First Aid: Hematology and Oncology – Flashcards
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Life span of RBC
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120 days
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Source of energy for RBC
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glucose (glycolysis and HMP shunt)
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Type of transporter found in the RBC membrane?
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Chloride HCO3 antiporter Allows for transport of CO2 from periphery to lungs
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Define: erythrocytosis
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Polycythemia or increased hemocrit
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Define: anisocytosis
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Varying RBC sizes
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Define: Poikilocytosis
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Varying RBC shapes
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Define: Reticulocyte
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Immature erythrocyte Marks erythroid proliferation
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Where are platelets derived from?
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Megakaryocytes
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Lifespan of a platelet
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8-10 days
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What do platelets interact with to form a plug?
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Fibrin
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What do platelets contain in their granules?
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Dense granules: ADP, calcium Alpha granules: vWF and fibrinogen
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1/3 of platelet pool is stored where?
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Spleen
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Physical symptom as a result of platelet dysfunction?
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Petechiae
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Platelet receptor for vWF:
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GpIb
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Platelet receptor for Fibrinogen:
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GpIIb/IIIa
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Normal range for PLATELETS
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150-400K
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Normal range for WBC
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4-10K
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Two types of leukocytes:
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Granulocytes: neutrophils, eosinophil, basophil Mononuclear: Monocytes, lymphocytes
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WBC differential (high to low):
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Neutrophil Lymphocytes Monocytes Eosinophils Basophils Mnemonic: Neutrophils Like Making Everyone Better
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Acute Inflammatory Response Cell, phagocyte Increased in bacterial infections Small granules: alkaline phosphatase, collagenase, lysozyme, lactoferrin Large granules: acid phosphatase, peroxidase, beta glucuronidase
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Neutrophils
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What happens to neutrophils in B12/Folate deficiency?
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Hypersegmented polys (5 or more lobes)
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What do increased band cells reflect?
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Increased myeloid proliferation Usually in bacterial infections or CML
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Cell that differentiates when it enters tissues. Kidney shaped nucleus with frosted glass cytoplasm
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Monocyte
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Phagocytic cell for bacteria, cell debris, old RBC Scavenger in tissues Derived from monocytes Activated by gamma-interferon Antigen Presenting Cell (MHCII). CD14 marker
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Macrophages
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Defends against helminthic infections Granules. Produce histaminase and arylsulfatase Phagocytic for antigen-antibody complexes
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Eosinophil
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Causes of Eosinophilia: NAACP
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Neoplastic Asthma Allergic process Collagen Vascular Disease Parasites
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Mediates allergic reactions Dense granules: heparin, histamine, leukotrienes
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Basophil Stains blue
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Mediate allergic reaction in local tissues Bind Fc portion of IgE to membrane and IgE crosslinks causing degranulation Release histamine, heparin, eosinophil chemotactic factors Type I hypersensitivity rxn
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Mast Cell
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Drug used to prevent mast cell degranulation in asthma prophylaxis
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Cromolyn Sodium
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Phagocytic antigen presenting cell. Express MHC II and Fc receptor Finger like projections
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Dendritic Cells
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Dendritic cells in the skin are called?
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Langerhans Cells
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Cells with round, densely staining nucleus with small amount of pale cytoplasm Mediate adaptive immunity
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Lymphocytes: B cells and T cells
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Surface markers on B lymphocytes:
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CD19 CD20
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Cell that produces a large amount of antibody specific to an antigen Off center nucleus with abundant RER and well-developed Golgi apparatus
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Plasma Cells
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Cancer from plasma cells
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Multiple Myeloma
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Surface markers for T lymphocytes:
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CD3 CD4 and CD8
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Cytotoxic T Cells recognize what class MHC?
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CD8 recognize MHC I
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Helper T Cell recognize what class MHC?
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CD 4 recognize MHC II
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Costimulatory signal required for activation of T cells?
