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121 Cards in this Set
- Front
- Back
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Leukemia |
Clonol neoplastic proliferation of white cells in the blood and bone morrow |
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AML |
Neonate |
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B-ALL T-ALL |
L3 Males medeastinal mass |
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Erythropoietin |
Made from peritubular interstitial cells of the kidney 10% liver Hypoxia increase erythropoietin |
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Bone marrow aspirate location |
Children - tibia Adults- iliac crest Sternum |
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Homeostasis |
Primary- platelet plug Secondary- fibrin Tertiary- plasmin |
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Normal PTT |
26-40 +\- 6 control |
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Daily iron requirements |
Men loss- 1mg/day Women loss during men’s- 1.5 mg/day Women loss during pregnancy- 2mg/day |
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Granulocytes |
Neutrophils -multilobules Esinophils - red Basophiles -blue |
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Agranulocytes |
Monocytes- kidney shape nucleus Lymphocytes |
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Pernicious anemia |
Autoimmune distraction of parietal cells in the stomach Absent IF Females Blacks Vitiligo thyroditis Extramedullay hemoposis |
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Acrocynosis |
Agglutination of cells in the cooler vessels of the periphery |
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Absorption of bile |
Terminal ilium |
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Bilirubin property |
Lipophilic insoluble in water |
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CLL |
Males >35 Increase lymphocytes 13q deletion |
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Rai classification of CLL |
Stage 0- lymphocytes >15 >40% bone marrow cells Stage 1- lymph node Enlargement Stage 2- hepatomegaly splenimegaly Stage 3- Hb <10 anemia Stage 4- platelet <100 thrombocytopenia |
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Binet classification of CLL Revised international classification |
Group A(good prognosis)- Hb >10 platelet >100 <3 sites of palpable organ enlargement Group B(intermediate prognosis)- Hb>10 platelet >100 >= 3 sites of palpable organ enlargement Group C (worst prognosis)- Hb < 10 platelet <100 |
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Pro lymphocytic leukemia |
Elderly Splenomegaly Minimal LN Lymphocyte >100 B cell in origin Worst prognosis |
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Malignant lymphomas |
Hodgkin lymphoma Non Hodgkin lymphom |
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Hodgkin lymphoma |
Bimodal age distribution Associated with EBV HIV AIDS |
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Reed sternberg cells |
Binucleate Thick nuclear envelope Perinucleolar halo Large esinophilic nucleus Abundant amphophilic cytoplasm |
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Hodgkin lymphoma histology |
Lymphocyte predominant (3) Nodular sclerosis (53) Mixed cellularuty (38) Lymphocyte depletion (worst prognosis) |
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Staging of Hodgkin lymphoma |
Stage 1- single region Stage 2- >= 2 above or below diaphragm Stage 3- both sides of the diaphragm including the spleen Stage 4- extra lymphatic involve my |
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HTLV-1 |
1-Transmission- vertical mother to child bread milk IV needles Sexual 2- retrovirus 3- systemic inflammatory disease 4- 4 types smoldering Acute Chronic Lymphoma 5- association |
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Systemic inflammatory disease in HTLV-1 |
CNS- tropical spastic paraparesis Skin- infective dermatitis Eyes- uveitis Muscle- polymyositis Lung- alveolitis Silvery glands- sjogen syndrom |
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Associations in HTLV-1 |
Lymphadenopathy Hepatosplenomegaly Hypercalcemia Skin involvement Abnormal lymphocytes in the peripheral blood |
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Ineffective eryhthroposis |
Death of RBC in bone marrow |
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Normal hemoglobin in male and female |
13-18 11.5-16.5 |
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RBC indices |
MCH- 26-32 MCHC- 32-36 MCV- 84-96 |
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Hemoglobin |
Haem and globin Haem- iron and protoporphyrin Globin- protein |
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Causes of microcytic hypochromic anemia |
Iron deficiency anemia Anemia of chronic disease Sideroblastic anemia Thalassemia Led poison |
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Iron deficiency anemia |
Decrease iron Iron from meat and green leafy vegetables Absorb in the duodenum Bound to transferin Stored as ferritin Absorb as ferrous |
