Quiz 4: Hematopathology Flashcards Preview

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Flashcards in Quiz 4: Hematopathology Deck (92):
1

Anemia is characterized by low oxygen transport capacity of the blood due to ... (4)

blood loss, impaired RBC production, increased RBC destruction, a combination of all these things

2

Anemia can be due to what 2 categories?

Excessive blood loss (hemorrhage or hemolysis) or failure of blood production

3

Decreased oxygenation of the renal JGA cells triggers the production of what?

EPO

4

With acute blood loss, ... blood loss allows for recycling of the Fe contained in the blood

internal

5

Immediately after acute blood loss, peripheral smear usually appears...

normal-- normal size (normocytic), normal color (normochormic)

6

What is polychromasia?

RBC's are released prematurely, leading to bone marrow stress.

7

Reticulocytes are usually (smaller/larger) than mature RBCs

larger

8

Chronic blood loss causes anemia only if... (2)

rate of loss exceeds the capacity of the marrow to restore adequate numbers of RBCs; iron stores are depleted such that inadequate hemoglobin is available.

9

Chronic blood loss is usually due to what (3) organ systems?

GI, Gyn, GU

10

What is a hemolytic anemia?

RBCs are prematurely destroyed

11

Hemolytic anemias are characterized by... (3)

shortened RBC life span, Hgb breakdown products accumulate, increase in BM erythropoiesis

12

What organ is the site of RBC destruction in the majority of hemolytic anemias?

Spleen

13

What are the 2 types of hemolytic anemais?

Intravascular (within the blood vessels); extravascular (hemolysis in the spleen)

14

A peripheral blood smear with numerous fragmented RBCs-- "helmet" cells or "schistocytes" is indicative of what?

intravascular hemolysis

15

Intravascular hemolysis is a result of:

mechanical trauma, antibody fixation, toxic injury to the RBCs

16

What are 2 examples of extravascular hemolysis?

sickle cell anemia and hereditary spherocytosis

17

In extrinsic hemolytic anemias, Abs are usually what class?

IgG

18

Intrinsic hemolytic anemias are ... while intrinsic hemolytic anemias are ...

acquired; congenital

19

Intrinsic hemolytic anemiaas are divided into what 3 groups?

abnormal hemoglobin, abnormal RBC metabolism, abnormal hemoglobin synthesis

20

What condition is the prototype of abnormal hemoglobin disorders?

Sickle cell anemia

21

sickle cells are formed dt

low pH, low oxygen tension

22

why does sickling occur more readily in acidic tissues?

low pH reduces oxygen's affinity for hemoglobin

23

What is MCHC?

Mean corpuscular hemoglobin concentration-- concentration of Hgb per cell.

24

Intracellular dehydration (increases/decreases) MCHC, facilitating sickling and vascular occulsion

increases

25

What is AIHA?

Autoimmunie hemolytic anemias

26

What test(s) are used to diagnose AIHA?

Coombs and indirect Coombs antiglobulin

27

What is the most common form of AIHA?

Warm Ab AIHA

28

AIHA is (extrinsic/intrinsic)

extrinsic

29

Half of warm Ab AIHA are... and half are ...

idopathic; secondary to SLE, Rx, or neoplastic dzs ie lymphoma

30

What is Cold Agglutinin AIHA caused by?

IgM Abs that bind and agglutinate RBCs at low temps (0*-4*C)

31

Peripheral smears of extrinsic hemolytic anemias resulting from RBC trauma show...

schistocytes, burr cells, helmet cells

32

What 2 conditions are the only conditions that cause major clinical problems associated with hemolysis?

TTP and HUS

33

what are (5) anemias of diminished erythropoiesis?

Megaloblastic anemia, iron deficiency anemia, anemia of chronic dz, anemia of renal failure, marrow stem cell failure

34

What are the keynotes of megaloblastic anemia?

Impaired DNA synthesis and distinctive morphological changes in the blood and bone marrow

35

What are the 4 most common causes of megaloblastic anemia?

B-12 deficiency; Folic acid deficiency; hyperthyroidism, pregnancy, disseminated cancer; inadequate diet and alcoholism

36

what is the morphology of megaloblastic anemia?

increased RBC size, increased MCV, normochromia, anisocytosis; hypersegmented nuclei of neuts and eos.; low reticulocytes, nucleated RBC's;hypercellular marrow with increased numbers of all types myeloid precursors

37

Coabalamine and folate are coenzymes required for the synthesis of what?

thymidine

38

Reduced thymidine results in what?

DNA synthesis is diminished and macrocytosis and ineffective erythropoiesis in erythroid precursors

39

In megaloblastic anemias, what is unaffected so cytoplasmic maturation is normal, leading to nuclear/cytoplasmic asynchrony?

RNA synthesis

40

Pernicious anemia is a chronic illness of impaired absorption of vit B-12 dt a lack of what?

Intrinsic factor

41

Adult form of pernicious anemia is a result of what?

auto-reactive T-cell response

42

An autoreactive T-cell response initiates what?

Gastric mucosal injury, triggering formation of autoantibodies, which then cause gastric mucosal destruction

43

There are 3 types of ab's found in pernicious anemia. Type I does what?

Blocks binding of B-12 to IF

44

There are 3 types of ab's found in pernicious anemia. Type II does what?

prevents binding of IF-B-12 complex to its ileal receptor

45

There are 3 types of ab's found in pernicious anemia. Type III does what?

Binds to the proton pump are are found in up to 50% of elderly pts with chronic gastritis

46

Which ab's occur in 90% of pts with pernicious anemia compared to only 5% of healthy adults?

