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98 Cards in this Set
- Front
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causes of microcytic anemia, lab findings
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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
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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
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mean corpuscular hemoglobin concentration =HB/HCT
Hemoglobin concentration within circulating RBCs (g/dL) |
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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. |
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mech of sideroblastic anemia
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Iron can become trapped in the mitochondia of rbc
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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
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lower Fe
increased Tf lower % sat, lower ferritin, increased Tf-R |
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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 |
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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
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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 |
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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 |
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what is HbE
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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
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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 |
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peripheral smear on alpha thal trait
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only mild microcytic, occ targets
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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)
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what
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b12 deficiency -
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folate in b12/folate deficiency
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folate lowered in rbcs for b12 defii
folate lowered in serum for folate defi |
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falsely low serum folate
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pregnancy, myeloma,
haptocorrin deficiency |
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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 |
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what is the retic index
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retic ct x hct/nl hct
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what is RPI
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retic ct/maturation correction
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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 |
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two causes of spherocytes
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HS (anykrin mutation is most common)
aiha |
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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 |
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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) |
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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
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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
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PNH mutations of
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GPI proteins
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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) |
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mech of pml dic
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release of granules/auer rods triggering coag cascade
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