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Low Yield Semmelweis > Hematology - From Slides > Flashcards

Hematology - From Slides Flashcards

1
Q

How many red blood cells I have in the body?

Use

Volume and Normal RBC Count

A

Volume: 5L

RBC Normal Count: 5 T/L or milion per microliter

5x5x10^12 = 25 x10^12

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2
Q

What is the number of RBC lost in a day? hour? second?

Normal amount in the body: 25 x10^12

RBC Lifespan:120 days

(*Therefore this the amount produced as well)

A

Day: 25 x10^12 / 120 = 2 x 10^11 / day

Hour: 2 x 10^11 / 24 = 10^10 /hr

Second: 10^10/ 3,600 = 3x10^6 /s

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3
Q

What is the number of WBC lost in a day? hour? second? Relative to RBC

What is the number of Platlets lost in a day? hour? second? Relative to RBC

Number is not nesscesery!

How is it possible?

A

Similar to RBC!

RBC lifespan is higher, Accumulate more but the turnover is the same - Equilibrium!

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4
Q

Two ways of checking the bone marrow?

Location and Aim

A
  • Bone Marrow Aspiration - Sternum, Static Check
  • Bone Marrow Biopsy - Crista Ilia, Function Check
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5
Q

What is the differential blood count of WBCs?

A

Neutrophills - 45-70%

Monocytes - 2-8%

Eosinophills - 0-4%

Lymphocytes - 25-45%

Basophills - 0-2%

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6
Q

What is the Normal WBC blood count?

A

4-10 G/L

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7
Q

What is the Normal PLT blood count?

A

150-400 G/L

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8
Q

“Tornochi Principle” - As cells are differentiating:

  • Cell Size
  • Nuclear/Cytoplasmic Ratio
  • Nuclear Chromatin Density
  • Basophilia of Cell
  • Number of Nucleoli
A
  • Cell Size: ↓
  • Nuclear/Cytoplasmic Ratio : ↓
  • Nuclear Chromatin Density: ↑
  • Basophilia of Cell: ↓
  • Number of Nucleoli:↓
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9
Q

Definition of Blast Cells:

A

The earliest, Non-Stem cells, precursor that is easilly recognizable with microscope.

(“Tornochi Principle”)

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10
Q

Granulocyte Lineage

Which cell is larger Promyelocyte or Myeloblast?

Which cell is more potent Promyelocyte or Myeloblast?

A

Promyelocyte - Larger

Myeloblast - More Potent

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11
Q

Granulocyte Lineage

Which cell has only eosinophillic kind of granules Promyelocyte or Myelocyte?

A

Promyelocyte - Only Eosinophillic

Myelocyte - Both kinds

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12
Q

Granulocyte Lineage

Which cell has a oval shape nucleus?

Which cell shows the first kidney shape nucleus?

What is the outcome of a Metamyelocyte?

A

Myelocyte - Oval Shape

Metamyelocyte (aka Juvenile)- first show kidney shape

Metamyelocyte turns to Band cell

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13
Q

Granulocyte Lineage

What is the first kind of cell that is normal to see sometimes out of the Bone Marrow?

A

Metamyelocyte

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14
Q

What is a Left Shift in Granulocyte distribution?

What are the causes?

A

High relative amount of Juvenile and Band cells presence in the blood.

Caused as a response to Infection or by Leukemia

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15
Q

What is a Right Shift in Granulocyte distribution?

What are the causes?

A

High relative amount of Hypersegmented Neutrophills (5 segements nucleus, Overmature) presence in the blood.

caused by suppression of bone marrow activity, as a hematological sign specific for pernicious anemia and radiation sickness.

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16
Q

Proerythroblasts and Erythroblasts

What is the most dominant visible change in their progression?

also called?

A

Pronormoblasts and Erythroblasts

Becoming more Eosinophilic

More Hb and Less DNA content as it differentiates

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17
Q

Erythroid lineage

What are the names of the subtypes of the normoblast progression?

A

Pronormoblast

↓

Basophillic Normoblast

↓

Intermediate (aka Polychromatophillic) Normoblast

↓

Eosinophilic Normoblast (aka Acidophilic/Orthochromatic)

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18
Q

Erythroid lineage

Eosinophilic Normoblast (aka Acidophilic/Orthochromatic) - what will be the outcome of this cell (Next step)?

and after that one..?

A

Reticulocyte

becomes a Mature RBC

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19
Q

Erythroid lineage

What types of the Erythroid lineage cells are present in:

1) The bone marrow
2) Periphery

A

Erythroid lineage

Bone Marrow - All cell steps

Periphery - Reticulocytes and RBCs

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20
Q

Erythroid lineage

What is the significance of elevated amount of Reticulocytes?

