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Pathophysiology > Week 4 - Hematology: CA, WBC disorders > Flashcards

Week 4 - Hematology: CA, WBC disorders Flashcards

1
Q

Eosinophilia

A

memorize all 3 *Hypersensitivity reaction *allergic reaction *Parasites (may not so in eosinophiles) Esosinophils 1-4%

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2
Q

Basopenia

A

*Acute infections, hyperthyroidism, and long-term steroid therapy Basophils 0-1%

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3
Q

MCV

RDW

A

Mean Corpuscular Volume (MCV): 80-100 size of RBC

Red Cell Distrubution With (RDW): width/size variation (increase more variation)

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4
Q

Monocytopenia

A

*Very little known about this condition *Prednisone treatment *Hairy cell Leukemia Monocytes 3-7%

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5
Q

Sideroblastic Anemia

A

Sideroblastic Anemia

  1. No protoporhyrin
  2. High Fe level (no protoporhyrin to bind to) > iron toxicity
  3. Low hct, mch low
  4. Features: Ring sideroblastsin bone marrow, impaired heme biosynthesis
  5. Product a dimorphic blood smear with microcytes and macrocytes
  6. Usually acquired: Myelodsplastic syndrome, Drugs (ETOH, INH), Toxins (lead, zinc), Nutrition (pyridoxine deficiency, copper deficiency)
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6
Q
  • Burkitt’s Lymphoma (type of Hodgkins)
A
  • B-cell lymphoma
  • EBV
  • African BL: mass involving the maxilla or mandible
  • Sporadic BL: mass in organ (rare)
  • Testing: biopsy “Starry sky” pattern
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7
Q

Leuocytosis

A

*stress, microorganisms *pathological 5,000 – 10,000/mm3

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8
Q

Neutropenia

A

1) Primary: congenital or acquired (leuemia) 2) Secondary: IS disorders or IS meds Neutrophils 57-67%

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9
Q

Lymphocytosis (T & B-Cells)

A

*Acute VIRAL infections (ex. Epstein-Barr virus) *Leukemia, lymphomas, some chronic infections Lymphocytes 23-33%

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10
Q

Hodgkin and Non-Hodgkins (only difference is Reed-Sternberg cells)

A
  • B-cells should have gone under apoptosis but survives
  • Causes: EBV
  • 5 year survival 83%
  • Most common in young adults
    • 2 peaks: 30-40 & 60-70
  • Painless lymphadenopathy, all the s/s of leukemia,
  • B-Symptoms: Fever, weight loss, night sweats
  • Reed-Sternberg Cells
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11
Q

Monocytosis

A

*Usually occurs with neutropenia in the later stages of a bacterial infection *chronic infections and correlates with extent of myocardial damage Monocytes 3-7%

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12
Q

Lymphoma

definition

major cell group

3 types

A
  • Cancer of the lymphocytes in the nodes (NOT in bone)
  • Majority B-cells
  • Hodgkins
    • Reed-Sternberg cells
      • Release cytokines, from malignant B-cells
  • Hodgkin and Non-Hodgkins (only difference is Reed-Sternberg cells)
  • Burkitt’s Lymphoma (type of Hodgkins)
  • Non-Hodgkins Lymphomas
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13
Q

Anemia Definition:

A

Men Hgb < 13 or Hct <40%

Women < 12 or Hct < 36%

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14
Q

Multiple Myeloma

A
  • Plasma cells (B cells)
  • Eats away at bone > calcium in bl. > renal failur
  • Hypercalcemia and renal failure are frequent
  • Punchout lesion on xray
  • Rouleaux in bl smear
  • High ESR, CRP (lots of inflammation)
  • Bence jones protein (80% of cases)
  • 2-5 year expectancy
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15
Q

Anemia of Chronic Blood Loss

A
  1. Occult blood test (test for blood loss in GI)
  2. Low transferrin saturation Fe/TIBC
  3. MCV low, MCH low (producing RCCs fast and losing free iron with blood)
  4. Iron low, Ferritin high, TIBC low
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16
Q

