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Learning Objectives > WBC Disorders > Flashcards

WBC Disorders Flashcards

1
Q

Mnemonic for multiple myeloma?

A

Calcium elevated
Renal failure
Anemia
Bone lytic lesions

Old age.

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2
Q

Presentation of multiple myeloma?

A

Back pain, compression fractures, may have signs of hyper calcium, foamy urine

Look for punched out lesions in skull on X-ray.

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3
Q

Why is MM so hard to treat?

A

It is highly differentiated - hard to kill without killing whole immune system. Less rapid division (which is usually a good thing but not in this case)

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4
Q

ALL Pathophysiology?

A

Young patients, young cells (lymphoblast) - maturation arrest will see in peripheral smear.

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5
Q

Presentation of AML / ALL

A

Anemia, tiredness, easy bleeding, frequent infections, bone pain, gum swelling (AML). Abrupt onset, very sick very fast

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6
Q

Risk factors for AML

A

Down’s syndrome, previous cancer tx, adult ~65

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7
Q

What is leukostasis?

A

AML - blasts clogging up vessels causing end organs damage - kidneys, liver etc. This is an emergency! Give them lots of fluids. Make sure they are hooked up with an oncologist.

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8
Q

What is tumour lysis syndrome?

A

Large tumours, or very responsive to tx - cells burst - release K+ and Phosphate into the blood. Also all the cytokines - huge inflammatory. Consequences of hyperkalemia - cardiac

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9
Q

Chromosome implicated in CML?

A

Philadelphia chromosome

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10
Q

Epstein-Bar associated with?

A

Hodgkin’s lymphoma, Non-Hodgkins

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11
Q

Reed-Sternberg cells?

A

Hodgkin’s lymphoma, look for super-clavicular LNs, no other symptoms

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12
Q

Febrile Neutropenia work up?

A

CBC, Blood cultures X2, urinanalysis/cultures. Culture any sites of infection.

Tx with Abx RIGHT AWAY, non-responder - anti-fungal therapy and transfusion with neutrophils

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13
Q

leukemia vs lymphoma

A

Leukemia - originating in blood and bone marrow

Lymphoma - solid tumor or mass of the lymph nodes, MALT, spleen, or bone marrow

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14
Q

Leukocytes

A

Leukocytes: all white blood cells

Myeloid and lymphoid

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15
Q

Neutrophils Function

A 
Multilobed nucleus (2-5), granulated 
Function-  integral in innate immunity; main cell in acute inflammation (5-6 lifespan), phagocytosis
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16
Q

Basophils Function

A

Granules contain mediators of acute inflammation (histamine)

Role in hypersensitivity rxn

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17
Q

Eosinophil

A

Two-lobed, red-orange staining

Cytotoxic cells that play a role in immune, inflammatory and parasitic responses

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18
Q

Monocytes

A

Innate immunity, become macrophages in tissue

Phagocytosis

19
Q

B Lymphocytes

A

Produce antibodies against a specific extracellular antigen (humoral immunity)
Stay in secondary lymphoid tissue

20
Q

T-lymphocytes function

A

Cell-mediated immune response, antigen specific

21
Q

Primary Lymphoid Organs

A

Bone Marrow and thymus

22
Q

Secondary Lymphoid Organs

A

Lymph node, spleen

23
Q

Multiple Myeloma Pathophysiology

A

Cancer of plasma cells that produce monoclonal immunoglobulins (antibody)

24
Q

Multiple Myeloma Immunoglobulin

A

M protein (messed up immunoglobulins )
Most common form of the M Protein:
IgG > IgA > IgD > IgM > Pure light chain myeloma

25
Q

MGUS

A

Premalignant plasma cell proliferative disorder

Risk factor for MM

26
Q

Leukemia (ALL) Pathogenesis

A

Early lymphoid precursors (lymphoblasts) grow and crowd bone marrow - are stuck in immature phase

27
Q

ALL - classic presentation?

A

Child, abrupt onset - bleeding, anemia, thrombocytopenia, pain, infections, rashes - vague sx.

Small people, small blasts, small mortality

28
Q

AML Pathophysiology

A

Myeloblasts - myeloid progenitors, older adults, may see Auer rods on smear.

29
Q

AML classic presentation

A

Adults over 65, anemia, bleeding, bone pain, leukaemia cutis, gum swelling

Large people, Large cells, Large mortality

30
Q

CML

A

Too many mature granulocytes - Philadelphia chromosome (BCR-ABL) not able to get rid of cells correctly

31
Q

CML - classic presentation

A

Any age, slow onset, spleenomegaly, BSx, bleeding and quadrant pain

32
Q

CLL - Pathophysiology

A

Too many mature B-cells, smudge cells,

33
Q

CLL - classic presentation

A

Asymptomatic, may have anemia and BSx, do not treat symptomatic, common in adults over 70

34
Q

Hodgkin’s Lymphoma - classic presentation

A

Asx, Reed-Strenberg cells, mainly B cell based, in lymph nodes and other lymph tissues

35
Q

Hodgkins prognosis?

A

Good prognosis, limited extra-nodal involvement

36
Q

Non-Hodgkin’s lymphoma - classic presentation

A

Mature B or T cells, from Epstein-Barr, H-pylori, HIV, environmental, autoimmune
- goes to extra nodal sites - so may have associated sx that way (bowel obstruction, marrow failure, spinal cord)

37
Q

Febrile Neutropenia Tx

A

Must admit febrile neutropenia, get cultures and treat aggressively with abx. Consider neupogen

38
Q

Criteria for Febrile Neutropenia?

A

Fever >38 for an hour, or a fever >38.3
And one of them following:
Absolute neutrophils <0.5 or less than 1 trending downwards

39
Q

Reasons for decreased neutrophils?

A

Decreased production - due to lack of B12/ folate, or malignancy or drugs (chemo)
Or increased peripheral destruction due to autoimmune

40
Q

When is your white cell count lowest following chemo?

A

Usually 5-10 days

41
Q

What should you not do on exam in febrile Neutropenia?

A

DRE! Risk of introducing infection

42
Q

Myeloma kidney

A

Often lots of WBC/ Ig chains, but doesn’t usually cause albuminuria - this indicates some other cause of kidney disease.

Hypercalcemia also leads to renal vasoconstriction and intratubular deposits

43
Q

Tx for myeloma kidney

A

Dc nephrotoxins, correct calcium, tx myeloma with chemo and Dexamethasone, extracorporeal methods, dialysis if needed

44
Q

Mastocytosis

A

Flushing, hypotension, syncope, mast cells in blood cells, skin lesions,

Learning Objectives (29 decks)

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