diseases of the blood Flashcards
diseases of the blood
1) big category
- anemias
- leukopenias
- thrombocytopenia
- leukemia
- lymphomas
- bleeding
reactive vs neoplastic lymph nodes
1) enlarged are active
- freely movable
- soft to firm
- tender
2) neoplastic
- fixed
- firm to hard
- non tender and non painful
- progressive enlargement
3) chronic specific infections
-tb
- movable, firm, minimal tender, progressive enlargement
lymphoid hyperplasia
1) reactive lymph node
- neck
- intraoral
2) reactive lymphoid hyperplasia (non nodal)
- palatine tonsil
- waldeyers ring
- hyperplastic lingual tonsil
3) a related lesion
- lymphoepithelial cyst
anemia
1) categorized by how big the cells are and how darkly they stain
2) microcytic
- low or normal RBC
- lead poisoning
- iron deficiency
3) normocytic anemia
- RBC look normal
- autoimmune diseases
- acute blood loss
- less O2 carrying
4) macrocytic
- larger RBC, redder
- vitamin B12 deficiency
- folic acid deficiency
clinical anemia
1) weakness, fatigue, pallor
result of
1) decreased number, size, or HgB content of RBC
- can be secondary to nutrient deficiency or RBC loss (chronic bleeding)
- failure of RBC formation (leukemia or other marrow space occupying disease)
- HgB malformation
anemia definition
1) decreased oxygen carrying capacity of blood
2) evaluate by blood draw
- RBC count
- Hb concentration
- hematocrit
- classified by red cell indices (MCV, MCH, MCHC)
3) size: micro, normo, macro
4) color: hyper, normo, hypo
MCV
1) mean corpuscular volume
- Hct/RBC
MCH
1) mean corpuscular hemoglobin
- HgB/RBC
iron deficiency anemia
1) pummer vinson syndrome
2) more prone to gastric carcinomas
3) get iron!
vitamin B 12 or folic acid deficiency
1) pernicious anemia
2) inflammation of the tongue
- enlarged, reddened, smooth
RBC destruction
1) autoimmune
2) fetal erythroblastosis
herediary
1) sickle cell anemia
2) thalassemia
aplasia
1) of the bone marrow
2) radiation
oral features of anemia
1) mucosal pallor
2) mucosal atrophy
3) hunters glossitis
4) rare jaw radiolucency
- increase hematopoiesis esp in thalassemia
sickle cell anemia
1) autosomal recessive
2) mutation thymine for adenine in B hemoglobin chain
3) weird step ladder trabecular pattern
thalaseemia
1) deficiency of alpha or beta Hgb chain
2) major and minor forms
3) enlarged jaws from increased hematopoiesis
aplastic anemia
1) total bone marrow aplasia
- etiology unknown but may be environmental toxin
2) clinical
- anemia, infection and bleeding
3) periodontitis, ulcer, bleeding
leukopenia
1) aplastic anemia
1) agranulocytosis
- myelodysplastic syndrome
3) neutropenia
- more bacterial infections bc less neutrophils
5) cyclic neutropenia
agranulocytosis
1) absence of granulocyte
2) more bacterial infection
3) idiopathic or drug induced
4) oral
- necrotic ulceration and gingivitis
5) histo
- absent or deficient neutrophils in ulcer base
generic neutropenia
1) decrease in circulating PMNs
2) increased susceptibility to infection
3) may be
- idiopathic
- drug induced (most common cause)
- secondary to other disease like leukemia, osteopetrosis, gaucher’s disease
- ineffective hematopoiesis (myelodysplasia)
cyclic neutropenia
1) associated periodic infections and may have accelerated periodontitis
2) oral
- aphthous like ulcers
- lymphadenopathy, fever
3) typical 21 day cycles
- 3-6 days each
- treated by oncologists
neutrophil dysfunction
1) x-linked defects in neutrophil and monocyte
2) opportunistic bacterial and fungal infection
- pneumonia
- lymphadenitis, etc
3) other related conditions
leukocytosis
1) inflammatory. infectious
2) more WBC circulating
3) bacterial or neutrophilic
4) viral, lymphocytic
- more lymphocytes
- infectious mononucleosis from EBV
5) neoplastic
- leukemia
leukemia definition
1) malignancies of WBC from blood marrow
2) lymphocytic, myelogenous (granulocyte)
3) expression in peripheral blood
- elevated WBC with blast atpical looking cells
classes of leukemia
1) acute
- immature and blast like
- fulminant course (rapid)
2) chronic
- mature cells
- indolent course (slower)
—
1) ALL
- children
2) AML
3) CML
4) CLL
- elderly
leukemia etiology
1) viral, chemical, radiation
2) downs and other syndromes
3) CML- Philadelphic chromosome t(9;22)
leukemia lab features
1) elevated WBC with abnormal differential
2) abnormal cells in peripheral blood
3) rare aleukemic form with leukopenia
4) abnormal bone marrow
oral manifestation of leukemia
1) bleeding
2) gingival enlargement
