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151 Cards in this Set
- Front
- Back
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What is the WBC differential from highest to lowest
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Neutrophils
Lymphocytes Monoctyes Eosinophils Basophils "Neutrophils Like Making Everything Better? |
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what do thrombocytopenia or platelet dysfunction result in
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petechiae
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what types of granules do platelets contain
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dense: ADP, Ca
alpha: vWF, fibrinogen |
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where is 1/3 of the platelet pool stored
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in the spleen
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what is the lifetime of the RBC
what is the lifetime of the platelet |
120 days
8-10 days |
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what are the 2 types of leukocytes and give examples.
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granulocytes (basophils, eosinophils, neutrophils)
mononuclear cells (monocytes, lymphocytes) |
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what are in basophil granules?
What are in mast cell granules? |
Basophil: heparin, histamine, and other vasoactive amines and leukotrienes (LTD-4)
Mast cells: heparin, histamine, eosinophil chemotactic factors |
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what drug is used to prevent mast cell degranulation (asthma treatment)
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cromolyn sodium
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what do eosinophils produce to prevent "overdoing" its job?
what is the function of the mediators released |
histaminase and arylsulfatase -- help limit the rxn following mast cell degranulation
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what are the causes of eosinophilia
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NAACP
Neoplasm Asthma Allergic processes Collagen vascular dz Parasites |
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in what condition do you see hypersegmented polymorphonuclear cells (PMN)
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Vit B12/Folate deficiency
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what leukocyte has a "frosted glass" cytoplasm and a kidney shaped nucleus?
Surface marker? |
monocyte
CD14 |
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what cytokine activates macrophages
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IFN-gamma
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what are the main inducers of primary antibody response
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dendritic cells
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what are Langerhans cell
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dendritic cells on the skin
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where are B cells located in the periphery
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follicles of lymph nodes,
white pulp of spleen unencapsulated lymphoid tissue |
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what is a plasma cell neoplasm
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multiple myeloma
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what cell has a clock-face chromatin distribution, and an off-center nucleus
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plasma cell
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what blood group is the universal recipient
what blood group is the universal donor |
recipient: AB
donor: O |
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what is erythroblastosis fetalis
what causes it |
hemolytic dz of the newborn
anti-Rh IgG Ab made by Rh mother that attacks fetus w/Rh+ blood |
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How do you prevent future erythroblastosis fetalis
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Rh antigen Ig given to mother after delivery
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what causes Hemophilia A
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deficiency of factor VIII (8)
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what causes Hemophilia B
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deficiency of factor IX (9)
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What is Vit K deficiency
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decreased synthesis of factors 2, 7, 9, 10, protein C, and protein S
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what does antithrombin do
what activates antithrombin |
inhibits thrombin and factors: 2, 7, 9a, 10a, 11a, 12a
heparin activates |
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what does bradykinin do
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increases:
vasodilation, pain, permeability, cough |
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how are plasmin and the complement cascade connected
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plasmin converts C3 to C3a
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what does the extrinsic coagulation pathway start with
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Tissue factor (thromboplastin) and Factor VII (7)
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what is thromboplastin
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tissue factor: converts VII to VIIa (extrinsic pathway)
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what are the components of platelet plug formation
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adhesion, aggregation, swelling
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what is adhesion (platelet plug formation)
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vWF mediates link of platelet GpIb receptor to subendothelial collagen
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what is aggregation (platelet plug formation)
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balance w/pro and anti-coagulation
TXA2 increases aggregation (released by platelets) NO, PGI2 decrease aggregation (released by endothelial cell) |
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what is swelling (platelet plug formation)
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binding of ADP on platelet receptor -> GpIIb/IIIa insertion on platelet membrane (initially intracellular) -> allows platelet cohesion (Ca also strengthens platelet plug)
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how does aspirin work on platelets
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inhibits COX, inhibiting TXA2 synthesis
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how do ticlopidine and clopidogrel work
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inhibits ADP-induced expression of GpIIb/IIIa --> decreased swelling of the platelet plug formation
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What drug inhibits GpIIb/IIIa directly
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Abciximab
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what does vonWillebrand's factor carry/protect?
