10 Hematology 2 Flashcards

0
Q

Acquired platelet dysfunction

A

D/t Aspirin, NSAIDs, systemic disorders (HIV, hep c)

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1
Q

Causes of thrombocytopenia

A

Failure of production, increase sequestration/destruction/dilution, quinine, drugs, liver dz, DIC, pregnancy, ITP, HIV, blood transfusion, ARDS, gram neg species

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2
Q

Hereditary intrinsic platelet disorder

A

Rare autosomal recessive
Glanzmann’s thrombasthenia and Bernard-Soulier syndrome

Dx: platelet aggreg test

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3
Q

Idiopathic thrombocytopenia purpura

A

Autoimmune, increased platelet destruction. Children (acute and self limited) and >60 yrs (chronic)
Causes: HIV, hep c, CMV, drugs, idiopathic

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4
Q

Petechaie, mucosal bleeding DDx

A

Vasculitis purpura, hemophilia, thrombocytopenia

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5
Q

Thrombotic thrombocytopenic purpura

A

Can’t break down vWF…increase platelet aggregation

Classic pentad: RBC fragmentation, thrombocytopenia, fever, transient hemolytic deficits, kidney failure

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6
Q

Von Willebrands disease

A

Autosomal dominant. Mild skin/mucosal bleeding, easy bruising, menorrhagia
Suspect if family hx
Definitive dx: plasma vwf antigen, vwf activity, factor 8

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7
Q

Acquired causes of risk to thrombosis

A

Heparin, anti-phospholipid antibodies, hyperhomocystinemia, stasis, CHF, pregnancy, obesity, trauma, sepsis, estrogen/oral contraceptives, smoking

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8
Q

Factor V Leiden mutation

A

5% prevalence in Europeans. Present in 20-60% of pts w spontaneous thrombosis

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9
Q

Protein C / S deficiency

A

Venous and/or arterial embolism, warfarin induced skin necrosis
May be acquired, w liver dz, chemo, DIC, warfarin

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10
Q

Hyperhomocystinemia

A

Genetic cause of risk for thromboembolism

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11
Q

Disseminated intravascular coagulation

A

Excess clotting, excess bleeding.
D/t abortion, retained dead fetus, infection, malignancy, shock/burns, severe diseases
Persistent bleeding, ecchymoses, GI bleeding
Dx: D-dimer

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12
Q

Hemophilias

A

Commonly factor VIII (A) or IX (B) deficient [<5% clotting factors]
Serious hemorrhage from minor injuries, hemarthrosis diagnostic, hematuria, bruising

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13
Q

Amyloidosis

A

Deposition of protein in vessels, increasing vascular fragility. Perioribital purpura or purpuric rash

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14
Q

Cryoglobulinemia

A

Causes small vessel vasculitis and purpura

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15
Q

Hypergammaglobulinemic purpura

A

Assoc w autoimmune, SLE; vascular purpura esp lower legs

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16
Q

Hyperviscosity syndrome

A

Very high IgM, seen in waldentroms macroglobulinemia

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17
Q

Hereditary hemorrhagic telangiectasia

A

Arteriovenous malformations. On face, lips, oral/nasal mucosa, phalanges

18
Q

Purpura simplex

A

Common! Easy bruising dt vascular fragility

D/t deficiency in flavonoids?

19
Q

Senile purpura

A

Dark ecchymoses, forearms and hands. Skin thin and atrophic

20
Q

Idiopathic hypereosinophilic syndrome

A

Eosinophils infiltrate organs and destroy stuff.

Dx: CBC w peripheral smear, B12 levels, IgG, IgE. EKG.

21
Q

Langerhan’s Cell Histiocytosis

A

Proliferative dendritic cells invade 1+organs. Eosinophilic granuloma (bone pain, swelling), Hand-Schuller-Christian dz, Letterer-Siwe dz
Dx: biopsy–Langerhan’s cells, radiograph–sharply demarcated bome lesions

22
Q

Essential thrombocythemia

A

Increased platelet count, megakaryocyte hyperplasia, hemorrhagic/thrombotic tendency
Sxs: weakness, HA, parasthesias of hands/feet, mild bleeding, digital ischemia (raynauds) splenomegaly, erythromelalgia, thrombosis

23
Q

Erythromelalgia

A

Erythematous burning hands (after exposed to warm)

