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Internal Med > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Which blood cells are produced in the myeloid lineage?

A

RBCs
granulocytes: neutrophils, basophils, eosinophils
Platelets
Monocytes

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2
Q

What blood cells are produced in the lymphoid lineage?

A

B & T lymphocytes

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3
Q

What are causes of neutropenia?

A 
Drug toxicity (chemo)
Severe infection
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4
Q

How can you treat neutropenia in a chemo patient?

A

GM-CSF

G-CSF

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5
Q

What are causes of lymphopenia?

A

Immunodeficiency (DiGeorge syndrome)
High cortisol state (Cushings)
Autoimmune destruction (SLE)
Whole body radiation (lymphocytes most sensitive to radiation)

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6
Q

What are causes of neutrophilic leukocytosis?

A

Bacterial infection
Tissue necrosis
High cortisol state

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7
Q

What is the importance of left shift neutrophilia?

What cell markers are decreased compared with mature neutrophils?

A

Many immature neutrophils leaving the circulation

Immature neutrophils have decreased Fc receptors (don’t work as well) as seen by decreased expression of CD16

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8
Q

What causes a monocytosis?

A

chronic inflammation

malignancy

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9
Q

What causes eosinophilia?

A

Allergic reactions
Parasitic infection
Hodgkin lymphoma (increased IL-5 production)

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10
Q

What causes basophilia?

A

CML

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11
Q

What causes lymphocytosis?

A

Viral infections

Bordetella pertussis

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12
Q

What are some clinical features of a CD8+ T cell response? (EBV infection)

A

generalized lymphadenopathy (paracortex)
splenomegaly (periarterial lymphatic sheath-PALS)
high WBC with atypical lymphocytes

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13
Q

How does a monospot test work?

A

Detects IgM heterophile antibodies
(takes 1 week after infection to test positive)
**screens but doesn’t diagnose Mono

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14
Q

How do you test to diagnose EBV

A

EBV viral capsid antigen

screening test is monospot/heterophile antibody test

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15
Q

What is a long term complication of EBV infection?

A

Higher risk of lymphoma if dormancy of virus in B cells

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16
Q

What cells types are most numerous in acute leukemia?

A

Immature (blast) cells

>20% blasts, that crowd out normal cells that result in anemia, thrombocytopenia or neutropenia

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17
Q

What do myeloid/lymphoid blasts cells look like (blood smear)?

A

Large, punched out nucleus (nucleolus), immature (very little cytoplasm)

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18
Q

What are the cell markers on myeloblasts?

A

myeloperoxidase (MPO)

crystalizes into Auer rods

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19
Q

What are the cell markers on lymphoblasts?

A

TdT+ on nuclear staining (DNA polymerase)
B-ALL: CD10, CD19, CD20
T-ALL: CD2-8 NOT CD10

20
Q

What are some genetic translocations associated with B-ALL (prognosis?)

A

t(12;21) – good prognosis, commonly seen in kids

t(9;22) – poor prognosis, commonly seen in adults

21
Q

What disease has t(12;21)?

A

B-ALL, usually kids with good prognosis

22
Q

What disease has t(9;22)?

A

B-ALL, usually adults with poor prognosis Ph+ALL

CML

23
Q

What are the features of T-ALL?

A

Thymic mass (mediastinal lymphoma)
Teenagers
TdT+, and CD2-8, NOT CD10

24
Q

How can you tell blasts cells are AML?

A

MPO on stain or crystalization into Auer rods

25
Q

What disease has t(15;17)?

A

AML

26
Q

What is the result to this translocation?

t(15;17)

A

Disrupts retinoic acid receptor –> promyelocytes (containing Auer rods) accumulate –> risk for DIC
Tx: ATRA causes cells to mature

27
Q

What is basophilic stippling and when do you see it?

A

Basophilic granules in RBCs

  • Anemia of Chronic disease
  • alcohol abuse
  • lead poisoning
  • thalassemias
28
Q

What are acanthocytes and when do you see them?

A

Spiny RBCs (spur cells)

  • liver disease
  • abetalipoproteinemia (cholesterol dysregulation)
29
Q

What are bite cells and when do you see them?

A

RBCs that look like they have a bite taken out

- G6PD deficiency

30
Q

What do you think when there are big, oval shaped RBCs on blood smear?

A

Macro ovalocytes

  • megaloblastic anemia (w/ hypersegmented PMNs)
  • marrow failure
31
Q

What are ringed sideroblasts and when do you see them?

A

Sideroblastic anemia

Excess iron in mitochondria

32
Q

What are schistocytes and when do you see them?

A

Darth Vader helmet cells

  • DIC
  • TTP/HUS
  • traumatic hemolysis (mechanical heart valves)
33
Q

What do you think when you see spherocytes on blood smear?

A

Hereditary spherocytosis

Autoimmune hemolysis

34
Q

What do you think when you see teardrop cells on blood smear?

A

Bone marrow infiltration (myelofibrosis)

35
Q

What do you think when you see target cells on blood smear?

A

HbC disease
Asplenia
Liver disease
Thalassemia

“HALT!” Said the hunter to his TARGET

36
Q

What are Howell-Jolly bodies and when would you see them?

A

Basophilic nuclear remnant in an RBC

  • functional hyposplenia
  • asplenia
37
Q

What are Heinz bodies and when would you see them?

A

Hgb precipitation from oxidation of sulfhydryl groups in an RBC (seen in crystal violet stain)

  • G6PD deficiency (w/ quinolones)
  • alpha-thalassemia
  • **phagocyte damage may turn them into bite cells
38
Q

What are the signs of multiple myeloma?

A

CRAB:
Calcium (high) from increased bone breakdown
Renal failure
Anemia
Bone lesions (lytic in skull and axial skeleton)
Protein (high in serum) from excess Igs

39
Q

What are Bence Jones proteins?

A

Free light chains:
immunoglobulin precipitates into tubular cast in the renal tubules
caused by myeloma nephrosis

40
Q

What is Hemophilia A?

A 
Deficiency of factor VIII
prolongs PTT (intrinsic pathway)
41
Q

What is Hemophilia B?

A 
Deficiency of factor IX
prolongs PTT (intrinsic pathway)
42
Q

What is Bernard-Soulier syndrome?

A

Defect in platelet plug formation

decreased GpIb –> defect in platelet to vWF adhesion

43
Q

What is Glanzmann thrombasthenia?

A

Defect in platelt plug formation
decreased GpIIb/IIIa –> defect in platelet to platelet aggregation
**no platelet clumbing on blood smear

44
Q

What is Immune thrombocytopenia?

A

anti-GpIIb/IIIa antibodies –> splenic macrophage consume platelet antibody complex
**decreased platelet survival (low number)
megakaryocytes on bone marrow biopsy

45
Q

What is thrombotic thrombocytopenic purpura?

A

deficiency or inhibition of vWF metalloprotease (ADAMTS 13) –> decreased degradation of vWF multimers –> platelet adhesion/aggregation –> thrombosis
**schistocytes, increased LDH

46
Q

What are some symptoms of TTP?

A

fever
thrombocytopenia
microangiopathic hemolytic anemia
neruologiv and renal symptoms

Internal Med (6 decks)

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