Chapter 21 - Alterations in Hematological Function Flashcards
Alterations in erythrocyte function can be related to either a) or b):
a) insufficient or excess number
b) normal number but with abnormal components
Anemia is a condition of too ____ erythrocytes in the blood
few
Polycythemia is a condition of too _____ erythrocytes in the blood
many
Leukocytosis is an __________ number of leukocytes in response to infection
increased
What is blood clotting used for?
to stop bleedin
Clotting disorders result from alterations in the interactions between endothelium, platelets, and _________ components
clotting
Anemia can be a reduction in the number of RBCs or a decrease in the quality or quantity of ____________
hemoglobin
Anemia is classified based on cell _____ and ____ content
size; Hb
Terms that end in ‘cytic’ refer to…
cell size
Terms that end in ‘chrome’ refer to…
Hb content
Anisocytosis is a type of anemia where cells vary in ______
size
Poikilocytosis is a type of anemia where cells assume various ______
shapes
Anemia reduces the ______ ______ capacity of blood
oxygen carrying capacity
Anemia results in a decrease in blood ________, increased ______ rate, and an ________ heart rate and stroke volume
viscosity; flow; increased
What is hypoxemia?
state of reduced oxygen levels in the blood
How does the body compensate hypoxemia?
vasodilation
Vasodilation due to hypoxemia results in…
-decreased resistance
-increased flow rate
-increased heart rate and stroke volume
Compensating for hypoxemia due to anemia can result in…
heart failure
Anemias are named based on their effects. Match:
a) macro
b) normo
c) micro
d) cytic
e) chromic
i) cell size (RBC)
ii) small
iii) Hb content
iv) large
v) normal
a) iv
b) v
c) ii
d) i
e) iii
Macrocytic-Nomochromic Anemia means…
-Large RBCs
-normal Hb content
What is the source of large RBCs with Macrocytic-Normochromic Anemia?
large stem cells (megaloblasts) in bone marrow
What is the cause of Macrocytic-Normochromic Anemia? (hint: nutrients)
inefficient DNA synthesis in RBCs due to vitamin B and Folic acid deficiency
Macrocytic-Normochromic Anemia results in RBCs _______ in circulation due to…
dying; DNA synthesis error resulting in eryptosis
Eryptosis`
premature death of damaged erythrocytes
What is vit B12 and folic acid used for in erythroblasts (undifferentiated RBCs in bone marrow)?
proliferation during differentiation
What is the most common macrocytic type of anemia?
Pernicious Anemia
Pernicious anemia is caused by a _______ deficiency
vit B
What does pernicious mean?
highly injurious or destructive
Pernicious anemia is an __________ condition
autoimmune
Pernicious anemia causes the person to produce antibodies against _________ cells
parietal
What do parietal cells produce?
intrinsic factor (IF) and HCl
What is intrinsic factor used for?
absorption of vit B12
What is HCl from parietal cells used for?
iron absorption
Pernicious anemia may also result from a past ________ infection
H. pylori
Pernicious anemia develops slowly over __-__ years
20-30
Pernicious anemia is severe when…
the patient seeks treatment
What are the early symptoms of pernicious anemia?
unspecific and usually ignored
What is a normal Hb level?
> 120 g/L
What is the Hb level of a pernicious anemic person experiencing symptoms?
70-80 g/L
What are the symptoms of pernicious anemia?
-fatigue
-paresthesia of feet and fingers
-abdominal pain
-nerve demyelination
Paresthesia
tingling, prickling feeling
The symptoms of pernicious anemia are ________
irreversible
Folate Deficiency anemia is a type of ______-cytic _____-chromic anemia
macro; normo
Folate (folic acid) is essential for the _____ and ____ synthesis in RBCs
DNA and RNA
Folates are ______________ necessary for t______ and p______ synthesis
coenzymes; thymine; purine
How do humans get folate?
diet (eating)
What is the daily folate requirement?
