Hematology/Oncology Flashcards
1
Q
Erythrocytosis
Anisocytosis
Poikilocytosis
Reticulocyte
A
- Erythrocytosis = polycythemia = increased RBCs
- Anisocytosis = varying sizes
- Poikilocytosis = varying shapes
- Reticulocyte = immature RBC
2
Q
Spectrin
A
supplies the biconcavity/flexibility of RBCs
3
Q
1/3 of platelets are stored in?
A
Spleen (lifespan = 8-10 days)
4
Q
Causes of polycythemia/erythrocytosis?
A
- Any time have increased EPO (hypoxia, renal cell carcinoma, HCC, pheochromocytoma, hemangioblastoma)
- Down’s babies at birth
- Polycythemia vera –> have increased RBCs, but normal EPO
5
Q
Barr bodies
A
=inactivated X in neutrophils
–>seen in all women + KF men
6
Q
When do you see hypersegmented polymorphic neutrophils?
A
-Vitamin B12/Folate deficiency
7
Q
Neutrophil chemotactic factors?
A
- Leukotriene B4
- IL-8
- C5a
8
Q
CD14 = cell marker for?
A
Macrophages
9
Q
Causes of Eosinophilia?
A
- DNA-CAAPA:
- Drugs
- Neoplastic
- Asthma (and Churg-Strauss)
- Collagen Vascular diseases
- Allergic processes
- Addison’s (adrenal insufficiency)
- Parasites (invasive)
- Acute Interstitial Nephritis
10
Q
Phagocytes:
- in brain
- in tissue
- in liver
- in joints
A
- brain = microglia
- tissue = macrophages
- liver = kupffer cells
- joints = A-cells
11
Q
Mast cells vs Basophils?
A
Both are similar, mediate allergic rxn
- Basophils in Blood
- Mast cells in tissue
-mast cells are involved in type 1 hypersensitivity rxns
12
Q
Langerhans cells
A
- dendritic cells on skin and mucous membranes
- act as professional APCs
- possess Birbeck granules = racquet-shaped intracytoplasmic granules
13
Q
Main inducers of primary antibody response?
A
Dendritic cells = professional APCs
14
Q
clock-face chromatin
A
Plasma cells (B cells differentiate into plasma cells; plasma cells produce lots of antibody specific to a particular antigen)
15
Q
plasma cell neoplasm?
A
Multiple Myeloma –> make a whole bunch of one particular type of B cell, all making one type of antibody (so see monoclonal antibody spike)
16
Q
CD3
A
on ALL T-cells
- ->Th also have CD4
- ->Cytotoxic also have CD8
17
Q
anti-AB antibodies (Ig type?)
A
-IgM –> don’t cross placenta
18
Q
anti-Rh antibodies (Ig type?)
A
=IgG –> can cross placenta and cause hemolytic disease of newborn (erythroblastosis fetalis) if fetus is Rh+
19
Q
Blood type A (example)
A
- have A antigen on RBC surface
- B antibody in plasma
20
Q
erythroplastosis fetalis
- cause?
- symptoms?
- hypersensitivity type?
- how to prevent?
A
- type 2 hypersensitivity rxn
- cause: Rh- mother exposed to Rh+ fetal blood during delivery; makes anti-Rh IgG –> can cross placenta in subsequent pregancies, causing hemolytic disease of newborn in next fetus who is Rh+
- Symptoms in infant: hepatosplenomegaly, severe anemia, jaundice, demise/death
- Treat/Prophylaxis = give mother Rhogam = Rho (D) Ig at first delivery to prevent all future erythroblastosis
21
Q
Deficiency of Factor VIII?
A
Hemophilia A
“Aight”
22
Q
Deficiency of Factor IX?
A
Hemophilia B
“Benine”
23
Q
Vitamin K deficiency?
A
decreased synthesis of “diSCo 1972”
- proteins C and S
- Factors X, IX, VII, II (10, 9, 7, 2)
*Vitamin K normally catalyzes carboxylation of glutamic acid residues on proteins involved with blood clotting
24
Q
Vitamin K antagonist?
A
Warfarin
–>acts by inhibiting Epoxide Reductase (vitamin K–>activated vitamin K)
25
Antithrombin inhibits?
