Red Cell Disease and Anaemia Flashcards
1
Q
blood is a specialised fluid composed of cells suspended in what liquid?
A
plasma
2
Q
what are the 3 types of blood cells?
A
red blood cells
white blood cells
platelets
3
Q
what is the term for the production of blood cells?
A
haemopoiesis
haematopoiesis
4
Q
where does haemopoiesis occur in the embryo?
A
yolk sac then liver
spleen from 3-7 months
5
Q
where does haemopoiesis occur at birth?
A
bone marrow of almost every bone
spleen and liver if needed
6
Q
where does haemopoiesis occur in the adult?
A
bone marrow of axial skeleton bones
7
Q
can long term haematopoietic stem cells self replicate?
A
yes
8
Q
can short term haematopoietic stem cells self replicate?
A
yes
9
Q
can multipotent cells self-replicate?
A
no
10
Q
where do T cells mature?
A
thymus
11
Q
how long does it take for reticulocytes to become mature RBC?
A
2/3 days
12
Q
how does a reticulocyte become a mature RBC?
A
the leftover RNA degrades
once fully degraded it becomes an erythrocyte
13
Q
how does platelet production differ to other blood cells?
A
it buds off megakarocytes instead
14
Q
what are the 3 subtypes of granulocytes?
A
neutrophils
eosinophils
basophils
15
Q
compare the staining of neutrophils, eosinophils and basophils?
A
eosinophils stain with eosin dye
basophils stain with basic dye
neutrophils stain with neither
16
Q
how many segments does the nucleus of a neutrophil have?
A
up to 5
17
Q
what colour are the granules of eosinophils?
A
bright orange/red
18
Q
what are the 2 main functions of eosinophils?
A
- fight parasitic infection
- hypersensitivity response
19
Q
compare the granules of eosinophils and neutrophils?
A
eosinophils have bigger and redder granules
20
Q
what are basophils known as when they are in tissue?
A
mast cells
21
Q
what is the main role of basophils/mast cells?
A
IgE mediated hypersensitivity reactions
22
Q
what substance is within the granules of basophils?
A
histamine
23
Q
what are monocytes known as when they are in tissue?
A
macrophages
24
Q
compare the nucleus of monocytes to neutrophils?
A
monocytes have a bigger more open nucleus
25
microscopically compare mature and activated lymphocytes?
mature- small with condensed nucleus, rim of cytoplasm
| activated- large with lots of cytoplasm, open nucleus
26
what are the 2 ways of recognising primitive precursors?
immunophenotyping
| bio-assays
27
where in the body do you get bone marrow samples from?
posterior iliac crest
28
what is the life span of a red blood cell?
120 days
29
what is the term for the production of red blood cells?
erythropoiesis
30
what happens to the haem group once haemoglobin has been broken down?
porphyrin converted to unconjugated bilirubin
| iron recycled
31
what hormone stimulates erythropoiesis?
erythropoietin (EPO)
32
what organ produces erythropoietin?
the kidney
33
the kidney produces erythropoietin in response to what?
low arterial PO2 in the proximal convuluted tubule
34
what are the 6 stages of erythropoiesis?
1. proerythoblast
2. basophilic erythroblast (early)
3. polychromatic erythroblast (intermediate)
4. orthochromatic erythroblast (late)
5. reticulocyte
6. erythrocyte
35
what is a proerythroblast derived from?
myeloid stem cells
36
at what stage in erythropoiesis does haemoglobin appear in the cytoplasm?
polychromatic erythroblast
37
what cell in erythropoiesis leaves the bone marrow and goes into the circulation?
reticulocyte
38
what is haematocrit?
the percentage of red blood cells in total blood volume
39
what is the normal male and female haematocrit?
males: 40-50%
females: 36-46%
40
how is ATP vital for maintaining cell volume in the red blood cells?
allows the Na/K/ATPase to function
| otherwise Na would remain within the cell and there would be osmotic movement of water into the cell causing swelling
41
how do red blood cells obtain ATP?
glyolysis
42
which state of iron can bind O2 in haem- Fe2+ or Fe3+?
