Dr. Singh Hematopathology Combined Lecture

Question 1

CASE 1: child comes in with fever, lethargy, pain, bruising,
Petichea
- HgB low
- WBC high
- Platelets low
BS : circulating blasts + little red specks in cytoplasm
BM : dry tap, biopsy shows packed cells
what does this patient have and how to make the final dx

Answer 1

BS shows myeloblasts
AML
Stained brown by myeloperoxidase (MPO)

Question 2

AML sx is fever, pain, fatigue and bruising for what reasons

Answer 2

Fever : low granulocytes (no energy and all of them are blasts) + opportunistic infection
Fatigue : low erythrocytes are made (no energy)+ reticulocytes are low
Bruising : low platelets (low energy)
Pain : BM growing enlarged by cells

Question 3

How to classify AML and what are some types

Answer 3

Cytogenetics (FISH study) to see what translocation happened

1. 8 :21 (classic)
2. 15 :17
3. Inversion 16

Question 4

CASE 2: elderly patient and she has dropped weight and difficulty walking, hurts to eat food due to stomach and mouth
PE : smooth and irritated swollen tongue
Hgb: low
WBC : low
Plt : low
MCV : high
MCH : N
MCHC : N
BS : many enlarged cells across many cell lines
BM : packed with cells
= what does she have and how to confirm

Answer 4

BS : megaloblastic anemia
Pernicious anemia and confirm with B12 counts + biopsy of the stomach (you see goblet cells, lymphocytes, and intestinal mucosa) AND anti-IF ABs or anti-parietal cell ABs

Question 5

Megaloblastic anemia conditions

Answer 5

Folate Deficiency (diet, pregnancy, other conditions, chronic blood loss)
B12 deficiency (from diet, pernicious anemia, h-pylori, chronic blood loss)

Question 6

Macrocytic anemia conditions

Answer 6

Thyroid hypothyroidism
Chronic lung disease/hypoxia
MDS
Hyperglycemia 
Cold aggluttinins

Question 7

What does the BM look like in pernicious anemia and reason for this

Answer 7

Packed with cells due to the cells that are being released are megaloblastic and macrocytic and dont function well = Anemia
SO the BM trys to make a bunch (DNA synthesis is effected)

Question 8

SX or B12 deficiency and reason for them

Answer 8

1. difficulty walking or CNS problems : B12 needed for methylation
2. Smooth swollen tongue, and sores on the side of them
3. Anemia : fatigue At times

Question 9

If you see gait or mental changes what should you include to test for

Answer 9

B12 levels

Question 10

How to TX pernicious anemia

Answer 10

Injectable B12

Question 11

CASE 3 : LUQ pain and palpable spleen,
- Hgb : normal
- WBC : N
- Plt : LOW 
PE : no easy brushing or bleeding

Answer 11

Large spleen + thrombocytopenia = hypersplenism

spleen is storing platelets used when needed = congestive splenomegaly due to liver cirrhosis from chronic hepatitis B

Question 12

Reason spleen starts storing platelets and enlarging

Answer 12

1. Something causes spleen to enlarge and platelets love staying in the spleen and start staying there many of them instead around circulation : still able come help when needed = they dont bleed excessively

Question 13

Immune thrombocytic purpura causes what simple

Answer 13

Spleen destroys all platelets due to autoimmune response to it IgG opsonizing and complement on them

Question 14

Ex of when you can have hypersplenism with thrombocytopenia

Answer 14

Of portal vein is clogged due to hepatitis or cirrhosis and the blood backs up to the splenic artery that leaves it for the liver
= a bunch of blood pools in the spleen and planets start being stored there
= CONGESTIVE SPLENOMEGALY

Question 15

How to TX thrombocytopenia when the patient has hypersplenism and spleen store the platelets

Answer 15

Make shunt from the liver portal vein to the IVC (allowing for some the bleed to be skipping the liver)

Question 16

can someone with congestive splenomegaly from cirrhosis of the liver have bleeding problems

Answer 16

Over time yes because the liver makes the clotting factors needed = deep wounds
= F2,7,9,10 (VIT K derived ones)

Question 17

CASE 4 : pt comes with Sickle Cell Disease with SC crisis pain
BS : sickles cell, darker pink-purple reticulocyte found also
PE : hip pain
= what is going on and how to confirm

Answer 17

Opioids helps pain and should be given during crisis

osteonecrosis of femoral head confirm with CT scan

Question 18

In SC what are the cells like

Answer 18

Sickle (polymerized of HbS continuously)

Sticky (inflammatory processes)

Question 19

What can happen in SC

Answer 19

Strokes
Pulmonary HTN
Cardiomegally
Ostronecrosis in BM
Spleen is infarcted and nonfunctional

Question 20

SC TX

Answer 20

1. Chronic transfusion: can cause Fe overload ????+ allimmunization from many transfusions (IgG mediated)
2. Pharmacotherapy to increase HbF : can cause a hard time for O2 to get to muscles and organs it needs
3. Gene therapy
4. Stem cell transplantation

Question 21

Reason it is had to get many transfusion for SC

Answer 21

Duffy protein is rare in as a-,b- in white people and very high in black people

Question 22

CASE 5 :pt started college, night sweats, fever for past 2 months, loosing weight, pain in chest after drinking alcohol 
PE : no heart attack 
X-ray : SHOWS WHAT ?
= what does he have and how to confirm
BS : What

Answer 22

X-ray = mediastinal mass
BS : Owel eye reed-stein berg cell (excising the LN involved)
Hodgkin’s lymphoma with B-type sx = confirm with the biopsy of entire LN taken out for the owl eye cells

Question 23

B sx are what

Answer 23

Night sweats
Fever
Loss of weight
= are more aggressive and tx more aggressively