50-200 mg/day
People with folate deficiency anemia have a ___________ appearance.
malnourished
Burning Mouth Syndrome is a symptom of _______ ______ anemia and presents as…
folate deficiency; red beefy tongue and scales on the mouth
What is the treatment for folate deficiency anemia?
oral folate
Effective Tx for FD anemia will have it disappearing in how long?
1-2 weeks
What is Microcytic-Hypochromic Anemia?
-small RBC
-reduced Hb amounts
Microcytic-Hypochromic anemia is caused by _____ metabolism disorders
iron
Iron metabolism disorders lead to problems with _______ and _______ synthesis
heme and globin
Iron deficiency anemia and __________ result from iron metabolism disorders
Thalassemia
Thalassemia
an inherited disorder causing reduced hemoglobin
Iron deficiency anemia is caused by a) chronic ______ _____ or b) inadequate ________ intake
blood loss; iron
There is no intrinsic dysfunction of iron metabolism with ______ _________ anemia
iron deficiency
A metabolic iron deficiency results from issues with a) iron delivery to _____ ______ or b) impaired iron __________ into bone marrow
bone marrow; absorption
A blood loss of __-__ mL/day can cause iron deficiency anemia
2-4 mL/day
Iron can be ___________
recycled
Blood loss disrupts iron recycling because…
there is no iron to recycle
Iron deficiency is caused by i) m____________ ii) s__________ iii) Pica iv) ______
medication; surgery; [iron] intake
Which medications can cause GI bleeding and lead to iron deficiency
Aspirin and NSAIDs
How do surgical procedures contribute to iron deficiency?
decrease transit time and thus absorption
Pica
disorder causing the eating of non-nutritional substances
Stage 1 IDA occurs when iron stores are ________ but RBC production remains normal
depleted
Which stage of IDA is characterized by insufficient iron transport to bone marrow and the creation of iron-deficient RBCs?
Stage 2
During stage 3 IDA, Hb deficient RBCs ________ normal RBCs and anemia occurs
replace
Iron deficiency anemia is not noticed until the Hb level reaches ___-___ g/L
70-80
What are the noticeable symptoms of IDA?
-changes in epithelial tissue structure
-Koilonychia
-Glossitis
-Dysphagia
Koilonychia
brittle and spoon shaped fingernails
Glossitis
atrophy of tongue papillae
IDA Dysphagia occurs due to a ____________ and inflammatory cells
web of mucus
How is IDA directly diagnosed?
bone marrow biopsy to measure iron stores
How is IDA indirectly diagnosed?
measure of:
-Ferritin levels
-Transferrin saturation
-Iron-binding capacity
What is the first step of IDA treatment?
eliminate sources of blood loss
What is the second step of IDA treatment?
iron replacement therapy
Iron replacement therapy is done until serum Ferritin level reaches __µg/L
50
What is Normocytic Normochromic Anemia?
normal size cells with normal Hb content but insufficient in numbers
What are the four normocytic normochromic anemias?
aplastic, posthemorrhagic, hemolytic, chronic inflammation
Aplastic anemia is an infiltrative disorder of _______ _______
bone marrow
Posthemorrhagic anemia occurs with sudden ______ _____ and normal _____ stores
blood loss; iron
Hemolytic anemia involves…
the destruction of RBCs
Hemolytic anemia can be a_________, h________, or due to hemolysis
acquired; hereditary
Acquired anemia is developed…
after birth
What is an example of hereditary anemia?
Sickle Cell Anemia
Hemolysis
destruction of RBCs
Hemolytic anemia occurs from the _________ (premature death of damaged erythrocytes)
eryptosis
Leukocyte alterations may be due to: a) or b)
a) too many or too few leukocytes
b) structurally or functionally defective cells
Leukocytosis occurs with a WBC count that is…
higher than normal
When does leukocytosis occur?
as a normal protective response to physiological stress
Is leukocytosis more common in acute viral or bacterial infections?
viral (especially EBV)
Leukopenia occurs with a WBC count that is…
lower than normal
When is the presence of leukopenia normal?
never
Leukopenia is defined as an absolute WBC count less than ____ x 10⁹/L
4.0
What is a normal absolute WBC count?
