Did I Pass the test?
What do you expect iron studies to be in a patient with IDA? (Serum Iron, Ferritin, TIBC, and Transferrin Sat)
The RBC is ingested by these cells ________ in the ________
macrophages in the spleen
Genetic defects: alpha thalassemia is due to _________ and beta thalassemia is due to a ____________
gene deletion/ point mutation - in both cases globin chains are suppressed
Which AIHA is indicated when there is an IgM antibody (anti-I) against the RBCs?
COLD AIHA
Megaloblastic Anemia is caused by a deficiency of _____ or _____
B12 or Folate
List two tests utilized in testing for hereditary spherocytosis and what those tests mean:
osmotic fragility/ DAT or coombs test
After ingestion, iron is released from heme, bound to _______ and transported to the bone marrow. Some may be stored as ______ or _______.
transferrin/ferritin/hemosiderin
What is hemoglobin Barts? How is it different from Hemoglobin H?
You see them both in alpha thal minor and major. It's not really that different. Barts is in infants due to gamma chains present, H is in adults due to beta chains being present.
Barts is Y4
H is B4
How would penicillin cause a drug-induced AIHA?
Which disorder causes a N/N anemia due to decreased EPO production?
anemia of chronic renal disease
Which microcytic anemia is characterized by an increased RDW due to an increase of total body iron that accumulates in the cytoplasm of the RBC? Why is RDW increased?
sideroblastic anemia/ ringed sideroblasts / dimorphic anemia
Globin is broken down and returns to the amino acid pool. Heme is broken down into ___________. Then (previous answer) is reduced to __________.
Biliverdin/Bilirubin
A patient suffers an acute hemolytic episode after ingesting fava beans. Why?
G6PD def. oxidized hemoglobin accumulates, spleen "bites" cells and cells are lysed. (no GSH protection for the RBC bc without GDPD, NADPH levels are not restored to restore levels of GSH)
What antibody is indicated in PCH? Which antigen is it specific to?
Donath landsteiner antibody against the P antigen
Describe how the presence of a chronic inflammatory disorder can lead to anemia?
Hepcidin = high in inflammation, keeps iron trapped in macrophages
Which tests can differentiate Beta Thal Minor from Beta Thal Major?
Hemoglobin A2 and Hemoglobin F are the top two. RBC count/anemia level can be helpful
List two findings that are only associated with intravascular hemolysis!
Hemoglobinemia and hemoglobinuria (hemosiderinuria)
What is the mutation that leads to Sickle Cell SS AND how do sickle cells get their shape?
A substitution of the amino acid valine for glutamic acid in the β-globin chain. under low oxygen tension the RBC polymerizes and sickles
True or False: DIC, TTP, and HUS will all have schistocytes
TRUE
This microcytic, hypochromic anemia is associated with impaired growth in children. You will see see basophilic stippling on the PB smear.
List and explain the 5 tests we discussed that can be used in testing for Pernicious Anemia
•B12
•MMA (methylmalonic acid)
•IFBAb (intrinsic factor blocking antibody)
•Parietal cell antibody
•Gastrin
What are haptoglobin and hemopexin? How are they used in laboratory testing to determine a patient's hemolysis?
bind to free heme, falling levels indicate intravascular hemolysis
abnormal complement activation, decreased DAF/MIRL, flow testing for CD55/CD59
True or False: Cold AIHA, Warm AIHA, Mixed-Type AIHA, Alloimmune AIHA will all be DAT positive
True
What are the two disorders of heme synthesis that we discussed? Explain the disorders and what clinical symptoms are present.
Porphyria / Hemochromatosis (photosensitivity/ iron overload)