Antithrombin inhibits:
- thrombin
- factors VIIa, IXa, Xa, XIa, XIIa
26
Drug that activates antithrombin?
Heparin
27
Coagulase
Produced by S. aureus
| -->can convert fibrinogen-->fibrin
28
tPA, Streptokinase, Urokinase:
All facilitate: plasminogen--> plasmin
| so, stimulate breakdown of clots!
29
vWF receptor on platelets? Fibrinogen receptor on platelets?
- vWF --> GpIb
- Fibrinogen --> GpIIb/IIIa
***vWF and Fibrinogen are both inside platelets
30
ESR in pregnancy?
increased
31
Decreased ESR:
- polycythemia
- sickle cell anemia
- CHF
- microcytosis
- hypofibrinogenemia
32
Spur cell (Acanthocyte)
Liver disease, Abetalipoproteinemia
| -->irregularly spiked RBCs
33
basophilic stippling
TAIL:
- Thalassemias
- Anemia of chronic disease
- Iron deficiency
- LEAD poisoning!
-->have denatured RNA within RBCs
34
type of anemia caused by folate or B12 deficiency?
Macrocytic, Megaloblastic anemia
35
iron deficiency anemia + esophageal web + atrophic glossitis?
Plummer-Vinson syndrome
36
"crew cut" on skull x-ray?
Bone Marrow expansion --> see in beta-thal major
- thalassemias
- Sickle cell disease
37
chipmunk facies
beta-thal major
38
Ringed sideroblasts
sideroblastic anemia = defect in heme synthesis (x-linked defect in ALA synthase gene)
-treat with B6 (Pyridoxine)
39
Lead poisoning symptoms: LEEAADDS
- Lead lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray
- Encephalopathy
- Erythrocyte basophilic stippling
- Abdominal colic
- Anemia (sideroblastic anemia)
- Drops (wrist and foot drop)
- Dimercaprol and EDTA = treatment
- Succimer = treatment for kids
40
Dimercaprol
treatment for lead poisoning (also EDTA)
41
Succimer
=treatment for kids with lead poisoning ("SUCks to be a kid with lead poisoning")
42
Hypersegmented neutrophils + glossitis +
increased homocysteine and:
-normal methylmalonic acid?
-increased methylmalonic acid?
- if normal methylmalonic acid: Folate deficiency
- if increased methylmalonic acid: B12 deficiency
***both cause megaloblastic macrocytic anemia (so have impaired DNA synthesis and ineffective erythropoiesis = pancytopenia)
43
Megaloblastic anemia that's not correctable by vitamin B12 or Folate?
--> Orotic Aciduria
44
Pancytopenia =
- Anemia
- Neutropenia
- Thromboctyopenia
45
Fanconi's anemia
DNA repair defect --> get aplastic anemia
| NOT the same as Fanconi's syndrome = proximal tubule reabsorption defect in kidneys!
46
Why anemia in kidney disease?
decreased EPO --> decreased hematopoiesis
47
Aplastic anemia
- Pancytopenia
| - Normal cell morphology, but hypocellular bone marrow with fatty infiltration
48
Hemolytic anemia in a newborn?
Pyruvate kinase deficiency --> decreased ATP --> rigid RBCs
49
HbC defect
Glutamic acid-to-lysine mutation
*pts with HbSC (1 of each mutant gene) have milder disease than HbSS pts (full sickle cell)
50
older pt, unexplaned anemia:
must rule out colon cancer
51
reversible etiologies of sideroblastic anemia?
- alcohol
| - lead
52
what vitamin should be supplemented in vegans/vegetarians?
B12 (may get deficiency --> megaloblastic anemia)
53
Hepcidin
released by liver, binds ferroportin on intestinal mucosal cells and macrophages
-increased in cases of inflammation: increased hepcidin-->decrease release of iron from macrophages
*this is what happens in anemia of chronic disease: decreased iron, decreased TIBC, increased ferritin
54
decreased iron + decreased TIBC + increased ferritin
anemia of chronic disease (inflammation--> increased hepcidin --> decreased release of iron from macrophages
55
Cause of hereditary spherocytosis?
