Block 1 Flashcards by Sarah Powell

Chromosomal mutation alpha thalassemia

Chromosome 16

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Chromosome mutation beta thalassemia

Chromosome 11

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Chronic myeloid leukemia mutation

t(9;22) - Philadelphia chromosome

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Myelodysplastic disorder mutation

Deletion on chromosome 5 or 7

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Myeloproliferative disorders mutation

JAK2 (tyrosine kinase)

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B cell chronic lymphocytic leukemia has aberrant expression of ___

CD5 B cells have two digit markers T cells have single digit markers Plasma cells have triple digit markers

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Follicular lymphoma mutation

t(14;18) Over expression of Bcl2 behind Ig promoter

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Mantle cell lymphoma mutation

t(11;14)

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Burkitt’s lymphoma mutation

t(8;14) c-MYC also t(8;22) or t(2;8)

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Differentiate Hodgkin or non-Hodgkin lymphoma Age > 60 +/- B symptoms Single, generalized, non-contiguous lymphadenopathy B or T cell proliferation Variable prognosis

Non-Hodgkin

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Differentiate Hodgkin or non-Hodgkin lymphoma Age variable Prominent B symptoms Contiguous, rarely generalized lymphadenopathy Reed-Sternburg, reactive cells Good prognosis

Hodgkin lymphoma

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MC leukemia >60 yo Asymptomatic Lymphocytes, spleen, and LN Autoimmune hemolytic anemia Small, round lymphocytes, diffuse growth, proliferation centers. Smudge cells CD19+, CD20+, CD5+, CD23+ FMC7- Deletions or trisomies Indolent course

B cell lymphoma CLL or SLL

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Generalized lymphadenopathy +/- B symptoms Follicular growth, mixed small and large cells Bone marrow paratrabaecular lymphoid aggregate CD19+, CD0+, CD10+ Germinal centers are Bcl2+ t(14;18) Bcl2 Indolent course

Follicular lymphoma

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Chronic inflammation tissue mass Gastric (H. Pylori), thyroid (Hashimoto’s), eye, lung Epithelial destruction Gastric, diffuse infiltration by lymphocytes CD19+, CD20+ CD5-, CD10- t(11,18), resistant to antibiotics

Extranodal Marginal Zone Lymphoma (MALToma)

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Splenomegaly, bone marrow fibrosis-dry tap, cytopenia Hairy cells Fried egg Myelofibrosis CD19+, CD20+, CD11c+, CD25+, CD103+ Tartrate resistant acid phosphatase (TRAP) BRAF mt Indolent course

Hairy cell leukemia

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Waldenstrom Macroglobulinemia - IgM monoclonal protein - hyper-viscosity, vision, neuro, bleeding, cryoglobulin (Raynaud’s), lymphadenopathy, splenomegaly Lymphocytes and plasma cells Rouleux RBCs IgM serum protein CD19+ and CD20+ lymphocytes CD138+ plasma cells Indolent course

Lymphoplasmacytic lymphoma

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Enlarging node/mass, B symptoms, de novo or transformation form low grade Common in HIV+, especially in brain Diffuse growth, large cells CD19+, CD20+, CD10 +/- Ki67 proliferation marker Aggressive course

Diffuse large B cell lymphoma

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Enlarging node/mass (terminal ileum) B symptoms Endemic in jaw in Africa, 100% EBV Sporadic HIV+ Diffuse growth Starry sky (apoptosis) Basophilic cytoplasm vacuoles CD19-, CD20+, CD10+ Ki67+ proliferation marker t(8;14) c-MYC Aggressive course

Burkitt lymphoma

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Lymphadenopathy, splenomegaly, GI tract, B symptoms Diffuse growth Cleaved cells CD19+, CD20+, CD5+, FMC7+ CD23- Cyclin D1 + t(11;14) cyclinD1 Promotes progression through the cell cycle Aggressive course

Mantle cell lymphoma

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CRAB Calcium elevation Renal complications Anemia Bone disease Elderly, 2x blacks Increased infections Urine Bence-Jones protein Amyloidosis- Congo red stain, Apple green birefringence Lyric, punched-out lesions Hyper-viscosity- headaches, fatigue, bruising, GI bleeding, vision abnormalities just as retinopathy IgG >3g/dL (serum M spike) Plasma cells > 20-30% in bone marrow CD19-, CD20- CD138+ Cytoplasmic light chain Translocations, gains or deletions Progressive course

