Hematology Exam (Patho 2)

What could lead to a decrease in Prothrombin time

-Malignancy -Thrombophlebitis

What could lead to increase in Prothrombin time

-Warfarin use -liver disease -vitamin K deficiency

Which condition is a known cause of eosinophilia? (select all that apply)

1. Asthma 2. Eczema 3. Atopic dermatitis Asthma, eczema, and atopic dermatitis may all increase eosinophil production resulting in eosinophilia. Prolonged infection may actually cause leukopenia, while poor protein intake has no known relationship to eosinophilia.

Changes in PTT: Increased with-

1. Hemophilia 2. von Willebrand disease 3. Lupus anticoagulant 4. Heparin use

Which function is recognized as the purpose of the continuous circulation of blood? (select all that apply)

1. Maintaining acid-base balance 2. Defending against invading infections 3. Removal of cellular waste products 4. Supporting cellular metabolism The continuous movement of blood guarantees that critical components are available to all parts of the body to carry out their chief functions: (1) delivery of substances needed for cellular metabolism in the tissues, (2) removal of the wastes of cellular metabolism, (3) defense against invading microorganisms and injury, and (4) maintenance of acid-base balance. Circulating blood does not function to prevent cell breakdown.

Changes in PTT: Decreased with-

1. May be clue for hypercoagulability states

Compare and contrast a thrombus with an embolus.

A thrombus is a blood clot that develops in a blood vessel and may cause it to become obstructed. An embolus is a mass composed of a detached thrombus or other matter that occludes a vessel. Unlike a thrombus, an embolus travels through the circulation until it lodges in a vessel. It can be composed of substances other than a blood clot, such as fatty globules, vegetations, amniotic fluid, or air.

Which form of leukemia is the most common in children?

Acute lymphoblastic leukemia (ALL) The most common leukemia in children is ALL and represents 80% of the leukemia in children. All other forms are much more commonly diagnosed in adults.

What is Disseminated Intravascular Coagulation DIC?

An acquired coagulation disorder in which both clotting and hemorrhage occur simultaneously Think "Death Is Coming"

How is anemia diagnosed?

Anemia can be diagnosed by a variety of tests to measure hemoglobin, hematocrit, reticulocyte count, mean corpuscular volume, iron, B12, folate, bilirubin, free erythrocyte protoporphyrin, and transferrin. The results of these tests can determine whether anemia is present and, if it is present, what type of anemia it is. Examining all of these factors and patient history is important in identifying the anemia type.

What are Fibrinogen and prothrombin essential for?

Blood clotting.

Platelets are essential in what physiological process?

Blood coagulation Platelets (thrombocytes) are essential for blood coagulation and control of bleeding.

A mnemonic sometimes used to remember the common tetrad of multiple myeloma is CRAB:

C = Calcium (elevated from bone loss), R = Renal failure, A = Anemia, B = Bone lesions.

When activated the platelets _____________. Degranulation makes platelets ___________ and bind together to form a platelet plug.

Degranulate, Aggregate

3 clotting factors are not made in the liver; these include:

Factor III - released from platelets (intrinsic pathway) and damaged endothelium (cells) lining the blood vessels (extrinsic pathway). Factor IV - from bone and absorption from food in gastrointestinal tract. Factor VIII - found in the endothelium lining blood vessel and platelets.

The intrinsic coagulation pathway begins:

In the blood vessels

Platelets are disc shaped when:

Inactive

What leads to a vessel spasm?

Injury

Plasma proteins are manufactured in the:

Liver

Which term refers to an abnormally high production of red blood cells?

Polycythemia Polycythemia is the medical term for abnormally high production of red blood cells.

What might Premature Destruction be caused by?

RBC membrane abnormalities, Hgb abnormalities, extrinsic physical factors. Normal age RBCs may be destroyed by gross damage as in trauma or extravascular hemolysis (in spleen, liver, bone marrow).

All blood cells start as:

Stem cells

What are the main pathologic features of multiple myeloma (MM)?

The common presentation of MM is characterized by elevated levels of calcium in the blood, renal failure, anemia, and bone (lytic) lesions.

