blood disorders Flashcards
(103 cards)
1
Q
what type of tissue does lymphoma arise from
A
peripheral lymphoid tissue
2
Q
which type of lymphoma is more common in men
A
Hodgkin lymphoma
3
Q
characteristics of Hodgkin lymphoma
A
- rare
- high cure rate
- more common in men
- familial pattern
- Reed sterning cells
4
Q
what is the peak of incidence of Hodgkin lymphoma
A
early 20’s and over 50
5
Q
Hodgkin lymphoma is more common in who (specifically)
A
immunosuppressed and those exposed to agent orange
6
Q
Hodgkin lymphoma spreads by what
A
contiguous extension
7
Q
Hodgkin lymphoma has what kind of origin
A
unicentric (single node)
8
Q
Hodgkin lymphoma requires what essential diagnosis criteria
A
the reed sternberg cell
9
Q
what are the two subgroups of Hodgkin lymphoma
A
- nodular sclerosis
- mixed cellularity
10
Q
what type of Hodgkin lymphoma is more common in women
A
nodular sclerosis
11
Q
what type of Hodgkin lymphoma has a worse prognosis
A
nodular sclerosis
12
Q
what type of Hodgkin lymphoma is more common in men
A
mixed cellularity
13
Q
does mixed cellularity Hodgkin lymphoma have a better or worse prognosis
A
better prognosis, but more constitutional problems
14
Q
manifestations of Hodgkin lymphoma
A
- enlargement of 1/more lymph nodes on the neck
- pruritis
- pain at the tumor site w/ alcohol use
- herpes zoster infections
- B symptoms
15
Q
what are the B symptoms
A
- weight loss (>10%)
- fever without chills
- drenching night sweats
16
Q
B symptoms are found in what % of patients
A
40% of patients
17
Q
B symptoms are common with what
A
advanced disease
18
Q
diagnosis of Hodgkin lymphoma
A
- labs (mild anemia, elevated/decreased lymphocytes)
- lymph node biopsy + reed sternberg cell
19
Q
treatment of Hodgkin lymphoma is determined by what
A
stage
20
Q
limited stage Hodgkin lymphoma is treated with
A
2-4 months of chemo followed by radiation
21
Q
advanced stage Hodgkin lymphoma is treated with
A
chemo
22
Q
advanced or refractory stage Hodgkin lymphoma is treated with
A
transplant (marrow/stem cell)
23
Q
Non-Hodgkin lymphoma involves what type of cells
A
B cell or T cell neoplasms
95% B cell
24
Q
Non-Hodgkin lymphoma originates where
A
multiple lymph nodes
25
where does Non-Hodgkin lymphoma spread to
lymphoid tissue (spleen, liver, bone marrow)
26
what type of lymphoma has unpredictable spread that is not localized
Non-Hodgkin lymphoma
27
incidence of Non-Hodgkin lymphoma increases by
decade
28
the median age of diagnosis for Non-Hodgkin lymphoma is
67
29
what is the itiology of Non-Hodgkin lymphoma
unknown
30
what are the subtypes of Non-Hodgkin lymphoma
- diffuse large B cell lymphoma (30%)
| - follicular lymphoma (22%)
31
manifestations of Non-Hodgkin lymphoma
initially few/no symptoms
- abnormal node size/consistency
- B symptoms
- decreased organ fx (pulmonary, renal, spleen, CNS)
- increased susceptibility to infection
32
diagnosis of Non-Hodgkin lymphoma
- lymph node biopsy
33
how is treatment of Non-Hodgkin lymphoma selected
through immunophenotyping and scans (CT, MRI, PET, bone)
34
treatment of Non-Hodgkin lymphoma
dependent on stage
35
treatment of early stage Non-Hodgkin lymphoma
localized radiation and chemo
36
treatment of aggressive Non-Hodgkin lymphoma
combination chemo + immunotherapy
37
treatment of highly resistant Non-Hodgkin lymphoma
bone marrow + peripheral stem cell transplant
38
what is leukemia
proliferation of malignant WBC in circulation
39
leukemia is most common in who
children and young adults
40
what are the 2 forms of leukemia
- lymphocytic
| - myelogenous
41
lymphocytic leukemia involves what
CA of the lymphoid stem cell line (lymphocytes)
42
myelogenous leukemia involves what
CA of the myeloid stem cell line (monocytes, granulocytes)
43
what type of leukemia involves blast cells
acute
44
leukemia impacts normal RBC which will cause
hypoxia
45
leukemia impacts normal WBC which will cause
impaired defense
46
what is the etiology of leukemia
idiopathic, but requires a mutated gene (oncogene)
47
risk factors for leukemia
- immunodeficiency
- T cell leukemia virus
- genetic predisposition
- radiation exposure
48
manifestations of leukemia
- leukopenia, thrombocytopenia, anemia
- bleeding/bruising
- recurrent infection
- fatigue, weakness
- fever in absence of infection
- general pain
49
why does someone with leukemia experience bleeding/bruising
d/t inadequate oxygen and ATP production (d/t impacted RBC)
50
why does someone with leukemia experience fatigue and weakness
d/t decreased oxygen (d/t impacted RBC)
51
how is leukemia diagnosed
blood and bone marrow evaluation
52
treatment of leukemia
- chemo + radiation
- antimicrobials
- colony-stimulating factors
- blood transfusions
- marrow/stem cell transplant
53
why is colony stimulating factor used for leukemia treatment
stimulates growth factor secretion by the bone marrow which promotes growth and differentiation of stem cells
54
what are the 4 stages of chemo + radiation treatment with leukemia
- induction (induce remission)
- CNS prophylaxis (deliver chemo via lumbar puncture)
- consolidation (once remission begins, intensify chemo to reduce leukemia cells)
- maintenance (decreased dosage maintained for 2 years)
55
what is the most common blood disorder
anemia
56
anemia is due to what
a RBC and/or Hb deficiency
57
RBC are removed by the
spleen
58
what is Hb
a protein within RBC's that is responsible for transporting oxygen
59
3 causes of anemia
- excessive loss (ex. hemorrhage)
- abnormal hemolysis
- deficient erythropoiesis
60
abnormal RBC number, structure or function causes
decreased oxygen-carrying capacity which causes systemic hypoxia and deficiency of ATP
61
what causes all the symptoms of anemia?
