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212 Cards in this Set
- Front
- Back
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Myeloblasts give rise to __________
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Neutrophils, Eosinophils, BAsophils
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Myeloid stem cell give rise to which 3 blasts?
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Myeloblasts, Monoblasts, Megakaryoblasts
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What is the immediate RBC (erythrocyte) precursor?
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Reticulocyte
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What to megakaryoblasts give rise to?
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Megakaryocytes--> platlets
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Lymphoblasts give rise to ____________
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T cell and B cells
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What is erythrocytosis?
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increased RBC's
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What is Anisocytosis?
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RBCs varying size
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What is poikilocytosis?
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RBC varying shapes
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How long do RBC's live?
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120 days
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What imporatant transporter is on the RBC membrane?
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HCO3/Cl
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T/F RBCs have a nucleus
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F
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What types of cells are leukocytes and how many are nl?
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Granulocytes (Basos, eos, neutros) and Monocytes (Lymphocytes and monos) nl is 4,000-10000/ microliter
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In what type of reaction are basophils central?
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Allergic
total # is <1% of leukocyes total |
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What is in basophilic granules?
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Heparin, histamine, LTNS and other vasoactive substance
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Mast cells contain what?
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Heparin, histamine, Eosin. Chemotactic Fx
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T/F Mast cells are found in blood
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F they are found in tissue, basophils are in blood
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In what dzs do you see basophilic stippling?
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Thallesemia, Anemia of chronic dz, Iron deficiency anemia, and lead poisoning (TAIL)
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What do eosinophils defend against?
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Helminths, protozoa, (use major basic protein)
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What are causes of eosinophilia?
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NAACP
Neoplasm, Asthma, Allergy, Collagen vascular dz, parasites |
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What is the acute inflammatory response cell?
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Neutrophils (40-75% of all WBCs)
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When do you see hypersegmented PMN's?
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B12/Folate deficiency
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Monocytes (2-10% of WBCs)differentiate into_____________
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Macrophages
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Macs are activated by which cytokine?
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IFN-gamma
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Macs present antigen on MHC 1 or 2?
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MHC 2
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T/F B cells are APCs?
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T they present on MHC 2
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Upon encountering antigen, B cells differentiate into ____________
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Plasma cells
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Which cells produce antibody?
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Plasma
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Th cells have which CD and respond to which MHC?
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CD 3 and 4, repsond to MHC 2
Tc cells have CD3 and 8 and respond to MHC1 |
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Langerhans cells are an example of what cell type?
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Dendritic cells "the professional APC"
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What test is used for the intrinsic pathway of coagulation?
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PTT
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What test is used for the extrinsic pathway?
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PT
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What is the initial factor in the extrinsic pathway and what activates it?
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VII activated by Tissue factor
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Draw the intrinsic and extrinsic coagualtion cascades.
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Look at p 306 bitches
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What inactivates Va and VIIIa?
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Protein C and S (both are vitamin K dependent)
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What inactivates IXa, Xa, XIa?
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antithrombin III
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What activates antithrombin III?
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Heparin
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What does tPA generate?
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PLasmin (which cleaves fibrin and busts up clots)
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What dz causes resistance to activated protein C?
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Factor V Leiden
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What 3 things does bradykinin do?
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increase vasodilation, permeability and pain
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What substance lead to activation of bradykinin and plasmin?
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Kallikrein
HMWK--> BK PLasminogen to plasmin |
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What factor in the coagualtion/lysis cascade activates complement?
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Plasminogen
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What factor activates Kallikrein?
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factor XIIa
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What antigen and antibody does blood group A have?
B? O? AB? |
A antigen B antibody
B antigen A antibody NO antigen, both antibodies both antigen, NO antibody |
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If you give an Rh- person Rh+ blood what Ig will proliferate?
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IgG (can result in hemolysis, renal failure, shock and death
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In what dz(s) do you find spherocytes?
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Heridetary spherocytosis, autoimmune hemolysis
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In what dz(s) do you find elliptocytes?
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hereditary elliptocytosis
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In what dz(s) do you find macro-ovalocytes?
