Hematology/Neoplasms Flashcards
a test to measure Hgb S
hemoglobin electrophoresis
low hemoglobin and hematocrit, small red blood cells, and an increased total iron binding capacity are all signs of…
iron deficiency anemia
lab test used to to evaluate red blood cell size
mean corpuscular volume
best laboratory test for detecting a clotting factor defect
aPTT
beta thalassemia minor, the genetic defect is in the ________
Hemoglobin
Cancers arise in cells that have alterations in the ______
genes
these are high at birth & cont to rise in some healthy infants during the 1st yr of life; steady decline occurs throughout childhood and adolescence until adult values reached
lymphocytes (neutrophils, eosinophils, monocytes)
For full-term neonates: these are comparable to counts in adults and remain so throughout infancy and childhood
platelets
normal erythrocyte life span in full-term infants
60-80 days
normal erythrocyte life span in pre-term infants
20-30 days
erythrocytes have many ______ in full-term infants
reticulytes
normal erythrocyte life span in children/adolescents/adults
120 days
aging causes erythrocytes to ________ while maintaining normal lifespan
replenish more slowly
Causes of \_\_\_\_\_\_\_ in Aging Fe++ depletion Decreased total serum Fe++ Decreased Fe++ binding capacity Decreased intestinal Fe++ absorption
erythrocyte replacement slowing
Signs of \_\_\_\_\_\_\_ in the hematological system: Platelet adhesiveness increases Lymphocyte function decreases T-cell function declines Humoral system less responsive
Aging
large cells with normal Hgb
macrocytic normochromic anemias
Risk Factors for \_\_\_\_\_\_\_\_: Dietary deficiency alcoholism cirrhosis malabsorption increased requirement state (pregnancy)
folate anemia
low maternal folate leads to ______
neural tube defects
Lab Findings in ________:
- Low RBC
- Low Reticulocytes
- Low WBC
- Low Plt
- Low serum Folate
- High MCV
- High Homocysteine
- Normal MCHC / MCH
- Normal methylmalonic acid
folate anemia
Folate deficiency leads to abnormal _______ in RBC (as in B12 deficiency)
DNA synthesis
Both ________ have defective DNA synthesis in the bone marrow
folate and B12 anemia
Clinical Manifestation of \_\_\_\_\_\_\_: Mild: fatigue weakness lethargy pale skin irritability SOB (nonspecific and vague) Severe: cheilosis (scales and fissures of the lips and corners of the mouth) stomatitis (inflammation of mouth) painful ulcerations of buccal mucosa & tongue (burning mouth syndrome) dysphagia flatulence watery diarrhea ***Generally don’t see neurologic or psychiatric manifestations**
Folate Anemia
condition with high MCV: the RBC’s are large w/ normal Hgb, MCHC, MCH
macrocytic anemia
a measure of the concentration of haemoglobin in a given volume of packed red blood cel
mean corpuscular hemoglobin concentration (MCHC)
average mass of hemoglobin per red blood cell in a sample of blood
mean corpuscular hemoglobin (MCH)
Autoimmune disorder that causes destruction of the parietal cells in the stomach with complete loss of intrinsic factor
Pernicious (B12 Deficiency) Anemia
enzyme that is necessary for the absorption of B12
intrinsic factor
Risk Factors for \_\_\_\_\_\_: Alcoholism cirrhosis bariatric surgery H. pylori medications (H2 blockers, proton pump inhibitors)
Pernicious (B12 Deficiency) Anemia
ineffective DNA synthesis in RBC production in bone marrow that produces megaloblasts that do not mature properly and die off early (happens slowly)
B12 deficiency patho
_____ mostly affects older women (median age = 60)
Pernicious (B12 Deficiency) Anemia
Lab Findings of \_\_\_\_\_\_\_ Low RBC Low Reticulocytes Low WBC Low Plt - High MCV - High homocysteine - High methylmalonic acid -Normal MCHC / MCH -Norm-low serum cobalamine (B12)
Pernicious (B12 Deficiency) Anemia
methylmalonic acid is high in pernicious anemia because…
B12 is needed to break it down
Clinical Manifestations of ________:
vague, nonspecific sx (similar to folate deficiency)
Severe cases: marked anemia & neurological deficits
Marked anemia:
-Weakness, fatigue
-Paresthesias of feet & fingers
-Difficulty walking
-Loss of appetite
-Abdominal pain
Neurological deficits:
-Peripheral nerve degeneration is r/t demyelinating lesions of spinal cord & cerebral cortex
-myelin degeneration & loss of nerve fibers in the dorsal and lateral columns of the spinal column and cerebral cortex
***Megaloblastic Madness
Delusions, hallucinations, outbursts, paranoid schizo ideation
Pernicious (B12 Deficiency) Anemia
small cell size with decreased Hgb
MCV, MCHC low
Microcytic Hypochromic Anemia
Causes of \_\_\_\_\_\_\_: Nutritional deficiency blood loss (slow-GI bleed, fast-hemorrhage) Less common: decreased GI absorption pregnancy renal failure
Iron Deficiency Anemia
______ results in pale, small RBCs with lower than normal Hgb concentration
Iron Deficiency Anemia
Lab Findings of \_\_\_\_\_\_: Low Hgb concentration Low reticulocytes Low RBCs Low MCV, MCH /MCHC Low serum Ferritin Low serum Fe++ Increased total Fe++ binding capacity
Iron Deficiency Anemia
Clinical Manifestations of \_\_\_\_\_\_\_: (s/sx depends on severity) Mild-moderate: no sx (explore hx of any bleeding or s/s of bleeding) Severe: fatigue headache palpitations decreased exercise tolerance weakness More advanced: sore tongue brittle or spoon-shaped nails (koilonychia) PICA
