Flashcards in Hematology D/O's Deck (53):
Blood is a specialized connective tissue of ___________ origin
The process of blood formation is addressed as ____________
________ bones of axial skeleton along with vertebrae (T10-L4) & the skull are the major bones containing _______ _______, generating blood cells
Flat bones (sternum, ribs, pelvic bones); bone marrow
_______ is ph balance for blood.
7.34-7.45 is ph balance for blood. Lung & Kidney manage acid/base balance for blood
What are some major Fx. of blood? Erythrocytes? Leukocytes? Platelets?
carrying oxygen & CO2; maintaining acid/base balance in body; elimination of waste; delivery of nutrients; distribution of hormones & other chemical messengers; clotting & prevention of excessive bleeding; immune defense
*Erythrocytes = O2 & CO2 transport
*Leukocytes = Defense & Immunity
*Platelets = Blood clotting
Blood is made up of ________; ________ & _______
Erythrocytes (RBC's); Leukocytes (WBC's) & platelets (blood clotting factors)
What is the difference between red bone marrow & yellow bone marrow?
(Myeloid) - Red marrow is made up of immature blood cells and can be found in flat bones of the body; yellow marrow is made up of fat cells & supports/nourishes adipose connective tissue for myeloid.
What is myelophthysis?
myelophthysis is the degeneration of active bone marrow (myeloid) & substitution of yellow marrow (fat)
__________ from the kidneys – increases the # of RBC precursors.
________ from the liver – stimulates the formation of platelets. TPO mRNA is expressed mainly in the liver, & to a lesser extent in kidney, spleen, lung, bone marrow, and brain, (smooth muscle).
_________ (DHT or active form of testosterone) stimulate
production of erythrocytes (RBCs). It explains higher Hematocrit in males versus in females.
Androgens - Normal Hct values are approximately 37-46% in females, & slightly more as 41-53% in males (due to active testosterone influence).
____-____ _____ or interleukins stimulate WBC formation.
Colony-stimulating factors (CSFs)
___________ is an excessive amount of cellular blood cells
* can be relative - bc of loss of fluid, ex. vomiting, diarrhea, heat, not enough drinking of water, severe burns
* or absolute - when bone marrow generates more than necc. RBC's - caused by bone marrow cancer -** primary absolute polycythemia - polycythemia rubra vera
** or secondary absolute polycythemia - can be KD cancer bc of erythropoeitin --- or bc of oxygen deprivation aka hypoxia
_______ ________ Disease is the most common genetic bleeding disorder
Von Willibrand Disease (clotting factor VIII) - a glycoprotein, manufactured by the endothelium of the blood vessels as
well as by the liver...indistinguishable from Hemophilia clinical presentations
1. Initial brief vasospasm, 2. Temp. platelet plug formation, 3. coagulation cascade, 4. clot retraction & 5. clot dissolution are the steps for a ________ ______
coagulation cascade (goal is to create fibrin)
*Intrinsic - inside of blood vessel injury
*Extrinsic - crashed tissues
_________ (increased WBC count): unless stated otherwise, should be understood as neutrophil count increase (neutrophilia): suspect acute bacterial infection 1st, followed by acute inflammation, necrosis, pregnancy, stress.
__________ (decreased WBC count): immunodeficiency, predisposing to overwhelming bacterial (pyogenic) infections
_________ (increased eosinophil count): parasitic infections, allergies
__________: transient (episodic) will most commonly signify viral infection, persistent should be evaluated for auto-immune pathologies, or, if the cells are immature, for white blood cell malignancies.
________: usually associated with immunodeficiency
________ (an increase in reticulocyte count): an indication of anemia or hypoxia (an organism needs more oxygen): suspect chronic bleeding; respiratory pathology; smoking, change of altitude; convalescence stage (recovery). Blood is not stewy yet like in Polycythemia.
Reticulocytosis - precursor for Erythrocyte
________ (increase in immediate precursor cells for neutrophils): suggests initial stage of an acute bacterial infection.
_______ - determines volume or size of RBC's in CBC
MCV - Mean Corpuscular Volume - 80-95 is normal
_____ - determines color & depends on hemoglobin concentration in cell
MCH (27-31 pg) or MCHC (32-36 gm) - Mean Corpuscular Hemoglobin Concentration -
_________ width is cell congruent or polymorphic - like in sickle cell
RCD - Random Cell Distribution width
What does it signify when a patient has neutrophilia?
Acute bacterial infection 1st; followed by acute inflammation; necrosis; pregnancy; or stress
What is the most common cause of transient lymphocytosis?
viral infection, persistent can be auto-immune pathology and if immature cells then check for WBC malignancies
______________: characterized by smaller cell size (diminished MCV) & poor Hb content (pale cells): it is usually due to deficient Hemoglobin production. The major & most common microcytic anemia is due to Iron deficiency!!! The major etiology of Iron deficiency anemia is chronic (insidious) blood loss!!!
Microcytic and hypochromic; heavy menses is main culprit for women and GI tract bleeding is main culprit for men.
____________: it is usually due to deficient DNA production, which contributes to inability of RBCs to mature, so they are arrested in a larger size with increased MCV. The most common etiology is due to deficient B12 or Folate content
Macrocytic (megaloblastic) - some jaundice/icteris might be present
_____ ___ ___ (the most common type of anemia, which is most commonly originated from an insidious blood loss): characterized (among other general anemia features, displayed above) by pica, pagophagia, koilonychia, & glossy tongue. The RBCs appear pale and small (microcytic and hypochromic).