Compare and contrast thrombocytopenia with thrombocytosis

Thrombocytopenia, a decreased number of circulating platelets, results in a decreased ability of the blood to clot. Causes can be either acquired or congenital. Thrombocytosis, an increased number of circulating platelets, results in increased intravascular clot formation, hemorrhage, or other clotting abnormalities. Common causes of thrombocytosis are responses to stress and malignancy of the bone marrow, which affects platelet development.

WBC Terms: Too Few & too many

Too Few: Leukopenia Too many: Leukemia

What are the three general functions of the hematologic system?

Transportation, regulation, and protection.

extrinsic coagulation pathway begins with:

Trauma to tissues

What are Globulins?

Two pairs of polypeptide chains

Why does vitamin K deficiency predispose an individual to a coagulation disorder?

Vitamin K is essential for the synthesis of normal prothrombin; clotting factors II, VII, IX, and X; and anticoagulant factors. Vitamin K deficiency results in prolonged bleeding time and may lead to hemorrhage.

Platelet adhesion formation is initiated by the:

Von Willebrand factor

____________ (coumarin) is another anticoagulant drug that acts to prevent clot formation. It alters vitamin K thus reducing the synthesis of the vitamin K coagulation Factors in the liver.

Warfarin

Prothrombin time is specific for measuring effects of:

Warfarin (Coumadin)

Which statement regarding lymphoma is true? Lymphomas are:

identified by palpable, tender lymph nodes. Lymphomas are initially identified by the presence of tender, lymph nodes that are enlarged enough to be palpated. They are the sixth most common cause of cancer death and are the result of injury to the DNA of the lymphoid tissue. Malignancy within the lymphatic tissue in the bone marrow is termed lymphocytic leukemia.

Pluripotent stem cells are:

immature and undifferentiated cells that are capable of maturing into any one of several types of blood cells: RBCs, WBCs, or platelets, depending on the body's needs.

What are band cells?

immature neutrophils

Which statement regarding endemic Burkitt lymphoma is true? It is:

observed as a tumor of the jaw. This is a type of non-Hodgkin lymphoma and is the most common type in the United States. It is diagnosed most often in children or young adults. It involves primarily the jaw. It is associated with Epstein-Barr virus, not the HIV virus.

What is hematopoiesis?

production of blood cells

What is Erythropoiesis?

red blood cell formation

To analyze Platelet disorders measure:

1. Platelet count 2. Bleeding time

Platelet's Role:

1. Vasospasm 2. Plug 3. Active clotting factors 4. Initiate repair

What are the 5 stages of Hemostasis?

1. Vessel spasm 2. Formation of platelet plug 3. Clot formation 4. Clot retraction 5. Clot dissolution

What dissolves clots?

Plasmin

How are leukemias classified?

The classification of leukemias is based on (1) the predominant cell involved, either myeloid or lymphoid, and (2) the point at which cellular maturation is arrested, which differentiates the two major forms: acute or chronic. Thus there are four types of leukemias: acute lymphocytic or myelogenous and chronic lymphocytic or myelogenous. Further classification of acute leukemia is based on structure, number of cells, genetics, identification of surface markers, and histochemical staining that provides significant therapeutic prognostic information.

What is Bilirubin?

breakdown product of hemoglobin -byproduct of Hgb released when RBCs destroyed, excreted in bile

The primary function of erythrocyte is to:

carry oxygen attached to its hemoglobin. Erythrocytes (red blood cells) are the most abundant cells of the blood, occupying approximately 48% of the blood volume in men and about 42% in women. Erythrocytes are primarily responsible for tissue oxygenation.

Hemoglobin's primary function is to:

carry oxygen from the lungs to the tissues. Hemoglobin (Hb), the oxygen-carrying protein of the erythrocyte, takes up oxygen in the lungs and exchanges it for carbon dioxide in the tissues.

Which statement regarding infectious mononucleosis (IM) is true? It is:

commonly caused by Epstein-Barr virus (EBV). Infectious mononucleosis is typically caused by the herpes virus and EBV, which accounts for approximately 85% of IM cases. It usually affects young adults between 15 and 35 years of age. There is characteristically an increase in lymphocytes. The poxvirus has no known connection to IM.

