Outcome 11 Hematology & Immunology Flashcards
Anemia can be a reduction of these 2 mechanisms
- quantity of rbc
2. quantity of hemoglobin
Anemia can be classified by what three characteristics
- colour
- size
- cause
3 classifications of colour in anemia
- hypochromic
- normochromic
- hyperchromic
3 classifications of size in anemia
- microcytic
- normocytic
- macrocytic
2 main causes of iron deficiency anemia
- blood loss
2. insufficient dietary intake of iron
What type of blood loss occurs in iron deficiency anemia?
slow, chronic hemorrhage
In folic acid deficiency anemia, red blood cells are prevented from maturing as there is not enough folic acid available for _____
DNA synthesis
Aplastic anemia is caused by an insult to the ____ cells in the bone marrow
hematopoietic
Sickle cell anemia can be caused by heredity; there is an inherited trait that causes red blood cells to acquire a sickle or elongated shape on _____
deoxygenation
Hemorrhagic anemia is caused by an acute, large decline in ____ in a short time
blood volume
Hemolytic anemia is caused by ____ of the red blood cells
abnormal destruction
Another term for agrunolocytosis
neutropenia
2 causes of agrunolocytosis
- drug toxicity
2. hypersensitivity
Polycythemia vera is an absolute increase in red blood cell mass due to an increase of what 3 substances?
- hemoglobin
- rbc count
- hematocrit
Cause of primary (absolute) polycythemia
unknown
Cause of relative polycythemia
reduction of plasma volume
Leukemia is classified by the ___ type and the degree of ___ of the ____ cells
cell type, degree of differentiation, neoplastic cells
Leukemia with a rapid onset and progression
acute leukemias
Leukemia where progression is slower, measured in years rather than months
chronic leukemias
ALL is an overproduction of ____ cells in the bone marrow and lymph nodes
immature lymphoid cells (lymphoblasts)
CLL causes an excess of _____ which are hypofunctional
mature-appearing lymphocytes
Most common staging system used for CLL
Rai system
Acute myelogenous leukemia is divided into seven subtypes using this classification
French-American-British (FAB) classification
3 phases of chronic myelogenous leukemia
- chronic phase
- accelerated phase
- blast crisis
Drug that can induce and maintain a remission of chronic myelogenous leukemia
Gleevec
Only risk factor for CML
exposure to radiation
Part of the body where the lymph normally collects in lymphedema
usually in the extremities
Lymphangitis is caused by a ____ at the site of local trauma or ulceration
bacterial invasion
2 main types of lymphoma
- Hodgkin’s disease
2. Non-Hodgkin’s lymphoma (NHL)
Staging system used to evaluate both types of lymphoma
Ann Arbor-Cotswolds staging system
What are the 3 “B symptoms” of lymphoma?
- unexplained weight loss
- persistent or recurrent fevers
- night sweats
The presence of ___ cells differentiates Hodgkin’s disease from other types of lymphoma
Reed-Sternberg cells
Treatment for multiple relapses of Hodgkin’s disease
bone marrow transplant
3 categories for Non-Hodgkin’s Lymphoma based on aggression
- indolent lymphomas
- aggressive
- highly aggressive
What is the effect on the red blood cells of an antigen-antibody incompatibility reaction?
hemolysis or agglutination of the RBCs that obstructs the flow of blood through capillaries
Most common type of hemophilia
classic hemophilia
Clotting factor that is deficient in classic hemophilia
Factor VIII
Cause of classic hemophilia
X-linked genetic inheritance (affects males)
Disseminated intravascular coagulation (DIC) causes these 2 process to occur simultaneously
- hemorrhage
2. thrombosis
DIC occurs secondary to a ____
major event (obstetric complications, septicemia, trauma, etc.)
