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Pathophysiology > 21. Hematologic Alterations > Flashcards

21. Hematologic Alterations Flashcards

1
Q

presence of blasts cells (immature/nonfunctional WBC) on a blood smear

A

leukemia

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2
Q

common clinical manifestations of leukemia

A
  • anemia -> fatigue - bleeding -> skin, gums, MM, GI tract, petechiae, ecchymosis - infection -> fever - weight loss/anorexia - bone pain - liver, spleen, and lymph node enlargement - elevated uric acid levels
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3
Q

most common type of macrocytic anemia and is caused by vitamin B12 deficiency

A

pernicious anemia (PA)

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4
Q

hereditary (AR) factor 9 deficiency; will have prolonged PTT

A

hemophilia B

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5
Q

5 types of normocytic-normochromic anemias

A
  • aplastic - posthemorrhagic - acquired hemolytic - hereditary hemolytic - anemia of chronic inflammation
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6
Q

erythrocytes that contain iron-laden mitochondria (iron granules) arranged in a circle around the nucleus rather than into Hgb

A

ringed sideroblasts

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7
Q

aggressive, fast growing leukemia with too many lymphoblasts (immature WBC) found in the blood and BM

A

acute lymphocytic leukemia (ALL)

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8
Q

cardiac compensatory mechanisms for anemia

A
  • tachycardia - increased stroke volume - capillary dilation
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9
Q

clinical manifestations of SAs

A
  • CV and respiratory manifestations - hemochromatosis (iron overload) - mild-moderate hepatosplenomegaly - bronze-tinted skin may occur
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10
Q

3 phases of CML

A
  • chronic phase (asymptomatic) - accelerated phase (primary sxs develop) - termal blast phase (blast crisis) -> survival of 3-6 months later stages resemble acute leukemia but w/ more prominent and painful splenomegaly
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11
Q

elevated reticulocyte count

A

hemolytic anemia

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12
Q

explain how DIC causes clots

A

massive activation of clotting cascade -> widespread microvascular thrombosis and vascular occlusion -> ischemic tissue damage

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13
Q

anemias that result due to ineffective erythrocyte DNA synthesis -> due to vitamin B12 or folate deficiencies

A

macrocytic (megaloblastic) anemia

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14
Q

old lab test that evaluated B12 absorption by administering radioactive B12 and measuring urine excretion

A

Schilling test

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15
Q

malignant lymphoma that progresses from one group of lymph nodes to another, including systemic symptoms and presence of B cells called Reed-Sternberg (RS) cells

A

Hodgkin lymphoma

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16
Q

reduction in the total number of erythrocytes in circulating blood or a decrease in the quality or quantity of hemoglobin

A

anemia

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17
Q

common causes of anemia

A
  • impaired erythrocyte production - blood loss (acute or chronic) - increased erythrocyte destruction - combo of these 3 factors
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18
Q

ex. of acquired hemolytic anemia

A

improper blood transfusion

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19
Q

symptoms of B cell lymphomas (HL, NHL, can be seen in LL)

A
  • fever - night sweats - weight loss
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20
Q

Dx of SAs

A

confirmed by bone marrow bx and presence of sideroblasts

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21
Q

anemias characterized by erythrocytes that are unusually large in size, thickness, and volume

A

macrocytic (megaloblastic) anemia

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22
Q

anemias characterized by abnormally small erythrocytes that contain abnormally reduced amounts of Hgb

A

microcytic-hypochromic anemias

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23
Q

Normal RBC level

A

4.2-6.1 million cells/mcL

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24
Q

reduction in all cellular components of the blood

A

pancytopenia

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25
Q

most common type of anemia throughout the world; depletion of iron stores and reduced Hgb synthesis

A

iron deficiency anemia

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26
Q

excessive RBC production

A

polycythemia

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27
Q

platelet count less than 150,000 platelets/uL

A

thrombocytopenia

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28
Q

hyperdynamic circulation from increased ECF and SV leads to what cardiac problems

A
  • cardiac murmurs - high-output heart failure
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29
Q

2 causes of IDA

A
  • inadequate dietary intake - chronic blood loss
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30
Q

later stage of CLL where cancer is found in the lymph nodes as well

A

small lymphocyte lymphoma (SLL) or Non-Hodgkins lymphoma

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31
Q

fast-growing B cell tumor that is more common is Africa

A

Burkitt lymphoma

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32
Q

leukemia most commonly seen in children

A

ALL

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33
Q

anemia due to damage to bone marrow erythropoiesis (bone marrow failure)

A

aplastic anemia

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34
Q

lab findings of HH?