Plasma cell myeloma

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Asymptomatic, labs negative IgG < 3g/dL Plasma cells < 10% 1% per year —> myeloma

Monoclonal gammopathy of unknown significance (MGUS)

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Leukocytosis, lymphadenopathy, splenomegaly, hypercalcemia, rash HTLV1+ Japan, Caribbean, Africa -mycoses fungoides -Sezary syndrome Lymphocytosis Clover leaf, flower cell CD3+, CD4+ Reverse transcriptase + Aggressive

Adult T cell leukemia/lymphoma

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Abdominal pain, weight loss, diarrhea, obstruction, celiac disease Small intestine, intraepithelial T cells Villous atrophy, ulcer, mass CD3+ Aggressive

Enteropathy associated T cell Lymphoma

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Lymphadenopathy, extranodal sites Adult and children Large pleomorphic cells (hallmark cells) CD30+, ALK+, CD15- t(2;5) Good prognosis unless ALK-

Anaplastic large cell lymphoma

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Destructive mass, commonly nasopharyngeal EBV associated Asia Destruction of blood vessels, necrosis CD3+, CD8+ T cells CD56+ NK cells Aggressive course

Extranodal NK/T cell lymphoma

Cutaneous lesions, patches, plaques, nodules Epidermotropism Pautrier’s microabscesses Cerebriform nuclei CD3+, CD4+ Indolent course Palliative treatment but not curative

Mycoses fungoides

Aggressive systemic variant of cutaneous T cell lymphoma Generalized erythroderma Lymphadenopathy Leukocytosis Cerebriform nuclei

Sezary syndrome

Unifocal- adults, lytic bone lesion Multifocal- children, multiple lytic lesions, skin, hepatosplenomegaly Oval cells, grooved cells Birbeck granules on electron microscopy CD1a+ S100+

Langerhans cell histiocytosis

Differentiate Classical Hodgkin’s (CHL) and Nodular Lymphocyte Predominant Hodgkin (NLPH) Age variable Single or contiguous LN Classical, lacunar, mononuclear cell type CD30+, CD15+ CD20- EBV+/- Good prognosis

CHL Includes: Nodular sclerosis Hodgkin lymphoma Mixed cellularity Hodgkin lymphoma Lymphocyte depleted Hodgkin lymphoma Lymphocyte rich Hodgkin lymphoma

Differentiate Classical Hodgkin’s (CHL) and Nodular Lymphocyte Predominant Hodgkin (NLPH) Male \<35yo Single LN Nodular, RS cell Popcorn cells Background cells- lymphocytes CD20+ CD30-, CD15- EBV- Very good prognosis

NLPH

70% of all CHL Young patients Mediastinal +/- B symptoms Broad collagen bands Nodules Classic RS cell, lacunar cells Background cells: eosinophils, neutrophils, lymphocytes CD30+, CD15+ CD20- EBV+

Nodular sclerosis Hodgkin lymphoma

CHL Older patients B symptoms No fibrosis Classic RS cells Background cells: eosinophils, neutrophils, lymphocytes CD30+, CD15+ CD20- EBV ++

Mixed cellularity Hodgkin lymphoma

CHL Older adults HIV+ Developing countries No fibrosis Classic RS cells Background cells: histiocytes and fibroblasts CD30+, CD15+ CD20- EBV+

Lymphocyte depleted Hodgkin lymphoma

CHL rare Young patients usually no B symptoms Nodular growth Classic RS cells Background cells: lymphocytes CD30+, CD15+ CD20- EBV+ infrequent

Lymphocyte rich Hodgkin lymphoma

Splenectomy increases risk of infection with ___ bacteria

Encapsulated

Epithelial neoplasm of the thymus Lymphocytes are non neoplastic Adults with SOB and a mediastinal mass Paraneoplastic syndrome Myasthenia gravis Pure red cell aplasia Graves, pernicious anemia, dermatomyositis Tx: resection Invasion decreases outcome