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RDW |
Red blood cell distribution width Normal size- low Various size- high |
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Anemia of chronic disease |
Hepcidin- lock away iron in inflammation Decrease EPO Acute phase reactant Increase ferritin Treat the underlying cause IV/SC EPO |
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Sideroblastic anemia |
Decrease protoporphyrin Prussian blue- stain iron Ring sideroblast |
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Causes of iron deficiency anemia |
Chronic blood loss Increase demand- pregnancy menses adolescent infants GIB Hookworm H.pylori Gastrectomy Autoimmune gastritis Poor diet |
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Laboratory findings for iron defiance anemia |
RBC indices -decrease Blood film- microcytic hypochromic Decrease iron Decrease ferritin Increase TIBC Increase TDW |
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Normal RBC |
Size of the nucleus of a lymphocyte Central area of pallor 1/3 the cell Spherical in shape |
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Treatment for iron deficiency anemia |
Treat the underlying cause Ferrous sulphate- 6 months 3months Hb 3months iron stores |
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Signs and symptoms of iron deficiency anemia |
SOB Weakness Lethargy Palpitation Koilonyichia PICA Angular Cheilitis Atrophic glossitis Oesphageal web Pallor |
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Lead poisoning |
Inhibit haem and globin synthesis Inhibit RNA |
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Reticulocyte index |
RCxpatientPCV/normal PCVx 1/maturation time |
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Spherocytes |
No central area of pallor Micro trick cells |
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Bite cells |
Fragmented cells G-6-PD deficiency X linked Intravascular hemolysis |
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Roulaux formation |
Cells stack on each other Multiple myeloma Inflammation |
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Leukoeryhroblast |
Granulocytes Nucleated red cells Tera drop cell |
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Bone morrow biopsy vs aspirated |
Cytology Histology |
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Indication for bone marrow biopsy |
Evaluation of primary marrow tumor Staging of tumor Assessing peripheral blood abnormality Assessing infectious disease Evaluation of metabolic storage disease |
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Haemoglobin curve shift the the left |
Decreased H Decreased 2,3 DPH Decrease CO2 Increase O2 HbF |
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Hemoglobin curve shift to the right |
Increase H Increase 2,3 DPH Increase CO2 HbS |
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Folate |
Absorb in proximal jijunum Green leafy vegetables 3 months Enter body as THF Vitamins B12 remove methyl group In plasma as monoglutamate In cells as polyglutamate Methotrexate inhigib DHF reductase |
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Hereditary spherocytosis |
Defect in anchor proteins spectrum ankyrin band 3.1 Increase RDW MCHC Jaundice Spherocytes Splenomegaly Fragile in osmotic fragility test unable to withstand hypotonic solution Howell-jolly bodies- nucleus in RBC Extravacular hemolysis Eosin- maleimide test Treatment- splenectomy |
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Hydroxyuria |
Increase HbF |
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Metabisuphiite test |
Cause sickling of RBC in patients with HbS |
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Warm autoimmune hemolytic anemia |
IgG Extravascular hemolysis Spherocytes Splenomegaly Agglutination @ 37•C ITP- Evan syndrome |
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Treatment of warm autoimmune hemolytic anemia |
Corticosteroids Rituximab anti CD 20 Splenectomy Alemtuzumab anti CD 52 |
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Laboratory findings for megaloblastic anemia |
Macrocyclic hyperchromic anemia MCV >96 Decrease reticularcyte count Unconjugated bilirum LDH Hypersegmented neutrophils Increase homocysteine Methylmalonic acid normal in B12 normal in folate Increase RDW Macrocytic anemia |
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Reticulocyte |
Large Bluish cytoplasm- residual RNA 2-3% Decrease RBC glade increase in RC 7-10 day increase |
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Hereditary elliptocytosis |
Defect in anchor protein- spectrin |
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Glucose 6 phosphate dehydrogenase deficiency |
Reduction of NADP to NADPH NADPH produce reduced glutathione Glutathione reduce oxidant stress X lined males Fava beans increase hemolysis Intravascular hemolysis Heinz body Bite cell Treat symptoms |
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Hereditary spherocytosis |
