Hemotology

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pszurnicki
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106440
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Hemotology
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2011-10-09 20:42:58
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Hemotology
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  1. What 2 conditions cause leukemoid rxns with neutrophils?
    • severe rxn in kids
    • otitis media
    • Pertusis--whooping cough
    • TB
    • Sepsis
  2. What test would be high in a person taking creatining?
    Creatinine
  3. What is mutation in PNH?
    mutation of GPI anchor protein----no DAF
  4. What causes the episode of PNH at night?
    respiratory acidosis increases lysis
  5. What 3 conditions can lead to Pancytopenia?
    • Vit B12 deficiency
    • PNH
    • Autoimmune hemolytic anemia e.g SLE
  6. Which Hemolytic anemias, Intravascular or extravascular produce could produce iron deficiency anemias? Why?
    • Intravascular because you get hemoglobinuria with hemoglobin lost and concomittant iron
    • In extravascular, rbcs are degraded in spleen so iron is sequestered
  7. Which hemolytic anemias could produce jaundice?
    extravascular bc rbc is broken down in spleen, so biliverdin is converted to biliverdin which then overwhelms the liver producing jaundice
  8. Which hemolytic anemia increases risk for AML?
    PNH
  9. What kind of test is done for PNH?
    acid hemolysis--Ham Test
  10. In what kind of anemia as shistocytes seen in?
    extrinsic hemolytic normocytic anemia
  11. What causes Microangiopathic anemia?
    • DIC
    • HUS
    • SLE
    • Malignant hypertension
    • Malignancy
    • prosthetic heart valves
    • aortic stenosis
  12. What two anemias have spherocytes?
    • auto-immune mediate
    • hereditary spherocytosis
  13. What gives a + coombs test?
    methyldopa
  14. What gives a warm agglutinin?
    • SLE
    • Neoplasms
    • drugs
  15. What gives a cold agglutinin?
    • mycoplasma pneumonia
    • infectious mononucleosis
  16. Difference between DIrect and indirect coombs?
    • direct--detection of antibodies on rbc
    • indirect--detection of antibodies in the serum
  17. What causes Aplastic Anemia?
    • parvob19
    • irradiation
    • leukemia
    • PNH indirectly by causing pancytopenia
    • vitamin B12
  18. How is hemolytic anemia different from aplastic crisis?
    • hemolytic anemia--high reticulocyte count
    • aplastic crisis------- lowe reticulocyte count
  19. When do you see a dry tap on BM aspirate?
    aplastic anemia
  20. Leuko-erythroblastic reaction with immature RBC and immature WBC with tear drop cells seen in what anemia?
    Myelophthisic anemia
  21. WHy is there no bilirubin in urine in hemolytic anemia?
    • 1.bc bilirubin is lipid soluble not water soluble
    • 2. bilirubin is bound to albumin in the blood and cant enter kidney
  22. Autoimmune destruction of RBC by IgG and IgM is different how?
    • IgG coated RBC's are destroyed in the spleen
    • IgM coated RBC's are destroyed by MAC
  23. What are the Haptoglobin levels in intrinsic hemolytic anemia?
    low bc it binds up the hemoglobin released up on hemolysis
  24. How is extrinsic and intrinsic hemolytic anemias different in terms of jaundice(unconjugated bilirubin) and hemoglobinuria?