Fe2+ (ferrous)
43
what is the function of NADH from glycolysis within the RBC?
keeps iron in the ferrous Fe2+ state
44
what is the function of NADPH?
reduces glutathione
45
what does 2,3 BPG do to the affinity of haem to oxygen?
reduces it
| shift curve to the right
46
what pathway creates NADPH?
pentose phosphae pathway
47
what is the purpose of reduced glutathione?
combats oxidative stress
48
what stable end product do free radicals get converted to? via what?
water (via hydrogen peroxide)
49
what converts hydrogen peroxide to water?
reduced glutathione
50
what is the consequence of glucose-6-phosphate dehydrogenase insufficiency?
deficiency of NADPH
| so lack of reduced glutathione, lifespan of RBC is much less than normal due to oxidative stress not being combatted
51
what are the 3 ways CO2 is transported in the blood?
dissolved
bound to Hb
as bicarbonate ion
52
in venous blood (with high CO2 content) describe the direction of HCO3-/Cl- flow?
HCO3- leaves the cell
| Cl- enters the cell
53
in arterial blood (with low CO2 content) describe the direction of HCO3-/Cl- flow?
HCO3- enters the cell
| Cl- leaves the cell
54
how many globin sub units are present in a single haemoglobin molecule?
4 globins
55
how many iron ions are there in a haemogobin molecule?
4 iron ions
56
what are the 4 chain present in adult haemoglobin? (HbA)
2 alpha chains
| 2 beta chains
57
what are the 4 chains present in haemoglobin F? (foetal haemoglobin)
2 alpha chains
| 2 gamma chains
58
does foetal Hb have a higher or lower affinity for O2 than adult Hb?
higher affinity for O2
59
does foetal Hb have a higher or lower affinity for 2,3, BPG than adulty Hb?
lower affinity for 2,3 BPG
60
when is haemoglobin not a good marker of anaemia?
rapid bleed
| haemodilution
61
compare reticulocytes to red blood cells under the microscope?
no central pallor
slightly bigger
slightly more purple
62
compare the reticulocyte count between anaemia caused by decreased production or increased loss/destruction of red cells?
- decreased production: low reticulocyte count
| - increased destruction: high reticulocyte count
63
what are the 2 subtypes which cause decreased production of erythrocytes?
- hypopoliferative
| - maturation abnormality
64
what are the two types of RBC maturation abnormalities causing anaemia?
cytoplasmic defects (impaired haemoglobinisation)
nuclear defects (impaired cell division)
65
is hypoproliferative anaemia microcytic, normocytic or macrocytic?
normocystic
66
do RBC precursor cytoplasmic defects cause microcytic, normocytic or macrocytic anaemia?
microcytic
67
do RBC precursor nuclear defects cause microcytic, normocytic or macrocytic anaemia?
macrocytic
68
what are the 2 main causes of increased loss/destruction of red blood cells?
haemolysis
| bleeding
69
if there is microcytic anaemia, what problem should you consider?
haemoglobinisation
70
if there is macrocytic anamia, what problem should you consider?
nuclear defects
71
what are the values of Hb in anaemia for males and females?
males less than 130 g/L
| females less than 120g/L
72
why do reticulocytes stain slightly purple?
remnants of DNA
73
how long does up regulation of reticulocyte production by the bone marrow in response to anaemia take?
a few days
74
what are the 5 main causes of hypochromic microcytic anaemia?
```
Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisning
Sideroblastic Anaemia (congenital)
```
75
why can lead poisoning cause reduced haemoglobin production?
disrupts the porphyrin ring so iron cannot bind to it
76
what is the most common cause of hypochromic microcytic anaemia?
iron deficiency
77
why is iron potentially toxic and therefore always bound to something to keep it safe?
because it can generate free radicals
78
1 haem group can bind how many molecules of O2?
1 molecule of O2
79
when fully saturated, 1g of Hb will bind how many mls of O2?