How can we recognize them?

A

Can tell us about over or under- production of RBCs

More oval than RBCs with network of ribosomal RNA aka Substancia Reticulofilamentosa (not by Giemsa)

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21
Q

Erythroid lineage

Normal Precentage of Reticulocytes

A

1% in Total RBC Count

but absolute measurement is more Important per individual

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22
Q

What is the difference in the amount of WBC and PLT to RBCs?

A

RBC/WBC - 10^3 (Tera to Giga)

RBC/PLT - 10 (Tera to 100 Gigas)

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23
Q

Anemia

What are the Major parameters to check for it?

A

RBC

Hb

Ht

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24
Q

Anemia

What is MCV?

A

MCV= Ht/RBC

Mean corpuscular volume (MCV) is a laboratory value that measures the average size and volume of a red blood cell.

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25
Q

Anemia

What is MCH?

A

MCH= Hb/RBC

The mean corpuscular hemoglobin , or “mean cell hemoglobin” (MCH), is the average mass of hemoglobin (Hb) per red blood cell (RBC) in a sample of blood.

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26
Q

Anemia

What is MCHC?

A

MCHC= MCH/MCV (actually Hb/Ht)

The mean corpuscular hemoglobin concentration is a measure of the concentration of haemoglobin in a given volume of packed red blood cell.

Because normally Ht is aroud 50% the MCHC is Normally twice as the Hb.

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27
Q

Anemia

What are the implications of a changes of MCH and MCV in anemia?

A

MCH - Hyper/Normo/Hypo-Chromatic Anemia

MCV - Micro/Normo/Macro-Cytic Anemia

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28
Q

What is the key findings in Iron Deficiency Anemia (IDA)?

A

Microcytic - MCV↓

Hypochromic - MCH↓

(MCHC is low)

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29
Q

What is the key findings in Megaloblastic Anemia (Normally from B12/Folate Deficiency)?

A

Macrocytic - MCV↑

Hyperchromic - MCH↑

(MCHC is Normal)

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30
Q

Anemia

What is the absolute measurment value of anisocytosis?

A

RDW - Red cell Distribution Width

RDW=MCV/Standard Deviation

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31
Q

Anemia - Tests Significance

Se LDH

Se Bi (Indirect)

Se Haptoglobulin

Coombs Test

A

LDH and Bi - (Uncojugated) ↑ - Hemolytic

Coombs Test - Autoantibodies

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32
Q

What is the Reticulocyte Index?

A

_RI = [Reticulocyte(%) * Ht] / [Correction Factor *Norm Ht]_

-The correction factor is based on the abillity of the Bone marrow to release the reticulocytes depending on the Severity of anemia by the Ht.

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33
Q

RBC with Basophilic Stippling

What does this indicate?

A

Lead Poisning

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34
Q

RBC - Eliptocytes

What does this indicate?

A

Megaloblastic Anemia

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35
Q

RBC - Schistocytes

What does this indicate?

A

Fibrin Fibrills in the blood stream

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36
Q

RBC - Howell Jolly Bodies

What does this indicate?

A

Megaloblastic Anemia or Splenectomy

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37
Q

RBC - Spherocytes

What does this indicate?

A

Heredetery or by Immune Hemolytic Anemia

38
Q

RBC - Target Cells

What does this indicate?

A

Thalassemia

39
Q

RBCs - Echinocytes (Burr cells)

What does this indicate?

A

Altered lipid in cell membrane
Artifact
Uremia
Piruvate‐kinase deficiency
Aged transfused RBC

40
Q

RBC - Anulocytes

What does this indicate?

41
Q

RBC - Which parasites can live in it?

A

Plasmodium Genus - Malaria

42
Q

Transferrin

What is the meaning of the TIBC and what else will relate to this in it?

A

Transferrin Saturation is the relative iron binding capacity

TIBC is the absulote actuall total Iron Binding capacity

43
Q

What is the initial change in IDA?

A

Serum Ferritin ↓ - Reflects the Storage of Iron in the body.