    • Extrinsic ---jaundice due to unconjugated bilirubin
    • intrinsic-- hemoglobinuria and iron deficiency
  25. What is the MOA of Methotrexate?
    folic acid analog blocks Dihydrofolate reductase
  26. What is the normal percentage of band forms in PBS?
    5%
  27. What is the difference between a Leukemoid rxn and Leukemia?
    • Leukemia---LAP - and + in Leukemoid
    • Leukemia- Baso and eosinophi + and - in Leukemoid
    • Organomegaly- - in leukemoid and + in leukemia
    • Signs of infection + in leukemoid
  28. Are LN tender or non tender in a neoplasm?
    non tender
  29. In what condition are LN tender?
    acute lymphadentitis---EBV, Pharyngitis
  30. What is the difference between Hodkin and Non-Hodkin lymphoma?
    • Hodking Lymphoma is more organized, it has
    • -1 population of cells
    • - Reed sterberng cells
    • -involves contigous LN
    • -doesnt disseminate to organs
    • -bimodal
    • -EBV associated
    • -B symptoms
    • Non-Hodking is sloppy
    • -disseminates to non-contigous LN
    • -disseminates to other organs
    • -composed of B and T cells
  31. What is considered good prognosis for Hogkin lymphoma?
    High lymphocytes and Low RS cells
  32. What causes chronic non-tender lymphadenitis?
    • Phenytoin
    • SLE and Infectious Mononucleosis
  33. How does liver failure cause anemia?
    liver fails to make transferrin which is needed to take iron from intestine to bm
  34. what makes up heme?