1.34 ml
80
what is iron stored as and where is it stored?
as ferritin mainly in the liver
81
how many iron atoms are bound to one molecule of transferrin?
2 iron atoms
82
what is genetic haemachromatosis?
excess iron absorption int he gut
83
how many ferric ions are stored within ferritin?
up to 4000
84
what are the main 2 reasons for nor absorbing enough iron?
coeliac disease
| achlorhydria
85
what is achlorhdria?
a problem with acid secretion
86
where is iron absorbed?
proximal small bowel
87
what is the commonest cause of blood loss causing iron deficiency?
menorrhagia
88
how many mls of blood are usually loss per menstruation?
30-40mls per month
89
what units is mean corpuscular volume measured in?
femtolitres
90
what is the normal limits for MCV?
80-100fl
91
what is the first cell in the erythroid line that doesn't have a nucleus?
reticulocyte
92
what is a megaloblast?
an abnormally large nucleated red cell precursor with an immature nucleus
93
in megaloblastic anaemias, is the defect in the nucleus or the cytoplasm?
nucleus
94
what are the 2 main causes of megaloblastic anaemia?
B12 deficiency
| folate deficiency
95
what biochemical cycles are B12 and folate important for?
methionine cycle and folate cycle
96
what is the importance of the methionine cycle?
produces a methyl donor, needed for DNA/RNA synthesis
97
what is the importance of the folate cycle?
needed for nucleoside synthesis
98
where is B12 absorbed?
in the terminal ileum
99
when B12 enters the stomach what does it bind to?
haptocorrin
100
what cells release intrinsic factor?
gastric parietal cells
101
why does B12 bind to haptocorrin in the stomach instead of intrinsic factor?
because of the acidic environment
102
when does B12 separate from haptocorrin and bind to intrinsic factor instead?
when the pH increases, so once entering the gut
103
what group of people are likely to get B12 deficiency due to lack of B12 in food?
vegans
104
what drugs can cause reduced absorption of B12?
PPI's/H2 receptor antagonists
105
where are folates absorbed?
duodenum and jejunum
106
what are folates converted to?
monoglutamates
107
compare the stores of vitamin B12 and folate?
vitamin B12: stores last for 2-4 years
| folate: stores last for 4 months
108
compare the sources of vit B12 and folate?
B12: animals
flate: leafy veg, yeast
109
why do vit B12 and folate deficiency cause jaundice?
premature haemolysis of RBC in the bone marrow
110
what neurological deficits can occur in vitamin B12 and folate deficiency?
- dorsal column problems (fine touch, vibration, prprioception)
- dementia
- psychiatric manifestations
111
what is pernicious anaemia?
autoimmune destruction of gastric parietal cells
112
what raw material of erythropoiesis is there a deficiency of in pernicious anaemia?
B12
113
what is pancytopaenia?
all blood cell types low
114
what is the nucleus of neutrophils in patients with B12/folate deficiency like?
hypersegmented nucleus
| more than 5 segments
115
what auto-antibodies are present in pernicious anaemia?
anti gastric-parietal cell
| anti-intrinsic factor
116
compare anti-gastric pareital cell and anti-intrinsic factor autoantibodies in terms of specificity and sensitivity?
anti-gastric parietal antibodies are more sensitive bur not specific
anti-intrinsic factor antibodies are more specific but not sensitive
117
what is the treatment of pernicious anaemia?
B12 injections for life
(sometime high dose oral hydroxycobalamin is used)
folic acid tablets
transfuse if life threatening
118
what are the 2 genuine causal subtypes of macrocytosis?
megaloblastic
| non-megaloblastic
119
what are the 4 main causes of non-megaloblastic macrocytosis?
- alcohol
- liver disease
- hypothyroidism
- marrow failure (the only one associate with anaemia)
120
what is spurious macrocytosis caused by?
MCV wrongly measured as high (ie increased reticulocytes or RBCs are sticking together because of cold agglutinins)
121
what are macroovalocytes and when are they most commonly seen?
enlarged oval shaped RBCs
| megaloblastic anaemia
122
what are the main two compents of the buffy coat?
white blood cells
| platelets
123
a unit of platelets is made out of the blood of how many donors?