Defect in anchor proteins spectrum ankyrin band 3.1 Increase RDW MCHC Jaundice Spherocytes polychromasia Splenomegaly Fragile in osmotic fragility test unable to withstand hypotonic solution Howell-jolly bodies- nucleus in RBC Extravacular hemolysis Eosin- maleimide test Treatment- splenectomy |
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Causes of vitamins B12 deficiency |
Pernicious anemia Vegetarian Gastrctomy Crohn’s disease Parasite Tapeworm |
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Aquired hemolytic anemia Autoimmune HA |
Antibodies produced by the body against its own RBC |
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Drug induce immune HA |
Penicillin Quinidine rhifampicin Methydopa |
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Red cell fragmentation |
Artificial heart valves Aortic stenosis Microangiopathic hemolytic anemia |
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Marching hemoglobinuria |
Damage of RBC in the small bones of the feet |
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Alpha and beta chromosomes |
Chr 16 Chr 11 |
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Types of Hb |
HbA- 2 alpha 2 beta HbA2- 2 alpha 2 delta HbF- 2 alpha 2gamma |
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Alpha thalassemia |
Gene deletion 4 alpha deletion hydrops fetalis Hb Barts Hby4 3 alpha deletion HbH splenomegaly |
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Beta thalassemia |
Point mutation Increase alpha more sever the anemia |
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Clinical feature of beta thalassemia |
Sever anemia Hepatosplenomegaly- extramedullary hemoposis Expansion of bone- hair on end X Ray Iron overload Infection Liver disease Osteoporosis HCC |
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Laboratory diagnosis of Thalassemia |
Mucrocytic hypochromic anemia Normoblast target cells basophillic stippling |
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Pernicious anemia association |
Female Blue eyes Grey hair Northern Europe Familial Blood group A Vitiligo Myxedema Hashimoto Thyritixicosis Addison Hypoparathyroidism |
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Marching hemoglobinuria |
Damage of RBC between the small bones of the feet |
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Beta thalassemia trait |
More sever than alpha thalassemia trait |
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Features of megalobladtic anemia |
Signs of anemia Jaundice excess breakdown of Hb ineffective eythroposis Glossitis(beefy red tongue) Angular cheilosis Purpura from thrombocytopenia |
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Signs of vitamin B12 deficiency |
Subacute combined degeneration of spinal cord Dementia Depression Demyelination Peripheral neuropathy Magaloblastic madness Optic atrophy Vitiligo Decrease osteoblasts activity |
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Subacute combined degeneration of the spinal cord |
S-adenosyl homocysteine not converted to S adenosyl methionine no methylation |
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Laboratory findings for megaloblastic anemia |
Macrocyclic hyperchromic anemia MCV >96 Decrease reticularcyte count Unconjugated bilirum LDH Hypersegmented neutrophils Increase homocysteine Methylmalonic acid decrease in B12 normal in folate |
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Laboratory diagnosis of Thalassemia |
Microcytic hypochromic anemia Normoblast target cells basophillic stippling Polychromasia Increase ferritin |
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Treatment of thalassemia |
Transfusion Iron chelation Splenectomy |
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Intravascular hemolysis |
Hemoglobinemia Hemoglobinuria Hemosiderinuria Decrease heptoglobin Methhaemalbinamenia |
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Splenic atrophy |
Howell jolly bodies Nucleated RBC |
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HbC |
Glutamic acid replace by lycsine HbC crystals |
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Complication of sickle cell anemia |
Painful crisis vaso occlusive crises Splenic sequestration Aplastic crises Acute chest syndrome Dactalytitis- vaso occlusive swollen hands and feet Stroke Retinopathy Heart failure Cholilithesis Hepatic sequestration Renal failure Priapism Osteomyelitis Leg ulcer A vascular necrosis |
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Haemochromatosis |
Beta thalassemia Cardiac- heart failure Endocrine- failure to thrive Delayed puberty Hypothyroidism Hypoparathyroidism Amenorrhea Liver dissent
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Treatment for aplastic anemia |
HLA matched sibling in sever cases Immunosuppressive therapy HLA match non sibling |
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Parvivirus B19 |
Pure red cell aplasia |
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Paroxysmal nocturnal hemoglobinuria |
