Heme Flashcards
1
Q
Iron Deficiency Anemia cause
A
↓ iron -> impaired hemoglobin production -> bone marrow pumps out small and pale RBC -> ↓ O2 to tissue -> ↑ BM activation -> ↑ poikilocytosis (shape) and anisocytosis (size) -> defective mitochondrial enzymes
Chronic bleeding (cancer, menses, h pylori, hookworms, etc)
Malnutrition
Absorption disorders
Gastrectomy/surgery
Pregnancy, childhood
2
Q
Iron Deficency Anemia diagnosis
A
- Serum iron level decreased
- Total iron-binding capacity increased
- Percentage transferrin saturation decreased
- Serum ferritin level decreased or normal
- Platelet count increased
- Reticulocyte count decreased
- FEP increased
- Peripheral blood smear
- Mentzer index >13
- Microcytic hypochromic RBC
- Basophilic stippling
- Howell-jolly bodies (if severe)
3
Q
Iron Deficiency Anemia comp
A
Plummer-Vinson syndrome (triad of IDA, esophageal webs, dysphagia)
Glossitis
4
Q
Iron Deficiency Anemia clinical
A
Fatigue, conjunctival pallor, palpitation, pica, spoon nails (koilonychia), SOB, hair loss
5
Q
a-Thalassemia cause
A
Cis or trans deletion on chromosome that results in absent/reduced alpha globin chains
a-globin gene deletions on chromo 16, decreased a-globin synthesis
autosomal recessive
6
Q
a-Thalassemia RF
A
Cis deletion - Asian populations
Trans deletion - African populations
areas of high incidence of malaria
7
Q
a-Thalassemia comp
A
chronic tissue hypoxia, leg ulcers, high output heart failure, hypermetabolic state, gallstones, bone marrow hyperplasia, bone marrow widens structural malformations, iron deposition in liver, myocardium, pancreas, and kidney
8
Q
a-Thalassemia sx
A
Feeling tired or weak
Shortness of breath
Paleness
Dizziness and fainting
Headaches
Pale skin or yellowing of the skin and eyes (jaundice)
A large abdomen from a spleen or liver that is larger than normal
Changes or problems with bones in the face
Dark urine
Poor appetite
Intellectual or developmental disabilities
9
Q
Lead Poisoning-Related Anemia RF
A
contaminated water, lead paint, industrial emissions (smelters, refiners, battery manufacturing, recycling) , lead-glazed ceramics
10
Q
Lead Poisoning-Related Anemia comp
A
developmental delays, learning difficulties, chronic kidney disease, HTN, low libido, infertility, SIADH,
11
Q
Lead Poisoning-Related Anemia clinical
A
fatigue, dyspnea, activity intolerance, abdominal pain, headache, difficulty concentrating, muscle/joint pain, confusion, ataxia
12
Q
Lead anemia DX
A
heavy metal testing
CBC
13
Q
Lead Poisoning-Related Anemia clinical
A
fatigue, dyspnea, activity intolerance, abdominal pain, headache, difficulty concentrating, muscle/joint pain, confusion, ataxia
14
Q
Beta Thalassemia cause
A
mutation in beta globins
1: carrier
2: mild anemia
15
Q
Beta Thalassemia comp
A
chronic tissue hypoxia, leg ulcers, high output heart failure, hypermetabolic state, gallstones, bone marrow hyperplasia, bone marrow widens structural malformations, iron deposition in liver, myocardium, pancreas, and kidney
16
Q
Beta Thalassemia RF
A
FH, Mediterranean, middle eastern, southeast Asian, African genetic descent
17
Q
Alpha thalassemia diagnosis
A
Microcytic
Basophilic stippling
Heinz’s bodies
Serum iron increased or normal
TIBC decreased or normal
Percentage saturation increased
Ferritin increased or normal
Reticulocyte increased or decreased
Serum LDH increased or normal
Haptoglobin decreased
Mentzer Index (Ratio of MCV/RBC) <13
18
Q
Beta Thalassemia DX
A
- CBC
- microcytic anemia
- target cells
- inc RBCS
- Hemoglobin electrophoresis with hemoglobin F and A2 quantitation
- Mentzer index <13
19
Q
Autoimmune Hemolytic Anemia path
A