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CD28 which binds to B7 on APC cell
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Features of Blood group A:
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A antigen on RBC surface anti-B antibody in plasma
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Features of Blood group B:
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B antigen on RBC surface anti-A antibody in plasm
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Features of Blood group AB:
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A and B antigens on RBC surface NO ANTIBODIES
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Who is the universal recipient of RBCs?
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AB - this blood group has no antibodes
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Features of Blood group O:
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NO ANTIGEN Antibodies to both in plasma
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Who is the universal donor of RBCs?
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O - this blood group has no antigen
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What class of antibody are the anti-A and anti-B antibodies?
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IgM Do not cross placenta
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What class of antibody are the anti-Rh antibodies?
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IgG Can cross the placenta
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Rh- mothers exposed to fetal Rh+ blood during delivery will make anti-Rh IgG. In subsequent pregnancies, antibodies will cross placenta causing?
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Erythroblastosis Fetalis
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What factors of the coagulation pathway require Vitamin K as a factor?
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Factor 2, 7, 9, 10 Protein C and S
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Hemophilia A is a deficiency of:
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Factor VIII
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Hemophilia B is deficiency of:
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Factor IX
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MOA: Warfarin
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Inhibit epoxide reductase in reaction to use Vit K as a cofactor
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MOA: Heparin
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Activates antithrombin, inhibiting Factor 2, 7, 9, 10, 11, 12
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Factor V Leiden mutation
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Factor V resistant to inhibition by activated protein C
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What induces GpIIb/IIIa expression on platelets?
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ADP released from the platelets
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vWF binds to what receptor?
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GpIb
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Fibrinogen binds to what receptor?
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GpIIb/IIIa
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What is the role of TXA2 (thromboxin A2)?
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Stimulate activation of new platelets
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MOA: Aspirin
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Inhibits coyclooxygenase and prevents TXA2 synthesis
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MOA: Ticlopidine and Clopidogrel
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Inhibit ADP-induced expression of GpIIb/IIIa. Nothing for fibrinogen to bind.
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MOA: Abciximab
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Inhibits GpIIb/IIIa directly
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Hypercoagulability Disorder Increased PT and PTT Clotting restricted to veins that manifest as PE, TIAs, Heart Attack, Stroke
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Factor V Leiden
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Bleeding Disorder with varying degrees of bleeding (bruising, nosebleed, heavy period) PTT prolonged, bleeding time prolonged Deficiency in vWF
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Von Willebrand's Disease
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Rare autosomal recessive deficiency of GpIb Demonstrates giant platelets Prolonged bleeding time, decreased platelets
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Bernard-Soulier Syndrome
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Deficiency of GpIIb/IIIa Increased mucosal bleeding Prolonged bleeding time
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Glanzmann's Thrombasthenia
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Theory behind Erythrocyte Sedimentation Rate
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Acute-phase reactants in plasma cause RBC aggregation. Aggregation causes the RBC to fall faster... thus increased ESR
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Causes of INCREASED ESR:
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Infection Autoimmune Disease (SLE, RA, Temporal arteritis) Malignant neoplasms GI disease (UC) Pregnancy
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Causes of DECREASED ESR:
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Polycythemia Sickle Cell Anemia Congestive Heart Failure Microcytosis Hypofibrinogenemia
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Acanthocyte (spur cell) Hint: Acantho = spiny
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Liver Disease Abetalipoproteinemia (lack of B48/B100)
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Basophilic Stippling
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Thalassemias Anemia of chronic disease LEAD POISONING
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Bite Cell (literally a RBC with a chunk missing)
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G6PD deficiency Bite caused by splenic macrophages trying to remove the Heinz bodies
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Elliptocyte
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Hereditary elliptocytosis may predispose to hemolytic anemia
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Macro-ovalocyte
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Megaloblastic anemia (Vit B12 or B9 deficiency) - Will also have hypersegmented PMNs Marrow failure
