What 2 conditions cause leukemoid rxns with neutrophils?
- severe rxn in kids
- otitis media
- Pertusis--whooping cough
What test would be high in a person taking creatining?
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
- 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?
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?
- Malignant hypertension
- prosthetic heart valves
- aortic stenosis
What two anemias have spherocytes?
- auto-immune mediate
- hereditary spherocytosis
What gives a + coombs test?
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?
- 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?
Leuko-erythroblastic reaction with immature RBC and immature WBC with tear drop cells seen in what 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?
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?
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
- -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?
- 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?
Whats the translocation in follicular lymphoma?
14 to 18 bcl overexpressed--antiapoptotic
Multiple follicles in the l.nodes is suggestive of ?
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
Lymphoepithelial lesions are seen where?
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?
Transformatio for BL?
8 to 14 cmyc
Starry sky appearance in what neoplasm?
Whats the difference between classical and lymphocyte predominance?
predominance is CD15 and 30 negative
T cell neoplasm with cutaneous involvement is?
CD 19, 20, CD 10
CD38, Cytoplasmic Ig
CD 19, CD20 CD5
TdT CD19+ CD1+
Tdt - CD19, CD20 CD10
CD19, CD20, BCL2
- Burkit Lymphoma
- 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?
Who suffers more from Nodular Sclerosing type of Hodgkin lymphoma?
WHat Hodgkin lymphoma variant has high RS and lymphocytosis?
Mixed Cellularity type of Hodgkin Lymphoma affects more what sex?
What Hodgkin Neoplasm has no CD15 and CD30 RS cells?
Lymphocyte Depleted Hodgkin variant is found in what population, what is it associated with?
- elderly males
- associated with EBV
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?
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?
- 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 predisposes to what?
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?
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?
How is MGUS and Waldenstrom Macroglobulinemia are different from MM how?
- MM-IgG M spike
- lytic bone lesions
What 4 conditions have M spikes?
- Waldenstrom Macroglobulienmia
- Solitary Plasmocytoma
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?
Hand-Schuller, Letter Siwe, eosinophilic granulomas are all variants of what tumor?
How do you get relative polycythemia vera?
dehydration, RBC mass is more concentrated
In which Polycythemia Vera are levels of EPO high?
- 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?
Which of the myeloproliferative disorders is associated with philadelphia chromosome?
What 2 disorders predispose to Acute Myelagenous Leukemia--t15:17?
- All myeloproliferative disorders
- Myelodysplastic syndromes
All myeloproliferative disorders lead to what two end points?
- Acute Myelogenous disease
The stimulus for fibroblasts to fibrose BM comes from what cell?
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?
- Microaphthamic anemia
- Tear drop RBC
Leukoerythroblastic rxn + tear drop RBC are seen in what myeloproliferative rxn? and causes what anemia?
- 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?
What is hypersplenism/Splenic Sequesteration?
pancytopenia and BM hyperplasia
Thymoma is often associated with what condition?
Most common neoplasm of anterior superior mediastinum?
What measures extrinsice coagulation pathway?
What are 3 causes for bleeding?
- blood vessel dysfunction
- platelet dysfunction
- coagulation dysfunction
What causes Bleeding time?
platelet dysfunction or low number
What test montiors Heparin?
What test monitors warfarin?
What causes Hemophilia A?
What is hemathrosis?
bleeding in the joints
If bleeding time and PTT, PT time are normal what is the 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
- L-ow platelet count
Hyaline Thrombi in circulation are seen in what bleeding disorder?
How is HUS manifested?
- 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?
Immediate bleeding in superficial areas is caused by what deficiency?
Delayed bleeding in the deep structures is caused by what deficiency?
Bleeding disorder with normal platelet count is ?
von willebrand disease
What stabilizes clotting factor 8?
What dz has coagulation and platelet defect?
What disorder has prolonged bleeding time, prothrombin time, partial thromboplastin time and decreased platelet count?
Unexplained bleeding is suggestive of what?
Causes of DIC?
- nephrotic syndrome
Cause for sideroblastic anemia?
- Lead poisoning
- Mitochondrial damge
- Vit B6 deficiency
WHat helminth causes vit B12 deficiency?
What vitamin deficiency can cause Babinski sign?
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