Lecture 1 Flashcards

Question

Chronic Leukemia

Answer 1

Fully differentiated myeloid and lymphoid cells onset is usually slow with non specific symptoms such as weakness and weight loss

Answer 2

immature lymphocytes progenitors Originate in bone marrow but filter to spleen, lymph nodes, CNS, and other tissues

Answer 3

Pluripotent myeloid stem cell in bone marrow | Interfere with maturation of all blood cells including granulocytes, erythrocytes, and thrombocytes

Answer 4

Most common in children 66-75% of all childhood cancers Pre-B or Pre-T cells Lymphoblasts

Answer 5

Mainly in older adults can be seen in children and young adults (65-70ish)

Answer 6

Clonal malignancy of B-lymphs Average age of diagnosis is 72 years old Rare younger than 40 Diagnostic hallmark of CLL is isolated increased lymphocytes Increased WBC with >75% lymphocytes Hypogammaglobulinemia common (increased risk for infection)

Answer 7

Progenitor cell disorder 33% of all leukemia and is common in older adults 3 phases: 1. Chronic Phase 2. Accelerated Phase 3. Terminal Phases PHILADELPHIA CHROMOSOME

Answer 8

Blood and bone marrow studies Assessment findings: splenomegaly (spleen enlargement), generalized lymphadenapathy (soreness of the lymph nodes), and hepatomegaly (enlarged liver) Bone marrow aspiration, lumbar puncture

Answer 9

Chemotherapy- kills every cell, good or bad | Bone marrow or stem cell transplant (ALL, AML if other treatments have failed)

Answer 10

solid tumors involving lymphoid tissue

Answer 11

malignant transformation of either T or B cell differentiation Most commonly originate in lymph nodes then spread throughout the body to multiple organs

Answer 12

Reed-Sternberg Cell typically originate in a single lymph node and then spreads to contiguous nodes Malignant B cells invade lymphoid organs Usually just one lymph node

Answer 13

painless lymphadenopathy isolated or widespread diagnosis: lymph node biopsy, CT, MRI, bone scans Treatment: depends on histologic type, stage, and clinical status of person Localized Radiation Chemo/Radiation Combined(most common)

Answer 14

painless lymph node enlargement Sometimes c/o dyspea and prolonged cough Mediastinal mass may be discovered on CXR Diagnosis: Lymph node biopsy with presence of Reed- Sternberg cells CT, CXR, MRI, Bone scan Treatment: Radiation and chemotherapy; no option must do both

Answer 15

B Cell malignancy of terminally differentiated plasma cells. Monoclonal paraprotein Proliferation of malignant plasma cells in the marrow and osteolytic bone lesions throughout the system manifestations: blood and bone marrow plasma cell dyscrasias osteoclasts paraproteins secreted by plasma cells cause hyperviscosity of body fluids and may break down into amyloid that can cause heart failure and neuropathy

Answer 16

process that maintains the integrity of a closed high pressure circulatory system after vessel injury

Answer 17

Normal level: 150,000- 400,000 per microliter

Answer 18

live 8 to 9 days in circulation many stored in the spleen released when needed large fragments of megakaryocytes in bone marrow

Answer 19

platelet production made in liver, kidney, smooth muscle, bone marrow production controlled by thrombopoietin

Answer 20

circulate as inactive procoagulation factors most are synthesized by the liver von Willebrand factor made by megakaryocytes and endothelium

Answer 21

``` Constrict blood vessels von Willebrand factor -->platelet Adhesion Degranulation of platelets--> ADP, TXA--> platelet aggregation Calcium-->coagulation cascade ```

Answer 22

Clotting is not expected to be the permanent solution to vessel injury. blood clotting is accompanied by processes designed to control the coagulation cascade and dissolve the clot once bleeding has been controlled.

Answer 23

5 stages 1. Vessel Spasm 2. Formation of platelet plug 3. Blood coagulation or development of fibrin clot 4. Clot retraction 5. Clot dissolution

Answer 24

helps platelets change shape and adhere to vessel wall

Answer 25

increased platelet function (thrombocytosis): platelet adhesion, formation of platelet clots, disruption of blood flow smoking, high cholesterol, diabetes mellitus, and hemodynamic stress Increased clotting activity (genetic & acquired): Genetic- factor V (Leiden mutation) polycythemia- sickle cell disease, hyperestrogenic state of pregnancy, oral contraceptions, smoking obesity

Answer 26

decrease in circulating platelets (<100,000/microliter) increased risk for bleeding splenic sequestration, decreased platelet production, dilution

Answer 27

Autoimmune disorder that results in platelet antibody formation and destruction of platelets.

Answer 28

Some sulfa, quinine, quinidine | heparin

Answer 29

Platelets are consumed by increased levels of fibrin Thrombotic Thrombocytic purpura (TTP), hemolytic- uremia syndrome (HUS)

Answer 30

hemophilia A (factor VIII defiency)- x linked recessive Von willebrand Disease (factor IX deficiency) Autosomal Dominant

Answer 31

Liver disease gallbladder disease Vitamin K deficiency (Fat soluble vitamin)

Answer 32

"loves to bleed" are genetic disorders Types: Hemophilia A(VIII)- most common Hemophilia B (IX) vo Willebrand's disease

Answer 33