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megaloblactic anemia (also hypersegmented PMNs), marrow failure
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In what dz(s) do you find helmet cells or shistocytes?
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DIC, traumatic hemolysis
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In what dz(s) do you find sickle cells?
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do you really need the answer?
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In what dz(s) do you find teardrop cells?
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myeloid metaplasia with myelofibrosis
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In what dz(s) do you find target cells?
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HbC dz, Asplenia, Liver dz, Thallessemia (HALT)
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In what dz(s) do you find poikilocytes?
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DIC, microvascular damage, TTP/HUS
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In what dz(s) do you find Burr cells?
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TTP/HUS
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What are psammoma bodies?
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Laminated, concentric calicfic spherules
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In what dz(s) do you find psammoma bodies?
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Papillary adenocarcinoma of thyroid
Serous papillary cystadenocarcinoma of ovary Meningioma Malignant mesothelioma PSaMMoma |
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What 2 congenital dz promote thrombus formation?
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Factor V leiden (common) and Protein C/S deficiency
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Iron deficiency anemia is what type of anemia?
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microcytic, hypochromic (MCV <80)
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What is the main difference between Fe deficiency anemia and anemia of chronic dz?
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TIBC is elevated in Fe deficiency (Serum Fe and ferritin are low) TIBC is low in ACD (ferritin is high due to increased storage of Fe in macs)
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Thallesemia is what type of anemia?
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Microcytic, hypochromic (MCV <80)
Target cells seen also |
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Lead poisoning and sideroblastic anemias are what type?
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Microcytic, hypochromic
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What is the difference between B12 and folate deficiency anemias?
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Nothing blood wise, but B12 also leads to neuro defects
Both are macrocytic (MCV >100) and megaloblastic c/ segmented PMNS |
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What type of anemia can Sulfa drugs and AZT cause?
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Macrocytic
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What type of anemia is involved c/ hemmorhage?
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Normocytic, normochromic
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What type of anemia is involved c/ enzymes defects and what are some of those enzyme defects?
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Normocytic/chromic
G6PD deficiency PK deficiency |
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What type of anemia are RBC membrane defects and Bone marrow disorders?
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Normocytic/chromic
example are Hereditary spherocytosis (RBC defect) and aplastic anemia or leukemia (Bone marrow) |
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What type of anemia is autoimmune hemolytic? Hemoglobinopathies (sickle cell, etc)?
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Normocytic/chromic
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T/F Anemia of chronic dz can be either normocytic or microcytic.
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T
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What test can distinguish between autoimmune and non- immune mediated RBC lysis?
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Direct Coombs
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What 2 serum markers can indicate RBC hemolysis?
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Decreased haptoglobin and increased LDH
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Chronic passive congestion of the lung (with blood) is most often caused by _____________
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Left sided heart failure or mitral stenosis (you will see heart failure cells (hemosiderin laden macs that ate up the RBCs in the alveoli)
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Hemmorragic (red) infarcts typically occur where?
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Lung and GI tract
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What fx predispose to thrombi?
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CHF, immobilization, polycythemia, Sickle cell, malignancy, smoking, OCP
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Von willibrand fx mediates adhesion between platelets (glycoprotein receptor) and what?
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subendothelial collagen
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What platelet component is a potent vasoconstrictor and aggregant?
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TXA2 (produced when arachadonic acid is activated by platelet membrane phospholipase)
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What is synthesized by endothelial cells to oppose platelet aggregation?
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PGI2
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Where are heparin like molecules that activate ATIII produced?
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endothelial cells, along with tPA,thrombomodulin, PGI2, NO, and Protein S
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What does thrombomodulin do?
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binds thrombin and changes it to activate protein C
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Factor XII to XIIa links what systems?
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fibrinolytic, coagulation, complement and kinin
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What is the second leading cause of heriditary thrombophilia?
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Prothrombin 20210A (mainly venous thrombi)
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What thrombotic dz has a paradoxical prolonged PT?
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Anti-phospholipid antibody (due to artifact of Ab and phospholipid reagent)
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If a clot had a two layer appearance of "chicken fat and currant jelly" when would it be found?
