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Blood, Cancer and Palliation > BCP Weeks 1 and 2 > Flashcards

BCP Weeks 1 and 2 Flashcards

1
Q

Hematocrit constitutes what % of whole blood?

A

Hematocrit:

  • 40 - 50% in males
  • 36 - 44% in females
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2
Q

What makes up the “buffy coat?”

A

Leukocytes and platelets (

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3
Q

How much blood does an average person have?

A

~ 5L (7% of body weight)

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4
Q

Where does hematopoiesis take place?

A
  • In the bone marrow

- In lymphoid tissues (tonsils, peyer’s patches, thymus, etc.)

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5
Q

Where does hematopoiesis take place in the fetus?

A
  • first in the yolk sac
  • then the liver and spleen
  • late in development in the bone marrow
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6
Q

What do mature red blood cells lack in addition to nuclei?

A

Mitochondria and other organelles

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7
Q

What is the approximate life span of a red blood cell in circulation?

A

120 days

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8
Q

Where are red blood cells broken down?

A
  • Liver
  • Spleen
  • Macrophages
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9
Q

Type of anemia resulting from a hereditary hemoglobin deficiency:

A

Thalassemia

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10
Q

Universal red cell donor:

A

Type O negative

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11
Q

Universal plasma/platelet donor:

A

Type AB

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12
Q

What is the function of neutrophilic granules?

A

Specialized lysosomes to destroy invaders

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13
Q

How do lymphocytes appear under a microscope?

A

Single, dark nucleus with little cytoplasm

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14
Q

What % of leukocytes are lymphocytes?

A

~ 30% (20 - 40)

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15
Q

True or false: like red blood cells, platelets do not contain mitochondria and other organelles.

A

False. Platelets lack nuclei but contain mitochondria, ribosomes and other organelles

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16
Q

What is the average life span of platelets?

A

5 - 10 days

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17
Q

What is Jak/STAT signaling involved in?

A
  • Leukopoiesis

- Thrombopoiesis

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18
Q

The presence of a Reed-Sterberg cell indicates what type of cancer?

A

Hodgkin’s Lymphoma

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19
Q

What does a Reed-Sterberg cell look like under a microscope?

A

A large, eosin staining, multi-nucleated (owl’s eye nuclei) cell

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20
Q

What microscopic finding is diagnostic of acute myelogenous leukemia?

A

myeloblasts with Auer rods

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21
Q

What type of leukemia is associated with a mutation in the “Philadelphia chromosome?”

A

Chronic myelogenous leukemia

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22
Q

How is bcr-abl produced and what does it do?

A
  • translocation of chromosomes 9 and 22

- leads to constitutively active Abl kinase

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23
Q

Common condition resulting from chemotherapy (among other causes) where bone marrow does not make blood cells:

A

Aplastic anemia

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24
Q

What molecular marker is associated with hematopoietic stem cells (HSCs)?

