestation
TIBC in anemia of chronic disease
characteristically decreased
TIBC in iron deficiency anemia
anemia, leukopenia, thrombocytopenia
pancytopenia in aplastic anemia
substances that can cause aplastic anemia
benzene, chloramphenicol, alkylating agents
Myelophthisic anemia
replacement of BM, often by a malignant neoplasm