Warm: IgG to Rh on RBC at normal body temp, antibody fixes complement + binds to RBC membrane -> antibody-coated RBCs destroyed extravascular by macrophages in spleen, liver
Cold: IgM, I, i, P
antibodies activate direct complement system attack, intravascular, complement-mediated
20
Q
Autoimmune Hemolytic Anemia RF
A
immune deficiencies, malignancies, certain drugs, measles, varicella, mycoplasma, H. influenza, lymphoproliferative disorders, autoimmune disorders, exposure to cold
21
Q
Autoimmune Hemolytic Anemia comp
A
venous thromboembolism, cholelithiasis, renal insufficiency, cardiac comp (older)
22
Q
Autoimmune Hemolytic Anemia clinical
A
pallor, fatigue, activity intolerance, bounding pulses, tachycardia, pulmonary congestion,
cold: hemoglobinuria, jaundice, pain in legs and back, anemia, acrocyanosis, Raynaud’s, anemia after infx
23
Q
Autoimmune hemolytic anemia dx
A
- High ferritin
- TIBC normal
- Reticulocyte count low
- CBC
- Normocytic/microcytic
- Normochromic/ hypochromic
- Low serum iron
24
Q
Glucose-6-Phosphate Dehydrogenase Deficiency path
A
inadequate G6PD, GSH -> oxidative stress -> build-up of free radicals, peroxides -> precipitation of hemoglobin -> disruption of cell membrane -> ↑ cellular rigidity -> extravascular hemolysis, accelerated removal of damaged RBCs by reticuloendothelial system in spleen; intravascular hemolysis may also occur
25
G6PD deficiency dx
- total serum bilirubin
- CMP
- rapid fluorescent spot test
- quantitative spectrophotometric analysis
- reticulocyte count
- serum aminotransferase
- lactate dehydrogenase
- A peripheral blood smear may show signs of hemolysis such as schistocytes.
26
Glucose-6-Phosphate Dehydrogenase Deficiency clinical
pallor, jaundice, dark urine, abdominal/back pain, renal insufficiency,
27
Hemolytic Disease of the Newborn path
fetomaternal hemorrhage exposes maternal circulation to antigens present on fetal RBCs -> maternal sensitization -> formation of maternal IgG antibodies against fetal RBCs -> IgG antibodies small enough to cross placenta -> antibody attachment to fetal cells -> agglutination -> microcirculatory impairment -> hemolysis, destruction of RBCs by macrophages in reticuloendothelial system
28
Hemolytic Disease of the Newborn comp
Acute bilirubin encephalopathy, cerebral palsy, auditory dysfunction, paralysis of upward gaze, and permanent intellectual dysfunction
29
Hemolytic Disease of the Newborn clinical
anemia and hyperbilirubinemia, which may present as lethargy, jaundice, conjunctival icterus, pallor, hepatosplenomegaly, tachycardia or bradycardia, increased oxygen requirement, and/or apnea
30
Hemolytic Disease of Newborn dx
maternal RBC antibodies (agglutination in an indirect antibody test) and/or a positive direct antibody test (DAT) in the infant's serum
31
Hereditary Spherocytosis path
mutation of genes encoding for proteins that secure RBC membrane skeleton to plasma membrane -> membrane destabilization -> rigidity, resistance to deformability -> hemolysis
32
Hereditary Spherocytosis comp
transient aplastic crisis caused by parvovirus B19
megaloblastic anemia
neonatal icterus, non-immune hydrops fetalis
33
Hereditary Spherocytosis clinical
Mild: anemia, splenomegaly, jaundice, modest reticulocytosis, normal hemoglobin, adolescents/adults
Moderate: anemia, reticulocytosis, hyperbilirubinemia, infants/children
Severe: anemia, hyperbilirubinemia, splenomegaly,
34
Hereditary Spherocytosis RF
northern European descent
35
Hereditary spherocytosis dx
Diagnosis is considered positive in patients who present Coombs-negative hemolysis with increased mean corpuscular hemoglobin concentration (MCHC), positive history for hereditary spherocytosis and spherocytes on microscopy, or by a positive result in a specialized test such as osmotic fragility, eosin-5-maleimide (EMA), or acidified glycerol lysis test (AGLT)
