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Pathophysiology > Ch 21- Alteration in Hematological Function > Flashcards

Ch 21- Alteration in Hematological Function Flashcards

1
Q

What are anemias?

A

conditions of too few erythrocytes or an insufficient volume of them in blood.

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2
Q

What are polycythemias?

A

erythrocyte (RBC) numbers or volume is excessive

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3
Q

Leukemia is a ______ disorders.

A

proliferative

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4
Q

What is leukocytosis?

A

increased #’s of leukocytes (response to infections

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5
Q

Clotting is to stop ____

A

bleeding

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6
Q

Clotting is the interaction between endothelium, ____, and clotting components.

A

platelets.

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7
Q

What is the reduction in total # of RBC in blood or decrease in quality or quantity of Hb?

A

anemia

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8
Q

What does the term that ends in - cytic refer to?

A

cell size

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9
Q

What does the term that ends in — chromic refer to?

A

Hb content

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10
Q

What does anisocytosis mean?

A

varying size

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11
Q

What does poikilocytosis mean?

A

assuming various shapes

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12
Q

Anemia manifestations:

A

reduced O2 carrying capacity of blood.

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13
Q

Reduced RBC in blood leads to reduction in _____ and volume of blood. As a result, blood _____ decreases which then the blood flows ____ = increased heart rate and stroke volume

A

consistency; viscosity; faster

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14
Q

What is hypoxemia?

A

reduced O2 levels in blood

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15
Q

How to compensate with hypoxemia?

A

= dilation of vessels
= decreased systemic resistance
= increased blood flow
= increased blood flow to heart
= increased heart rate and stroke volume

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16
Q

T or F: Compensation in regards with hypoxemia can result in heart failure.

A

True

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17
Q

What is the cause of macrocytic-normochromic?

A

ineffective RBC DNA synthesis

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18
Q

What is the result of RBC DNA synthesis? What condition is this associated?

A

affected RBC die in circulation leading to anemia; macrocytic normochromic

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19
Q

What is eryptosis?

A

premature death of damaged erythrocytes.

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20
Q

What is the most common macrocytic type caused by vit b deficiency?

A

pernicious amenia

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21
Q

What does pernicious mean?

A

highly destructive or injurious

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22
Q

Pathophysio of PA: autoimmune condition produced antibodies against _____ cells which produce ____ factor (IF). IF is required for absorption of Vitamin __. This vitamin is required for ____ synthesis in RBC.

A

parietal; intrinsic; B12; DNA

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23
Q

What are some manifestations for PA?

A
  • develops slowly (20-30 yrs)/ situation sever when pt seeks tx
  • early symptoms non specific – often ignored
  • When Hb level is 70-80 g/L pt experience classic symptoms
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24
Q

What is the normal Hb level for PA?

A

120 g/L

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25
Q

What are some of the classic symptoms of PA?

A
  • fatigue
  • parethesia (e.g., tingling, prickling feeling) of feet & fingers
  • abdominal pain
  • nerve demyelination
  • symptoms are irreversible
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26
Q

What is the essential vitamin for RBC RNA and DNA synthesis?

A

folate

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27
Q

Folate are coenzymes required for synthesis of ____ & _____ which affects RBC undergoing rapid cell production

A

thymine; purines

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28
Q

What is the daily requirement of folate?

A

50-200 mg/day

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29
Q

T or F: Humans entirely depend on diet to meet daily folate requirement.

A

true

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30
Q

What presents as red beefy tongue?

A

burning mouth syndrome

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31
Q

What are some manifestations for folate deficiency anemia?

A
  • malnourished appearance
  • scales on mouth and burning mouth syndrome
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32
Q

What is the tx for folate deficiency anemia?

A
  • oral folate administration. If effective, anemia disappears in 1-2 weeks
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33
Q

What type of anemia is associated with ab., small RBC; contain reduced amounts Hb

A

Microcytic hypochromic anemias

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34
Q

The cause of microcytic hypochromic anemias is ___ metabolism disorders = ____ synthesis disorders = ____ synthesis disorders

A

Fe; heme; globin

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35
Q

What is the result of microcytic hypochromic anemias?

