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107 Cards in this Set

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RBC form:

Spherocyte
(2)
Hereditary Spherocytosis;

Autoimmune hemolysis
RBC form:

Elliptoctye
Hereditary Elliptocytosis
RBC form:

Macro-ovalocyte
(2)
Megaloblastic anemia;

Marrow failure
RBC form:

Helmet cell (schistocyte)
(2)
DIC;

Traumatic hemolysis
RBC form:

Teardrop cell
Myeloid metaplasia w/ myelofibrosis
RBC form:

Acanthocyte
Spiny appearance in Abetalipoproteinemia
RBC form:

Target cell
(4)*
HALT:

HbC disease;

Asplenia;

Liver Dz;

Thalassemia
HALT
RBC form:

Poikilocyte
(2)
TTP/HUS;


DIC
RBC form:

Burr cell
TTP/HUS
(3)* Microcytic Anemias
Iron deficiency;

Thalassemias;

Lead poisoning
LIT
Dx:

pallor, fatigue, DOE, decreased Hct, Hb, RBC, hypochromic, microcytic, Increased TIBC
Iron Deficiency anemia
Differential for Iron deficient anemia and reason of difference
(2)
Anemia of chronic Dz - TIBC is Low

B-Thalassemia minor - A2 Hb is increased
(5)* causes of Eosinophilia
NAACP:

Neoplasm;
Asthma;
Allergy;
Collagen Vascular Dz;
Parasites
NAACP
what does Protein C and S do to coagulation cascade?

what are they dependent on?
Inactivate Va and VIIIa


dependent on: Vitamin K
what does Antithrombin III inactivate in the coagulation cascade?
(4)

what drug is Antithrombin III activated by?
Inactivates:
IXa,
Xa,
XIa,
Thrombin

Drug: Heparin
what drug generates Plasmin to cleave fibrin?
tPA
(4)* causes of folate deficiency
IPOD:

Intestinal malabsorption
Pregnancy;
Oral contraceptives or Phenytoin;
Diet (usu alcoholism)
IPOD
Dx:

normochromic, normocytic anemia, inflammatory state, decreased Iron, decreased TIBC, Increased Ferritin
Anemia of Chronic Dz
Dx:

pancytopenia, fatigue, pallor, mucosal bleeding, petechiae, hypocellular bone marrow
Aplastic anemia
what (2) changes in bloodwork indicate RBC hemolysis?

how is immune vs non-immune cause distinguished?
blood:
Decreased Haptoglobin;
Increased LDH

Immune: Direct Coombs test
what medication causes Aplastic anemia?
Chloramphenicol
Definition:

anemia due to shortening of RBC life span
(increased RBC destruction)

what is common lab to all types?
Hemolytic anemia

common lab:
Increased Indirect Bilirubin
(4)* Hemolytic anemia types
Heme MAP:

Hereditary Spherocytosis;

Microangiopathic (DIC, TTP/HUS)

Autoimmune anemia;

Paroxysmal Noctournal Hemoglobinuria (PNH)
Heme MAP
Dx:

extravascular hemolysis, spherocytosis, positive Direct Coombs

What gammaglobulin?
Warm Hemolytic anemia

Gamma: IgG

[Warm weather is GGGreat]
Dx:

extravascular hemolysis, spherocytosis, recent pneumonia or mono

what gammaglobulin?
what antibody is it mediated by?
Cold Hemolytic anemia

Gamma: IgM

Ab: Anti-I Ab (has I blood antigen)

[Cold ice cream...MMMM]
what autoimmune anemia deals with newborns?
Erythroblastosis Fetalis

(Rh or ABO incompatability)
Dx:

Increased Mean Corpuscular Hemoglobin Concentration
(MCHC)
Hereditary Spherocytosis
Dx:

normocytic, normochromic, RBC are small and round w/ no central pallor, increased MCHC

where is defect?
(2)
Genetics?
Hereditary Spherocytosis

defect:
Spectrin or Ankyrin

genetics:
Auto Dominant
Definition:

intravascular hemolysis due to a membrane defect causing increased sensitivity of RBC to the lytic activity of complement; causes blood red urine in morning

what gene mutation?
what is high in urine?
what is test to Dx?
Paroxysmal Noctournal Hemoglobinuria

Gene: PIG-A (impaired GPI)

urine: Increased Hemosiderin

Test: Ham test (C59-neg RBC)
RBC forms:

"Bite cells"
G6PD deficiency
(2) common enzyme deficiencies causing Anemia
G6PD deficiency;

Pyruvate Kinase deficiency
Dx:

Autosplenectomy
Sickle cell
what bug affects the bone in Sickle cell?
Salmonella
Dx:

microcytosis, hypochromia, target cells, inc Hb-F, hemosiderosis
Beta Thalassemia Major
Dx:

minimal hypochromic, microcytic anemia, inc Hb-A2
Beta Thalassemia Minor
what is the serum of a 3/4 loss in alpha thalassemia?

