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Barry Patho II Mid

6-16-10 Patho II Blood

"cytic" refers to the morphologic class cell size
"chromic" refers to the Hb content (ex hyperchromic)
Anisocytosis is a person with different size RBCs
Poikilocytosis is RBCs with different shapes
Anemia is defined in what two ways? decreased # of circulating RBCs or in the quality or amount of Hb
What are the causes of anemia? decreased production of RBCs, destruction of RBCs or a combination of both
What is the name of the first and second cell types in the production of an RBC? Hemocytoblast and proerythroblast
What takes place in phase 3 of RBC production? Ejection of nucleus
Another name for the RBC stem cell Hemocytoblast
What happens in phase 1 of RBC synthesis Ribosome synthesis
What is another name for the RBC in the committed cell stage Proerythroblast
What happens in phase 2 of RBC synthesis Hemoglobin accumulation
How wide is an average RBC 7.5 um
How thick is an average RBC 2.0 um
When does hypoxemia present asymptomatic when it happens gradually without greater oxygen demand
How does one compensate for anemia through CV, Resp, and Hematological system. increase reabsorbtion of fluid from extravascular comp., increase vol (with decrease viscosity), increase circulation (more turbulent)
What does anemia do to the heart Causes tachycardia and eventually CHF
What are the S/S in ineffective compensated anemia Dyspnea, tachycardia, dizziness and fatigue at rest
Severe or sudden onset of anemia causes Peripheral vasoconstriction, increase Na H2O retention, decreased urine output
Icterus accumulation of products from broken RBCs
Anemia caused by Vit B12 def. causes myelin degeneration of the nervous system in the spinal cord and peripheral nerves
S/S of anemia caused by Vit B12 (10 of them) paresthesia, extreme weakness, gait disturbances, spasticity and reflex abnormalities, abdominal pain, nausea, vomiting, anorrexia, and low grade fever
What is the tx for anemia palliation of symptoms and correction of underlying cause - blood transfusions, dietary corrections, and admin of vitamins or iron
Megaloblastic anemias result from defective DNA synthesis
Megaloblasts results from def. of vit B12 or folate acid
megaloblasts turn into Macrocytes
pernicious anemia is caused by def Vit B12 that is caused from the lack of the intrinsic factor (IF) in the gastric mucosa (cogenital - atrophy of the gastric mucosa) or after partial or total gastrectomy
Chronic atrophic gastritis can be caused by (3 things) Alcohol, hot tea, smoking
5 vague symptoms of pernicious anemia infections, mood swings, and renal, CV or GI problems
Weakness, fatigue, distal paresthesias, and neurological manifestations occur when Hb level is ? less than 8 g/dl
Neurological manifestations (related to pernicious anemia)are due to demylination of the lateral and posterior columns of the spinal cord
Symptoms that appear when Hb is less than 8g/dl (8 of them) weakness, fatigue, distal paresthesia, neurological manifestations (ataxia, spasticity, loss of the vibration and position sense), anorexia, abdominal pain, weight loss,and sore tongue
Hepato-splenomegaly is diagnosed by (4 things) clinical manifestations, blood test, bone marrow aspiration and Schilling test
Schilling test measures the urine excretion of administered radioactive cobalamin
A positive Schilling test for pernicious anemia is identified by low urinary excretion of cobalamin
If intrinsic factor (IF) is given and cobalamin excretion increases, what does this mean? It is the secondary confirmation test of the diagnosis of pernicious anemia
What happens in 1-3 yrs of untreated pernicious anemia Death
What prevents death in pernicious anemia Life long administration of Vit B12
Folic acid is a component of (3 things) thymine, adenine, and guanine
The daily requir.of folic acid 50-200ug
Three resons for folate acid deficiency Alcoholism, chronic malnourished, and diets low in vegetables
Clinical manifestions of folate anemia are similar to pernicious anemia with the addition of (4 things) Stomatitis (painful ulcerations of the buccal mucosa and tongue), dysphagia, flatulence, and liquid diarrhea
What manifestation is usually not present in folate anemia that is in pernicious anemia Neurologic manifestations
Tx for folate anemia (the 2 doses) Folate daily - 1 mg normally, 5 mg alcoholics
Macrocytic - normochromatic anemias (2 of them) Pernicious anemia and folate anemia
Name microcytic - hypochromatic anemias (3 of them) Iron def. anemia, porphyrin and Hb synthesis disorders, and globin synthesis disorder
The most common anemia worldwide Iron def. anemia
