Goljan Hematology Rbc I-V

Front 1

how do you correct a retic count for degree of anemia

Back 1

pt Hct/45 x retic count

polychromasia present? divide by 2

Front 2

ferritin

Back 2

circulation form of iron storage- represents amount of iron in bone marrow

Front 3

transferrin

Back 3

carrying protein for iron, made in the liver

Front 4

transferrin vs TIBC

Back 4

think of these as the same- transferrin is the carrier protein so the more present, the more iron can be bound (TIBC)

Front 5

chronic inflammation and iron stores

Back 5

iron stored in macrophages in bone marrow: inflamation= trying to keep iron from bacteria, but keep it away from RBCs as well

Front 6

least common microcytic anemias

Back 6

sideroblastic anemias.
1. Alcohol
2. lead poisioning

Front 7

rate limiting enzyme in porphyrin synthesis

Back 7

ALA synthase

heme is the feedback mechanism

Front 8

dx for microcytic anemia

Back 8

iron def
anemia of chronic disease
thalassemia
sideroblatic anemia

Front 9

ddx for macrocytic anemias

Back 9

folate def
vitamin B12 def (neurologic findings)

Front 10

ddx for normocytic anemia with retic index below 3%

Back 10

blood loss (<1 week)
early iron def
early anemia of chronic dz
aplastic anemia
renal disease (low epo)

Front 11

normocytic anemia, corrected retic >3% (intrinsic RBC defects)

Back 11

Mem defects (H. spherocytosis, H. elliptocytosis, paroxysmal noc hemoglobinuria)

Abnormal Hb (sickle cell dz)

Deficient enzymes (G6PD, pyruvate kinase)

Front 12

target cell ddx

Back 12

Hem C disease
Asplenia
Liver disease (alcoholics)
Thalasemia

"HALT"

Front 13

ddx for decreased serum ferritin

Back 13

iron def (ferritin is iron storage protein)

Front 14

ddx for increased serum ferritin

Back 14

anemia of chronic disease
Iron overload disease

Front 15

ddx for decreases serum iron

Back 15

Iron Def
Anemia of chronic disease

serum iron represents transferrin level- coorelated with TIBC

Front 16

common causes of iron def in neonates

Back 16

blood loss (meckel diverticulum)

Front 17

common causes of iron def in adult males < 50

Back 17

Peptic ulcer disease (GI BLOOD LOSS)

Front 18

common causes of iron def in women < 50

Back 18

menorrhagia

Front 19

common causes of iron def in adults > 50

Back 19

bloodloss think polyps/colorectal cancer

Front 20

clinical and lab findings in iron def anemia

Back 20

glossitis, spoon-nails, decreased MCV, decreased iron sat

increased TIBC

Front 21

stages of iron def anemia

Back 21

absent iron stores-> decreased serum ferritin-> decreased serum iron, increased TIBC,-> normocytic normochromic anemia-> microcytic hypochromic anemia

Front 22

most common anemia in hospitalized patients

Back 22

anemia of chronic disease

Front 23

where is the iron in anemia of chronic disease?

Back 23

in the macrophages - hepcidin is released in response to inflamation and it enters macrophages and prevents release of iron to transferrin

Front 24

Lab findings in anemia of chronic disease

Back 24

low MCV, low serum iron, low TIBC

increased ferritin

Front 25

epidemiology of thalassemia

Back 25

autosomal recessive
alpha- SEasian, blacks
beta- greeks, italinians, blacks

Front 26

Hb electropheresis in alpha thal

Back 26

normal- decreased alpha (chain that matches with beta(A), gamma (F), delta(A2)

therefore, every type is decreased proportionally

Front 27

black v asian a thal trait

Back 27

-a/-a black trait
--/aa asian trait

Front 28

labs in a thal

Back 28

low MCV, Hb and Hct

increase RBC count

normal serum ferritin and Hb electropheresis

Front 29

Hemoglogin H

Back 29

four beta chains- combo of three a gene deletions in alpha thal

Front 30

hemoglobin bart

Back 30

four gamma chains- combo of 4 a gene deletions in alpha thal- not compatable with life= hydrops fetalis

Front 31

labs in beta thal minor

Back 31

decreased MCV, Hb, Hct
Hb electrophoresis: decreased HbA, increased HbA2, increased HbF

Front 32

anemia in b thal major vs minor

Back 32

minor- mild microcytic anemia

major- severe hemolytic anemia

Front 33

common causes of sideroblastic anemia

Back 33

alcoholism (chronic)- leadin cause
Pyridoxine (B6) deficiency (ALA syn cofactor)
Lead poisoning (protein denaturization)

Front 34

see a 'ringed sideroblast' - most likely cause?

