Heme Pt 2 + collab questions

Aplastic anemia causes

-most common is primary acquired (autoimmune disease) -secondary acquired (exposure to chemicals or ionizing radiation) -familial (defective telomerase -> shortened telomeres) -inflammation

Pernicious anemia

-most common type of megaloblastic anemia; due to chronic gastritis or an autosomal recessive mutation -vit b 12 deficiency

Bence-Jones protein

free immunoglobulin light chains that collect in blood + urine, indicative of multiple myeloma

What happens around 5 months of gestation?

hemoatopoiesis begins in bone marrow

Relative polycythemia

hemoconcentration of blood due to dehydration -> fixed by fluid admin or correction

Anemias of increased RBC destruction

hemolytic anemia

Iron overload (primary)

hereditary hemochromatosis (HH)

Hemophilia may occur due to ______ deficiency resulting from a(n) _______ mutation. A. VIII ... X-linked recessive B. IX ... X-linked recessive C. vWF ... X-linked recessive D. All of the above E. A and B, but not C

E. A and B, but not C •To be X-linked, the gene must be on the X chromosome, and vWF is not (it's on chromosome 12).

REVIEW: Damaged endothelial cells release vonWillibrand factor (vWF) which promotes clotting by: A. Binding to GP-1B receptors on platelets to stimulate activation B. Inhibiting antithrombic activity C. Inducing a confirmational shape change in platelets that increases shear force which further stabilizes the platelet plug D. A and C, but not B E. All of the above

E. All of the above

JAK2 receptor mutation

EPO is "always on" and results in primary polycythemia (PV)

Leukemia

clonal malignant disorder of leukocytes in bone marrow and blood -> uncontrolled proliferation of malignant leukocytes

Multiple myeloma

clonal plasma cell cancer in bones; may have large amounts of monoclonal proteins that resemble usual immunoglobulins

Agranulocytosis

complete absence of granulocytes (neutrophils, eosinophils, and basophils) in the blood

Basopenia

decrease in basophils

Eosinpenia

decrease in eosinophils due to migration of eosinophils to inflammatory sites

Monocytopenia

decrease in monocytes - RARE

Lymphocytopenia

deficiency of lymph cells due to immune deficiencies and neoplasia

Neutropenia

deficiency of neutrophils due to anemias, leukemia, lymphoma, nutritional deficiency

Embolus

detached thrombus

What does anemia result in?

diminished oxygen carrying capacity, reduced blood consistency and volume (more viscous)

Anemia of chronic disease

disease or inflammation reduces erythropoiesis

Secondary thrombocythemia

due to splenectomy or reactive to inflammatory conditions

Leukocytosis

elevated WBC count

What does polycythemia do to liver and spleen?

enlargement due to pooling blood -> HTN

Lymphadoenopathy

enlargement of lymph nodes

Splenomegaly

enlargement of the spleen which may increase susceptibility to rupture

Polycythemia

excessive RBC production -> increased viscosity and increased platlet # -> hypercoagulative state

Iron deficiency anemia

-most common anemia worldwide -anemia caused by inadequate iron intake (poverty, parasites, pregnancy, GI inflammation) so can't make heme

Anemias of decreased RBC production: macrocytic (megaloblastic)-normochromic

-DNA issue •large stem cells form large RBC •folate deficiency, B12 deficiency (dietary), chemotherapy •cells die prematurely

Iron deficiency anemia symptoms

-Fatigue -Tachycardia -Palpitations -Tachypnea on exertion -Smooth tongue -Koilonychia (spoon nails) -Pica

Anemias of decreased RBC production: microcytic-hypochromic

-abnormally small RBC w/reduced Hb or reduced Hb in cells of normal size -results from •iron metabolism issues •porphyrin and/or heme synthesis issues •globin synthesis disorders

ALL

-acute lymphocytic leukemia; most common in children; B, T, NK cells -stem cell-like cell overproduction

AML

-acute myelogenous leukemia; any cell that is NOT B, T, NK aka monocytes or granulocyte path; most common in adults -immature blast cells replace normal cells

Where does RBC production occur in embryonic development?

vessels of yolk sack around 2 weeks of gestation

CLL

-chronic lymphocytic leukemia -very slow, monoclonal B lymphocytes (65:33)

CML

-chronic myelogenous leukemia; Philadelphia translocation -> due to ionizing radiation -asymptomatic -> accelerated -> blast phase

Aplastic anemia pathophysiology

-hypocellular bone marrow is replaced with fat -elevated levels of inflammatory cytokines -may arise from dysregulation in immune cell development stages

What alters platelet function?

-increased bleeding w/normal platelets -disorders of platelet-vascular wall adhesion -disorders of platelet-platelet interactions -disorders of platelet granules/secretion and arachidonic pathways -deficiency of enzymes -drug effects

What happens when you have tissue hypoxia?