Loss of albumin can result in dramatic:

fluid shifts, edema, hypotension, and even death.

Which statements regarding folate are TRUE? (select all that are true)

1. Decreased folate absorption may lead to pernicious anemia. 2. Pregnant women require more folate. 3. Folate is stored in the liver. 4. Folate is necessary for DNA synthesis. Folate is necessary for DNA and RNA synthesis. Folate absorption occurs principally in the upper small intestine and is stored in the liver. Folate supplements are prescribed for pregnant women because pregnancy increases the demand for folate. Decreased B12 absorption may lead to pernicious anemia.

Neutropenia, a condition involving the blood's neutrophil count, is believed to be caused by its: (select all that apply)

1. Decreased production 2. Increased turnover 3. abnormal distribution 4. reaction to an overwhelming infection. The causes of neutropenia, in addition to an overwhelming infection, include decreased production, increased turnover, and abnormal distribution. Decreased vitamin intake can cause decreased production due to the lack of appropriate building blocks.

Which situation is a characteristic of the triad of Virchow? (select all that apply)

1. Injury to endothelium 2. Abnormalities of blood flow 3. Hypercoagulability of the blood The triad of Virchow includes the factors that predispose to thrombus formation and include injury to the endothelium, abnormalities of blood flow, and hypercoagulability of the blood. The condition is not affected by either a decrease in clotting factor or poor vitamin A absorption.

Microcytic-hypochromic anemia is known to be a result of disorders involving: (select all that apply)

1. Iron metabolism 2. porphyrin synthesis. 3. globin synthesis. 4. Heme production Research supports that microcytic-hypochromic anemia is a result of disorders involving iron metabolism, porphyrin synthesis, heme production, and globin synthesis. The inability to absorb vitamin B12 results in pernicious anemia, which is a microcytic-normochromic anemia.

What statement concerning leukocytes (white blood cells) is TRUE? (select all that apply)

1. Leukocytes are involved in the removal of debris, including dead or injured cells. 2. Leukocytes are located in both tissue and circulating blood. 3. Leukocytes may be either a granulocyte or an agranulocyte. Leukocytes (white blood cells) defend the body against organisms that cause infection and also remove debris, including dead or injured host cells of all kinds. The leukocytes act primarily in the tissues but are transported in the circulation. The average adult has approximately 5000-10,000 leukocytes/mm3 of blood. Leukocytes are classified according to structure as either granulocytes or agranulocytes. The neutrophil (polymorphonuclear neutrophil [PMN]) is the most numerous and best understood of the granulocytes.

When considering both acquired and familiar forms, which statement regarding acquired thrombotic thrombocytopenic purpura (TTP) is true? It is: (select all that apply)

1. More common in females 2. caused by platelet aggregates. 3. occurring more frequently. The condition is a result of platelet clumping seen most commonly in adult females. While reported cases of acquired TTP are increasing, the cause is yet to be identified. It is rarely observed in infants and is certainly life threatening if not treated effectively and promptly.

The known causes of lymphadenopathy include: (select all that apply)

1. Neoplastic disease 2. Inflammatory condition 3. lipid storage disease. 4. immunologic disorders. Lymphadenopathy may be caused by neoplastic disease, immunologic or inflammatory conditions, endocrine disorders, and lipid storage disease. Currently there is no research to support a connection between cardiac disease and lymphadenopathy.

Which statement correctly describes hematopoiesis? (select all that apply)

1. The human body's need for 100 billion new blood cells per day is supplied. 2. Mitotic division of undifferentiated cells into blood cells occurs. 3. Production is increased when the body experiences a chronic infection. The typical human requires about 100 billion new blood cells per day. Blood cell production, termed hematopoiesis, is constantly ongoing, occurring in the liver and spleen of the fetus and only in bone marrow after birth. This process involves the biochemical stimulation of populations of relatively undifferentiated cells to undergo mitotic division (i.e., proliferation) and maturation (i.e., differentiation) into mature hematologic cells. Hematopoiesis continues throughout life, increasing in response to proliferative disease, hemorrhage, hemolytic anemia (in which erythrocytes are destroyed), and chronic infection.

