Chapter 20 Flashcards
(41 cards)
1
Q
-hemoglobin synthesis requires ______, ______, ______, and ______
-the red cell production is regulated by the ______ of the arterial blood. a decrease oxygen supply stimulates ______
It is mediated by the kidneys which produce ______
A
iron vitamin B12 vitamin B6 folic acid oxygen content erythropoiesis erythropoietin
2
Q
the volume of packed RBC expressed as a percentage of total peripheral blood
A
hematocrit
3
Q
denotes the mean volume of RBC
A
mean corpuscular volume (MVC)
4
Q
denotes the content of hemoglobin per RBC
A
mean corpuscular hemoglobin (MHC)
5
Q
denotes the concentration of hemoglobin in RBC
A
mean corpuscular hemoglobin concentration (MCHC)
6
Q
-______is a reduction of hemoglobin in the blood to below-normal levels. Hb is <13.5 g/dL in males and <12.5 g/dL in females. when Hb levels are below ______ then blood transfusion is needed
A
anemia
8 g/dL
7
Q
Chronic
inflammation and malignant condition
A
Anemia due to chronic disease
8
Q
Microcytic anemia are due to decreased production of hemoglobin (Fe, Hb & protoporphyrin ring structure). Example: Iron deficiency anemia, anemia due to chronic disease, sideroblastic anemia & thalassemia
-RBC size decreases, and lose their color
A
Microcytic homochromic Anemia
9
Q
-iron deficiency in anemia: ______
-infants: ______
-children: ______
adults (20-50 years): ______ in males and ______ in females
-elderly: ______ in the western world; ______ infection in the developing world
-other causes include malnutrition (vegetarians), and gastrectomy surgery (acids aid iron absorption by maintaining the Fe2+ state, which is more absorbed than Fe3+)
-serum iron and ferritin levels decrease but total iron binding capacity increase (Transferrin)-Lab test
-supplement of iron (ferrous state Fe2+ high affinity for oxygen)
A
dietary lack or blood loss breast-feeding (human milk is low in iron) poor diet peptic ulcers menorrhagia or pregnancy colon polyps/carcinoma hookworm
10
Q
- two forms: idiopathic(no one knows the reason) and secondary
- bone marrow depleted of ______ and consist only of ______, fat cells, and ______
- uncontrollable infections. bleeding tendency, chronic fatigue, sleepiness, and weakness. Patients often crave for ice cubes
A
aplastic anemia
hematopoietic cells
fibroblasts
scattered lymphpcytes
11
Q
- caused by deficiency of vitamin B12 or folic acid
- ______: dietary folate is obtained from geen vegetables and some fruits. it is absorbed in the jejunum. (important for hemoglobin production)
- inadequate intake in the diet or because of malabsorption caused by intestinal disease like in alcoholics, elderly or increased demand like pregnancy or cancer
- vitamin B12 deficiency
- ______: autoimmune disease due to autoantibodies against parietal cells and intrinsic factor. common cause of deficiency of vitamin B12
- lack of the ______: stomach cancer or gastric bypass surgery
- diagnosis: ______: by oral radioactive B12 with or followed by cold B12
A
macrocytic (megaloblastic) anemia folic acid deficiency pernicious anemia gastric intrinsic factors Schilling test
12
Q
- fatigue, shortness of breath, weakness and neurologic symptoms
- with appropriate and prompt therapy neurological may be reversible
A
megaloblastic anemia (B12 deficiency)
13
Q
- genetic defect in the synthesis of HbA that reduces the rate of globin chain synthesis
- no abnormal ______
- ______: reduced synthesis of the alpha chain of globin
- a-thalassemia is usually due to gene deletion; normally, ______ genes are present on ______
- one gene deleted: ______
- two genes deleted: mild anemia with ______ RBC count
- three genes deleted: ______
- four genes deleted: lethal in utero (______). The gamma chains from tetramers (Hb Barts) that damage RBCs. Mothers carrying a fetus with Hb bart have a increased risk for obstetric complications
A
Thalassemia hemoglobin produced a-Thalassemia 4 alpha chromosome 16 asymptomatic increased severe anemia hydrops fetalis
14
Q
- reduced synthesis of the beta chain of globin
- ______ or thalassemia trait
- heterozygotes
- mild, nonspecific symptoms
- ______
- homozygotes
- severe and serious disease
- chronic transfusions are often necessary for survival
A
B-thalassemia
B-thalassemia minor
B-thalassemia major
15
Q
B-thalassemia patients have ______, facial bones and cranial bones in a characteristic in ______ appearance
A
distorted long bones
crew-cut
16
Q
- antibody-mediated (______ or ______) destruction of RBCs
- IgG mediated disease usually involves ______. IgG binds RBCs in the relatively ______ temperature of the central body (warm agglutinin); membrane of antibody coated RBC is consumed by ______, resulting in spherocytes
- associated with ______ (most common cause), and certain drugs (classically, penicillin and cephalosporins)
- treatment involves stoppages of the drugs, steroids, if necessary, ______