-increased rate and depth of breathing -causes SOB, palpitations, dizziness, fatigue

Thrombotic Thrombocytopenic Purpura

-platelets aggregate and occlude small BV -> microthrombi -due to enzyme deficiency (reduced digestion of vWF -> increased clotting) -familial (rare) or acquired (acute, severe)

Leukemia genetics

-reciprocal translocation between chromo 9&22 (Philadelphia chromosome) to form BCR-ABL1

Hemolytic anemia

-reduction in RBCs due to excessive, premature destruction -congenital -acquired

Folate deficiency anemia

-similar to B 12 deficiency -megaloblastic cells w/clumped nuclear chromatin

Progression of iron deficiency anemia

1. body iron stores are depleted 2. iron transport to bone marrow reduced 3. small Hb deficient cells enter circulation and replace normal RBC (SYMPTOMS)

Reduced immune system function during pregnancy and ovulation is most likely to result in: A. Basopenia B. Eosinophilia C. Leukocytosis D. Thrombocytopenia

A. Basopenia •The suffixes "philia" and "cytosis" indicate an increase in cell number. The suffix "penia" indicates a decrease in cell number. Thrombocytopenia is a lack of platelets, which is less likely to occur than a lack of basophils (which is needed to reduce rejection of implantation).

Retention of fetal hemoglobin (HbF) production later into childhood would most likely ________ the severity of sickle cell anemia related crisis events. A. Decrease B. Increase

A. Decrease

In sickle cell disease, HbS transformation to sickle shape is most likely to occur when RBC are: A. Deoxygenated B. Oxygenated C. Neither of the above: HbS is not reactive to oxygen saturation

A. Deoxygenated •Sickle cell disease symptoms are most commonly induced by a reaction of the mutated beta chain to reduced oxygen saturation.

Which of the following disorders is best described as an unregulated release of thrombin with subsequent accelerated fibrin formation? A. Disseminated intravascular coagulation B. Essential thrombocythemia C. Heparin-induced thrombocytopenia D. Immune thrombocytopenic purpura

A. Disseminated intravascular coagulation

In the placenta, oxygen is most likely to be transferred from _______ to ________. A. HbA ... HbF B. HbF ... HbA

A. HbA ... HbF •Fetal hemoglobin has a higher affinity for oxygen than does adult hemoglobin because adult beta chain binding 2,3-BPG reduces its affinity for oxygen. 2,3-BPG does not bind well to the fetal gamma chain.

Which of the following electrolyte imbalances is most likely to accompany multiple myeloma? A. Hypercalcemia B. Hyperkalemia C. Hypernatremia D. Hyperphosphatemia

A. Hypercalcemia •Osteoclast activation is a characteristic of multiple myeloma. It results in the breakdown of bone and the release of calcium into blood. •NOTE: multiple myeloma is also known as "plasma cell myeloma"

Your 25-year-old female patient presents to the clinic complaining of lack of energy, generalized weakness, and heavier than usual menstrual bleeding for the past 6 months. Lab results show she has low hemoglobin, and that the erythrocytes are smaller and contain less hemoglobin than normal. Your patient most likely has a ____________ anemia due to _____________. A. Microcytic hypochromic - iron deficiency B. Normocytic normochromic - acute blood loss C. Microcytic hypochromic - polycythemia vera D. Megaloblastic - B12 deficiency

A. Microcytic hypochromic - iron deficiency •Chronic blood loss due to excessive menstrual bleeding has most likely depleted her iron stores, resulting in iron deficiency anemia. Lack of iron to incorporate into the heme molecule in developing erythrocytes will result in abnormally small RBCs that contain less hemoglobin -> microcytic hypochromic.

REVIEW: IL-6, which is a pro-inflammatory cytokine, increases hepatocyte release of the hormone _____. This hormone is used to regulate the body's ____. A. hepcidin, iron B. hepcidin, calcium C. transferrin , iron D. transferrin, calcium

A. hepcidin, iron •IL-6 increases hepatocyte release of hepcidin, which functions to regulate the body's iron, making A the correct answer.

At _______ gestation, fetal red blood cell production is predominantly occurring in the ________. A. 2 weeks ... spleen B. 8 weeks ... liver C. 4 months ... bone marrow D. 6 months ... spleen

B. 8 weeks ... liver •In general, at 2 weeks it would be primarily in the yolk sac, at 4 months in the liver/spleen, and at 6 months in the bone marrow.

