Week 4 - Hematology: CA, WBC disorders Flashcards
Eosinophilia
memorize all 3 *Hypersensitivity reaction *allergic reaction *Parasites (may not so in eosinophiles) Esosinophils 1-4%
Basopenia
*Acute infections, hyperthyroidism, and long-term steroid therapy Basophils 0-1%
MCV
RDW
Mean Corpuscular Volume (MCV): 80-100 size of RBC
Red Cell Distrubution With (RDW): width/size variation (increase more variation)
Monocytopenia
*Very little known about this condition *Prednisone treatment *Hairy cell Leukemia Monocytes 3-7%
Sideroblastic Anemia
Sideroblastic Anemia
- No protoporhyrin
- High Fe level (no protoporhyrin to bind to) > iron toxicity
- Low hct, mch low
- Features: Ring sideroblastsin bone marrow, impaired heme biosynthesis
- Product a dimorphic blood smear with microcytes and macrocytes
- Usually acquired: Myelodsplastic syndrome, Drugs (ETOH, INH), Toxins (lead, zinc), Nutrition (pyridoxine deficiency, copper deficiency)
- Burkitt’s Lymphoma (type of Hodgkins)
- B-cell lymphoma
- EBV
- African BL: mass involving the maxilla or mandible
- Sporadic BL: mass in organ (rare)
- Testing: biopsy “Starry sky” pattern
Leuocytosis
*stress, microorganisms *pathological 5,000 – 10,000/mm3
Neutropenia
1) Primary: congenital or acquired (leuemia) 2) Secondary: IS disorders or IS meds Neutrophils 57-67%
Lymphocytosis (T & B-Cells)
*Acute VIRAL infections (ex. Epstein-Barr virus) *Leukemia, lymphomas, some chronic infections Lymphocytes 23-33%
Hodgkin and Non-Hodgkins (only difference is Reed-Sternberg cells)
- 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
Monocytosis
*Usually occurs with neutropenia in the later stages of a bacterial infection *chronic infections and correlates with extent of myocardial damage Monocytes 3-7%
Lymphoma
definition
major cell group
3 types
- Cancer of the lymphocytes in the nodes (NOT in bone)
- Majority B-cells
- Hodgkins
- Reed-Sternberg cells
- Release cytokines, from malignant B-cells
- Reed-Sternberg cells
- Hodgkin and Non-Hodgkins (only difference is Reed-Sternberg cells)
- Burkitt’s Lymphoma (type of Hodgkins)
- Non-Hodgkins Lymphomas
Anemia Definition:
Men Hgb < 13 or Hct <40%
Women < 12 or Hct < 36%
Multiple Myeloma
- 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
Anemia of Chronic Blood Loss
- Occult blood test (test for blood loss in GI)
- Low transferrin saturation Fe/TIBC
- MCV low, MCH low (producing RCCs fast and losing free iron with blood)
- Iron low, Ferritin high, TIBC low
4 classification of Leukemia
- Acute – more severe systems (does not refer to time)
- Chronic – cancerous cells are more similar to normal cells
- Myeloid – more cells
- Lymphoid – B cells (most often) and T cells
Leukopenia
*ALWAYS abnormal (infections, cancers, autoimmune) *predisposes a person infections 5,000 – 10,000/mm3
RBC Life Cycle
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
- Acute Lymphoblastic Leukemia (ALL)
- 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
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%
3 Types of Microcytic anemia
- Iron deficiency: low MCV, high RDW
- Thalassemia: low MCV, normal RDW
- Chronic blood loss: MCV low
Iron Deficiency
- cause
- Key symptoms
- Diagnosis
- MCV
- MCH
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:
- Decreased: RBCs, Hb, Hct, Ferritin, Fe, Transfer Saturation <20% (Fe/TIBC)
- Increased TIBC
Symptoms of Cancer
Symptoms of all Cancers similar - know for exam
- Pain: late sx, obstruction, pressure, destruction, inflammation
- ***fatigue
- Cachexia
- Anemia, leukopenia, thrombocytopenia
- Infections
- GI effects
Neutropenia Approach
- History – drugs, toxins, recurring mouth sores
- Physical – splenomegaly, bone pain
- Blood film – are granlocyctic precusors or blasts present
- Bone Marrow
- Congenital
- Acquired
- Felty’s Syndrome (RA, splenomegaly, neutropenia)
- Systemic lupus erythematous neutropenia
- Autoimmune
- Medications
Reticulocytes
*last 1-2 days in blood *important in evaluating for possible pathologies (high CA?, low production issue)
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
- 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
- Acute Myelogenous leukemia (AML)
- 65+ adults
- *Auer rods* -, red-staining, rod-like granule inclusions
- Prior chemotherapy or radiation abnormal
Eosinopenia
*primary cause – migration of cells to inflammatory sites Esosinophils 1-4%
Normocytic, Normochromic Anemia – MCV normal (normal size)
- Increase destruction or reduced production
- Acute blood loss
- HCT low d/t hemodiution (fluid moves in from interstitial space to compensate)
- Production of EPO (erythropoietin) by the kidneys > increase reticulocyte count after 1 week
- Aplastic Anemia: b. marrow dysfunction
- Posthemorrhagic anemia
- Hemolytic Anemia: destruction of RBCs, sickle cell
Anemia of Chronic Inflammation: chronic infections, inflammatory diseases, or malignancies
“Never Let Money Eat Banana “ said Grandpa Ben
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
Functions of B12 and Folate
- Formation of RBC
- DNA production (needed to convert homocysteine to methionine)
- Maintenance of Myeline (B12)> demyelinated DNA > neurologic disease
- Methylmalonyl CoA – B12 is a cof-factor needed by enzyme in catabolism of fatty acid
- Folic acid deficiency: megaloblastic anemia & glossitis (inflammation of tongue)
- Only B12 has neurologic complications
- paresthesia of fingers and toes
- spastic and flaccid paralysis
- Increased levelos of hom
Platelets
*last 1-2 weeks *constantly producing plts *fragments of myeloid stem cells
Anemia Causes
- Bleeding – acute & chronic
- 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..)