4 causes of iron def. anemias parasitic infestations, decreased ingestion of Fe (malnutrition), pregnancy, chronic blood loss
The mls of daily blood loss that can cause anemia 2-4 mls (1-2 OF Fe)is sufficient to cause anemia
The three characteristic stages of the development of iron def. anemia Stage I = Fe storage depleted but Hb and RBC normal, Stage II = Fe def. causes erythropoiesis, Stage III = small Hb def. cells replace circulating old normal RBC
S/S when Fe anemia Hb drops below 7-8g/dl (10 things) fatigue, weakness, dyspnea, pale skin and mucose membranes, koilonychia nails, glossitis, gastritis, headache, irritability, neuromuscular changes
Two lab tests to evaluate Fe anemia Directly (bone marrow biopsy) or indirectly (serum ferritin, transferrin saturation, or total iron-binding capacity)
The most conclusive diagnosis of Fe anemia an increase of 1-2 g/ml after initiation of Fe therapy
Name 5 normocytic - normochromic anemias Aplastic anemia, posthemorrhage anemia, hemolytic anemia, anemia of chronic inflammation, sickle cell anemia
Aplastic anemia results from (2 things) Bone marrow hypoplasia or aplasia
Pancytopenia where all the series are effected
Aplastic anemias are either ? or ? and may be further calssified as ? or ? Aplastic anemias are either hereditary (fanconi anemia - defect in DNA repair)or acquired which may be further classified as primary (idiopathic 50% of cases with 80% over 50 yrs of age) or secondary (by chemical agents and ionizing radiation)
PRCA, what is it and what series does it effect Pure red cell aplasia, it effects the red series only
True / false: PRCA is very common when eating raw chicken on OBT False, it is very rare
Palliative treatment for aplastic anemia (2 things) Blood transfusions and bone marrow transplant (or pharmacological stimulation of the marrow function)
What "ectomy" might take place with aplastic anemia Splenectomy
The most common type of hemolytic anemia with normal Hb Cogentital hemolytic anemia (or Acholuric jaundice)
The cause of cogenital hemolitic anemia An unknown abnormality of protein in thje RBC membrane that causes increased Na permeability leading to increase ATP consumption and premature death r/t overworked (as well as abnormal RBC shape - spherocyte)
What happens to a spherocyte when it circulates through the spleen adios amigo
When (developmental stage) do clinical manifistation of cogenital hemolitic anemia occur neonatal period or early infancy
Tx of cogenital hemolytic anemia blood exchange transfusion and/or phototherapy
What "megaly" is almost always present after infancy (r/t cogenital hemolytic anemia) Splenomegaly
What % of splenectomies occur with cogenital hemolytic anemia 50%
What is the most serious complication during childhood with cogenital hemolitic anemia Aplastic crisis (RBC production shut down for 10 days from parvovirus B19)
Specific test to diagnose cogenital hemolitic anemia None
Clinical cure for cogenital hemolitic anemia Splenectomy (done after 5 yrs of age)
Thing to be evaluated to diagnose cogenital hemolitic anemia (4 things) Family history, blood smear, osmotic fragility, and autohemolysis
Sickle cell anemia is chacaterized by the presents of Hb S
Hb S results from glutamic acid being replaced by Valine
Hb S reacts when subjected to (2 things) Deoxygenation and dehydration
True/False: When Hb S reacts it turns into the shape of a buttermilk biscuit and is soft and fluffy False, cresent and stiff
Sickled cells do what to microcirculation and thereby cause what 3 things occlude and cause ischemia, pain, infarction
T/F: Sickle cells under go hemolysis and sequestration in the liver False, both hemolysis and sequestration in spleen - only seq. in liver
What does sickle cells cause in the bone marrow and sometimes liver Erythropoiesis - the production of RBC related to decreased O2 delivery to kidneys which secrete erythropoietin
Name 4 types of anemic crises Vasoocclusive, Aplastic, Sequestration, and Hyperhemolytic
Vasoocclussive (thrombotic) crisis crisis which may be spontaneous or precipitated by infections, exposure to cold, decreased PO2, decreased pH, or localized hypoxemia
Aplastic crisis crisis results from RBC with a shorter survival (10-20 days)and a compromised compensatory responce
Sequestration crisis crisis in both the spleen and liver
Hyperhemolitic crisis crisis is unusual but may occur in association with certain drugs and infections
The most frequent cause of death in patient with sickle cell Infection (meningitis and general sepsis)
What test confirms the present of Hb S in the blood Sickle cell solubility test
What test reveals the amount of Hb S in the RBC Hb electrophoresis