Thymoma

Identify the disease

Iron deficiency anemia Hypochromic and microcytic RBCs

Identify the disease

Anemia of chronic disease Increased Ferritin Decreased serum iron Decreased transferrin Decreased % saturation Decreased TIBC Increased FEP

Identify the disease

Sideroblastic anemia

Identify the diseases (2)

Target cells EITHER: sickle cell anemia (normocytic, extravascular hemolysis) B thalassemia (microcytic)

Identify the diseases (2)

Expanded hematopoiesis EITHER: sickle cell anemia (normocytic, extravascular hemolysis) B thalassemia (microcytic)

Identify the diseases (2)

Megaloblastic anemia Either: B12 or folate deficiency Enlarged RBCs and WBCs, including neutrophils which appear as hypersegmented

Identify the cell type Appears in ___ anemias

Reticulocytes Normocytic anemias

Identify the disease

Hereditary spherocytosis Extravascular hemolysis and normocytic anemia

Identify the disease

Sickle cell anemia Extravascular hemolysis and normocytic anemia

Identify the disease

Hemoglobin C HbC crystals in RBCs Extravascular hemolysis and normocytic anemia

Identify the substance present in this slide

Hemosiderin Iron storage not readily available

Identify the disease

G6PD Heinz bodies and Bite cells

Identify the disease

Immuno hemolytic anemia (IHA) RBC agglutination, can be due to IgG or IgM

Identify the disease

Microangiopathic hemolytic anemia Schistocytes and Helmet cells

Identify the disease

Aplastic anemia Bone marrow is replaced by fat cells Normocytic anemia with decreased production of RBCs

Differentiating leukemoid reaction from CML Leukemoid reaction: Asymptomatic or symptomatic? Present/not toxic granulation? Present/not basophils? Present/not increased alkaline phosphatase? Present/not altered genetics?

Symptomatic Present toxic granulation Absent basophils High LAP Normal genetics

Identify the disease

Leukemoid Reaction Band cells high LAP ABSENT BASOPHILS (CML)

Identify the disease

CML PRESENT BASOPHILS Increased blast cells (left shift) Low LAP t(9;22)

Infectious Mono or B cell lymphoma (CLL/SLL)? young patient Fever, pharyngitis, LN and splenomegaly Acute Atypical lymphocytes Positive Monospot/EBV Normal flow cytometry Self-limiting

Infectious mononucleosis

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Infectious mononucleosis Atypical but BENIGN lymphocytes

Identify the disease

B cell lymphoma (CLL/SLL) small lymphocytes with condensed chromatin and scant cytoplasm Smudge cells

Identify the disease 2:1 kappa:lambda light chain ratio

Reactive follicular hyperplasia Normal light chain ratio, therefore not malignant (malignant shows 1 LC)

Identify the disease

Polycythemia vera Giant platelets Hypochromia as a result of repeated phlebotomy

PV or Secondary Polycythemia? Elevated WBC and platelets Splenomegaly Normal o2 low EPO Bone marrow shows all myeloid cells Abnormal genetics, JAK2 mt

Polycythemia Vera

Identify the disease

Essential thrombocytosis Elevated platelets Increased megakaryocytes

Identify the disease

Primary Myelofibrosis Leukoerythroblastic reaction Tear-drop RBC Nucleated RBC Myeloid precursors (Bone marrow shows fibrosis)

Identify the disease

Myelodysplastic Syndrome Peripheral smear shows dysplastic/bilobed neutrophils (Pseudo-Pelger-Huet cells) Bone marrow is hypercellular with megakaryocytes Ringed sideroblasts also present

Identify the disease

AML - acute myeloid leukemia Myeloblasts with Auer rods, azurophilic granular material

Identify the disease CD34+ TdT+

Acute lymphoid leukemia (ALL)

Identify disease

Follicular lymphoma Equally sized abnormal follicles

Identify the disease

MALToma Invades gastric mucosa

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Hairy cell leukemia

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Lymphaplasmacytic lymphoma

Identify the disease Bcl2+

Follicular lymphoma (Follicular hyperplasia shows unevenly sized follicles and Bcl2-)