4/4 loss? (name)
3/4: HbH (B4-tetramers)


4/4: Hb-Barts
(Hydrops fetalis - fetal death)
D-negative mother gives birth to a D-positive child. what should be administered and to whom?
Anti-D IgG to mother
when does Hemolytic Dz of the newborn occur w/ respect to mother and baby's blood?
Rh incompatability:
Mother - d (Rh-)
Child - D (Rh+)

ABO incompatability:
Mother - O
Child - A, B, or AB
which blood condition has ineffective erythropoiesis?
B-Thalassemia Major
what cell provides a membrane phospholipase to promote Arachidonic Acid metabolism?
Platelets
what promotes platelet aggregation?
(6)*
PET TAC:

PAF,
Epinepherine,
Thrombin,
Thromboxane,
ADP,
Collagen
PET TAC
Lab abnormalities for:

all Throbocytopenias
Dec Platelet count,

Inc Bleeding Time
Lab abnormalities for:

Hemophilia A or B
Inc PTT (only)
Lab abnormalities for:

von Willebrand's Dz
Inc Bleeding Time

Inc PTT
Lab abnormalities for:

DIC
Dec Platelet count,

Inc Bleeding Time,

Inc PT,

Inc PTT
Definition:

Hereditary resistance to activated Protein C;
MCC of hereditary thrombophilia
Factor V Leiden
Factors associated w/ PT
Factors:

II, V, VII, X
Factors associated w/ PTT
All except VII
what (2) shunts can cause a paradoxical emboli?
Patent foramen ovale,

ASD
Factor deficiency:

Hemophilia A
factor VIII
Factor deficiency:

Hemophilia B
factor IX
what (2) Dx will cause Inc PT?
DIC,

Macrohemorrhages
Definition:

Autosomal dominant Dz w/ local malformations of venules and capillaries of skin and mucous membranes, often complicated by hemorrhage
Osler-Weber-Rendu syndrome
Dx:

thromboycytopenia, increased megakaryocytes, anti-platelet Ab
ITP
Dx:

thrombocytopenia, helmet cells (schistocytes), Inc LDH, neuro abnormalities, renal insufficiency, fever
TTP
Definition:

Defect in platelet adhesion leading to decreased VIII
von Willebrand Dz
Definition:

Autosomal recessive problem w/ unusually large platelets w/ lack of a glycoprotein needed for adhesion

what glycoprotein?
Bernard-Soulier Dz

glycoprotein:
GPIb-IX

[Bad-Sticking Dz]
difference b/t platelet Adhesion and Aggregation

which does aspirin affect?
Adhesion - sticking to walls

Aggregation - sticking to each other
(Aspirin)
Definition:

Dz caused by the hereditary deficiency of a platelet surface glycoprotein required for formation of fibrinogen bridges b/t adjacent platlets (can't aggregate)

what glycoprotein?
Glanzmann Thrombasthenia

glycoprotein:
GPIIb-IIIa

[Glanzmann cant aGGregate]
Definition:

widespread systemic clotting w/ consumption of platelets and coagulation factors (II, V, VIII and fibrinogen)

who is it most commonly seen in?
Disseminated Intravascular Coagulation
(DIC)

MC: OB patient
Dx:

low platelet count, increased bleeding time & PT/PTT, schistocytes, Increased fibrin split products

what test to confirm?
DIC

test:
D-Dimer test (fibrin split products)
(4)* causes of DIC
COTS:

Cancer;
OB malfunction;
Transfusion rxn;
Sepsis (gram negative bug)
DIC-COTS
what is the only platelet disorder that does not have an Increased Bleeding Time?
Hemophilia (A or B)
what is the AA substitution of Sickle cell?
(what position/chain?)
VAL -> GLU at position 6
on Beta-chain
what is the AA substitution of HgC?
LYS -> Glutamic acid
RBC forms:

Howell-Jowel Bodies
(2)
Spleen problem

Sickel cell
MCC Cancer pushing out Tear drop cells in:

1. Children

2. Man

3. Woman
Children = ALL

Man = Prostate Mets

Woman = Breast Mets
MCC of malignancy in children
ALL
list Leukemia type by age of onset
ALL: < 15 yo

AML: 15 - 40

AML + CML: 40 - 60
(AML has auer rod)

CLL: > 60 yo
Dx:

Inc lymphoblasts, positive CD10 or CALLA, responsive to therapy
ALL
Dx:

Inc Myeloblasts, Auer rods

what translocation?

what does it lead to?
AML-M3


t(15;17) Retinoic acid

leads to: DIC
MC AML type

what translocation?
AML-M2

t(8;21)
Dx:

RBC w/ crystal inclusions
HbC
which AML affects the skin and gum and deals w/ Monocytes?
AML-M5
Dx:

