Blood Diseases - 2 Flashcards
What are the reasons for decreases in normal red cells?
Usually bleeding - chronic from GI
What are the reasons for decreases abnormal red cells?
autoimmune
hereditary conditions - span (<120 days)
removed by the spleen
Why would the spleen enlarge if cells have reduced life span?
due to overactivity of spleen trying to remove dead RBCs
What is microcytic, macrocytic, and normocytic in anaemia cell terminology ?
o microcytic
- small RBC - Fe def., Thalassaemia
o macrocytic
- large RBC - B12/folate def., Retics
o normocytic
- normal RBC - bleed, renal, chronic disease
What is hypochromic?
- hypo (less) chromic (colour)
Due to there being less Haemoglobin in the red cells
most often microcytic and hypochromic
What is ansiocytic?
Red cells are always a range of sizes even in normal people. This is exaggerated in anisocytosis – very big cells and very small cells in the same sample
What are macrocytic cells a sign of?
immature RBCs that have not shrunk
What are reticulocytes?
oAlmost mature RBC
oReleased early into the circulation to replace losses
oWill raise MCV (mean cell volume)
When would reticulocytes be present and how would they look?
have residual organelles and are larger
when patient has lost blood and is rapidly trying to replace RBCs
What are signs?
things a clinican can see upon examination
What are symtoms?
symptoms are things the patient will conplain about
What are the signs of anemia?
pale (mucosa)
tachycardia
smooth tongue/ loss of papilla (iron deficiency)
Rarely
enlarged liver
enlarged spleen
What are the symptoms of anaemia?
tired and weak
dizzy
SOB (shortnessofbreath)
palpitations
What oral disease commonly presents with iron deficiency?
angular chelitis
What oral sign can occur with vit B12 deficiency?
beefy (inflammed, smooth) tongue
What are the investigations that are required to diagnose anaemia in order?
- history
-FBC (ferritin and RC folate/ vit B12)
-GI blood loss
found in FOB (faecal occult blood)
endoscopy (upper), colonoscopy (lower)
-renal function (erythropoetin levels)
-bone marrow exam (last restort)
How is anaemia treated?
o Replace haematinics
o Transfusions - production failure
o Erythropoeitin replacement via injection due to production failure
-Renal disease
What are the problems that anaemia may cause dentally?
oGeneral Anaesthesia - O2 capacity
oDeficiency States
- Fe usually
- mucosal atrophy (thinning)
- Candidiasis
- Recurrent Oral Ulceration
- Sensory changes
- inflammation of tongue
- smoothness of tongue
What is a possible cause of anemia in females?
menstrual blood loss
Where does GI bleeding occur in elderly people?
upper/ lower GI
Where does GI bleeding occur in young people?
upper GI
What does a less differentiated cancer mean?
more aggressive
When can a haematological cell line turn neoplastic?
numer of stages
the earlier, the more potentially aggressive the malignancy
What mutation happens to cause the malignancy?
DNA mutation (usually translocation)
Switches “off” a tumour suppressor gene or switches “on” an
oncogene
Clonal proliferation
What are characteristics of cancer cells?
Uncontrolled proliferation
Loss of apoptosis
Loss of normal functions/products
What do acute and chronic denote?
clinical behaviour and span
What terms decribe the point in the cell line or the cell type at fault?
Lymphocytic, lymphoblastic or myeloid
What is “blast”?
immature cell
What leukaemia is serious and life threatening?
acute leukaemia
What is leukaemia and what conditions does it result in?
Describes a group of cancers of the bone marrow which prevent normal manufacture of the blood and therefore result in:
Anaemia
Infection (Neutropenia)
Bleeding (Thrombocytopenia)
What is the pathogenesis of leukaemia?
clonal proliferation
replacement of marrow
increasing marginalisation of productive normal marrow - marrow failure, organ infiltration
What type of Leukaemia occurs in very young children, causing them to go into a Catabolic state?
acute lymphoblastic
not fatal
What are the clinical presentations of leukaemia?
