Patho Final

Front 1

The Hematologic System
• Includes

Back 1

– Blood
• Plasma
liquid components of blood
• Cells/Corpuscles – corpuscle doesn’t have a nucleus
– RBC - corpuscle, no nucleus
– WBC (B, T, basophils, neutrophils, eosinophils, macrophages, etc)
– Platelets – no nucleus
• Bone marrow
• Lymph system

Front 2

Shock
– • Signs

Back 2

– depends on the type
o Tachycardia
o Weak pulse
o Hypotension
• Low blood pressure
o Cool, moist skin
o Pallor

Front 3

– • shock Types

Back 3

o Hypovolemic – blood volume, when someone looses too much blood, heart doesn’t have enough blood to keep their BP up
o Cardiogenic – caused by heart, someone has a heart attack where part of heart stops working, or arythmia
o Obstructive - when something is blocking blood flow. Most common is called a pulmonary embolism
• More likely to clot in a vein than in an artery
• Will get stuck in the lungs pulmonary artery
• DVT – deep venous thrombosis
• typically in veins of leg
o Neurogenic
o Septic – overwhelming infection, esp in the blood and possibly other organs.
• Inflammation – causes blood vessels to dilate
• Get widespread vasodilation
• Drops BP

Front 4

Anemia -

Back 4

a sx, not a disease!
Have a decrease of red blood cells or oxygen in the blood
• Etiology (different causes)
– Iron deficiency
o Chronic blood loss
• GI bleeding, ulcer, gastritis, tumor in colon
o NSAIDs,
• Contribute to iron deficiency, can cause gastritis
– Chronic disease
o Inflammatory, infectious, neoplastic
– Nutritional
o Vit B12, folate, iron, alcoholism
– Infectious diseases
o AIDS, tuberculosis
– Neoplastic
o Chemo/radiation – anemia is a common side effect, bc bone marrow is damaged
o Bone marrow infiltration (lymphoma, mylemoma)
– Other
o Splenomegaly, autoimmune, hereditary, etc.
Clasifications
o size
o Normocytic vs. macrocytic vs. microcytic
o Color
o Normochromic vs. hyperchromic vs. hypochromic
o Shape
o Anisocytosis, poikilocytosis, etc

Front 5

Vitamin B12 absorption

Back 5

o Intrinsic factor
o Binds to VB12 and transports it
o Needed to get b12 into the diet
o Produced by stomach
o Absorbed in the ilium
o Causes of b12 malabsorption
o Pernicious anemia
• Vitamin b deficiency
o Bacterial overgrowth in ilium
o Surgical resection
• Stomach or ilium removed
o Dietary deficiency (vegetarians)
o Tapeworm infection
o Severe crohn’s disease

Front 6

ANEMIA

Back 6

o Clinical manifestations – if severe enough
o Fatigue
o Weakness
o Dyspnea – shortness of breath
o Tachycardia
o Fatigability
o Pallor (skin, palms, fingernails, mucosa, conjuctiva)
o Angina in pre-existing CAD
o DX (dx is easy but underlying cause is more difficult to find)
o CBC (low Hct, Hg)
• To find the anemia
• Hct is the hematocrit
o Peripheral smear
• See if there’s abnormal cells
o Iron and ferritin/transferrin
• Associated with iron storage
o Vitamin B12 and folate
o Etc
o TX
o Tx underlying disease
o Replace deficiencies
o Erythropoietin (Epo, EpoGen – synthetic epo)
o Blood transfusion

Front 7

HEMOCHROMATOSIS

Back 7

o ET
o Atuosomal resessive
o Entirely genetic
o Pathophysiology
o Excessive iron absorption by small intestine
o Presents at 50-60 years old
o CM
o Iron accumulation in liver, pancreas, skin, heart, and other organs
o SX
o Weakness, fatigue, abdominal pain, arthritis, hepatomegaly (enlargement of the liver), darkened skin
o Can lead to:
• cirrhosis, DM, pulmonary fibrosis, cardiac mypoathy, impotence and sterility
o TX
o iron avoidance
o No cure
o Phlebotomy – bleeding to help decrease iron stores

