-
What 2 conditions cause leukemoid rxns with neutrophils?
- severe rxn in kids
- otitis media
- Pertusis--whooping cough
- TB
- Sepsis
-
What test would be high in a person taking creatining?
Creatinine
-
What is mutation in PNH?
mutation of GPI anchor protein----no DAF
-
What causes the episode of PNH at night?
respiratory acidosis increases lysis
-
What 3 conditions can lead to Pancytopenia?
- Vit B12 deficiency
- PNH
- Autoimmune hemolytic anemia e.g SLE
-
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
-
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
-
Which hemolytic anemia increases risk for AML?
PNH
-
What kind of test is done for PNH?
acid hemolysis--Ham Test
-
In what kind of anemia as shistocytes seen in?
extrinsic hemolytic normocytic anemia
-
What causes Microangiopathic anemia?
- DIC
- HUS
- SLE
- Malignant hypertension
- Malignancy
- prosthetic heart valves
- aortic stenosis
-
What two anemias have spherocytes?
- auto-immune mediate
- hereditary spherocytosis
-
What gives a + coombs test?
methyldopa
-
What gives a warm agglutinin?
-
What gives a cold agglutinin?
- mycoplasma pneumonia
- infectious mononucleosis
-
Difference between DIrect and indirect coombs?
- direct--detection of antibodies on rbc
- indirect--detection of antibodies in the serum
-
What causes Aplastic Anemia?
- parvob19
- irradiation
- leukemia
- PNH indirectly by causing pancytopenia
- vitamin B12
-
How is hemolytic anemia different from aplastic crisis?
- hemolytic anemia--high reticulocyte count
- aplastic crisis------- lowe reticulocyte count
-
When do you see a dry tap on BM aspirate?
aplastic anemia
-
Leuko-erythroblastic reaction with immature RBC and immature WBC with tear drop cells seen in what anemia?
Myelophthisic anemia
-
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
-
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
-
What are the Haptoglobin levels in intrinsic hemolytic anemia?
low bc it binds up the hemoglobin released up on hemolysis
-
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
-
What is the MOA of Methotrexate?
folic acid analog blocks Dihydrofolate reductase
-
What is the normal percentage of band forms in PBS?
5%
-
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
-
Are LN tender or non tender in a neoplasm?
non tender
-
In what condition are LN tender?
acute lymphadentitis---EBV, Pharyngitis
-
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
-
What is considered good prognosis for Hogkin lymphoma?
High lymphocytes and Low RS cells
-
What causes chronic non-tender lymphadenitis?
- Phenytoin
- SLE and Infectious Mononucleosis
-
How does liver failure cause anemia?
liver fails to make transferrin which is needed to take iron from intestine to bm
-
what makes up heme?
protoporphyrin + Fe
-
What makes us Hemoglobin?
Heme + globin
-
What makes up HbA2?
2 alpha and 2 delta
-
How is Leukemia different from Lymphoma in terms of cells?
leukemia--high blast count, not in lymphoma
-
Lymphomas are monoclonal or polyclonal?
monoclonal
-
Whats the translocation in follicular lymphoma?
14 to 18 bcl overexpressed--antiapoptotic
-
Multiple follicles in the l.nodes is suggestive of ?
follicular lymphoma
-
Diff between small and lg cell lymphoma?
lg cell elderly as well as kids affected and you see extranodal involvement
-
Small lymphocytic leukemia vs chronic lymphocytic leukemia?
SCC--confined to LN, CLL has peripheral lymphocytosis
-
What age group CLL affects
>60
-
Lymphoepithelial lesions are seen where?
MALTOMA
-
Extranodal marginal zone lymphoma in the stomach?
MALTOMA- h pylori
-
What autoimmune dz is associated with extranodal zone lymphoma?
-
Which neoplasm has Pre T and Pre B cells?
lymphoblastic lymphoma
-
Transformatio for BL?
8 to 14 cmyc
-
Starry sky appearance in what neoplasm?