A

CD34+

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25
True or false: Cytokines trigger WBC formation via Jak/STAT signaling
True
26
CBC vs. CBC with differential:
- CBC: WBCs, RBCs + indices, platelets | - CBC with differential: CBC + amount of each type of WBC
27
What do elevated basophils suggest?
Myeloproliferative disorder
28
What do elevated neutrophils indicate?
Bacterial infection
29
What do elevated lymphocytes indicate?
Viral infection
30
What do elevated monocytes indicate?
chronic infection or inflammation
31
What does the phrase "left shift" refer to?
Increase % of immature neutrophils in the blood. Normal response to infection, generally bacterial.
32
Which count is a measure of how well the bone marrow is making blood?
Reticulocyte count (corrected count = retic x hct/45)
33
How is reticulocyte count used to classify anemias?
- Low = bone marrow production problem - Normal = iron/folate/B12 deficiency - High = hemolysis or blood loss
34
What is anemia of chronic disease?
Anemia characterized by: - iron sequestration - relative lack of EPO response - not due to any other cause
35
3 reasons for a low platelet count:
- low production - high clearance - sequestration (from a clot)
36
What is the function of alpha granules in platelets?
Signal endothelial cells to start clot formation
37
What is the function of dense granules in platelets?
Activate other platelets
38
What is a common side effect of drugs that target kinases?
Bleeding
39
GP1b dysfunction leads to what disease?
Bernard-Soulier Syndrome
40
3 reasons why people get blood clots:
- clotting activates improperly - clotting does not self-regulate properly - clotting resists breaking down properly
41
2 vitamin K dependent natural antithrombotic factors produced in the liver.
Proteins C and S
42
How does factor V Leiden leads to increased thrombosis?
Proteins C and S can only cleave factor V at a specific site. With factor V Leiden this site is altered.
43
Antiphospholipid syndrome:
- autoantibodies to phospholipids - antibodies: anticardiolipin, anti-beta-2-glycoprotein I, etc. - Lupus anticoagulant not a specific antibody, but an effect of the condition on lab assay.
44
What is the "1 in 5" rule:
1 in 5 people that have a stroke will test + for antiphospholipid antibodies.
45
Physiologic effects of warfarin (coumadin):
- blocks vitamin K recycling | - decreases factors 10, 9, 7, and 2 (1972)
46
What can you give to treat both von Willebrand's disease and hemophilia A?
DDAVP: promotes the release of vWF, leading to both increased vWF and increased factor VIII.
47
Important facts about TTP (thrombotic thrombocytopenic purpura):
- Characterized by long vWF multimers | - PT and PTT not affected b/c doesn't activate coag pathway
48
Important facts about DIC (disseminated intravascular coagulation):
- Shattered red blood cells | - activates and depletes coag pathways, so PT and PTT affected
49
True or false: anticoagulants can be used to break down a clot.
False
50
Schematic dosing for warfarin:
One size fits 1/3. Start everyone on 5 mg qd and adjust to target INR. 1/3 of patients will be good on 5 mg.
51
2 major indications for warfarin therapy:
- prevent embolic stroke in a fib | - treating or preventing a VTE or PE
52
Clopidogrel:
- ADP blocking leads to decreased platelet activation | - Used in combination with aspirin in coronary syndromes and stents
53
Dipyridamole:
- Increases level of cAMP leading to platelet activation | - Used with aspirin for stroke prevention
54
Abciximab, tirofiban, eptifibatide:
- IIa-IIIb blocking leads to decreased platelet-platelet binding - Used for acute MI
55
5 Ps of hypercoagulation:
- Pregnancy - Prothrombin 20210 mutation - Protein C, S deficiency - Polycythemia vera - Paroxysmal nocturnal hemoglobinuria - Smoking
56
HAD of hypercoagulation:
- HIT - Hyperhomocysteinemia - Antithrombin III deficiency - Dysfibrinogenemia
57
CAUSED of hypercoagulation:
- CHF - Antiphospholipid syndrome - Uremia - Surgery - Estrogen - Diabetes
58
CLOTS of hypercoagulation:
- Cancer - Factor V Leiden - Obesity - Travel, Thalassemia, Thyroid disease - Sepsis
59
UFH:
- Potentiates AIII - Used for immediate anticoagulant effect - Monitor aPTT, heparin levels and platelets - IV infusion (usually bolus + drip)
60
LMWH:
- Blocks only Factor Xa - Longer half life than UFH - SubQ injection
61
Drugs used to break apart existing clots:
tPA's
62
Gold standard test for iron stores:
Bone marrow (serum ferritin most direct but not most reliable)
63
Lab tests for B12 deficiency:
MMA or homocysteine
64
Lab tests for folate deficiency
homocysteine
65
causes of B12 deficiency:
- achlorhydria - pernicious anemia - surgery
66
3 facts about pernicious anemia:
- Antibodies to parietal cells - Lack of intrinsic factor - Associated with other autoimmune diseases
67
Uses for cryoprecipitate:
- DIC - Hypofibrinogenemia - Bleeding from excessive anticoagulation
68
Treatments for leukemia:
AML: anthracycline + cytarabine, BMT ALL: chemo (daunorubicin, vincristine, prednisone, asparaginase) CML: Leukapheresis + myelosuppression. Tyrosine kinase inhibitors. CLL: Observe or combination chemo (fludarabine, cyclophosphamide, rituximab or bendamustine with rituximab)
69
SSx of non-Hodgkin lymphoma:
- In bone, trabecular infiltrate of monoclonal lymphoid aggregates - Lymph node involvement - Fever, weight loss, drenching night sweats
70
Treatment for Burkitt Lymphoma:
Intense cyclic chemotherapy + intrathecal chemo
71
SSx of myelofibrosis:
- Extreme fatigue, anemia, splenomegaly - BMBx shows fibrosis, atypical megakaryocytic - Smear shows leukoerythroblastosis
72
Tx for myelofibrosis:
- Jak2 inhibitor (ruxolotinib) - BMT - Splenectomy/radiation
73
Prototype for indolent NHL:
Follicular Lymphoma
74
Prototype for aggressive NHL:
Diffuse Large B cell lymphoma
75
Prototype for highly aggressive NHL:
Burkitt's Lymphoma
76
How is LDH used in the assessment of lymphoma?
Correlates with tumor burden, used for risk stratification.
77
Tx for DLBCL:
R-CHOP
78
SSx for multiple myeloma:
CRAB: - hyperCalcemia - Renal dysfunction - Anemia - Bone pain Also, M protein in serum or urine

Blood, Cancer and Palliation (3 decks)

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