hypoxia
62
mild anemia is often
not detected
63
manifestations of moderate anemia
- chronic fatigue
- dyspnea
- palpitations
64
manifestations of severe anemia
- exhaustion, weakness
- headache
- dizziness
- sensitivity to cold
65
why does severe anemia cause sensitivity to cold
d/t ATP deficiency
| aerobic ATP production produces heat, anaerobic doesn't
66
how does iron deficiency cause anemia
oxygen binds iron on Hb
| reduces the oxygen carrying capacity of Hb
67
with iron deficiency anemia these tests will be normal
RBC and Hb
68
iron deficiency anemia requires what test
ferritin test
69
treatment of iron deficiency anemia
- treat the cause
| - PO iron for 4-6 months then reassess
70
excess iron can cause what
constipation and toxicity
71
what is folic acid
a vitamin essential for the body to make DNA, RNA and metabolize amino acids
72
what is B12
a vitamin required for function of CNS and metabolism of all cells
73
a deficiency in what will cause abnormal DNA synthesis and cell maturation causing defective blood cells
B12 or folic acid
74
a deficiency in B12 or folic acid will cause
abnormal DNA synthesis and cell maturation causing defective blood cells
75
treatment of B12 and Folic acid deficiency
- treat the cause
| - B12/folic acid supplements
76
pernicious anemia is caused by a problem with
intrinsic factor excreted by stomach mucosa
77
what does intrinsic factor do
binds vitamin B12 for absorption
78
treatment of pernicious anemia
- passive absorption (high dose B12)
| - IM (if neuro symptoms occur ex. headache, dizziness)
79
what is aplastic anemia
bone marrow failure causing hematopoiesis
80
what causes aplastic anemia
- 65% idiopathic
| - 35% autoimmune, radiation, toxic chemicals
81
treatment of aplastic anemia
- withdraw the cause (radiation etc)
- transfusion (until recovered)
- marrow transplant
82
what causes hemolytic anemia
excessive or premature hemolysis of RBC
83
hemolytic anemia etiology
- genetics (ex. thalassemia)
| - acquired (ex. autoimmunity)
84
manifestations of hemolytic anemia
- anemia manifestations
- jaundice
- splenomegaly
- hepatomegaly
85
what causes jaundice
excessive RBC breakdown causing a bilirubin buildup
86
Hb is broken down into iron, globin and heme which is broken down into what and used for what
- iron (stored in the liver to be reused in Hb)
- globin = amino acids (reused for proteins)
- heme = bilirubin (excreted)
87
if there is too much bilirubin the liver becomes ______ and causes bilirubin to ______ and ______ in the tissues
overwhelmed
circulate
deposit
88
why must renal function be monitored in a patient with hemolytic anemia
if the liver can't keep up with excessive bilirubin, full molecules will get through causing sedimentation in the kidneys (glomerulus)
89
causes of hemorrhagic anemia
- peptic ulcer disease (gradual bleed into stomach/duodenum)
- tumor
- heavy menses
- hemorrhoids
90
treatment of hemorrhagic anemia
treat the cause
91
the severity of acute hemorrhagic anemia depends on
- site
- volume
- rate
92
chronic hemorrhagic anemia may be hard to diagnosis because it is
gradual, ongoing blood loss that is concealed
93
sickle cell anemia is what type of abnormality
autosomal recessive
94
to have sickle cell anemia the person must have how many defective alleles
2 (homozygous)
95
if only 1 sickle cell allele is affected the person will have
sickle cell trait (mild/no symptoms)
96
manifestations of sickle cell anemia
- thrombosis
- infarction
- jaundice
- low GFR, renal failure
97
in sickle cell anemia, glutamic acid is replaced with _____ in the _____
valine in the beta chain
98
valine carries oxygen normally but once ____ occurs what happens?
once dissociation occurs, Hb crystalizes causing the cell to sickle, hemolyze and release crystalized Hb in the blood
99
why does sickle cell anemia impair perfusion
- the shape of the cell impedes flow
| - crystallization increases viscosity
100
treatment of sickle cell anemia
- supportive treatment (oxygen, rest, pain, fluids/electrolytes)
- hypertransfusion
- hydroxyurea
- marrow transplant
101
how does hydroxyurea help those with sickle cell anemia and why is it bad?
- prevents crystallization and hemolysis, facilitating the formation of fetal hemoglobin
- has severe SE, is hepatotoxic, can cause leukemia and is toxic to the marrow
102
why does sickle cell anemia cause pain?
systemic ischemia d/t occlusions
103
thalassemia is a disease of
hemoglobin synthesis