4.5 to 11.0 x 10⁹/L
Leukopenia is associated with a reduction in __________
neutrophils
Reduced neutrophils = increased _________________
risk of infection
A neutrophil count below ____ x 10⁹/L poses risk for a rapidly increasing infection
1.0
A neutrophil count below ____ x 10⁹/L poses risk for a life-threatening infection
0.5
Infectious mononucleosis (IM) is an infection of ___ lymphocytes
B
Mono is b_____, acute, and self-____________
benign; limiting
Which virus is responsible for 85% of mono cases?
Epstein-Barr virus
Mono may also be cause by HIV, hep ____, and r_________
A; Rubella
____% of all people have been infected with EBV, most in early childhood
95%
Why do early EBV infections rarely develop into mono?
the early infection is asymptomatic and supplies the body immunity to EBV
Why is mono called the kissing disease?
it is transmitted through saliva
Why does the mono infection begin with B cells?
they have receptors for EBV
Mono infection begins in the ___________ cells of the throat area and spreads to __________ tissue
epithelial; lymphoid
Leukemia is a malignant disease of the _______ _______ and blood
bone marrow
Leukemia is characterized by uncontrolled proliferation of ________ _________
malignant leukocytes
The presence of malignant leukocytes decreases production of __________ cells
hematopoietic
Chromosomal abnormalities and ___________ are common in leukemia
translocations
Hematopoietic Cells
immature cell that can develop into all types of blood cells
What are the 5 categories of lymphoid neoplasms defined by WHO?
- Precursor (immature) B cells
- Peripheral (mature) B cells
- Precursor (immature) T cells
- Peripheral (mature) T cell and NK cells
- Hodgkin’s Lymphoma (Reed-Sternberg cells)
Acute leukemia involves ______________ and immature cells called ______ cells
undifferentiated; blast
The onset of acute leukemia is _____ and has a _______ survival time
rapid; short
Chronic leukemia involves ______________ cells that are not functionally normal
differentiated
Chronic leukemia has a _______ progression
slow
Most lymphoid neoplasms arise from ______________ pathways
differentiation
What genetically abnormal cells drive leukemia?
stem-like cancer cells (SLCCs)
Leukemias are ________ disorders
clonal
Which abnormal WBCs fill bone marrow and spill into blood?
Leukemic blasts
What is bone marrow pancytopenia?
a reduction in the production of all blood cellular components
The Philadelphia chromosome translocation involved chromosomes ___ and ___
9 and 22
The Philadelphia chromosome translocation is seen in ___% of Chronic Myeloid Leukemia and ___% of Acute Lymphocytic Leukemia
95%; 30%
What is the result of the Philadelphia chromosome translocation?
a unique protein called BCR-ABL
What does the BCR-ABL protein do?
reduces apoptosis and the release of immature cells into circulation
Acute leukemia can be ______ or _____
ALL or AML
What does acute lymphocytic leukemia (ALL) affect?
B cells, T cells, NK cells
What does acute myeloid leukemia (AML) affect?
RBCs, platelets, eosinophils, neutrophils, and basophils
Most cases of ALL affect…
children age 1-10
Most cases of AML affect…
older adults
AML results in a decreased rate of ___________ and differentiation which leaves the blood populated with dysfunctional blood cells
apoptosis
What are the signs and symptoms of acute leukemia?
-fatigue (due to anemia)
-bleeding (due to low platelet count)
-fever (due to infections)
Chronic lymphocytic leukemia (CLL) is a _______ growing cancer with many ________ lymphocytes in bone and blood
slow; immature
What is the most common leukemia in adults in the Western world?
Chronic Lymphocytic Leukemia (CLL)
Chronic myeloid leukemia is a slow developing cancer with too many _______ cells being made in bone marrow
myeloid
RBCs and platelets originate from ___________ stem cells
myeloid
What is the main deficit of CLL?
B cells fail to mature into plasma cells and thus they can’t synthesize antibodies
What % of CLL patients can’t synthesize antibodies?