36
Sickle cell anemia path
point mutation of beta globin gene -> produces hemoglobin S -> RBC polymerize, deform into sickle/crescent-shaped forms when deoxygenated
37
Sickle cell anemia RF
areas where there are mosquitoes that carry malaria
38
Sickle cell anemia comp
ischemia/infraction, stroke, transient ischemic attack, seizures, MI, dysrhythmias, cardiomyopathy, HF, thromboembolism, leg ulcers, sudden death, acute chest syndrome, pulmonary HTN, priapism, pregnancy complications, osteoporosis, proliferative retinopathy, retinal detachment, multiorgan failure
39
Sickle cell anemia clinical
fatigue, activity intolerance, exertional dyspnea, hypersplenism, pain, vaso-occlusion, dactylitis, increased risk of infx,
40
Sickle Cell anemia dx
- “Sickle” shaped RBC with pointed ends on peripheral smear
- TIBC deceased
- Transferrin decreased
- electrophoresis
41
Anemia of chronic disease cause
infx, cancer, diabetes, autoimmune,
42
Anemia of chronic disease path
systemic inflammation -> ↑ circulation cytokines, IL-1, IL-6, TNF alpha, IFN beta, IFN gamma -> ↑ hepcidin secretion by liver -> ↓ iron absorption from GI tract, ↓ iron sequestration in reticuloendothelial system -> ↓ iron available for erythropoiesis -> ↓ secretion erythropoietin -> ↓ erythrocyte lifespan
43
Anemia of chronic disease labs
* normochromic normocytic
* low serum iron
* high ferritin
- TIBC normal
- Reticulocyte count low
44
Aplastic anemia cause
Fanconi anemia, Shwachman-Diamond syndrome, SLE, graft-versus-host disease, paroxysmal nocturnal hemoglobinuria, chemotherapy, carbamazepine, phenytoin, indomethacin, sulfonamides, Epstein-Barr, HIV, hepatitis, herpes, solvents, benzene, pesticides, radiation, idiopathic
45
Aplastic anemia path
bone marrow hypoplasia/aplasia, hematopoietic cell loss -> ↓ production of cell lineages -> peripheral pancytopenia
46
Aplastic anemia clinical
shorter lifespan, ↑ infx, neutropenia-related sepsis, gingival nares, ecchymosis, petechiae, heavy menstrual flow, occult blood in stool, intracranial hemorrhage, pallor, fatigue, dyspnea, activity intolerance, cardiorespiratory compromise
47
Aplastic anemia dx
- Normocytic
- Normochromic
- Serum iron elevated
- Reticulocytes count decreased
- Bone marrow aspiration
48
Megaloblastic anemia cause
cobalamin and/or folate deficiency due to diet, malabsorption, medications, surgery, pancreatic insufficiency, alcoholism
49
Megaloblastic anemia path
impaired DNA synthesis during erythropoiesis -> uncoordinated maturation of cytoplasm and nuclei in erythroblasts -> abnormally large RBCs + deflective cells w/ fragile membranes -> RBC die prematurely -> anemia
50
Megaloblastic anemia RF
alcohol use, old age, strict diets,
51
Megaloblastic anemia clinical
fatigue, activity intolerance, pallor, tachycardia, bounding pulse, jaundice, splenomegaly, glossitis
52
megoblastic anemia dx
- Macrocytic
- Ferritin increased
- B12 decreased
- Folate decreased
- Bilirubin increased
- Peripheral smear- neutrophil 5 or more segments
53
sideroblastic anemia cause
X-linked/autosomal recessive/mitochondrial inheritance, myelodysplastic syndromes, myeloproliferative neoplasms, excessive alcohol, isoniazid, chloramphenicol, copper deficiency, zinc overload
54
sideroblastic anemia path
impaired erythropoiesis, hemoglobin synthesis -> reduced iron in RBCs + defective RBCs undergo apoptosis w/in bone marrow + fewer functional RBCs in circulation -> anemia
55
sideroblastic anemia RF
genetics, alcohol, diet
56
