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Bloc F - Defense > Hematology > Flashcards

Hematology Flashcards

1
Q

Factors influencing the CBC?

A
  1. Activity
  2. Stress
  3. Altitude
  4. Time of day
  5. Medications
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2
Q

Information in a routine CBC?

A
  • Total White blood cell count
  • Total red cell count
  • Hemaglobin
  • Hematocrit: % of red blood cells in X volume of blood
  • Mean cell volume (MCV): average size of RBCs
  • Mean cell haemoglobin (MCH)
  • Mean corpuscular hemoglobin concentration (MCHC)
  • Red Cell Distribution width
  • Platelet count
  • Mean platelet volume
  • Relative (can be wrong)
    • Neutrophil
    • Lymphocyte
    • Monocyte
    • Eosinophil
    • Basophil
  • Absolutes
  1. Manual Differentials (microscope)
  2. Automated (machine)
  • Reticulocytes/nucleated red blood cells
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3
Q

What test is not included in a CBC that is very important in the diagnosis of RBCs disorders??

A

Reticulocyte count: should be the starting point for any assessment of anemia (low blood hemoglobin)

  • Too few reticulocytes – impaired production
  • Increased reticulocytes – accelerated destructions
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4
Q

What are white blood cells counts?

A
  • All circulating nucleated hematopoietic cells with the exception of nucleated red blood cells (NRBCs).
  • WBC used to diagnose and manage patients with hematologic and infectious diseases, or problems with the immune system.
  • Used to monitor patients receiving cytotoxic drugs, radiation therapy, and some antimicrobial drugs
  • The absolute neutrophil count, (ANC) is helpful in monitoring chemotherapy patients, and the absolute neutrophil count is a superior indicator of infection and inflammation
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5
Q

What is the role of Neutrophils?

A

Neutrophils are granulocytes and account for 50%–62% of WBC

Neutrophils are subclassified according to their age or maturity, which is indicated by changes in the nucleus

  1. Metamyelocyte: youngest neutrophil, large nucleus, round or bean-shaped
  2. Neutrophil band or stab (3%–6%): the nucleus is elongated and curved (horseshoe or S-shape)
  3. Segmented neutrophil: mature neutrophil, the nucleus is separated into 2-5 segments or lobes

Don’t normally circulate, they stick to blood vessels and go where they need to go when there is a signal (demargination)

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6
Q

What is the role of Lymphocytes?

A

Lymphocytes are agranulocytes. They are the brain of the immune system, response to specific organisms, types:

  1. T cell: matures in thymus, recognize antigen and stimulates immune response
  2. B cell: stimulated by T cells, matures in the bone marrow, several subtypes divided into regulator or effector cell, synthesis antibodies
  3. Natural killer cells: respond to a changes in normal cell states, directly attacks tumour and virally infected host cells
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7
Q

What is the role of Monocytes?

A
  • Monocytes are agranulocytes
  • Monocytes: the largest WBC circulating in peripheral blood
  • Monocyte –> macrophage in the tissue
  • Macrophages in tissue have different names related to the particular tissue in which they are found
    * Are the predominant leukocyte within 48 hours after injury
  • Monocytes and macrophages are described as one system: mononuclear phagocyte system
  • Macrophages: first cell to engulf and process the antigen and present it to the lymphocytes stimulating a specific immune response to that antigen. They destroy the organism while keeping its cell surface markers to give to the lymphocytes so that they can identify that organism and mount a defense
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8
Q

In what conditions basophils and eosinophils increase?

A
  • Bacterial infections
  • Acute inflammatory diseases
  • Cancer (particularly with marrow metastasis)
  • Tissue necrosis
  • Acute transplant rejection
  • Surgical and orthopedic trauma
  • Myeloproliferative diseases
  • Steroid use
  • Pregnancy (mainly during the third trimester)
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9
Q

What is the role of eosinophils ?

A

To kill larger organisms

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10
Q

What is the role of basophils?

A

hypersensitivity reactions (allergies)

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11
Q

What are the granulocytes WBC?

A
  1. Eosinophils
  2. Basophils
  3. Neutrophils
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12
Q

What are the agranulocytes WBCs?

A
  1. Lymphocytes
  2. Monocytes
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13
Q

What WBCs are hard to count?

A
  1. Monocytes
  2. Basophils
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14
Q

What is Neutrophilia?

A

+++ neutrophils

  1. Caused by acute bacterial infection Þ rise 4 to 6 hours after an invasion by microorganisms
    * *“Shift to the left”:** infection present, new neutrophils, immune system is active
  2. Associated with obesity and smoking, the stress of surgery, medications
    * *“Shift to the right”** = an increased neutrophil count without the immature cells
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15
Q

What is Neutropenia?