4 (if pooled) can be 1 if donor uses specifically donates platelets
124
a unit of blood is made out of the blood of how many donors?
1
125
how much blood is given in an average donation?
465ml of blood
126
what is the minimum weight for blood donors?
50kg
127
what is the minimum Hb for blood donors?
13. 5g/dL (males)
| 12. 5g/dL (females)
128
how often can donors donate?
every 12 weeks (try to make it every 16 weeks)
129
what temperature are red cells stored at?
4 degrees +/-2
130
what is the shelf life of red cells?
35 days (must be used within 4 hours of leaving controlled storage)
131
what temperature are platelets stored at?
22 degress
132
what is the shelf life of platelets?
7 days
133
what temperature is fresh frozen plasma stored at?
-30 degrees
134
what is the shelf life of fresh frozen plasma?
up to 3 years (transfuse within 4 hours of thawing)
135
what antigens do A, B, AB and O blood groups carry?
A- A antigens
B- B antigens
AB- A and B antigens
O- no antigens
136
what antibodies do A, B, AB and O blood groups carry?
A- anti B antibody
B- anti A antibody
AB- no antibody
O- anti A and anti B antibody
137
what can happen is you transfuse ABO-mismatched red cells?
binding of patient's antibody to donor's antigen - haemolytic transfusion reaction
138
what kind of Ig are ABO- antibodies?
IgM (pentameric)
| some IgG
139
what chromosome are ABO genes located on?
chromosome 9
140
what chromosome are Rh (D)genes located on?
chromosome 1
141
why do most of us not have rheusus antibody (anti-D) in our blood yet most of us have ABO antibodies in our blood?
exposure to bacteria gives us ABO antibodies
| bacteria do not carry Rh like antigens
142
what happens in an ABO reaction in vitro?
agglutination
143
what happens in an ABO reaction in vivo?
complement activation and hamolytic reaction
144
what Ig are irregular blood allo-antibodies?
IgG
145
what is the test method for detection or red cell allo-antibodies?
the indirect antiglobulin test (IAT)
146
how do delayed transfusion reactions occur?
complement is not activated (like in an acute reaction) so reaction occurs in the spleen where macrophages attack the cells
147
why do spherocytes appear in delayed transfusion reactions?
cell membrane has been damaged
148
what are the 3 main haemoglobinopathies?
alpha thalassaemia
beta thalassaemia
sickle cell anaemia
149
what globin chains make up HbA? (Adult Hb)
2 alpha
| 2 beta
150
what globin chains make up HbA2?
2 alpha
| 2 delta
151
what globin chains make up HbF? (Foetal Hb)
2 alpha
| 2 gamma
152
in adults what is usual percentages of the different types of haemoglobin?
HbA- 75%
HbA2- 2.5%
HbF- 0.5%
153
how many alpha globin genes are there in total?
4
154
what chromosome are the alpha globin genes on?
chromsome 16 (2 on each)
155
how many beta globn genes are there in total?
2
156
what chromosome are the beta globin genes on?
chromosome 11 (1 on each)
157
at what age are adult levels of haemoglobin A reached at?
6-12 months of age
158
what is a haemoglobinopathy?
hereditary conditions affecting globin chain synthesis
159
what are the 2 main groups of haemoglobinopathies?
1. decreased rate of globin chain synthesis
| 2. structurally abnormal globin
160
in alphas thalassaemia what chains are affected?
alpha chains (slower production)
161
in beta thalassaemia what chains are affected?
beta chains (slower production)
162
what is the small survival advantage of thalassaemias?
malaria
163
what causes alpha thalassaemia trait?
deletion of one or 2 alpha genes from chromosomes 16
164
what causes alpha thalassaemia HbH disease?
deletion of 3 alpha genes from chromsomes 16
165
what causes alpha thalassamaemia Barts hydrops fetalis?
deletion of all 4 alpha genes from chromosomes 16
166
what kind of anaemia do you get with alpha thalassaemia trait?
microcytic, hypochromic red cells with mild anaemia
167
what is the treatment of alpha thalassaemia trait?
asymptomatic, no treatment needed
168
what kind of anaemia do you get with HbH disease?
microcytic, hypochromic red cells with mild to severe anaemia
169
what globins make up HbH?