Identify the disease

Diffuse large b cell lymphoma (DLBCL)

Identify the disease

Burkitt lymphoma Starry sky (apoptosis) Basophilic cytoplasmic vacuoles

Identify the disease

Mantle cell lymphoma Cleaved cells

Identify the disease

Burkitt's lymphoma Starry sky (apoptosis)

Identify the disease Lytic, punched out lesions of __ cel myeloma

Plasma cell myeloma

Identify the disease

Rouleaux cells of Plasma cell Myeloma

Identify the disease

Clover leaf cells of Adult T cell lymphoma/leukemia (ATLL)

Identify the disease Large pleomorphic cells of \_\_\_?

Anaplastic large cell lymphoma

Identify the disease

Mycoses Fungoides Pautrier's microabscesses Epidermotropism Cerebriform nuclei

\_\_\_ cells are usually present in ___ Hodgkin Lymphoma

Reed-Sternberg cells in Classical Hodgkin's lymphomas

Identify cell type and disease

Grooved nuclei of Langerhans cell Histiocytosis

Identify structure and disease

Birbeck granules of Langerhand cell Histiocytosis

\_\_\_ Hemostasis Platelet adhesion and activation by binding to exposed subendothelial ECM. Secreted products recruit other platelets to form a temporary hemostatic plug.

Primary

\_\_\_\_ Hemostasis Activation of the coagulation cascade by the release of tissue factor. Polymerized fibrin and platelet aggregates together form a solid, permanent plug.

Secondary

Activation of counter-regulatory mechanisms by ___ restricts the hemostatic plug to the site of injury to break down the clot.

tissue plasminogen activator (tPA)

Platelet (GpIb) to ECM (exposed collagen) adhesion is mediated by \_\_\_\_\_?

vWF

Aggregation is reversible and caused by the release of ___ from already adhered platelets.

ADP

Platelet-to-platelet adhesion is mediated by what platelet protein and what other molecule?

GpIIb/IIIa Fibrinogen

Defect in GpIIb/IIIA is called ?

Glanzman Thrombasthenia

Deficiency of GpIb is called ?

Bernard-Soulier syndrome

Deficiency of platelet adhesion to exposed collagen is called ?

vWF disease

The fibrinolytic system is mediated mainly by ___ which acts primarily on fibrin to cleave clots. Also activates complement system by cleaving C3 into C3a and C3b. Broad-spectrum endopeptidase fibrin --\> TPA and FSPs Elevated breakdown products in thrombotic states such as DIC

Plasmin

Alpha-2 antiplasmin and alpha-2 macroglobulin are ____ inhibitors, which prevent the cleavage of clots (decreased fibrinolysis).

plasmin

\_\_\_ is an inhibitor of clotting factors II, IX, X, and XII, thrombin, proteins C and S, plasmin, and kallikrein Potentiated by heparin

Antithrombin-III

\_\_\_ inhibits Vit-K dependent clotting factors II, VII, IX, and X

Coumadin (Warfarin)

(2) Vit K dependent protease inhibitors First activated by thrombin-thrombomodulin complex and inhibits factors V and VIII in the presence of its cofactor (2)

Proteins C and S

Defects in ___ hemostasis typically present as petechiae, whereas defects in ____ hemostasis present as bleeding into joints and soft tissue.

Primary Secondary

Disease? An autoimmune disorder associated with IgG or other processes Platelet phagocytosis by splenic macrophages, but normal sized spleen Prolonged bleeding Normal PT, PTT Increased megakaryocytes in bone marrow Tx: glucocorticoids in chronic disease

Immune Thrombocytopenic Purpura (ITP)

Disease? Formation of abnormal Ab that activate platelets after treatment with clot inhibitor Leads to thrombocytopenia and arterial thrombosis (life threatening)

Heparin-induced Thrombocytopenia (HIT)

Disease? Impaired platelet production and increased destruction lead to thrombocytopenia CD4 and CXCR4 on megakaryocytes allow these cells to be infected. Then they are prone to apoptosis and their ability to produce platelets is impaired.