4 classification of Leukemia

A
  1. Acute – more severe systems (does not refer to time)
  2. Chronic – cancerous cells are more similar to normal cells
  3. Myeloid – more cells
  4. Lymphoid – B cells (most often) and T cells
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17
Q

Leukopenia

A

*ALWAYS abnormal (infections, cancers, autoimmune) *predisposes a person infections 5,000 – 10,000/mm3

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18
Q

RBC Life Cycle

A

Kidney detects low RBCs > sends EPO > b. marrow in long bone produce reticulocytes > RBCs (kids 60days, toddler 90 days, adults 120) > spleen > recycle globin and send heme to liver > heme turns into bilirubin > intestines

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19
Q
  • Acute Lymphoblastic Leukemia (ALL)
A
  • Most common type of childhood leukemia, 1/3 of all pediatric CA
  • <15 and >50
  • B cell (85%) or T Cell (15%)
  • 5 year survival rate 80%
  • Accumulation of blast cells in b marrow > suppress normal hematopoiesis > physical crowding
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20
Q

Mononucleosis

A

*Caused by EBV – B cells *Transmission usually by saliva through person contact “kissing disease” *Fever, fatigue, sore throat, swollen lymph glands *Triad: FEVER, PHARYNGITIS, LYMPHADENOPATHY *Splenomegaly – watch for spleen rupture 1-2%

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21
Q

3 Types of Microcytic anemia

A
  1. Iron deficiency: low MCV, high RDW
  2. Thalassemia: low MCV, normal RDW
  3. Chronic blood loss: MCV low
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22
Q

Iron Deficiency

  • cause
  • Key symptoms
  • Diagnosis
  • MCV
  • MCH
A

Microcytic hypochromic (low MCV, low MCH)

Causes:

1) diet
2) impaired absorption (celiac, chronic diarrhea, low gastric HCL),
3) Increase requirements (growing infants, children/adolescents, menstruating, pregnant)
3) Chronic blood loss: menorrhagia, varices, PUD, UC, Crohn’s, GI cancers, hemorrhoids, parasites

Symptoms: fatigue, tachycaria, palpations, tachypnea, pallor, can be ASYMPTOMATIC

Key symptoms: Kaoilonychia (bumpy nail), alopecia, tongue (shiny, red, no papillae), angular stomatitis

Diagnosis:

  1. Decreased: RBCs, Hb, Hct, Ferritin, Fe, Transfer Saturation <20% (Fe/TIBC)
  2. Increased TIBC
23
Q

Symptoms of Cancer

A

Symptoms of all Cancers similar - know for exam

  1. Pain: late sx, obstruction, pressure, destruction, inflammation
  2. ***fatigue
  3. Cachexia
  4. Anemia, leukopenia, thrombocytopenia
  5. Infections
  6. GI effects
24
Q