A
  • elevations in serum iron levels and ferritin levels (iron in hepatocytes) - decreased TIBC (transferrin is saturated)
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35
Q

clinical manifestations of IDA

A
  • typical anemia symptoms - nails become brittle and “spoon-shaped” - tongue papillae atrophy (soreness/redness/burning) - gastritis - neuromuscular changes (numbness/tingling) - irritability and headache
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36
Q

although the hallmark of HIT is thrombocytopenia, what else are patients at risk for?

A

thrombosis due to activation, aggregation, and consumption of platelets

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37
Q

symptoms of TTP (5)

A
  • extreme thrombocytopenia (<20,000) - intravascular hemolytic anemia - ischemic signs and symptoms (most often in CNS) - kidney failure - fever
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38
Q

Normal hematocrit (Hct) level

A

38-54%

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39
Q

leukocytosis vs leukopenia

A
  • leukocytosis: WBC count is high - leukopenia: WBC count is low
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40
Q

vitamin K is required for synthesis of which clotting factors

A

2, 7, 9, 10, protein C, and protein S

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41
Q

Endemic and sporadic locations of Burkitt lymphoma

A
  • endemic: mandible - sporadic: pelvic/peritoneum
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42
Q

common AR disorder of iron metabolism and is characterized by increased GI iron absorption and tissue deposition

A

hereditary hemochromatosis (HH)

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43
Q

common presentation of MM

A
  • hypercalcemia - renal failure -> secondary to hypercalcemia and Bence Jones proteins - anemia - bone lesions - Bence Jones protein in urine (Ig fragments formed by bone lesions)
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44
Q

Tx for sickle cell crisis

A
  • pain control - O2 - rehydrate (dehydration major cause)
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45
Q

multisystem disorder (defect of ADAMS 13) characterized by thrombotic microangiopathy (TMA) -> platelets aggregate and cause occlusion of arterioles and capillaries within microcirculation -> increased platelet consumption and tissue ischemia

A

thrombotic thrombocytopenic purpura (TTP)

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46
Q

nodal involvement for non-hodgkin lymphoma

A

localized to single axial group of nodes

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47
Q

stem cell disorder w/ hyperplastic and neoplastic BM alterations that causes uncontrolled proliferation of RBCs (normally due to JAK2 mutation)

A

polycythemia vera (PV) or primary polycythemia

48
Q

ex of hereditary hemolytic anemia

A

sickle cell anemia

49
Q

Normal hemoglobin (Hgb) level

A

11.7-14.9 g/dL (lower end in females)

50
Q

physiologic increase in EPO secretion by kidneys in response to underlying systemic disorder (ex. tissue hypoxia)

A

secondary polycythemia

51
Q

explain how DIC causes bleeding

A
  • widespread thrombosis causes consumption of platelets and clotting factors - also causes activation of plasmin and fibrinolysis (try to break up clots) -> lysis of clotting factors and inhibition of platelet aggregation OVERALL: platelets and clotting factors all used up from clots but even if they were available -> clotting system would inhibit further clots from forming to stop potential bleeding
52
Q

4 common symptoms of anemia (due to tissue hypoxia)

A
  • weakness/fatigue - pallor (skin and mucous membranes) - dyspnea on exertion and increased RR - dizziness and syncope
53
Q

symptoms of pernicious anemia

A
  • weakness/fatigue - paresthesias in feet and fingers (neuro manifestations from B12 deficiency) - difficulty walking - loss of appetite/weight loss - sore tongue that is smooth and beefy red
54
Q

immature form of neutrophils; elevated in blood during infection (high production from BM)