sideroblastic anemia comp
iron overload, hemochromatosis, erythroid hyperplasia of bone marrow, increased risk of infx, acute leukemia, infx fatal
57
sideroblastic anemia clinical
fatigue, dyspnea, palpitations, pallor, mild jaundice, hepatosplenomegaly, cardiac arrhythmias, HF
58
Sideroblastic anemia dx
- Microcytic/ normocytic
- Hypochromic
- Basophilic stippling
- Ferritin elevated
- Serum iron elevated
- Transferrin saturation elevated
59
Polycythemia Vera path
JAK2V617F mutation
hematopoietic stem cell -> ↑ RBCs, platelets, basophils, eosinophils -> ↑ blood viscosity, ↑ total blood volume -> may evolve into spent phase
60
Polycythemia Vera RF
radiation, age, genetics
61
Polycythemia Vera comp
HTN, Budd-Chiari syndrome, DVT, arterial thrombosis, MI, gout, AML
62
Polycythemia Vera clinical
headache, fatigue, dizziness, dyspnea, plethora, cyanosis, pruritus, gastric ulcers, DVT, MI, portal vein thrombosis, hyperemic and inflamed extremities, bleeding gums, epistaxis, ecchymoses, GI bleed, hepatosplenomegaly, HTN
63
Polycythemia Vera dx
- Increased RBC
- Increased Hgb
- High platelets
- High WBCs
- High LDH
- Panmyelosis in the BM
- Low EPO level
- Positive JAK2 mutation
- May also have increased platelets and granulocytes
64
Disseminated Intravascular Coagulation cause
DIC TEAR
Delivery TEAR: obstetric
Infection
Cancer: prostate, pancreas, lung, stomach
Toxemia of pregnancy
Emboli
Abruptio placentae
Retain fetus products
preeclampsia, obstetric hemorrhage, retained dead fetus, critical illness, mucin-secreting adenocarcinoma, acute promyelocytic leukemia, infx/sepsis (gram - bacteria), massive tissue injury, intravascular hemolysis, shock, snakebites
65
Disseminated Intravascular Coagulation path
release of procoagulants, tissue factors, bacterial components, enzymes/major endothelial injury -> excessive activation of coagulation cascade -> thrombosis of small/medium blood vessels -> activation of fibrinolysis to resolve clots -> fibrin degradation products released into circulation -> interfere w/ platelet aggregation, clot formation
66
Disseminated Intravascular Coagulation RF
sepsis, cancer, blood transfusion reaction, pancreatitis, liver disease, surgery, anesthesia,
67
Disseminated Intravascular Coagulation comp
thromboembolism, tissue hypoxia, infraction, hypoxia of kidney, liver, lung, brain
68
Disseminated Intravascular Coagulation dx
- a low platelet count
- elevated D-dimer concentration
- decreased fibrinogen concentration
- prolongation of clotting times such as prothrombin time (PT)
69
Hemophilia A cause
X-linked recessive mutation F8 gene
70
Hemophilia A path
quantitative/qualitative deficiency of factor VII -> insufficient activation of the intrinsic pathway -> defect in common coagulation pathway -> increased tendency for bleeding
71
Hemophilia A RF
male
72
Hemophilia A comp
intracerebral hemorrhage, stroke
73
Hemophilia A clinical
asymptomatic
easy bruising, prolonged bleeding, hematomas, muscle hematomas, hemophilic pseudotumor, GI bleeding, hematuria, severe epistaxis, joint irregularity and disability,
74
Hemophilia A dx
high aPPT
normal PT
platelet count normal
75
Hemophilia B cause
mutation of F9 on X chromosome
76
Hemophilia B path
qualitative/quantitative deficiency of coagulation factor IX -> insufficient activation of intrinsic coagulation pathway -> impaired hemostasis
77
Hemophilia B comp
intracerebral hemorrhage, stroke
78
Hemophilia B RF
genetics, male
79
Hemophillia B dx
high aPPT
normal PT
platelet count normal
80
Hemophilia B clinical
bleeding sponatenously or after trauma
81
Von Willebrand Disease def
defective platelet function w/ normal platelet count
82