44
Q

AML, MPN, MDS are all examples for :

A

Malignant Myeloid Groups of Disroders

45
Q

Neutrophills>7.5 G/l with Elevation of Band cells

this is defined as -

A

Neutrophillia caused by infection - Left Shift

46
Q

Eosinophills>0.5 G/l

A

Eosinophillia

47
Q

Leukomoid Reaction

A

Infection causing left shift

ddx from leukemia by markers

48
Q

Granulocytopenia:

General Causes (3)

A

Granulocytopenia:

  • Decreased granulocytopoiesis (aplasia)
  • ​Maturation problem
  • Increased loss of granulocytes
49
Q

Granulocyte count of Granulocytopenia

  • neutrophilic granulocyte count > 1 G/l :
  • 0.5 G/l < count < 1 G/l :
  • count < 0.5 G/l :
A

Granulocyte count of Granulocytopenia

  • neutrophilic granulocyte count > 1 G/l – no symptoms or mild infections
  • 0.5 G/l < count < 1 G/l – increased risk for infections
  • count < 0.5 G/l – severe bacterial and fungal infections, sepsis
50
Q

Major cause of Agranulocytosis

51
Q

Leukemia

  • What is the difference between Acute and Chronic ?
A

Leukemia

  • Acute - Death without treatment in a few weeks, Undifferentiated white blood cells
  • Chronic - Death without treatment in a few years, Differentiated white blood cells
  • Both are Malignant
52
Q

Leukemia

  • What is a Proliferative Advantage?
A

Leukemia

  • Ineffective inhibition of Proliferation in Malignant WBC due to genetic mutation. “Anti-Social WBC”.
  • This causing Chronic Leukemia
53
Q

Leukemia

  • What is a Maturation Inhibition?
A

Leukemia

  • Differentiation is halted in Malignant WBC due to very high rate of genetic mutation - Causing Acute Leukemia from Chronic Leukemia.
54
Q

Acute Myeloid Leukemia

  • What is a the precentage of Blast cells in Blood and Bone marrow?
A

Acute Myeloid Leukemia

  • Blood > 20%
  • Bone marrow > 20%
55
Q

Acute Myeloid Leukemia

  • WHO Classification: By Pathomechanism (4 types)
A

Acute Myeloid Leukemia

  • AML with reccurent genetic defects
  • AML from MDS/MPN
  • Therapy Induced AML
  • Mixed phenotype (M+L) and NOS (Non-otherwise specified)
56
Q

Acute Myeloid Leukemia

  • Key Symptomes
A

Acute Myeloid Leukemia

  • Hepatosplenomegaly with lymphadenopathy
  • Infections
  • Bleeding tendency
  • Anemia
  • Weight loss
  • DIC / Leukemic Thrombi
  • Osteomyelofibrosis
  • Auer rod in WBC
57
Q

Acute Myeloid Leukemia

  • Diagnosis
A

Acute Myeloid Leukemia

  • Hiatus Leukemicus - In preipheral blood
  • Bone marrow - Blast level > 20%
  • Genetic Abnormalties - Lamda/Kappa Ratio
  • Reciprocal Translocation
  • Immnuophenotyping
58
Q

Myeloproliferative Neoplasms

  • Unique Features
A

Myeloproliferative Neoplasms

  • Differentiated cells in periphery
  • Fibrosis
  • Progression to AML is common
59
Q

Myeloproliferative Neoplasms

  • CML is differentiated from other MPN by -
  • What is the detection method?
A

Myeloproliferative Neoplasms

  • Philadelphia Chromosome Positvity : 9:22 chromosomal translocation - ABL-BCR
  • Abl-BCR gene is detected by FISH
60
Q

Myeloproliferative Neoplasms

  • What are the different forms of Ph Negative MPNs?
  • What is the common mechanism of Mutation?
A

Myeloproliferative Neoplasms

  • Polycythemia vera (PV)
  • Essential thrombocytemia (ET)
  • Idiopathic myelofibrosis (IMF)
  • Other less common forms
  • ​Caused by different JAK mutations
61
Q

Chronic Myeloid Leukemia

  • What is the normal and CML M:E ratio?
A

Chronic Myeloid Leukemia

  • ​Normal - 2:1
  • CML - 30:1
62
Q

Polycythemia vera

Single base pair mutation?

A

Polycythemia vera

JAK2 (vast majority of cases)

63
Q

Polycythemia vera

DDX

A

Polycythemia vera

Polyglobulemia?

  1. EPO↑: Doping, Paraneoplastic, Altitude, Lung/Heart Disease (Mostly COPD), Hemoglobinopathies.
  2. Plasma Volume↓
64
Q

Myelofibrosis and ET

3 common Mutations?

A

Myelofibrosis and ET

JAK2, CALR, MPL

65
Q

Essential Thrombocythemia

DDX

A

Essential Thrombocythemia

MDS, IMF, PV, CML, Bleeding

66
Q

What is the Ph- MPN that is most likely to develop to AML?

A

Myelofibrosis

67
Q

MDS

Classification? (5)

A

MDS

  • SLD: Single lineage dysplasia (Refractory Anemia)
  • RS: Ring Sideroblasts
  • 5q- : Mononuclear megakaryocytes
  • MLD: Multilineage dysplasia
  • EB: Excess Blasts
68
Q

Infectious Mononucleosis

cause? and cell effected?