BL
-
Whats the difference between classical and lymphocyte predominance?
predominance is CD15 and 30 negative
-
T cell neoplasm with cutaneous involvement is?
Mycosis Fungoides
-
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
-
What are the 5 classes of Hodking?
- Nodular sclerosis
- Mixed Cellularity
- Lymphocyte Rich
- Lymphocyte Depletion
- Lymphocyte Predominance
-
Collagen Banding with lacunar RS cells is indicative of what Hodgkin Neoplasm?
Nodular Sclerosing
-
Who suffers more from Nodular Sclerosing type of Hodgkin lymphoma?
women
-
WHat Hodgkin lymphoma variant has high RS and lymphocytosis?
Mixed cellularity
-
Mixed Cellularity type of Hodgkin Lymphoma affects more what sex?
males
-
What Hodgkin Neoplasm has no CD15 and CD30 RS cells?
Lymphocyte Predominance
-
Lymphocyte Depleted Hodgkin variant is found in what population, what is it associated with?
- elderly males
- associated with EBV
- HIV
-
How much lymphoblasts must be present to be considered acute vs chronic?
- >20% for actue
- <20% for chronic
-
What population gets Acute Leukemias?
young and elderly
-
What population gets Chronic Leukemias?
midlife range Pts
-
Which tumor has Auer Bodies?
Acute Myelogenous Leukemia responds to all-trans retinoic acid M3 subtype
-
How can Treatment of AML M3 produce DIC?
release of Auer Rods
-
What neoplasm has TdT+ marker?
Acute Lymphoblastic Leukemia/lymphoma
-
CLL affects what age group?
>60
-
What neoplasm has a risk of becoming CLL?
small Lymphoblastic lymphoma
-
What is the difference between small lymphoblastic lymphoma and chronic lymphoblastic leukemia?
- SLL--localized to BM
- CLL-- foundin periphery
-
What 3 conditions produce Warm agglutinins?
- SLE
- Chronic Lymphoblastic leukemia
- methyl dopa
-
In what neoplasm are Smudge cells seen?
CLL-affects the elderly
-
What translocation is present in AML M3?
15 to 17
-
What condition predisposes to AML?
MDS
-
MDS predisposes to what?
AML
-
What condition changes into CLL?
Small lymphoblastic Lymphoma
-
How is Multiple Myeloma different from Waldenstrom Macroglobulinemia?
- no bone lytic lesion/IgM in Waldenstrom
- bone(punched out HOles) IgG in MM
-
Bence-Jones proteins are found in what neoplasm?
MM
-
Monoclonal globulin protein in urin/blood caused by what?
Bence Jones protein Waldenstrom macroglobulinemia and MM
-
Sheet cells of plasma cells/russel bodies are present in what condition?
MM
-
How is MGUS and Waldenstrom Macroglobulinemia are different from MM how?
- MM-IgG M spike
- lytic bone lesions
-
What 4 conditions have M spikes?
- MGUS
- Waldenstrom Macroglobulienmia
- Solitary Plasmocytoma
- MM
-
Where are the lesions in Solitary Plasmocytoma?
-
B cells with hair like projections are stained with what?
TRAP-tartate resistant alkaline phosphathase
-
Grooved nucleus , tennis racket appearance, eosinophilic granuloma are all indicative of what tumor?
histiocytosis--langerhans cells
-
Hand-Schuller, Letter Siwe, eosinophilic granulomas are all variants of what tumor?
Histiocytosis X
-
How do you get relative polycythemia vera?
dehydration, RBC mass is more concentrated
-
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
-
Which of the myeloproliferative disorders has no mutations in JAK2?
Polycythemia Vera
Myelofibrosis
Essential Thrombocytopenia
CML?
CML
-
Which of the myeloproliferative disorders is associated with philadelphia chromosome?
CML
-
What 2 disorders predispose to Acute Myelagenous Leukemia--t15:17?
- All myeloproliferative disorders
- Myelodysplastic syndromes
-
All myeloproliferative disorders lead to what two end points?