Mutation of PIGA gene on chromosome X Deficiency in GPI anchor protein Intravascular hemolysis pancytopenia thrombosis Jaundice Splenomegaly Flow cytometry- CD 55 & CD 59 |
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Complication of PNH |
Thrombosis Pulmonary hypertension AML |
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Aplastic anemia |
No jaundice or splenomegaly Fat cells in bone morrow |
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Purple top tube |
EDTA- anticoagulant |
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Hb electrophoresis |
AS- controls Wash to remove proteins antibodies SDG same molecular weight A2 CEO same band CEO darker A2- above S F- below S H- below controls |
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Sickle cell solubility test |
Differentiate SDG High and low molecular phosphate High molecular phosphate- S precipitate |
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PT/PTT prolong |
Mixing study- correct factor deficiency No correct time depended factor |
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Fibrin degradations produce |
Confirm DIC |
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Aplasia |
Platelet <20 Neutrophils Reticulocyte <1% Decrease bone morrow cellularity |
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Factors that increase iron absorption |
Heme form Ferrous Acid Sugar amino acid Increase demand Increase erythropoietin |
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Pathophysiolgy of PNH |
At night increase acidosis that activate the complement system which cause lyses of RBC |
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Criteria for blood donation |
Age 17-70 Weight 50kg 9 months after childbirth No underlying condition Occupation- bus driver airplane heavy machine 1 year after tattoo or pierce 2 months after live vaccine |
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Neonatal hematology |
Increase neutrophils 4 day Nucleated red cells 4 days |
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Clinical features of hemolytic disease of the newborn |
Sever disease- intrauterine death due to hydrops fetalis eyrthroblastic fetalis Moderate disease- anemia jaundice hepatosplenomegaly Kernictorus CNS damage deafness epilepsy Eyrthroblastic fetalis Mild disease- anemia with or without jaundice Increase reticulocyte count |
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Hemolytic disease of the newborn |
Mother Rh-D negative Fetus Rh- D positive During birth Rh-D from the fetus entered maternal circulation causing sensitization of the mother to produce antibody to Rh-D positive antigen During second pregnancy the Rh- D positive antibody cross the placenta and damage Rh-D positive fetus Administer anti-D antibody to mother after birth 72hr to mop up antibody Kleihauer test to confirm |
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Syphillis blood product |
In platelet |
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Burr cells |
Renal failure |
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Zieve’s syndrome |
Hemolytic anemia with alcoholic intoxication |
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Hypothyroidism on anemia |
Macrocytic anemia MCV decrease with thyroxine therapy Decrease EPO |
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Leuckodepletion |
Decrease white cell <5 x 10 white cell |
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Platelet concentrate |
Stored a room temperature Contraindications in heparin induced thrombocytopenia TTP HUS |
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Fresh frozen plasma |
-30•C |
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Cryoprecpitate |
From throwing of FFf 4• Contain factor 8 and fibrinogen Stored at less -30 |
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Physiological anemia in pregnancy |
Plasma volume 45% Red cell mass 25% Please decrease 10% Increase coagulation factors Decrease fibrinolysis |
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Causes of folate deficiency |
Alcohol Pregnancy Methotrexate |
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AML stain |
Myeloperoxidase Sudden black Esterase |
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Criteria for polycythemia |
PCV> 0.55 55% O2 sat- 92% Splenomegaly Leucocytosis thrombocytosis |
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Treatment for CML |
Hydration Allopurinol Analgesic |
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Best prognosis for non Hodgkin’s lymphoma |
Small cleaved cell lymphoma |
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Chronic vs Acute DIC |
Thrombosis more than bleeding Bleeding more than thrombosis |
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Side effect of aspirin |
Premature closure of ductus arterioles |
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Side effect o heparin |
Osteoporosis Urticaria Thrombocytopenia Tissue necrosis Hyperkalemia increase aldosterone |
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Tumor lysis syndrome |
Hyperuremia causing renal failure |
