Worms! (but not pinworms or ascariasis which are NOT invasive)
Corticosteroids- they sequester eosinophils in lymph nodes
Epstein Barr virus -P?
-initially replicates in the epithelial cells of the oropharynx, then spreads to B cells in lmyph nodes and attaches to their CD21 receptors --> B cell proliferation & increased synthesis of IgM antibodies
Epstein Barr -Rx?
Epstein Barr virus -C?
-fatigue -exudative tonsillitis -hepatosplenomegaly !spleen can rupture in contact sports!
Possible causes of basophilia?
malignant diseases of the bone marrow stem cells -a block in stem cell differentiation produces proliferation of cells in the earlier stages
Leukemias-Newborn to 14 years old -suspect?
Acute Lymphoblastic leukemia (ALL)
Leukemias- Persons 15-39 -suspect?
Acute myeloblastic leukemia (AML) (21% 5 year prognosis)
Leukemias - Persons >60 -suspect?
Chronic lymphocytuc leukemia (CLL)
Most common overall type of leukemia?
Most common leukemia AND cancer in children?
-abrupt onset of signs and symptoms -fever d/t infection -bleeding from thrombocytopenia fatigue from anemia -bone pain d/t marrow expansion -generalized painless lymphadenopathy
Polycythemia vera Chronic myelogenous leukemia Myeloid metaplasia with myelofibrosis Essential Thrombocytopenia
# RBC's per microliter of blood
total umber of RBC's in the body in mL/kg
RBC count =
ratio of RBC mass to PV
Polycythemia vera -P?
JAK 2 gene mitation on short armm of chromosome 9 -causes clonal expansionof myeloid stem cell --> increased production of RBC's, granuloctyes, mast cells, & platelets
Polycythemia vera -C?
-hepatosplenomegaly -ruddy face (d/t vessel congestion) -thrombotic events (d/t hyperviscosity of blood) -INTENSE pruritis after bathing (d/t histamine release from mast cells -Gout
Polycythemia vera -L?
-decreased EPO -increased RBC count, mass, and PV -late stages will have hypercellular bone marrow with fibrosis
Chronic Myelogenous Leukemia (CML) -E?
-occurs in 40-60+ year olds -exposure to radiation/benzene a major risk factor
T9:22 translocation of ABL proto-oncogene -proto-onco gene fuses with the break cluster region BCR on chromosome 22 (chromosome 22 with translocation = Philadelphia chromosome) -causes neoplastic clonal expansion of the pluripotential stem cell
-hepatosplenomegaly -generalized painless lymphadenopathy -blast crisis = increase in number of myeloblasts/lymphoblasts
-basophilia -thrombocytosis (only leukemia with this feature) -Philadelphia chromosome (not specific to CML) -BCR-ABL fusion gene (most sensitive and specific test for CML)
Myelofibrosis and Myeloid Metaplasia (MMM) -P?
-d/t mutation of JAK2 gene on short arm of chromosome 9 (same mutation may manifest as polycythemia vera)
-MASSIVE splenomegaly with portal HTN -splenic infarcts w/ left soded pleural effusions
-bone marrow fibrosis -tear drop cells
Hydroxyurea Inferon alpha
Acute Myeloblastic Leukemia -E?
-occurs b/t 15 - 59 years old
AML -C & L?
-DIC -Gum infiltration -**AUER RODS!! Splinter-shaped rods in the cytosol of myeloblasts, fused with azurophilic granules
-start with cytarabine & danorubicin -add chemo/radiation -maintenance: cytarabine
Acute Lymphoblastic leukemia (ALL) -E?
-MOST common leukemia and cancer in children (newborns to 14 years of age)
-clonal lymphoid stem cell disease -can be B cell, or T cell
-B cell commonly metastasizes to CNs or testicles -T cell type often presents as anterior mediastinal mass or acute leukemia
BM often totally replaced by lymphoblasts
-start w/ vincristine, prednisone, L-asparaginase -add chemo/radiation -maintenance w/ methotrexate + 6-mercaptopurine +/- bone marrow transplantation if needed
Adult T-cell leukemia -E?
-associated with human T-cell leukemia virus (HTLV-1)
Adult T- cell leukemia -P?
-activation of TAX gene, which inhibits TP52 suppressor gene = neoplastic proliferation of CD4 T helper cells
Adult T- cell leukemia -C?
-hepatosplenomegaly -skin infiltration -lytic bone lesions (lymphoblasts release osteoclast activating factors) with hypERcalcemia
Chronic Lymphocytic Leukemia (CLL) -E?
-occurs in pts >60 -most common leukemia
neoplastic disorder of virgin B cells
"smudge" cells = fragile leukemic cells -BM completely replaced by neoplastic B cells -Neutropenia -HypOgammaglobinemia (immature B cells can't turn into plasma cells and secrete Ig's)
Hairy Cell Leukemia (HCL) -E?
occurs in middle aged men
Leukemia withOUT lymphadenopathy -splenomegaly (site of proliferation) -autoimmune vasculitis and arthritis
-leukemic cells have hair like projections -BM backs with neoplastic cells, increased reticulin fibers -Positive tartrate resistant acid phosphatase stain (TRAP)