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27 Cards in this Set
- Front
- Back
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leukocyte/ white blood cells 5 types |
1) basophils 2) eosinophils 3) neutrophils 4) monocytes 5) lymphocytes
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WBC- total white blood cell count how many is normal why is it useful?
differential white cell count (aka "diff") |
4,500-10,00 bands 3-5% useful as both a diagnostic tool and in following the course of disease if needed, order a differential separately
diff: proportions of different types of leukocytes in the smear of the patient's venous blood |
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two basic groups of leukocytes |
- grandulocytes neutrophils (or segs) 50-70% relative value (2500-7000 absolute value) eosinophils 1-3% basophils: 0.4- 1%
- agranulocytes lymphocytes 25-35% relative value (1700-3500) monocytes 4-6% relative value (200-600) |
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granulocytes/PMNs neutrophils |
the body's primary defense against bacterial infection and physiologic stress - comprised majority of WBC (60%) - bands (immature neutrophils) 3-5% of WBC
increased with infections, granuocytic leukemia, burns
decreased with drugs, viral infections, bone marrow invasion or aplasia |
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granulocytes/PMNs eosinophils |
attack parasites and act as phagocytes antigen- antibody complexes
increased during an allergic reactions- hay fever, asthma, drug hypersensitivity, parasitic infection, pernicious anemia
decreased with infections, exogenous cortisone |
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granulocytes/PMNs basophil |
not well understood but similar to mast cells - secrete anti- coagulant and vasodilatory substances as histamines, heparin, and serotonin - main function is secreting substance which mediate the hypersensitivity reaction - possible phagocytory capability
increased with CML, polycythemia, myeloid metaplasia |
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non-granulocytes |
the main constituents of the immune system - defense against pathogenic micro organisms such as viruses,bacteria, fungi - T cell matures in thymus gland - B cell matures in bone marrow - second most common WBC in adults (neutrophil #1) - increased during infections, TB, lympocytic leukemia |
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monocytes |
phagocytes and precursors of macrophages - largest blood cells - in presence of an inflammation site, monocytes quickly migrate from the blood vessel and start an intense phagocytory activity increased during monocytic leukemia, TB, collagen disease,chronic infection or inflammation |
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bands/immature neutrophils |
in general, a high number of immature cells in the peripheral blood reflects - "push on the marrow" to produce cells in large quantities (ie common manifestation of bacterial infection is a shift to the left with high # of immature granulocytes or bands seen on differential) - developmental arrest suggestign primary hematologic disease |
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neutropenia definition formula |
absolute decrease in the number of circulating neutrophils in the blood
absolute neutrophil count (ANC)
ANC = (WBC x (% neutrophils + % bands))/ 100 |
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neutropenia - values for: mild moderate severe |
1000-1500 500-1000 <500 <200 |
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diagnostic studies of the hematologic system |
- radiologic studies: CT/MRI of lymph tissues - biopsies bone marrow exam lymph node biopsies |
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leukemia |
group of malignant disorders of the hematopoietic tissues characteristically associated with increased numbers of white cells in the bone marrow and/or peripheral blood |
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classification of leukemias two origins, acute and chronic list all four |
myeloid orgin, acute is acute myeloid leukemia )(AML)
myeloid orgin, chronic chronic myeloid leukemia (CML)
lymphoid, acute: acute lymphoblastic leukemia (ALL)
lymphoid, chronic: chronic lymhpocytic leukemia (CLL)
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causes of acute leukemias |
- idiopathic (most) - underlying hematologic disorders - chemicals, drugs - ionizing radiation - viruses (HTLV I) - herediaary/ genetic conditions |
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red flag |
- elevated or decreased WBC count with any blasts - refer to oncology |
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myeloproliferative disorders - what are the chronic myeloproliferative disorders? - what are they characterized by? |
- polycythemia vera (PCV) -essential thrombocytopenia (ET) - chronic myelogenous leukemia (CML) - myelofibrosis with myeloid metaplasia
characterized by increased red blood cell mass or erythrocytosis |
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polycythemia vera 1) incidence 2) clinical features |
1) median age: 60 but seen bt 20-85, more in men than women, untreated PCV surival 6-18 months but treated >10 years 2) non specific complaints: HA, weakness, dizziness, excessive sweating, pruritus (after shower, ASA helps), t - erytromelagia/acra lparesthesias (burning pain/ parathesias in hands/feet with redness, pallor or cyanosis, responds to ASA or reduction in plt count to normal) - thrombosis (verous or arterial) transient visual disturbances - splenomegaly +/- hepatomegaly |
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polycythemia vera thrombosis |
- 2ndary to increased blood viscosity and platelet number, 15% of major thrombotic complication ie CVA, MI, thrombophlebitis, DVT, PE -denovopresenttion in pts with Budd-Chiari syndromeand portal, splenic, or mesenteric vein thrombosis |
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polycythemia vera GI symptoms |
- high incidence of epigastric distress, history of PUD, and gastroduodenal erosision on upper endoscopy |
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polycythemia vera what do you find on physical exam? |
- splenomegaly - facial plethora (ruddy cyanosis) - hepatomegaly - injection of conjuctival small vessels - excoriation of skin suggesting severe pruritus - stigmata of prior arterial or venous thrombotic event - gouty arthritis - erythromelalgia |
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erythromelalgia |
burning in feet or hands accompanied by erythema, pallor, or cyanosis in presence of palpable pulses - microvascular thrombic complication in PCV and ET |
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polycythemia vera diagnostic criteria |
- first r/o secondary causes of erythrocytosis major - increased red cell mass: males>= 36, females >= 32 -arterial oxygen saturation = > 92 - splenomegaly
minor criteria: - platelet count > 400,00/ micro L - WBC > 12,000 microL - leukocyte alkaline phosphatase score >100 - vit B12 > 900 requires all 3 major and 2 minor |
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polycythemia vera course and prognosis
what's the mean survival? how long can chronic last? what can it progress to? what is the major source of morbidity and mortality |
- mean survival is 14 years - chronic phase may last for years - progress is myelofibrosis and AML - thrombosis major source of morbidity and morality |
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revised WHO criteria for PCV |
major: - Hbg > 18.5 in men, 16.5 g/dL in women - presence of JAK2 V617F or functionally similar mutation
minor: - bone marrow biopsy shows hyper cellularity for age with trilineage growth with prominent erythroid, granulocytic, and megakaryocytic proliferation - serum erythropoietin level below normal reference range - endogenous erythroid colon formation in vitro |
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polycythemia vera treatment |
- phlebotomy: reduce viscosity HCT < 45 but increased risk of thrombosis within 3 years leading to + low dose aspirin - hydroxyurea: non alkalating inhibits enzyme ribonuclotide diphosphate reductase involved in DNA synthesis, reduced incidence of thrombosis compared to phelbotomy - interferon alpha: anti proliferative and celluar differentiating effects, relieves intractable pruritus and reduces spleen size |
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polycythemia vera causes of death |
- thrombosis - hematologic malignancies (AML or MDS) - non hematologic malignancies - hemorrhage - myeloid metaplasia with myelofibrosis |
