Shared Flashcard Set

Details

Hematology Internship Section 2
Part A: Mini Cases to Complete
62
Biology
Undergraduate 4
10/05/2015
Click here to study/print these flashcards.

Create your own flash cards! Sign up here.

Additional Biology Flashcards

 

 

Cards

Term
Case 1:
A 75 year old male admitted to the hospital with abdominal pain, pallor, and tachycardia. he had been having very dark stools for a long time.
RBC - 3.6 x 10^6 / microliter
HB - 7.5 g/dL
Hct - 25%

Calculate the MCV
 Definition
69.4 fL
Term
Case 1:
A 75 year old male admitted to the hospital with abdominal pain, pallor, and tachycardia. he had been having very dark stools for a long time.
RBC - 3.6 x 10^6 / microliter
HB - 7.5 g/dL
Hct - 25%

Calculate the MCH
 Definition
20.8 pg
Term
Case 1:
A 75 year old male admitted to the hospital with abdominal pain, pallor, and tachycardia. he had been having very dark stools for a long time.
RBC - 3.6 x 10^6 / microliter
HB - 7.5 g/dL
Hct - 25%

Calculate the MCHC
 Definition
30.6%
Term
Case 1:
A 75 year old male admitted to the hospital with abdominal pain, pallor, and tachycardia. he had been having very dark stools for a long time.
RBC - 3.6 x 10^6 / microliter
HB - 7.5 g/dL
Hct - 25%

State the Expected RBC Morphology
 Definition
Hypochromic, Microcytic
Term
Case 1:
A 75 year old male admitted to the hospital with abdominal pain, pallor, and tachycardia. he had been having very dark stools for a long time.
RBC - 3.6 x 10^6 / microliter
HB - 7.5 g/dL
Hct - 25%
Serum Fe - 20 micrograms/dL
TIBC - 450 micrograms/dL
Ferritin - 8 nanograms/mL

What is likely the cause of the anemia?
 Definition
Iron Deficiency
Term
Case 1:
A 75 year old male admitted to the hospital with abdominal pain, pallor, and tachycardia. he had been having very dark stools for a long time.
RBC - 3.6 x 10^6 / microliter
HB - 7.5 g/dL
Hct - 25%
Serum Fe - 20 micrograms/dL
TIBC - 450 micrograms/dL
Ferritin - 8 nanograms/mL

Would you expect the retic to be high, low, or normal?
 Definition
Low or Normal
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

Calculate the MCV
 Definition
9.6 fL
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

Calculate the MCH
 Definition
32 pg
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

Calculate the MCHC
 Definition
33.3%
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

What is the Expected RBC Morphology?
 Definition
Normocytic / Normochromic
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

The bone marrow shoes 10% cellularity with mostly reticulum cells, lymphocytes, and plasma cells.

What type of anemia is present?
 Definition
Aplastic
--Probably due to field chemicals
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

There were 20 cells with blue-green particles in ten fields in the new methylene blue slide.

Calculate the Uncorrected Retic %
 Definition
2%
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

There were 20 cells with blue-green particles in ten fields in the new methylene blue slide.

Calculate the Corrected Retic %
 Definition
1.1%
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

There were 20 cells with blue-green particles in ten fields in the new methylene blue slide.

Calculate the Absolute number of retics
 Definition
50,000 / microliter
(2% x 2.5 x 10^6 / microliter)
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

There were 20 cells with blue-green particles in ten fields in the new methylene blue slide.

Calculate the RPI
 Definition
0.55
(1.1/2)
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

Does this patient have an adequate reticulocyte response for his hemoglobin?
 Definition
No, for this low of a hematocrit, the retic # should be increased
Term
Case 2:
A 52 year-old farmer was seen by his doctor for malaise, pallor, and ease of bruising.
WBC - 2100 microliter
RBC - 2.5 x 10^6 / microliter
Hgb - 8.0 g/dL
Hct - 25%
Plt - 40,000 microliter

Is this what you would expect for this type of anemia?
 Definition
Yes, Aplastic anemia usually has a low retic #
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

What is the cause of the anemia?
 Definition
Folate Deficiency
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

Explain the WBC and Plt values
 Definition
Folate deficiency affects all 3 cell lines producing pancytopenia
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

What is the expected RBC morphology based on the calculated indices?
 Definition
Macrocytic
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

What is the term for all cell lines being decreased?
 Definition
Pancytopenia
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

Describe how the bone marrow would probably look
 Definition
Megaloblastic - large basophilic RBC precursors;
Asynchrony;
Loose Chromatin and Nucleus NOT maturing;
Hypercellular;
Giant Metas & Bands
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

The retic was 1.0%.

Is this what you would expect for this patient?
 Definition
Yes, megaloblastic anemia presents with lower than normal retic #s
Term
Case 3:
A 28-year-old homeless pregnant woman is in the ER in labor. She had no prenatal care.
WBC - 4,100 microliter
RBC - 2.3 x 10^6 / microliter
Hgb - 9.0 g/dL
Hct - 25%
Plt - 140,000
WBC Morphology: 10 granulocytes have 6 or 7 lobes
B12 - 580 pg/mL
Folate - 1.8 ng/mL

The retic was 1.0%.