Which statement about the neutrophil is TRUE? (select all that apply)

1. They bring about the process of inflammation. 2. Their death results in the release of digestive enzymes. 3. They are responsible for initial phagocytosis. Neutrophils are the chief phagocytes of early inflammation. Soon after bacterial invasion or tissue injury, neutrophils migrate out of the capillaries and into the damaged tissue, where they ingest and destroy contaminating microorganisms and debris. Neutrophils are sensitive to the environment in damaged tissue and die in 1 or 2 days. The breakdown of dead neutrophils releases digestive enzymes from their cytoplasmic granules. These enzymes dissolve cellular debris and prepare the site for healing.

Functions of the Lymphatic system:

1. Transportation • Carries fluid away from tissues; carries wastes away from tissues 2. Absorption • Absorbs fats and transports fats to blood • Stores blood (spleen) • Destroys worn-out erythrocytes (spleen) 3. Protection • Filters waste products out of blood and filters foreign substances out of blood (including dead blood cells, bacteria, smoke by-products, cancer cells) 4. Blood Cell Storage and Production • Stores lymphocytes and monocytes • Produces erythrocytes during fetal development (made in the spleen in fetus)

Life span of a platelet?

11 DAYS (1 to 2 weeks)

Normal platelet count:

150,000-400,000 cells/mm3

How do cell size and content determine classification of anemia?

Anemias can be classified with respect to the size and hemoglobin content of the erythrocytes. Cell size is described as macrocytic (large), normocytic (normal), or microcytic (small). The amount of hemoglobin determines the color (chromaticity) of the cell. To further describe an anemia, the terms hyperchromic (increased hemoglobin content), normochromic (normal hemoglobin content), or hypochromic (decreased hemoglobin content) are used. For instance, pernicious anemia is classified as a macrocytic-normochromic anemia. All of these factors are necessary to identify the etiology of the anemia.

What is the blood forming organ?

Bone marrow

What is Burkitt lymphoma?

Burkitt lymphoma is a tumor that occurs in children from East-Central Africa and New Guinea. It involves the facial bones and jaw. In Africa, Burkitt lymphoma is associated with the Epstein-Barr virus. There is also an American type of Burkitt lymphoma that affects the abdomen and is characterized by extensive bone marrow replacement

Identify the three pathologic causes of DIC, and describe the manifestations associated with DIC.

DIC can be caused by many primary diseases or injuries. The most common causes are obstetric complications and malignancies. Disorders that result in systemic inflammatory processes, such as septic shock, major burns, and acute respiratory distress syndrome (ARDS), also can cause DIC. Manifestations of DIC are the result of microvascular thrombi in major organs or of hemorrhaging throughout the tissues of the body. Ischemia results in cerebral hypoxia, necrosis and gangrene of the skin, renal failure, ARDS, and gastrointestinal necrosis. Failure of hemostasis causes intracranial hemorrhage, ecchymoses and petechiae of the skin and mucous membranes, and bleeding into the lungs, kidneys, and gastrointestinal tract. Both excessive bleeding and excessive clotting can ultimately lead to shock and multiple organ failure.

Which description appropriately defines the term anemia?

Decreased erythrocytes in circulating blood. Anemia is a reduction in the total number of erythrocytes in the circulating blood or a decrease in the quality or quantity of hemoglobin. This can be the result of blood loss or inadequate erythrocyte production.

Which statement regarding iron deficiency anemia (IDA) is true?

Fatigue is an early, nonspecific symptom. Early symptoms are nonspecific and include fatigue, weakness, shortness of breath, and pale earlobes, palms, and conjunctiva. In the elderly, mental confusion, memory loss, and disorientation may be wrongly perceived as "normal" events associated with aging. IDA develops slowly through three overlapping stages. The onset of symptoms is gradual, and individuals usually do not seek medical attention until hemoglobin levels drop to 7 or 8 g/dl.