``` Slow, persistent bleeding from minor traumas and cuts Delayed bleeding after minor trauma Epistaxis GI bleeding (ulcers, gastritis) Hematuria Ecchymoses and SQ hematomas Hemarthrosis Pain, neurological symptoms from hematoma putting pressure on nerves ```

Answer 34

the ability to form blood clots is reduced

Answer 35

``` Reduction in platelets below 150,000 Causes: Chemotherapy Aspirin/NSAID therapy Types: Immune Thrombocytopenic Purpura Thrombotic Thrombocytopenia Purpura Heparin-Induced Thrombocytopenia and Thrombosis Syndrome ```

Answer 36

Bleeding (post-procedure) Petechiae, purpura, ecchymosis Hemorrhage

Answer 37

Serious bleeding and thrombotic disorder MEDICAL EMERGENCY Is an abnormal response of the normal clotting cascade stimulated by a disease process or disorder. in pregnant women, someone with multiple trauma

Answer 38

``` Obstetric Conditions: Abruption placentae, Dead fetus syndrome, Amniotic fluid embolism Cancers: APML, metastatic cancer Infection: Sepsis, bacterial meningitis, parasitic infections Trauma: Burns, snake bite, heatstroke Blood Transfusion reactions ```

Answer 39

``` No well-defined sequence Weakness, malaise, fever Bleeding Thrombosis Pallor, petechiae, purpura, hematomas, hemoptysis, hematuria, etc. EKG changes ```

Answer 40

``` Blood test that measures the levels of: RBCs WBCs Platelets Hemoglobin (Hgb) Hematocrit (Hct) Other “Differentials” in the RBCs and WBCs ```

Answer 41

red blood cells contain hemoglobin that carries oxygen ``` Normal Level RBCs Men – 4.2-5.4 Women – 3.6-5.0 Hemoglobin (11-15) Men – 14-16.5 Women – 12-15 Hematocrit (35-45) Men – 40%-50% Women – 37%-47% ```

Answer 42

production of red blood cells after birth RBC's ar3e normally produced in bone marrow RBC's live approx 120 days

Answer 43

abnormally low number of circulating RBC's, level of Hgb or both decreased o2 carrying capacity causes: decreased RBC production Blood loss: acute and chronic increased RBC destruction

Answer 44

Trauma | chronic blood loss (iron deficiency anemia)

Answer 45

transfusion reaction sickle cell anemia Destruction of RBC’s at a rate that exceeds production. ``` Clinical manifestations Jaundice Spleen and/or liver enlargement Renal failure secondary to hemoglobin accumulation in the renal tubules All other S/S of anemia ``` Complications Infection secondary to spleen failure Aplastic and hemolytic crisis Organ infarction

Answer 46

anemia caused by blood loss Result of a sudden hemorrhage. Clinical Manifestations 10 % - None 20% - No detectable S/S at rest, tachycardia and postural hypotension w/activity 30% - Normal supine BP at rest, postural hypotension and tachycardia with exercise 40% - BP, CVP, and CO below normal at rest; rapid, weak pulse and cold clammy skin 50% - Shock and potential death

Answer 47

Examples: PUD Hemorrhoids Menstrual and postmenstrual blood loss

Answer 48

A group of diseases that have an autosomal recessive genetic basis involving inadequate production of normal hemoglobin. ``` Clinical manifestations Pallor All other symptoms of anemia Develops by two years of age and causes developmental delays Splenomegaly and hepatomegaly – jaundice ```

Answer 49

A group of anemias caused by impaired DNA synthesis and characterized by the presence of LARGE RBC’s ``` Types: Iron deficiency anemia Cobalamin (Vitamin B12) deficiency Gastritis Gastrectomy Folic acid deficiency Poor nutrition, malabsorption in small intestine Alcohol abuse Hemodialysis ```

Answer 50

A disease in which the patient has a general pancytopenia (decrease in all blood cell types) and hypocellular bone marrow May be caused by chemotherapy ``` Clinical manifestations Anemia symptoms Thrombocytopenia Neutropenia Diagnostic studies CBC Total serum iron and TIBC ```

Answer 51

``` Production and presence of TOO MANY RBC’s Clinical manifestations Hypertension secondary to hypervolemia Headache, pain, dizziness, visual disturbances Pruritis from histamine release Angina, heart failure, thrombophlebitis Blood vessel distention Stroke, PE and other “clot” disorders ```

Answer 52

Number of stem cells and bone marrow deplete with age, thus causing problems with the following: number of RBC’s (anemia) clotting ability ability to fight infection oxygen transportation compensation for an acute or chronic disorder

Answer 53

Hyperbilirubinemia in the neonate: Increased serum bilirubin Most common cause of jaundice in neonate Can place the neonate in danger of brain damage Treated with phototherapy or exchange transfusion

Answer 54

``` Erythroblastosis fetalis (rh + mother and rh- infant) Rh positive infant and Rh negative mother ```