- extravascular intrinsic hemolytic normocytic anemia
- caused by defect in proteins interacting with RBC membrane skeleton and plasma membrane (ankyrin, band 3, protein 4.2, spectrin)
- premature removal of RBCs by spleen --> splenomegaly, aplastic crisis; eventually need splenectomy
56
Labs for PNH (paroxysmal nocturnal hemoglobinuria)?
increased urine hemosiderin
57
complication of PNH?
thrombosis
58
Treatment for sickle cell anemia?
- Hydroxyurea --> increases HbF
| - Bone marrow transplant = ultimately
59
Coomb's positive anemia?
autoimmune hemolytic anemia (ie warm agglutinin or cold agglutinin anemias)
60
microangiopathic anemia
- see schistocytes
- RBCs damaged when passing through obstructed or narrowed vessel lumina
- see in: DIC, TTP-HUS, SLE, malignant HTN; prosthetic valves, aortic stenosis...
61
rate limiter of heme synthesis?
ALA synthase (delta-aminolevulinic acid synthase)
62
effect of heme on ALA synthase activity
low heme--> increased ALA synthase
| lots of heme-->decreased ALA synthase
63
Rate limiter of heme synthesis
ALA synthase (requires B6!)
64
tea-colored urine + blistering cutaneous photosensitivity?
- Porphyria cutanea tarda (most common porphyria)
- d/t deficiency of Uroporphyrinogen Decarboxylase (needed for heme synthesis); get accumulation of Uroporphyrin (hence the tea-colored urine)
65
painful abdomen + red-wine colored urine + polyneuropathy + psych disturbances; precipitated by drugs:
Acute Intermittent Porphyria
- d/t deficiency of Porphobilinogen Deaminase (aka uroporphyrinogen-I-synthase)
- accumulate Porphobilinogen, ALA, and uroporphyrin (in urine)
66
Treatment for Acute Intermittent Porphyria?
-Glucose and Heme --> inhibit ALA synthase
67
Defect in factors I, II, V, VII, X -->?
increased PT (extrinsic pathway defect)
68
Defect in all factors EXCEPT VII and XIII?
increased PTT
69
Defects in platelet plug formation?
increased BT (bleeding time)
70
Bernard-Soulier disease:
- defect
- labs (BT =bleeding time; PC=platelet count)
defect in Gp1b--> so vWF can't bind platelets for platelet plug formation
* increased BT
* decreased PC
71
Glanzmann's thrombasthenia:
- defect?
- BT/PC?
- defect in GpIIb/IIIa --> platelets can't link to eachother, so no platelet aggregation for platelet plug formation
- increased BT
- no effect on PC
72
ITP = Idiopathic Thrombocytopenic Purpura:
- defect?
- labs?
- defect:have anti-GpIIb/IIIa antibodies--> antibodies bind platelets --> complex gets consumed by splenic macrophages
- increased BT
- decreased PC
- also have increased megakaryocytes (trying to make more platelets!)
73
TTP = Thrombotic Thrombocytopenic Purpura
- defect?
- labs?
deficiency of vWF metallprotease --> decreased degradation of vWF multimers: so: increased vWF multimers--> increased platelet aggregation and thrombosis--> decreased platelet survival
- increased BT
- decreased PC
- schistocytes
- increased LDH
74
Affect of aspirin on BT/PC?
increased BT
no effect on PC
(like Glanzmann's)
75
All platelet disorders effects on BT/PC?
- all increase BT
| - all decrease PC, except Glanzmann's
76
most common inherited bleeding disorder?
von Willebrand's disease
77
PC, BT, PT, PTT findings in von Willebrand's disease?
- increased BT
- increased or normal PTT (depends on severity)
- normal PC and PT
78
-treatment for von-Willebrand's disease?
DDAVP = Desmopressin (releases vWF stored in endothelium)
79
PC, BT, PT, PTT findings in DIC?
| -other lab findings?
- decreased PC
- increased BT
- increased PT
- increased PTT
-also: schistocytes, increased D-dimers (fibrin split products), decreased fibrinogen, decreased factors V and VIII)
80
Causes of DIC?
"STOP Making New Thrombi"
- Sepsis
- Trauma
- Obstetric complications
- acute Pancreatitis
- Malignancy
- Nephrotic syndrome
- Transfusion
81
Factor V Leiden
most common cause of inherited hypercoagulability
| -production of mutant factor V, that can't be degraded by protein C
82
Cryoprecipitate
contains fibrinogen, factor, VIII, factor XIII
| -used to treat coagulation factor deficiencies (if deficient in fibrinogen or factor VIII)
83
CD30+ and CD15+ cells of B-cell origin?
