Dr. Singh Hematopathology Combined Lecture Flashcards
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
BS shows myeloblasts
AML
Stained brown by myeloperoxidase (MPO)
AML sx is fever, pain, fatigue and bruising for what reasons
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
How to classify AML and what are some types
Cytogenetics (FISH study) to see what translocation happened
- 8 :21 (classic)
- 15 :17
- Inversion 16
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
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
Megaloblastic anemia conditions
Folate Deficiency (diet, pregnancy, other conditions, chronic blood loss) B12 deficiency (from diet, pernicious anemia, h-pylori, chronic blood loss)
Macrocytic anemia conditions
Thyroid hypothyroidism Chronic lung disease/hypoxia MDS Hyperglycemia Cold aggluttinins
What does the BM look like in pernicious anemia and reason for this
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)
SX or B12 deficiency and reason for them
- difficulty walking or CNS problems : B12 needed for methylation
- Smooth swollen tongue, and sores on the side of them
- Anemia : fatigue At times
If you see gait or mental changes what should you include to test for
B12 levels
How to TX pernicious anemia
Injectable B12
CASE 3 : LUQ pain and palpable spleen, - Hgb : normal - WBC : N - Plt : LOW PE : no easy brushing or bleeding
Large spleen + thrombocytopenia = hypersplenism
spleen is storing platelets used when needed = congestive splenomegaly due to liver cirrhosis from chronic hepatitis B
Reason spleen starts storing platelets and enlarging
- 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
Immune thrombocytic purpura causes what simple
Spleen destroys all platelets due to autoimmune response to it IgG opsonizing and complement on them
Ex of when you can have hypersplenism with thrombocytopenia
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
How to TX thrombocytopenia when the patient has hypersplenism and spleen store the platelets
Make shunt from the liver portal vein to the IVC (allowing for some the bleed to be skipping the liver)
can someone with congestive splenomegaly from cirrhosis of the liver have bleeding problems
Over time yes because the liver makes the clotting factors needed = deep wounds
= F2,7,9,10 (VIT K derived ones)
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
Opioids helps pain and should be given during crisis
osteonecrosis of femoral head confirm with CT scan
In SC what are the cells like
Sickle (polymerized of HbS continuously)
Sticky (inflammatory processes)
What can happen in SC
Strokes Pulmonary HTN Cardiomegally Ostronecrosis in BM Spleen is infarcted and nonfunctional
SC TX
- Chronic transfusion: can cause Fe overload ????+ allimmunization from many transfusions (IgG mediated)
- Pharmacotherapy to increase HbF : can cause a hard time for O2 to get to muscles and organs it needs
- Gene therapy
- Stem cell transplantation
Reason it is had to get many transfusion for SC
Duffy protein is rare in as a-,b- in white people and very high in black people
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
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
B sx are what
Night sweats
Fever
Loss of weight
= are more aggressive and tx more aggressively