HIV Associated Thrombocytopenia

Disease? Excessive activation of platelets, which deposit as thrombi in small vessels Can cause microangiopathic hemolytic anemia and widespread organ dysfunction. Consumption of platelets leads to thrombocytopenia Deficiency in platelet enzyme ADAMTS13 (vWF metalloprotease), normally degrades vWF Neuro symptoms

Thrombotic Thrombocytopenic Purpura (TTP)

ITP or TTP? Ig attack platelets Acute and Chronic No thrombosis Hemorrhage Large immature platelets Steroids or splenectomy

ITP - Immune thrombocytopenic purpura

ITP or TTP? Microangiopathic hemolytic anemia Schistocytes (helmet cells) Thrombosis Hemorrhage Neuro symptoms ADAMTS13 deficiency

TTP - thrombotic thrombocytopenic purpura

Disease? Childhood onset Verotoxin-producing E. coli O157:H7 Absorbed in gastric mucosa where it alters endothelial cell function and results in platelet activation and aggregation Bloody diarrhea Petechiae Increased renal failure

Hemolytic Uremic Syndrome (HUS)

\_\_\_ irreversibly inhibits COX and can suppress the synthesis of TXA2, necessary for platelet aggregation.

Aspirin

Disease? MC inherited bleeding disorder spontaneous bleeding from mucous membranes, menorrhagia plasma levels measured as Ristocetin cofactor activity, which is reduced Increased bleeding time Normal platelet count

von Willebrand Disease

Disease? Factor VIII deficiency X-linked recessive; inversion of X abolishes synthesis of Factor VIII MC hereditary disease associated with life-threatening bleeding massive, spontaneous hemorrhage Prolonged PTT Normal PT

Hemophilia A

Disease? Factor IX deficiency X-linked recessive

Hemophilia B Christmas Disease

Disease? acute or chronic activation of the coagulation cascade consumption of coagulation factors Widespread microthrombi and microangiopathic hemolytic anemia Thrombi in all organs 2 major mechanisms trigger this disease: release of tissue factor or other procoagulants into circulation OR widespread endothelial injury Schistiocytes and helmet cells Disease secondary to malignancy, obstetrics, sepsis, trauma, uncontrolled bleeding, surgery, etc. Decreased platelet count and fibrinogen Increased bleeding time, PT, and PTT Increased fibrin split products and D dimer

DIC - Disseminated intravascular coagulation

Disease? post-transfusion fever and chills within 6 hours Attributed to release of donor leukocyte inflammatory mediators Responds to antipyretics Increased incidence with increased blood storage time

Febrile nonhemolytic reaction

Spontaneous abortion is most commonly caused by what?

Chromosomal abnormalities (MC trisomies) Others include: infection, endocrine abnormality, uterine abnormality, immunologic dysfunction, or teratogenic causes

\_\_\_ abortion Uterine bleeding without cervical dilation, 50% will abort Tx: bed rest

Threatened

\_\_\_\_ abortion Uterine bleeding with cervical dilation 100% will abort Tx: curettage

Inevitable

\_\_\_ abortion Some products of conception remain in the uterus Tx: curettage

Incomplete

\_\_\_ abortion Intrauterine fetal death without onset of labor tc: curettage

Missed

\_\_\_\_ abortion 3+ consecutive spontaneous abortions

Habitual

\_\_\_\_ abortion infection of products of conception along with infection of upper genital tract Tx: antibiotic and evacuation

Septic

Pregnancy outside the uterine cavity, most commonly the fallopian tube ampulla. Risk: PID, previous incidence, adhesions, endometriosis, previous surgery, IUD, in vitro fertilization Classic triad: unilateral pelvic or lower abdominal pain, vaginal bleeding, tender adnexal mass following 2-6 weeks of amenorrhea Abrupt onset of excruciating abdominal pain with rapid progression to shock, indicative of tubal rupture. Dx: serum bHCG, ultrasound, laparoscopy/biopsy. Presence of chorionic villi is essential

ectopic pregnancy

What trimester is this placenta currently in?

First trimester Chorionic villi composed of a delicate mesh of central stroma surrounded by two discrete layers of epithelium outer = syncytiotrophoblast inner = cytotrophoblast

What trimester is this placenta currently in?