Front 8

LEUKOCYTES (WBC)
o Types

Back 8

o Granulocytes
• Basophils
• Eosinophils
• Neutrophils (polymorphonucleocytes) PMN
• Monocytes
o Lymphocytes
• B and T cells
o

Front 9

Leukocytosis

Back 9

o An increase in WBC
o Eg. Infectious dx, hemorrhage
o

Front 10

Leucopenia

Back 10

o Decrease in WBC
o Eg, bone marrow failure (lymphoma, leukemia, chemo/rad, ect)
o Shock
o Nutritional deficiency
o Splenomegaly – enlargement of the spleen
o

Front 11

Eosinophilia

Back 11

o Allergic and parasitic infection
o

Front 12

Neutrophilia

Back 12

o Increased WBC and PMN (neutrophils)
o Bacterial infection
o

Front 13

Lymphocytosis

Back 13

o Increase WBC
o Viral infection
o EBV – ebstein barr virus
o Lymphocytic leukemia

Front 14

LUKEMIA

Back 14

o Malignant neoplasm of blood forming cells
o A liquid tumor bc cells do not form a solid tissue
o Two classes
o Lymphocytic or myelogenous (monocytes, granulocytes, erythrocytes, platelets)
o patho
o Bone marrow gradually gets replaced by abnormal clones
o Two classes in terms of presentation
o Acute and chronic
o ALL - most common in children – acute, lymphocytic lukemia
o AML – most common among adults – acute, myelogenous lukemia
o CLL – chronic, lymphocytic lukemia
o CML – chronic, myelogenous lukemia
o Common symptoms:
o Anemia, infection, bleeding tendencies

Front 15

ACUTE LEUKEMIA

Back 15

o Incidence
o More common in older adults (AML)
o Etiology/patho
o Rapidly progressive
• Spreads quickly
o Blast cells in marrow and blood gets replaced quickly
o Risks
o Hereditary
o Radiation
o Benzene – chemical that can cause problem
o Chemo
o Human leukocyte virus (HTLV-1)
o CM
o Flu-like acute febrile illiness at first
o Bleeding
• Gingival – gums
• Epistaxis - nose
• mid cycle menstrual
• heavy menstruation
o bone pain
• sternum, ribs, tibia
o arthralgias
• joint pain
o weakness
o pallor
o delirium
o DX
o Blood and marrow biopsy
o Chromosomal studies
o Lumbar puncture if involves CNS
o TX (medical emergency)
o Combination chemo
o Supportive care
• IV fluids
• TX anemia
• Tx infection
o Bone marrow transplant
• After chemo
o Prognosis
o Untreated, uniformly fatal
o Type, age and severity all affect outcome with tx
o Overall 5 year survival for adults 44%
o Long term disease free 30%

Front 16

LYMPHOMA

Back 16

o Malignant neoplasm of lymphatic system
o Most commonly arise from lymph nodes
o Nodes are filled with WBC
o From more mature WBC in the LN than with leukemia
o More solid form of tumor, forms a mass
o Classified as:
o Hodgkin’s disease and non hodgkins lymphoma
o Non hodgkins lymphoma
o B and T cell types
o Many types

Front 17

HODGKINS DISEASE

Back 17

(type of lymphoma)
o Incidence
o Increases with age
o Peaks at 20s and 60-70
o RF
o Age
o Male gender
o Toxins (benzene, herbicides)
o EBV
o HIV immunodeficiency
o Pathogen
o Not completely understood
o Probably monoclonal B-cells producing IL-13
• Signaling molecule = interleukin
o Reed-sternberg cell
• Tumor tissue cells form binucleated cells that look like it is dividing
o CM
o Lymphatic
• Painless swelling of nodes
• Contiguous spread
o Starts in LN, will spread to other nodes in that region
• Fatigue
• Fever/night sweats
• Pruitis - itchyness
• Weight loss/anorexia
• Edema (face, neck, arm, legs, etc)
• Depending on area of LN tumor tissue
• Anemia
o Pulmonary
• Cough, dyspenia, chest pain, cyanosis
o Others
• CNS (nerve root/spinal cord compression
• Hepatic (jaundice, hepatosplenomegaly)
• Renal (renal failure due to ureteral obstruction
o DX
o Node biopsy
o Staging by CT (to determine stage of lymphocyte progression)
o lymphangiograp

