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Clinical Medicine I > HemOnc > Flashcards

HemOnc Flashcards

1
Q

term for process of blood cell production in

  • adult bone marrow
  • liver/spleen of fetus (mainly liver)
A

hematopoiesis

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2
Q

differentiation of hematopoietic stem cells

(hematopoiesis process)

A
  • stem cell pool: proginitor cells ->
  • bone marrow pool ->
  • peripheral blood:
    • granulocytes
    • megakaryocyes -> trhomboytes
    • erythrocytes
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3
Q

primary residence of hematopoietic stem cells

A

bone marrow (myeloid tissue)

  • red vs. yellow
  • adult active bone marrow:
    • pelvic bones
    • vertebrae
    • cranium and mandible
    • stermun and ribs
    • humerus and femur
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4
Q

these control differentiation of hematopoietic progenitor cells

and the stem cells found in these

A

niches

  • osteoblastic niche
    • mesenchymal stem cells (MSC)
      • differentiate into osteoblasts, adipocytes, chondrocytes (chartilage)
  • vascular niche
    • hematopoietic stem cells (HSC)
      • progenitors of all hematologic cells
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5
Q

terms for unlimited vs. more limited differentiation hematopoietic cells

and what controls differentiation

A
  • pluripotent cells - unlimited differentiation potential
  • multipotent cells - more limited, but differentiate into many types
  • colony-stimulating factors (CSFS) or hematopoietic growth factors
    • stimulate progenitor cells to mature
    • synthetic CSFS can be used to increase neutrophils
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6
Q

development of RBCs

A

erythropoiesis

  • erythroblasts (normoblasts) derive erythrocytes
  • stimulated by erythropoietin (EPO)
    • produced by peritubular cells in the kidneys
    • response to tissue hypoxia
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7
Q

reticulocyte count

(what is it)

A
  • part of any enemia workup
  • immature erythrocytes
  • index of erythropoietic activity
    • indicates if new RBCs are being producted
    • # of circulating RBCs is constant if healthy
  • in each step hemoglobin increases and nucleus decreases
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8
Q

term for formation of WBCs

A

leukopoiesis

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9
Q

leukopoiesis stimulated by 2 types of chemical messengers

A

from red bone marrow and matre WBCs

  • interleukins (numbered IL-3, IL-5, etc)
  • colony-stimulating factors / CSFS (named for WBC type they stimulate)
  • all WBCs (leukocytes) come from hemocytoblasts (progenitor of WBCs) that branches into 2 pathways:
    • Lymphoid stem cells - produce B and T lymphocytes
    • Myeloid stem cells - produce all other elements
      • eosinophils, basophils, neutrophils, monocytes
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10
Q

function of neutrophil

A

phagocytize bacteria (first responder)

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11
Q

function of eosinophil

A

kill parasitic worms

complex role in allergy/asthma

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12
Q

function of basophil

A

release histamine and other inflammatory mediators

contain heparin (anticoagulant)

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13
Q

function of lymphocyte

A

immune response via antibodies or direct attack

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14
Q

term for formation of platelets

A

thrombopoiesis

hematopoietic stem cell -> megakaryocyte -> platelet fragments

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15
Q

indications for peripheral blood smear

A
  1. verification of automated results
  2. potential immediate diagnosis
  3. can narrow differential diagnostic list
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16
Q

terms for erythrocyte alterations

too many, too few, abnomal components

A
  • polycythemias - too many
  • anemia - too few
17
Q

4 causes of anemia

A
  1. impaired erythrocyte production
    • lowered hemoglobin synthesis
    • DNA synthesis
    • stem cell
    • bone marrow infiltration
    • pure red cell aplasia
  2. acute/chronic blood loss
  3. increased erythrocyte destruction
    • intrinsic (within RBC) vs. extrinsic (outside RBC)
  4. combination of the above
18
Q

anemia classifications

A
  • etiologic factor (cause)
  • size
    • -cytic
    • macrocytic (large), microcytic (small), normocytic (normal)
  • hemoglobin content
    • -chromic
    • normochromic (normal amount), hypochromic (decreased)
  • appearance
    • anisocytosis - RBCs present in various sizes
    • poikilocytosis - RBCs present in various shapes
19
Q

different microcytic anemias

A
  • iron deficiency
  • thalassemia major
  • thalassemia minor
20
Q

important H&H measurements

A
  • hemaglobin (g/dL)
  • hematocrit (% of RBC in whole blood)
  • red blood cell count (x10^6 /uL of blood)
  • mean cell volume - MCV (fL)
  • reticulocyte count (no/uL of blood)
21
Q