24
Myelofibrosis
-->loss of hematopoietic cells, extramedullary hematopoiesis (liver, spleen) Usu primary from neoplastic changes in marrow stem cells Or secondary--malignancies, infections, toxins, autoimmune Sxs: anemia, hepatomegaly/ splenomegaly, leukemia (10%), weight loss, malaise, fever
25
Polycythemia Vera
Chronic, myeloproliferative disorder, increase RBC mass (independent of EPO) Sxs: increased blood vol, pruritis after warm bath, ruddy cyanosis, erythromelalgia, hepatomegaly, splenomegaly, bleeding/bruising/thrombosis Definitive Dx: elevation of all 3 peripheral blood cells, splenomegaly, no cause for secondary erythrocytosis
26
Other causes of erythrocytosis
Hypoxia, smoking, rumors, testosterone, lung dz, high altitude, diuretics, dehydration
27
Acute myeloid leukemia
May be secondary after chemo/radiation, BM replaced w blast cells
28
Acute lymphoid leukemia
Children <10yrs. Most common pediatric cancer. Look toxic. Fever longer than a week...red flag
29
Acute leukemias
Ssxs: anemia, infection, easy bruising, bleeding, pallor, fatigue, fever, wt loss, bone pain May see LAD, splenomegaly, hepatomegaly
30
Chronic leukemias
Abnormal leukocytosis w or wo cytopenia in otherwise asx person.
31
Chronic lymphoid leukemia
Lymphocytes accumulate in marrow then spread to lymph nodes and lymphoid tissue Malignant transformation of B cells Ssxs: insidious, weakness, fatigue, wt loss, fever, night sweats, hepatosplenomegaly, LAD Hallmark: lymphocytosis peripherally and in BM
32
Chronic myeloid leukemia
Median age 45-55 Platelets can be high Ssxs: fatigue, anorexia, wt loss, minor LAD, night sweats, ab fullness, bleeding problems, blast crisis where blast cell tumors develop Dx: Philadelphia chromosome
33
CML DDX
Leukemoid reactions from infection, myelofibrosis
34
Myelodysplastic syndrome
Pre-leukemic. Somatic mutation of hematopoietic precursors Ssxs: pallor, weakness, fatigue, fever, infxns, bleeding, exercise intolerance, angina, dizziness Dx: peripheral smear and BM, macrocytic anemia w high RDW
35
Hodgkin lymphoma
Idiopathic. May be genetic, toxins, EBV, smoking, immunosuppression *past infection w varicella, MMR, pertussis negatively assoc w development Ssxs: painless cervical LAD, pain w alcohol, pruritis. Night sweats, fever, wt loss, nodular LNs. Pancytopenia, paraplegia, Horner's Dx: Reed Sternberg cells
36
Non-Hodgkin Lymphomas
Ssxs: peripheral LAD, anemia, result of compression of organs by big LNs Aggressive--rapid growing LNs, fever, night sweats, wt loss, uric acid/gout Indolent--slow growing LNs, cytopenia, hepatosplenomegaly Dx: destruction of LN architecture and invasion of capsule, mediastinal LA on CXR
37
Big lymph nodes DDX
Non-Hodgkin lymphomas, infectious mono, toxoplasmosis, CMV, leukemia, sarcoidosis, lung CA, TB
38
Burkitt's Lymphoma
Highly undiff B cell lymphoma, areas outside LNs. Mostly seen in central Africa related to EBV Most rapidly growing human tumor
39
Mycosis Fungoides
Rare T cell tumor that affects skin, may spread to internal organs Insidious itchy plaque. Usu >50yrs
40
Waldenstrom's Macroglobulinemia
B cells --> excess IgM Ssxs: hyperviscosity*, circ impairment, fatigue, weakness, wt loss, bleeding of skin/mucosa, visual impairment, HA, peripheral neuropathy, Raynauds, LAD, heart problems Dx: incidentally w protein electrophoresis, elevated serum plasma viscosity
41
Multiple myeloma
Tumors-->excess IgG, IgA. Bence Jones proteins Ssxs: bone pain, wt loss, fatigue, recurrent infxns, renal failure, pathological fractures, anemia Dx: CBC, ESR, CMP, CRP. "M Spike". X rays--punched out bone lesions **progressive and fatal
42
Primary hemochromatosis
Excess iron absorption by hepcidin-->tissue damage. Ssxs: fatigue, weakness, bronzed skin, hypergonadism, liver cirrhosis, DM Dx: test iron, gene assay, liver bx Tx: phlebotomy
43
Secondary iron overload
Causes: thalassemias or sideroblastic anemias, exogenous iron, massive transfusions, liver dz