A

Fe deficiency anemia; Thalassemia

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36
Q

What is thalassemia?

A

inherited disorder causing reduced Hb

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37
Q

What is the cause of IDA?

A

-metabolic iron deficiency
- chronic blood loss or inadequate iron intake

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38
Q

What is metabolic iron deficiency?

A

insufficient iron delivery to bone marrow OR impaired iron absorption in bone marrow

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39
Q

Metabolic iron deficiency = dysfunction in ____ metabolism

A

iron

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40
Q

How much blood loss can cause IDA?

A

2-4 ml/day

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41
Q

In IDA, the iron deficiency is due to:

A
  • meds that cause GI bleeding (e.g., aspirin, NSAIDs)
  • surgical procedure
  • insufficient Fe intake
  • Pica
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42
Q

What is pica?

A

disorder causing the eating of non-nutritional substances

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43
Q

What are some examples of pica?

A

chalk, dirt, paper

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44
Q

IDA develops in ___ stages. Name and describe them

A
  • three
    -Stage 1 –> Fe stores are depleted; RBC production still normal
  • Stage 2 –> insufficient Fe transported to marrow; beggining of Fe-deficient RBC production
  • Stage 3 –> Hb deficient RBC begins to replace normal RBC that are being destroyed; anemia occurs
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45
Q

For pt with IDA, it is not noticeable until the Hb level is ____g/L, the pt then experiences classic symptoms. Name these classic symptoms.

A

70-80 g/L
Classic symptoms:
- structural changes in epithelial tissue
- Koilonychia
- Glossitis
- Dysphagia due to web mucus and inflammatory cells at esophageal opening.

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46
Q

What is koilonychia and glossitis? What type of condition is this symptom associated with

A

koilonychia – finger nails become brittle and spoon shaped

glossitis – tongue papillae atropy

Both of these condition are classic symptoms of iron deficiency anemia (IDA)

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47
Q

What are the diagnosis for IDA? (2 types: direct & indirect)

A

direct: iron stores measure by bone marrow biopsy

indirect: measurement of serum levels of Ferritin, Transferrin saturation or total iron-binding capacity

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48
Q

What is the tx for IDA? (2-step)

A

1st step: eliminate sources of blood loss
2nd step: iron replacement therapy until serum Ferritin level reaches 50ug/L

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49
Q

Which type of anemias is characterized by normal size and normal Hb content but insufficient in numbers?

A

normocytic-normochronic anemia

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50
Q

T or F: Different anemia indicate reason for insufficient numbers

A

true

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51
Q

What are the 4 distinct anemias?

A
  1. aplastic
  2. posthemorrhagic
  3. hemolytic
  4. chronic inflammation
52
Q

Describe the 4 distinct anemias?

A

aplastic
- infiltrative disorders of bone marrow

posthemorrhagic
- sudden blood loss with normal iron stores

hemolytic
- destruction of RBC incudes: ACQUIRED (developed after birth), HEREDITARY (e.g., sickle cell anemia), HEMOLYSIS (destruction of eryptosis)/

chronic inflammation
- inflammatory diseases.

53
Q

What is the condition where WBC count is higher than normal since it a normal protector response to physiological stressors?

A

leukocytosis

54
Q

T or F: Leukocytosis is rare in acute viral infections.

A

FALSE; Leukocytosis is rare in acute bacterial infections

55
Q

T or F: Leukocytosis is more common in acute viral infections.

A

TRUE

56
Q

What is type of virus leukocytosis is commonly found?

A

Epstein-Barr Virus

57
Q

T or F: Presence of leukopenia is normal.

A

FALSE; presence of leukopenia is NEVER normal

58
Q

What condition of leukocytes is when the WBC count is lower than normal?

A

Leukopenia

59
Q

T or F: Associated reduction in neutrophils = decreased risk of infection.

A

FALSE; there is an INCREASED risk of infection

60
Q

What is the neutrophil count where infection increases rapidly?

A

below 1.0 x 10 to the ninth power/L

61
Q

What is the absolute WBC count for leukopenia? What is the normal count?

