Hematology, Oncology, immune Flashcards
Describe HL
Localized single group of nodes. Prognosis is better than NHL. Characterized by reed sternberg cells.»_space;55 years age. 50% cases assoc with EBV. Symptoms include low grade fever, night sweats, weight loss.
Describe NHL
More common. Multiple peripheral nodes. Involve B cells. 20-40 years age. Assoc with HIV. Fewer constitutional symptoms compared to HL
Reed sternberg cells found in?
HL. Binucleate “owl eyes” that are CD15 and CD30 B cell origin. Modular sclerosing form most common (which is one out of four subtypes of HL)
Describe IgA
Prevents attachment of bacteria/virus to mucus membrane
Does NOT fix complement
Crosses epithelial cells
Released in secretions
Describe IgG
2 DELAYED response to antigens
Fixes complement
CROSS placenta
Most abundant in serum
Describe IgE
Bind mast cells and basophils
Mediate hypersensitivity
lowest concentration
Describe IGM
1 IMMEDIATE response to antigen
Does NOT cross placenta
Fixes complement
Describe IL1-12
“HOT T-bone stEAK”
IL8- neutrophils chemotactic factor
IL10- INHIBITS inflammation
IL12- T cell maturation, NK cells
Which cytokines are secreted by macrophages?
IL-1,6,8,12,TNF alpha
Cytokines secreted by T cells?
IL-2,3
Cytokines released from Th2 cells
IL-4,5,10
Describe interferons
Part of innate host defense with viruses. Cells that act locally on uninfected cells “priming” cells for viral defense. ACTIVATES RNAse l and PK–> apoptosis
Describe steps of platelet plug formation (primary hemostasis) in platelet… INJURY, ADHESION, ACTIVATION, AGGREGATION
INJURY, VWF binds to exposed collagen– ADHESION, platelets bind to VWF via GplB at site of specific injury– platelet release ADP and Ca (for coagulation cascade)– ADP helps platelets adhere to endothelium– ACTIVATION, ADP binding to Hpllb/IIIa expression at platelet surface–AGGREGATION, fibrinogen binds to GpIIb/IIIa receptors and links platelets. balance between pro-aggregation and anti-aggregation factors – temp plus stops bleeding.
Describe coagulation cascade, where is hemophilia A/B?
Hemo A- factor VIII, Hemo B- factor IX
Describe platelet plug formation/ thrombogenesis and where does ASA, clopidogrel, abciximab act. Where are the deficiencies?
ASA inhibited cyclooxygenase (TXA2 synthesis), clopidogrel inhibits GPIIb/GPIIa expression. Abciximab inhibits GPIIB/GPIIa directly. Deficiencies vWF, Bernard soulier, glanzmann.
Describe microcytic anemias <80
Not a lot of RBX and the existing RBC are small. HEMOGLOBIN problem! Iron deficiency, ACD, thalassemia (inherited abnormality), lead poisoning, sideroblastic anemia (iron get in but can’t get out).
Iron deficiency can lead to…
Conjunctivial pallor under eyes, and Plummer Vinson syndrome associate with iron deficiency, esophageal webs, and strophic glossitis.
Describe alpha and beta thalassemia
Alpha is alpha globulin deletions cause decrease in alpha globin synthesis in asian and African populations.
Beta is point mutations causing decrease in beta globulin synthesis in Mediterranean pop.
Describe macrocytic anemia
Due to folate and B12 deficiency. Megaloblastic is errors in blood DNA production. Folate, b12, robotic aciduria. Non magloblastic include liver dz, alcoholism, reticulocytosis.
Describe normocytic anemia
Hemolytic due to intrinsic or extrinsic (environmental factors). Or non-hemolytic. Nonhemolytic: ACD, aplastic anemia, CKD, iron deficiency. Hemolytic intrinsic: RBC membrane defect (hereditary spherocytosis), RBC enzyme deficiency (G6PD PK), hBC defect, paroxysmal nocturnal hburia, SCA. Hemolytic extrinsic: autoimmune, microangiopathic, macroangiopathic, infections.
Draw out lane values of anemia including Fe deficiency, Chronic dz, hemochromatosis of Serum iron, transferrin TIBC, ferritin.
Draw
Describe leukopenias
Decrease in WBC..
Neutropenia- seen in sepsis/postinfection. <1500
Lymphopenia- seen in HIV, digeorge syndrome. <1500
Describe heme synthesis, porphyria, lead poisoning.
Porphyria is defect in heme synthesis leading to accumulation of heme precursors. Lead inhibits specific enzymes needed in heme synthesis.
Lead poisoning affected enzyme, accumulate substrate, symptoms
Ferrochelatase and ALA dehyratase. Protoporphyrin accumualted. Children= mental deterioration via lead pain. Adults=demyelination
Acute intermittent porphyria. Affected enzyme, accumulated substrate, symptoms
Porphyobilinogen deaminase enzyme. Porphobilinogen accumulated. 5P’s symptoms painful abdomen, port-wine urine, polyneuropathy, psychological disturbances, precipitated by drugs. Tx. Glucose and heme.
Porphyria cutaneous Tara. Affected enzyme. Accumulated substrate, symptoms
Uroporphyrinogen decaroxylase. Uroporphyrin accumulated. Blisters and Most Common porphyria.
Draw out heme synthesis.
Draw
Basophilic stippling
BASICally ACiD Alcohol is LeThal. ACD, alcohol abuse, lead poisoning, thalassemia.
Describe multiple myeloma “monoclonal M protein spike”
Think CRAB: hypercalcemia, renal insufficiency, anemia, bone lyrics lesions/back pain.
Chromosomal translocations 9:22, 8:14, 11:14, 14:18, 15:17
Philly/CML (BCR able gene), burkitts, mantel cell hyperplasia, follicular lymphoma, AML.
Describe types of NHL
Burkitts lymphoma (8:14), diffuse large B cell (14;18)MOST common , mantle cell (11:14), follicular (14:18).
Describe chronic myeloproliferative disorders and examples
JAK2 is involved in hematopoietic growth factor signaling. Mutations lead to myeloproliferative disorders other than CML. I.e. Polycythemia Vera (erythromelalgia, intense itching after hot shower), essential thrombocytosis (overproduction of abnormal platelets–> bleeding). Myelofibrosis (teardrop RBC)
Heparin Vs. Warfarin
HEPARIN: route parenteral, site of action is blood, speed is rapid, actives antithrombin which DEC actions if IIa and factor Xs. Duration of actions is hours. Tx of overdose protamine and monitor PTT (intrinsic pathway). Doesn’t cross placenta. WARFARIN: route oral, site of action liver, speed is slow, impairs synthesis of Vit K dependent clotting factors, duration is days. Tx of overdose IV vitamin K or fresh frozen plasma. Monitor with PT/INR (extrinsic pathway). Cross placenta
Draw cancer drug cell cycle. Include antimetabolites, etoposide, bleomycin, vinca alkaloids/taxol
Draw
Draw common chemotoxicities “man” include cisplatin, vincristine, bleomycin,doxorubicin, trastuzumab, cyclophosphamide, 5FU, 6MP, methotrexate.
Draw