- FIbrosis
- or
- Acute Myelogenous disease
-
The stimulus for fibroblasts to fibrose BM comes from what cell?
Megakaryocyte
-
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
-
Leukoerythroblastic rxn + tear drop RBC are seen in what myeloproliferative rxn? and causes what anemia?
- Myelofibrosis
- micophthisic anemia
-
What causes essential thrombocytopenia?
uncontrolled proliferation of Megakaryocytes
-
What causes refractory anemia?
- Myelodysplastic Sydnrome
- ineffective erythropoeiosis
- and pancytopenia
-
A dragging sensation in the abdomen means?
splenomegaly
-
What is hypersplenism/Splenic Sequesteration?
pancytopenia and BM hyperplasia
-
Thymoma is often associated with what condition?
Myesthenia Gravis
-
Most common neoplasm of anterior superior mediastinum?
Thymoma
-
What measures extrinsice coagulation pathway?
Intrinsic pathway?
-
What are 3 causes for bleeding?
- blood vessel dysfunction
- platelet dysfunction
- coagulation dysfunction
- DIC-
-
What causes Bleeding time?
platelet dysfunction or low number
-
What test montiors Heparin?
PTT
-
What test monitors warfarin?
PT
-
What causes Hemophilia A?
CF 8
-
What is hemathrosis?
bleeding in the joints
-
If bleeding time and PTT, PT time are normal what is the problem?
vascular problem
-
What causes idiopathic thrombocytopenic purpura?
ab to GpIIb/IIIa
-
Normal platelet count?
150-400 x 10^3
-
What happens to Megakaryocytes in ITP?
increased in the BM
-
What are howell jowel bodies?
RBC with protein in it after splenectomy
-
Hows ITP different from CLL?
- CLL- 20% blasts
- ITP--high megakaryocytes
-
Thrombotic Thrombocytopenic purpura is caused by?
absence of ADAMT13 vWF metalloprotease which normally degrades vWF
-
What are the findings in TTP?
- Renal failure
- Elevated Temp
- N-neurological symptoms
- A-anemia
- L-ow platelet count
-
Hyaline Thrombi in circulation are seen in what bleeding disorder?
TTP
-
How is HUS manifested?
- anemia
- thrombocytopenia
- renal failure
- NO CNS
-
Difference between TTP and HUS
HUS has no CNS involvement
-
Bernard Soulier is caused by what?
Absence of GpIb
-
Glanzman's is caused by what?
absence of GIIb
-
What is the difference between Bernard Soulier and Glanzman's?
- bernard--failure of adhesion
- Glanzman's--failure of aggregation
-
Large platelets are seen in hwat platelet defect?
Bernard Soulier
-
Immediate bleeding in superficial areas is caused by what deficiency?
bleeding--platelet
-
Delayed bleeding in the deep structures is caused by what deficiency?
coagulation--clotting factors
-
Bleeding disorder with normal platelet count is ?
von willebrand disease
-
What stabilizes clotting factor 8?
vWF
-
What dz has coagulation and platelet defect?
von willebrand
-
What disorder has prolonged bleeding time, prothrombin time, partial thromboplastin time and decreased platelet count?
DIC
-
Unexplained bleeding is suggestive of what?
DIC
-
Causes of DIC?
- nephrotic syndrome
- Trauma
- malignancy
- infection
- pregnancy
- pancreatitis
-
Cause for sideroblastic anemia?
- Lead poisoning
- Mitochondrial damge
- Vit B6 deficiency
-
WHat helminth causes vit B12 deficiency?
Diphylobothrium
-
What vitamin deficiency can cause Babinski sign?
vitamin B12
-
How can vit b12/folate deficiency cause arteriosclerosis?
can convert homocystein to methionine so homocysteine builds up in the intima layer
-
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
-
Splenomegaly has what effect on the destruction of RBC?
it increases it
-
What anemia predisposes to AML?
What myeloid disorder?
- Paroxysmal Nocturnal Hemoglobinuria
- Myelodysplastic
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