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at an autopsy as this is a post-mortem clot
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If you have a pulmonary embolism what does the infarct look like?
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wedge-shaped hemmorrhagic
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Where do arterial thrombi usually orginate?
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mural of left atrium associated c/ mitral stenosis or a-fib (if in ventricle associated c/ MI)
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What are 3 common site of arterial thrombi arrest?
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Carotid branches(often middle cerebral), branches of mesenteric, branches of renal artery
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What often causes fat emboli?
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multiple fractures, long bone fractures
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What are "the bends" and what complication can result?
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decompression sickness associated c/ diving as nitrogen comes out of tissues leading to possible air embolus
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What is anasarca?
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generalized edema
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What are the causes of aplastic anemia?
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Radiation, benzene, chloramphenicol, alkalating agents, antimetabolites, viral agents (Parvo, EBV, HIV), Fanconi's anemia, or idiopathic (immune mediated)
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What is the dz associated c/ pancytopenia with normal cell morphology and hypocellular bone marrow?
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aplastic anemia
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Where is the mutation in Sickle cell dz?
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replacement of glutamate c/ valine in the Beta chain
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What is characteristic of a skull x-ray in sickle cell?
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Crew cut
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What can precipitate sickling?
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low O2 or dehydration (the mutation make RBCs hydrophobic)
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What are possible complications of sickle cell?
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lung sequestrations, autosplenectomy, osteomylitis (from salmonella), increased risk of infx, vaso-occlusive crisis
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T/F HbC defect is a Beta mutation similar to sickle cell
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T but the dz is milder
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T/F Homozygotes for HbS are the only ones c/ dz
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T
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How many alpha globin genes are there?
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4
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HbH is what globin configuration?
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beta 4 tetramers, it lacks 3 alpha genes
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Hb Barts is what globin configuration?
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Gamma 4 tetramers, lack all 4 alpha genes and results in hydrops fetalis and intrauterine death
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Match the thalasemia with the at risk population: Asia and Africa or Mediterranean
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Asia/Africa --Alpha
Med--Beta |
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T/F In beta thalasemia, fetal Hg increases for compensation
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T but is usually inadequate
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T/F in Beta thalasemia minor, beta chains are produced
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T but they are underproduced, in Beta major they are not produced
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Besides anemia that requires transfusion, what are some other complications of beta thalasemia major?
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Cardiac failure due to 2 hemochromatosis
Marrow expansion leading to skeletal deformities |
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What are the causes of DIC (disseminated intravascular coagulation?
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STOP Making New Thrombi
Sepsis (gram -) Trauma Ob complication (most common) Pancreatitis, acute Malignancy Nephrotic Syndrome Transfuion |
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What are the lab results in DIC?
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Prolonged PT/PTT (use up all coags), increased D-dimer, low platelets, shistocytes
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What glycoprotein link to aggregate platelets?
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GPIIb-IIIA
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What is the pathophysiology of Henoch-Schonlein purpura?
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Allergic hypersensitivity as immune rxn damages endothelium
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What are associated findings c/ Henoch-Scholein purpura?
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Palpable purpura (urticaria), fever, arthralgias, GI/Renal involvement
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What aurosomal dominant dz is characterized by localized malformations of the capillaries and venules, possibly resulting in hemmorrhage?
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Hereditary hemmorrhagic telangiectasia (osler-weber-rendu)
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What infx can damage the vascular endothelium?
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Ricketsia and meningicocci
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What is the pathphys of ITP?
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Autoimmune
antiplatelet antibodies (maybe IgG from mother) coat and damage platelets and are then removed by the spleen. Dx based on thrombocytopenia c/ increased megs |
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T/F ITP is usually self-limited in adults
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F it is usually chronic in adults and short lived p/ infx in kids
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What RBC shape is seen in TTP?
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helmet or shistocytes
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What other sx are associated c/ TTP?
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Neuro deficits, renal insufficiency and fever
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What lab result is abnormal in Classic Hemophilia (fx VIII deficiency)?