Von Willebrand Disease cause
autosomal dominant/recessive
83
Von Willebrand Disease path
quantitative/qualitative deficiency of vWF -> impaired platelet aggregation, adhesion, dysfunction of factor VII -> deficiency in coagulation cascade -> bleeding tendency
84
Von Willebrand Disease RF
genetics
85
Von Willebrand Disease comp
severe bleeding, pregnancy probs
86
Von Willebrand Disease clinical
asymptomatic
surgery/trauma bring on
spontaneous epistaxis, easy bruising, excessive bleeding from wounds, bleeding gums, menorrhagia, GI bleeding, internal/joint bleeding
87
Immune Thrombocytopenic Purpura def
autoimmune condition where body makes antibodies to thrombocytes/platelets
88
Immune Thrombocytopenic Purpura cause
Acute: children after viral infx
Chronic: females of reproductive age, no underlying trigger, or by hepatitis C, HIV, lupus
89
Immune Thrombocytopenic Purpura path
IgG antibodies from the spleen -> bind to GPIIb/IIIa on platelet -> target for destruction of platelets in spleen
90
Immune Thrombocytopenic Purpura clinical
asymptomatic
| purpura (red/purple spots small)
91
Immune Thrombocytopenic Purpura RF
women, no vaccination,
92
Immune Thrombocytopenic Purpura comp
hemorrhage
93
Immune Thrombocytopenic Purpura clinical
asymptomatic
purpura (red/purple spots small)
epistaxis
94
Vitamin K Deficiency def
lack of Vit K
95
Vitamin K Deficiency cause
exclusive breastfeeding, medication, lack of Vit K1 prophylaxis at birth, malabsorption, low intake, diseases of SM intestine, liver, gallbladder, pancreas
96
Vitamin K Deficiency path
↓ phylloquinone ( vit K) -> ↓ bile salts make fat soluble vitamin soluble -> ↓ incorporation into GI micelles -> ↓ absorbed by small intestine -> ↓ integrated into chylomicrons -> ↓ transported to portal circulation -> ↓ liver use to synthesize coagulation factors, other essential proteins
97
Vitamin K Deficiency RF
infants: no K1 prophylaxis, immature liver, low K stores, sterile gut, maternal ingestion of coumarin-like anticoagulants/some anticonvulsants/antibiotics,
adults: prolonged diarrhea, antibiotics, low intake, TPN administration
98
Vitamin K Deficiency comp
intracranial hemorrhage, impaired bone mineralization, vascular calcium deposits
99
Vitamin K Deficiency clinical
low bone density signs, gingival bleeding, epistaxis, easy bruising, hematuria, melena, umbilical stump/circumcision site bleeding, vomiting, seizures
100
Acute Lymphoblastic Leukemia (ALL) def
uncontrolled proliferation of partially developed white blood cells/lymphoblasts, cancer
101
Acute Lymphoblastic Leukemia (ALL) cause
B cell: translocation (12,21) and (9,22) Philadelphia chromosome
T cell: NOTCH1 mutation
abnormal chromosome number
102
Acute Lymphoblastic Leukemia (ALL) path
mutations -> loss ability to differentiate into mature blood cells -> stuck in blast cells -> don't function effectively and divide uncontrollably -> other cells get crowded out -> leading to anemia, thrombocytopenia, and leukopenia -> blast cells spill into blood travel to thymus, lymph nodes, liver, spleen to enlarge
103
Acute Lymphoblastic Leukemia (ALL) RF
young age
down syndrome
radiation exposure
alkylating chemotherapy
104
Acute Lymphoblastic Leukemia (ALL) comp
intracranial hemorrhage
105
Acute Lymphoblastic Leukemia (ALL) clinical
Fever, fatigue, SOB, pallor, bruising, petechiae, epistaxis, Bone pain, Hepatosplenomegaly, lymphadenopathy, easy bleeding, inc infx, thymus enlargement
106
Acute Myeloblastic Leukemia (AML)
| def
uncontrolled proliferation of myeloblasts, cancer
107
Acute Myeloblastic Leukemia (AML) cause
chromosomal translocations (15, 17), myelodysplastic syndrome
108
Acute Myeloblastic Leukemia (AML) path