Reed-Sternberg cells
84
Most common Hodgkin's lymphoma? Prognosis?
- Nodular Sclerosing
- Excelent prognosis (b/c Lymphocytes>>>R-S cells)
- see collagen banding in lymph node
- mostly young adults
85
t(8;14) c-myc gene
Burkitt's lymphoma (non-Hodgkin lymphoma; neoplasm of mature B cells)
86
Most common adult non-Hodgkin lymphoma?
Diffuse large B-cell lymphoma
| -->20% of cases are in kids though
87
t(11;14); affects cyclin D regulatory gene
Mantle Cell Lymphoma
| -affects older males; poor prognosis
88
t(14;18) bcl-2 overexpression
- Follicular Lymphoma
- affects adults
- indolent course, but difficult to cure
- bcl-2 inhibits apoptosis (normally; it's a proto-oncogene)
89
Lymphoma caused by HTLV-1?
Adult T-cell lymphoma
- ->adults present with cutaneous lesions
- ->aggressive
90
Mycosis fungoides/Sezary syndrome
- mature T-cell lymphoma; adults present with cutaneous lesions
- indolent
91
Bence-Jones protein
Multiple Myeloma
| -Ig light chains in urine (don't see on urinalysis though)
92
Rouleaux formation
Multiple Myeloma
93
most common primary tumor arising within bone in elderly?
Multiple Myeloma
94
CRAB symptoms of Multiple Myeloma:
- hyperCalcemia
- Renal insufficiency
- Anemia
- Bone lytic lesions/Back pain
95
Down syndrome pts: increased risk of which cancers?
- ALL
| - AML
96
stains TRAP positive (tartrate-resistant acid phosphatase)
Hairy cell leukemia
| -mature B-cell tumor in elderly; cells have filamentous, hairlike projections
97
Age group affected by ALL?
<15 years old
- most responsive to therapy
- may spread to CNS and testes
- t(12;21) = better prognosis
98
Hallmark of Acute Leukemias?
- lots of blast cells (>20% blasts)
| - rapid onset and progression
99
Auer rods
AML = t(15;17)
| -responds to vitamin A
100
Which leukemia can be treated with Vitamin A?
AML
- t(15;17)
- auer rods
101
t(9,22), bcr-abl
Philadelphia chromosome
- CML
- 30-60 yrs old
- more mature cells (<5% blasts); insidious onset
- resonds to imatinib = bcr-abl tyrosine kinase inhibitor
102
Imatinib
treatment for CML
| -inhibits bcr-abl tyrosine kinase
103
Teardrop cell
Myelofibrosis
- ->fibrosis of bone marrow (
- ->bone marrow is crying because it's fibrosed :(
104
```
JAK2 mutations: positive/negative?
Philadelphia chromosome?
-polycythemia vera
-essential thromboyctopenia
-myelofibrosis
-CML
```
* JAK2:
- positive in polycythemia vera, essential thrombocytosis, myelofibrosis
- negative in CML
* Philadelphia:
- only positive in CML
105
thombolytics mechanism? (streptokinase, urokinase, tPA, APSAC)
aid conversion of plasminogen-->plasmin, which cleaves thrombin and fibrin clots
106
Affect of aspirin on BT, PT, PTT
increased BT
| -no effect on PT, PTT
107
Ticlopidine toxicity?
-Neutropenia (should monitor CBC during first few months of trtmt)
(Ticlopidine = ADP-receptor blocker, so inhibits platelt aggregation; like Clopidogrel)
108
Drug side effect = tinnitus?
Aspirin!
109
Raloxifene vs Tamoxifen: Which is better for osteoporosis prevention?
- both are SERMs
- ->antagonists in breast (treat breast cancer)
- ->agonists in bone (bone-building)
- Tamoxifen may increase risk of endometrial carcinoma, b/c it's a partial endometrial agonist
- Raloxifene is an endometrial antagonist, so no increased risk of endometrial carcinoma; so, better choice for osteoporosis trtmnt