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Ringed Sideroblasts
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Sideroblastic anemia Cells are NUCLEATED (abnormal). Granules of iron in the perinuclear mitochondria is pathologic
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Schistocyte, Helmet Cell
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DIC TTP/HUS Traumatic hemolysis: ex metal heart valve prosthesis
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Sickle Cell
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Sickle Cell Anemia
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Spherocyte
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Hereditary Spherocytosis Autoimmune hemolysis
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Teardrop Cell
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Bone marrow infiltration "Forcing the RBC out of its home"
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Target Cell
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HbC (glycine replaced with lysine) Asplenia Liver disease Thalassemia
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Heinz Bodies
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G6PD deficiency May be seen in alpha-thalassemia
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Process between Heinz Bodies
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Oxidation of hemoglobin sulfhydryl group leads to denatured hemoglobin precipitating and damaging to RBC
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Howell-Jolly Bodies
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Functional hyposplenia or asplenia MOTHBALL Ingestion (naphthalene)
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Name two infections that can cause destruction of RBCs
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Malaria Babesia
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Iron, Transferrin, Ferritin, % transferrin saturation Iron Deficiency
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Iron: Decreased Transferrin: Increased (trying to transport more iron) Ferritin: Decreased (no iron to store) % saturation: Way decreased
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Formula for % Transferrin Saturation
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Serum iron/TIBC
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Iron, Transferrin, Ferritin, % transferrin saturation Chronic Disease
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Iron: Decreased (iron not being transported) Transferrin: Decreased (iron not being transported) Ferritin: INCREASED (all iron in cells) % saturation: no change
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Iron, Transferrin, Ferritin, % transferrin saturation Hemochromatosis
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Iron: Increased Transferrin: Decreased Ferritin: Increased % saturation: INCREASED
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Iron, Transferrin, Ferritin, % transferrin saturation Pregnancy/OCP
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Iron: no change Transferrin: Production is increased Ferritin: no change % saturation: Decreased
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Tests the function of common and extrinsic pathway (Factor I, II, V, VII, and X)
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PT
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Tests function of common and intrinsic pathway (All factors except VII and XIII)
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PTT
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Sign of platelet plug formation?
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Increased bleeding time
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Transfusion therapy: Packed RBCs
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Increase Hb and O2 carrying capacity Use: acute blood loss and severe anemia
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Transfusion therapy: Platelets
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Increase platelets by about 5000 Use: stop significant bleeding (thrombocytopenia, qualitative platelet defects)
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Transfusion therapy: Fresh Frozen Plasma
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Increase coagulation factor levels Use: DIC, cirrhosis, warfarin overdose
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Transfusion therapy: Cryoprecipitate
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Contains fibrinogen, factor VIII, factor XIII, vWF, and fibronectin Use: Treat coagulation factor deficiencies
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Risk of Blood Transfusion:
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1. Infection 2. Transfusion reactions 3. Iron Overload 4. Hypocalcemia 5. Hyperkalemia - RBCs lyse in old blood units
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Lymphoid or myeloid neoplasms with widespread involvement of the bone marrow.
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Leukemia
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Where can you find tumor cells in patients with leukemia?
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Peripheral blood
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Discrete Tumor masses arising from the lymph nodes
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Lymphoma
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What type of lymphoma is characterized by Reed-Sternberg cells?
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Hodgkin's Lymphoma
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Translocation: t(9,22) Philadelphia chromosome
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CML bcr-abl hybrid
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Translocation: t(8,14)
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Burkitt's Lymphoma c-myc activation
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Translocation: t(11,14)
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Mantle Cell Lymphoma cyclin D1 activation
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Translocation: t(14,18)
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Follicular lymphomas bcl-2 activation
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Translocation: t(15,17)
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M3 Type of AML (responsive to all trans retinoic acid)
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What is the common feature of the Chronic Myeloproliferative Disorders?
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JAK2 mutations Exception is CML ... Philadelphia Chromosome mutation