Iron Xu Anemia
_______ anemia of any origin: prominent jaundice!!!
______ of ___ ____: normal RBCs but diminished count/ Hematocrit.
Anemia of chronic disease
_____ or _____ Deficiency: large red blood cells due to deficient cellular DNA; slight jaundice
B12( Homocystein found in blood/prone to ischemic Heart disease) or Folate (methonine/methyl-malonic acid found in blood)
*in these cases a gastroenterologist needs to be involved
________ test is most frequently used along with serum Iron test to evaluate either Iron deficiency or Iron overload conditions. ______ is used to calculate the transferrin saturation by Iron. In healthy individuals, about 20-40% of available transferrin sites are saturated by iron.
Total Iron-binding Capacity (TIBC)
Patients, who suffer with chronic auto-immune atrophic
gastritis (the etiology remains obscure & usually noted as familial disease), are unable to produce Intrinsic Factor complex as carrier molecules for cyanocobalamin
(Vit. B12) absorption through the mucosal barrier of jejuno-ileum. This complex is produced by parietal cells of the stomach, which are atrophied in this condition. This PARTICULAR MALABSORPTION B12 Deficiency Anemia is addressed as _______ ______. It is considered as a
very strong prerequisite to gastric cancer.
____ ____ _____ is a hereditary hemolytic anemia, which is caused by a point mutation on the gene, coding for beta-chain of adult Hemoglobin A. It is of an autosomal-recessive inheritance mode.
Sickle Cell Anemia - glutamic acid is substituted by valine at position 6 of a betachain in Hemoglobin molecules, leading to production of Hemoglobin S instead of Hemoglobin A which leads to sickling (ice picks). ---major pathogenesis of SC anemia is generalized hemolysis with thrombosis & ischemia
How is Iron Deficiency diagnosed?
Major storage source of iron, FERRITIN is measured; binding of iron to TRANSFERIN is measured as TIBC. In iron deficiency the storage of iron aka Ferritin is depleted while TIBC is increased.
Deficiency of ______ leads to accumulation of pro-inflammatory substance amino-acid homocysteine. This substance contributes to vascular injury and eventually to chronic ischemic heart disease & other chronic vascular pathological events.
Vitamin B12 - known to result as well in significant neurological deficit which can be irreversible: peripheral neuropathies, dementia, & loss of coordination
_______ and normochromic: suspect anemia of chronic disease like congestive heart failure or acute blood loss
_____ _______ disease: caused by genetic defect of different inheritance mode (mostly AUTOSOMAL) of a gene, coding for Von Willebrand factor production. May present as qualitative or quantitative deficiency of vWF molecules. This is the most common genetic bleeding disorder.
Von Willebrand - very similar to hemophilia in its clinical presentations. However, it has more relevance to heavy menstrual bleedings along with spontaneous bleeding &
thrombosis. It should be differentiated with other bleeding D/O's by essaying certain clotting factors & investigating bleeding times.
(Differential Diagnosis for Menorrhagia)
Hemophilia_____ & ____ are both hereditary X-linked recessive disorders of predominantly males. They are caused by mutations of the genes, which code for clotting factors VIII and IX respectively.
Hemophilia A and B
* Hemophilia A (xu of clotting factor VIII) - most common.
* Hemophilia B (xu of clotting factor IX) is otherwise known as Christmas disease by the name of the first patient described.
* Both are clinically indistinguishable & characterized by spontaneous or post-traumatic excessive bleeding, muscle hematoma formation, bleeding in multiple joints (hemarthrosis).
The most common Leukemia of childhood is ___ ____ ____
Acute Lymphocytic Leukemia (ALL)
___________ absolute Polycythemia aka Polycythemia rubra vera is myelo-proliferative D/O of the bone marrow itself - sort of red blood cell cancer.
___________ absolute Polycythemia could be due to KD cancer, producing an excessive amount of erythropoieitin or any circumstances when body is starving for oxygen
Philadelphia chromosome has to do with a mutual translocation of chromosomes _____ & ____. It is the most prevalent in Chronic Myelogenous or myeloid leukemia (CML) and is found in 95% of cases of & 5% of cases of ALL
9 & 22
Hodgkin’s lymphoma is characterized by relatively specific finding of so called ____-_____ bi-nucleated cells, found w/in the parenchyma of lymph nodes, spleen & liver.
Reed-Sternberg cells --- Hodgkins (SOLID) & Non-Hodgkins (SOLID & LIQUID) lymphoma are both malignant but NON-HODGKINS lymphoma might have leukemia component as well
T/F Platelets have a nucleus.
False, platelets have a cell membrane but NO nucleus & can't reproduce
T/F Serum does not contain fibrinogen.
True, serum is plasma w/o fibrinogen. Fibrin strands of clots squeeze serum (plasma without fibrinogen) from the clot & cause it to shrink at the end of a hemostasis process.
Of the coagulation factors synthesized in the liver, factors
II, VII, IX, and X & prothrombin require the presence of vitamin ____ for normal activity. In vitamin ___ deficiency, the liver produces the clotting factor, but in an inactive form. Vitamin ____ is a fat-soluble vitamin that is continuously being synthesized by intestinal bacteria.
The _____ falls in microcytic (small cell) anemia and rises in macrocytic (large cell) anemia. Some anemias are normocytic (i.e., cells are of normal size or MCV).
MCV - Mean Corpuscular Volume
The ______ is the concentration of hemoglobin
in each cell. Hemoglobin accounts for the color of red blood cells. Anemias are described as normochromic (normal color or _____) or hypochromic (decreased color or ______).
MCHC - Mean Corpuscular Hemoglobin