Neutropenia Approach

A
  1. History – drugs, toxins, recurring mouth sores
  2. Physical – splenomegaly, bone pain
  3. Blood film – are granlocyctic precusors or blasts present
  4. Bone Marrow
  5. Congenital
  6. Acquired
    1. Felty’s Syndrome (RA, splenomegaly, neutropenia)
    2. Systemic lupus erythematous neutropenia
    3. Autoimmune
  7. Medications
25
Reticulocytes
\*last 1-2 days in blood \*important in evaluating for possible pathologies (high CA?, low production issue)
26
**Sickle Cell Disease (Normmocytic, Normochromic Anemia)**
\***inherited Anemia (HbS)** \*Acute crisis: fluids, oxygen, pain control, transfusions \*Treatment: transfusion therapy, hydroyurea, magnesium and clotrimazole may reduce frequency of vasoocculusive crisis \*Full vaccination program essential before functional hyposplenishm develops \*Gene Therapy Transplant may be curative
27
* **Chronic Myeloproliferative Disorders (CML)**
* **Adults 25-60 yo** * **95% of cases – _Philadelphia chromosome_** * **Transposition of chromosomes 9 and 22** * **Radiation – cancer treatment and wars** * **Insidious onset** * 3 phases * Chronic phase: most patients, milder sx (live 4-5 years, if untreated) * Accelerated phase: increased blast cells, splenomegaly * Blast Crisis Phase: increase blast cells
28
* **Acute Myelogenous leukemia (AML)**
* **65+ adults** * **_\*Auer rods\*_ -, red-staining, rod-like granule inclusions** * **Prior chemotherapy or radiation abnormal**
29
Eosinopenia
\*primary cause – migration of cells to inflammatory sites Esosinophils 1-4%
30
**Normocytic, Normochromic Anemia – MCV normal (normal size)**
1. Increase destruction or reduced production 2. Acute blood loss 1. HCT low d/t hemodiution (fluid moves in from interstitial space to compensate) 2. Production of **EPO** **(erythropoietin)** by the kidneys \> increase reticulocyte count after 1 week 3. Aplastic Anemia: b. marrow dysfunction 4. Posthemorrhagic anemia 5. Hemolytic Anemia: destruction of RBCs, sickle cell Anemia of Chronic Inflammation: chronic infections, inflammatory diseases, or malignancies
31
“Never Let Money Eat Banana “ said Grandpa Ben
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
32
**Functions of B12 and Folate**
1. Formation of RBC 2. DNA production (needed to convert homocysteine to methionine) 3. Maintenance of Myeline (B12)\> demyelinated DNA \> neurologic disease 4. Methylmalonyl CoA – B12 is a cof-factor needed by enzyme in catabolism of fatty acid 5. Folic acid deficiency: megaloblastic anemia & glossitis (inflammation of tongue) 6. Only B12 has neurologic complications 1. paresthesia of fingers and toes 2. spastic and flaccid paralysis 7. Increased levelos of hom
33
Platelets
\*last 1-2 weeks \*constantly producing plts \*fragments of myeloid stem cells
34
**_Anemia Causes_**
1. Bleeding – acute & chronic 1. GI or brain 2) Low Bone Marrow Production a) decrease or abnormal production d/t deficiency of raw material (Fe, folate, B12) 3) Destruction (Hemolysis): a) hemolytic anemia (sickle cell, thalassemia, etc..)
35
Aplastic Anemia
Normalcytic, normalchromic \*pancytopenia with empty marrow \*Most idiopathic – abnormal T cell inhibition of hematopoisesis \*Treatment: 1) IS (CSA and antithymocyte globulin) 2) allogenic BMT Irradiate CMV negative blood products until CMV status known
36
Basophilia
\*Inflammation and hypersensitivity reactions \> HISTAMINE Basophils 0-1%
37
Neoplasm Staging
1. **One – confined to its organ of origin** 2. **Two – local invasion** 3. **Three – advanced to regional structures** 4. **Four – spread to distant sites**
38
Anisocytosis!! Poikylocytosis !!
Anisocytosis (different sizes) Poikylocytosis (diffent shapes
39
**Polycythemia Vera** (1 in 200,000 in US)
* Too many RBCs * Abnormal, idiopathic * S/S **hyperviscosity, splenomegaly, thrombi, infarct, HA,** **_Pruritis after warm bath/shower_**_, **plethora (ruddy complexion) in the face, palms, nailbeds, mucosa, and conjunctive**_**.** tinnitus, chorea, delirium, visual disturbance, angina, thrombosis, ischemia * Test: **CBC** * Tx: phlebotomy (blood letting)
40