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
Basophilia
*Inflammation and hypersensitivity reactions > HISTAMINE Basophils 0-1%
Neoplasm Staging
- One – confined to its organ of origin
- Two – local invasion
- Three – advanced to regional structures
- Four – spread to distant sites
Anisocytosis!!
Poikylocytosis !!
Anisocytosis (different sizes)
Poikylocytosis (diffent shapes
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)
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%
Neoplasm risk factors
- Name based on the tissue of orgin (lymphone, leukemia, adenocarcinoma)
- Read book to learn types of cancers
- Increase with aging
- Causes
- environmental
- Non-responsive to Feedback (anti-browth)
- Tumor suppressor genes
- Viruses
- EBV
- Kaposi Sarcoma Herpes virus (developed in HIV patients
- HPV
- HBV, HBC
- H. pylori > gene mutation, methylation error
- Genetics (small role, usually in kids), colon CA, breast CA
- Lifestyle: alcohol, smoking, food (sugar)
- Obesity: waist vs height (waist x2 = height), insulin resistance
- Low physical activity
- Ionizing radiation
- Ultraviolet radiation
- Chemicals: asbestos, dyes, rubber, paint, plastics (benzene), heavy metals
- Pollution: PM2.5
Neutrophilia
*BACTERIA *Initial infection or inflammation *Increase need – Bands shift to the left (Lukemoid reaction) Neutrophils 57-67%
Gradulocytes
*Basophils *Eosinophils *Neutrophils (Grandpa Ben)
Leukemia Symptoms
*bone & joint pain because marrow is packed with cancer cells
*bone marrow: can’t produce RBC, WBC, platelets
- RBC (anemia, pale, fatigue, SOB, weakness, loss of appetite, weight loss, night sweats (less oncotic pressure in blood and increase hydrostatic press > leaks out)
- WBC: infection, fever, frequent infections
- Platelets: bleeding, Petechia, purpura
*all lymphomas and leukemis have same symptoms (think through)
*WBC may be high, but can’t use those WBC
- Chronic Lymphocytic Leukemia (CLL)
- he most common leukemia in adults
- Incidence usually > 40
- B Cell origin
- Poor prognosis
- Treatment suppress Ab > infection
Lymphocytopenia
*immune deficiencies, drug destructions, viral destruction *radiation or acquired immunodeficiency disorders (AIDS) Lymphocytes 23-33%
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)
Macrocytic (Megaloblastic) Anemia
- High MCV (huge cells) & normal or high MCH
- reticulocytosis
-
Two types: B12 & folate
- B12 (cobalamin) deficiency)
- Macrocytic, normochromic or hyperchromic (large RBC with normal or increased Hb content)
- Pernicious anemia: IF deficiency (intrinsic deficiency (release in stomach). B12 binds with IF to be absorbed in stomach
- Congenital
- Atrophic gastritis
- AI (antibody binding to IF)
- Celiac disease, IBD
- Metformin (interferes with b12 absorption
- Treatment: IM B12 (never give folate)
- Schilling test: distinguishes pernicious anemia from other causes
-
Folate Deficiency
- Same as B12, except no neurologic issues
- r/t diet (beans, lentils, asparagus, leafy greens)
- Spina Bifada
- Glossitis (inflammation of tongue)
- B12 (cobalamin) deficiency)
Thalassemia
- No or reduced Globin > no hemoglobin
- Poikilocytosis (variation in shape) and basophilic stippling may be seen in blood smear
- Two types
- Beta=thalassemia: hemoglobin electrophoresis
- Alph-thalassemia: Hgb H (Beta-4) or DNA analysis
- 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)
4 Types of Myloproliferative Disorders
Acute Lymphoblastic Leukemia (ALL)
Acute Myelogenous Leukemia (AML)
Chronic Myeloproliferative Disorders (CML)
Chronic Lymphocytic Leukemia (CLL)
Anemia of Chronic Disease
- Infection, disease, RA
- Iron low, Ferritin high, TIBC low (iron deficiency will be lower than chronic disease)