A

Infectious Mononucleosis

EBV

causes atypical B cells formation to be attacked by T cells

69
Q

Infectious Mononucleosis

Associasion with

A

Infectious Mononucleosis

Burkitts/Hodgkin/B Lymphoma

Nasolaryngelal Carcinoma

70
Q

Infectious Mononucleosis

Diagnosis and DDX

A

Infectious Mononucleosis

DDX: Lymphoma

  1. increased lymphocytes (12‐18 G/L)
  2. presence of at least 10% atypical lymphocytes on peripheral smear
  3. a positive serologic test for Epstein-Barr virus (Paul‐Bunnel
    antibody) .
71
Q

Infectious Mononucleosis

A

Infectious Mononucleosis

Downy Cells

72
Q

ALL and AML

ddx - Incidence as a function of Age

A

ALL and AML

AML mostly in elderly (“Mevogarim”)

ALL mosly in children (“Lo-mevogarim”)

73
Q

CLL

  • Prevelance?
  • Is it common in children? which age?
A

CLL

  • The most common leukemia!
  • Not in Children (at all)! 60-80~
74
Q

CLL

  • Prognosis?
  • Treatment?
A

CLL

  • Many years (more than 10 years)
  • Treatment could resolve the disease with significant side effects
  • Thearpy should start later than other cancers - same effectivity less time with side effects
75
Q

CLL

  • Lymph node Equivalent?
A

CLL

  • Small lymphicytic Lymphoma (SLL)
  • Same immunophenotype and cytogenetics but in SLL there is solid tissue disease.
76
Q

CLL

  • Lymphocyte count suggestive of CLL?
  • What is the effectivity of these lymphocytes in inflammation?
A

CLL

  • The absolute lymphocyte count is > 5 G/L and may be up to 300 G/L - Diagnosis!
  • Very low effectivity - Monoclonal Lymphocytes! (Not specific for infection)
77
Q

CLL

  • What are the surface markers for CLL?
A

CLL

  • CD5+, CD19+ together ! (B and T cell mixed markers)
  • CD23+ - Mental cell lymphoma will have a negative value CD23 - ! (ddx)
  • CD52+ - Prognostic Marker
78
Q

CLL

  • Typical Cells seen in CLL (not diagnostic)
A

CLL

  • Smudge Cells
  • Gumprecht bodies
79
Q

What are the B-Symptoms?

A

B symptoms

  • Fever
  • Night sweats
  • Weight loss
80
Q

Monoclomal Gammopathies

Kinds?

A

Monoclomal Gammopathies

  • MGUS (Bengin - “Undetermined Significance”)
  • Multiple Myeloma
  • Smoldering Myeloma
  • Plasmacytoma
81
Q

Monoclomal Gammopathies

Immunofixation result?

A

Monoclomal Gammopathies

  • Kappa to Lambda ratio is not 50%
82
Q

Monoclomal Gammopathies

Parameter in blood?

A

Monoclomal Gammopathies

  • Monoclonal immunoglobulins
  • aka Paraprotein or M-Protein
83
Q

MGUS

What is the meaning of the diagnosis?

A

MGUS

  • This is a premalignant state!
  • Will progress to Multiple Myeloma - 20% in 15 years
  • Can be prevented!
84
Q

Plasmacytoma

  • Where does the Plasma cells reside?
A

Plasmacytoma

  • Peripheral Plasma cell tumor
85
Q

Multiple Myeloma

  • Where does the Plasma cells reside?
A

Multiple Myeloma

  • In the bone marrow, hence it is a Myeloma
86
Q

Multiple Myeloma

  • Further state for progression of the disease?
A

Multiple Myeloma

  • Plasma cell Leukemia (out to peripheral blood)
  • It is an end stage not many patient reach
87
Q

Multiple Myeloma

  • What is the 5 year survival rate?
A

Multiple Myeloma

  • 35%
88
Q

Multiple Myeloma

  • Clinical Presentation : CRAB
A

Multiple Myeloma

  • HyperCalcemia
  • Renal Insufficiency
  • Anemia
  • Lytic Bone lesions
89
Q

Multiple Myeloma

  • Lab tests results
A

Multiple Myeloma

  • ESR ↑↑
  • M-Peak (also in MGUS) and Hyperproteinemia
  • Anemia
90
Q

Smoldering Myeloma

  • Significant finding (+ddx from M.M)
A

Smoldering Myeloma

  • Plasma cells in the Bone marrow >10%
  • ddx: No clinical symptoms of Multiple Myeloma!

Low Yield Semmelweis (37 decks)

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