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Slackers Guide to Blood and Urine

Slackers Guide to Blood and Urine. Mike Ori. Disclaimer. These represent my understanding of the subject and have not been vetted or reviewed by faculty. Use at your own peril. I can’t type so below are common missing letters you may need to supply e r l

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Slackers Guide to Blood and Urine

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  1. Slackers Guide to Blood and Urine Mike Ori

  2. Disclaimer • These represent my understanding of the subject and have not been vetted or reviewed by faculty. Use at your own peril. • I can’t type so below are common missing letters you may need to supply • e r l • I didn’t use greek letters because they are a pain to cut and paste in.

  3. List the conceptual classifications of anemia

  4. Production • Destruction (hemolysis) • Loss (bleeding)

  5. What is haptoglobin and what does a decrease in levels imply

  6. A serum protein that binds free hemoglobin. Decrease is typically due excess hemoglobin in the blood as would be found in hemolytic anemia

  7. What are the two categories of hemolytic anemia

  8. Intrinsic • An issue with the RBC itself such as structural defects, enzyme defects, hemoglobin synthesis • Extrinsic • A problem that arises external to the RBC but that impacts its integrity. • Antibodies • Mechanical damage

  9. Differentiate the morphology of target cells, spherocytes, and schistocytes

  10. Target cells are RBC’s with a small peak in the center of the central pallor • Spherocytes are RBC’s that have lost cell membrane and thus loose their biconcave disk structure and its associated central pallor • Schistocytes are RBC’s that have been fragmented

  11. Distinguish heinz bodies, bite cells

  12. Heinz bodies are condensations of hemoglobin

  13. Describe hereditary spherocytosis

  14. A disease of the spectrin substructure of RBC membranes due to mutations in ankyrin or spectrin itself. • Splenomegaly • Hemolytic anemia • Reticulocytosis

  15. Describe Glucose-6-phosphate dehydrogenase deficiency’s impact on RBC’s

  16. Recall that G6PDH is important for oxidative repair of tissues. G6PDH defects occur in which the enzyme is labile as opposed to absent. In nucleated tissues, the enzyme is replaced but in the RBC it cannot be replaced. Therefore, enzyme concentration decreases more rapidly than in in wild-type individuals leading to more rapid accumulation of oxidative damage and premature RBC failure. • Hemolysis occurs after an oxidative stress such as during illness or with fava bean ingestion

  17. Describe sickle cell disease

  18. Sickle cell disease occurs due to a single protein substitution in the beta globin chain. This mutation causes the affected B chains to polymerizes under oxidative stress. This leads to cell damage and the characteristic sickled shape. Membrane damage leads to shortened half-life. • Sickle cell trait = heterozygous • Sickle cell disease = homozygous

  19. List the crisis types that can occur with sickle cell disease

  20. Painful – due to occlusion of the microvasculature. Autosplenectomy and priapism • Aplastic – sudden drop in RBC’s due to loss of RBC production as occurs with parvovirus infection in the marrow • Sequestration – sludging in the spleen leads to accumulation of RBC’s

  21. Why is sickle cell disease not typically apparent until late infancy?

  22. Fetal hemoglobin production continues to occur giving a2g2 hemoglobin that is not susceptible to sickling. After about 6 months, a2B2 production increases and a2g2 decreases.

  23. What is are cold and warm antibodies?

  24. Cold antibodies are those that are active at temperatures less than that of the body. In contrast, warm antibodies are active at body temperature. IgG is typically a warm antibody while IgM is typically cold

  25. Why do you care about cold and warm antibodies?

  26. Cold antibodies typically do not cause severe hemolytic disease while warm antibodies can.

  27. Distinguish megaloblastic from microcytic

  28. Megaloblastic = MCV > 100 fl • Microcytic = MCV < 75 fl

  29. Define Reticulocyte distribution width

  30. A number expressing the range in sizes of RBC’s found in a CBC. Megaloblastic, microcytic, schistocytes, spherocytes, reticulocytes all affect the RDW.

  31. Define reticulocyte index

  32. Measures the number of reticulocytes in blood corrected for HCT values and for maturation. Values > 2 indicate normal marrow response in anemia.

  33. Distinguish anemias seen in chronic disease and in the following deficiencies: B12, Folate, Iron

  34. B12 and folate deficiency cause a normochromicmegaloblastic anemia. • B12 • Neurologic defects • Methylmalonic acid in urine • Folate • No neuro deficits • FIGlu in urine • Iron deficiency causes a microcytic hypochromic anemia • Increased Total iron binding capacity (TIBC) • Decreased transferrin saturation • Decreased serum iron • Decreased stores (ferritin?) • Anemia of chronic disease produces a normochromicnormocytic anemia in response to increased IL-1, TNF-a, and IFN-g caused by chronic disease processes. • Normocyticnormochromic to mild microcytic microchromic anemia • Decreased TIBC • Low serum iron • Normal stores (ferritin?)

  35. Discriminate the causes of B12 deficiency

  36. Inadequate amounts in diet • Achloridia (failure to be freed in stomach) • Lack of intrinsic factor (gastric parietal cells) • Exocrine pancreas deficiency • Ileal disease (leading to decreased absorption) • In contrast to folate the body stores up to 5 years of B12

  37. Describe aplastic anemia

  38. Pancytopenia due to failure of the marrow. • Most cases (65%) are idiopathic but any of the following are known causes • Viruses • Idiosyncratic drug reactions • Chloramphenicol • Pesticides • Nuclear war • Try slipping this one to the attending • Radiation • Presumably from sources other than warheads • Fanconi’s anemia • Microscopically the marrow will by hypocellular with fat infiltration

  39. Define red cell aplasia

  40. Failure of the marrow to produce only RBC’s. • Primary = idiopathic • Secondary • Parvovirus • Chronic kidney disease with decreased EPO

  41. What are the clinical manifestations of anemia

  42. Acute • Anxiety and agitation • Headaches • Resting or orthostatic hypertension • Light headedness • Syncope • Diaphoresis • Systolic flow murmur (why?) • Both • Pallor • Jaundice • Tachycardia, palpitations • Dyspnea

  43. List the blood transfusion products

  44. Children dose at 10ml/kg

  45. List the common transfusion reactions

  46. Febrile • /\ T > 1C • Allergic • Hives, itching, etc • Hemolytic • Premature destruction of RBC’s • Bacterial contamination • Especially platelets which are stored at room temp • Transfusion Related Acute Lung Injury • Respiratory failure • Fluid overload

  47. What are the two types of hemostasis

  48. Primary • Platelet aggregation • Early staunching of flow • Secondary • Activation of coagulation cascade • Intrinsic, extrinsic, and common pathway

  49. List the common coagulation tests

  50. Prothrombin Time (PT) • Extrinsic pathway and common pathway • Activated Partial Thromboplastin Time (aPTT) • Intrinsic pathway and common pathway • D-Dimer • Fibrin split product specific for clots • Fibrin degradation products are less specific • Mixing studies • Indicate whether a factor is missing or whether an inhibitor is present

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