How can prenatal diagnosis of sickle cell be made Chorionic Villus sample (8-10 wks gestation) or Amniocentesis (15 wks gestation)
Treatment of sick cell anemia is aimed at Prevention (prevent consequences and crisis)
5 triggers of sickle cell crisis Fever, infection, dehydration, acidosis, and exposure to cold temp
Tx for sickle cell (5 of them) bone marrow transplant, blood transfusion, oral administration of folate, spenectomy, and genetic counseling
If both parents have sickle cell trait, what is the % the child will have the disease 25%
Thalassemia (a microcytosis disease) is charactered by the impairment of what Impaired rate of synthesis of one of the alpha or beta chains
What are the 2 major classifications of Thalassemias and the 2 sub classes Alpha Thalassemia or Beta Thalassemia and then either Minor or Major
Both alpha and beta thalassemia are life threatening in children who are (4 things) weak, failure to thrive, show poor development, and are cardiac compromised
An untreated child with thalassemia will die at what age 5-6 yrs
Diagnosis of thalassemia is based on (4 things) Family history, clinical manifestations, peripheral blood smear (microcytosis), and Hb electrophoresis
Tx for thalassemia includes (4 things) blood transfusions, iron chelation therapy (experimental), spenectomy, and neocyte transfusion (experimental)
The definition of polycythemia excessive production of RBC
What type of polycythemia results from hemoconcentration of the blood due to dehydration The Relative Type (actual absolute RBCs numbers are normal as well as bone marrow function)
The Absolute Type of Polycythemia is further classified as Primary or Secondary
The other name for Absolute Primary Polycythemia Polycythemia Vera (PV)- a neoplastic (cancerous)disorder where RBC mass is self distructive.Also hyperplasia of the bone marrow with inc. platlets and WBC leads to altered Pluripotential
Polycythemia cause what to the blood volume and viscosity They both go up, increasing probabilitiy of thromboembolism and tissue infaction/necrosis
Clinical S/S of polycythemia (12 of them) H/A, hepatomegaly, spenomegaly, drowsiness, delirium, mania, psycotic depression, visual disturbances, GI thrombosis, portal HTN, angina, and chorea
How is abosulte polycythemia diagnosed blood test = increase in absolute RBCs and total blood volume
What is the Tx for Absolute polycythemia phlebotomy Q 3-4 momths, radioactive phosphorus, myelosuppresive drugs (clorambucil)
Absolute secondary polycythemia is usually caused by Secretion of erythropoieten in responce to hypoxemia (high altitude, heavy smoking, CFH, COPD)or cancer (tumors associated with renal, hepatomas, and cerebellular hemangioblastomas
Excessive white blood cells is called Leukocytosis
Decreased or ineffective WBCs is called Leukopenia
T/F: leukocytosis and leukopenia usually involve more than one type of WBC in the same individual? False
The physiological causes for leukocytosis are (10 of them) Infection, strenuous exercise, emotional stress, temp changes, ANESTHESIA, surgery, pregnancy, drugs, hormones, and toxins
The pathological causes for leukocytosis include (2 of them) Malignancies and hematological disorders
Causes for leukopenia (4 of them) Radiation, anaphylactic shock, SLE, and some chemotherapeutical agents
WBC count less than ? are at risk for infection Less than 1000/mm3
WBC count less than ? are at risk for life threatening infection Less than 500/mm3
An increase in Granulocytes and Monocytes can be from (2 things) Infection or myeloprolifrative disorders
A decrease in Granulocytes and Monocytes can be from (2 things) Used up faster than can be made, or depression/suppression of bone marrow
Granulocytosis usually refers to Neutrophilia (which is present in the early stages of infection = above 7500/ul)
Neutrophilia in which count is higher than 100,000/ul may cause Thrombus due to increase in viscosity
An increase in the release of immature WBC is called a Shift to the Left ( the degree of shift is usually related to the serverity of the infection)
Neutropenia is a count less than ? and is seen in ? Less than 2000/ul and is seen in servere prolonged infections
Causes for decreased neutrophil production (3 things) Aplastic anemia, Leukemia, Drug-induced neutropenia
Decreased neutrophil life span is related to Autoimmune disorder (SLE and RA)
Abnormal neutrophil distribution and sequestration are caused by (3 things) Hypersplenism, starvation, and anorexia nervosa
Eosinophilia usually occurs in ? and give 6 examples Allergic reactions - Asthma, hay fever, drug reactions, pemphigus (a blistering autoimmune dz), some types of dermatitis and parasitic invasions
Eosinopenia is caused by migration of eosinophils into sites of inflammation.