mutations -> loss ability to differentiate into mature blood cells -> stuck in blast cells -> don't function effectively and divide uncontrollably -> other cells get crowded out -> leading to anemia, thrombocytopenia, and leukopenia -> blast cells spill into blood travel to thymus, lymph nodes, liver, spleen to enlarge
109
Acute Myeloblastic Leukemia (AML) RF
down syndrome
radiation
alkylating chemotherapy
110
Acute Myeloblastic Leukemia (AML) comp
DIC
111
Acute Myeloblastic Leukemia (AML) clinical
easy bleeding, inc infx, Fever, fatigue, SOB, pallor, bruising, petechiae, epistaxis, Bone pain, swelling of gums
112
Chronic Myelogenous Leukemia (CML) def
cancer rapid proliferation of mature granulocytes/precursors
113
Chronic Myelogenous Leukemia cause
Philadelphia chromosome t(9,22) BCR-ABL gene
trisomy of chromosome
doubling of Philadelphia chromosome
114
Chronic Myelogenous Leukemia path
mutation -> tyrosine kinase is one -> rapid division of myeloid cells -> spill into blood -> liver spleen cause to swell
115
Chronic Myelogenous Leukemia RF
adult age, radiation, benzene
116
Chronic Myelogenous Leukemia comp
Recurrent infections, bleeding
117
Chronic Myelogenous Leukemia clinical
chronic: asymptomatic, fatigue, weight loss, fever,
accelerated phase: pallor, SOB, splenomegaly, hepatomegaly, lymphadenopathy, recurrent infx, bleeding, petechiae, ecchymoses,
blast crisis: bone pain, fever, anemia, significant splenomegaly, inc bleeding, basophilia
118
Chronic Lymphocytic Leukemia def
cancer, proliferation of mature, functionally abnormal B lymphocytes in bone marrow and don't die
119
Chronic Lymphocytic Leukemia path
mutation -> interfere w/ B cell receptors -> activate tyrosine kinase (bruton's tyrosine kinase and other) -> prevent maturation and slow death - move to lymph nodes
120
Chronic Lymphocytic Leukemia clinical
fatigue, SOB, pallor, bruising, petechiae, epistaxis, fever, pneumonia, sepsis, lymphadenopathy
121
Burkitt’s Lymphoma def
B lymphocyte tumor
122
Burkitt’s Lymphoma cause
chromosomal translocation t(8,14)
123
Burkitt’s Lymphoma path
translocation -> Myc gene moved adjacent to IgH promoter sequence -> upregulation of Myc gene -> Myc gene simulates cell growth, metabolism -> increased cell division
124
Burkitt’s Lymphoma RF
EBV infection, Africa
125
Burkitt’s Lymphoma clinical
“Starry sky” appearance
126
Burkitt’s Lymphoma clinical
“Starry sky” appearance (b-cells w/ no cytoplasm and tingible-body macrophages w/ dead neoplastic cells)
extranodal involvement at jaw (Africa) or ileocecal junction
127
Subtypes of Classical Hodgkin Lymphoma
nodular sclerosis: most common, nodules surrounded by collagen, lacunar cell
mixed cellularity: b lymphocytes, plasma cells, eosinophils, lymphocytes, neutrophils, histocytes, immunocompromised
lymphocyte-rich: lymphocytes surrounding Reed-Sternberg cells, best prognosis
lymphocyte-depleted: lack of normal lymphocytes, abundance of Reed-Sternberg cells, immunocompromised
128
Hodgkin Lymphoma cause
mutation in DNA
129
Hodgkin Lymphoma path
mutation -> cell growth and division
130
Hodgkin Lymphoma RF
20, 60s< EBV
131
Hodgkin Lymphoma comp
second cancer
132
Hodgkin Lymphoma clinical
spread to nearby lymph nodes in a contiguous manner
swollen lymph nodes that are painless, rubbery, non-erythematous, nontender including cervical
supraclavicular and axillary
fever, weight loss, night sweats
Reed-Sternberg cells (binucleated neoplastic B cells)
133
Non-Hodgkin Lymphoma def
cancer of the B or T cells
134
Non-Hodgkin Lymphoma cause
chromosomal translocation (14, 18) BCL2 gene, BCL-6 and BCL-2 mutation, Human T-Lymphotropic Virus, chromosomal translocation (11, 14) BCL1 gene