4 beta chains (non-functional)
170
why is HbH formed in HbH disease?
not enough alpha chains, so there are excess beta chains which form tetramers -HbH
171
why does splenomegaly occur in HbH disease?
extramedullary haematopoiesis
172
why do you get jaundice in HbH disease?
haemolysis
| ineffective erythropoiesis
173
why is folic acid supplementation needed in HbH disease?
increased RBC turnover so increased folic acid demand
174
in Hb Bart's hydrops fetalis syndrome, what haemoglobin forms are present?
```
Hb Barts (fetal) - 4 gamma chains
HbH (adult) - 4 beta chains
```
-do not carry oxygen
175
when do most people with Hb Barts hyrdops fetalis usually die?
in utero
176
what can be seen on blood film of alpha and beta thalassaemias?
microcytic hypochromic RBC
target cells
anisopoikilocytosis
177
what tests can you do to diagnose thalassaemias?
- HPLC (high performance liquid chromatography)
| - haemoglobin electrophoresis
178
what type of testing can you use to assess risk of alpha thalassaemia in pregnancy?
molecular testing to look for alpha thal trait
179
what causes beta thalassaemias?
point mutations to beta globin genes on chromosomes
180
what type of Hb is affected by beta thalassaemia?
HbA
181
what are the three types of B thalassaemia?
b thal trait
b thal intermedia
b thal major
182
what is the genotype of B thalassaemia trait?
B+/B or BO/B
183
what is the genotype of B thalassaemia intermedia?
B+/B+ or BO/B+
184
what is the genotype of B thalassaemia major?
BO/BO
185
what haemolobin is present in B thalassaemia major?
HbF (mainly)
| small amounts of HbA
186
when does B thalassaemia major present?
6-24 months
187
why will B thalassaemia not present in utero?
HbF is not affected
188
what is the management of B thal major?
regular blood transfusion
189
what are the 2 main purposes of blood transfusions for B thal major?
suppress ineffective erythropoiesis
| inhibit over absorption of iron
190
what is the main cause of mortality in B thal major?
iron overload from transfusion
191
how do you try combat iron overload when giving blood tranfusions to patients with thalassaemias?
iron chelating drugs such as desferrioxamine
192
how do iron chelating drugs such as desferrioxamine work?
bind to iron and so complexes formed are excreted in urine or stool
193
what is the pathophysiology of sickle cells?
point mutation in codon 6 of the beta globin gene (glutamine changed to valine), structure of beta chain is changed
194
what happens to HbS if exposed to low oxygen levels?
polymerises and so distorts the red cell and so damages the RBC membrane
195
what is the genotype of sickle cell trait? HbAS (asymptomatic carrier state)
(B/Bs)
| one abnormal B gene
196
when may HbAS sickle?
in severe hypoxia
197
what haemoglobin types do you see in HbAS?
HbA
| HbS (less)
198
what is the genotype of sickle cell anaemia?
Bs/Bs
| 2 abnormal B genes
199
what haemoglobin types do you see in HbSS?
HbS >80%
| no HbA
200
what is a sickle crisis?
episode of tissue infarction due to vascular occlusion
201
why does hyposplenism occur in HbSS?
repeated splenic infarcts
202
what are the 5 main precipitants of a sickle crisis?
```
hypoxia
dehydration
infection
cold
stress/fatigue
```
203
what two prophylactic measures are used for patients with sickle cell anaemia because of their hyposplenism?
prophylactic penicillin
| vaccination
204
why is folic acid supplementation given in sickle cell anaemia?
increased rbc turnover so increased folic acid demand
205
what is the function of hydroxycarbamide in sickle cell anaemia?
induces HbF production to reduce severity of disease
206
what is sickle cell disease?
one beta chain has the sickle cell, the other beta chain has another mutation (eg beta thalassaemia)
207
compare severity of HbSC (sickle cell disease) and HbSS (sickle cell anaemia)?
