Rbc and bleeding disorders

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A bleeding disorder is a condition that affects the way your blood normally clots. What does bone marrow do The clotting process, also known as coagulation, changes blood from a liquid to a solid. Bone marrow donation needle When you’re injured, your blood normally begins to clot to prevent a massive loss of blood. Bone marrow color Sometimes, certain conditions prevent blood from clotting properly, which can result in heavy or prolonged bleeding.

Bleeding disorders can cause abnormal bleeding both outside and inside the body. Stem cell bone marrow transplant Some disorders can drastically increase the amount of blood leaving your body. Bone marrow donor registry Others cause bleeding to occur under the skin or in vital organs, such as the brain.

• Classical RBC’s and platelets, as in in the lab or your office with WRIGHT’s stain.

• Erythroblasts (normoblasts) seen in the marrow and/or the peripheral smear.

• Bone marrow biopsy stained with H&E (left), and smear stained with Giemsa (right). Bone marrow transplant rejection BOTH have special advantages!

• This is a very intense slide, you may have to write a lot of stuff down and listen well!

• The most common reason for a DECREASED M:E ratio with a NORMAL marrow cellularity might be a hemolytic anemia, although a DECREASE in the M cells (myeloid) would also cause this, especially if the cellularity was DE-creased. Salman khan donates bone marrow Please understand this!

• Note lack of a central pallor and a microcytosis, i.e., low MCV

• G6PD converts glucose-6-phosphate into 6-phosphoglucono-?-lactone and is the rate-limiting enzyme of the pentose phosphate pathway.

• Heinz bodies, precipitated hemoglobin are seen quite well on a methylene blue stain.

• At first the spleen may be enlarged (left) because of HYPERPLENISM due to hemolysis, later it may infarct itself due to small vessel occlussive disease and be quite small (right), perhaps only 1/10 its normal size.

• Note the “spiculated” appearance of the outer table of the skull due to extreme erythroid hyperplasia! How is this different from a myeloma skull?

• PIGA makes GPI, defective PIGA makes defective or inadequate GPI. Bone marrow donation center Why does the term hemoglobinuria imply hemolysis? What does “paroxysmal” mean” Ans: Sudden, UN-controllable

• What is the difference between an “agglutinin” and a “hemolysin”? Ans: “-lysis” implies complement fixation

• The Coombs is a routine test used in the workup of just about ALL kinds of hemolytic anemias

• Anemias of diminished erythropoesis. Bone marrow biopsy cpt code Doesn’t this just really boil down to three items?

• Megaloblasts on top, macrocytes on bottom. Blood bone marrow What is the difference between a megaloblast and a macrocyte? What is the difference between a megaloblast and an erythroblast?

• A great diagram of the iron cycle. Bone marrow biopsy by needle aspiration cpt code Know what heme, transferrin, ferritin, and hemosiderin are in the iron cycle

• Relate hypochromia, microcytosis, anisocytosis to the Wintrobe indices: Ans: MCHC, MCV, RDW, respectively

• Golden brown refractile pigment on H&E is HEMOSIDERIN when it stains BLUE by the Prussian Blue method! Any marrow that has stuff staining with Prussian Blue, is NOT an iron deficiency!

• Most are hypochromic (low MCHC), and microcytic (low MCV) like Fe deficiency anemias but have NORMAL iron stores (i.e., hemosiderin).

• Fanconi syndrome and Fanconi anemia are two completely different disorders, but named after the same guy, even though the “syndrome was NOT described by him. Risks for bone marrow donors Fanconi’s Anemia is characterized by short stature, skeletal anomalies, increased incidence of solid tumors and leukemias, bone marrow failure (aplastic anemia), and cellular sensitivity to DNA damaging agents such as mitomycin C. Blood and bone marrow cancer If you understand the cell differentiation concept, why would an aplastic anemia be less likely to involve lymphocytes?

• The NORMAL adult RED bone marrow in the axial skeleton should be about 50% cells and 50% fat. How do you get bone marrow What is this? Perhaps around 90:10?

• What do you think the most serious consequence might be for a person with increased RBCs and platelets?

• Doesn’t this really boil down to TWO things? 1) Reduced platelet function, and 2) everything else?

• At what platelet count level does SPONTANEOUS bleeding generally occur? Ans: 20K Platelets normally 150K-300K

• At what platelet count level does SPONTANEOUS bleeding generally occur? Ans: 20K Platelets normally 150K-300K

• Any thrombocytopenia of increased destruction should have INCREASED megakaryocytes in the marrow! JUST LIKE a hemolytic anemia has an erythroid HYPER-plasia, same principle!

• For all practical purposes, the same as Hemophilia A. What is the function of the red bone marrow How to differentiate? Factor assays! Note the AMAZING similarities between Hemophilia A and B

• What is a “consumptive” coagulopathy? Ans: the platelets and many clotting factors are “consumed”, i.e., used up!

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