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carries/protects factor VIII (8)
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How does Vit K get activated
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epoxide reductase activates Vit K
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how does warfarin work
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inhibits epoxide reductase, blocking Vit K activation
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What is the most common inherited bleeding disorder?
GpIb receptor deficiency? GpIIb/IIIa receptor deficiency? |
most common: von Willebrand's disease; affect adhesion platelet
GpIb deficiency: Bernard-Soulier syndrome GpIIb/IIIa deficiency: Glanzmann's thrombasthenia |
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What activates Protein C into APC (activated Protein C)
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Protein S and thrombomodulin from endothelial cells
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what does Protein C do?
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cleaves and inactivates 5a, 8a
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What is Factor V Leiden mutation
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produces a factor V resistant to APC's inhibition
most common cause of inherited hypercoagulability |
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how does tPA work
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catalyzes plasminogen conversion to plasmin --> cleavage of fibrin mesh
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when do you see bite cells
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G6PD deficiency
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when do you see acanthocytes (spur cells)
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liver dz, abetalipoproteinemia
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when do you see schistocyte, helmet cell
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DIC, TTP/HUS, traumatic hemolysis, SLE, malignant HTN
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What are Heinz bodies
when do you see them |
oxidation of iron from ferrous to ferric form -> denatured Hb precipitation and damage to RBC membrane
seen is alpha-thalassemia, G6PD deficiency Lead to bite cells after phagocytes take a "bite" off the Heinz bodies |
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what are the pathologic RBC forms seen in G6PD deficiency
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bite cells and Heinz bodies
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what does Hb Barts lead to?
Which population is affected the most? why? |
Hb Barts: gammax4
leads to hydrops fetalis Asians are affected the most b/c loss of both alpha genes on same chromosomes (-/-, a/a) |
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what is alpha-thalassemia?
affected population? |
decreased alpha-globin synthesis b/c of a mutation in alpha-globin gene
Asians and Africans |
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what happens when there are 3 gene deletions in alpha-thalassemia? which population is affected? why?
what happens when there are 1-2 gene deletions? |
3 gene: HbH dz (beta4); affected in Africans b/c tend to have loss of one gene on each chrom (-/a, -/a)
1-2 gene: NOT assoc w/anemia |
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what is the defect in beta-thalassemia
what Hb is present in both types |
point mutations in splicing sites and promoter sequences
increased HbF |
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what are the 2 types of B-thalassemia
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Minor (heterozygote) and Major (homozygous)
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what is B-thalassemia minor
how is the dx confirmed |
heterozygous
B chain is underproduced asymptomatic dx: confirmed by increased HbA2 (>3.5%) |
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what is B-thalassemia major
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homozygous
B chain is absent -> severe anemia requiring blood transfusion (secondary hemochromatosis) -marrow expansion ("crew cut" on skull X-ray) -> skeletal deformities -Chipmunk facies |
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what anemia has chipmunk facies
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b-thalassemia major
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what anemia causes a secondary hemochromatosis
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B-thalassemia major b/c of blood transfusion required for severe anemia
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what is a HbS/B-thalassemia heterozygote
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mild to moderate sickle cell dz depending on amt of B-globin production
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what is the defect in sideroblastic anemia
what are the reversible etiologies |
defect in heme synthesis
X-linked defect in delta-aminolevulinic acid synthase gene EtOH, lead |
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what are the microcytic, hypochromic anemias
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Fe deficiency
a-thalassemia B-thalassemia Lead poisoning Sideroblastic anemia Anemia of chronic disease (can be normocytic or microcytic) |
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what is PT
What does it test |
Prothrombin Time
extrinsic pathway tests function of factors 1, 2, 5, 7, 10 |
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what is PTT
What does it test |
Partial Thromboplastin Time
intrinsic pathway tests fxn of ALL factors, EXCEPT 7 and 13 |
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List 3 macrocytic anemia
What is impaired in all? |
MCV > 100
Megaloblastic anemia due to folate deficiency Megaloblastic anemia due to vitamin B12 deficiency non-megaloblastic macrocytic anemia impaired DNA synthesis --> delayed maturation of nucleus |
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Findings of folate deficient megaloblastic anemia.