Anti-parietal cell ab's

47

Pts with pernicious anemia have a 2 to 3 fold increase incidence of what?

gastric carcinoma

48

Pernicious anemia often coexists with what other anemia? Why?

Iron deficiency; achorhydria prevents solubilization of dietary ferric iron from foodstuffs

49

How is pernicious anemia diagnosed?

endoscopy directed biopsy of gastric mucosa showing depleted parietal cells

50

Neurological symptoms and findings may be present in the absence of anemia dt B-12 deficiency in which patients?

Patients taking folate or on a high folate diet

51

What are the primary diagnostic features of B-12 deficiency?

low serum or RBC B-12 level; low hgb, hct, RBC counts; MCV elevated; decreased wbc and platelet count; increased serum homocysteine and methylmalonic acid levels; mild jaundice; inability to absorb B-12 supplements

52

Continual dietary supply of what vitamin is needed because it is not stored in the body in large amounts?

Folic acid

53

Which medications interfere with the absorption of folic acid?

dilantin, lithium, sulfasalazine, oral contraceptives

54

RBCs in folate deficiency are abnormally (large/small) in the blood

large (megalocytes)

55

RBCs in folate deficiency are abnormally (large/small) in the bone marrow

large (megaloblasts)

56

What are the primary diagnostic findings of folate deficiency?

RBS abnormally large in blood and bone marrow (megalocytes, megaloblasts); hypersegmented neuts; decreased folate levels in serum or RBC; elevate homocysteine in serum

57

What are 3 primary causes of folate deficiency?

decreaesd intake, increased requirements, impaired use

58

Unlike B-12 deficiency, folate deficient pts do NOT exhibit what?

neurologic complications associated with myelin loss in nerves of the posterior column

59

What might mask the diagnosis of combined B-12 and folic acid deficiency?

pt with folic acid replacement

60

What is the most common nutritional disorder in the world?

Iron deficiency anemia

61

What are 4 causes of iron deficient anemia?

dietary lack, impaired absorption, increased requirement, chronic blood loss

62

Dietary lack of iron is most common where?

Developing world.

63

Why is the lack of iron most common in the developing world?

Vegetarian diet

64

Dietary lack of iron occurs most often in what populations?

Elderly, infants, children, poor

65

Impaired absorption of iron is found in what conditions?

Celiac dz, chronic diarrhea, other czs of malabsorption

66

What are 3 examples of dietary substances that inhibit the absorption of nonheme iron?

phytates, tannins, phosphates

67

What form of iron comes from animal products?

Heme form

68

What is the most common cause of iron deficiency anemia in the western world?

chronic blood loss

69

Iron deficiency induces a ... and ... anemia

microcytic, hypochromic

70

When does iron deficiency anemia appear?

iron stores are completely depleted, low serum iron, low serum ferritin, low transferrin saturation

71

What does the PB of iron deficiency anemia look like?

microcytic, hypochromic RBCs with central zone of pallor and poikilocytosis-- small, elongated red cells aka pencil, cigar cells, or elliptocytes

72

What is diagnostically significant in iron deficient anemia?

disappearance of stainable iron from mononuclear phagocytic cells in the marrow

73

What are the 3 C's of anemia of chronic disease?

Chronic infections, connective tissue disease, cancer

74

ACD (unlike IDA) is characterized by what?

Low iron levels and low TIBC, with normal or even elevated ferratin levels

75

ACD generally presents as...

normocytic, normochromic anemia

76

Aplastic anemia is a BM failure syndrome characterized by what 2 things?

PB Pancytopenia, BM hypoplasia

77

What is the morphology of aplastic anemia?

BM is largely devoid of hematopoietic elements, shows largely fat cells, fibrous stroma, scattered or clustered foci of lymphocytes and plasma cells remain

78

What is aplastic anemia?

failure of the pluripotent stem cells to produce RBCs, WBCs, and mgakaryocytes

79

What are the major causes of morbidity and mortality from aplastic anemia?

Infection and bleeding

80

With aplastic anemia, thrombocytopenia may present as...

mucosal and gingival bleeding or petechial rashes

81

With aplastic anemia, neutropenia may manifest as...

overt infections, recurrent infections, or mouth and pharyngeal ulcerations

82

WBC disorders are classified into what 2 categories?

Proliferative and leukopenias

83

What are the 2 types of proliferative WBC disorders?

reactive and neoplastic

84

Leukopenia is an (increase/decrease) in leukocytes?

decrease

85

Proliferative WBC disorders are an (increase/decrease) in leukocytes?

increase

86

Which type of proliferative WBC disorders are less common and more clinically important?

neoplastic

87

Leukopenia is usually dt a decrease in what?

Neutrophils

88

What is agranulocytosis?

marked reduction in neutrophil count with increased susceptibility to infections

89

What is the pathogenesis of neutropenia?

Decreased/ineffective neutro production; removal of neutros from circulation

90

Decreased production of leukocytes can be caused by: (4)

Suppression of myeloid stem cells (aplastic anemia, infiltrative marrow d/o's --tumors, granulomatous dz); Drug suppression of granulocytic precursors; Defective precursors in marrow (megaloblastic anemia, myelodysplastic syndromes); Genetic defects (Kostmann syndrome)

91

Increased removal of neutrophils can be caused by: (3)

Immune mediated injury (SLE, drugs); Splenic sequestration (increased destruction dt enlargement of the spleen); Increased peripheral utilization (overwhelming infxns)

92

Which myeloid stem cell can go on to become a WBC?

myeloblast