Hematology/Oncology Flashcards
what do azurophilic granules contain (lysosomes)
- proteinases, acid phosphatase, myeloperoxidase and beta-glucoronidase
what are important chemotactic agents?
C5a, IL8, LTB4, kallikrein, plately-activating factor
what stimulates macrophages?
y-interferon, can work as antigen presenting cells through MHC 2
what are the causes of esosinophilia?
PACCMAN Parasites Asthma Churg Strauss Chronic adrenal insufficiency Myeloproliferative disorders Allergic Neoplasia (hodgkins lymphoma)
what type of hypersensitivity reaction do mast cells do?
type 1
what are dendritic cells?
highly phagocytic APCs, function as link between innate and adaptive immune system. Have MHC 2 and Fc receptors (Langerhan cells in the skin)
what are lymphocytes?
B, T and NK cells (B and T are adaptive), NK is innate
which is humoral and which is cellular?
B=humoral (when antigen comes they differentiate into plasma cells that produce antibodies)
T=cellular (diff into cytotoxic T cells and T helper cells
what are echinocytes?
burr cells- see them in liver disease, ESRD, pyruvate kinase deficiency
what are sideroblasts?
see them in marrow with special prussian blue stain, extra iron
what are target cells?
hbC, asplenia, liver disease, thalassemia
what cells are seen in G6PD?
bite cells
what causes basophilic stippling?
lead poisoning, myelodysplastic syndromes, thalassemias
when can you see heinz bodies?
G6PD deficiency
what is sideroblastic anemia?
the body has iron, but can’t incorporate into RBCs. Can be genetic or myelodysplastic (AML)
what is fanconi anemia?
genetic disease with repaired response to DNA damage. Get bone marrow failure, short stature, abnormal thumbs, absent radii, skin hyperpigmentation (cafe au lait spots), abnormal facies, abnormal kidneys and decreased fertility
what is Diamond Blackfan anemia?
only anemia (dec erythroid progenitor cells), not pancytopenia, including craniofacial malformations, thumb or upper limb abnormalities, cardiac defects, urogenital malformations, and cleft palate.
What is Plummer Vinson syndrome?
triad of iron deficiency anemia, dysphagia and esophageal webs
what is the inheritance of G6PD?
X linked recessive
What is acute intermittent porphyria?
AD - porphobilinogen deminase- get abdo pain, blood in urine, polyneuropathy, psychological disturbance, precipitated by drugs
what is porphyria cutanea tarda?
most common- enx-uroporphyrinogen decaroxylase (AD), get blistering photosensitivity and hyperpigmentation, worse with alcohol
What is TTP and how does it present?
TTP- def in ADAMTS13 (vWF metalloprotease) so you get vWF multimers- presents with fever, thrombocytopenia, MAHA, neuro symptoms, renal failure- need plasmapheresis and steroids
What are the two mixed platelet and coagulation disorders (think about things that affect bleeding time and coags)?
- von Willebrand disease (AD, inc BT and PTT_ give desmopressin which releases vWF from endothelium
- DIC
What are the hereditary thrombosis syndromes leading to hypercoagulability?
- Antithrombin deficiency (dec inhibition of 2a and 10a), but shouldn’t change PT, PTT or thrombin time)
- Factor 5 Leiden (protein C can’t inactivate- preg loss, DVT, cerebral vein thromb)
- Protein C & S deficiency (can’t inactivate 5 and 8- skin necrosis with hemorrhage after warfarin)
- Prothrombin gene mutation (factor 2)
which type of lymphoma is associated with Reed Sternberg cells?
Hodgkins (owl-eye, identical mirror image bilobed or binucleate) CD15, CD30
what is a marker for pre-B and pre-T cells? What is a marker for just pre-B cells?
- TdT+
2. CD10+
which cancer is associated with philadelphia chr?
CML (t, 9, 22)
what is langerhan cell histiocytosis?
get immature cells that don’t activate T cells properly, lytic bony lesions, skin rash, AOM, birbeck granules
How does heparin work?
activates antithrombin so factor 2a and 10a inhibited, short half life
-reverse with protamine sulphate
which anticoag crosses placenta?
warfarin
heparin does not (used in preg)
how do clopidogrel and ticagrelor work?
ADP receptor inhibitor, irreversibly block ADP- block gpIIb/IIIa on platelet surface so you can’t get plt aggregation
How does hydroxyurea work for cancer?
inhibits ribonucleotide reductase- you get decreased DNA synthesis (S phase) and myelosuppression
How does Bevacizumab work?
inhibits VEGF-angiogenesis, blood vessel formation
What is Imatinib used for?
BCR-ABL (philadelphia chr in CML) and c kit in GI stromal tumours
How does Rituximab work?
monoclonal antibody against CD20 on B cells- for B cell neoplasms
How does tamoxifen/raloxifene work?
selective estrogen receptor modulator (SERM), blocks estrogen receptors on ER + cells- for breast and bone
- tamoxifen (only partial in endometrium so can actually increase risk)
- raloxifene full antagonist in endometrium
- cause DVT and PE
How does rasburicase work?
converts uric acid to allantoin
What are the common toxicities?
- cisplatin/carboplatin
- vincristine
- bleomycin/bisulfan
- doxorubicin
- trastuzumab
- cyclophosphamide
- cisplatin/carboplatin-ototoxicity, nephrotoxicity
- vincristine- peripheral neuropathy
- bleomycin/bisulfan-pulmonary fibrosis
- doxorubicin-cardiotoxicity
- trastuzumab-cardiotoxicity
- cyclophosphamide-hemorrhagic cystisis