Iron Deficiency Anemia
Normal cell size and Hgb
Normochromic/Normocytic Anemias
anemia caused by accelerated destruction of RBCs in which Erythrocyte production is unable to keep up with destruction
Hemolytic Anemia
type of hemolytic anemia that occurs due to deficiency in CD55 and CD59, a complement mediated intravascular lysis of RBCs & release of Hgb
Paroxysmal nocturnal hemoglobinuria
type of hemolytic anemia in which autoantibodies against antigens normally on the surface of the erythrocyte are present:
• Warm reactive antibody type
• Cold agglutinin type
• Cold hemolysin type (paroxysmal cold hemoglobinuria)
**named according to the optimal temperature at which the antibody binds to the erythrocyte
Autoimmune hemolytic anemias
type of hemolytic anemia that is due to an allergic rxn against foreign antigens: the drug (penicillin, cephalosporins, hydrocortisone)
“Hapten-Hypersensitivity”
Immune Hemolytic Anemia
Signs of _________:
Jaundice - unconjugated bili
(Icterus)
Splenomegaly
Hemolytic Anemia
Signs of \_\_\_\_\_\_\_: anemia hemoglobinuria fatigue abd pain thrombosis
Paroxysmal nocturnal hemoglobinuria
Evaluation of _______:
Bone marrow aspirate showing abnormal increase in erythrocyte stem cells (erythroid hyperplasia)
Hemolytic Anemia
Lab Findings for \_\_\_\_\_\_\_: Low CBC High Hgb/Hct High reticulocytes Normal to High MCV
Hemolytic Anemia
Cause of ______:
Dehydration
Relative Polycythemia
Dehydration leads to decreased fluid in blood which means less floating space 2 groups of hemoconcentration -high Hgb/Hct/ RBC -Disturbed fluid balances -Stress-induced
Relative Polycythemia
Abnormal regulation of multipotent hematopoietic stem cells that is associated with a gene mutation and neoplastic transformation of bone marrow stem cells & absolute increased RBC mass
Primary Absolute Polycythemia
Polycythemia Vera
Key Points of \_\_\_\_\_\_: Rare in ages <40 Men>Women Cause unknown No cure Increased risk for stroke/ MI /HTN
Primary Absolute Polycythemia
Polycythemia Vera
Lab Findings for \_\_\_\_\_\_\_: Absolute increase in RBC mass leukocytosis (increased WBC) thrombocytosis (increased plt) increased uric acid (due to excess proliferation) normal O2 sat
Primary Absolute Polycythemia
Polycythemia Vera
Clinical Manifestations of \_\_\_\_\_\_\_\_: s/sx are all d/t increased blood viscosity • SOB • Dizziness • Red-colored face • Bluish extremities
Primary Absolute Polycythemia
Polycythemia Vera
Acute, self-limiting viral infection of B lymphocytes usually caused by Epstein Barr Virus (EBV) (~85% of cases)
Infectious Mononucleosis
Viral Causes of \_\_\_\_\_\_: Epstein Barr cytomegaly adenovirus HIV Hep A Influenza A & B Rubella
Infectious Mononucleosis
Bacterial Causes of _______:
Toxoplasmosis and Diphtheria
Infectious Mononucleosis
Bacterial Causes of _______:
Toxoplasmosis and Diphtheria
Infectious Mononucleosis
- Virus enters oropharynx, nasopharynx, or salivary epithelial cells & spreads to lymphoid tissue & B cells
- Virus causes widespread infxn of B lymphocytes that have receptors for the EBV
Meanwhile, the unaffected B lymphocytes produce IgG, IgM, & IgA against the virus
Cell-mediated response is in the form of cytotoxic T cells & cytokines that directly attack the EBV infected cells
This immune response produces cellular proliferation in the lymphoid tissue–specifically nodes, tonsils, spleen, & liver.
Patho of Infectious Mononucleosis
Labs for ______:
CBC (Differential with at least 50% lymphocytes and 10% atypical lymphocytes- classic triad, high leukocytes)
Monospot (qualitative test for heterophilic antibodies which increase as the illness progresses)
EBV specific antibodies
positive IgM antibodies (may not appear for 7-10 days)
Infectious Mononucleosis
Clinical Manifestations of \_\_\_\_\_\_\_\_: Sore throat Sore, Inflamed tonsils Exudate on tonsils (grey, thick) Fatigue (can last up to 2 months) Malaise Arthralgia ***Classic triad of symptoms: Fever, pharyngitis, and lymphadenopathy of the cervical lymph nodes (lasts 7-20 days)
Infectious Mononucleosis
incubation of Infectious Mononucleosis
30-50 days
prodomal phase of Infectious Mononucleosis with sx of fever, arthralgia, malaise
3-5 days
Adults 40 and older with mononucleosis are more likely to have infection from _______ or _________
cytomegaly virus or bacterial
Mononucleosis is more common in ages ______with ______/1000 cases per year
15-35
6-8
State of hypercoagulability which increases risk of thrombosis
thrombophilia
type of thrombophilia that results from defects in proteins that are involved in hemostasis
Inherited conditions (mostly autosomal dominnt) that increase risk for thrombosis
Ex: Factor V Leiden
Primary (hereditary)
type of thrombophilia that is caused by condition/disease that promotes venous stasis or changes in coagulation factors
Ex: Pregnancy
Secondary (acquired)
Genetic disease that is the most common hereditary thrombophilia
Factor V Lieden
Key Points of ________:
- Increases the risk of blood clots
- Alters clotting factor V
- Protein C cannot be degraded
- Hormonal birth control increases risk even without this factor – so women are screened
Factor V Lieden
Labs for _____:
Protein C
Genetic Testing
Factor V Lieden