Busy. Please wait.

Forgot Password?

Don't have an account?  Sign up 

show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.

By signing up, I agree to StudyStack's Terms of Service and Privacy Policy.

Already a StudyStack user? Log In

Reset Password
Enter the email address associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know (0)
Know (0)
remaining cards (0)
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

RBC Disorders


Anemia: morphology rel to MCV <80 = microcytic; 80-100 = normo; >100 = macro
Diff Dx for micro anemia TICS: thal, iron def, chronic inflammation, sideroblastic
Anemia: RBC production problem (vs destruction prob) distinguished by: Retic count; hypoproliferative = retic low (<2); hyper = retic high (>3)
Formula: corrected retic % retic x HCT/45% = absolute % retics
Hypoproliferative anemia due to: Marrow damage, Fe def, dec'd stimulation
Hyperproliferative anemia due to: BM failure to compensate for blood loss or RBC destruction
Degrees of thalassemia dz Hydrops fetalis = all 4 genes deleted (fatal); Hgb-H dz = 3 deleted (MCV=60-70); A-thal trait = 2 genes (MCV=70-80); silent carrier = 1 gene deleted
Thal: Hgb-H dz labs Hgb elect = 10-40% Hgb H; retic is high
Beta thal types Major (Cooley's): both beta globin genes mutated, severe anemia, txn dept; intermedia: txn in stress; minor rarely need txn
Tx for Hgb H dz Splenectomy? & folic acid
Tx for beta thal major Txn, splenectomy, Fe chelation; allogeneic BM trans to cure
Most common cause of anemia worldwide Fe def anemia
Causes of Fe def anemia Dec’d intake/ Poor diet; dec’d absorption; Inc’d loss (GI bleed, menorrhagia,neoplasm); Inc’d reqs (PG, lactation)
Tx for Fe def anemia Oral Fe supplement (ferrous sulfate)
Anemia of chronic dz Mostly normal labs (poss microcytic); low erythropoietin; tx underlying dz & coexisting defs; epo?
Enzyme disorder: adequate Fe but can't get it into Hgb; Fe accumulates in ? Sideroblastic anemia; in RBC mitochondria
Sideroblastic findings High serum Fe, large spleen/liver; mod anemia, low MCV; BM sideroblasts
Tx: Sideroblastic anemia Dept on cause (ETOH, Pb, leukemia, TB Rx); txn/chelation
Macrocytic anemias Folic acid def; B12 def
Causes of B12 def Diet (vegans); malabsorption: inadequate IF prodn (70%), terminal ileum dz (sprue, Crohns), tapeworm, drugs
S/S = Glossitis, periph neuropathy (Stocking-glove paresthesias); MCV 110-140; low retic, hyperseg PMNs, high methylmalonic a. B12 def
Tx B12 def Replacement tx: IV B12; frontload dose
B12 def vs folic acid def B12: meat/dairy; to 5000 mcg in liver (3 yrs); Folic acid: fruit/veg; 5-20 mg stored (few mos)
Causes folic acid def Inadeq intake (ETOH, teens, elder); inc’d req: PG, malignancy, anemias, hemodialysis; Malabsorption [sprue, drugs (phenytoin, barbituates)]; Impaired metabolism (ETOH, methotrexate)
Folic acid def findings Malnourished; glossitis, cheilitis; NO neuro S/S; RBC folate <150 ng/mL
PRCA is contracted: Acquired or idiopathic
Autoimmune dx mediated by T lymphocytes or (rarely) IgG antibody against erythroid precursors PRCA
Poss causes include thymoma, solid tumors, SLE, RA, HIV/hep, phenytoin PRCA
PRCA findings Normal lab except low retic; severe anemia S/S
PRCA Tx Stop all meds; poss thymoma resection; IV Ig
Due to BM failure (injury or suppression); pancytopenia Aplastic anemia
Causes of aplastic anemia Idiopathic (50-65% ; likely autoimmune); Phenytoin, sulfonamides; chemotherapy, radiotherapy; benzene, solvents, insecticides; hep, HIV, EBV; PG, SLE, GVHD; Hereditary (rare): Fanconi’s anemia
Aplastic anemia findings NO hepatosplenomegaly; pancytopenia (purpura, pallor, petechiae); low retic; hypocellular BM
Aplastic anemia: diff dx from: 1-MDS; 2-hairy cell; 3-normo 1=abn cells; 2=splenomegaly & abn lymph cells; 3=SLE, hypersplenism, dissem'd infxn
Aplastic anemia tx Family HLA typing; supportive tx (txn/infxn); immunosuppn; GF; BM txplant
Aplastic anemia prognosis Untx'd = fatal; HLA matched txplant: 60-90% cure; ATG tx: partial remission 60-80% (1/3 relapse & 20-50% MDS)
Hemo anemias: intrinsic vs extrinsic Intrinsic = prob w/membrane, z defects, hgb (usu hereditary); Extrinstic = autoimmune, drugs or mechanical trauma (often acquired)
Reticulocytosis may reflect: Hemolytic anemias
Hemo anemia lab findings Low haptoglobin; high LDH, indirect bili (not >4-5mg/dL unless underlying liver dz), retic; hemoglobinuria; stable or falling hgb