HbSC is a much milder version of HbSS
208
what are the 3 reasons that reds cells are particularly susceptible to damage?
- biconcave shape subjected to high arterial pressures
- rely on glucose metabolism (no mitochondria)
- cant make new proteins (no nucleus)
209
what happens to the bone marrow red cell production in haemolysis?
increased bone marrow red cell production
210
what happens to the reticulocyte count in haemolysis?
increased reticulocyte count
211
compare the meaning of extravascular and intravascular haemolysis?
intravascular- haemolysis occurs in the circulation
| extravascular- haemolysis occurs in the spleen and liver (reticuloendothelial system)
212
which is the most common type of haemolysis- intravascular or extravascular?
extravascular
213
why can splenomegaly or hepatomegaly occur in extravascular haemolysis?
hyperplasia at site of RBC destruction
214
what type of bilirubin is released into the blood stream during RBC breakdown by the spleen?
unconjugated bilirubin
215
compare intravascular and extravascular haemolysis in terms of normality of breakdown products?
intravascular- abnormal products
| extravascula- normal products
216
what 4 abnormal products from intravascular haemolysis are found in the blood and urine?
1. free haemoglobin in blood
2. methaemoglobin in blood
3. haemoglobin in urine
4. haemosiderin in urine
217
what colour does haemoglobin turns urine?
pink
| turns black on standing
218
what does the kidney metabolise excess iron into? (ie during intravascular haemolytic aneamia)
haemosiderin
219
what are the 3 main causes of intravascular haemolytic anaemia?
- ABO incompatible blood transfusion
- G6PD deficiency
- severe falciparum malaria (Blackwater fever)
220
what 2 normal products from extravascular haemolysis are found in the blood and urine?
1. unconjugated bilirubin in the blood
| 2. urobilinogen in the urine
221
what is the function of haptoglobin?
binds to free Hb
222
what happens to haptoglobin levels in haemolysis?
falls (in both intra and extravascular causes)
223
what is seen on blood film when RBCs have membrane damage?
spherocytes
224
what is seen on blood film when RBC's have oxidative damage?
heinz bodies
225
what is seen on blood film when RBCs have gone through mechanical damage?
red cell fragments
226
what is the function of the direct coombs test?
looks for antibodies against the RBC which are bound to it's membrane
227
what is the definition of haemolysis?
premature RBC destruction
228
compare warm and cold autoantibodies in terms of the type of Ig?
warm autoimmune haemolysis: IgG
cold autoimune haemlysis: IgM
229
in haemolytic transfusion reactions are immediate IgM mediated reactions intravascular or extravascular?
intravascular
230
in haemolytic transfusion reactions are delayed IgG mediated reactions intravascular or extravascular?
extravascular
231
what antibody is usually involved in haemolytic disease of the new born?
anti-D
232
how can severe burns lead to the production of microspherocytes?
capillaries become damaged
| as the RBC goes through damaged capillary it destroys its membrane --> spherocyte
233
what is zieve's syndrome?
haemolysis (due to cell membrane defect)
alcoholic liver disease
hyperlipidaemia
234
where does transferrin transport iron from and to?
from donor tissues (macrophages, intestinal cells, hepatocytes) to erythroid marrow
235
compare the terms apo-transferrin and holo-transferrin?
apo-transferrin has no iron bound
| holo-transferrin has iron bound
236
what is the usual transferrin saturaion?
20-50%
237
compare iron overload and iron deficiency in terms of transferrin saturation?
iron overload- increased transferrin saturation
iron deficiency- decreased trasnferrin saturation
238
why is serum ferritin not always accurate at reflecting storate ferritin?
acts as an acute phase protein so goes up in inflammation
239
compare inorganic iron (from veg diet) to haem (animal meat) in terms of easiness to absorb?
haem iron easier to absorb than inorganic iron
240
why do acidic foods make it easier to absorb iron?
shifts Fe3+ to Fe2+ (the form which is absorbed)
241
what iron transporter is on the duodenal enterocytes mucosal surface?