A

bands

55
Q

common node involvement in Hodgkin lymphoma

A

multiple peripheral nodes - cervical nodes (usual starting site) - axillary nodes - inguinal nodes

56
Q

clinical manifestations of DIC

A
  • oozing from puncture sites - GI bleeding - weakness/fatigue - cyanosis/hypoxiemia - hematuria/oliguria/renal failure
57
Q

aggressive, fast growing leukemia w/ too many myeloblasts (immature WBC that are not lymphoblasts) found in the blood and BM

A

acute myelogenous leukemia (AML)

58
Q

most common cause of infectious mononucleosis

A

epstein-barr virus (EBV)

59
Q

slow-growing cancer in which too many immature lymphocytes are found mostly in the blood and BM

A

chronic lymphocytic leukemia (CLL)

60
Q

Most cases of pernicious anemia result from what? How does this cause anemia

A
  • autoimmune/chronic gastritis -> destruction of IF -> malabsorption of B12 in ileum - also caused by total/partial gastrectomy
61
Q

progressive clonal expansion of B cells, T cells, or NK cells (mostly B cells)

A

Non-Hodgkin lymphomas

62
Q

heterogenous group of inherited or acquired disorders characterized by anemia of varying severity and presence of ringed sideroblasts in bone marrow

A

sideroblastic anemias (SAs)

63
Q

anemia caused by sudden blood loss w/ normal iron stores

A

posthemorrhagic anemia

64
Q

Normal WBC count

A

5,000-10,000

65
Q

clinical manifestations of PV

A
  • unique feature: aquagenic pruritus (painful itching when exposed to heat or water) - red color in face, hands, feet, ears, and mucous membranes - engorgement of retinal and cerebral veins -> cerebral thrombosis likely - HA, delirium, mania, psychotic depression, chorea, visual disturbances
66
Q

lymphoid progenitors

A

B cells and T cells

67
Q

leukemia caused by BCR-ABL fusion gene derived from reciprocal translocation of chromosomes 9 and 22 (Philadelphia chromosome)

A

CML

68
Q

rare variant of NHL but more common in children; vast majority is of T-cell origin

A

lymphoblastic lymphoma (LL)

69
Q

refers to hemoglobin content

A

-chromic

70
Q

causes of DIC (5)

A
  • trauma - sepsis - cancer - products of conception - injury to endothelium
71
Q

renal compensatory mechanisms for anemia

A
  • RAAS - increased salt and H2O retention - increased extracellular fluid
72
Q

benign, acute, self-limiting, lymphoproliferative syndrome characterized by acute infection of B cells and usually transmitted through saliva

A

infectious mononucleosis (IM)

73
Q

common causes of prolonged PTT

A

Heparin therapy Hemophilia

74
Q

essential (diet dependent) vitamin required for RNA and DNA synthesis in maturing erythrocytes

A

folate (folic acid)

75
Q

Normal PT range

A

10-13 seconds

76
Q

immature RBC released from bone marrow; still have nucleus; should not be too many in blood

A

reticulocyte

77
Q

acquired clinical syndrome characterized by widespread activation of coagulation resulting in formation of fibrin clots in microvasculature throughout body

A

disseminated intravascular coagulation (DIC)

78
Q

EBV is linked to which lymphoma

A

Burkett’s lymphoma

79
Q

Dx for Hodgkin’s lymphoma

A
  • lymph node bx - chest CT/MRI to see extent of nodal involvement
80
Q

On CBC diff, which cells have the 2 highest values?

A
  • neutrophils (highest) - lymphocytes (2nd)
81
Q

leukemia caused by transformed precursor B cells in children and mixture of B cell or T cell precursors in adults

A

ALL

82
Q

molecule produced by split products of fibrin clot degradation

A

D-dimer

83
Q

most common clinical finding in patients w/ CLL

A

lymphadenopathy (most are asymptomatic)

84
Q

myeloid progenitors

A
  • basophils - eosinophils - neutrophils - monocytes - erythrocytes - platelets
85
Q

elevated fibrin degradation products (FDP) and D-dimer are hallmark findings of what?