Distinguishing Etiology of Hemolysis Clinical & FH; Direct Coombs; Peripheral blood smear; morpho (Heinz bodies, sickle cells, parasites); Hgb electrophoresis
Due to spectrin pro in cytoskeleton Hereditary spherocytosis
Triad: anemia, splenomegaly and jaundice Hereditary spherocytosis
Pigment type gallstones; chronic leg ulcers Hereditary spherocytosis
Hereditary spherocytosis findings Mod micro anemia; reticulocytosis; high indirect bili; Neg coombs
Hereditary spherocytosis tx Folic acid 1mg po qd; splenectomy for severe
Acquired stem cell disorder making RBC membrane prone to lysis by complement PNH
PNH findings Episodic hemolytic anemia; Venous thrombosis; Deficient hematopoiesis -> pancytopenia; reddish-brown urine; Hemoglobinuria, esp. first morning urine
Episodic hemolytic anemia; Venous thrombosis; Deficient hematopoiesis -> pancytopenia ... indicate: PNH
PNH labs Flow cyto = absence of CD59 Ab; normocytic; hemoglobinuria
In PNH, increased risk of: leukemia/myelofibrosis
PNH tx Tx Fe def; prednisone for hemolysis; BM txp if severe
Episodic hemolytic anemia related to oxidative stress (hereditary) G6PD def
G6PD def prevalence >200M worldwide (usu AA men); X linked recessive; females rare
Stress triggers of G6PD def Infxns; toxins/drugs (sulfa/antimalarial); fava beans
G6PD def findings No splenomegaly or chronic hemolytic anemia; bite cells/Heinz bodies; Reticulocytosis and inc bili in crisis;
G6PD def tx Splenectomy for severe; (txn rarely); avoid stressors (ASA,sulfa, antimal, fava)
Autosomal recessive disorder in which abnormal Hgb leads to chronic hemolysis Sickle cell disorders
In sickle cell dz, rate of sickling depends on: Conc of Hgb S, dehydration, presence of other Hgb (F), hypoxemia & acidosis
Sickle cell prevalence 8% of AA: Hgb S gene; 1/400 AA have SSA; onset in 1st yr (Hgb F falls); 40-50 yr life exp
S/S = Pallor, jaundice, splenomegaly, leg ulcers, pigment gallstones, priapism Sickle cell
2 RBC conditions w/pigment gallstones Hereditary spherocytosis, sickle cell
Sickle cell: vascular occlusion leading to infarction Pulmonary (acute chest syndrome); Retinal (blindness?); Renal (to renal failure ); Stroke, even in kids; Splenic infarcts; aseptic necrosis of femoral head
Sickle cell labs v low hgb (7-10); sickled cells = 5-50% of RBCs; reticulocytosis; NRBCs; Leukocytosis, thrombocytosis, high indirect bili
Sickle cell tx Folic acid 1 mg po qd; hydrate, low alt, vax (flu/pneumo/mening)
SSA longterm issues Splenectomy: infxn probs; narco abuse; Hydroxurea to inc hgb F
Acquired disorder which IgG autoantibody formed that binds to RBC membrane AIHA (autoimmune hemo anemia)
AIHA: ___% are idiopathic; seen in ___ 50% ; lupus, NHL, CLL
AIHA findings Pos coombs test; severe anemia (6-10); high retic & ind bili; spherocytes & NRBC; Evans syndrome (immune thrombocytopenia)
AIHA tx Prednisone 1 mg/kg/d; splenectomy if fail; Rituximab, Danazol, IVIG if fail; avoid txn
Acquired hemolytic anemia due to IgM autoantibody Cold agglutinin dz
Cold agglutinin dz causes Idiopathic or neoplasm or post-infxn (Monoclonal gammopathy, mono, mycoplasma)
Cold agglutinin dz findings Mottled/numb fingers/toes; anemia is rarely severe; mild reticulocytosis; spherocytes; Pos Coombs for complement; Pos cold agglutinin test; Chilled blood will look clumped on slide
Cold agglutinin dz tx Symptomatic, avoid cold; poss Rituximab or immunosupp or plasmapheresis; no splenectomy/steroid
Defn neutropenia PMN <1500 (AA may have 1200 normal)
Absolute Neutrophil count formula WBC x (% segs + % bands) = ANC
Neutropenia findings Stomatitis; fever; poss septicemia, pneumonia and cellulitis
Neutropenia tx DC potl causative agents; tx infxns; poss GF (G-CSF) for severe
Anemia: no hepatosplenomegaly aplastic anemia
Anemia: No neuro S/S Folic acid def
Aplastic anemia S/S No hepatosplenomegaly
Reticulocytosis hemolytic anemias
Neg Coombs hereditary spherocytosis
Pos Coombs AIHA, cold agglutinin
Heinz bodies Hemolytic anemias (G6PD)
Low retic hypoproliferative anemia; B12; PRCA; aplastic anemia
Evans syndrome (immune thrombocytopenia) AIHA
Anagrelide may be used for: P vera; thrombocytosis
Cytoreductive tx (eg, thrombocytosis); Anagrelide, hydroxyurea
Engorged retinal veins P vera; waldenstrom
Created by: Adam Barnard Adam Barnard