Prothrombin is converted into THROMBIN (an enzyme) that is a catalyst to convert the plasma protein FIBRINOGEN into FIBRIN. ----> THEN WHAT

Fibrin traps RBCs. Clot formed

Who should not receive an ORAL iron supplement?

Gerontologic patients or older adults

A platelet count of 500,000 or less increases the risk of:

Hemorrhage

Partial Thromboplastin Time (PTT) is specific for measuring the effects of:

Heparin

____________ is given by injection (unable to cross GI membranes) to prevent thrombus formation especially in patients at risk for DVT and pulmonary emboli.

Heparin

The most common source of drug-induced thrombocytopenia is:

Heparin Heparin is the most common cause of drug-induced thrombocytopenia because of its effect on the clotting of human blood. The other choices are not known to cause thrombocytopenia.

Contrast the principal features of Hodgkin lymphoma with those of non-Hodgkin lymphoma.

Hodgkin lymphoma and non-Hodgkin lymphoma are both lymphoid malignancies. Non-Hodgkin lymphomas are of B- and T-cell origin; Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are large, multinuclear transformed cells of controversial origin. Hodgkin lymphoma arises in a single node or chain of nodes and usually spreads to contiguous nodes. It often begins in an enlarged, painless node in the neck. The cervical, axillary, inguinal, and retroperitoneal nodes are most commonly affected. Hodgkin lymphoma generally occurs either in the second and third decades or later in the sixth or seventh decades. Weight loss, fever, and night sweats are common. Non-Hodgkin lymphomas are not characterized by Reed-Sternberg cells. They originate in multiple peripheral nodes and tend to spread widely and noncontiguously. The incidence of non-Hodgkin lymphoma is greater than that of Hodgkin lymphoma and occurs primarily in people older than 50 years. Fever, weight loss, and night sweats are uncommon.

How to treat relative polycythemia?

Hydration

Platelet destruction by antibodies. IgG adheres to platelet and triggers immune response. Most of the platelets are destroyed in the spleen... This is referred to as:

Immune or idiopathic thrombocytopenia purpura (ITP).

Discuss the pathophysiology of iron deficiency anemia.

In IDA the body's iron stores are depleted either because of inadequate diet or chronic blood loss, or both. In stage I, red blood cell production continues normally and the hemoglobin content of those cells remains normal. In stage II, insufficient amounts of iron are transported to the bone marrow, and iron-deficient red cell production begins. In stage III the hemoglobin deficient red blood cells enter the circulation and replace normal, aged erythrocytes that have been destroyed.

What condition is manifested chiefly by an increase in the numbers of circulating granulocytes and monocytes?

Increased numbers of circulating granulocytes (neutrophils, eosinophils, basophils) and monocytes are chiefly a physiologic response to infection.

Why is iron important to hemoglobin synthesis, and why is iron deficiency related to anemia?

Iron is an essential component of the hemoglobin molecule and therefore must be available in adequate amounts for the synthesis of normal hemoglobin. Iron deficiency decreases the quantity and/or quality of hemoglobin, resulting in a decrease in the oxygen-carrying capacity of the blood (anemia). Much of the iron in the red blood cells is recirculated.

What is true regarding iron deficiency anemia?

It is common in children due to their extremely high need for iron for normal growth. It is common in children due to their extremely high need for iron for growth. Incidence is not related to race but is increased in the children of homeless women most likely due to poor nutrition. It is most commonly found between the ages of 6 months and 2 years.

Which statement regarding immune thrombocytopenic purpura (ITP) is true?

It is more common in females It is more common in females between 20 and 40 years of age. It usually starts with minor problems such as petechiae and an initial platelet count of 150,000.

erythropoietin is secreted in the ________ and stimulates stem cells of bone marrow to produce red blood cells.

Kidney

What is the pathogenesis of ALL?

Leukemias are considered clonal disorders in that a single progenitor cell undergoes transformation. ALL is not caused by a cellular proliferation but is, instead, caused by the blocking of differentiation. Leukemic cells accumulate continuously and compete with normal cellular proliferation. Thus, ALL is a disorder of both accumulation and proliferation.