reduction in quantity of either RBCs or hemoglobin
anemias
anemia is not a disease, it is a ____ of various diseases
symptom
3 color classifications of RBCs
- hypochromic
- normochromic
- hyperchromic
3 size classifications of RBCs
- microcytic
- normocytic
- macrocytic
4 causes of anemia
- acute or chronic blood loss
- impaired production of RBCs
- inherited hemolytic conditions
- anorexia nervosa
6 types of anemia
- iron-deficiency
- folic-acid deficiency
- aplastic
- sickle cell
- hemorrhagic
- hemolytic
type of anemia: secondary to blood loss through hemorrhage; insidious bleed and even heavy menstrual flow or insufficient intake of dietary iron
iron deficiency
type of anemia: results when insufficient amounts of folic acid are available for DNA synthesis, thus preventing the maturation of blood cells
folic acid deficiency
folic acid deficiency is clinically similar to ___ anemia
pernicious
type of anemia: results from an insult to hematopoietic cells in the bone marrow
aplastic
in aplastic anemia, production of these 3 cells are reduced
- erythrocyte
- leukocyte
- thrombocyte
type of anemia: chronic HEREDITARY hemolytic form of anemia
sickle cell
in sickle cell anemia, sickle or elongated shaped cells obstruct ____ and lead to tissue hypoxia
capillary flow
type of anemia: results from large decline in blood volume or hypovolemia in a short time
hemorrhagic
type of anemia: caused by abnormal destruction of RBCs
hemolytic
3 other causes of hemolytic anemia
- heredity
- toxins
- certain bacteria
blood dyscrasia in which leukocyte levels become extremely low; can have a rapid onset
agranulocytosis
aagranulocytosis is also called ____
neutropenia
2 causes of agranulocytosis
- drug toxicity
2. hypersensitivity
agranulocytosis is treated with aggressive ____ therapy
anti-microbial
abnormal increase in amount of hemoglobin, RBC count, or hematocrit, causing an increase in RBC mass
polycythemia
polycythemia is also known as ____
polycythemia vera
polycythemia is caused by a sustained increase in _____ of bone marrow
hematopoiesis
polycythemia is also caused when ____ is reduced by dehydration, plasma loss, burns, fluid and electrolyte imbalance
plasma volume
family of drugs to treat polycythemia
myelosuppressive drugs
polycythemia is treated through ____ to reduce blood volume
periodic phlebotomy
overproduction of immature lymphoid cells in bone marrow and lymph nodes
acute lymphocytic leukemia (ALL)
ALL tends to occur in ____ or those older than ____
children; 65
contributing factors in ALL
radiation, exposure, chemicals, drugs, smoking, genetic factor
diagnostic test for ALL
peripheral blood smear
in ALL, aggressive chemo is used for 2 to 3 years and the central nervous system is treated ____
prophylactically
type of radiation therapy to treat ALL
intracranial
type of transplantation for adult ALL patients with poor prognostic features
allogenic bone marrow transplantation
slowly progressing disease; neoplasm that involves lymphocytes; most patients are males
chronic lymphocytic leukemia (CLL)
CLL is caused by _____ changes
chromosomal
CLL is caused by the deletion of chromosome #__
13
2 diagnostic tests for CLL
- peripheral blood smear
2. bone marrow studies
treatment for CLL is held until ____
symptomatic
rapidly progressive neoplasm of cells committed to the myeloid line of development
acute myelogenous leukemia (AML)
in AML, leukemic cells accumulate in these 3 areas
- bone marrow
- peripheral blood
- other tissues
3 other names for AML
- acute myeloid
- myelocytic
- granulocytic
rapid accumulation of myeloblasts in AML lead to these 2 conditions
- pancytopenia
2. anemia
most common adult leukemia
AML
risk factors for AML include family Hx, previous treatment with ionizing radiation, chemo, ovarian cancer, breast cancer and chronic exposure to _____
benzene
many cases of AML are related to _____
treatment such as chemotherapy or radiation
chemo is the first treatment approach to AML and ____ during the first remission may improve survival
bone marrow transplantation
slowly progressing neoplasm arising in hematopoeitic stem cell or early progenitor cell
chronic myelogenous leukemia (CML)
2 other names for CML
- chronic myeloid
2. myelocytic
CML results in excess of mature-appearing but hypofunctioning ____
neutrophils
CML occurs most often in adults over age ___
