Chapter 11: Hematology-WBC disorders

Question 1

Increase in neutrophils

Answer 1

most commonly seen in the presence of inflammation and infections

Question 2

What is a Left shift?

Answer 2

aka Bandemia

-absolute increase in the number of bands (immature neutrophils) whether or not the total number of WBC increases

Question 3

Increase in eosinophils

Answer 3

allergic and atopic conditions as well as parasitic infections

Question 4

What are lymphocytes for

Answer 4

critical component of immune system, responsible for both humoral and cellular immune responses

Question 5

Common features of chronic neutropenia

Answer 5

gingivitis and oral mucosa ulcerations

Question 6

What is leukopenia?

Answer 6

total WBC count <4,000 cells/mm

Question 7

Most common causes of leukopenia and neutropenia

Answer 7

transient responses to infections (bacterial or viral) or drugs

Question 8

when neutropenia is prolonged, severe or accompanied by decreases of other cells types

Answer 8

bone marrow examination should be done

Question 9

Marked decease in lymphocytes should prompt

Answer 9

further eval for underlying immune disorder (like SCID)

Question 10

What is primary hemostasis and what are key participants

Answer 10

• vasoconstriction and formation of a platelet plug at site on injury
• platelets and vessel wall are key participants

Question 11

What is secondary hemostasis

Answer 11

formation of a fibrin mesh form the action of soluble coagulation factors on the surface of platelets and other cells
-brought about by platelets that are activated at the site of tissue injury in combo w exposed tissue factor

Question 12

Defects in primary hemostasis typically cause

Answer 12

bruising and mucocutaneous bleeidng

Question 13

Defects in secondary hemostasis typically cause

Answer 13

hemarthrosis and hematomas

Question 14

What is more common Hemophilia A or B

Answer 14

A (1/5,000 males) vs B (1/25,000 males)

Question 15

Tx of Hemophilia A & B

Answer 15

Tx of choice = recombinant factors VIII (A) or IX (B)

-Can give DDAVP (synthetic vasopressin) for A because it cause increased release of VIII but no effect on IX

Question 16

Complication of therapy for hemophilia

Answer 16

• Formation of inhibitors (neutralizing IgG antibodies aginst VIII or Ix)
• occur in 10% of patients w/ A and 1% of patients w/ B

Question 17

Signs of VWD

Answer 17

easy bruising, epistaxis, gingival bleeding, menorrhagia, mucocutaneous bleeding

Question 18

Tx of VWD

Answer 18

DDAVP increase the release of vWF from endothelial cells (t x of choice for patients w/ type I VWD)

Question 19

What are the vitamin K dependent factors

Answer 19

II, VII, IX, X, protein C and protein S

Question 20

Common causes of vitamin K deficiency

Answer 20

• antibiotic induced suppression of bacteria that produce K
• cystic fibrosis
• overdose of warfarin
• maternal use of warfarin
• maternal use of AED

Question 21

Most common disorder resulting from vitamin K deficiency

Answer 21

-hemorrhagic disease of the newborn (occurs in neonates who do not receive intramuscular vitamin K at birth)

Question 22

Breast milk and vitamin K

Answer 22

POOR source of vitamin K (thats why we give 1mg IM when born)

Question 23

Tx of vitamin K deficiency

Answer 23

nutrtional disorders and malabsorptive states respond to parenteral admin of vitamin K
-fresh frozen plasma or prothrombin complex concentrate is indicated for severe bleeding along w/ vitamin K