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PTT
PT, platelets, bleeding time and thrombin time are normal More common than B |
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What lab result is abnormal in Hemophilia B (factor IX)?
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PTT
PT, platelets, bleeding time and thrombin time are normal |
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What lab result is abnormal in Vitamin K deficiency?
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PT and PTT
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What lab result is abnormal in von Willibrands?
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PTT and bleeding time
it is both a primary and secondary hemostatic defect |
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Hemophilia A and B are what mode of inheritance?
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X linked
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Is bleeding time prolonged in platelet defects or hemophilia?
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platelet defects (primary hemostasis disorders)
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What 2 things does Von willibrand factor do?
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Carrier for factor VIII
mediates platelet adhesion as it reacts c/ GPIb-IX-V on the platlet and the subendothelium |
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Where are all coagulation fx produces except for Von Willibrand Fx?
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liver so liver dz can have abnormal PT/PTT, thrombin time nad bleeding time
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What is the mode of inheritance for Von willibrand dz?
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AD, usually mild, most common bleeding dz
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What is the difference in presentation between platelet abnormalites and Coag fx abnormalites?
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Platelets--microhemmorrhage, bleeding from gums, epistaxis, petechai, increased bleeding time
Coags--macrohemorrhage, bleeding into joints, easy bruising |
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With increased serum bilirubin (Such as in hemolytic anemias) how might a pt present?
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jaundice, pigment gallstones, increased retic. count
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What Ig mediates warm agglutinin hemoyltic anemia and what are the causes?
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IgG (Warm weather is GGGreat), SLE, CLL or meds (methyldopa)
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Match the anemia with the site of hemolysis: Warm agglutinin, Cold Agglutinin, Paroxysmal Nocturnal Hemoglobinuria, Microvascular
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Cold is usually extravascualar the rest are intravascular
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What Ig mediates Cold agglutinin anemia and what are some causes?
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IgM (cold ice cream, MMMM), often seen during recovery from Mycoplasma or mononucleosis, precipitated by cold
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What test can you use for AI anemias?
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Coombs +
Direct: anti-Ig Ab added to pts RBCs, if they agglutinate then + Indirect: normal RBC's added to pt serum, agglutinate =+ |
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What defect do you get with hereditary spherocytosis?
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Spectrin/Ankyrin resultins in extravascular hemolysis, osmotic fragility test to confirm
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What are Reed Stermburg cells pathomnemonic for?
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Hodgekin's lymphoma
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What virus is associated c/ Hodgekins?
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EBV
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What age is Hodgkins most common?
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young and old (bimodal), most are more common in men
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T/F Hodgekins often spreads extranodally.
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F it is usually localized to a single group of nodes and spread is contiguous
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Mediastinal lympadenopathy is associated c/ which type of lymphoma?
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Hodgekins lymphoma
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Most Non-hodgkin's lymphoma's involve which cells?
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B cells (some are of T cell origin)
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Does Hodgkin's or non-Hodgekin's have more constitutional sx?
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Hodgekin's
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Does non-Hodgkin's lymphoma usually have extra-nodal involvement?
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Yes, often multiple peripheral nodes and non-contiguous spread
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Is Hodgkin's or non-Hodgkin's associated c/ HIV?immunsuppression?
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Non-hodgkins
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What is the most common type of Hodgkin's lymphoma?
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Nodular sclerosing, 65-75%, few RS cells and many lymphos
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What are the cell marker's and px for Nodular sclerosing Hodgkins?
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CD 15 and CD 30 (no CD 45)
excellent |
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What demographic usually gets Nodualr sclerosing Hodgkins?
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younger women
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What type of Hodgkins demonstrates the most Reed Strunberg cells?
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Mixed cellularity (25% of all HL)
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Owl eye cells are _____________
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Reed sternberg, necessary but not sufficient for a dx of Hodgkins
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Multiple myeloma is a monoclonal _________________
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plasma cell (fried egg appearance)
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What type of Ig is the most common in multiple myeloma?