- IgM-mediated disease usually involves ______. IgM binds RBCs and fixes complement in the relatively ______ temperature of the extremities (cold agglutinin)
- associated with ______ and ______
A
immune hemolytic anemia IgG or IgM extravascular hemolysis warm splenic macrophages SLE splenectomy intravascular hemolysis cold mycoplasma infectious mononucleosis
17
Q
- clonal proliferation of hematopoietic stem cells
- uncontrolled production of red blood cells to mutation. ______ level is decreased
- clinical symptoms are mostly due to ______ of blood. blurry vision and headache, increased risk of ______, flushed face due to congestion (plethora) and itching, especially after ______ (due to histamine release from increased mast cells)
A
primary polycythemia, or polycythemia vera erythropoietin hyperviscosity venous thrombosis bathing
18
Q
- increased red blood cell volume owing to bone marrow hyperplasia caused by erythropoietin (increase)
- usually caused by prolonged ______
- living at high altitudes, anoxia secondary to chronic lung disease, congenital heart disease
A
secondary polycythemia
hypoxia
19
Q
- reduction in white blood cell count to below-normal levels
- ______: decreased number of circulating neutrophils
- bacterial infections and drug toxicity
- ______: deceased number of circulating lymphocytes
- bacterial, viral, fungal, and parasitic infections
- example: SLE, HIV, etc.
A
leukopenia
neutropenia (agranulocytosis)
lymphopenia
20
Q
- increased number of white blood cells in the peripheral blood
- ______: bacterial infection (beginning of the infection)
- ______: allergies and some skin diseases or parasitic infections
- ______: viral infections, chronic infections, some autoimmune disorders
A
leukocytosis
granulocytosis, or neutrophilia
eosinophilic leukocytosis, or eosiniphilia
lymphocytosis
21
Q
malignant diseases involving white blood cell precursors in the bone marrow and peripheral blood (acute and chronic)
- myeloid
- lymphoid
A
malignant diseases of white blood cells
leukemias
22
Q
lymphoid cell malignant diseases predominantly involving the lymph nodes
- non-hodgkin’s lymphoma
- hodgkin’s lymphoma
A
malignant diseases of white blood cells
lymphomas
23
Q
malignant disease of plasma cells
A
malignant disease of white blood cells
multiple myeloma
24
Q
- the causes of most lymphomas and leukemias, like the causes of most other malignant tumors, are unknown
- viruses: HTLV-1, EBV
- endogenous oncogenes
- ______ (Philadelphia chromosome)
A
chronic myelogenous leukemia
25
- bone marrow is infiltrated with malignant cells
- ______ of blasts; defined as the accumulation of > ______ blasts in the bone marrow
- increased blasts "crowd-out" normal hematopoiesis, resulting in an ______ (fatigue), thrombocytopenia (bleeding), or neutropenia (infection).
- blasts usually enter the blood stream, resulting in a high ______ count
```
leukemia
neoplastic proliferation
20%
acute anemia
WBC
```
26
- most common form of leukemia in children
- massive infiltration of the ______ and ______ with immature lymphoid cells (blasts)
- recurrent infections, generalized weakness, and bleeding into the skin and major internal organs
- treatment: excellent prognosis with ______ (requires prophylaxis to scrotum and CSF)
acute lymphoblastic leukemia
bone marrow
peripheral blood
chemotherapy
27
- this is the most common form of acute leukemia in adults (50-60 years)
- there is ______ of myeloblasts in the bone marrow (20% myeloblasts)
- without treatment, most patients die within 6 months after the onset of symptoms
- treatment: ______ (vitamin A derivative) for M3 with t(15:17) chromosome
acute myelogenous leukemia
clonal proliferation
all trans retinoic acid
28
- malignant disease of pluripotent hematopoietic stem cells
- bone marrow and peripheral blood overgrown with ______. associated with Philadelphia chromosome t(9:22)
- treatment: ______ (e.g., imantinib), bone marrow transplant and chemo
chronic myelogenous leukemia
malignant stem cells
tyrosine kinase inhibitors
29
- ______ of mature B cells characterized by hairy cytoplasmic processes. cells are positive for tartrate-resistant acid phosphatase (TRAP)
- clinical features include ______ (due to accumulation of hairy cells in red pulp area)
- excellent response to ______, an adenosine deaminase inhibitor (adenosine accumulates to toxic levels in neoplastic B cells)
hairy cell leukemia
neoplastic proliferation
splenomegaly
2-CDA (chemo)
30
- malignant disease involving lymphoid cells
- involvement of lymph nodes leads to generalized ______ and is called ______
- most patients survive 7 to 9 years from the time of diagnosis
treatment: ______
chronic lymphocytic leukemia
lymphadenopathy
small lymphocytic lymphoma
chemotherapy
31
-it affects any age group
-malignant cells often infiltrate the lymph nodes, spleen, thymus, or bone marrow, but they may also involve any other organ in the body.