    protoporphyrin + Fe
  35. What makes us Hemoglobin?
    Heme + globin
  36. What makes up HbA2?
    2 alpha and 2 delta
  37. How is Leukemia different from Lymphoma in terms of cells?
    leukemia--high blast count, not in lymphoma
  38. Lymphomas are monoclonal or polyclonal?
    monoclonal
  39. Whats the translocation in follicular lymphoma?
    14 to 18 bcl overexpressed--antiapoptotic
  40. Multiple follicles in the l.nodes is suggestive of ?
    follicular lymphoma
  41. Diff between small and lg cell lymphoma?
    lg cell elderly as well as kids affected and you see extranodal involvement
  42. Small lymphocytic leukemia vs chronic lymphocytic leukemia?
    SCC--confined to LN, CLL has peripheral lymphocytosis
  43. What age group CLL affects
    >60
  44. Lymphoepithelial lesions are seen where?
    MALTOMA
  45. Extranodal marginal zone lymphoma in the stomach?
    MALTOMA- h pylori
  46. What autoimmune dz is associated with extranodal zone lymphoma?
    • sjogran
    • hashimotos
  47. Which neoplasm has Pre T and Pre B cells?
    lymphoblastic lymphoma
  48. Transformatio for BL?
    8 to 14 cmyc
  49. Starry sky appearance in what neoplasm?
    BL
  50. Whats the difference between classical and lymphocyte predominance?
    predominance is CD15 and 30 negative
  51. T cell neoplasm with cutaneous involvement is?
    Mycosis Fungoides
  52. CD 19, 20, CD 10
    CD38, Cytoplasmic Ig
    CD 19, CD20 CD5
    TdT CD19+ CD1+
    Tdt - CD19, CD20 CD10
    CD19, CD20, BCL2
    • Burkit Lymphoma
    • MM
    • Small cell lymphoma
    • Lymphoblatic lymphoma
    • Large cell lymphoma
    • Follicular lymphoma
  53. What are the 5 classes of Hodking?
    • Nodular sclerosis
    • Mixed Cellularity
    • Lymphocyte Rich
    • Lymphocyte Depletion
    • Lymphocyte Predominance
  54. Collagen Banding with lacunar RS cells is indicative of what Hodgkin Neoplasm?
    Nodular Sclerosing
  55. Who suffers more from Nodular Sclerosing type of Hodgkin lymphoma?
    women
  56. WHat Hodgkin lymphoma variant has high RS and lymphocytosis?
    Mixed cellularity
  57. Mixed Cellularity type of Hodgkin Lymphoma affects more what sex?
    males
  58. What Hodgkin Neoplasm has no CD15 and CD30 RS cells?
    Lymphocyte Predominance
  59. Lymphocyte Depleted Hodgkin variant is found in what population, what is it associated with?
    • elderly males
    • associated with EBV
    • HIV
  60. How much lymphoblasts must be present to be considered acute vs chronic?
    • >20% for actue
    • <20% for chronic
  61. What population gets Acute Leukemias?
    young and elderly
  62. What population gets Chronic Leukemias?
    midlife range Pts
  63. Which tumor has Auer Bodies?
    Acute Myelogenous Leukemia responds to all-trans retinoic acid M3 subtype
  64. How can Treatment of AML M3 produce DIC?
    release of Auer Rods
  65. What neoplasm has TdT+ marker?
    Acute Lymphoblastic Leukemia/lymphoma
  66. CLL affects what age group?
    >60
  67. What neoplasm has a risk of becoming CLL?
    small Lymphoblastic lymphoma
  68. What is the difference between small lymphoblastic lymphoma and chronic lymphoblastic leukemia?
    • SLL--localized to BM
    • CLL-- foundin periphery
  69. What 3 conditions produce Warm agglutinins?
    • SLE
    • Chronic Lymphoblastic leukemia
    • methyl dopa
  70. In what neoplasm are Smudge cells seen?
    CLL-affects the elderly
  71. What translocation is present in AML M3?
    15 to 17
  72. What condition predisposes to AML?
    MDS
  73. MDS predisposes to what?
    AML
  74. What condition changes into CLL?
    Small lymphoblastic Lymphoma
  75. How is Multiple Myeloma different from Waldenstrom Macroglobulinemia?
    • no bone lytic lesion/IgM in Waldenstrom
    • bone(punched out HOles) IgG in MM
  76. Bence-Jones proteins are found in what neoplasm?
    MM
  77. Monoclonal globulin protein in urin/blood caused by what?
    Bence Jones protein Waldenstrom macroglobulinemia and MM
  78. Sheet cells of plasma cells/russel bodies are present in what condition?
    MM
  79. How is MGUS and Waldenstrom Macroglobulinemia are different from MM how?
    • MM-IgG M spike
    • lytic bone lesions
  80. What 4 conditions have M spikes?
    • MGUS
    • Waldenstrom Macroglobulienmia
    • Solitary Plasmocytoma
    • MM
  81. Where are the lesions in Solitary Plasmocytoma?
    • bone
    • soft tissue
  82. B cells with hair like projections are stained with what?
    TRAP-tartate resistant alkaline phosphathase
  83. Grooved nucleus , tennis racket appearance, eosinophilic granuloma are all indicative of what tumor?
    histiocytosis--langerhans cells
  84. Hand-Schuller, Letter Siwe, eosinophilic granulomas are all variants of what tumor?
    Histiocytosis X
  85. How do you get relative polycythemia vera?
    dehydration, RBC mass is more concentrated
  86. In which Polycythemia Vera are levels of EPO high?
    Low?
    • high in Secondary--due to cyanotic disease, tumors, no feedback inhibition
    • low in Primary--EPO receptor mutation--feedback inhibition
  87. Which of the myeloproliferative disorders has no mutations in JAK2?
    Polycythemia Vera
    Myelofibrosis
    Essential Thrombocytopenia
    CML?
    CML
  88. Which of the myeloproliferative disorders is associated with philadelphia chromosome?
    CML
  89. What 2 disorders predispose to Acute Myelagenous Leukemia--t15:17?
    • All myeloproliferative disorders
    • Myelodysplastic syndromes
  90. All myeloproliferative disorders lead to what two end points?
    • FIbrosis
    • or
    • Acute Myelogenous disease
  91. The stimulus for fibroblasts to fibrose BM comes from what cell?
    Megakaryocyte
  92. Leukoerythroblastic reaction of immature RBC and WBC with a left shift is see in what myeloproliferative disorder?
    ANd leads to what kind of anemia?
    What kind of characteristic RBCs are seen in the PBS?
