Episode 8-HemePath Flashcards by Austin Shackelford

What are the three CBC tests that can demonstrate anemia?

1.MCHC 2.Hematocrit 3.RBC count

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Pallor,Tachycardia / Palpitations, Worsening of angina are some of the less common symptoms of what condition?

Anemia

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What are the four basic causes of acquired anemias?

1.Specific Deficiencies (iron, B12, B9) 2.Blood Loss (acute or chronic) 3. Chronic Disease (TONS) 4.Hemolysis (aquired autoimmune hemolytic anemia)

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HE LOVES THIS QUESTION STYLE: What is the MOST COMMON cause of anemia worldwide?

Iron Deficient Anemia

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What are the two results of iron deficient anemia? Which CBC tests do we use to see these results?

MicroCytic (MCV decreased) and HypoChromic (MCH & MCHC decreased)

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Which anemia is associated with PENCIL CELLS? This occurs because of unbalanced surface membrane to _______ due to reduced _________.

Iron Deficient Anemia….cytoplasmic volume….hemoglobin

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A reduced rate of _________ synthesis results in more cell division and subsequently smaller cells. Lower levels of hemoglobin in the RBCs make them appear “______”.

hemoglobin…“pale”

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What is the molecule that binds iron in the blood? What is the molecule that stores iron in the liver?

Transferrin in the blood, Ferritin in the liver

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What is the major cause of Iron deficiency?

Overt or Occult BLOOD LOSS

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What are: traumatic hemorrhage, hematemesis, melena, hemoptysis, severe menorrhagia, and gross hematuria ALL EXAMPLES OF?

OVERT blood loss

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What are the four main causes for iron deficient anemia?

1.Blood Loss 2.Drecreased Iron Absorption 3.Diet 4.Inreacsed Iron requirements

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What can a problem with the GI tract (e.g., bleeding ulcer, inflammatory bowel disease, etc.) or an issue with a drug impairing iron absorption lead to?

Iron deficient anemia c/o decreased iron absorption

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Which cause for Iron deficient anemia is most common for vegans and elderly?

Lack of iron in DIET

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What can result if a child is growing (in the womb or out) and they are not receiving enough iron?

Iron deficient anemia c/o changing Iron requirements

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Decreased vitamin B12 levels produce RBCs that are _________ (_______ is elevated).

MACROCYTIC….MCV

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What is another name for Vitamin B12 deficient anemia?

MEGALOBLASTIC ANEMIA

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All actively dividing RBCs in the bone marrow require DNA synthesis in order to undergo mitosis. The metabolic pathways involved in replication of DNA are complex, and involve both ________ and ______.

vitamin B12…. folate.

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Which cellular process is not affected in Megaloblastic anemia?

RNA Synthesis…proteins keep building up inside the cell

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What is needed to absorb Vitamin B12 in the gut? What type of anemia is the result if this is not present?

Intrinsic Factor….PERNICIOUS ANEMIA

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What are the two causes for a lack of Intrinsic factor?

AutoImmune Attack on:1. The Intrinsic Factor itself or 2.The PARIETAL cells in the STOMACH

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What is the result of an autoimmune attack on Parietal Cells of the stomach (OTHER then pernicious anemia :))

Chronic Atrophic Gastritis

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Recap: What are the three ways of developing a Vitamin B12 deficient anemia?

Lack of IF (Pernicious Anemia) 2.Diet(strict vegans) 3.Gastric Bypass Surgery!

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Which deficiency produces the same clinical features as vitamin B12 deficiency?

Folate deficient anemia

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What are the two key players in DNA synthesis in respect of this lecture?

Vitamin B12 and Folate

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Does Folate require intrinsic factor to be absorbed?

NO!

In which anemia does the MCV remain normal? This anemia is described as __________.

Acute Blood Loss Anemia.....NORMOCYTIC

Which type of blood loss is associated with iron deficient anemia in the developed world?

Chronic Blood Loss Anemia

Why can renal failure cause anemia?

Less ErythroPOetin!!

_________ anemias are disorders in which the red cells are destroyed faster than normal. What is the long, fancy name for this?

Hemolytic, AIHA (aquired autoimmune hemolytic anemia)

What are the three categories of inherited anemias?

1.Red Cell Membrane(hereditary spherocytosis, elliptocytosis) 2.Red Cell Enzymes (G6DP deficiency) 3.Hemoglobin Molecules(sickle cell, thalassemia)

Which genes are affected in Elliptocytosis?

The same ones as spherocytosis!! Spectrin, Ankyrin, Band 3 and Protien 4.2

The defects of Elliptocytosis destabilize the________ ________ of cells and the cells go poof!

cytoskeletal scaffolding

Osmotic fragility is a test used to detect _________ and ________.

spherocytosis....elliptocytosis

What is calculated int he osmotic fragility test? How much of the cells lyse at this amount of osmotic pressure?

The Mean Corpuscular Fragility (MCF)..Where 50% of the cells lyse

What is the MOST COMMON enzymatic disorder in the WORLD affecting over 400 million people?? What type of genetic disorder is it?

Glucose-6-Phosphate Dehydrogenase (G6PD)...X linked

G6PD is the only source for ____ in the RBC. What is the function for this molecule?

NADPH...Keeps GLUTATHIONE in REDUCED form!!

