CLS 442 RBC Cards

iron deficiency anemia

• serum ferritin: decreased

• Serum iron: decreased/normal

• TIBC: increased

• Transferrin saturation: decreased

• FEP/ZPP: increased

• sTfR: increased

• Hg content of retics: decreased

• BM iron (Prussian blue reaction): no stainable iron

• Sideroblasts in BM: none

increased

TIBC level in IDA is ________ (increased/decreased/normal?)

increased

sTfR level in IDA is ________ (increased/decreased/normal?)

beta-thalassemia minor

• serum ferritin: increased/normal

• Serum iron: increased/normal

• TIBC: normal

• Transferrin saturation: increased/normal

• FEP/ZPP: normal

• sTfR: normal

• Hg content of retics: decreased

• BM iron (Prussian blue reaction): increased/normal

• Sideroblasts in BM: normal

anemia of chronic inflammation

• serum ferritin: increased/normal

• Serum iron: decreased

• TIBC: decreased

• Transferrin saturation: decreased/normal

• FEP/ZPP: increased

• sTfR: normal

• Hg content of retics: decreased

• BM iron (Prussian blue reaction): increased/normal

• Sideroblasts in BM: none/very few

• Other special tests: specific tests for inflammatory disorders or malignancy

sideroblastic anemia

• serum ferritin: increased

• Serum iron: increased

• TIBC: decreased/normal

• Transferrin saturation: increased

• FEP/ZPP: increased

• sTfR: normal

• Hg content of retics: normal

• BM iron (Prussian blue reaction): increased

• Sideroblasts in BM: increased (ring)

true

True or false: In IDA, ferritin levels begin to decrease in stage 1.

stage 2

At what stage of iron deficiency does TIBC begin to increase?

stage 3

At what stage of iron deficiency does the hemoglobin test decrease?

hepcidin

increased ______ inhibits iron absorption from intestines and iron release from macrophages/hepatocytes

normochromic, normocytic

rbc morphology in anemia of chronic inflammation

true

True or false: lead inhibits ALA dehydratase leading to accumulation of ALA

4.00-6.00 × 10^6/uL

ASCP reference index for RBC count

Vitamin B12 deficiency

serum MMA is increased in…..

pernicious anemia

an autoimmune disease in which an autoantibody is raised against IF (intrinsic factor) or gastric parietal cells

ineffective erythropoiesis

Why is the reticulocyte count low in megaloblastic anemia?

Schilling test

test used to distinguish cobalamin deficiency due to malabsorption, dietary deficiency, or absence of IF

Diphyllobothrium latum

What parasite may be responsible for a patient’s vitamin B12 deficiency?

pernicious anemia

An H. pylori infection may cause _______________ (type of anemia) by destroying parietal cells.

>7.5%

In stage one of the Schilling test, what result indicates normal B12 absorption?

12.0-18.0 g/dL

hemoglobin ASCP reference index

35-50%

ASCP reference range for HCT

76-100 fL

MCV ASCP reference range

26-34 pg

MCH ASCP reference range

32-36 g/dL

MCHC ASCP reference range

11.5-14.5%

RDW ASCP reference range

transferrin

Fe transport protein

ferritin

major Fe storage form

Hemosiderin

H2O insoluble Fe storage form (long-term)

Hemoglobin A (Hgb A)

Type of hemoglobin which comprises 97% of adult hemoglobin

HCT/RBC x 10

formula for MCV

HB/RBC x 10

formula for MCH

HB/HCT x 100

formula for MCHC

spherocytes

main abnormal RBC formed in extravascular (macrophage-mediated) hemolysis

schistocytes

main abnormal RBC formed in intravascular (fragmentation) hemolysis

anemia, splenomegaly, jaundice

triad of conditions seen in hereditary spherocytosis

hereditary spherocytosis

intrinsic RBC defect which involves mutations in proteins which maintain vertical attachements

ankyrin, spectrin

most of the protein mutations in hereditary spherocytosis are in ______ and _______

false

True or False: LDH is decreased in hereditary spherocytosis

hereditary spherocytosis

decrease in fluorescence in eosin-5’-maleimide binding test by flow cytometry is an expected result for which RBC defect?

hereditary elliptocytosis

rbc defects in horizontal interactions

paroxysmal nocturnal hemoglobin (PNH)

• rare chronic IV hemolytic anemia, acquired membrane defect

• RBCs lack CD55 and CD59

• absence of CD55 and CD59 renders RBCs susceptible to spontaneous lysis complement

CD55 and CD59 detection by flow cytometry

confirmatory test for PNH

G6PD deficiency

RBC deficiency which prevents the production of NADPH

oxidants would build up, leading to premature hemolysis

What happens if G6PD is missing in RBCs?

G6PD deficiency

• moderate to severe, usually normochromic/normocytic

• with severe variants: marked anisocytosis, poikilocytosis, spherocytosis, and schistocytosis

• Bite cells (not specific), Heinze bodies (denaturated Hb, only with supravital staining)

• Profound reticulocytosis (up to 30%)

• Very low serum haptoglobin, high indirect bilirubin, high LDH, increased plasma Hb (IV hemolysis)

PK deficiency

• __________ causes premature destruction of RBCs — without ___, depletion of ATP results in lack of membrane integrity

• Clinical presentation: anemia, jaundice, splenomegaly & gallstones (chronic hemolysis)

• neonates: severe anemia

• adults: severe to compensated

immune hemolytic anemia

• IgM mediated hemolysis can result in both extravascular and intravascular hemolysis

• IgG mediated hemolysis is predominantly extravascular → RBCs removed by macrophages in the spleen/liver

• DAT: positive

warm autoimmune hemolytic anemia (WAIHA)

• Immunoglobulin: IgG

• Optimum reactivity temperature of autoantibody: 37ºC

• Sensitization detected by DAT: IgG or IgG + complement

• Complement activation: variable

• Hemolysis: Extravascular primarily

• Autoantibody specificity: Panreactive

• Other laboratory findings: Polychromasia, spherocytes

cold agglutinin disease (CAD)

• Immunoglobulin: IgM

• Optimum reactivity temperature of autoantibody: 4ºC

• Sensitization detected by DAT: Complement

• Complement activation: Yes

• Hemolysis: Extravascular; some intravascular

• Autoantibody specificity: I (most), i (some), Pr (rare)

• Other laboratory findings: RBC agglutination may be present; hemoglobinuria

paroxysmal cold hemoglobin (PCH)

• Immunoglobulin: IgG

• Optimum reactivity temperature of autoantibody: 4ºC

• Sensitization detected by DAT: Complement

• Complement activation: Yes

• Hemolysis: Intravascular

• Autoantibody specificity: P (Donath-Landsteiner Ab)

• Other laboratory findings: Polychromasia, spherocytes, schistocytes, NRBCs, anisocytes, poikilocytosis; hemoglobinuria; Anti-P positive

lead poisoning (sideroblastic anemia)

urine ALA is high in _____

hemolytic uremia syndrome

• caused by bacteria that produce Shiga toxin

• the most common cause of disease is ingestion of improperly cooked meat especially in children

• the endothelial cell damage: activation of platelets, formation of platelet-fibrin thrombi, blockages in the microvasculature of the glomeruli, acute renal failure

thrombotic thrombocytopenic purpura (TTP)

a type of MAHA which is caused by a deficiency of ADAMTS13

hemoglobinuria (fragmentation hemolysis)

What does root beer-colored urine indicate?