40
CML is caused by exposure to ____ radiation
ionizing
CML is associated with abnormal chromosome #___
22
triphasic course for CML
- chronic
- accelerated
- blast
only chance for complete CML cure
bone marrow transplantation
bone marrow transplantation is an option for about __% of patients
25
abnormal collection of lymph; usually in extremities
lymphedema
in lymphedema, patient experiences no pain but extremities become swollen and ____
grossly distended
t or f. lymphedema can only be inflammatory
f. lymphedema may be inflammatory or mechanical
t or f. if untreated, lymphedema becomes permanent
t
treatment for lymphedema is aimed at reducing ____
swelling
the affected limb in lymphedema is elevated above the heart to encourage ____
drainage of lymph
inflammation of lymph vessels
lymphangitis
in lymphangitis, ____ may develop in surrounding tissue
cellulitis
lymphangitis is caused by ____ into lymph vessels at the site of local trauma or ulceration
bacterial invasion
t or f. occasionally, no portal of entry is detectable in lymphangitis
t
family of drugs to treat lymphangitis
systemic antibiotics
2 types of lymphoma
- hodgkins
2. non-hodgkins
cancer of the body’s lymphatic system in which tumors arise in lymph tissue and spread to other lymph nodes, spleen, liver and bone marrow
hodgkin’s disease
2 peaks of incidence in hodgkin’s disease
- patients in their 20s
2. patients over the age of 50
4 risk factors in hodgkin’s disease
- previous Hx of malignancy
- prior chemo/radiation
- family Hx
- exposure to EPV
stage 1 and 2 of hodgkin’s disease may be treated with ____ alone
radiation
stages 1, 2, and 3 of hodgkin’s disease is treated with ____
combined chemoradiotherapy
higher stages of hodgkins is treated with ____ alone
chemo
preferred therapy for hodgkin’s
ABVC therapy
number of heterogenous neoplasms of lymphoid cells
non-hodgkin’s disease (NHL)
incidence of NHL reaches a peak in this group
preadolescents
2 risk factors of NHL
- personal Hx
- family Hx
- previous chemo/radiation/immune therapy
lymphomas where treatment is put on hold until symptomatic
indolent lymphomas
type of chemotherapy to treat aggressive lymphomas
CHOP chemotherapy
transfused blood has antibodies to the recipient’s RBCS; the recipient has antibodies to the donor RBCs
transfusion incompatibility reaction
most severe transfusion incompatibility reactions are related and characterized by ____ or ____
hemolysis; agglutination
ABO- and Rh- incompatible blood and antigens are not revealed in screening
transfusion incompatibility reaction
reaction that produces hemolysis or agglutination
antigen-antibody reaction
treatment for transfusion incompatibility reaction include ___ before a transfusion
transfusion protocol mandates
family of drugs to treat mild transfusion incompatibility reaction
antihistamines
hereditary bleeding disorder resulting from deficiency of clotting factors
classic hemophilia
classic hemophilia is caused by this type of genetic disorder in males
x-linked
classic hemophilia may also be caused when hemophilia is transmitted from asymptomatic carrier ____ to ____
mother to son
classic hemophilia may also be caused when ____ is functionally inactive; any minor trauma can initiate a bleeding episode
clotting factor (factor viii)
t or f. there is no cure for classic hemophilia
t
treatment in classic hemophilia is to prevent ____
crippling deformities
condition of simultaneous hemorrhage and thrombosis
disseminated intravascular coagulation (DIC)
disseminated intravascular coagulation (DIC) occurs when ____ activates ____
thrombin; fibrin
in disseminated intravascular coagulation (DIC) thrombin activating fibrin causes ____ to form where it is not needed
clots
thrombin in clots causes excessive ____ and additional bleeding
fibrinolysis
4 predisposing factors
- hypotension
- hypoxemia
- acidosis
- stasis of capillary blood
disseminated intravascular coagulation (DIC) is treated with IV _____
heparin
2 other treatment options for disseminated intravascular coagulation (DIC) when serious hemorrhage is present
- platelet replacement
2. plasma clotting factors
progressive impairment of immune system caused by HIV
acquired immunodeficiency syndrome (AIDS)
acquired immunodeficiency syndrome (AIDS) directly damages the _____ and is ultimately life threatening