Specific examples of eosinophilia (6 of them) Cushing syndrome, surgery, shock, trauma, burns, or mental distress
Basophilia is very rare but may be seen in Myeloproliferative disorder
Basopenia is seen in (3 things) Hyperthyroidism, acute infections, and long-term steroid therapy
Monocytosis is commonly seen in the late recovery stages of bacterial infections (when phagocytosis is needed)along with leukopenia, also seen during chronic infections like TB and SBE
Monocytopenia is rare and has been identified with (2 things) Hairy cell leukemia and prednisone therapy
Lymphocytosis is typical of what type of infection Viral (rare in bacterial infections), it is also present in antigen reactions
Lymphocytopenia is associated with ? (5 things) and is very serious problem in cases with? Neoplasms, immune deficiencies, radiation, chemo, and viruses. Serious in cases with AIDS
Leukemia is a clonal (originating from same ancestor), malignant disorder that decreases production and function of normal hemapoietic (blood producing)cells
Leukemias are classified Acute or chronic and as Myeloid or Lymphoid
Acute leukemias are those classified by Undifferenitiated or immature cell (usually a blast cell)with rapid onset and short survival time
In Chronic leukemias the predominant cell is apperently mature but does not function normally (longer survival period than acute)
Clinical manifestations of acute leukemia are Related to bone marrow depression such as fatigue, bleeding, fever (the early sign), infection (oral, resp, lower colon, GU, and skin), anorexia, decreased sweet/sour taste, weight loss, loss of muscle, neurological issues (H/A, vomiting, papilledema
Diagnosis of leukemia is done by Blood test and bone marrow biopsy
Treatment for Acute Leukemia is Chemotherapy (tx of choice), bone marrow transplant, supportive care, immunotherapy agents
Treatment for chronic leukemia includes bone marrow transplant and chemotherapy
Multiple myeloma is what type of cancer B cell cancer
Multiple myeloma cells produce large amount of one class of immunoglobulins - usually IgG - known as M protein
M protein causes infiltration and destruction of organs (particularly bones)
Diagnosis of Multiple Myeloma is made by Radiographic, lab studies, and biopsy of the lesion
Treatment of multiple myeloma includes (4 things) Chemo, Radiation, Plasmapheresis, and bone marrow transplant
Malignant Lymphomas involve the proliferation of (2 things) Lymphocytes and histiocytes (and their precursors and derivatives)
Malignant Lymphomas are found in what tissue Lymphoid tissue
Malignant lymphomas are classified as (3 of them) Lymphoid leukemia (B cell origin), Non-Hodgkin lymphoma (T cell origin), and Hodgkin disease
Hodgkin Disease is characterized by the presence of the Reed-Sternburge cells, lymphadenopathy, enlarged lymph nodes in different locations, fever, night sweats, and wt loss
Hodgkin disease is diagnosed by simple CXR, lymphangiography, and biopsy of enlarged lymph nodes
Treatment for Hodgkin disease includes Radiotherapy and chemotherapy with important success
What is different in the clinical findings between Hodgkin and Non-Hodgkin diseases There are no Reed-Sternberg cells in Non-Hodgkin disease
What are the differences in the S/S and treatments of Hodgkin and Non-Hodgkin diseases None
Created by: smorrissey1



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