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Pathophysiology > Cont > Flashcards

Cont Flashcards

1
Q

What are 2 causes of iron deficiency anemia

A

o Most common nutritional deficiency

o Chronic Blood loss

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2
Q

Characteristics of the cells in iron deficiency anemia

A

o Microcytic hypochromic
o Small cells and pale
o Loss of iron or decrease ingestion of iron

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3
Q

Characteristics of iron

A

o Iron is absorbed through the GI tract and you normally lose some each day
o Iron is recycled when RBC die
o Look at iron levels and iron storage
o Iron is stored in the liver in the form of ferratin
o Iron is low during Iron Deficiency Anemia

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4
Q

Characteristics of ferratin

A
  • Ferratin is directly related to iron levels
  • Found in the bone marrow, liver, spleen, and skeletal muscle
  • Ferratin varies directly with iron
  • Ferratin can be low or normal
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5
Q

Characteristics of transferrin

A
  • A blood protein that transports iron from one place to another by binding to it
  • Made by the liver
  • High transferrin in Iron Deficiency Anemia
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6
Q

What is Total iron binding capacity

A

• The degree to which the potential transporting capacity is occupied by actual plasma iron

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7
Q

Does iron defiency anemia have high/low transferrin levels

A

High- the are inversely related to iron levels
o The body is trying to deliver more iron to the bone marrow
• Refection of the liver making more transport iron

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8
Q

What are symptoms of Iron deficiency anemia

A

o Fatigue
o Weakness
o SOB
o Pallor

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9
Q

Treatment of iron deficiency anemia

A

Oral Iron supplements

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10
Q

What are causes of megaloblastic/macrocytic anemia

A

-B12 or folic acids deficiency

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11
Q

What is necessary for DNA synthesis

A

B12 and folic acid

o No B12 or folic acid=no DNA production= Decreased production of cells

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12
Q

Does RNA synthesis stop when DNA syntheisis stops?

A

o DNA synthesis stops but RNA synthesis continues so you get fewer cells with a large nucleus and abundant cytoplasm

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13
Q

What do the cells look like

A

• Characterized by macrocytic cells

o The cells are enlarged because of the lack of folate and B12

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14
Q

Who is at risk for macrocytic anemia?

A

o Vegetarians- they lack B12

o People who lack intestinal absorption- can’t absorb B12 so your body is short

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15
Q

Why would you lack intestinal absorption?

A

 Crones Disease
 Gastric Bypass
 Short Bowel Syndrome
-or lack intrinsic factor

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16
Q

What does intrinsic factor do?

A

 Necessary for the absorption of B12
 Protein secreted by the gastric mucosa
 IF binds to the dietary B12 and travels to the ilium to be absorbed

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17
Q

What are situations when you have a problem with intrinsic factor?

A
  • Gastrectomy
  • Resection of the ileum
  • Inflammatory Bowel Disease
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18
Q

What is another effect of B12 deficiency?

A

Pernicious Anemia

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19
Q

Characteristics of Pernicious Anemia

A
  • Autoimmune disease that features autoantibodies against your gastric mucosal cells and IF
  • Inability to produce IF
  • These cells ensure that dietary B12 will not be absorbed by the ilium
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20
Q

What are characteristics of anemia of chronic disease?

A
  • Low output of RBC by the bone marrow, but have the ability and the nutrients to have functional RBC
  • Depresses bone marrow production
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21
Q

When is anemia of chronic disease typically seen?

A

Renal failure and cancer

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22
Q

What are 3 pathological mechanisms of anemia of chronic disease?

A

o RBC survival is shortened
o Erythropoiesis is impaired
o Iron reutilization is impaired

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23
Q

Characteristics of the cells in anemia of chronic disease

A

-Normocytic normochromic anemia

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24
Q

Characteristics of Aplastic Anemia

A

• Bone marrow failure
• Results in pancytopenia
• Failure to produce all marrow elements
o Red cells, white cells, and megakaryocytes

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25
Q

What are side effects of aplastic anemia

A

o Hemorrhage due to low platelets

o Infection bc Low WBC

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26
Q

How are the cells in aplastic anemia

A

normocytic normochromic

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27
Q

What can cause aplastic anemia

A

• Can be idiopathic, autoimmune, or hypocellular bone marrow, lots of fat content

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28
Q

Characteristics of polycythemia

A

• Excessive number of red cells in the blood

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29
Q

How many types of polycythemia are there?