nervous system
cause for acquired immunodeficiency syndrome (AIDS)
HIV types 1 or 2
in acquired immunodeficiency syndrome (AIDS), HIV attacks ____, leaving the body defenseless against infection and malignancy
helper T lymphocytes
t or f. acquired immunodeficiency syndrome (AIDS) is cureable
t
upon diagnosis of AIDS, the number of ___ and ___ present is measured to determine when to begin treatment
- CD4 T
2. HIV RNA
treatment for acquired immunodeficiency syndrome (AIDS); classification of drugs
HAART drugs
there are __ drug combinations in HAART treatment
3
HAART is a combination of 2 ___ and 1 ___
nucleoside reductase inhibitors; protease inhibitor
acquired b-cell deficiency resulting in decreased antibody production and/or function
common variable immunodeficiency (CVID)
another name for common variable immunodeficiency (CVID)
acquired hypogammaglobulinemia
in common variable immunodeficiency (CVID), the patient has a Hx of ____
chronic or current infections
common symptom of common variable immunodeficiency (CVID)
GI disease
2 peaks of incidence in common variable immunodeficiency (CVID)
- ages 18-25
2. ages 1-5
common variable immunodeficiency (CVID) is thought to be the result of genetic defects leading to these 2 conditions
- immune system dysregulation
2. failure of B-cell differentiation
t or f. common variable immunodeficiency (CVID) treatment is aimed at preventing ____
infections
failure to produce normal levels of IgA
selective immunoglobin A (IgA) deficiency
t or f. the majority of IgA deficiency is symptomatic
t. asymptomatic
inheritance that plays a role in IgA deficiency
autosomal dominant or recessive
IgA deficiency is thought to progress to ______
common variable immunodeficiency (CVID)
t or f. there is no cure for IgA deficiency
t
near absence of serum immunoglobulins and increased susceptibility to infection
x-linked agammaglobulinemia
another term for x-linked agammaglobulinemia
bruton’s agammaglobulinemia
infants with agammaglobulinemia have absent or near absent ____
tonsils and adenoids
in x-linked agammaglobulinemia, congenital x-linked disorder only affects ____
males
x-linked agammaglobulinemia occurs due to a defect in the ____ gene
bruton tyrosine kinase (BTK)
treatment for x-linked agammaglobulinemia is aimed at improving child’s ____
immune defenses
group of disorders that result from a disturbance in the development and function of both T and B cells
severe combined immunodeficiency (SCID)
severe combined immunodeficiency (SCID) manifests as severe, recurrent infections with these 6 factors
- bacteria
- viruses
- fungi
- protozoa
- chronic diarrhea
- failure to thrive
2 common infections associated with severe combined immunodeficiency (SCID)
- pneumocystis pneumonia
2. mucocutaneous candidiasis
2 types of severe combined immunodeficiency (SCID)
- x-linked
2. autosomal recessive
both types of severe combined immunodeficiency (SCID) are due to ____
genetic mutations
genetic mutations in severe combined immunodeficiency (SCID) lead to defects in ____ into B and T cells
stem cell differentiation
only curative treatment for most types of severe combined immunodeficiencies (SCIDs)
bone marrow transplantation
congenital condition of immunodeficiency that results from defective development of the pharyngeal pouch system
DiGeorge’s anomaly
another term for DiGeorge’s anomaly
thymic hypoplasia or aplasia
children with DiGeorge’s anomaly have these 4 structural abnormalities
- abnormally wide set eyes
- downward slanting eyes
- low set ears with notched pinnas
- small mouth
DiGeorge’s anomaly is the result of abnormal development of the _____ during the 12th week of gestation
third and fourth pharyngeal punches
DiGeorge’s anomaly causes these 3 conditions
- cardiac anomalies
- hypoplastic thymus
- hypocalcemia
in DiGeorge’s anomaly, ____ is treated to restore electrolyte balance and reduce risk of seizures
hypocalcemia
2 types of transplantation to treat DiGeorge’s anomaly
- thymic
2. bone marrow
group of disorders characterized by persistent and recurrent candidal (fungal) infections of the skin, nails and mucous membranes
chronic mucocutaneous candidiasis (CMC)
in chronic mucocutaneous candidiasis (CMC), symptoms develop during the first ___ years of life
2 to 3