DMT 1
242
what iron transportser is on the duodenal enterocytes serosal surface?
ferroportin
243
what is the function of hepicidin?
inhibits ferroportin
244
where is hepicidin produced?
liver
245
how much iron do we need in our body?
4g
246
what are the 2 main causes for poor transferrin saturation in anaemia of chronic disease?
1. increased cytokines caused increased ferritin (Fe2+ preferentially binds to this)
2. increased hepicidin blocks ferroportin-mediated release of iron
247
how much iron in our body indicates overload??
5g and over
248
when does haemochromatosis usually present?
middle age or later
249
what is the cause of haemochromatsis?
mutations in HFE gene causing reduced hepicidin synthesis and so increased iron absorption in the gut
250
is the haemochromatisis HFE mutated gene autosomal recessive or dominant?
autosomal dominant
251
what percentage saturation of transferrn suggests iron loading?
50% or more
252
what is the treatment of haemochromatosis?
venesection
253
what is renal anaemia?
anaemia due to reduced EPO production
| hypoproliferative anaemia)
254
what shape is the nucleus of a moncyte/macrophage?
horse-shoe shaped
255
compare passenger and driver mutations?
passenger mutations do not confer a growth advantage to the cell
driver mutations confer a growth advantage to the cell
256
what is the most common childhood cancer?
acute lymphoblastic leukaemia
257
what is a clone?
a population of cells dervied from a single parent cell
258
how do you treat acute promyelocytic leukaemia? (no chemo needed!)
vitamin A analogue
| arsenic
259
what classes as significant weight loss?
10% loss of body weight
260
in hodgkins disease, what can happen when you drink alcohol?
pain in the area of the lymph node
261
compare bacterial and viral infection in terms of the site of lymphadenopathy?
bacterial- regional lymphadenopathy
| viral- generalised lymphadenopathy
262
compare viral, bacterial, lymphoma and mets carcinoma lymph nodes in terms of tenderness?
viral: tender
bacterial: tender
lymphoma: non tender
mets: non tender
263
why are bacterial and viral lymph nodes tender?
very rapid increase in size causes painful stretching of the capsule
264
compare viral, bacterial, lymphoma and mets carcinoma lymph nodes in terms of consistency and surface?
viral: hard and smooth
bacterial: hard and smooth
lymphoma: rubbery/soft and smooth
mets: hard and irregular
265
compare viral, bacterial, lymphoma and mets carcinoma lymph nodes in terms of surface skin inflammation?
viral: no skin inflammation
bacterial: skin inflammation
lymphoma: no skin inflammation
mets carcinoma: no skin inflammation
266
compare viral, bacterial, lymphoma and mets carcinoma lymph nodes in terms of tethering?
viral: not tethered
bacterial: can be tethered
lymphoma: not tethered
mets carcinoma: tethered
267
how do you diagnose lymphoma?
biopsy
268
what is the role of immunohistochemistry in diagnosing lymphoma? (ie looking for CD numbers)
confirms lymphoma and helps to subclassify
269
what cells are found in hodgkins lymphoma and what are they derived from?
reed sternberg cell
| very abnormal B cells
270
what are the 2 main classes of lymphoma?
hodgkins lymphoma
| non hodgkins lymphoma
271
what are the 2 main classes of non hodgkins lymphoma?
B cell NHL
| T cell NHL
272
what are the 2 main classes of B cell NHL?
low grade B cell
| high grade B cell
273
which is more common, B cell NHL or T cell NHL?
B cell NHL (90%)
274
what is the prognosis for T cell NHL?
poor
275
why is low grade B cell NHL basically incurable?
cells are dividing so slowly that treatment wont be able to kill them all- chemo might give a response but will inevitably relapse
