Lap midicine Flashcards

Question

1- What dose ESR Measure

Answer 1

ESR test measure the rate sediment ▶️ترسب When is in inflation RBCs increase mainly fibrinogen ▶️Rouleaux formation

Answer 2

Take 0.4 mL of sodium 🧂 solution +1.6 mL of blood in EDTA After one hour Men<13 Women<20

Answer 3

High : Arthritis , vasculitis ,appendicitis,Heart valve infection ,SLE ,Rheumatic Arthritis Anemia ,Lymphoma physiology pregnancy 🔽polycythemia Vera

Answer 4

Is quantitative measure the degree of anisocytosis Normal 11.5% 14.5 %

Answer 5

Are newly released RBCs supravital staighn Men (0,5-1,5%) Above Hemolytic Anemia , spherocytosis and G6PD Low iron defiance and Aplastic Anemia Renal failure

Answer 6

Definition: RBC, white blood cell (WBC), and platelet production that occurs outside the confines of the bone marrow Common sites: for EMH are the liver and spleen. Pathogenesis: 1- Intrinsic bone marrow disease (e.g., myelofbrosis) 2- Accelerated erythropoiesis (e.g., severe hemolysis in sickle cell disease) The process expands the bone marrow cavity. Radiograph of the skull shows a “hair-on-end” appearance, due to expansion of the bone marrow within the skull bones. 3- EMH produces hepatosplenomegaly N.B.: In the fetus, hematopoiesis (blood cell formation) begins in the yolk sac and subsequently moves to the liver and finally the bone marrow by the fifth to sixth months of gestation.

Answer 7

Mean Corpuscular Volume (MCV) = Average volume of RBCs = (Normal: 80-100 fl) or cubic micron µm3 MCV = HCT% x 10 / RBC count → Average volume of a single RBC - Used to classify anemia into: - Microcytic (MCV < 80): e.g. - Iron deficiency anemia, - Thalassemia, - Anemia of chronic disease - Macrocytic (MCV > 100): e.g. Folate deficiency or Vit. B12 deficiency - Normocytic (MCV 80 – 100): e.g. - Hemolytic anemias, - Aplatic anemia, - Anemia of chronic disease - Bone marrow metastasis 1 - Chronic renal Measure the average concentration of hemoglobin in packed RBCs - It gives the Ratio of the weight (amount) of hemoglobin to the volume of red blood cells MCHC = Hb (g/dl) x 100 / HCT (%) = g / dl - Normal = 30-35 g/dl - Used to classify anemia into: - Normal MCHC: → Normochromic anemia e.g. ……..…… - Decreased MCHC: → Hypochromic anemia e.g. ……..…… - Increased MCHC: → e.g. Hereditary spherocytosis Lab Med: RBCs Disorders: Lab Med: RBCs Disorders: 1 1 Prof. Magdy ElShamy Prof. Magdy ElShamy 27 27 Mean Corpuscular Hemoglobin (MCH) MCH Is a measure of the average weight (amount) of hemoglobin per a single red blood cell. = Hb (g/dl) x 10 / RBC count = picogram (pg) / cell Normal value : 27 - 32 pg / cell picogram (pg) / cell - Used to classify anemia into: - Decreased MCH: → associated with microcytic anemia - Increased MCH: → associated with macrocytic anemia N.B.: MCHC is more commonly used than MCH to classify anemia

Answer 8

Defenation: Acute leukemias are characterized by clonal proliferation of myeloid or lymphoid precursors (Blast cells) with reduced capacity to differentiate into more mature cellular elements. Pathogenesis: Block in stem cell di ﬀerentiation at an early stage leading to a monoclonal proliferation of neoplastic leukocytes behind the block (blasts) 2- Blasts accumulating in the B. marrow → suppress the growth of normal hematopoietic cells → eventually this suppression produces bone marrow failure → which accounts for the major clinical manifestations. 3- Leukemic Blast cells ➡️entire peripheral blood 🩸

Answer 9

Bone Marrow: - has increased immature leukemic cells (Blasts); - the diagnostic criteria is > 20% blasts in the bone marrow - Peripheral Blood: - has decreased mature forms and - increased immature forms called Blasts - Infiltration of various organs: is a common feature

Answer 10

Symptoms & signs at presentation are either due to depression of depression of normal normal bone marrow function or organ infiltration These include: Abrupt onset of - Anemia → pallor, dyspnea, fatigue - Neutropenia → fever, recurrent infections e.g. sore throat, pneumonia - Thrombocytopenia → bleeding as (petechiae, ecchymoses, epistaxis, gum bleeding) - Generalized Lymphadenopathy, splenomegaly & hepatomegaly (due to dissemination of the leukemic cells). are more marked in ALL than in AML - Tissue infiltrations e.g. testis & meninges: more in ALL, (→ headache, vomiting) skin, gum and bone: more in AML (Bone pain & tenderness due to marrow expansion & infiltration)

Answer 11

Anemia  Anemia (…….….) (…….….), , Fever Fever (………….), (………….), bleeding bleeding (…….…….), (…….…….),   Generalized Generalized Lymphadenopathy Lymphadenopathy. . Moderate Moderate Hepatosplenomegaly Hepatosplenomegaly  Tissue infiltration e.g. testicular, meningeal (→ headache, vomiting) (→ headache, vomiting)   Bone pain and tenderness: Bone pain and tenderness: due to bone marrow expansion by the leukemic cells due to bone marrow expansion by the leukemic cells

Answer 12

Anemia (…….….), Fever (………….), bleeding (…….…….),  Moderate Hepatosplenomegaly. No significant lymphadenopathy Tissue infiltration e.g. skin, gums, bone (bone pain & tenderness)

