Important Heme

aniosocytosis

size variation

poikilocytosis

shape variation

spherocytosis

round RBCs

schistocytosis

damaged cells, mechanical damage

sickle cells show abnormal what

hemoglobin

reticuolocytes

Baby RBCs

neutrophils target

bacteria

eosinophils attack

parasites and allergies

b lymphocytes produce

antibodies

t lymphocytes attack what and regulate what

infected cells, regulate immune response

monocytes fight in what

chronic infections

spontaneous major bleeding in thrombocytopenia if platelet count is below what

20,000

risk of spontaneous thrombosis if platelets are over what

750,000

what is important and present in the platelet plug

Von Willebrand factor

vitamin K dependent factors

2, 7, 9, 10

what do damaged blood vessels release in the extrinsic pathway

tissue factor

what does thrombin activate

fibrinogen (factor I)

what does Prothrombin time (PT) monitor and what is the key factor

extrinsic pathway, VII

what is PT paired with

INR (international normalized ratio)

what does partial thromboplastin time (PTT) monitor and what is the key factor

intrinsic pathway, VIII & IX

what converts plasminogen to plasma

tissue plasminogen activator (tPA)

RBC size lab

mean cell volume (MCV)

RBC shape lab

none, look under microscope

amount of Hgb in RBC lab

mean corpuscular hemoglobin (MCH)

most common anemia worldwide

iron deficiency anemia

what is a hereditary disorder of hemoglobin synthesis

thalassemia

iron deficiency anemia supplement

Ferrous Sulfate 325 mg po TID x 3-6 months

on empty stomach

hemoglobin S

abnormal beta chain resulting in sickle cell anemia

if someone only has 1 gene coding for alpha global synthesis, what disease do they have

Hemoglobin H disease

if someone only has 2 genes coding for alpha global synthesis, what disease do they have

Thalassemia minor (trait)

alpha thalassemia heme H electrophoresis

Hemoglobin H

beta thalassemia electrophoresis

Hemoglobin A2 and F

what hemoglobin is predominant in beta thalassemia

Hemoglobin F

what is the most common cause of a B12 deficiency

Pernicious anemia

what is unique about B12 deficiency

there are nervous system symptoms

bite cells

damage from splenic macrophages removing Heinz bodies

what kind of gene is sickle cell anemia

autosomal recessive

what is special about sickle cell anemia

hemoglobin S

sickle cell trait is what for Hgb S gene

heterozygous

sickle cell disease is what for Hgb S gene

homozygous

what is unique to sickle cell labs

Howell-Jolly bodies

what lab looks for the presence of fibrin end products

D-dimer

what kind of destruction occurs to platelets in ITP

autoimmune destruction

ITP treatment

self-limited

steroids

intravenous immunoglobulin

what is seen on a TTP blood smear

schistocytes

what is the most common inherited bleeding disorder

Von Willebrand disease

Von Willebrand disease treatment

DDAVP or von Willenbrand factor

what does aspirin do

reduces platelet aggregation

what does heparin do

inactivates thrombin and factor Xa

what is heparin use monitored by

PTT

what does Warfarin do

blocks vitamin K synthesis in the liver

what is Warfarin monitored with

PT

Hemophilia A treatment

replace factor VIII

Hemophilia B treatment

replace factor IX

what does disseminated intravascular coagulation (DIC) release into the blood stream

tissue factor (III)

labs for DIC

PT, PTT, platelets, D-dimer

what is the most common hereditary blood coagulation disorder

Factor V (leiden) mutation

what occurs in Factor V mutation

factor V becomes resistant to protein C inactivation

how is Factor V mutation diagnosed

genetics testing

what is the most common PID immune component affected by

antibody deficiencies

what will a pt with selective IgA deficiency have after a plasma or blood transfusion

anaphylactic reaction

what is seen in common variable immunodeficiency

inadequate vaccination responses

what is seen in specific antibody deficiency

inadequate IgG antibody response to vaccines

what do infants with SCID make

few or no T cells

with or without B cells

what should pts with SCID not receive

live attenuated vaccines

what is the definitive treatment of SCID

hematopoietic stem cell transplant or bone marrow transplant

what do phagocyte defects cause

recurrent pyogenic infections

what is rare and <1% of identified PID

complement defects

what kind of disease is complement defects and what does it resemble

systemic autoimmune disease

lupus

disorders of innate immunity first line treatment

refer to immunologist

disorders of innate immunity other treatment

IgG-RT

anti fungal and antibiotic prophylaxis

vaccinations

bone marrow transplantation

what do fevers release

pyrogens from leukocytes

what does a fever impair

pathogen activity

what does an inflammatory response release

histamine, serotonin, heparin

signs of inflammation

calor, dolor, rubor, adema

what does adaptive defenses rely on

antigen identification

what cell directly attack and destroy other cells

cytotoxic T cells (CD8+)

what do antibodies/immunoglobulins activate

compliment system

what is unique to polycythemia vera

JAK2 gene mutation

what is unique to secondary/reactive thrombocytosis

release of interleukin 6 (IL6)

what symptom is seen in essential thrombocytosis

erythromelaglia

what is seen in an essential thrombocytosis bone marrow biopsy

increased megakaryocytic

essential thrombocytosis diagnosis

diagnosis of exclusion

CBC in essential thrombocytosis

elevated platelets, can be over 2 million

CBC in reactive thrombocytosis

platelets rarely over 1 million

what type of malignancy is multiple myeloma

plasma cell malignancy of bone

what is unique to blood smear for multiple myeloma

Rouleaux smear

what is unique to x-ray for multiple myeloma

lytic lesions

multiple myeloma diagnosis test

SPEP, UPEP

multiple myeloma definitive diagnosis

bone marrow biopsy

what does serum protein electrophoresis test for

high gamma globulin

what does urine protein electrophoresis test for

Bence-Jones proteins

what are seen in the electrophoresis tests of multiple myeloma

high gamma globulin and Bence-Jones proteins

what is the most common childhood leukemia

acute lymphoblastic leukemia

what is seen in acute myelogenous leukemia

auer rods on smear

what type of leukemia has no clear etiology

AML

what leukemia is slow growing cancer of the blood and bone marrow

CLL

what is excessively produced in CLL

B lymphocytes

CLL treatment

watch and wait

what is the specific chromosomal abnormality of CML

philadelphia chromosome