Blood Pathology Pt 2: Lymphoma, Myeloma, Hemostasis, Bleeding and Thrombotic Disorders

Question 1

non hodgkin lymphoma

Answer 1

malignant proliferation of lymphoid cells in peripheral lymph nodes
skips around
extranodal involvement is common
many subtypes
most are b cell
over 40 yo

Question 2

hodgkin lymphoma

Answer 2

younger patients
good prognosis
contiguous spread
good prognosis
consequence of EBV
5 subtypes
reed-sternberg cells

Question 3

symptoms of no hodgkin

Answer 3

painless, extranodal manifestations, b symptoms (weight loss, night sweats, fever)

Question 4

low grade non hodgkin

Answer 4

older patients, incurable, small mature cells, non destructive

Question 5

high grade non hodgkin

Answer 5

younger patients
aggressive
large distinct cells
destruct

Question 6

small lymphocytic lymphoma

Answer 6

low grade nh
same thing as cll
cd5+
long course, lethal infections

Question 7

malt lymphoma

Answer 7

low grade nh
Mucosa Associated Lymphoid Tissue
H. pylori
can be cured early with antibiotics

Question 8

follicular lymphoma

Answer 8

low grade nh
small cleaved centroblast
grades 1-3
bcl2

Question 9

4 stages of follicular lymphoma

Answer 9

single node
2+ nodes on same side of diaphragm
lymph nodes on both sides of diaphragm
diffuse extranodal involvement

can have a or b subset in each (no additional symptoms, or weight loss, night sweats, fever)

Question 10

mycosis fungoides

Answer 10

low grade nh

skin lesions, blood involvement, cerebriform lymphocytes, t cell immunophenotype

Question 11

large cell lymphoma

Answer 11

high grade nh
large b cells
grows fast
extranodal involvement
bad prognosis

Question 12

lymphoblastic lymphoma

Answer 12

high grade nh
typical patient: teenage boy with mediastinal mass
same as all

Question 13

burkitt lymphoma

Answer 13

high grade nh
children/young adults
african preference
fast growing
starry sky pattern
genetic

Question 14

nodular sclerosis

Answer 14

hodgkin
tumor splits into 2 nodes
LACUNAR cells
common

Question 15

mixed cellularity

Answer 15

hodgkin
rs cells surrounded by eosinophils, lymphocytes and histiocytes
common

Question 16

lymphocyte predominance

Answer 16

hodgkin

nodules contain small lymphocytes with histiocytes and rs cells

Question 17

multiple myeloma

Answer 17

malignant proliferation of plasma cells
monoclongal gammopathy
decreased immunoglobulins
ostolytic lesions

Question 18

manifestations of multiple myeloma

Answer 18

weakness, infections, renal failure, bone pain, hyperglycemia, bence jones proteins in urine

Question 19

CRAB

Answer 19

multiple myeloma
calcium elevated
renal failure
anemia
bone lytic lesions

Question 20

treatment of multiple myeloma

Answer 20

chemo and radiation

bone marrow transplant

Question 21

hemostasis

Answer 21

formation annd removal of a blood clot

Question 22

clotting formation

Answer 22

bm exposed with injury
platelet adheres wi vWF
platelet releases granules (ca2+ activates clotting, ADP activates other platelets, thromboxane increases stickiness)
platelets express fibrin receptors
fibrin and platelets form plug

Question 23

clot cascade inhibition

Answer 23

tfp1 - factor 7
atiii - factors 7, 9, 11, 10, thrombin
protein c - factors 8 and 5

Question 24

clot lysis

Answer 24

t-pa - converts plasminogen to plasmin

PLASMIN - bomb that blows up clot

Question 25

fdp

Answer 25

fibrin degradation product | measured from blood as an indicator of clot status

Question 26

warfarin

Answer 26

vit k dependent factor inhibits use of vitamin k NO CLOTTING = bleed to death (rat poison)

Question 27

lab tests for clotting

Answer 27

platelet lab test - particle counter bleeding time - make incision and see how long it takes to stop bleeding coagulation test - draw blood, watch for thrombin formation

Question 28

platelet bleeding

Answer 28

superficial, petechia, spontaneous

Question 29

factor bleeding

Answer 29

deep, big bleeds, trauma

Question 30

partial thromboplastin time

Answer 30

measures platelets in plasma from intrinsic pathway | with phospholipid and calcium

Question 31

prothrombin time

Answer 31

measures platelets in plasma from extrinsic pathway | uses a prothrombin ratio

Question 32

von willebrand disease

Answer 32

``` loss of factor 8 most common bleeding disorder autosomal dom vWF decreased symptoms - mucosal bleeding, deep joint bleeding ```

Question 33

hemophilia a

Answer 33

most common factor deficiency x-linked recessive reduced factor 8

Question 34

hemophilia b

Answer 34

reduced factor 9 less common x linked recessive

Question 35

disseminated intravascular coagulation

Answer 35

widespread activation of coagulation decreased clotting factors and platelets increased fdps

Question 36

causes of disseminated intravascular coagulation

Answer 36

``` MOST malignancy obstetric complications spesis trauma ```

Question 37

thrombic microangiopathies

Answer 37

thrombosis in capillaries and arterioles due to an endothelial injury

Question 38

thrombic thrombocytopenic purpura (TTP)

Answer 38

deficiency of adamst13 | big vWF multimers trap platelets

Question 39

hemolytic uremic syndrome (HUS)

Answer 39

related to e. coli infecton | toxin damages endothemium

Question 40

idiopathic thrombocytopenic pupura

Answer 40

antiplatelet antibodies coat platelets splenic macrophages consume platelets (bruising after minor trauma)

Question 41

thrombic disorders

Answer 41

hemostasis involving the formation of an intravascular clot or thrombus risk factors: smoking, increased stasis, hypercoagulability

Question 42

fates of thrombi in venous thrombosis

Answer 42

propagation - accumulate additional platelets and fibrin embolization - dislodge and travel to other sites in vessel dissolution - shrinkage/disappearance of recent thrombi organization and recanalization - older thrombi re-used, capillaries reform

Question 43

mural venous thrombosis

Answer 43

thrombi that adhere to vessel wall, partially restricting flow

Question 44

occlusive venous thrombosis

Answer 44

thrombi that cut off blood flow

Question 45

embolus venous thrombosis

Answer 45

detatched intravascular solid, liquid, or gas mass carried in blood can lodge in vessel and completely block blood flow

Question 46

what can high estrogen cause in regard to thrombic disorders?

Answer 46

increased plasma fibrinogen increased factors 7 and 10 reduced antithrombin3