Back 34

Alcoholism; followed by B6 def and Lead poisioning

(sideroblastic anemias)

Front 35

ALA synthase

Back 35

enzyme (rate-limiting) in heme synthesis

B6= cofactor- no B6= sideroblastic anemia

low B6 (pyridoxine) leading cause - isoniazid therapy for TB

Front 36

see 'course basophilic stippling' think?

Back 36

lead poisoning

Front 37

abdominal colic w diarrhea in adults

encephalopathy, cerebral edema, growth retardation in children

Back 37

lead poisoning

Front 38

see increased density in epiphysis on xray, with anemia

Back 38

think lead poisoning- Pb deposition

Front 39

Fanconi syndrome with anemia

Back 39

Pb poisoning- prox RTA-loss of bicarb in urine, aminoacduria, phosphaturia, glucosuria

Front 40

Lab findings in sideroblastic anemias

Back 40

increased serum iron, increased ferritin

decreased MCV decreased TIBC

ringed sideroblasts in bone marrow

Front 41

patients at risk for decreased intake of B12

Back 41

vegan diet & infants of vegan dieters

elderly (malnutrition)

Front 42

where is B12 absorbed?

Back 42

terminal ileum

Front 43

Explain intrinsic factor's role

Back 43

secreted by parietal cells (body-fundus) complexes with B12 in duodenum after pancreatic enzymes cleave R-binder. Reabsorbed as a complex with B12 in the termainal ileum

Front 44

possible ways to interfere with the intestinal reabsorbtion of B12

Back 44

Chron's or Celiac dz of terminal ileum
bacterial overgrowth
fish tapeworm (diphyllobothrium latum)
pancreatitis (no pancreatic enzyme to remove R-binder)

Front 45

R-binder

Back 45

syn. in salivary glands; binds free B12, protects/carries to duodenum, cleaved from B12 by pancreatic enz

Front 46

what food is folate in?

Back 46

green veggies, animal protein

Front 47

folate reabsorption location & blockers

Back 47

jejunum-

blocked by alcohol, oral contraceptives

Front 48

most common cause of folate def

Back 48

decreased intake:
-malnutrition (infants/elderly)
-chronic alcoholics

Front 49

what builds up in the abscence of B12 and/or folate? effects?

Back 49

homocysteine
effects- high levels associated with thrombosis/MI

Front 50

ddx for high MCV anemia?

Back 50

B12 or Folate def - problem in DNA synthesis (thymidylate synthase) pathway-> cells cannot divide

Front 51

pernicious anemia

Back 51

autoimmune vs parietal cells: no IF= no B12 absorbtion.
-lack gastric acid
-macrocytic anemia
- increased gastric adenocarcinoma

Front 52

clinical findings in B12 def

Back 52

pernicious anemia (macrocytic)
smooth, sore tongue (glossitis)
neurologic symptoms

Front 53

Lab findings in B12 def (other than low serum B12)

Back 53

Macrocytic anemia
increased homocysteine (no dna syn) and methylmalonic acid (no odd chain FA metab)
SMEAR: pancytopenia, HYPERSEGMENTED NEUTROPHILLS

Front 54

hypersegmented neutrophil DDX

Back 54

folate def
B12 def

Front 55

Shilling test basics

Back 55

test for etiology of B12 def: replace possible defects in absorbtion until cause is found (IF, antibiotics[bac overgrowth], pancreatic enz)

Front 56

differnce in clinical findings: B12 vs folate

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B12 def is only one to result in neurologic defects due to impaired odd chain FA metabolism

Front 57

folate & fetal health

Back 57

maternal folate def prior to conception -> increased risk of open neural tube defects

Front 58

Lab findings in folate def

Back 58

hypersegmented neutrophills
macrocytic anemia
pancytopenia
decreased **RBC folate** best indicator of folate stores **