How would you retic change after therapy?
 Definition
After therapy, the retic # would be vastly increased
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

What does a negative DAT rule out?
 Definition
AIHA
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

An osmotic fragility was performed and the child's cells began to lyse at 0.70% saline. What is the diagnosis?
 Definition
Hereditary spherocytosis
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Why is the child only mildly anemic, if at all?
 Definition
BM is keeping up - Anemia is compensated
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Explain the LD
 Definition
LD & Bilirubin are often Increased in hemolytic anemia. RBCs have a higher concentration of LD & releases it when they burst.
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

What would you expect the retic % to be?
 Definition
Vastly Increased
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Are the indices Abnormal?
 Definition
MCHC is Abnormal (Increased)
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Are the indices Correct?
 Definition
Yes, they are correct.
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Calculate the MCH
 Definition
33.7 pg
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Calculate the MCHC
 Definition
38.1%
Term
Case 5:
A 4-year-old child named March Christianson was admitted to the hospital for a broken leg. He had no other symptoms.
RBC - 5.5 x 10^6 / microliter
Hgb - 11.0 g/dL
Hct - 36.0%
RBC Morphology - Marked microcytosis, hypochromasia; Marked target cells and moderate basophilic stippling. All other lab results normal.

Is this child anemic?
 Definition
No, not for a 4-year-old
Term
Case 5:
A 4-year-old child named March Christianson was admitted to the hospital for a broken leg. He had no other symptoms.
RBC - 5.5 x 10^6 / microliter
Hgb - 11.0 g/dL
Hct - 36.0%
RBC Morphology - Marked microcytosis, hypochromasia; Marked target cells and moderate basophilic stippling. All other lab results normal.

Given the indices and morphology, list 3 conditions which would have to be considered in the differential diagnosis
 Definition
Iron Deficiency, Lead Poisoning, Thalassemia Trait
Term
Case 5:
A 4-year-old child named March Christianson was admitted to the hospital for a broken leg. He had no other symptoms.
RBC - 5.5 x 10^6 / microliter
Hgb - 11.0 g/dL
Hct - 36.0%
RBC Morphology - Marked microcytosis, hypochromasia; Marked target cells and moderate basophilic stippling. All other lab results normal.

Serum Fe, TICB, & Ferritin were all normal. There was no indication of exposure to old pain.

What is the most likely diagnosis?
 Definition
Thalassemia Trait
Term
Case 5:
A 4-year-old child named March Christianson was admitted to the hospital for a broken leg. He had no other symptoms.
RBC - 5.5 x 10^6 / microliter
Hgb - 11.0 g/dL
Hct - 36.0%
RBC Morphology - Marked microcytosis, hypochromasia; Marked target cells and moderate basophilic stippling. All other lab results normal.

What test would be most useful in confirming the diagnosis?
 Definition
Hemoglobin Electrophoresis
--Quantitating A2 & F Hgb
Term
Case 5:
A 4-year-old child named March Christianson was admitted to the hospital for a broken leg. He had no other symptoms.
RBC - 5.5 x 10^6 / microliter
Hgb - 11.0 g/dL
Hct - 36.0%
RBC Morphology - Marked microcytosis, hypochromasia; Marked target cells and moderate basophilic stippling. All other lab results normal.

What is the most likely ethnic background on this child?
 Definition
Mediterranean, Asian, or Black
Term
Case 6: List the most likely anemia along with the main reason for the assumption.

Patient - 65 year old with rheumatoid arthritis
Hgb - 11.3 g/dL
Hct - 36%
RBC 4.60 x 10^6 / microliter
Other tests: Decreased Serum Iron, Decreased TIBC, Increased Ferritin

Calculate the Indices - MCV
 Definition
78.2 fL
Term
Case 6: List the most likely anemia along with the main reason for the assumption.

Patient - 65 year old with rheumatoid arthritis
Hgb - 11.3 g/dL
Hct - 36%
RBC 4.60 x 10^6 / microliter
Other tests: Decreased Serum Iron, Decreased TIBC, Increased Ferritin

Calculate the Indices - MCH
 Definition
24.6 pg
Term
Case 6: List the most likely anemia along with the main reason for the assumption.

Patient - 65 year old with rheumatoid arthritis
Hgb - 11.3 g/dL
Hct - 36%
RBC 4.60 x 10^6 / microliter
Other tests: Decreased Serum Iron, Decreased TIBC, Increased Ferritin

Calculate the Indices - MCHC
 Definition
31.4%
Term
Case 6: List the most likely anemia along with the main reason for the assumption.