Front 18

MULTIPLE MYELOMA

Back 18

o malignant neoplasm of plasma cells in bone marrow
o similar to leukemia
o but you see plasma cells instead – abnormal secreting of Ig’s by B cells
o later spread to spleen, liver, kidney
o secrete immunoglobulin’s (Abs)
o incurable

Front 19

MYELOPROLIFERATIVE DISORDERS

Back 19

o neoplastic transformation of a hematopoietic stem cell or precursor cell
o types
o polycythemia vera
o myelofibrosis
o essential thrombocytopenia
o all can progress to AML
o acute myelogenous lukemia

Front 20

DISORDERS of HEMOSTASIS

Back 20

o hemostasis – normal clotting of the blood
o platelets contribute to the clotting
o Thrombocytosis
o Etiologies
• Reactive, increased production or decreased destruction of platelets
o CM
• Increased viscosity
• Thrombosis (fingers, toes, hepatic, mesenteric, pulmonary)
o Thrombocytopenia
• Inadequate production, increased destruction of splenic sequestration
• Common in leukemia, cancers, and after chemo
• Other causes
• Splenomegaly
• Bone marrow failure
• Nutritional deficiencies
• Prosthetic heart valves
• Heparin therapy – a blood thinner that can cause thrombocytopenia
• Auto-antibodies (idiopathic thrombocytopenic purpura)
• NSAID’s
• Permanently inhibits platelet cyclo-oxygenase
o Decreases function of thromboxane A2
• Needed for platetlets to clot
• Must be stopped before surgical procedures
• Disseminated intravascular coagulation (DIC)
• Overactivation of coagulation cascade
o Diffuse coagulation in small vessels through out the

Front 21

HEMOPHILIA

Back 21

o Sex linked recessive trait on X-chromosome
o More likely for male to get it than female
o Rare for female to get it
o Abnormality of plasma proteins important for coagulation cascade
o types
o Hemophilia A
• Factor VIII abnormality
• Most common
o Hemophilia B
• Factor Ix abnormality
o Von willebrand disease
o Loss of clotting factor called vWF which carries factor VII in blood and helps its action
o Autosomal dominant
• Heredity is a little different

Front 22

SICKLE CELLS ANEMIA

Back 22

o Etiology/Risk
o Hereditary autosomal recessive hemolytic anemia
• Not sex related
• One copy they have sickle cell disease, not sickle cells anemia
o Protection against malaria?
• More common in Africa
• Trait protects us somewhat against malaria
• If they have this trait they get a much weaker form of malaria
• Therefore more common in areas where malaria is more common
o Crisis caused by stress of infection
o hypoxia (physical exertion, high altitudes, etc)
o Pregnancy
o Trauma
o Dehydration
o Emotional disturbance
o Extreme temperatures
o Fatigue
o Patho
o Hemoglobin
• Made up of four chains (2 alpha, 2 beta chains)
• mutated in beta chain
• when not bound to oxygen, change form and polymerize into rods
o odd shaped RBC’s block blood vessels – chain reaction
• get less blood flow, becomes hypoxic, more sickleling
• sickleing happens when not Hg is not bound to Oxygen
o Spleen, kidney, bone, marrow, eye, and head of femur are very susceptible
o CM
o

Front 23

THALASSEMIA

Back 23

o group of diseases similar to sickle cell in that it hast to do with abnormal Hg chains
o inherited hemolytic anemia’s
o primarily Mediterranean and southern Chinese
o genetic alteration leads to insufficient numbers of hemoglobin chains
o can be alpha or beta (most common)