Third trimester Chorionic villi composed of stroma with a dense network of dilated capillaries surrounded by markedly thinned-out syncytiotrophoblast and cytotrophoblast layers, which appear as one layer.

Disease? Low lying placenta, especially one that covers the cervical os. Severe hemorrhage can result in cervical dilation and early delivery Painless vaginal bleeding without any warning after 28 weeks Complete, partial, or marginal Intrauterine fetal growth retardation Can also be complicated by placenta accreta

Placenta previa

Disease? Lack of formation of the decidual plate, thus, chorionic villi extend into myometirum. The placenta cannot separate normally following delivery. Results in severe hemorrhage

Placenta accreta

Disease? Premature separation of the placenta prior to delivery with the formation of a retroplacental blood clot. Blood supply, therefore oxygen and nutrients, to the fetus is compromised. Risk: HTN, prior incident, maternal age, multiparty, cocaine, cigarettes, trauma Painful vaginal bleeding, uterine tenderness, fetal distress, shock, DIC After 30 weeks (third trimester)

Abruptio placenta

Disease? Umbilical cord inserted into the sides of the membrane, rather than the central part of the placental tissue

Velamentous placenta

Disease? Separate placental lobes

Succenturiate lobes

Disease? Expansion of maternal surface centrally unto the fetal surface

Circumvellate placenta

\_\_\_ placenta

Bipartite (almost two)

MCC postpartum hemorrhage

Uterine atony

Disease? In monochorionic twins, the donor twin sometimes becomes anemic and the recipient becomes plethoric

Twin-twin transfusion syndrome

Disease? Infection of fetal membranes, amnion and chorion Usually ascending infection from the genital tract E. coli, group B strep, and gonorrhea Premature rupture of membrane and early delivery

Acute chorioamnionitis

Disease? A dense band-like inflammatory exudate on the amniotic surface Acute inflammatory cells

Acute chorioamnionitis

Disease? Acute inflammation of the placental cord

Acute funisitis

Disease? Infection of chorionic villi

Villitis (placentitis)

Disease? HTN, edema and proteinuria in pregnancy Usually nulliparous Severe disease can cause headaches, dizziness, and visual disturbances HELLP: hemolytic anemia, elevated liver enzymes, low platelets

Pre-eclampsia

Disease? HTN, edema, and proteinuria in pregnancy that progress to seizures and DIC

Eclampsia

Tx for grand mal seizure control | (used in eclampsia)

MgSO4

Disease?

Placental infarct

Disease? Maternal vascular lesion observed in pre-eclampsia and idiopathic intrauterine growth retardation Characterized by fibrinoid necrosis of the vessel wall, an accumulation of lipid-laden macrophages, and a mononuclear perivascular infiltrate

Acute atherosis

Disease? No fetal parts or normal chorionic villi Entire uterus is filled with edematous, avascular villi with the appearance of a bunch of grapes. Trophoblastic proliferation of both syncytio- and cytotrophoblasts with atypia. 46XX or 46XY Empty ovum fertilized by either (more commonly) one sperm (with subsequent chromosome duplication) or two sperm without duplication Increased bHCG Ultrasound: snowstorm pattern Increases risk of choriocarcinoma

Complete hydatidiform mole

Disease? Villous enlargement, edema, and trophoblastic proliferation of both syncytio- and cytotrophoblasts with atypia.

Complete hydatidiform mole

Disease? Only part of the placenta shows changes. Fetal parts along with normal placental structures in the unaffected portion 69 XXY triploidy one or two sperm fertilize a NORMAL egg does not usually increase the risk of choriocarcinoma

Partial hydatidiform mole

Disease? Malignant cytotrophoblasts and syncytiotrophoblasts Uterine bleeding Elevated bHCG Widespread metastases are common Risk: molar pregnancy, spontaneous abortion, 25% normal pregnancy

Choriocarcinoma

Disease? Malignant cytotrophoblasts and syncytiotrophoblasts Uterine bleeding Elevated bHCG Widespread metastases are common Risk: molar pregnancy, spontaneous abortion, 25% normal pregnancy

Choriocarcinoma

Block 1 Flashcards

(144 cards)