individuals with chronic mucocutaneous candidiasis (CMC) have a ____ deficit specific to ____ making them susceptible to infection
t-cell deficit; candida albicans
treatment for chronic mucocutaneous candidiasis (CMC) is directed at eliminating infections along with correcting _____
immunologic defects
congenital disorder characterized by inadequate B and T cell function
Wiskott-Aldrich syndrome
in Wiskott-Aldrich syndrome, the child expereinces these 3 conditions
- eczema
- thrombocytopenia
- increased susceptibility to bacterial/viral infections
Wiskott-Aldrich syndrome is an ____ trait affecting only males
x-linked inherited trait
Wiskott-Aldrich syndrome is caused by mutations in gene encoding the _____
Wiskott-Aldrich Syndrome Protein (WASP)
the only curative therapy for Wiskott-Aldrich syndrome
bone marrow transplantation
2 diagnostic tests for HIV/AIDS
- ELISA
2. Western Blot Test
diagnotistic test for HIV/AIDS: enzyme linked immunosorbent assay
ELISA
diagnotistic test for HIV/AIDS: done to confirm positive ELISA result
Western Blot Test
autoimmune condition where RBCs are destroyed by antibodies
autoimmune hemolytic anemia
2 types of autoimmune hemolytic anemia
- warm antibody anemia
2. cold antibody anemia
in autoimmune hemolytic anemia, RBC’s are destroyed by antibodies which causes ____ to the cells
agglutination
diagnostic test for autoimmune hemolytic anemia
Coombs test
warm anemia is treated with these 2 families of drugs
- corticosteroids
2. cytotoxic drugs
2 warm anemia treatments
- splenectomy
2. IV immune globulin administration
cold anemia is treated by avoiding ____
cold
in cold anemia, _____ is helpful for reducing hemolysis
plasmapheresis
anemia caused by chronic atrophic gastritis
pernicious anemia
in pernicious anemia, production of ____ and ____ are decreased
- HCI acid
2. intrinsic factor
pernicious anemia results in ___ deficiency
vitamin B12
vitamin B12 required for ____ is deficient; causing RBCs to be deformed and reduced in number
RBC formation
majority of patients with pernicious anemia have ____ which are cytotoxic to the ____
antiparietal cell antibodies; parietal cells
pernicious anemia is associated with these 2 other diseases
- Grave’s disease
2. Hashimoto’s thyroiditis
diagnostic test for pernicious anemia
schilling test
treatment for pernicious anemia
B12 injection
acquired disorder that results from isolated deficiency of platelets
idiopathic thrombocytopenic purpura (ITP)
_____ with unknown cause in a patient with idiopathic thrombocytopenic purpura (ITP) requires medical attention
multiple bruising
idiopathic thrombocytopenic purpura (ITP) may occur after ____
viral infections like rubella or mumps
in idiopathic thrombocytopenic purpura (ITP), ____ is administered to help with clotting
vitamin K
decreased number of circulating neutrophils caused by production of anti-neutrophil antibodies
immune neutropenia
in immune neutropenia, there is an almost complete absence of ____ in the blood
neutrophils
rare disorder caused by trans-placental transfer of maternal IgG that reacts with fetal neutrophils
isoimmune neutropenia
immune neutropenia is often associated with this
accelerated turnover of neutrophils or increased neutrophil production
3 treatment options for immune neutropenia
- corticosteroids
- immune globulin
- G-CSF
autoimmune kidney disease characterized by presence of antibodies directed against an antigen in glomerular basement membrane (GBM)
Goodpasture’s syndrome
another name for Goodpasture’s syndrome
anti-GBM antibody disease
t or f. there is no known cause for Goodpasture’s syndrome
t
3 treatment options for Goodpasture’s syndrome
- plasmapheresis with immunosuppressive agents
- hemodialysis
- kidney transplants
chronic, autoimmune disease characterized by unusual autoantibodies in the blood that target tissues of the body
systemic lupus erythemaosus (SLE)
systemic lupus erythemaosus (SLE) is informally known as ____
lupus
3 factors that may predispose individuals to lupus
- genetic
- hormonal
- environmental
to prevent the exacerbation of lupus, avoid unnecessary _____
light exposure
patterns of ____ occurs with SLE
butterfly rash
immunosuppressive meds would be required to treat SLE when _____ is present
organ-threatening disease
Chronic, progressive disease characterized by mostly sclerosis (hardening) of skin, with scarring of certain internal organs.
