51 terms

White Blood Cells - Hematology

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-penia
deficiency
-osis
abnormal increase
Possible causes of eosinophilia?
Worms! (but not pinworms or ascariasis which are NOT invasive)
Eosinopenia, d/t?
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?
myeloproliferative disorder
Leukemias
-E?
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?
CLL
Most common leukemia AND cancer in children?
ALL
Leukemia
-C?
-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
Leukemia
-L?
Low WBC count
Blast cells present (immature WBC's)
Hypercellular BM w/ blast cells
Thrombocytopenia
Chronic Myeloproliferative disorders (4)
Polycythemia vera
Chronic myelogenous leukemia
Myeloid metaplasia with myelofibrosis
Essential Thrombocytopenia
RBC count=
# RBC's per microliter of blood
RBC mass=
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
CML
-P?
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
CML
-C?
-hepatosplenomegaly
-generalized painless lymphadenopathy
-blast crisis = increase in number of myeloblasts/lymphoblasts
CML
-L?
-basophilia
-thrombocytosis (only leukemia with this feature)
-Philadelphia chromosome (not specific to CML)
-BCR-ABL fusion gene (most sensitive and specific test for CML)
CML
-Rx?
Imatinib mesylate
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)
MMM
-C?
-MASSIVE splenomegaly with portal HTN
-splenic infarcts w/ left soded pleural effusions
MMM
-L?
-bone marrow fibrosis
-tear drop cells
MMM
-Rx?
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
AML
-Rx?
-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)
ALL
-P?
-clonal lymphoid stem cell disease
-can be B cell, or T cell
ALL
-C?
-B cell commonly metastasizes to CNs or testicles
-T cell type often presents as anterior mediastinal mass or acute leukemia
ALL
-L?
BM often totally replaced by lymphoblasts
ALL
-Rx?
-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
CLL
-P?
neoplastic disorder of virgin B cells
CLL
-L?
"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)
CLL
-Rx?
Chlorambucil
Hairy Cell Leukemia (HCL)
-E?
occurs in middle aged men
HCL
-C?
Leukemia withOUT lymphadenopathy
-splenomegaly (site of proliferation)
-autoimmune vasculitis and arthritis
HCL
-L?
-leukemic cells have hair like projections
-BM backs with neoplastic cells, increased reticulin fibers
-Positive tartrate resistant acid phosphatase stain (TRAP)
HCL
-Rx?
Purine analogs- w/ dramatic response :)