**_Mononucleosis_**
\*Caused by EBV – B cells \*Transmission usually by saliva through person contact “kissing disease” \*Fever, fatigue, sore throat, swollen lymph glands **\*Triad: FEVER, PHARYNGITIS, LYMPHADENOPATHY** \*Splenomegaly – watch for spleen rupture 1-2%
41
**Neoplasm risk factors**
1. Name based on the tissue of orgin (lymphone, leukemia, adenocarcinoma) 2. Read book to learn types of cancers 3. Increase with aging 4. Causes 1. environmental 2. Non-responsive to Feedback (anti-browth) 3. Tumor suppressor genes 4. Viruses 1. **EBV** 2. Kaposi Sarcoma Herpes virus (developed in HIV patients 3. HPV 4. HBV, HBC 5. H. pylori \> gene mutation, methylation error 6. Genetics (small role, usually in kids), colon CA, breast CA 7. Lifestyle: alcohol, smoking, food (sugar) 8. Obesity: waist vs height (waist x2 = height), insulin resistance 9. Low physical activity 10. Ionizing radiation 11. Ultraviolet radiation 12. Chemicals: asbestos, dyes, rubber, paint, plastics (benzene), heavy metals 13. Pollution: PM2.5
42
Neutrophilia
\*BACTERIA \*Initial infection or inflammation \*Increase need – Bands shift to the left (Lukemoid reaction) Neutrophils 57-67%
43
Gradulocytes
\*Basophils \*Eosinophils \*Neutrophils (Grandpa Ben)
44
**Leukemia** **Symptoms**
\*bone & joint pain because marrow is packed with cancer cells \*bone marrow: can’t produce RBC, WBC, platelets 1. RBC (anemia, pale, fatigue, SOB, weakness, loss of appetite, weight loss, night sweats (less oncotic pressure in blood and increase hydrostatic press \> leaks out) 2. WBC: infection, fever, frequent infections 3. Platelets: bleeding, Petechia, purpura \*all lymphomas and leukemis have same symptoms (think through) \*WBC may be high, but can’t use those WBC
45
* **Chronic Lymphocytic Leukemia (CLL)**
* **he most common leukemia in adults** * **Incidence usually \> 40** * **B Cell origin** * **Poor prognosis** * Treatment suppress Ab \> infection
46
Lymphocytopenia
\*immune deficiencies, drug destructions, viral destruction \*radiation or acquired immunodeficiency disorders (AIDS) Lymphocytes 23-33%
47
Anatomy of Blood
45% RBCs 55% plasma: wbc, plt, 90% water, protein (clotting factors, albumin, globulins), hormones, Fats (HDL/LDL, triglycerides), electrolytes, hormones, genes, nutrients, waste (BUN, creatinine, uric acid, bilirubin)
48
**Macrocytic (Megaloblastic) Anemia**
1. **High MCV (**huge cells) & normal or high MCH 2. reticulocytosis 3. _Two types: B12 & folate_ 1. B12 (cobalamin) deficiency) 1. **Macrocytic, normochromic or hyperchromic** (large RBC with normal or increased Hb content) 2. Pernicious anemia: IF deficiency (intrinsic deficiency (release in stomach). B12 binds with IF to be absorbed in stomach 1. Congenital 2. Atrophic gastritis 3. AI (antibody binding to IF) 3. Celiac disease, IBD 4. Metformin (interferes with b12 absorption 5. Treatment: IM B12 (never give folate) 6. Schilling test: distinguishes pernicious anemia from other causes 2. _Folate Deficiency_ 1. Same as B12, except no neurologic issues 2. r/t diet (beans, lentils, asparagus, leafy greens) 3. Spina Bifada 4. Glossitis (inflammation of tongue)
49
**Thalassemia**
1. **No or reduced Globin \>** no hemoglobin 2. Poikilocytosis (variation in shape) and **_basophilic stippling_** may be seen in blood smear 3. Two types 1. Beta=thalassemia: hemoglobin electrophoresis 2. Alph-thalassemia: Hgb H (Beta-4) or DNA analysis
50
* **Non-Hodgkins Lymphomas**
* **More severe than Hodgkins** * **B-cells (90%), NK** * **B-Symptoms: fever, wt loss, night sweats** * **Indicates disease is more wide-spread & worse prognosis** * **Rituximab: commercial AB that attacks B-cell antigen causing it to lysis (sudden death, tumor lysis syndrome)**
51
52
4 Types of Myloproliferative Disorders
Acute Lymphoblastic Leukemia (ALL) Acute Myelogenous Leukemia (AML) Chronic Myeloproliferative Disorders (CML) Chronic Lymphocytic Leukemia (CLL)
53
**_Anemia of Chronic Disease_**
1. Infection, disease, RA 1. Iron low, Ferritin high, TIBC low (iron deficiency will be lower than chronic disease)

Pathophysiology (9 decks)

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