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Hematology – ABIM
Blood smear
| Question | Answer |
|---|---|
| What type cells of in iron deficiency? | Target cells and teardrop cells |
| What cells do you see after a splenectomy? | Target cell and Howell jolly bodies (DNA fragments) |
| What cells do you see in liver disease? | Target cells, spur cells, Heinz bodies (hemoglobin fragments) |
| What cells do you see in myelofibrosis? | Teardrop self, howell jolly bodies (DNA fragments), teardrop cells |
| What diseases are suggested by spherocytes? | Increased osmotic fragility in diseases such as hereditary spherocytosis and autoimmune hemolytic anemia |
| What diseases are suggested by schistocytes? | Mechanical trauma to the red blood cells by artificial heart valves, DIC, HUS/TTP. |
| What disease do you think of when you see burr cells? | Uremia (anemia of uremia) |
| What diseases when you see spur cells? | Liver disease, can't absorb dietary fats |
| What disease when you see bite cells? | G6 PD |
| What diseases when you see howell jolly bodies ( DNA fragments)? | MDS, sickle cell anemia, celiac, splenectomy. The presence of a Howell-Jolly body indicates a previous splenectomy or a functionally asplenic state such as sickle cell disease. |
| What disease when you see Heinz bodies (hemoglobin fragments)? | G6 PD, chronic liver disease, Alpha thalassemia |
| what should you see on blood smear when you have G6 PD? | Heinz bodies (hemoglobin fragments), and bite cells |
| What diseases when you see basophilic stippling? | Lead poisoning and myelofibrosis. myelodysplastic syndrome, be idiopathic, or occur in the context of alcoholism, copper deficiency or lead toxicity, or the use of certain drugs (such as linezolid, isoniazid). |
| What diseases when you see teardrop selves? | myelofibrosis, iron deficiency, beta thalassemia major |
| rouleaux formation | multiple myeloma will cause rouleaux formation, or stacking of the erythrocytes. This “stacked-coin” appearance of the erythrocytes can be seen in any condition associated with increased plasma proteins, including polyclonal or monoclonal gammopathies. |
| Anticoagulation strategies for pregnant women with a mechanical valve prosthesis include... | - dose-adjusted unfractionated heparin - dose-adjusted low-molecular-weight heparin |
| Risks of warfarin for pregnant women | lesser risk of maternal thromboembolism than LMWH but a greater risk of fetal embryopathy. Warfarin is avoided during pregnancy because it crosses the placenta, causes fetal anticoagulation throughout the pregnancy, and is a teratogen. |
| anticoagulant treatment of choice around the time of delivery for a pregnant patient | Intravenous UFH. The dose effect must be measured by activated partial thromboplastin time and the dose adjusted to a therapeutic level. Fixed-dose subcutaneous UFH may not provide adequate anticoagulation. |
| How to dose LMWH in pregnancy | LMWH dose must be adjusted to antiâfactor Xa activity in order to provide adequate anticoagulation |
| Anticoagulant to use with the patient who is breast-feeding and has a mechanical heart valve | Warfarin (not excreted in breast milk) or low molecular weight heparin (minimally excreted in breast milk). Should not use fondaparinux has been demonstrated to be excreted in the milk of lactating rats, so should not use while breast-feeding. |
Created by:
christinapham
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