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hypersegmented neutrophils, glossitis, decreased folate, increased homocysteine but normal methylmalonic acid (MMA)
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How are the findings of vit b12 deficient megaloblastic anemia different?
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both homocysteine and MMA are elevated
has neurological sxs; subacute combined degeneration |
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list 6 causes of nonmegaloblastic macrocystic anemia.
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1. Liver disease
2. alcoholism: macrocytosis and bone marrow suppression in the absence of folate/b12 deficiency 3. reticulocytosis 4. metabolic disorder: congenital deficiencies of purine or pyrimidine synthesis 5. drugs: 5-FU, AZT, hydroxyurea 6. hypothyroidism |
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What is Schilling test?
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a test that defines the cause of B12 deficiency
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how are the findings of nonmegaloblastic macrocytic anemia different from megaloblastic anemia
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nonmegaloblastic: NO pancytopenia, only anemia, no hypersegmented neutrophils, thin/large target cells
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Whta does MCV indicate?
MCHC? RDW? |
MCV: avg vol of RBC
MCHC: avg Hb concentration in RBC (e.g. low = greater central pallor area) RDW: measure size variation of RBC (e.g. more anistocytosis = greater RDW) |
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What are the findings of aplastic anemia?
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nonhemolytic, normocytic anemia
pancytopenia normal cell morphology hypocellular bone marrow with fatty infiltration |
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What classification is hereditary spherocytosis belong to?
defect? |
intrinsic hemolytic normocytic anemia
defective RBC membrane skeleton (ankyrin, band 3, 4, spectrin) |
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List disorders of intrinsic hemolytic normocytic anemia (6)
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1. hereditary spherocytosis
2. G6PD deficiency 3. pyruvate kinase deficiency 4. Sickle cell anemia 5. paraxysmal nocturnal hemoglobinuria 6. HbC defect |
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what is the presentation of pyruvate kinase deficiency?
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hemolytic anemia in a newborn
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list 6 complications of sickle cell anemia.
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1. aplastic crisis
2. Salmonella osteomyelitis 3. splenic sequestration crisis 4. autosplenectomy --> increased infection with the KS SHiN organisms (encapsulated) 5. painful crisis (vaso-occlusive) 6. renal papillary necrosis (low O2 here) |
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what is defective in PNH?
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decay-accelerating factor and GPI anchor --> complement mediated RBC lysis
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What are 3 autoimmune hemolytic anemia?
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1. Warm aglutinin (IgG)
2. Cold Agglutinin (IgM) 3. Erythroblastosis fetalis |
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What causes cold autoimmune hemolytic anemia (3)
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1. cold
2. mycoplasma pneumoniae 3. mononucleosis |
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What causes Schistocytes? (4)
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microangiopathic anemia
caused by DIC, TTP-HUS, SLE, and malignant HTN |
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What 2 protozoans can cause hemolytic anemia?
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malaria
Babesia |
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Fe, TIBC, Ferritin values for?
1. Fe deficiency 2. chronic disease 3. hemochromatosis 4. Sideroblastic anemia |
1. Fe deficiency: decreased Fe, increased TIBC, decreased ferritin
2. chronic disease: decreased Fe, decreased TIBC, increased ferritin 3. hemochromatosis: opposite of Fe 4. sideroblastic anemia: increased Fe, normal TIBC, increased ferritin |
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What substrate is accumulated in lead poisoning?
presenting sxs? |
protoporphyrin in blood
microcytic anemia, GI, and kidney disease CNS problems: children: mental deterioration adults: headache, memory loss, demyelination |
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What are the findings of lead poisoning?
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LEAD
Lead Lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray Encephalopathy and Erythrocyte basophilic stippling Abdominal colic and sideroblastic Anemia Drops: wrist and foot |
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What is the first line tx for lead poisoning? how about in kids
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first line: Dimercaprol and EDTA
Succimer for kids |
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Porphobilionogen deaminase deficiency.
