- infection, bleeding, fever/chills, tachycardia/pnea, lethargy, weight loss, splenomegaly - high WBC count - cytoplasm containing Auer rods

Unit 2 - Hematology Part 2 Flashcards by Maddie White

neutrophilia

“shift to the left” - increase in PMN’s
acute inflammation
occurs during periods of stress, violent exercise, infection

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neutropenia

“shift to the right”

chemotherapy

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monocytosis

chronic inflammation

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eosinophilia

allergy

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basophilia

myeloproliferative disorders

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lymphocytosis

infectious mono, hepatitis, mumps, lymphomas, malignancies

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leukocytopenia and agranulocytopneia

occurs in certain viral infections and in bone marrow depression

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leukemia

malignancy of red bone marrow and immature/ineffective WBC’s are produced

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acute leukemia

Large numbers of immature wbc’s
Platelets and rbc’s are deceased
Major causes of mortality are infection and bleeding
Rapidly fatal without treatment

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2 types of acute leukemia

Acute Myeloblastic Leukemia (AML)

Acute Lymphoblastic Leukemia (ALL)

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Acute Myeloblastic Leukemia (AML)

Mostly adults-most common Leukemia

Anemia, Thrombocytopenia, Immature Granulocytosis

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s/s of AML

infection, bleeding, fever/chills, tachycardia/pnea, lethargy, weight loss, splenomegaly
high WBC count
cytoplasm containing Auer rods

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Auer rods

rod shaped bodies in cytoplasm of immature granulocytes

clumped lysosomes

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acute leukemia and gout

gout caused by elevated levels of uric acid
1st metatarsal joint most common
forms topsoil (crystallized uric acid deposits) - and kidney stones

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Acute Lymphoblastic Leukemia (ALL)

Acute hemorrhage
Fulminating infection
Common Lymphoid Progenitor cell origin
Form Lymphocytes (T cells and B cells)
- Mutation in the Common Lymphoid Progenitor
Undifferentiated, immature circulating
lymphocytes (“lymphoblasts”)
Disease progresses rapidly-esp. in adults
Can be fatal in weeks

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risk factors ALL

Exposure to radiation
Exposure to certain chemicals
Smoking
Other blood disorders: myelodysplasia, polycythemia vera
Genetic disorders-Down Syndrome
white males

Most common childhood cancer (cure rate 85-90%)
Peak incidence at 4-5 years of age

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s/s ALL

enlarged, painful lymph nodes
enlarged liver and spleen
Unexplained bleeding (nosebleeds, bruising.)
Anemia, Thrombocytopenia, Infection Prone
Weight loss and malaise
Fever and night sweats
Lethargy
Bone and joint pain
CNS and other organ involvement-aggressive invading lymphoblasts

Chronic Leukemia and 2types

moderate increase in WBC ‘s

Chronic Myelogenous (Myelocytic) Leukemia (CML)
Chronic Lymphogenous (Lymphocytic) Leukemia (CLL)

Chronic Myelogenous (Myelocytic) Leukemia (CML)

Middle aged adults-slow (indolent) onset
May be asymptomatic
Mild/Moderate Granulocytosis
Mixture of Mature/Immature Granulocytes
Mild anemia and thrombocytopenia

Most patients (95%)with CML have the Philadelphia chromosome

Philadelphia chromosome-#22

A reciprocal translocation, an exchange of genetic material, between chromosomes 9 and 22.

band cells and segmented cells in CML

Band cells-immature neutrophils (c-shaped nucleus)

Segmented cells-mature neutrophils

s/s CML

May be asymptomatic
Fatigue
Weight loss
Enlarged spleen
Easily bruised
Night sweats-Nocturnal diaphoresis

risk factors and survival CML

Risk factors: Being male and aging

Survival after 8 years-95.2% (2011)
Bone Marrow conversion-Progresses to acute myeloblastic stage (“blast” crisis)

Chronic Lymphocytic Leukemia (CLL)

Older adults >50 years of age (70’s and up)
Median survival: 8-10 years (2014)

Proliferation of B lymphocytes
Mild/Moderate anemia and thrombocytopenia
Signs/symptoms similar to CML including splenomegaly

Progressive Disease
Tendency for Bleeding and Infection increase

bone marrow conversion of CLL

Autoimmune Hemolytic Anemia Severe Thrombocytopenia Aplastic Anemia Diffuse large B-cell lymphoma (Richter's syndrome)

subtype of CLL - hairy cell leukemia

Indolent B cell lymphocytic leukemia 5:1 Male: Female >50 years of age Splenomegaly, Fatigue Lowered RBC’s and Platelets (Easy to bruise; easy to bleed)

disorders of hemostasis - coagulation

series of steps that form a platelet and fibrin clot for the purpose of limiting hemorrhage

3 major steps in coagulation

1. transient vasoconstriction 2. platelet aggression 3. stepwise activation of clotting factors

Activation of the clotting cascade - 3 pathways

``` Extrinsic Pathway (Tissue Damaage Pathway) Intrinsic Pathway (Surface Contact Pathway) Common Pathway ```

lab tests for hemostasis disorders

Extrinsic Pathway-Prothrombin Time (ProTime): 12-15 seconds Intrinsic Pathway-Activated Partial Thromboplastin Time (aPTT): 25-30 seconds Prothrombin time-reported as International Normalized Ratio (INR): 0.8-1.2

disorders of hemostasis - Purpura

bruising induced by vasculitis Small vessel inflammation Bleeding beneath the skin May be autoimmune, age related, or idiopathic

Schamberg’s Disease

Disease-leaking blood vessels - Mostly in males - Usually occurs on the legs - Cause unknown - Pruitus common

Hereditary Vasculitis

Hemorrhagic Purpura (Osler-Weber-Rendu syndrome) ``` Henoch Schonlein (SHURN-line) Purpura Etiology: Immune complexes-reason is unknown Young males often affected Clinical Manifestations Purpura & Petechiae Arthritis-pain & swelling Nephropathy Gastrointestinal symptoms ```

senile purpura

aging induced purpora

hemophilia

bleeding disorder usually occurs in males (sex linked recessive)

types of hemophilia

Hemophilia A-Classic Hemophilia (most common) Clotting Factor VIII (antihemophilic factor-AHF) Hemophilia B-Clotting Factor IX (Christmas Factor) Christmas Disease

von Willebrand’s Disease

``` platelet deficiency von Willebrand’s factor (vWF) missing vWF synthesized by Megakaryocytes Most common inherited clotting disorder Lack of platelet adherence to collagen in the vessel wall & to each other Outcome-excessive bleeding ```

Thrombocytopenia

- platelet deficiency, often a side effect of cancer that has metastasized to bone marrow

Idiopathic Thrombocytopenia (ITP)

- autoimmune disorder Acute (< 6 months)-Children and Teens Chronic (> 6 months)- Adults Females: Males 3:1

types of thrombosis

primary: myeloproliferative disorder resulting in over production of platelets secondary

Disseminated Intravascular Coagulation (DIC)

- hyper coagulation disorder, clotting mechanism is stimulated by release of cytokines and widespread clotting occurs Maternal Premature Birth, Pre-eclampsia - Cancer - Trauma - Sepsis - Burns - Snake bites (poisonous)