Patient - 65 year old with rheumatoid arthritis
Hgb - 11.3 g/dL
Hct - 36%
RBC 4.60 x 10^6 / microliter
Other tests: Decreased Serum Iron, Decreased TIBC, Increased Ferritin

Name the Type of Anemia
 Definition
Anemia of Chronic Disease or Inflammation
Term
Case 6: List the most likely anemia along with the main reason for the assumption.

Patient - 65 year old with rheumatoid arthritis
Hgb - 11.3 g/dL
Hct - 36%
RBC 4.60 x 10^6 / microliter
Other tests: Decreased Serum Iron, Decreased TIBC, Increased Ferritin

Name the Reason for the Anemia
 Definition
Older adult with mild hypochromatic microcytic anemia, Decreased Iron, Decreased TIBC, with Increased Iron Stores
Term
Case 7:
Patient - Life Long Vegetarian (no dairy either) with "stomach problems" and tingling extremities.
MCV - 120 fL
RBC Morphology - Macro-ovalocytes
WBC Morphology - Hypersegmented Neutrophils
Folate: Normal
B12: Decreased
Schilling Test: Normal

What is the type of Anemia
 Definition
Vitamin B12 Deficiency
Term
Case 7:
Patient - Life Long Vegetarian (no dairy either) with "stomach problems" and tingling extremities.
MCV - 120 fL
RBC Morphology - Macro-ovalocytes
WBC Morphology - Hypersegmented Neutrophils
Folate: Normal
B12: Decreased
Schilling Test: Normal

What is the cause of the anemia
 Definition
Related to his/her diet
Term
Case 8:
Patient - Child with abdominal pain and poor mental development.
RBC Morphology: Dimorphic cells with coarse basophilic stippling
MCV: 78 fL
Urine contains elevated porphyrins.

What type of anemia is present?
 Definition
Lead Poisoning
Term
Case 9:
Patient - Moderate anemia in person of SE Asian origin had target cells and the following electrophoresis:
Cellulose acetate - heavy band only at C
Citrate - Heavy band only at A

What type of anemia is present?
 Definition
Hgb E Disease
Term
Case 10:
Patient - Child with slight jaundice. Positive family history for anemia.
RBC Morphology - Marked ovalocytes
Other tests - Osmotic fragility began lysis at 0.70%; complete lysis at 0.50% salt.

What type of anemia is present?
 Definition
Hereditary Ovalocytosis
Term
Case 11:
Patient - Asian person with moderate hypochromic, microcytic anemia.
Elevated Barts's hemoglobin on electrophoresis as well as H Hemoglobin.

What type of anemia is present?
 Definition
Hgb H Disease
Term
Case 12:
Patient - Young woman with SLE (Lupus)
MCV: 90 fL
RBC Morphology - Moderate polychromasia and slight Spherocytes
Other tests: Retics 5.5%; DAT +

What type of anemia is present?
 Definition
AIHA
Term
Case 13:
Jaundiced older patient with the following:
MCV - 104 fL
Retic - 1%
Morphology - Slight Macrocytosis with many Target cells
Liver enzymes: Abnormal

What type of anemia is present?
 Definition
Liver Disease
Term
Case 14:
Black male developed anemia following prophylactic treatment for malaria.
Hgb - 8.0 g/dL
Hct - 24%
RBC - 2.50 x 10^6 / microliter
Retic - 8%
Bilirubin - Increased
Osmotic fragility - Began lysis at 0.55%; Complete lysis at 0.35% salt
Supravital stain: Round inclusions at periphery of RBCs

What type of anemia is present?
 Definition
G6PD Deficiency
Term
Case 15:
Health adult of Greek origin
Hgb - 12.0 g/dL
Hct - 39%
RBC - 5.80 x 10^6 / microliter
Iron Studies - All normal
Kleihauer Stain: 8% of cells were dark pink
There were many target cells and basophilic stippling

What type of anemia is present?
 Definition
Thalassemia Trait
Term
{image:|}
 Definition
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Smith
[image]
 Definition
Sickle Trait
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Williams
[image]
 Definition
Infant with hemoglobin C Disease
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Phan
[image]
 Definition
Hgb E Trait
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Phillips
[image]
 Definition
Normal Adult
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Tontini
[image]
 Definition
B Thalassemia Trait
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Clark
[image]
 Definition
Normal Infant
Term
Match the following cellulose acetate hemoglobin (pH 8.6) electrophoresis patterns:
Richards
[image]
 Definition
Hgb SC Disease
Term
Case 4:
A 5-year-old boy, with no evidence of bleeding, had jaundice and a tender, distended abdomen. His older brother has similar but milder symptoms.
RBC - 3.5 x 10^6 / microliter
Hgb - 11.8 g/dL
Hct - 31%
RBC Morphology - Marked Spherocytes, Marked Polychormasia
T. Bili: 5.9 mg/dL
D. Bili: 0.8 mg/dL
LD: 1500 U/L

Explain the Bilirubin
 Definition
LD & Bilirubin are often Increased in hemolytic anemia. Bilirubin is a breakdown product of Hgb so Indirect bilirubin goes up when there is hemolysis.
Supporting users have an ad free experience!