scleroderma
another term for scleroderma
systemic sclerosis
scleroderma is classified these 2 ways
- diffuse
2. limited
scleroderma that involves symmetric thickening of skin of extremities, face and trunk
diffuse
scleroderma that tends to be confined to the skin of fingers and face
limited
t or f. scleroderma is an autoimmune disease
t
prognosis of scleroderma depends on the ____ affected
organs
autoimmune disease featuring inflammation in various glands of the body
Sjögren’s syndrome
in Sjögren’s syndrome, this is the main result of inflammation of the glands
dryness
Sjögren’s syndrome is often associated with this condition
rheumatoid arthritis
Sjögren’s syndrome is more common in families that have a member with an _____
autoimmune disorder
treatment for Sjögren’s syndrome include relieving symptoms where there is____, such as increasing fluid intake, chewing gum and using oral sprays
dryness
2 families of drugs to lessen immune inflammation in Sjögren’s syndrome
- prednisone
2. antimalarial medications
chronic inflammatory, systemic disease that affects the joints
rheumatoid arthritis (RA)
one of the most severe forms of arthritis causing deformity and disability
rheumatoid arthritis (RA)
rheumatoid arthritis (RA) is __ times more common in females than maes
3x
if untreated, rheumatoid arthritis (RA) can cause these 3 conditions
- destruction of cartilage
- joint deformity
- destruction of adjacent bone
form of rheumatoid arthritis that affects children less than 16 years old
juvenile rheumatoid arthritis (JRA)
juvenile rheumatoid arthritis (JRA) begins most commonly between the ages ____
2 to 5
in juvenile rheumatoid arthritis (JRA), it is believed that the _____ in the joints are related to an autoimmune disease
pathologic changes
heredity may play a role in some children with juvenile rheumatoid arthritis (JRA), particularly those with this condition
spondylitis
in juvenile rheumatoid arthritis (JRA), braces or splints may be needed to correct ____ and _____
- growth disturbances
2. joint contracture
t or f. juvenile rheumatoid arthritis (JRA) is treated exactly as adult rheumatoid arthritis
t
systemic, usually progressive inflammatory disease affecting primarily the spinal column
ankylosing spondylitis
ankylosing spondylitis typically affects the ____ area of the spine first
sacroiliac
in ankylosing spondylitis, periods of _____ occur
exacerbation; remission
ankylosing spondylitis may be related to genetic basis and an association with these genes
HLA-B27
disease of muscle that features inflammation of the muscle fibres
polymositis
in polymositis, muscle fibers affected are mostly closest to the ____
trunk and torso
polymositis is ____; there are cycles of flares, relapses and remissions
cyclical
polymositis occurs when ____ spontaneously invade and injure muscles
WBC
screening for polymositis must rule out ____
cancer
inflammatory disease of the CNS that attacks the myelin sheath
multiple sclerosis
4 types of multiple sclerosis
- relapsing-remitting-relapsing
- primary-progressive
- secondary-progressive
- progressive-relapsing-progressive
multiple sclerosis is an ____ that increases one’s susceptibility to the disease
inherited trait
2/3rds of multiple sclerosis develop from ages ____
20 to 40
therapy used to treat multiple sclerosis
immunosuppressive
chronic progressive neuromuscular disease that stem from the presence of autoantibodies to the acetylcholine receptor
myasthenia gravis
myasthenia gravis is characterized by extreme muscular weakness without ____
atrophy
myasthenia gravis is an autoimmune mechanism in which a faulty transmission of nerve impulse to and from the CNS, especially in the ____
neuromuscular junction
myasthenia gravis is associated with these 2 conditions
- thymus hyperplasia
2. thymoma
family of drugs to treat myasthenia gravis
anticholinesterase drugs
surgical intervention to treat the tumor in the thymus gland in myasthenia gravis
thymectomy
inflammation in the walls of the blood vessels
vasculitis
2 types of vasculitis
- small vessel
2. systemic necrotizing
vasiculitis in which the affected vessel becomes necrotic when it is obstructed by a thrombus and results in an infarct of adjacent tissue
small vessel vasculitis
small vessel vasculitis affects these 3 areas
- capillaries
- arterioles
- venules
vasculitis that primarily affects medium and large arteries
systemic necrotizing vasculitis
systemic necrotizing vasculitis occurs in ____ and ____ conditions
cutaneous; systemic
systemic necrotizing vasculitis can result in these 2 conditions
- ulceration
2. paralysis of an affected nerve
some forms of systemic necrotizing vasculitis are related to these 2 factors
- amphetamine use
2. development of hepatitis b and c
2 tests to diagnose systemic necrotizing vasculitis
- CBC ESR RA factor determinaton
2. serum tests for immunoglobulin
treatment for systemic necrotizing vasculitis involves decreasing the ____ of the arteries
inflammaton