Most clotting factors (proteins) are synthesized in the:

Liver

Define what is meant by the following statement: Multiple myeloma is heterogeneous.

MM tumors are highly heterogeneous and involve mutations in different signaling pathways. Investigators observed frequent mutations in KRAS, NRAS, BRAF, FAM46C, TP53, and DIS3, and many mutations were found in the same pathway. Defining driver mutations and heterogeneity is essential for treatment decisions.

Which statement regarding Hodgkin lymphoma is true?

Peak incidence occurs in the early 20s through the 30s and then later in life. The peak incidence occurs during the early 20s and 30s and again in the sixth and seventh decades of life. The incidence is greatest in whites and economically advantaged countries. There is an increase in Reed-Sternberg cells.

The hypoxic intrauterine environment stimulates erythropoietin production...

Resulting in Polycythemia

What are the risk factors for adult NHL?

Risk factors for adult NHL include being older, male, or white having one of the following: certain inherited immune disorders, an autoimmune disease, HIV/AIDS, exposure to a variety of mutagenic chemicals, certain pesticides, infection with certain cancer-related viruses (e.g., Epstein-Barr virus, HIV, HTLV-1), a diet high in meats and fat, and taking immunosuppression drugs after an organ transplant. Gastric infection with Helicobacter pylori increases the risk for gastric lymphomas. NHL is a disease of middle age, usually found in persons over 50 years old.

Which form of anemia is caused by altered heme synthesis in erythroid cells?

Sideroblastic Sideroblastic anemias are a heterogeneous group of disorders characterized by anemia of varying severity due to a dysfunction in the erythroid cells that results in a faulty production of heme. Iron deficiency anemia is usually a result of pregnancy or caused by a continuous loss of blood. Microcytic-hypochromic anemia is caused by small erythrocytes that contain reduced amounts of hemoglobin. Megaloblastic anemia is caused by unusually large erythrocytes.

What is a diagnostic test for Hodgkin Lymphoma??

Stern-berg Reed cells

Non-Hodgkin Lymphoma develops from abnormal ____ or ____cells while Hodgkin Lymphoma develops from abnormal ____ cells.

T or B, B

PLATELET TERMS: TOO FEW & TOO MANY

THROMBOCYTOPENIA & THROMBOCYTOSIS

What is the significance of the Philadelphia chromosome, and how is it related to leukemia?

The Philadelphia chromosome, which results from a translocation mutation, is a diagnostic marker for chronic myelogenous leukemia (CML). It is present in erythroid, megakaryocyte, and macrophage cell lines. It is related to leukemia because the mutation results in transformation and occurs early in the stem cell stage. It causes abnormal proliferation of cells of the myeloid line, especially granulocytes and macrophages in all stages of differentiation.

What are the classic symptoms of IM?

The classic symptoms of IM are pharyngitis, lymphadenopathy, and fever.

What is the cause of infectious mononucleosis (IM)?

The most common cause of IM is Epstein-Barr virus (EBV).

Erythropoietin causes:

an increase in red cell production and release from bone marrow.

Pernicious anemia is:

associated with end-stage type A chronic atrophic gastritis. Pernicious anemia is associated with end-stage type A chronic atrophic gastritis, but is the result of an autoimmune disorder, not a viral infection. It is due to the absence of intrinsic factor and generally occurs in the elderly with mean age of onset of age 60. Body unable to absorb B12.

Iron is:

freed from Hgb during bilirubin formation; transported to bone marrow via transferrin and reclaimed for new Hgb production.

What is Thrombopoietin?

hormone that regulates platelet formation

What is the primary function of albumin as a component of human blood? Albumin:

regulates the movement of water and solutes via osmotic pressure. Albumin (about 60% of total plasma protein) serves as a carrier molecule for both normal components of blood and drugs. Its most essential role is regulation of the passage of water and solutes through the capillaries by the process of osmosis, not intravascular pressure. Fibrinogen is the most plentiful of the clotting factors and is the precursor of the fibrin clot. Plasma is a complex aqueous liquid containing a variety of organic and inorganic elements.

Platelet levels are maintained by

thrombopoietin and IL-11