Anaemia
Neutropenia (infections, latent or aquired)
Lymphadenopathy - neck lumps
Bone pain- especially in children
Hepatomegaly/ Splenomegaly - swollen abdomen
What is the difference between lymphocytic and lymphoblastic?
- Lymphocytic - mature lymphocytes (healthy immune system cells)
- Lymphoblastic - immature lymphocytes (not fully functional)
What type of leukaemia results in an increase of neutrophils?
philidelphia chromosome
chronic myeloid
What type of Leukaemia occurs in the Elderly (over 70) and is usually Asymptomatic?
b-cell clonal lymphoproliferative disease
chronic lymphocytic
What forms of Leukaemia affects elderly individuals more?
chronic lymphocytic
acute myeloid
What is lymphoma?
Clonal proliferation of lymphocytes arising in a lymph node or associated tissue
solid tumour but some cells in blood
What are the two types of lymphoma?
- Hodgkin Lymphoma (Hodgkin’s disease)
- Non-Hodgkin Lymphoma
What is the most common lymphoma?
non-hodgkin lymphoma
What are symtoms of lymphoma?
fever
swelling of face/neck
lump in neck, armpits or groin
excessive sweating
unexpected weight loss
loss of appetie
breathlessness
Where does cancer proliferation occur in lymphoma?
tissue proliferation occurs in the lymphoid tissues rather than the bone marrow in leukaemia
lymph nodes
What does staging require?
imaging
-CT, PET or MRI
What does staging depend on?
no of nodes involved and sites
extra-nodal involvement
systemic symptoms
What are characteristics of hodgkin lymphoma?
- Peak incidence age 15-40 years males
- Painless lymphadenopathy, fever, night sweats, weight loss, itching
- High survival
What are the characteristics of non-hodgkin lymphoma?
- B-cell (85%) or T-cell (15%) types
- Any age (more indolent in elderly)
- Aetiology: microbial factors, autoimmune disease associated, immunosuppression
- lymphadenopathy, oral swelling, oropharyngeal diseases
- marrow failure symptoms common (normal lymphoma symptoms not common)
- Fatal (relapse after treatment)
What is multiple myeloma?
Malignant proliferation of plasma cells derived from b cells
What are the features of multiple myeloma?
- Monoclonal paraprotein in blood and urine
- Lytic bone lesions > pain and fracture
- Excess plasma cells in bone marrow > marrow failure
What does multiple myeloma cause?
infections
bone pain and fractures
renal failure
amyloidosis
What is treatment for multiple myeloma?
mostly monoclonal antibody drugs and turnover suppression medicine
What is the types of treatment of haematological malignancies?
- Chemotherapy
- Radiotherapy
- Monoclonal antibodies – increasingly important * ‘Biologic’ medication that targets specific cell types
- Haemopoietic stem cell transplantation
What concepts must be understood before treating haematological malignancy?
- Induction
- Remission
- Maintenance & consolidation
- Relapse
What is supportive therapy that is important?
- Nutrition
- Psychological and social support
- Prevention and treatment of infection
- Managing symptoms of therapy side effects
- Correcting marked blood component deficits
- Pain control
What is chemotherapy?
- Cells with high turnover rate targeted
- Side effects well known but newer agents are improving: hair loss, nausea and vomiting, tiredness
- Long-term risk of oncogenesis in surviving patients
Whatis radiotherapy?
- Cytotoxic effect of ionizing radiation
- Beam directed form outside body
- Adjacent healthy tissue will also be irradiated
- Effect of this minimised using complex spatial positioning, targeting and dosing techniques
arranged by computers to minimise harm
What is monoclonal treatment?
Monoclonal antibody therapy in cancer utilizes antibodies designed to bind to specific antigens on cancer cells to
- Directly induce cancer cell death (cytotoxic effect).
- Deliver cytotoxic drugs or radioactive payloads to cancer cells.
- Stimulate the immune system to attack cancer cells (immunotherapy).
What is haemopoietic stem cell transplant?
replaces damaged bone marrow with healthy stem cells (from donor - allogenic or patient - autologous) to restore blood cell production. Used for treating blood cancers and disorders.
very high risk