Inc lymphoblasts, positive CD5, hypogammaglobinemia, smudge cells, warm hemolytic anemia
CLL
Dx:

splenomegaly, pancytopenia, B-cell dz w/ hair-like projections

what is test?
Hairy cell Leukemia


Test:
TRAP
Leukemia that is CD10 positive
ALL
Dx:

Extreme leukocytosis, myeloid precursor cells, low LAP
CML

philadelphia chromosome - t(9;22)
bcr-abl
Dx:

Marked erythrocytosis, splenomegaly, decreased erythropoietin, bleeding and thrombosis
Polycythemia vera
Dx:

extramedullary hematopoiesis (liver and spleen), myelofibrosis in bone marrow, anemia, massive splenomegaly, teardrop-shaped RBC
Chronic Idiopathic Myelofibrosis
(MMM)
Dx:

thrombocytosis in periphery and megakaryocytosis in marrow (platelets > 1 million)
Essential Thrombocythemia
Dx:

Atypical lymphocytes, young-adult, hepatosplenomegaly, fever and sore throat

Dx test?
Mononucleosis

(EBV)

Test: Heterophil Ab
Dx:

lytic lesions in bone, bone pain, M-protein spike, hyperglobinemia, hypercalcemia, renal insufficiency, immunoglobulins in urine, RBC congregation
Multiple Myeloma

MR BRA:
M-spike (IgA or IgG),
Rouleau form of RBC,
Bone lesions (lytic),
Renal insuff: Bence-Jones protein,
Amyloidosis
Dx:

many cells in intermediate stage b/t B-cells and plasma cells, Monoclonal IgM spike, Hyperviscosity, abnormal bleeding, retinal vascular dilation, Bence-Jones protein (10%)
Waldenstrom Macroglobulinemia
t(9;22)
CML
t(8;14)
Burkitt lymphoma
t(15;17)
AML type M3
what does AML-M3 respond to?
all-Trans Retinoic Acid
(vit A)
t(11;22)
Ewing sarcoma
t(11;14)
Mantle cell lymphoma
(4) types of Hodgkin lymphomas

what cell is seen in all of them?
Nodular Sclerosing,

Mixed Cellularity,

Lymphocyte Predominant,

Lymphocyte Depleted

(Reed-Sternberg cells)
Dx:

fibrous bands in LN and Lacunar cells, CD15 and CD30 positive, more common in women, usu in mediastinum
Nodular Sclerosing
Hodgkins lymphoma
Dx:

Hodgkin's w/ most RS cells, eosinophil and plasma cell infiltrate
Mixed Cellularity
Hodgkins lymphoma
Dx:

lymphoma common in men < 35, "potato in neck", popcorn cells, best prognosis
Lymphocyte Predominant
Hodgkins lymphoma
Dx:

lymphoma w/ very few lymphocytes and extensive fibrosis and necrosis, poorest prognosis
Lymphocyte Depletion
Hodgkins lymphoma
Lymphoma staging I-IV
I: one LN

II: >1 LN on same side of diaphragm

III: LN involvement on both sides of diaphragm and possibly spleen

IV: spread to one or more extralymphatic organs
Dx:

B-cell lymphoma, older person, positive CD5, possible CLL
Small Lymphocytic Lymphoma
Dx:

B-cell lymphoma, angulated grooved cells in Nodular pattern, bcl-2 positive
Follicular lymphoma
Dx:

similar to Small Lymphocytic lymphoma, but w/ t(11;14)
Mantle Cell lymphoma
Dx:

lymphoma that arises in sites of chronic inflammation or autoimmune Dz. (Sjogren: parotid; Hashimoto's: thyroid; H.pylori gastritis: stomach)

what is another name?
Extranodal Marginal Zone B-cell lymphoma

(MALToma)
Dx:

B-cell lymphoma that presents as a large, extra-nodal mass; seen in elderly and AIDS patients
Diffuse Large B-cell lymphoma
Dx:

T-cell lymphoma seen in children, from thymic lymphocytes, can progress to ALL
(T-precursor) Lymphoblastic lymphoma
Dx:

B-cell lymphoma, linked to EBV infection, "starry sky" appearance
Burkitt's lymphoma
(c-myc)

t(8;14)
what is the difference in presentation of Burkitt's in Africa and America?
Africa - Jaw lesion


America - Pelvis or Abdomen lesion
Dx:

lymphoma w/ dermal infiltrates of CD4 cells w/ cerebriform nuclei and "Pautrier microabscesses" in epidermis
Cutaneous T-cell Lymphoma
Definition:

Leukemic form of Cutaneous T-cell Lymphoma (w/ skin lesions and cerebriform nuclei)
Sezary syndrome
difference b/t the M-spike in Multiple Myeloma and Waldenstrom?
MM: IgA or IgG - M-spike

Waldenstrom: IgM - M-spike