HemeOnc Flashcards
CD14
Macrophage
Histaminase and arylsulfatase
Eosinophils
Hypersegmented neutrophil
B12/folate deficient
Heparin and histamine
Basophils, Mast cells
vWF receptor
Fibrinogen receptor
vWF: Gp1b
Fibrinogen: gpIIb/gpIIIa
CD34
Bone marrow stem cell
CD19/CD20
B cell
CD3/CD4
TH1/TH2
CD3/CD8
Cytotoxic t cell
Hemophilia A vs Hemophilia B
A- Factor VIII def
B - Factor IX def
Factors that vitamin K deficiency affects
II, VII, IX, X, protein C, protein S
Epoxide reductase
Reduces Vitamin K so it is active
Factors antithrombin inhibits
II, VII, IX, X, XI, XII
gpIb deficiency affects?
gpIIb/gpIIIa defiency affects?
gpIb - affects adhesion
gpIIb/gpIIIa - affects aggregation
Clopidogrel/Ticlopidine affect?
gpIIb/gpIIIa -> Decreased aggregation
Abciximab affects
gpIIb/gpIIIa
What affect do polycythemia and CHF have on ESR?
Decrease ESR
G6PD deficiency leads to what microsopic changes?
Heinz bodies, Bite cells
Asplenia leads to what microscopic change?
Howell Jolly bodies
What is the cause of hemolytic uremic syndrome?
E. coli O157:H57 from beef
Toxin damages endothelial cells -> leads to Hemolytic Uremic syndrome
Abnormal ristocetin test
And therapy
Looks at vWF disease
Therapy: Desmopressin will increase vWF release from Weibel Palade bodies in endothelial cells
What enzyme activates vitamin K? What acts on this enzyme to inhibit?
Vitamin K - Activated by epoxide reductase
K then gamma carboxylates to activate II, VII, IX, X, C, S
Inhibited epoxide reductase by warfarin
What do endothelial cells produce to decrease thrombosis?
PGI2
Function of thrombin
Converts fibrinogen to fibrin
What does DIC affect?
Activates the coagulation cascade
What is the function of tPa?
Activates plasminogen to plasmin which breaks down fibrin clots and decreases clotting factors
How can fibrinolysis disorder be distinguished from DIC?
DIC - low platelet count, and increased D Dimers
Fibrinolysis disorder -> Increased plasmin which affects fibrin and clotting factors but no change in platelets and no elevation of D dimers
How do endothelial cells prevent thrombosis?
Release tPa, which activates plasmin to cleave fibrin and clotting factors
Prostacyclin (PGI2), and NO release
heparin like molecules to increase antithrombin III
What effect does homocysteine have?
What can cause an elevation in this?
endothelial damage is caused by elevated homocysteine
Caused by decreased B12/folate levels -> Decreased homocysteine to methionine
Or caused by decreased homocysteine to cystathionine
What hb levels define anemia in males and females?
Males < 13.5
Females < 12.5
Esophageal web, glossitis, beefy red tongue, iron def anemia
plummer vinson syndrome
People with thalassemia are protected against what?
Plasmodium falciparum malaria
What are the types of alpha thalassemia?
1 mutation - asymptomatic
2 mutations - cis: asian -> can pass to offspring
trans: african
Three genes: HbH formation
Four genes: Hydrops fetalis and Hb Barts
What are the forms of B thalassemia to know?
Chromosome 11 (alpha thal is 16)
B/B+: relatively minor, target cells seen and HbA2 increases (alpha2/delta2)
B0/B0 -> increased HbF increased HbA2
Crewcut appearance, extramedullary hematopoiesis
inc. risk of parvovirus B19
What population has increased risk of parvovirus B19 aplastic crisis?
B thalassemia major
B12 or folate deficiency leads to a buildup of what substance that damages endothelial cells leading to coagulation?
Homocysteine
Where is folate absorbed in the body?
Jejunum
Where and how is B12 absorbed?
Terminal ileum via intrinsic factor formed by gastric parietal cells
What lab finding is specific to Folate deficiency?
Normal methylmalonic acid
What step is impaired in B12 deficiency?
What are the clinical findings?
B12 deficiency: Excess methylmalonic acid
Dec. conversion of methylmalonic acid to succinyl coA
CLinical findings: Spinal cord degeneration -> afects posterior column and lateral corticospinal tract
What is the first step that should be done in assessing a normocytic anemia?
Take the reticulocyte count and multiply by the hematocrit/45
> 3% is good
<3% means there is a problem making blood cells
How can extravascular vs intravascular normocytic anemias be distinguished?
Extravascular - Jaundice due to increased unconjugated bilirubin via protoporphyrin breakdown from Hb via splenic macrophages
Intravascular normocytic anemia - Hemosidenuria due to increased hemoglobin breakdown and iron absorption in the renal tubules, and decreased haptoglobin which binds the hemoglobin in the blood from RBC breakdown
What causes spherocytosis?
Defect of cytoskeletal proteins
Osmotic fragility test
Hereditary spherocytosis
What biochemical substitution is found in sickle cell anemia?
Replace glutamic acid with valine
When is dactylytis seen?
What about acute chest syndrome with vasoocclusion in pulmonary microcirculation?
Dactylytis - Children with sickle cell anemia
Acute chest syndrome - Adults with sickle cell (similar to CHF)
What is the major complication of sickle cell TRAIT?
Eventual inability to concentrate urine as sickling occurs in renal medulla
What is the biochemical change in hemoglobin C?
Replacement with lysine (lyCine) and HbC crystals
What marker distinguishes immature left shift leukocytes?
Decreased CD16 Fc receptor
What cell line is increased in CML?
t(9:21)
Basophils
What kind of cells undergo hyperplasia in infectious mononucleosis?
Where are they located?
T cells
Paracortex
White pulp of spleen -> Periarterial lymphatic sheath
What initial screening test is done to check for EBV mononucleosis?
What if it is negative?
What secondary test is performed to confirm?
Monospot test
Negative -> CMV
Secondary test -> EBV viral capsid test
What do ALL cells have positive nuclear staining for?
Tdt -> DNA polymerase
B cells - CD 10/19/20
T cells - CD2 to CD8!!! not CD10!!
What group is most at risk for ALL?
Down syndrome children AFTER the age of 5 years
What translocation is a marker for good prognosis in ALL? What is poor?
Good - t(12:21)
Poor - t(9:22)
What is seen in AML in terms of cytoplasmic staining?
Auer rods
MPO (myeloperoxidase)
What is the translocation in Acute Promyelocytic Leukemia?
t(15:17)
retinoic acid
Down syndrome before age 5
acute megakaryoblastic leukemia
CD 5 CD 20 and smudge cells
CLL
TRAP with dry tap bone marrow w/ accumulation in red pulp of spleen
Treatment?
Hairy cell leukemia
2-CDA -> adenosine deaminase inhibitor