Hematopathology

Question 1

Erythrocytosis/Polycthemia

Answer 1

increase in red blood cell count- HCT and Hb levels high, false/”pseudo”: due to reduction is plasma volume, dehydration, vomiting & diarrhea

• primary: polycythemia
• secondary: high altitude

Question 2

Pancytopenia

Answer 2

decrease in all myeloid elements

Question 3

Leukopenia

Answer 3

decrease in white blood cell count

Question 4

Pancytosis

Answer 4

increase in all myeloid elements

Question 5

Anemia

Answer 5

decrease in red blood cell count

Question 6

Leukocytosis

Answer 6

increase in white blood cell count

Question 7

Neutropenia

Answer 7

decrease in neutrophil count

Question 8

Neutrophilia

Answer 8

increase in neutrophil count

Question 9

Thrombcytopenia

Answer 9

decrease in platelet count

Question 10

Thrombocytosis

Answer 10

increase in platelet count

Question 11

Normocytic Anemia

Answer 11

normal size and appearance

Question 12

Macrocytic Anemia

Answer 12

cells larger than normal, high mean corpusular volume(MVC)

Question 13

Microcytic Anemia

Answer 13

cells smaller than normal, low mean corpusular volume(MCV)

Question 14

Normochromic Anemia

Answer 14

Hemoglobin concentration is in normal range, RBCs appear deep red with small area of central pallor

Question 15

Hypochromic Anemia

Answer 15

Hemoglobin concentration is reduced, RBCs have increased area of central pallor

Question 16

Signs and Symptoms of Anemia

Answer 16

tired, easy fatigability, tachycardia, dyspnea, dyspnea on exertion, skin pallor, dizziness,

Question 17

Pathological Mechanisms of Anemia

Answer 17

blood loss, decreased RBC production, increased RBC destruction (hemolysis)

Question 18

Acute Blood Loss

Answer 18

could be: normochromic, normocytic- caused by accident, surgery, parturition/childbirth

Question 19

Chronic Blood Loss

Answer 19

leads to iron deficiency anemia- caused by menstruation, bleeding ulcer, malignant colon cancer

Question 20

Iron Deficiency Anemia

Answer 20

• most common type, could be: microcytic, hypochromic
• caused by nutritional deficiency, susceptible populations include infants, children, pregnant/lactating women, and pre-menopausal, or chronic blood loss from heavy gynecological bleeding, or GI ulcer or malignancy

Question 21

Where is iron absorbed in the body

Answer 21

duodenum

Question 22

Iron Laboratory Tests

Answer 22

serum ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation (TSAT)

Question 23

Anemia Treatments

Answer 23

nutritional: supplements, diet recommendations; blood loss: gynecological( hormonal treatments), and GI cancer( surgery)

Question 24

Megalobastic Anemia

Answer 24

impaired DNA synthesis, caused by vitamin B12 or folic acid deficiency, macrocytic-normochromic anemia, pancytopenia

Question 25

Folate Deficiency

Answer 25

nutritional (alcoholics, pregnancy/lactation), intestinal diseases (inhibit folate uptake in GI tract): celiacs disease, inflammatory bowel disease

Question 26

How is B12 absorbed?

Answer 26

Intrinsic Factor (IF) is secreted by parietal cells in the stomach- required for absorption in the small intestine

Question 27

Vitamin B12 Deficiency

Answer 27

- caused by autoimmune disorders, surgery such as gastrectomy and removal of terminal ileum - nutritional deficiency (vegans) - treated with cyanocobalamin injections intramuscularly (IM) monthly or large doses of B12 tablets

Question 28

Anemia of Chronic Disease

Answer 28

associated with chronic diseases that produce systemic inflammation, impaired iron utilization, low iron serum volume, reduced total iron-binding capacity, normal ferritin, abundant stored iron in tissue macrophages

Question 29

Anemia of Chronic Renal Disease/Renal Failure

Answer 29

kidneys produce erythropoietin (EPO)- decreased EPO in chronic kidney disease leads to decrease erythropoiesis, which is treated with recombinant EPO

Question 30

Hemolytic Anemia

Answer 30

sickle cell anemia, thalassemia

Question 31

Sickle Cell Anemia

Answer 31

- hereditary hemoglobinopathy - point mutation in beta-globin of hemoglobin, red blood cell distortion - hemolytic anemia- leads to vaso-occlusive crisis:microvascular obstruction- ischemic tissue damage

Question 32

Beta-Thalassemia

Answer 32

"cooley's anemia", microcytic/hypochromic, point mutations on beta globin gene: no normal beta globin protein, alpha4 globin forms instead = unstable precipitates

Question 33

What is the result of white blood cell overproduction?

Answer 33

infection, leukemias, lymphomas

Question 34

Polycythemia vera

Answer 34

- increased marrow production of RBCs, granulocytes and platelets - associated with activating points on the tyrosine kinase JAK2 gene, elevated hematocrit, increased hemoglobin, low serum erythropoietin

Question 35

Blood Coagulation Tests

Answer 35

prothrombin time (PT), activated partial thromboplastin time(aPTT), fibrinogen levels, D-dimer levels, platelet levels

Question 36

Prothrombin Time (PT)

Answer 36

assesses the extrinsic pathway of coagulation - adds recombinant tissue factor to plasma, prolonged of the PT means the patient has functional deficiency in one or more clotting factor (II, V, VII, X, and fibrinogen)

Question 37

Activated Partial Thromboplastin Time (aPTT)

Answer 37

measure of the intrinsic pathway, screens function of factors (XII, XI, IX, VIII, X, V, II and fibrinogen)

Question 38

Platelet Disorder Symptoms

Answer 38

bruises easily, bleeding-petachiae (lower extremeties, buccal cavity, pressure points)

Question 39

Thrombocytopenia

Answer 39

low platelet count (<150,000/mcL)- risk of spontaneous hemorrhage if <10,000/mcL

Question 40

Acquired Platelet Disorders

Answer 40

- Aspirin: acetylates cycloocygenase cox-1, blocks production of platelet thromboxane A2 (necessary for platelet aggregation)- this last for the lifetime of the platelet (7-10 days)- no aspirin before surgery - NSAIDS- reversible inhibition of cyclooxygenase

Question 41

Coagulopathies

Answer 41

due to deficient or abnormal/less functional coagulation factors- could be hereditary or acquired

Question 42

Hemophilia

Answer 42

common types: A (factor VIII deficiency), B (factor IX deficiency)- X linked recessive disorder- symptoms include spontaneous bleeding into joints, muscles, and internal organs

Question 43

Hemophilia A

Answer 43

most common sex-linked bleeding disorder, mutation of factor VIII gene on the X chromosome- bleeding could be mild, moderate, or severe- patients develop arthritis from repeated bleeding into joints- treated with human recombinant factor VIII

Question 44

Von Willebrand Disease

Answer 44

due to abnormal von willebrand factor- autosomal inheritance, which is responsible for platelet adherence after vascular endothelium injury and platelet aggregation

Question 45

How does severe liver disease lead to coagulation defects?

Answer 45

the liver produces most coagulation factors

Question 46

How does a vitamin K deficiency lead to coagulation defects?

Answer 46

vitamin K is required for post-translational modification and functional factors II, VII, IX, and X- vitamin K is produced by gut bacteria so this mostly affects babies and adults with nutritional deficiencies, taking prolonged antibiotics, or colon resection

Question 47

Hypercoagulability

Answer 47

inherited syndrome, acquired- venous stasis (prolonged immobility or congestive heart failure)