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IgG (55%) IgA (25%)
You will see a monoclonal Ig spike on electrophoresis |
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A pt presents c/ bone lesions, back pain, hypercalcemia, renal insufficiency, anemia and recent hx of infx. You determine that he has a myeloid tumor. What might you expect in the urine?
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Bence Jones proteins (Ig Light chains)
This is multiple myeloma. Back pain and hypercalcemia are almost pathomnemoic (according to JJ Cohen) |
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The Roulou formation is what and found in what dz?
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Stacked RBC's
Multiple myeloma |
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What is different between Waldenstroms and Multiple myeloma?
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No bone lesion in Waldenstroms and IgM is the main overproduced Ig
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What is the most common Non-hodgkins lymphoma in adults?
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Follicular
associated c/ t(14,18) and bcl expression difficult to cure |
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What is the most common Non-hodgkins lymphoma in kids and what cells does it affect?
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Lymphoblastic
T-cells commonly presents c/ ALL |
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What are the genetics of Burkitt's?
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t(8,14)
c-myc moves next to heavy chain Ig |
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Burkitt's has what type of appearance histologically?
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Starry sky--sheets of lymphocytes c/interspersed macs
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In what age group and type of cell does Burkitt's usually occur?
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Kids and B cells
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What virus is associated c/ Burkitt's?
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EBV--might see jaw lesion in endemic places like Africa
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What disorder is associated c/ t(9;22) "the philadelphia chromosome"?
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CML (bcr-abl hybrid)
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What disorder is associated c/ t(11;22)?
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Ewing's sarcoma
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What disorder is associated c/ t(15;17)
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M3 type of AML
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What can you tx the M3 type of AML with?
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trans-retinoic acid
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Leukemia causes increased leukocytes in the blood and full bone marrow which can lead to what complications?
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Anemia (decreased RBCs), bleeding (decreased platelets) and infx (decreased mature WBCs)
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In leukemia, Leukocytes can infiltrate which 4 main areas?
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bone marrow, spleen, liver, and lymph nodes
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Match acute or chronic leukemia with the following: blasts or mature cells, kids/older people or mid life, short, drastic course or long less devastating course
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Acute--blasts, kids/old, short course
Chronic--mature cells, mid-life, less devastating |
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ALL involves which cells?
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Lymphoblasts (occurs in kids)
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AML involves which cells?
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myeloblasts (occurs in older adults)
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Which acute leukemia is most responsive to therapy?
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ALL
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CML is associated c/ which cells?
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Myeloid stem cells, presents c/ increased Neutrophils and metamylocytes
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With regard to CML, what does "blast crisis" mean?
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it has progressed to AML
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CLL involves which cells?
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Lymphocytes, Non-antibody B cells
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T/F CLL has few sx
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T it may present c/ lymphadenopathy, hepatosplenomegaly, smudge cells on blood smear
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What are Auer rods?
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peroxidase + cytoplasmic inclusions in granulocytes and myeloblast seen in AML M3
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What is Histocytosis X caused by?
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Langerhans cells that infiltrate the lung. Worse c/ smoking
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What 3 factors contribute to platelets aggregation besides GP interaction?
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ADP and TXA2 and 5-HT
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Where is Intrinsic fx produced? absorbed?
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stomach
absorbed c/ B12 in the distal ileum |
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What are the neuro changes associated c/ B12 deficiency?
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ataxia, hyperreflexia, impaired position
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Hemolytic anemias result in an increase in unconjugated (indirect) or conjugated bili?
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Unconjugated
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Paroxysmal Nocturnal Hemoglobinuria pts lack which protective marker on RBCs?
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CD59
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What are the two most common enzyme deficincies that lead to hemolytic anemia?
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G6PD (most common)--no NADPH so can't deal c/ oxidative stress such as primquinilone, sulfas, fava beans
Pyruvate kinase is 2nd |
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Beta thalassemia major shortens RBC life and increases what type of hemoglobin?
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Hgb F Alpha 2 gamma 2
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Beta thalassemia minor shortens RBC life and increases what type of hemoglobin?
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A2 Alpha2 and delta2
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Warfarin and pregnancy =
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contraindication
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What are possible side effects of heparin? what could you give the pt long term?