What is the condition? accumulated substrated? |
Acute intermittent porphyria
porphobilinogen, delta-ALA, uropophyrin (urine) |
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What are the sxs of acute intermittent porphyria (5)?
Tx? |
5P's
Painful abdomen Pink urine Polyneuropathy Psychological disturbances Precipitated by drugs NO PHOTOSENSITIVITY tx: glucose and heme --> inhibit ALA synthase |
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What is the cofactor for ALA synthase?
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vitamin B6 (pyridoxine)
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deficiency of ADAMTS 13.
Condition? |
thrombotic thrombocytopenic purpura (TTP)
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what is the pathogenesis of TTP?
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deficiency ADAMTS 13 (vWF metalloprotease) --> decreased degradation of vWF multimers
large vWF multimers --> more platelet aggregation and thrombosis |
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what is the pentad of TTP
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neurologic sxs
renal sxs fever thrombocytopenia microangiopathic hemolytic anemia (with schistocytes) |
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What causes HUS? main presentation?
what is the triad of HUS? |
shiga-like toxin of EHEC (O157:H7 E. coli); presents with blood diarrhea
triad: thrombocytopenia, acute renal failure, microangiopathic hemolytic anemia (schistocytes) |
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what is the pathogenesis of HIT (heparin induced thrombocytopenia)?
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heparin binds to platelet --> autoAbs against platelet --> platelet destruction and overactivate remaining platelets
hypercoagulabe, thrombocytopenic state |
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what sxs are present in untreated hemophilia?
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macrohemorrhage: hemarthroses (bleeding into joints), easy bruising, increased PTT
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What is the most common inherited bleeding disorder?
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von Willebrand's disease
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what causes DIC?
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STOP Making New Thrombi
Sepsis (gram negative) Trauma Obstetric complications Panceatitis acute Malignancy Nephrotic syndrome Transfusion |
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What are the lab findings in DIC?
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schistocytes, increased fibrin split product (d-dimers), decreased fibrinogen, decreased factor V and VIII (due to protein C)
decreased platelet count increased BT, PT, and PTT |
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what is the most common causeof inherited hypercoagulability?
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factor V Leiden disease
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what hereditary disease increases the risk of hemorrhagic skin necrosis following administration of warfarin?
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protein C or S deficiency
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what hereditary thrombosis syndrome reduce the normal increase in PTT after administration of heparin?
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ATIII deficiency
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List characteristics of Hodgkin's lymphoma.
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Presence of Reed-Sternberg cells
Localized, single group of nodes; extranodal rare; contigous spread Consitutional ("B) signs and sxs: low-grade fever, night sweats, weight loss Mediastinal lymphanodpathy (nontender) bimodal distribution: young and old more common in men good prognosis: high lymphocyte to RS ratio |
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List characteristics of non-Hodgkin's lymphoma.
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may be associated with HIV and immunosuppression
multiple, peripheral nodes; extranodal involvment common; noncontiguous spread majority involve B cells fewer constitutional signs/sxs peak incidence for certain subtypes at 20-40 YO |
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Which Hodgkin's lymphoma is more common in women and associated with lacunar cells?
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nodular sclerosing
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Which Hodgkin's lymphoma has the worst prognosis? why?
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lymphocyte depleted
low lymphocyte to RS cell ratio |
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Which Hodgkin's lymphoma has the best prognosis? age group affected?
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lymphocyte predominant
<35 YO males |
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Burkitt's lymphoma
Genetics? association? histology? |
t(8, 14) c myc gene
Starry-sky appearance: sheets of lymphocytes with interspersed macrophages associated with EBV |
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what is the most common adult NHL?
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diffuse large B-cell lymphoma
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Follicular lymphoma
Genetics prognosis |
A non-Hodgkin's lymphoma
t(14,18) bcl-2 difficult to cure but indolent course |
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which lymphoma is associated with Helicobacter pylori?
Origin? |
extranodal marginal zone lymphoma
derived from MALT |
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what tumor is associated with HTLV-1?
classification? sxs? course? |
adult T cell lymphoma (a NHL)
cutaneous lesions aggressive course |
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what NHL presents with cutaneous patches/nodules and has an indolent course?