A

2

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30
Q

What are the types of polycythemia

A

o Relative

o Absolute

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31
Q

Describe relative polycythemia

A

 Caused by low plasma volume

 Loss of fluid causes concentration of RBC

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32
Q

Examples of relative polycythemia

A
  • GI loss, fluid loss, dehydration, diuretic

* Less fluid Higher amount of stuff inside

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33
Q

Describe absolute polycythemia

A

 The number of RBC is increased

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34
Q

What are the 2 kinds of absolute polycythemia?

A
  • Primary

- Secondary

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35
Q

Describe primary polycythemia

A

o Over-production by the bone marrow

o Occurs with a bone marrow malignancy called Polycythemia Vera

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36
Q

Describe secondary polycythemia

A

o Conditions outside the bone marrow that stimulate the marrow to produce RBC

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37
Q

What are examples of secondary polycythemia

A
  • Chronic hypoxia, lung disease, COPD, high altitudes

- They need to increase their affinity for O2 in blood to get oxygen to the tissues

38
Q

What are characteristics of bleeding disorders

A

-Vascular or platelet deficiency

39
Q

What can cause platelet malfunctions?

A 
o	Toxins
o	Drugs
o	Marrow Failure
o	Hypersplenism 
o	Immune thrombocytopenia
40
Q

How long do anti-inflammatories damage the platelets for?

A

The life of the drug

41
Q

How does aspirin damage platelets?

A

• Blocks cyclooxygenase
• Helps form thryoboxance A2
o This will cause you to thin your blood and not clot as easy

42
Q

What are 3 things that excessive bleeding is associated with?

A
  • Fragile blood vessels
  • Low platelet count/defective platelet function
  • Decreased coagulation factor activity
43
Q

Describe intravascular clotting

A

o Intravascular clotting is always abnormal and secondary to another disease

44
Q

What can cause coagulation factor deficiency?

A
  • Liver disease
  • Genetic Defects
  • Intravascular Coagulation
45
Q

What are 2 examples of thrombotic disorders?

A
  • Lupus Anticoagulant

* Factor V Leiden

46
Q

Describe lupus anticoagulant

A

Autoimmune antibody that can’t go into coagulation

47
Q

Describe factor V leiden

A

o Commonly seen with young girls on birth control

o Familial history is important

48
Q

o Decreased number of leukocytes

A

• Leukocytopenia

49
Q

o Decreased number of T and B lymphocytes
o Seen in AIDS
o Viral problems can cause this

A

• Lymphopenia

50
Q

o Decreased numbers of neutrophils

o More susceptible to infections

A

Neutropenia

51
Q

What can cause neutropenia

A
  • Acute inflammation
  • Drug induced- many chemos and other medications because it is generalized
  • Autoimmune or idiopathic
  • More susceptible to bacterial and fungal infections
  • Respiratory tract is the most common site of infection
  • Accelerated removal of neutrophils
  • Malignancy because it crowds the marrow and then neutrophils can’t be formed
52
Q

o Characteristic of mono

 Causes hepatomegaly and splenomegaly

A

• Lymphocytosis

53
Q

o Increase in peripheral WBC

A

• Leukocytosis

54
Q

o Immature forms are released into blood flow

A

Left Shifts

55
Q

o When immature neutrophils are released into the blood in response to something that could be malignant

A

• Band neutrophils

56
Q

o Enlarged lymph nodes

o Lymphoma can present here (because the job is to filter)

A

• Lymphadenopathy

57
Q

What can cause lymphadenopathy?

A

 Infection
 Autoimmune
 Anything that effects immune system can enlarge them

58
Q

o Inflammation of lymph nodes

A

• Lymphadenitis

59
Q

o Severe neutropenia

o Neutrophils less than 200

A

• Agranulocytosis

60
Q

o Increase in WBC in the blood

o Don’t see malignant cells in the blood (in tumor form)

A

• Leukemia

61
Q

o Increase in the WBC in the tissues

o See malignant cells (in tumor form)

A

• Lymphoma

62
Q

What lineage line does lymphoid neoplasms effect

A

• Lymphoid Line= T and B cells

63
Q

Describe acute lymphoblastic leukemia

A

o Common in children
o Down syndrome patients are 20% more prone to this
o 80% are B cell types
o T cells are more aggressive
o See a lot of lymphocytes
o Cells infiltrate liver, spleen, lymph nodes
o If a little kid comes in with a fever that won’t go away- run a CBC

64
Q

Describe chronic lymphoblastic leukemia

A

o B cell lineage is most common
o T cells are more aggressive
o A gene defect that stops lymphocytes for apoptosis
 If B cells are effected it stops B cells and antibodies
o Males more than females
o Around 60 years old
o Have lymphadenopathy and splenomegaly and lymphocytosis