extranodal spread of lymphoma
-all age groups are affected (but more common in adults than in children)
lymphoma
32
- this is the most common form of lymphoma in the US (45% of all)
- it is mostly seen in older people
- the tumor is slow growing
- most patients present with long-standing enlargement of the lymph nodes and only mild constitutional symptoms
- most patients survive 7 to 9 years after diagnosis of the disease
NHL: follicular lymphoma
33
-this is the most common aggressive form of NHL
-tissues is infiltrated with______ that have irregular nuclear outlines and prominent nucleoli. clinically aggressive (high-grade)
Treatment: ______
NHL: diffuse large-cell lymphomas
large lymphoid cells
chemotherapy
34
- this is a highly malignant tumor composed of small B cells associated with EBV
- ______ are often more prominent than enlarged lymph nodes
- sub-saharan africa (involves jaw)
- children infected with EBV
- ______: children and young adults most often affected and abdominal mass (e.g., ovarian or intestinal mass). Most children and young adults can be cured
- lab test: characterized by high ______ and ______ appearance on microscopy
```
burkitt's lymphoma t(8:14)
extranodal masses
sporadic variant
mitotic index
starry sky
```
35
- EBV infection that results in a lymphocytic leukocytosis comprised of reactive CD8+ T cells.
- EBV is transmitted by ______ (kissing disease) classically affects teenagers and also EBV infects infants
- clinical symptoms: oropharynx, resulting in ______. Liver, resulting in ______ with hepatomegaly and elevated liver enzymes
- diagnostic test: Monotest: detects ______
```
infectious mononucleosis (IM)
saliva
pharyngitis
hepatitis
IgM
```
36
- age distribution curve is bimodal, with one peak at 25 years and another at 55 years
- there are 4 types of this disease: (1-4)
- ______ cells are present (hallmark pathological symptom)
- bilobed or multilobed nucleus and prominent nucleoli surrounded by a ______
```
hodgkin's lymphoma
nodular sclerosis
lymphocyte-rich
mixed cellularity
lymphocyte-depleted
reed-sternberg
clear halo
```
37
swollen lymph nodes int he neck (right) sometimes indicate the presence of ______
hodgkins disease
38
- lymph nodes are ______ (neck and mediastinum)
- extranodal involvement and leukemic spread are rare
- prognosis of the disease depends primarily on clinical stage
- stage I and II tumors are associated with an excellent prognosis and a high rate of cure (>90%) with ______
- advanced disease has a less favorable prognosis
hodgkin's lymphoma
enlarged
chemotherapy
39
- malignant disease of plasma cells
- most patients older than 45 years of age
- malignant plasma cells typically proliferate in the ______ and destroy the surrounding bone (bone fractures)
- punched-out holes (______) in the skull, ribs and the vertebrae
- hypercalcemia
- renal failure and ______
- infection
- rouleaux formation of RBCs on blood smear: increased serum protein ______ charge between RBCs
- diagnosis is based on the following:
- X-ray studies (______)
- urine contains bence jones protein (______)
- bone marrow biopsy (neoplastic plasma cells in increased numbers): fried egg appearance
- most patients die within 3 to 4 years, primarily of ______
```
multiple myeloma
bone marrow
lytic lesions
proteinuria
decreases
lytic lesions
IgG
kidney failure or infection
```
40
only drug approved to treat multiple myeloma is ______
ninlaro
41
- congenital clotting factor defects: ______
- acquired clotting factor deficiencies
- ->inadequate production of clotting factors
- hemophilia
- sex-linked congenital clotting factor deficiency
- ______: deficiency of factor VIII
- ______: deficiency of factor IX
- uncontrollable ______ following trauma
- subcutaneous ______ (collection of blood in the tissues under skin)
```
clotting factor deficiencies
hemophilia
hemophilia A
hemophilia B
bleeding
hematomas
```