A

Absolute WBC count = <4.0 x 10 to the ninth power/L

Normal count = 4.5 to 11.0 x 10 to the ninth power/L

62
Q

What is the neutrophil count for possibility of life threatening infection?

A

below 0.5 x 10 to the ninth power/L

63
Q

What disorder is associated with malignant disorder of bone marrow and usually also blood?

A

leukemia

64
Q

What is the main feature of leukemia?

A

uncontrolled proliferation of malignant leukocytes = decreased production of hematopoietic cells

65
Q

What is the result of uncontrolled proliferation of malignant leukocytes?

A

decreased production of hematopoietic cells

66
Q

What are hematopoietic cells?

A

immature cell that can develop into all type of blood cells

67
Q

T or F: Chromosomal ab and translocation are common in leukemia.

A

TRUe

68
Q

Identify the name of WHO guidelines that divide lymphoid neoplasms into 5 categories defined by cell of origin:

  1. Immature B cells –>
  2. Mature B cells
  3. Immature T cells
  4. Mature T cells and NK cells
  5. Reed-Sternberg cells
A
  1. Precursor B-cell neoplasms
  2. Peripheral B- cell neoplasms
  3. Precursors T cell neoplasms
  4. Peripheral T cell and NK neoplasms
  5. Hodgkin’s lymphoma
69
Q

T or F: Most lymphoid neoplasms arise from B and T cells differentiation.

A

TRUE

70
Q

Leukemia are clonal disorders that are genetically driven by abnormal _______.

A

stem-like cancer cells (SLCCs)

71
Q

What are leukemic blasts?

A

abnormal WBC which fill bone marrow and spill into blood

72
Q

As leukemic blasts fill the bone marrow, normal bone marrow cells cease to function which result in?

A

pancytopenia

73
Q

What is pancytopenia?

A

reduction in production of all blood cellular components

74
Q

As pancytopenia occurs, translocation occur. What translocation involves chromosome 9 and 22?

A

Philadelphia chromosome translocation

75
Q

What chromosomes are involved in Philadelphia chromosome translocation

A

9 & 22

76
Q

PCT is seen in 95% of what type of leukemia?

A

Chronic myeloid leukemia

77
Q

PCT is seen 30% in what type of leukemia?

A

Acute lymphocytic leukemia

78
Q

What is the result of PCT?

A

unique protein called BCR-ABL.

79
Q

What does BCR-ABL do in our body?

A

results in reduced in apoptosis and release in immature cells into circulation

80
Q

What are the two type of acute leukemia?

A
  1. ALL: Acute Lymphocytic Leukemia
  2. AML: Acute myeloid leukemia
81
Q

What does ALL affect?

A

Affects B, T and NK cells

82
Q

What does AML affect?

A

affects RBC, platelets, eosinophils, neutrophils and basophils

83
Q

What are the signs of symptoms of acute leukemia?

A

-fatigue by anemia
- bleeding by low platelet count
-fever due to infections by dysfunctional immune response

84
Q

ALL cases are common in what age group?

A

children ages 1-10 yrs old

85
Q

AML cases are common what age group?

A

older adults

86
Q

AML decreases the rate of ____/differentiation in affected cells = blood become populated with ______ blood cells.

A

apoptosis; dysfunction

87
Q

What are the two types of chronic leukemia?

A

CLL: Chronic lymphocytic leukemia
CML: Chronic myeloid leukemia

88
Q

What is the difference between CLL and CML?

A

CLL
- slow growing cancer
- too many immature lymphocytes found in cells bone and blood

CML
- slow developing cancer
- too many myeloid cells (RBC & platelets) being made in bone marrow

89
Q

What is the pathophysiology of CLL and CML:

A

CLL
- B cells fail to mature into plasma cells; inability to sythesize antibodies.
- affects 60% patients

CML
- Philadelphia chromosome and presence of BCR-ABL protein
- present in 95% pt
- cause of CML is exposure to ionizing radiation.

90
Q

What are the manifestations of CML? (Hint: Three phases)

A

chronic phase
- 2-5 yrs; may be asymptomatic

accelerated phase
- 6-18 months; proliferation of malignant cells; splenomegaly (enlarged spleen); develops infections

terminal blasts phase
- 3-6 months survival; rapid and progressive leukocytosis

91
Q

What does spleen do?