A
      • neutrophils due to severe prolonged infection
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16
Q

What is Monocytosis?

A

+++ monocytes

  1. Absolute monocytosis: marker of a myeloproliferative disorder (e.g., chronic myelomonocytic leukemia) until proved otherwise Þ bone marrow examination and cytogenetic studies + hematology consultation
  2. Relative monocytosis: seen during recovery from drug-induced neutropenia
17
Q

What is Lymphocytosis?

A

+++ lymphocytes due to viral or B-cell leukemia

18
Q

What is Eosinophilia?

A

+++ eosinophils in response to parasitic infections (e.g. toxoplasmosis, GI parasites)

19
Q

What is Basophilia?

A

An hypersensitive response, look for allergies

20
Q

Gross component of blood?

A

55% plasma (acellular), serum = plasma without clotting factors

45% cellular elements

21
Q

What are the causes of anemia?

A
  • Deficiency of RBC “building blocks”
  • Congenital anomaly of the contents of RBC
  • Anomaly in the production of the RBC
  • Accelerated RBC loss via bleeding
  • Accelerated destruction of RBC (i.e. decreased lifespan) – hemolysis
  • Chronic illness with suppressed erythropoiesis
22
Q

What is the approach to anemia?

A
23
Q

B12 deficiency can be due to what?

A
  • Pernicious anemia (autoimmune destruction of parietal cells of the stomach Þ no intrinsic factor)
  • Nutrition
  • Malabsorption due to associated gastrointestinal abnormalities
24
Q

Folate deficiency can be caused by what?

A
  • drugs
  • increased loss (dialysis)
  • increased utilization (pregnancy, psoriasis)
  • malabsorption
  • nutrition
25
Q

Most common cause of anemia worldwide?

A

Iron deficiency

26
Q

What is Thalassemia anemia?

A

An haemoglobin structure problem, common in Mediterranean, Middle Eastern, African, South and Southeast Asian descent

27
Q

What is Hemolytic anemia?

A

An increased breakdown of red blood cells –> high LDH, biliburin, reticulocyte

CAUSES:

  1. Extra-corpuscular (outside)
  2. Red blood cell membrane (inside) Þ sickle cell anemia
  3. Enzyme defects (inside)
  4. Hemoglobin (inside)
28
Q

Myeloproliferative Disease?

A
  • Increased cell number but intact differentiation
  • May affect one ore more cell lines
  • CML – protoype disease driven by bcr-abl kinase
29
Q

lMyelodysplastic Disease?

A
  • Low and high risk disease – may transform to AML
  • Impaired Differentiation: Increased bone marrow cells with decreased circulating cells
30
Q

Acute Myeloid Leukemia?

A
  • Most common in adults
  • Variable prognosis depending on cytogenetics
  • Treatment is targeted treatment and chemotherapy
31
Q

lAcute Promyelocytic Leukemia (M3)?

A
  • Type of AML
  • PML-RARa gene from translocation of chromosomes 15 and 17
  • Good prognosis with All-trans-Retinoic Acid
32
Q

Acute Lymphoblastic Leukemia?

A
  • Most common in children
  • Excellent response to multiagent chemotherapy if in childhood, prognosis worse in adults
  • Types:
  1. B lineage (80%)
  2. T lineage (20%)
33
Q

Types of Chronic leukemia?

A
  1. Chronic lymphocytic leukemia (CLL)
    1. A subtype of B cell lymphoma
    2. Atypical CD5 expression (CD5 is a T cell marker)
  2. Chronic myeloid leukemia (CML)
34
Q

Types of Myeloproliferative neoplasms?

A
  1. Chronic Myeloid Leukemia
    Mainly white blood cells affected that results in accumulation of uncontrolled granulocytes
    Starts with chronic phase (4-7 years) Þ accelerated Þ blast phase
    Treatment is targeted therapy
  2. Essential Thrombocytosis – mainly platelets affected
  3. Polycythemia vera – mainly rbc cells affected
  4. Myelofibrosis – mainly accumulation of bone marrow fibroblasts
35
Q

Clinical manifestations of acute leukemia?

A
  • Pancytopenia from marrow failure: neutropenia, anemia, thrombocytopenia
  • Constitutional Symptoms: fevers, fatigue, bone pain, malaise
  • Direct Tissue Infiltration by blast cells
  • Leukostasis syndromes: accumulation of blasts in microcirculation with impaired perfusion
  • Tumour Lysis Syndrome
  • Coagulation Disturbances
  • Usually short duration of symptoms (weeks to months)

Bloc F - Defense (7 decks)

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