135
Non-Hodgkin Lymphoma path
mutations -> uncontrolled cell division
136
Non-Hodgkin Lymphoma RF
old age, smoking, FH,
137
Non-Hodgkin Lymphoma comp
metastases, respiratory problems
138
Non-Hodgkin Lymphoma clinical
swollen lymph nodes that are painless, rubbery, non-erythematous, nontender in bone marrow, GI tract, spinal cord, fever, weight loss night sweats
139
Mantel cell Lymphoma RF
male
140
Marginal Zone Lymphoma RF
older people, H. pylori, hepatitis C
141
Follicular Lymphoma clinical
waxing/waning lymphadenopathy
142
Diffuse Large B-cell lymphoma def
b cell lymphoma, aggressive growth of b cells, most common in adults
143
Diffuse Large B-cell lymphoma cause
BCL-6 and BCL-2 mutation
144
Mantel cell Lymphoma cause
chromosomal translocation (11, 14) BCL1 gene
145
Adult T-cell Lymphoma def
proliferation of T cell
146
Adult T-cell Lymphoma cause
Human T-Lymphotropic Virus
147
Adult T-cell Lymphoma path
Human T-Lymphotropic Virus RNA -> DNA -> incorporates into T cell DNA -> cancer
148
Adult T-cell Lymphoma clinical
severe hypercalcemia, bone lesions
149
Mycosis Fungoides clinical
patch or plaque like lesions that look like fungal infection, Pautrier micro abscesses in the epidermis
150
Lymphoplasmacytic Lymphoma
bone marrow, lymph nodes, spleen, Waldenstrom macroglobulinemia
151
Adult T-cell Lymphoma cause
Human T-Lymphotropic Virus
152
Adult T-cell Lymphoma clinical
severe hypercalcemia, bone lesions
153
Mycosis Fungoides clinical
patch or plaque like lesions that look like fungal infection, Pautrier micro abscesses in the epidermis, erythroderma
154
Subtypes of Non-Hodgkin Lymphoma B cell
```
Lymphoplasmacytic Lymphoma
Marginal Zone Lymphoma
Mantel cell Lymphoma
Diffuse Large B-cell lymphoma
Follicular Lymphoma
```
155
Subtypes of Non-Hodgkin Lymphoma T cell
Mycosis Fungoides
| Adult T-cell Lymphoma
156
Multiple Myeloma def
cancer of plasms cells in bone marrow
157
Multiple Myeloma cause
t(14, 11), t( 14,6), deletion of gene TP53 tumor suppressor on chromosome 17
158
Multiple Myeloma RF
alcohol consumption, obesity, radiation, FH
159
Multiple Myeloma comp
amyloidosis, renal failure, death, UTIs, pneumonia, hyper-viscosity syndrome
160
Multiple Myeloma path
bone marrow cells, myeloma cells secrete cytokines, IL6, NF-kB -> promote proliferation, survival myeloma cells -> bone resoprtion, monoclonal free light chains, inhibited hematopoiesis, and IL1beta, TNFalpha -> bone lesions, renal disease, anemia, and high calcium
161
Multiple Myeloma clinical
CRAB (calcium, renal disease, anemia, bone lesions)
confusion, somnolence, constipation, N, thirst, fatigue, pallor, fever, infections, bleeding, bone lesions, pain, fractures, spinal cord compression, paresthesia, Bence Jones, Tamm-Horsfall proteins
162
Babesiosis def
infection of RBC by Babesia microti, ducani, or divergems
163
Babesiosis cause
Ixodes scapularis tick, contaminated blood transfusion
164
Babesiosis def
infection of RBC by Babesia microti, ducani, or divergems
165
Babesiosis RF
endemic area, May-September, blood transfusions, >50, male, asplenia, malignancy, HIV/AIDS, immunosuppressive drugs, coinfection w/ Borrelia and/or Anaplasma, premature birth
166
Babesiosis comp
CHF, noncardiac pulmonary edema, acute respiratory distress syndrome, splenic infarct, splenic rupture, septic shock, MI, disseminated intravascular coagulation, death
167
Babesiosis clinical
asymptomatic, fatigue, fever, chills, headache, myalgia, arthralgia, anorexia, N, cough, hypotension, poor prefusion, pulmonary edema, acute renal failure, disseminated intravascular coagulation
168
Babesiosis clinical