3) ulceration
4) infection
5) localized chloroma
leukemia treatment
1) induction and maintenance phases
- chemo
- radiation
- bone marrow or stem cell transplant -
2) treatment produces many side effects as the disease progresses
leukemia prognosis
1) ALL
- fair
2) CLL
- best
3) AML
- worst
4) CML
- bad
WHO simple classification of lymphomas
1) precursor B cell neoplasms
2) peripheral B cell neoplasm
3) precursor T cell neoplasms
4) peripheral T cell and NK cell neoplasms
5) hodgkin lymphoma
hodgkin lymphoma
1) malignancy of reed-sternberg cells
- predominantly nodal disease, almost never orally
- early features mimick infection
- treatment with chemo and radiation
2) owl’s eye appearance of reed-sternberg cells
3) affects one single lymph node chain but can spread to contiguous nodes
4) infects young adults around age 32
5) usually curable with chemo
non hodgkin lymphone
1) 5x more common than hodgekin
- worse prognosis
2) seen in lymph nodes and extra nodal sites
- and seen intraoral and primary jaw tumors
3) most are B cell tumors
more indolent lymphomas
1) less treatment options
2) Takes years to kill
3) if you didnt treat them, they will survive quite long before it kills them
burkitts lymphoma
1) endemic and sporadic
2) mainly extranodal
- rarely with lymph nodes
3) sheets of blue cells with macrophages
- dark sea with starry sky
4) associated with AIDs
5) malarial belt of africa (endemic)
- associated with EBV
6) sporadic (bowels, and viscera)
midline granuloma
1) can have ulcerated lesion of palate
2) pain and necrosis
plasma cell lesions
1) multiple myeloma
2) plasmacytoma
3) extramedullary plasmacytoma
4) defective protein (M protein) in blood and urine
- histology is always sheets of neoplastic plasma cells
multiple myeloma
1) older people 60>
2) little holes in the bone
3) plasma cells in the bone marrow
- myeloma
4) lower back pain
5) punched out radiolucencies
6) amyloid deposits in tongue
solitary plasmacytoma
1) solitary bone lesion of Ig producing malignant plasma cells
2) might not be detected in blood and urine
- no bone marrow involvement
3) often progress to myeloma
know the clotting cascade diagram
1) intrinsic and extrinsic pathway
blood coagulation in vivo
1) platelets with tissue factor
2) platelet aggregation
-also need von willebrand
bleeding disorders
1) platelets and clotting factors
- need thromboxin A2 and von Willebrand for platelet aggregation
- can’t take aspirin if you have bleeding problems
2) easy bruising, prolonged bleeding, spontaneous gingival hemorrhage, hematoma, bleeding elsewhere, pupura
testing for bleeding disorders
1) prothrombin time
- efficacy of extrinsic pathway
- mostly factor VII
2) partial thromboplastin time
- intrinsic pathway
- factor VIII and IX
3) platelet count
4) bleeding time, clotting time
5) platelet aggregation assay
platelet deficiency
1) thromobocytopenia
- numbers of platelets low
2) defective adhesion
- thrombasthenia and thrombocytopathia
vascular wall fragility
1) vitamin C deficiency
2) hereditary hemorrhagic telangectasia
- microbleeds everywhere
coagulation factor deficiency
1) tests for PTT and PT, and INR
2) hereditary / genetic
- factor 8, factor 9, von willebrands deficiency, etc.
3) acquired
- primary liver disease
- biliary obstruction
- steatorrhea
- anticoagulant drug
what does aspirin do
1) block thromboxane A2
2) bleeding issues
how does a new clot initiate
1) formation of platelet plug
- platelets stick to proteins using von willebrand
2) activation of coagulation cascade
- tissue factor, initiate the cascade
3) inhibition of fibrinolysis
- disturbed endothelial cells secrete PA1 which limits fibrinolysis
primary or secondary deficiency of platelets
1) primary idiopathic thrombocytopenic purpura
2) secondary leukemia, HIV, aplastic anemia
thrombocytopenia
1) primary autoimmune
2) secondary due to drug exposure or other disease
- clinical hemorrhage, esp petichiae
thrombocytopathia
1) aspirin toxicity inhibits for the platelet life 8-10 days
2) vonwillbrands disease
- deficient vWF
3) primary hereditary defect
- GP-IIIa are required for aggregation
wafarin
blocks vitamin K
heparin
1) anti thrombin, plasma thromoplastin
GI malabsorption
1) sprue or biliary disease
2) deficient vitamin K
memorize beautiful diagram
:(
important points on clotting cascafe
1) actual initiating event in body is exposure of tissue factor to blood
2) intrinsic arm initiators are not necessary for clotting in vitro