A

DIC

86
Q

2 types of microcytic-hypochromic anemias

A
  • iron-deficiency anemia (IDA) - sideroblastic anemias (SA)
87
Q

most common cause of thrombocytopenia secondary to increased platelet destruction; usually secondary to infections or other conditions that cause large amounts of antigen in the blood -> immune complex w/ platelets -> destruction

A

immune thrombocytopenic purpura (ITP)

88
Q

hereditary factor 8 deficiency; will have prolonged PTT

A

hemophilia A

89
Q

T/F: pernicious anemia is a fast acting anemia

A

False; develops slowly over time (20-30 years)

90
Q

most common adult leukemia

A

AML

91
Q

lab test for folate deficiency anemia

A

serum folate levels

92
Q

what type of Hgb content is found in macrocytic anemias

A

normal Hgb content (normochromic)

93
Q

PV does what to blood volume, viscosity, and pressure

A

increases all 3

94
Q

TIBC is equivalent to what?

A

transferrin saturation (iron transporter in the blood)

95
Q

classic symptoms of infectious mononucleosis

A
  • pharyngitis - lymphadenopathy - fever - fatigue (may last 1-2 months after infection) - splenomegaly may occur
96
Q

manifestations specific to folate deficiency anemia

A
  • cheilosis (scales/fissures in mouth) - stomatitis (inflammation of mouth) - burning mouth syndrome (painful ulcers in buccal mucosa and tongue) - GI problems: dysphagia, flatulence, and watery diarrhea
97
Q

anemias characterized by erythrocytes that are relatively normal in size and Hgb content but insufficient in number

A

normocytic-normochromic anemias (NNAs)

98
Q

anemia caused by immune destruction of erythrocytes

A

acquired hemolytic anemia

99
Q

lab findings for IDA

A
  • decreased iron levels - increased total iron binding capacity (TIBC) - transferrin is empty
100
Q

most treatable version of lymphoma

A

Hodgkin’s lymphoma

101
Q

plasma cell (B cell) cancer characterized by slow proliferation of malignant cells w/ tumor cell masses in the BM usually resulting in destruction of the bone

A

multiple myeloma (MM)

102
Q

group of bone marrow failure disorders where blood cells in BM don’t mature; precursor to leukemia

A

myelodysplastic disorder (MDS)

103
Q

primary source of vitamin K

A

green leafy vegetables

104
Q

anemia caused by abnormalities of RBC membrane or cytoplasmic contents; present at birth

A

hereditary hemolytic anemia

105
Q

immune mediated, adverse drug reaction caused by IgG antibodies against heparin-platelet factor 4 complex -> platelet activation -> platelet consumption

A

heparin-induced thrombocytopenia (HIT)

106
Q

refers to cell size

A

-cytic

107
Q

measure of the extrinsic clotting pathway

A

prothrombin time (PT)

108
Q

anemia associated with chronic infections, chronic inflammatory diseases, and malignancies

A

anemia of chronic inflammation

109
Q

measure of the intrinsic clotting pathway

A

partial thromboplastin time (PTT)

110
Q

normal platelet (Plt) count

A

150,000-300,000

111
Q

what lab results are seen in PV?

A

increase RBC and total blood volume

112
Q

very early and immature form of WBC; sign of leukemia when increased numbers found on blood smear

A

blast cells

113
Q

current lab test for PA

A

methylmalmonic acid and homocysteine levels

114
Q

slowly progressing disease w/ too many blood cells (not lymphocytes) made in the BM

A

chronic myelogenous leukemia (CML)

115
Q

common cause of prolonged PT

A

Coumadin therapy

116
Q

Normal PTT range

A

30-45 seconds (other references say 25-35 seconds)

Pathophysiology (20 decks)

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