Answer 13

Peripheral blood: CBC: 1- Anemia: : is almost always present, usually Normochromic Normocytic 2- Thrombocytopenia: Platelet count → is usually below 100,000 /μL 3- Total leucocytic count: usually raised, but ranges from less than 10,000 cells/µL up to 100,000 cells/µL or more 4- Blood film: (differential count): usually show - characteristic leukemic blast cells (Lymphoblasts, OR myeloblasts) - Neutropenia is also a common finding in the peripheral blood N.B: The peripheral blood sometimes: TLC is normal or ↓ & contains No blasts (aleukemic leukemia); in such cases the diagnosis can be established only by bone marrow examination II- Bone marrow aspirate: (Diagnostic) usually shows - increased cellularity with Lab Med: WBCs Disorders: Lab Med: WBCs Disorders: - high percentage of abnormal lymphoid or myeloid blast cells (>20%)

Answer 14

Definition: - CML is a clonal myeloproliferative disorder where Neutrophils (mature) and their precursors (immature myeloid cells) increase in the peripheral blood & the bone marrow. Pathogenesis: - Translocation between chromosome 9 and chromosome 22 results in an abnormal chromosome 22 which is called Philadelphia chromosome (Ph) Leading to malignant proliferation of hematopoietic stem cells. - In more than 95% of patients, the leukemic cells are Philadelphia positive (Ph +ve) = t(9;22) BCR-ABL fusion gene is the most sensitive and specifc test for chronic myelogenous leukemia

Answer 15

Clinical Features: - Age: mostly Adults between 25 - 45 yrs, = Middle age, sometimes older Can occur in childhood and adolescence. - Onset is usually gradual, may be discovered accidentally during routine laboratory investigation. - C/P: Easy fatigability, weakness (signs & symptoms of anemia), Low grade fever, and weight loss - Marked splenomegaly (in ↑ 90% of cases), - Lymph node and liver are moderately enlarged due to infiltration by leukemic cells.

Answer 16

Peripheral blood: (CBC): 1- Anemia, usually Normocytic Normochromic 2- Total leukocyte count is elevated, often ↑ 100,000 cells/μL. -The cells are mainly neutrophils, bands, metamyelocytes & myelocytes Myeloblasts are less than 5% - Increased Basophils (common) and may be increase eosinophils, 3- Platelet count: usually Increased (Thrombocytosis) II- Bone marrow aspirate: - The bone marrow is markedly hypercellular due to hyperplasia of granulocytic (mainly) & megakaryocytic precursors. III- Neutrophil Alkaline Phosphatase (NAP) score: The NAP score is markedly low or zero in CML Neutrophils Normal Neutrophils contain this enzyme in their granules. IV- Cytogenetic Analysis: Ph chromosome is present in peripheral blood & bone marrow cells

Answer 17

course of CML is of slow progression - After a variable period The main cause of death in CML is transformation into acute leukemia (Acute Blast Transformation or Blast Crisis) marked by: 1- increasing number of blast cells in the peripheral blood (> 10%) and bone marrow (> 20%) 2- Increasing anemia, splenomegaly, thrombocytopenia Course of CML: CML may be Biphasic or Triphasic: - CML chronic phase (< 5% blasts) → Accelerated Phase (blasts 5% - <20% in PB or BM) → Acute Blast Transformation (blasts ≥ 20%) - CML chronic phase (< 5% blasts) → Acute Blast Transformation (blasts ≥ 20% In PB or BM)

Answer 18

CLL is a clonal lymphoproliferative disease characterized by uncontrolled proliferation and accumulation of Mature looking lymphocytes in the blood, bone marrow, lymph nodes and spleen - Most CLL (95%) are due to B lymphocyte clonal proliferation

Answer 19

Usually old age (over 50 y), with slow onset (over years) - Early, often Asymptomatic & discovered accidentally (How?? (Persistent Absolute Lymphocytosis) - With BM infiltration → Easy fatigability, weakness (signs & symptoms of anemia), weight loss, -First, Generalized lymph node enlargement (Lymphadenopathy), a common clinical sign, and later Spleen, & liver enlargement - May be bleeding tendency (due to thrombocytopenia) - Recurrent bacterial & viral infections (due to hypo gammaglobulinemia)

Answer 20

Immunophenotyping: - Lymphocytes are monoclonal (derived from one clone of cells). - They are B cells in most cases with co-expression of CD 19 and CD 5. IV- Serum immunoglobulins are decreased (Hypogammaglobulinemia) Computed Tomography (CT) Scan: - For cervical, chest, and pelvi-abdominal regions - To evaluate the extent of lymph node enlargement and presence of splenomegaly Peripheral blood: (CBC) 1- Hb may be Normal. Anemia (Normocytic Normochromic) may occur 2- Total leukocytic count: is increased with Persistent Absolute Lymphocytosis 3- Blood film shows small mature-appearing lymphocytes + characteristic smudge cells (due to cell rupture) 4- Thrombocytopenia occurs in advanced cases (due to BM infiltration) N.B.: - In some cases there is production of autoantibodies leading to autoimmune hemolytic anemia and/or autoimmune thrombocytopenia II- Bone marrow aspirate: - Bone marrow is heavily infiltrated with normal-appearing neoplastic lymphocytes (>30%)

Answer 21

The course and prognosis: are extremely variable - Many patients live up to10 years after diagnosis and die of unrelated causes; - The median survival is 4 to 6 years. Treatment :is indicated in advanced and/or symptomatic disease: e.g. - Doubling of lymphocyte count in 6 months - B.M. failure = ……………, ……………, ………………….. - Autoimmune hemolytic anemia - Systemic manifestations: fever, night sweats, weight loss - Massive lymphadenopathy or splenomegaly

Lap midicine Flashcards

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