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MI Immuno/Heme > Cytopenia and Cythemia > Flashcards

Cytopenia and Cythemia Flashcards

1
Q

What type of anemia is marked by decreased reticuloctes, hypocellular marrow, which increased erythropoietin, normal MCV, and normal haptoglobin?

A

Aplastic anemia - characterized by pancytopenia and a hypocellular bone marrow filled with fat and stroma

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2
Q

Causes of aplastic anemia

A

Often due to destruction of multipotent hematopoietic stem cells:

  1. Radiation
  2. Drugs (i.e. chloramphenicol)
  3. Chemicals (benzene and glue sniffing)
  4. Infections (especially hepatitis C)
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3
Q

Pancytopenia

A
  1. Anemia
  2. Agranulocytosis
  3. Thrombocytopenia
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4
Q

Signs of pancytopenia

A
  1. Fatigue (due to decreased RBCs)
  2. Infections (due to decreased WBCs)
  3. Bleeding (decreased platelets)
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5
Q

Pancytopenia w/ decreased reticulocytes

A

Consistent w/ aplastic anemia

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6
Q

Cyclic neutropenia

A

Disease characterized by accelerated apoptosis of neutrophil precursors

Nuclear fragmentation and membrane blebbing are features seen in apoptosis

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7
Q

Inherited aplastic anemia caused by abnormal DNA interstrand crosslink repair

A

Fanconi anemia

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8
Q

Signs of Fanconi anemia

A

Hypoplasia of kidneys, thumbs, spleen, and radii

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9
Q

Most common cause of pure red cell aplasia

A

Immune-mediated loss of erythroid precursor cells

PRCA - normal WBCs and platelets

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10
Q

Disease associated w/ thymoma (mediastinal tumor), myasthenia gravis, and parvovirus B19 infection

A

Pure red cell aplasia

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11
Q

What type of infection is characterized by intranuclear inclusions w/i pronormoblasts

A

Parvovirus B19 infection - cause of pure red cell aplasia in individuals w/ chronic hemolytic anemia

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12
Q

Most common viral cause of aplastic crisis in Pt’s w/ sickle cell and other chronic hemolytic disorders?

A

Parvovirus B19 infection of erythroid progenitor cells (pronormoblasts)

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13
Q

What type of virus is parvo B19?

A

Nonenveloped ssDNA virus

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14
Q

Tick-borne infection characterized by flu-like and neurologic symptoms along with leukopenia and asterisk-shaped cytoplasmic inclusions in neutrophils and monocytes.

A

Ehrlichia chaffeensis

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15
Q

What vector transmits Ehrlichia chaffeensis

A

Amblyomma americanum (lone star tick)

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16
Q

A significant leukocytosis in the setting of a bacterial infection with an increased leukocyte alkaline phosphatase score

A

Consistent w/ leukmoid reaction

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17
Q

Basophilic oval inclusions in neutrophils (Dohle bodies) along with increased LAP (leukocyte alkaline phosphatase) and peripheral leukocytosis (white cell count over 50,000).

A

Leukmoid reaction

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18
Q

Neutrophilia w/o left shift

A

May result from demargination of neutrophils in the peripheral blood - can be caused by corticosteroids

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19
Q

Signs of infectious mononucleosis

A
  1. Sore throat
  2. Fever
  3. Palatal petechiae
  4. Lymphadenopathy
  5. Splenomegaly
  6. Atypical lymphocytsosis in peripheral blood smear
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20
Q

Atypical lymphocytes in mono

A

Larger than normal w/ abundant cytoplasm, the periphery of which may be condensed and more blue in appearance

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21
Q

How long should contact sports be avoided in a Pt w/ infectious mono?

A

4 wks

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22
Q

EBv infects what cells?

A

CD21+ B lymphocytes

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23
Q

EBv cuases proliferation of what cells?

A

CD8+ T lymphocytes

Seen as atypical lymphocyte in peripheral smear and paracortex of nodes

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24
Q

Heterophile Ab test

A

Monospot test

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25
Q

Metastatic disease associated w/ EBv

A

Burkitt lymphoma

Nasopharyngeal carcinoma

Hodgkin lymphoma

Diffuse large B cell lymphoma

Primary CNS lymphoma

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26
Q

Heterophile-negative mononucleosis causes

A

Cytomegalovirus (second most common cause of mononucleosis)

27
Q

Neutrophil presence in lymph nodes

A

May be present w/ acute bacterial lymphadenitis

Neutrophils do not typically preside in lymph nodes

28
Q

Medullary sinuses of lymph nodes may be filled w/ macrophages under what conditions?

A

Crhonic inflammatory disorders - i.e. TB

29
Q

Cat-scratch fever infectious organism

A

Bartonella henselae

30
Q

Bartonella henselae causes what disease(s)

A

Cat-scratch disease and bacillary angiomastosis

31
Q

Infectious disease of immunosuppresed individuals characterized by vascular lesions of skin

A

Bacillary angiomatosis - caused by Bartonella henselae

32
Q

Transmission of Bartonella henseale

A

Pathogen is typically transmitted from the feces of cat fleas via cat sratch

33
Q

Lymph node biopsy showing necrotizing granulomas and stellate-shaped microabscesses

A

Characteristic of cat scratch fever

34
Q

Relative polycythemia

A

Polycythemia w/ normal RBC mass

35
Q

Causes of relative polycythemia

A

Dehydration

Excessive diuresis

36
Q

Absolute polycythemia

A

Polycythemia w/ increased RBC mass

37
Q

Causes of absolute polycythemia

A

Primary polycythemia (w/ decreased EPO levels)

Secondary polythemia (increased EPO levels)

38
Q

What stimulates interstitial cells in kidney to increase release of EPO?