    • Myelofibrosis
    • Microaphthamic anemia
    • Tear drop RBC
  93. Leukoerythroblastic rxn + tear drop RBC are seen in what myeloproliferative rxn? and causes what anemia?
    • Myelofibrosis
    • micophthisic anemia
  94. What causes essential thrombocytopenia?
    uncontrolled proliferation of Megakaryocytes
  95. What causes refractory anemia?
    • Myelodysplastic Sydnrome
    • ineffective erythropoeiosis
    • and pancytopenia
  96. A dragging sensation in the abdomen means?
    splenomegaly
  97. What is hypersplenism/Splenic Sequesteration?
    pancytopenia and BM hyperplasia
  98. Thymoma is often associated with what condition?
    Myesthenia Gravis
  99. Most common neoplasm of anterior superior mediastinum?
    Thymoma
  100. What measures extrinsice coagulation pathway?
    Intrinsic pathway?
    • PT
    • PTT
  101. What are 3 causes for bleeding?
    • blood vessel dysfunction
    • platelet dysfunction
    • coagulation dysfunction
    • DIC-
  102. What causes Bleeding time?
    platelet dysfunction or low number
  103. What test montiors Heparin?
    PTT
  104. What test monitors warfarin?
    PT
  105. What causes Hemophilia A?
    CF 8
  106. What is hemathrosis?
    bleeding in the joints
  107. If bleeding time and PTT, PT time are normal what is the problem?
    vascular problem
  108. What causes idiopathic thrombocytopenic purpura?
    ab to GpIIb/IIIa
  109. Normal platelet count?
    150-400 x 10^3
  110. What happens to Megakaryocytes in ITP?
    increased in the BM
  111. What are howell jowel bodies?
    RBC with protein in it after splenectomy
  112. Hows ITP different from CLL?
    • CLL- 20% blasts
    • ITP--high megakaryocytes
  113. Thrombotic Thrombocytopenic purpura is caused by?
    absence of ADAMT13 vWF metalloprotease which normally degrades vWF
  114. What are the findings in TTP?
    • Renal failure
    • Elevated Temp
    • N-neurological symptoms
    • A-anemia
    • L-ow platelet count
  115. Hyaline Thrombi in circulation are seen in what bleeding disorder?
    TTP
  116. How is HUS manifested?
    • anemia
    • thrombocytopenia
    • renal failure
    • NO CNS
  117. Difference between TTP and HUS
    HUS has no CNS involvement
  118. Bernard Soulier is caused by what?
    Absence of GpIb
  119. Glanzman's is caused by what?
    absence of GIIb
  120. What is the difference between Bernard Soulier and Glanzman's?
    • bernard--failure of adhesion
    • Glanzman's--failure of aggregation
  121. Large platelets are seen in hwat platelet defect?
    Bernard Soulier
  122. Immediate bleeding in superficial areas is caused by what deficiency?
    bleeding--platelet
  123. Delayed bleeding in the deep structures is caused by what deficiency?
    coagulation--clotting factors
  124. Bleeding disorder with normal platelet count is ?
    von willebrand disease
  125. What stabilizes clotting factor 8?
    vWF
  126. What dz has coagulation and platelet defect?
    von willebrand
  127. What disorder has prolonged bleeding time, prothrombin time, partial thromboplastin time and decreased platelet count?
    DIC
  128. Unexplained bleeding is suggestive of what?
    DIC
  129. Causes of DIC?
    • nephrotic syndrome
    • Trauma
    • malignancy
    • infection
    • pregnancy
    • pancreatitis
  130. Cause for sideroblastic anemia?
    • Lead poisoning
    • Mitochondrial damge
    • Vit B6 deficiency
  131. WHat helminth causes vit B12 deficiency?
    Diphylobothrium
  132. What vitamin deficiency can cause Babinski sign?
    vitamin B12
  133. How can vit b12/folate deficiency cause arteriosclerosis?
    can convert homocystein to methionine so homocysteine builds up in the intima layer
  134. How does Vitamin B12 cause neuropathy?
    • Vit B12 needed to convert FA--> methylmalony-coa to succinyl Coa...
    • if vit b12 deficient FA accumulate and cause cell dysfunction
  135. Splenomegaly has what effect on the destruction of RBC?
    it increases it
  136. What anemia predisposes to AML?
    What myeloid disorder?
    • Paroxysmal Nocturnal Hemoglobinuria
    • Myelodysplastic

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