Unit 2 - Hematology Part 2 Flashcards
neutrophilia
“shift to the left” - increase in PMN’s
acute inflammation
occurs during periods of stress, violent exercise, infection
neutropenia
“shift to the right”
chemotherapy
monocytosis
chronic inflammation
eosinophilia
allergy
basophilia
myeloproliferative disorders
lymphocytosis
infectious mono, hepatitis, mumps, lymphomas, malignancies
leukocytopenia and agranulocytopneia
occurs in certain viral infections and in bone marrow depression
leukemia
malignancy of red bone marrow and immature/ineffective WBC’s are produced
acute leukemia
Large numbers of immature wbc’s
Platelets and rbc’s are deceased
Major causes of mortality are infection and bleeding
Rapidly fatal without treatment
2 types of acute leukemia
Acute Myeloblastic Leukemia (AML)
Acute Lymphoblastic Leukemia (ALL)
Acute Myeloblastic Leukemia (AML)
Mostly adults-most common Leukemia
Anemia, Thrombocytopenia, Immature Granulocytosis
s/s of AML
- infection, bleeding, fever/chills, tachycardia/pnea, lethargy, weight loss, splenomegaly
- high WBC count
- cytoplasm containing Auer rods
Auer rods
rod shaped bodies in cytoplasm of immature granulocytes
clumped lysosomes
acute leukemia and gout
- gout caused by elevated levels of uric acid
- 1st metatarsal joint most common
forms topsoil (crystallized uric acid deposits) - and kidney stones
Acute Lymphoblastic Leukemia (ALL)
Acute hemorrhage
Fulminating infection
Common Lymphoid Progenitor cell origin
Form Lymphocytes (T cells and B cells)
- Mutation in the Common Lymphoid Progenitor
Undifferentiated, immature circulating
lymphocytes (“lymphoblasts”)
Disease progresses rapidly-esp. in adults
Can be fatal in weeks
risk factors ALL
Exposure to radiation Exposure to certain chemicals Smoking Other blood disorders: myelodysplasia, polycythemia vera Genetic disorders-Down Syndrome white males
Most common childhood cancer (cure rate 85-90%)
Peak incidence at 4-5 years of age
s/s ALL
enlarged, painful lymph nodes
enlarged liver and spleen
Unexplained bleeding (nosebleeds, bruising.)
Anemia, Thrombocytopenia, Infection Prone
Weight loss and malaise
Fever and night sweats
Lethargy
Bone and joint pain
CNS and other organ involvement-aggressive invading lymphoblasts
Chronic Leukemia and 2types
moderate increase in WBC ‘s
Chronic Myelogenous (Myelocytic) Leukemia (CML) Chronic Lymphogenous (Lymphocytic) Leukemia (CLL)
Chronic Myelogenous (Myelocytic) Leukemia (CML)
Middle aged adults-slow (indolent) onset May be asymptomatic Mild/Moderate Granulocytosis Mixture of Mature/Immature Granulocytes Mild anemia and thrombocytopenia
Most patients (95%)with CML have the Philadelphia chromosome
Philadelphia chromosome-#22
A reciprocal translocation, an exchange of genetic material, between chromosomes 9 and 22.
band cells and segmented cells in CML
Band cells-immature neutrophils (c-shaped nucleus)
Segmented cells-mature neutrophils
s/s CML
May be asymptomatic Fatigue Weight loss Enlarged spleen Easily bruised Night sweats-Nocturnal diaphoresis
risk factors and survival CML
Risk factors: Being male and aging
Survival after 8 years-95.2% (2011)
Bone Marrow conversion-Progresses to acute myeloblastic stage (“blast” crisis)
Chronic Lymphocytic Leukemia (CLL)
Older adults >50 years of age (70’s and up)
Median survival: 8-10 years (2014)
Proliferation of B lymphocytes
Mild/Moderate anemia and thrombocytopenia
Signs/symptoms similar to CML including splenomegaly
Progressive Disease
Tendency for Bleeding and Infection increase
bone marrow conversion of CLL
Autoimmune Hemolytic Anemia
Severe Thrombocytopenia
Aplastic Anemia
Diffuse large B-cell lymphoma (Richter’s syndrome)
subtype of CLL - hairy cell leukemia
Indolent B cell lymphocytic leukemia
5:1 Male: Female >50 years of age
Splenomegaly, Fatigue
Lowered RBC’s and Platelets (Easy to bruise; easy to bleed)
disorders of hemostasis - coagulation
series of steps that form a platelet and fibrin clot for the purpose of limiting hemorrhage
3 major steps in coagulation
- transient vasoconstriction
- platelet aggression
- stepwise activation of clotting factors
Activation of the clotting cascade - 3 pathways
Extrinsic Pathway (Tissue Damaage Pathway) Intrinsic Pathway (Surface Contact Pathway) Common Pathway
lab tests for hemostasis disorders
Extrinsic Pathway-Prothrombin Time (ProTime): 12-15 seconds
Intrinsic Pathway-Activated Partial Thromboplastin Time (aPTT): 25-30 seconds
Prothrombin time-reported as International Normalized Ratio (INR): 0.8-1.2
disorders of hemostasis - Purpura
bruising induced by vasculitis
Small vessel inflammation
Bleeding beneath the skin
May be autoimmune, age related, or idiopathic
Schamberg’s Disease
Disease-leaking blood vessels
- Mostly in males - Usually occurs on the legs - Cause unknown - Pruitus common
Hereditary Vasculitis
Hemorrhagic Purpura (Osler-Weber-Rendu syndrome)
Henoch Schonlein (SHURN-line) Purpura Etiology: Immune complexes-reason is unknown Young males often affected Clinical Manifestations Purpura & Petechiae Arthritis-pain & swelling Nephropathy Gastrointestinal symptoms
senile purpura
aging induced purpora
hemophilia
bleeding disorder usually occurs in males (sex linked recessive)
types of hemophilia
Hemophilia A-Classic Hemophilia (most common)
Clotting Factor VIII (antihemophilic factor-AHF)
Hemophilia B-Clotting Factor IX (Christmas Factor)
Christmas Disease
von Willebrand’s Disease
platelet deficiency von Willebrand’s factor (vWF) missing vWF synthesized by Megakaryocytes Most common inherited clotting disorder Lack of platelet adherence to collagen in the vessel wall & to each other Outcome-excessive bleeding
Thrombocytopenia
- platelet deficiency, often a side effect of cancer that has metastasized to bone marrow
Idiopathic Thrombocytopenia (ITP)
- autoimmune disorder
Acute (< 6 months)-Children and Teens
Chronic (> 6 months)- Adults
Females: Males 3:1
types of thrombosis
primary: myeloproliferative disorder resulting in over production of platelets
secondary
Disseminated Intravascular Coagulation (DIC)
- hyper coagulation disorder, clotting mechanism is stimulated by release of cytokines and widespread clotting occurs
Maternal Premature Birth, Pre-eclampsia
- Cancer
- Trauma
- Sepsis
- Burns
- Snake bites (poisonous)