asymptomatic, fatigue, fever, chills, swears, headache, myalgia, arthralgia, anorexia, N, cough, hypotension, poor prefusion, pulmonary edema, acute renal failure, disseminated intravascular coagulation
maltese cross
169
Plasmodium species (Malaria) def
single cell parasites that get spread by mosquitoes
170
Plasmodium species (Malaria) cause
P. falciparum, P. vivax, P. malariae, P. ovale, P. knowlesi
171
Plasmodium species (Malaria) cause
P. falciparum (few days), P. vivax, P. malariae (few weeks), P. ovale, P. knowlesi
172
Plasmodium species (Malaria) path
P-infected female anopheles mosquito hunts for a blood meal in evening -> Plasmodium is in a sporozoite stage in salivary gland -> mosquito's proboscis piece skin sporozoites spill into bloodstream -> liver start asexual reproduction called schizogony -> over 1-2 weeks P. falciparum, malariae, knowlesi multiply asexually & mature to merozoites -> 1 mon-years P. ovale and vivax go dormant -> merozoites bind to duffy receptor on all different stages of RBC --> asexual reproduction 2-3 days -> trophozoite -> late trophozoite -> hemozoin/schizont -> replication -> release into RBC -> some turn into gametocytes and taken up by mosquitos -> mature and fuse into a zygote in gut -> ookinete -> oocyst rupture releasing sporozoites -> into salivary gland
173
Plasmodium species (Malaria) clinical
paroxysm of fevers P. falciparum (variable), P. vivax (48 h), P. malariae (72), P. ovale (48), P. knowlesi (24 h)
174
Plasmodium species (Malaria) comp
death, organ failure, cerebral malaria (altered mental status, seizure, coma), diarrhea, jaundice, vomiting, liver failure
175
Plasmodium species (Malaria) clinical
paroxysm of fevers P. falciparum (variable, worst infx), P. vivax (48 h), P. malariae (72), P. ovale (48), P. knowlesi (24 h)
fatigue, headaches, jaundice, splenomegaly,
Susan just headed for fiji
176
Schistosomiasis def
parasitic flatworms that cause damage in the mesenteries of the bladder
177
Schistosomiasis cause
Schistosoma haematobium, S. japonicum, and S. mansoni
178
Schistosomiasis path
Schistosoma eggs are eleminated in feces or urine into water -> eggs hatch and release miracidia -> miracidia penetrate snail tissue -> sporocyst develop in snail -> free-swimming cercariae released from snail into water -> cercariea penetrates skin -> cerciarea loses tails during penetration and becomes shcistocomulae -> migration to liver through circulation -> adult form -> migration to mesenteric venules/vesical venous plex -> egg deposit -> inflammation -> fibrosis
179
Schistosomiasis RF
male, rural areas, contact w/ fresh water bodies in endemic areas
180
Schistosomiasis comp
bacteremia, infertility, intestinal obstruction, nephrotic syndrome, renal failure, cardiomegaly, acute myelopathy
181
Schistosomiasis clinical
Acute: pruritic papular/urticarial rash of legs/feet, fever, urticaria, chills, arthralgia, myalgia, headaches, angioedema, dry cough, abdominal pain, diarrhea
chronic: abdominal pain, poor appetite, diarrhea, hepatosplenomegaly, portal HTN, ascites, dyspnea, cor pulmonale, hematuria, pyuria, dysuria, frequency, seizures, sensory/motor impairment, cerebellar syndrome
182
Plasma cell Microscopic Anatomy
clock face chromatin distribution and eccentric nucleus,
183
Plasma cell Origins
spleen and lymph node
184
Plasma cell Maturation
bone marrow
185
Plasma cell function
large amounts of antibody specific to particular antigens
186
Plasma cell regulation
transcription factors
187
Plasma cell synthesis
antigen-activated B in spleen and lymph node -> plasmablast -> plasma cells
188
Plasma cell degradation
2-3 days
189
How does hepcidin effect iron levels in body?
inhibits ferroportin-1
190