What are the two characteristics of RBCs in G6PD deficiency?

Heinz Bodies (cluster of denatured hemoglobin..olive w/ dot) and Bite Cells (look like bites have been taken out by the spleen!)

Sickle cell disease results from a _____ mutation in the _____ globin gene, resulting in a change of amino acid number 6 (___----> ___). The resultant hemoglobin produced by the faulty gene is referred to as _______ __ (___).

point...Beta...Glu (Glutamine)---->Val (Valine)....hemoglobin S (HbS) (HbShitty! or HbSickle)

In sickle cell anemia, these RBCs to do not flow well through small vessels, and are more adherent than normal RBCs to vascular endothelium, leading to vascular ______ and sickle cell ______.

occlusion...crises

__________ arises as a result of diminished or absent production of one or more of the globin chains.

Thalassemia

What is the end result for thalassemia?

Chronic Hemolysis...WEIRD!

Where do Thalassemia's occur?

Same places as Sickle cell! (Africa, Medit, Mid East, Asia, India)

How is Thalassemia classified?

After the gene associated..."alpha-thalassemia"=alpha glob in chain alteration

The consequence of impaired production of glob in chains in thalassemia leads to RBCs being __________ and _________.

MICROCYTIC.....HYPOCHROMIC

Leukemia literally means “white blood”, so-called because of the ________ numbers of white cells in the peripheral blood of patients with leukemia at the time of diagnosis. The cancer occurs with white blood cell _______.

ENORMOUS....precursors

What are the two forms of Leukemia?

Chronic and Acute

_____ _______ tends to present more dramatically, and must be treated early or death will occur within a short period of time.

Acute leukemia

In general, _______ ________ is more indolent (slow growing) and in some cases may not require therapy for years. They can be discovered by chance!

chronic leukemia

In both acute and chronic leukemias, there is progressive accumulation of abnormal white blood cells in the_____ ______ and other organs, which spill out into the peripheral blood.

Bone Marrow

In leukemia, patients tend to also have a reduced number of ______ and _________.

RBCs and megakaryocytes (High WBCs, Low RBCs, Low Platelets)

What does AML stand for?

Acute Myeloid Leukemia

What are the three WBCs that come from the Myeloid line?

Basophils, Eosinophils, and Neutrophils (ALL the granulocytes)

What is the most common acute leukemia affecting Adults?

AML

What are the 5 main symptoms of AML?

1.Anemia (and all that comes with it) 2.Suseceptible to infection (low lymphocytes) 3.Brusing/Bleeding (low Platelets) 4.Bone Pain 5.Respiratory/Neruo Manifestations (c/o high viscosity "sludging" of blood)

What does ALL stand for?

Acute Lymphoblastic Anemia

What are the three cells of the lymphocyte line?

1.B-Lymphocytes 2.T-Lymphocytes 3.Natural Killer Cells

Which acute leukemia is most common in childhood? About when does it occur?

Acute Lymphocytic Leukemia...2-5 years of age

What are the 5 main symptoms of ALL?

Which leukemia has the "Philadelphia" chromosome?

Chronic Myeloid Leukemia

When in life is Chronic Myeloid Leukemia presentation most common?

Between 40-60 Years of age

Which two chromosomes are swapping in the Philadelphia chromosome?

Philadelphia Chromosome = Top of Chromosome #22 + Bottom of Chromosome #9 (AND VICE VERSA!)

The Philadelphia Chromosome mutation of CML leads to transcription of proteins with high ______ _______ activity.

tyrosine kinase

What are the three phases of CML?

1.Chronic Phase (Asymptomatic..left side pain, abdominal swelling) 2.Accelerated Phase 3.Blast Crisis (resembles acute leukemia)

Which CML phase are 85% of patients at during diagnosis?

1. Chronic Phase

What does CLL stand for?

Chronic Lymphoblastic/Lymphocytic Leukemia

What is the MOST common adult leukemia?

CLL

What is the male:female ration of CLL? When is the peak incidence?

2male:1female..60-80yrs old

In contrast to Leukemias, lymphomas are _____ ______ _____ and can originate within many different lymphoid tissues, namely the ______ ______ (which is the most common), spleen, liver, GI tract, thymus or bone marrow.

solid tumor masses....lymph nodes

What causes Hodgkin's Lymphoma?

UNKNOWN!

What are the 6 presentations of Lymphoma?

1.Itchy Skin 2.Night Sweats 3.Weight Loss 4.ENLARGED LYMPH NODES 5.Splenomegaly 6.Hepatomegaly

___________ cells (“______ cells”) are characteristically seen when lymph nodes are biopsied in Lymphoma; these are B lymphocytes that have lost the ability to produce _______.

Reed-Sternberg cells (“popcorn cells”)....anitbodies

Basically, __________ are a group of lymphomas that include everything but Hodgkin’s lymphoma.

Non-Hodgkin's Lymphomas

What is more common: Hodgkins or Non-Hodgkins?

Hodgkins (2-3:100,00people) vs (66,000 new cases per year)

What are the symptoms of Non-Hodkins Lymphoma?

1.Itchy Skin 2.Night Sweats 3.Weight Loss 4.ENLARGED LYMPH NODES 5.Splenomegaly 6.Hepatomegaly