A

Anemia-induced tissue hypoxia

39
Q

Normal bone marrow cellularity

A

~50% (decreases w/ age over 50)

40
Q

Paroxysmal nocturnal hemoglobinuria presdisposes Pt’s to what type of anemia?

A

Aplastic anemia

41
Q

Most cases of Fanconi anemia develop what?

A

Acute myelogenous leukemia

42
Q

What promotes proliferation and differentiation of progenitor cells of neutrophils, eosinophils, and monocytes/macrophages in the bone marrow?

A

Granulocyte-macrophage colony-stimulating factor (GM-CSF)

43
Q

Recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) can be used to treat?

A

Neutropenia due to stem cell destruction

44
Q

Myeloophthisic anemia

A

Results from space-occupying lesions of the bone marrow (ophthisic means hard)

Such as metastases (prostate cancer in men, breast cancer in women), granulomas (TB or sarcoidosie) or fibrosis (myelofibrosis)

45
Q

Presence of leukoerythroblastosis in the peripheral blood and the presence of teardrop RBCs characterizes?

A

Myelophthisic anemia -

leukoerythroblastosis refers to finding in the peripheral blood
immature white cells, such as myelocytes and metamyelocytes, and immature red blood cells, such as nucleated red blood cells (nRBCs).

46
Q

Increased destruction of neutrophils causes what marrow finding?

A

Hyperplasia of the bone marrow with and increase in the number of granulocytic precursors

47
Q

Causes of increased neutrophil destruction

A
  1. Immune mediated (Felty’s syndrome)
  2. Drug rx’ns (aminopyrine and some sulfonamides)
  3. Sequestration in the spleen due to hypersplenism
  4. Increased utilization - overwhelming infections
48
Q

Felty’s syndrome

A

Combo of RA (which produces an ulnar deviation of fingers), splenomegaly, and neutropenia

Significant # of Pt’s w/ Felty’s syndrome have monoclonal proliferation of large granular lymphocytes (NK cells)

B&B
49
Q

Causes of neutrophilia

A
  1. Acute bacterial infections
  2. Tissue necrosis (i.e. MI, trauma, burns)
50
Q

What malignancy is associated w/ eosinophilia?

A

Hodgkin lymphoma

51
Q

Lymphocytosis is not seen w/ bacterial infections, except for what?

A

Bordetella pertussis (whooping cough)

Produces lymphocytosis-promoting factor

52
Q

Receptor for EBv?

A

CD21 - on pharyngeal epithelial cells and B lymphocytes

53
Q

Toxoplasma lymphadenitis

A

Reactive B lymphocytes result in hyperplasia of the lymphoid follicles and germinal centers (follicular hyperplasia)

Characterized histologically by follicular hyperplasia, proliferation of monocytoid B cells, and epithelioid histiocytes infiltrating lymphoid follicles

54
Q

What proliferating cells cause hyperplasia of the interfollicular regions and the paracortex

A

Reactive T lymphocytes - occurs during viral infections

55
Q

Polycythemia rubra vera is caused by a mutation in?

56
Q

lab findings: increased EPO, decreased O2 saturation, plasma volume unchanged

A

Secondary polycythemia with appropriate causes of increased EPO

57
Q

Polycythemia due to inappropriate secretion of EPO

A

Paraneoplastic syndrome seen with:

Renal cell carcinomas
Hepatocellular carcinomas
Cerebellar hemangioblastomas

58
Q

Increased reticulocytes in the peripheral smear rules out what type(s) of anemia?

A

anemias caused by decreased red blood cell production in the bone marrow:

iron deficiency anemia
vitamin B12 deficiency anemia
folate deficiency anemia
aplastic anemia

59
Q
A

Hypoplasia of thumbs - associated w/ Fanconi anemia

60
Q

Peripheral smear obtained from Pt w/ sickle cell disease. Lab shows Hg of 5.6 g/dL. What is the likely cause?

A

Caused by parvovirus B19

Causes aplastic anemia in children with hemolytic anemia

61
Q

In otherwise healthy children, parvovirus B19 causes what physical finding?

A

Slap cheek appearance

62
Q

15 y/o girl is evaluated due to persistent fever, fatigue, and sore throat. Physical exam reveals splenomegaly and symmetric posterior cervical lymphadenopathy. Peripheral smear results are shown. What is the Dx, what are the cells shown?

A

Infectious mononucleosis

CD8+ lymphocytes

63
Q

Where is EPO normally made?

A

Renal peritubular interstitial cells of the renal cortex

64
Q

Tumor most associated w/ secondary polycythemia

A

Renal cell carcinoma

MI Immuno/Heme (35 decks)

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