blood disorders Flashcards
what type of tissue does lymphoma arise from
peripheral lymphoid tissue
which type of lymphoma is more common in men
Hodgkin lymphoma
characteristics of Hodgkin lymphoma
- rare
- high cure rate
- more common in men
- familial pattern
- Reed sterning cells
what is the peak of incidence of Hodgkin lymphoma
early 20’s and over 50
Hodgkin lymphoma is more common in who (specifically)
immunosuppressed and those exposed to agent orange
Hodgkin lymphoma spreads by what
contiguous extension
Hodgkin lymphoma has what kind of origin
unicentric (single node)
Hodgkin lymphoma requires what essential diagnosis criteria
the reed sternberg cell
what are the two subgroups of Hodgkin lymphoma
- nodular sclerosis
- mixed cellularity
what type of Hodgkin lymphoma is more common in women
nodular sclerosis
what type of Hodgkin lymphoma has a worse prognosis
nodular sclerosis
what type of Hodgkin lymphoma is more common in men
mixed cellularity
does mixed cellularity Hodgkin lymphoma have a better or worse prognosis
better prognosis, but more constitutional problems
manifestations of Hodgkin lymphoma
- enlargement of 1/more lymph nodes on the neck
- pruritis
- pain at the tumor site w/ alcohol use
- herpes zoster infections
- B symptoms
what are the B symptoms
- weight loss (>10%)
- fever without chills
- drenching night sweats
B symptoms are found in what % of patients
40% of patients
B symptoms are common with what
advanced disease
diagnosis of Hodgkin lymphoma
- labs (mild anemia, elevated/decreased lymphocytes)
- lymph node biopsy + reed sternberg cell
treatment of Hodgkin lymphoma is determined by what
stage
limited stage Hodgkin lymphoma is treated with
2-4 months of chemo followed by radiation
advanced stage Hodgkin lymphoma is treated with
chemo
advanced or refractory stage Hodgkin lymphoma is treated with
transplant (marrow/stem cell)
Non-Hodgkin lymphoma involves what type of cells
B cell or T cell neoplasms
95% B cell
Non-Hodgkin lymphoma originates where
multiple lymph nodes
where does Non-Hodgkin lymphoma spread to
lymphoid tissue (spleen, liver, bone marrow)
what type of lymphoma has unpredictable spread that is not localized
Non-Hodgkin lymphoma
incidence of Non-Hodgkin lymphoma increases by
decade
the median age of diagnosis for Non-Hodgkin lymphoma is
67
what is the itiology of Non-Hodgkin lymphoma
unknown
what are the subtypes of Non-Hodgkin lymphoma
- diffuse large B cell lymphoma (30%)
- follicular lymphoma (22%)
manifestations of Non-Hodgkin lymphoma
initially few/no symptoms
- abnormal node size/consistency
- B symptoms
- decreased organ fx (pulmonary, renal, spleen, CNS)
- increased susceptibility to infection
diagnosis of Non-Hodgkin lymphoma
- lymph node biopsy
how is treatment of Non-Hodgkin lymphoma selected
through immunophenotyping and scans (CT, MRI, PET, bone)
treatment of Non-Hodgkin lymphoma
dependent on stage
treatment of early stage Non-Hodgkin lymphoma
localized radiation and chemo
treatment of aggressive Non-Hodgkin lymphoma
combination chemo + immunotherapy
treatment of highly resistant Non-Hodgkin lymphoma
bone marrow + peripheral stem cell transplant
what is leukemia
proliferation of malignant WBC in circulation
leukemia is most common in who
children and young adults
what are the 2 forms of leukemia
- lymphocytic
- myelogenous
lymphocytic leukemia involves what
CA of the lymphoid stem cell line (lymphocytes)
myelogenous leukemia involves what
CA of the myeloid stem cell line (monocytes, granulocytes)
what type of leukemia involves blast cells
acute
leukemia impacts normal RBC which will cause
hypoxia
leukemia impacts normal WBC which will cause
impaired defense
what is the etiology of leukemia
idiopathic, but requires a mutated gene (oncogene)
risk factors for leukemia
- immunodeficiency
- T cell leukemia virus
- genetic predisposition
- radiation exposure
manifestations of leukemia
- leukopenia, thrombocytopenia, anemia
- bleeding/bruising
- recurrent infection
- fatigue, weakness
- fever in absence of infection
- general pain
why does someone with leukemia experience bleeding/bruising
d/t inadequate oxygen and ATP production (d/t impacted RBC)
why does someone with leukemia experience fatigue and weakness
d/t decreased oxygen (d/t impacted RBC)
how is leukemia diagnosed
blood and bone marrow evaluation
treatment of leukemia
- chemo + radiation
- antimicrobials
- colony-stimulating factors
- blood transfusions
- marrow/stem cell transplant
why is colony stimulating factor used for leukemia treatment
stimulates growth factor secretion by the bone marrow which promotes growth and differentiation of stem cells
what are the 4 stages of chemo + radiation treatment with leukemia
- induction (induce remission)
- CNS prophylaxis (deliver chemo via lumbar puncture)
- consolidation (once remission begins, intensify chemo to reduce leukemia cells)
- maintenance (decreased dosage maintained for 2 years)
what is the most common blood disorder
anemia
anemia is due to what
a RBC and/or Hb deficiency
RBC are removed by the
spleen
what is Hb
a protein within RBC’s that is responsible for transporting oxygen
3 causes of anemia
- excessive loss (ex. hemorrhage)
- abnormal hemolysis
- deficient erythropoiesis
abnormal RBC number, structure or function causes
decreased oxygen-carrying capacity which causes systemic hypoxia and deficiency of ATP
what causes all the symptoms of anemia?