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Bleeding, thromboctyopenia, DDIs
LMW heparin--acts on Xa more |
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What could you use to reverse heparin side effects?
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Protamine sulfate-- +charge binds heparin
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What is warfarins MOA?
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Interferes c/ synthesis of vitamin K dep fx (II, VII, IX, X and C and S
EXtrinsic pathway |
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heparin or warfarin for PE, MI, stroke, DVT (Acute stuff) or chonic stuff?
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Heparin-acute, IV or in pregnancy
warfarin-chronic, oral |
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Heparin vs. warfarin: PT or PTT?
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Heparin--PTT
Warfarin-PT (INR) |
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What do urokinase, tPA and streptokinase do?
|
activate plasminogen to plasmin to bust up clots early in MI or stroke (ischemic)
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What use does ASA have in regards to blood?
|
prevents formation of TXA2 by inhibiting COX1 and 2 (no conversion of arachadonic acid to PGs)
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Which drugs block ADP receptors thus preventing expressing of GP IIb/IIIa and platelet aggregation?
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Clopidogrel, ticlopene
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What id abciximab and what does it do?
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monoclonal anitbody that binds GP IIb and IIIa on activated platelets preventing aggregation
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What class of anti-cancer agents work in S phase?
|
antimetabolites
etoposide |
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What class of anti-cancer agents work in G2 phase?
|
etoposide
Bleomycin |
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What class of anti-cancer agents work in M phase?
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Vinca alkaloids and taxols
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What class of drug is methotrexate? 5-fluorocil?
|
both are antimetabolites
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What are the side effects of most antimetabolites?
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myelosuppression
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Methotrexate and 5 Fu work together to _______________
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decrease thymidine synthesis
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What is MTX used to tx that is not cancer?
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rheumatoid arthritis, psoriasis, abortion (ectopic pregnancy)
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What type of cancer is 5-FU used to tx?
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Colon and other solid tumors
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What is 6 mercaptopurine's (6 MP)MOA?
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blocks purine synthesis, mainly used in leukemia and lymphoma (not CLL or HOdgkins)
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What is cytarabine's MOA?
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inhibits DNA plymerase, used for AML
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What is cyclophosphamide's and ifosfamide's MOA?
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alkylating agents, link intrastrand DNA at guanine
must be activated by liver |
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What are nitrosoureas' MOA?
Carmustine, lomustine, semustine, streptozocin |
alkylate DNA, cross BBB, require activation in Liver
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What are cisplatin and carboplatin and what do they tx?
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act like alkylating agents
Testicular, bladder, ovary and lung carcinomas |
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What is Busulfan's MOA?
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alkylates DNA
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What is doxorubicin's MOA?
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generates free radicals and intercalates DNA to break it up and prevent replication
Cardiotoxic, alopecia, myelosuppression |
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What is Dactinomycin used for?
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Wilm's tumor, Ewing sarcoma, rhabdomyosarcoma
it is an intercalater of DNA |
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What is Bleomycins MOA?
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induced free radicals to break DNA strands
used in testicular cancer and lymphomas |
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What is the most commonly used glucocorticoid in cancer tx?
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presnisone
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What is etoposide's MOA?
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inhibits topoismorase II
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What is tamoxifen (also ralozifene) used for and how does it work?
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Breast cancer.(maybe for osteoporosis)
blocks binding of estrogen to estrogen positive cells |
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What is Herceptin used for and what is it?
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Breast cancer
monoclonal AB against HER-2 (erb-B2) |
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What is Imatinib (Gleevac)?
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Philadelphia chromosome brc-abl tyrosine kinase inhibitor
use for CML, GI stromal tumors |
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What are Vincristine/vinvlatine's MOA?
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M-phase alkaloids that bind tubulin and prevetn formation of mitotic spindle
Used for Wilm and choriocarcinoma side effect: Neurotoxic, paralytic ileus |
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What class is Paclitaxel and what does this class do?
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Taxol
hyperstablizes microtubules so mitotic spindle can't break down used for breast and ovarian carcinoma |