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mycosis fungoides
Sezary syndrome |
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what Ig's are predominant in multiple myeloma?
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IgG (55%)
IgA (25%) |
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What is associated with M spike due to IgM, hyperviscosity and no lytic bone lesions?
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Waldenstrom's macroglobulinemia
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what is MGUS?
increases the risk of what? |
monoclonal gammopathy of undetermined significance (MGUS)
asympatomatic multiple myeloma but increases the risk of MM and Waldenstrom's |
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How are acute leukemia and chronic leukemia different clinically?
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acute: blasts predominate; children or elderly; short and drastic course
chronic: more mature cells; midlife age range; longer and less devastating course |
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stains TRAP. What tumor? age group?
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hairy cell leukemia in elderly
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Auer rods
responds to all-trans retinoic acid what tumor? |
AML (M3)
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what indicates good prognosis for AML (M3)?
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t(15,17): responsive to all-trans reitinoic acid (vit A)
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t(9,22), bcr-abl
what tumor? complication? tx? |
CML
blast crisis: transforming to AML or ALL responds to imatinib |
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how are leukemoid reaction different from CML in terms of lab findings?
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leukemoids rxn: increased leukocyte alkaline phosphates; no increase in basophils and eosinophils; WBC left shift (e.g. 80% band cells)
CML: no increase in leukocyte AP and increased basophils and eosinophils |
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what is the complication of tx of AML M3 ?
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DIC from release of Auer rods
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Birbeck granules
S-100 Cd1a what tumor? |
Langerhands cell histiocytoses (histiocytosis X)
or Letterer-Siwe disease, Hand-Schuller-Christian disease, eosinophilic granulomas |
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what disease is JAK 2 mutation positive and has fibrotic obliteration of bone marrow?
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myelofibrosis
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list 4 chronic myeloproliferative disorders.
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polycythemia vera
essential thrombocytosis myelofibrosis CML |
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Heparin
MOA? how do you reverse heparin toxicity? |
cofactor for activation of antithrombin, decreased thrombin and Xa
use protamine sulfate (positve charge) to neutralize heparin (negative charge) |
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What is the advantage of using low-molecular-weight heparin (e.g. enoxaparin)?
disadvantage? |
advantages: better bioavailability (F) and longer half-life (2-4x longer), lower chance of HIT
disadvantage: not easily reversible |
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How do you reverse heparain-induced thrombocytopenia (HIT)?
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use direct thrombin inhibitors (Argatroban, Lepirudin, bivalirudin)
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Argatroban, Lepirudin, bivalirudin
class? indication? |
direct thrombin inhibitor
use for pts with HIT |
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Coumadin
MOA? what lab value is increased? |
interferes with vit-K dependent clotting factors (II, VII, IX, X, proteins C/S)
PT is increased (extrinsic pathway) |
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compare and contrast heparin and warfarin in terms of:
1. site of action 2. duration of action and indications 3. tx of acute overdosing 4. monitoring method 5. crosses placenta? |
Heparin:
1. blood 2. rapid and acute action; used for immediate anticoagulation (MI, DVT, stroke, PE) 3. tx overdose with protamin sulfate 4. PTT (intrinsic) 5. does not cross placenta warfarin 1. liver 2. slow and chronic usage 3. tx overdose with IV vitamin K and fresh frozen plasma 4. PT/INR (extrinsic pathway) 5. yes, so teratogenic (not indicated during pregnancy) |
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streptokinase, urokinase, alteplase, anistreplase
class? MOA? indication? |
thrombolytics
direct/indirect conversion of plasminogen to plasmin --> cleaves thrombin and fibrin clots indicated for early MI and early ischemic stroke |
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how do cancer cells develop resistance against chemotherapy?
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MDR gene is involved
produces transmembrane ATP-dependent efflux pump increases efflux and decreases influx of drug |
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List antimetabolites indicated for cancers (5).