hypoxia
mild anemia is often
not detected
manifestations of moderate anemia
- chronic fatigue
- dyspnea
- palpitations
manifestations of severe anemia
- exhaustion, weakness
- headache
- dizziness
- sensitivity to cold
why does severe anemia cause sensitivity to cold
d/t ATP deficiency
aerobic ATP production produces heat, anaerobic doesn’t
how does iron deficiency cause anemia
oxygen binds iron on Hb
reduces the oxygen carrying capacity of Hb
with iron deficiency anemia these tests will be normal
RBC and Hb
iron deficiency anemia requires what test
ferritin test
treatment of iron deficiency anemia
- treat the cause
- PO iron for 4-6 months then reassess
excess iron can cause what
constipation and toxicity
what is folic acid
a vitamin essential for the body to make DNA, RNA and metabolize amino acids
what is B12
a vitamin required for function of CNS and metabolism of all cells
a deficiency in what will cause abnormal DNA synthesis and cell maturation causing defective blood cells
B12 or folic acid
a deficiency in B12 or folic acid will cause
abnormal DNA synthesis and cell maturation causing defective blood cells
treatment of B12 and Folic acid deficiency
- treat the cause
- B12/folic acid supplements
pernicious anemia is caused by a problem with
intrinsic factor excreted by stomach mucosa
what does intrinsic factor do
binds vitamin B12 for absorption
treatment of pernicious anemia
- passive absorption (high dose B12)
- IM (if neuro symptoms occur ex. headache, dizziness)
what is aplastic anemia
bone marrow failure causing hematopoiesis
what causes aplastic anemia
- 65% idiopathic
- 35% autoimmune, radiation, toxic chemicals
treatment of aplastic anemia
- withdraw the cause (radiation etc)
- transfusion (until recovered)
- marrow transplant
what causes hemolytic anemia
excessive or premature hemolysis of RBC
hemolytic anemia etiology
- genetics (ex. thalassemia)
- acquired (ex. autoimmunity)
manifestations of hemolytic anemia
- anemia manifestations
- jaundice
- splenomegaly
- hepatomegaly
what causes jaundice
excessive RBC breakdown causing a bilirubin buildup
Hb is broken down into iron, globin and heme which is broken down into what and used for what
- iron (stored in the liver to be reused in Hb)
- globin = amino acids (reused for proteins)
- heme = bilirubin (excreted)
if there is too much bilirubin the liver becomes ______ and causes bilirubin to ______ and ______ in the tissues
overwhelmed
circulate
deposit
why must renal function be monitored in a patient with hemolytic anemia
if the liver can’t keep up with excessive bilirubin, full molecules will get through causing sedimentation in the kidneys (glomerulus)
causes of hemorrhagic anemia
- peptic ulcer disease (gradual bleed into stomach/duodenum)
- tumor
- heavy menses
- hemorrhoids
treatment of hemorrhagic anemia
treat the cause
the severity of acute hemorrhagic anemia depends on
- site
- volume
- rate
chronic hemorrhagic anemia may be hard to diagnosis because it is
gradual, ongoing blood loss that is concealed
sickle cell anemia is what type of abnormality
autosomal recessive
to have sickle cell anemia the person must have how many defective alleles
2 (homozygous)
if only 1 sickle cell allele is affected the person will have
sickle cell trait (mild/no symptoms)
manifestations of sickle cell anemia
- thrombosis
- infarction
- jaundice
- low GFR, renal failure
in sickle cell anemia, glutamic acid is replaced with _____ in the _____
valine in the beta chain
valine carries oxygen normally but once ____ occurs what happens?
once dissociation occurs, Hb crystalizes causing the cell to sickle, hemolyze and release crystalized Hb in the blood
why does sickle cell anemia impair perfusion
- the shape of the cell impedes flow
- crystallization increases viscosity
treatment of sickle cell anemia
- supportive treatment (oxygen, rest, pain, fluids/electrolytes)
- hypertransfusion
- hydroxyurea
- marrow transplant
how does hydroxyurea help those with sickle cell anemia and why is it bad?
- prevents crystallization and hemolysis, facilitating the formation of fetal hemoglobin
- has severe SE, is hepatotoxic, can cause leukemia and is toxic to the marrow
why does sickle cell anemia cause pain?
systemic ischemia d/t occlusions
thalassemia is a disease of
hemoglobin synthesis