anemia symptoms

A
  • often none
  • fatigue, dyspnea, palpations, pallor
  • decreased exercise tolerance
  • HG <7.5: CO, stroke volume, HR increase
  • severe Sxs:
    • cardiac- dizziness, HA, syncope, tinnitis, vertigo, MI
    • irritable, decreased sleep and concentration
    • cold sensitivity, yellowing skin/eyes
    • GI: indigestion, anorexia, nausea
    • abnormal menstruation, amenorrhea/increased bleeding
    • impotence, loss of libido
    • enlarged spleen
22
Q

assessing anemia

(what to determine)

A
  • is it decreased RBC production
    • reticulocytes inappropriately low
    • MCV, MCHC are informative
    • bone marrow exam often required for Dx
    • usually acquired
  • increased RBC destruction (hemolysis)
    • reticulocyte count increased
    • RBC morphology on blood smear informative
    • no bone marrow exam
    • usually inherited
  • blood loss
    • must be ruled out
23
Q

anemia workup

A
  • CBC
    • MCV: micro vs. macro
    • reticulocyte count: distinguish decr. production vs. hemolysis
      • elevation = hemolysis
      • reduction = failure to produce
  • peripheral blood smear
    • esp. in enexplained anemia - pathologist will examine
  • bone marrow examination
    • quantitiy/quality of RBC precursors: defect in production
      • hypoplasia or ineffective erythropoiesis
    • cellularity: ratio of myeloid to erythroid precursors
      • increased by inclusion of leukocytes, infection, leukemoid reaction, neoplastic myeloid cells
      • presence of cellular infiltrates: leukemia, lymphoma, multiple myeloma
24
Q

anemia d/t blood loss

A
  • acute loss
    • sxs secondary to hypovolemia and hypoxia
    • vital signs reflect CV compensation
    • assess postural orthostatic signs:
      • supine to sitting: hypovolemia (loss >1000ml)
        • pulse increase of 25%+
        • systolic BP fall of 20+
    • loss >1500ml leads to cardiovascular collapse
    • leukocytosis (left shift) on labs
    • tx
      • transfusion of PRBCs, monitor and volume replacement
      • control bleeding
      • emergent coagulation profile
  • chronic loss
    • usually lesions in GI tract or uterus
      • stool specimens and rectal exam
    • manifests like iron deficiency anemia
25
Q

3 major anemia classifications

(according to size or MCV of RBCs)

A
  1. microcytosis
    • iron deficiency
    • thalassemias
    • amemia of chronic disease
    • sideroblastic (acquired: drugs, congenital)
      • atypical, abnormal nucleated erythroblasts w/ granules of iron accumulated in perinuclear mitochondria
  2. macrocytosis
    • RBC aplasia
    • alcoholism
    • aplastic anemia
    • myelodysplastic syndromes
    • megaloblasic anemias
    • hemolytic anemias
      • extrinsic- antibody, microangiopathic, toxins, malaria
      • intrinsic- RBC membrane defect, hemoglobinopathies
  3. normocytosis
    • anemia of chronic disease
    • acute hemorrhage
    • hemoglobinopathies
    • primary bone marrow failure
      • aplasia
      • myelophthisis
    • secondary to chronic disease
26
Q

anemia characterized by small RBCs with reduced hemoglobin

A

microcytic-hypochromic anemia

27
Q

causes of microcytic-hypochromic anemia

A
  • disorders of iron metabolism
  • disorders of porphyrin and heme synthesis
  • disorders of globin synthesis
28
Q

the microcytic-hypochromic anemias

(improper HGB making cell smaller / MCV <80fl)

A

TICS

  • T - thalessemias
    • hemoglobin electrophoresis to quantify HGB A2 and F
  • I - iron deficiency
    • TIBC (total Fe binding), serum ferritin, transferrin (% Fe saturation)
  • C - chronic disease/inflammatory
    • inflammation can be detected w/ CRP or ESR
    • 30% microcytic, 70% normocytic
    • kidney damage MCC - can’t excrete EPO
  • S - sideroblastic
29
Q

significant reduction in size of circulating RBCs

w/ insufficient amounts of Fe

A

iron-deficiency microcytic-hypochromic anemia

30
Q

function of monocytes

A

phagocytosis in tissues

Clinical Medicine I (8 decks)

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