A

control blood level of WBC, RBC and platelest

92
Q

What is the diagnosis and tx for CLL?

A

characterized by accumulation of monoclonal B cells in blood

tx: stem cell transplant

93
Q

What are monoclonal B cells?

A

there is higher than normal # of identical B cells found in blood

94
Q

T or F: Progressive CLL= chemotherapy but curative.

A

FALSE; NOT CURATIVE

95
Q

T or F: No survival advantage for immediate vs delayed tx.

A

TRUE

96
Q

What is the tx for CML?

A

current modalities do not cure disease

97
Q

What condition is characterized by enlarge lymph nodes due to increase in lymphocytes and monocytes?

A

lymphodenopathy

98
Q

What is difference between localized LO and generalized LO?

A

Localized LO: drainage from infected area

Generalized LO: occurs less often; occurrence with infection, malignant disease with adults

99
Q

What are the causes of LO?

A

= neoplastic disease
= immune or inflammatory conditions
= endocrine disorders
= lipid storage diseases

100
Q

What are the basic groups of HL and NHL?

A

= B-cell neoplasms
= T- cell neoplasms
= NK-cell neoplasms

101
Q

What are malignant lymphomas?

A

proliferation of malignant lymphocytes

102
Q

What are lymphomas?

A

result of genetic mutation or infection

103
Q

What is the result of malignant lymphomas?

A

= cell with uncontrolled and excessive growth accumulates in lymph nodes

104
Q

T or F: Lymphoma is the most common blood cancer in Canada.

A

TRUE

105
Q

What are the 2 classifications of malignant lymphomas?

A

HL and NHL

106
Q

What type of malignant lymphoma the progressess from one group of lymph nodes to another?

A

HL

107
Q

What are some diagnostic with HL?

A

presence of unique B cells - aka Reed-Sternberg (RS) cells used to diagnoses BUT don’t always appear with cancer

108
Q

What gender and age group does HL most commonly diagnosed?

A

= incidence higher in males; median age 64 with 2 peaks: 20-40 yrs and 60-70 yrs old

109
Q

T or F: Reed-Sternberg cells are large binuclear cells that are necessary for diagnosis of HL.

A

True

110
Q

T or F: HL appears to be derived from B cell that have not undergone Successful Immunoglobulin Rearrangement (SIR)

A

TRUE

111
Q

What are SIR?

A

proper alignment of two light chains and two heavy chains of antibody

112
Q

T or F: Proper SIR would not induce proper apoptosis.

A

FALSE; Proper SIR would incduce proper apoptosis

113
Q

T or F; Survival of SIR linked to EBV providing factors that expand tissue growth

A

true

114
Q

What is the first sign of HL?

A

enlarged painless lymph node on neck

115
Q

What are the common systemic symptoms of HL?

A
  • fever without infection
  • drenching night sweats
  • itchy skin (pruritus)
  • weight loss
  • combined appearance of these symptoms = poor diagnosis
116
Q

What is the diagnosis for HL?

A

blood work: complete blood count; sedimentation rate; lymph node biopsy

117
Q

What is NHL?

A

heterogenous group of lymphoid tissue neoplasms with differing patterns of activity and response to tx

118
Q
A
119
Q

NHL cancers are differentiated from HL primary by a lack of ____-_____ cells

A

Reed-Sternberg

120
Q

NHL is best described as progressive clonal expansion of , and __ cells

A

B,T and NK

121
Q

What % of B cells are associated with NHL?

A

90%

122
Q

For NHL, oncogenes activated by _____

A

translocations

123
Q

NHL spreads in an ______ manner and spread ____. Diffuse ___ cell NHL is the most common NHL

A

unpredictable; early; B

124
Q

What term is associated with genes that transform a cell into tumor cell?

A

oncogenes

125
Q

What are the risk factors for NHL? (5 points)

A

= old, male and white
= afflicted by autoimmune disease
= infection by certain cancer related virus (EBV, HIV and Hepa C)
= immune suppressants related to organ transplant
= gastric infection with H. pylori

Pathophysiology (20 decks)

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