What phase of the cell cycle are they used in? |
all are S-phase specific
1. Methotrexate (MTX) 2. 5-fluorouracil (5-FU) 3. 6-Mercaptopurine (6-MP) 4. 6-thioguanine (6-TG) 5. Cytarabine (ara-C) |
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Methotrexate (MTX)
MOA? toxicity and rescue? 2 drugs with similar MOA? indication other than cancer? |
folic acid analog that inhibit dihydrofolate reductase
myelosuppression (megaloblastic macrocytic anemia like folate deficiency); reversible with leucovorin (folinic acid) macrovesicular fatty change in liver and mucositis; teratogenic trimethoprime (TMP) and pyrimethamine indicated for abortion, ectopic pregnancy, Rheumatoid arthritis, and psoriasis |
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5-FU
MOA? toxicity and rescue? |
pyrimidine analog --> inhibits thymidylate synthase
myelosuppression, rescue with thymidine (not with leucovorin) photosensitivity |
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List 4 types of antitumor antibiotics.
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1. Dactinomycin (Actinomycin D)
2. Doxorubin (Adriamycin) / daunorubicin 3. Bleomycin 4. Etoposide (VP-16) / tenoposide |
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Actinomycin D
MOA? indications? |
an antitumor antibiotic
intercalates in DNA used for childhoold tumors (Wilm's tumor, Ewing's sarcoma, rhabdomyosarcoma) |
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Doxorubicin
MOA? (2) toxicity? (2) |
an antitumor antibiotic
generates free radical and noncovalent intercalation in DNA --> breaks DNA cardiotoxicity (dilated cardiomyopathy and arrhythmia) marked alopecia |
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Bleomycin
MOA? what cell cycle phase is affected? toxicity? |
an antitumor antibiotic
G2-phase specific free radicals --> DNA breaks pulmonary fibrosis |
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List 3 types of alkylating agents.
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1. cyclophosphamide, ifosfamide
2. Nitrosoureas (carmustine, lomustine, semustine, streptozocin) 3. Busulfan |
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cyclophosphamide
MOA? toxicity and rescue? |
an alkylating agent
covalently X-link DNA at guanine N-7. Require bioactivation by liver hemorrhagic cystitis, which can be partially rescued by mesna |
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Busulfan
toxicity? |
an alkylating agent
pulmonary fibrosis |
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List 2 types of microtubule inhibitors.
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1. Vincristine, vinblastine
2. Paclitaxel and other taxols |
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Vincristine, vinblastine
MOA? toxicity? |
block polymerization of microtubules so that mitotic spindles cannot form
vincristine: peripheral neurotoxicity, paralytic ileus vinblastine: bone marrow suppression |
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Paclitaxel and other taxols
MOA? |
hyperstabilization of microtubules; cannot break down
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Cisplatin, carboplatin
MOA? toxicity |
cross-link DNA
nephortoxicity and acoustic nerve damage |
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hydroxyurea
MOA? clinical use? |
inhibits ribonucleotide reductase --> inhibit DNA synthesis (S-phase specific)
melanoma, CML, SICKLE CELL DISEASE (increase HbF) |
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what is the most commonly used glucocortcoid in cancer chemotherapy?
|
prednisone
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Tamoxifen, raloxifene
MOA? toxicity? |
SERMs: receptor antagonist in breast and agonist in bone
tamoxifen may increase the risk of endometrial carcinoma via partial agonist effects Raloxifene does NOT cause endometrial CA b/c it's an endometrial antagonist hot flashes |
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ABVD regimen:
indication? drugs? |
indicated as first line tx for Hodgkin's lymphoma
Adriamycin (doxorubicin) Bleomycin Vinblastine (oncovin) Darcabazine |
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MOPP regimen:
indication? drugs? |
for Hodgkin's lymphoma, Wilm's tumor, and choriocarcinoma; no longer used
Mustargen (nitrogen mustard) Oncovin (vincristine) Procarbazine Prednisone |
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CHOP regimen
indication? drugs? |
for non-Hodgkin's lymphoma
Cyclophosphamide Hydroxydaunorubicin (similar to doxorubicin) Oncovin (vinblastin) Prednisone |