65
Q

Describe lymphoma

A

o Specifically malignancy of lymph tissue so the blood work will not effect that, tissue is ABNORMAL
o Lymph tissue normally has follicular pattern
o If you have lymphoma- you lose follicular pattern
o Looks like CLL- but in lymphoma your blood counts are normal
o Small cell lymphocytic lymphoma and CLL are essentially the same disease

66
Q

Describe Hogdkins Lymphoma

A

o Solid tumors or cells derived from lymphoid cells
o Between 10-30 and over 50 years old
o Maybe Epstein Barr

67
Q

What type of Hogdkins Lymphoma is most common

A

o Nodular Sclerosis Type is most common and least aggressive

68
Q

Characteristics of Hodgkins lymphoma

A

o Staged by where the node travels
o Cervical and mediastinal regions
o Painless lymphadenopathy
o Mostly only lymph node involvement
o Reed Sternberg Cells – characteristic of Hodgkins Lymphoma
o Deficiency in cell mediated T cell immunity

69
Q

Describe non-Hodgkins Lymphoma

A

• T cell and Diffused Type is going to be worst prognosis
• Diffused Type- more aggressive
o Uniform pattern without pattern of lymph node
• Follicular Type- less aggressive
• Can involve other organs
o Seen in lungs, GI tract and bone

70
Q

Describe multiple myeloma

A
  • Commonly effects elderly
  • Cancer of plasma cells
  • Get plasma cell proliferations that increase the growth of plasma cells
  • Have excess immunoglobulins
  • Have high protein in blood and urine
71
Q

How do you see a spike in immunoglobulins?

A
  • Do electrophoresis on blood and see spike of immunoglobulins
  • IgG is produced in an unregulated fashion
  • IgA is 25% of the time
72
Q

What specific protein is elevated in multiple myeloma

A

• Elevated Bence Jones protein are light chains of the antibody that are produced and secreted into the urine= MULTIPLE MYELOMA

73
Q

What effects does multiple myeloma have on the body?

A

o Renal Failure/Kidney disease- Starts as acute and goes chronic

  • Filtered by kidney and results in kidney damage
  • • Increase osteoclastic activity
74
Q

How does increase in osteoclastic activity effect the body?

A

o Increases Ca levels
o Hypercalcemia
o Punch out lesions (occurs in the spine and skull)

75
Q

Why does pancytopenia result from multiple myeloma?

A

because the bone marrow is too crowded to produce other things

76
Q

How do you confirm multiple myeloma?

A

• Do a bone marrow biopsy

77
Q

What immunoglobulin does Waldenstrom effect

A
  • IgM

- Causes headaches, dizziness, and sluggishness

78
Q

General characteristics of acute phases

A

• Characterized by Blasts
• Abrupt onset presenting with hemorrhage or infection of immature forms of cells
• Bone pain and tenderness (because of fast infection of bone marrow
• Liver and spleen enlarged
• Headaches, vomiting
• Leukostosis- sluggish blood flow because increased number of WBC in the cell line
o Sluggish blood flow causes confusion in the brain because less blood is getting there

79
Q

General characteristics of chronic phase

A

• More mature malignant cells

80
Q

Describe acute myeloid leukemia

A
  • Primary disease or evolution from chronic myeloproliferative disorder
  • Primary is more aggressive and rapid
81
Q

Characteristics of chronic myeloid leukemia

A

• Philadelphia chromosome

o Shortened chromosome 22 and a translocation from chromosome 9

82
Q

T/F- You can have CML as a primary disease or because of myeloproliferative disorders

A

True

83
Q

What are examples of the myeloproliferative disorders?

A

o Polycytemia vera
o CML
o Essential thrombocythemia
o Myelofibrosis

84
Q

What is a characteristic of polycythemia vera?

A

 Increased RBC

85
Q

What is a characteristic of CML?

A

 Malignant granulocytes

86
Q

What is a characteristic of Essential thrombocythemia

A

 Malignant megakaryocytes

87
Q

What does myelofibrosis cause?

A

 Cell changes
 Replacement of bone marrow filled with adipose tissue
 Usually the end/fatal stage
 Normal to fibrous tissue

88
Q

What are the 2 disorders of the spleen and a characteristic of each?

A 
oSplenomegally- enlarged spleen
-Infection
oHyperspleenism
-Overactivity of spleen
-Recieveing an elevated amount of WBC
89
Q

What are 2 disorders of the thymus

A
  • Hereditary

- Myasthenia gravis

90
Q

Example of a hereditary thymus disorder

A

 DeGeorge Syndrome

• No maturity of T cells

91
Q

Example of myasthemia gravis thymus disorder

A

 Associated with thymomas

• Mostly benign (no malignant potential)

Pathophysiology (18 decks)

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