60%
The main effect of CML is…
Philadelphia chromosome (BCR-ABL protein)
The Philadelphia chromosome is present in ____% of CML patients
95%
What is the only known cause of CML?
exposure to ionizing radiation
CML has ____ phases
3; chronic, accelerated, terminal blast
Stage 1 CML - Chronic Phase: lasts ___ to ___ years and may be asymptomatic
2 to 5
Stage 2 CML - Accelerated Phase: lats ___ to ___ months and involves…
-6-18 months
-proliferation of malignant cells
-splenomegaly
-infections
Splenomegaly
enlarge spleen
Stage 3 CML - Terminal Blast phase: lasts ___-___ months before death and involves rapid __________
3-6; leukocytosis
What does the spleen do?
control levels of WBCs, RBCs, platelets
CLL is characterized by the accumulation on monoclonal B cells in blood which means…
a higher number of IDENTICAL B cells are found
Is there a survival advantage of immediate (vs. delayed) treatment for CLL?
no
Progressive CLL is treated with ____________ but it is not curative
chemotherapy
______ _____ transplant achieves prolonged disease-free survival for CLL patients
stem cell
Is there a cure for CML?
no
With lymphadenopathy (LO), why are lymph nodes enlarged?
due to an increase in lymphocytes and monocytes
Enlarged lymph nodes are palpable and ________ to touch
painful
Localized LO indicates…
drainage from an infected area
Generalized LO occurs less often with…
infection of malignant disease in adults
Lymphadenopathy can be caused by… (4)
- neoplastic disease
- immune or inflammatory conditions
- endocrine disorders
- lipid storage diseases
What does malignant mean?
very virulent or infectious
Hodgkin’s and Non-Hodgkin’s lymphoma can be ____, _____, or ______ cell neoplasms
B, T, or NK cell
Malignant lymphomas results from the proliferation of malignant lymphocytes into the _________ system
lymph
Lymphomas result from ________ _________ or infection
genetic mutation
What is the most common blood cancer in Canada?
lymphoma
What factors contribute to the lymphoma incidence doubling in Canada since 1970?
-immune disorders
-diet
-metabolic syndrome
-environmental factors
What is Hodgkin’s lymphoma (HL)?
a malignant lymphoma that progresses from one group of lymph nodes to another
What cells are used to diagnose HL, but don’t always appear with cancer?
Reed-Sternberg cells (unique B cells)
HL incidence is high in ________ with an average age of _______
males; 64
HL incidence peaks at ___-___ years and ___-___
20-40; 60-70
Reed-Sternberg cells are THE malignant transformed ______________
lymphocyte
RS cells are _________
binuclear
What triggers the mechanism for RS cell transformation?
unknown
HL is caused by B cells that have not undergone SIR which is…
successful immunoglobulin rearrangement
Proper SIR involves…
the alignment of the two light chains and two heavy chains of the antibody
Proper SIR = proper _________ induction
apoptosis
The survival of SIR is linked to ______ providing factors that expand tissue growth
EBV
What is the first sign of HL?
enlarged painless lymph node on the neck
Systemic HL Symptoms:
-fever but without infection
-night sweats
-pruritus (itchy skin)
-weight loss
A combined appearance of HL symptoms means…
poor prognosis
How is HL diagnosed?
complete blood count (CBC), sedimentation rate, lymph node biopsy
What is Non-Hodgkin’s lymphoma (NHL)?
heterogeneous group of lymphoid tissue neoplasms with differing patterns of activity and responses to treatment
With NHL, B, T, and NK cell neoplasms arise when?
at various levels of differentiation
How does NHL differentiate from HL?
lack of RS cells
What is the best description of NHL?
clonal expansion of B, T, and NK cells
___ cells make up 90% of NHLs
B
What are oncogenes?
genes that transform a cell into tumour cells
What activates oncogenes?
translocations
NHL spreads in an _____________ manner and _______
unpredictable; early
What is the most common NHL?
B cell NHL
What are the risk factors of NHL?
-old, male, white
-autoimmune disease
-cancer related virus infection (HIV, EBV, hep C)
-immune suppressants related to organ transplant
-H. pylori infection