Leukemia pathophysiology

B-cell and T-cell differentiation pathways (usually B cell origin, but can be any step)

Erythroblastosis fetalis is best described as a(n): A. Allergic disease in which maternal Hb and fetal Hb are antigenically incompatible B. Alloimmune disease in which maternal blood and fetal blood are antigenically incompatible C. Autoimmune disease in which immature leukocytes are released into the bloodstream D. X-linked recessive disease

B. Alloimmune disease in which maternal blood and fetal blood are antigenically incompatible •A: Hemoglobin, when contained within cells, is generally not immunogenic. •C: erythroblastosis refers to immature RBC, not WBC •D: blood cell antigens are autosomally determined

Sickle cell disease results from an autosomal recessive mutation on the gene for the _______ chain of hemoglobin. A. Alpha B. Beta C. Gamma D. None of the above

B. Beta

The most common cause of iron deficiency anemia is: A. Autoimmune disease B. Chronic blood loss C. Decreased dietary intake D. Vitamin deficiency

B. Chronic blood loss

A type I hypersensitivity allergic disorder caused by asthma, hayfever, or drug reaction is most likely to induce: A. Basopenia B. Eosinophilia C. Monocytosis D. Neutropenia

B. Eosinophilia •The suffixes "philia" and "cytosis" indicate an increase in cell number. Eosinophils are more responsive to allergy than are monocytes. The suffix "penia" indicates a decrease in cell number, not an increase.

REVIEW: Less hepcidin, more GI iron absorption is to __________ as more hepcidin, less GI iron absorption is to __________: A. Primary polycythemia vera, pancytopenia B. Hereditary hemochromatosis, anemia of inflammation (ACD) C. Iron deficiency anemia, Secondary Iron overload D. Pernicious anemia, normocytic normochromic anemia

B. Hereditary hemochromatosis, anemia of inflammation (ACD) •hereditary heomchromatosis is a autosomal recessive disorder of hepcidin regulated iron absorption. Less hepcidin, more GI iron absorption. Anemia of inflammation or anemia of chronic disease (ACD) leads to increased hepcidin, decreased GI iron absorption.

Increased numbers of abnormal WBC in blood are typically classified as: A. Anemias B. Leukemias C. Lymphomas D. Thalassemias

B. Leukemias

This type of Anemia is related to a Vitamin B12 deficiency: A. Post-hemorrhagic anemia B. Macrocytic-Normochromic anemia C. Microcytic- Hypochromatic anemia D. Normocytic- Normochromatic anemia

B. Macrocytic-Normochromic anemia •Pernicious anemia under this type is correlated with Vit B12 deficiency.

Pernicious anemia can be due to: A. Accelerated RBC destruction B. Reduction in formation of intrinsic factor C. Autoantibodies against platelets D. Decrease in dietary folate

B. Reduction in formation of intrinsic factor

Hemolytic disease of the newborn is most likely to occur if: A. The mother is Rh positive and the fetus is Rh negative B. The mother is Rh negative and the fetus is Rh positive C. The mother has type A blood and the fetus has type O blood D. The mother has type AB blood and the fetus has type B blood

B. The mother is Rh negative and the fetus is Rh positive •Antibodies form in the mother against antigens that are foreign to her system - in this case Rh factor. Since the reaction is IgG mediated, the antibodies cross the placenta. The ABO response may occur but it is IgM mediated and IgM does not cross the placenta so would not cause a hemolytic response.

Purpura is most likely an outcome of: A. Hemostasis B. Thrombocytopenia C. Thromboembolic disease D. Thrombophilia

B. Thrombocytopenia •Thrombocytopenia specifically reduces platelet concentrations, thereby increasing diffuse bleeding.

A Philadelphia chromosome translocation is described as _______ and is most commonly associated with _______. A. t(6;14) ... Down syndrome B. t(9;22) ... chronic myelogenous leukemia C. t(12;21) ... acute lymphatic leukemia D. t(22;X) ... vonWillebrand disease

B. t(9;22) ... chronic myelogenous leukemia

In leukemia: A. A single progenitor cell undergoes a malignant change B. Bone marrow becomes over crowded with abnormal cells C. Erythropoiesis decreases D. All of the above E. None of the above

D. All of the above

Which virus is most frequently associated with the development of endemic Burkitt lymphoma in children of African descent? A. Adenovirus B. Cytomegalovirus C. Epstein-Barr virus D. Human papillomavirus

C. Epstein-Barr virus

Red blood cell production in the liver sinusoids predominates in a(n): A. Adult B. Embryo at 2 weeks gestation C. Fetus at 4 months gestation D. Fetus at 7 months gestation E. None of the above

C. Fetus at 4 months gestation

The most common blood disorder in children world-wide is: A. Beta thalassemia B. Chronic myelogenous leukemia C. Iron deficiency anemia D. Thrmobocytopenia

C. Iron deficiency anemia

Hereditary hemochromatosis is most likely to result from an inherited autosomal recessive disorder that leads to abnormal: A. Autoimmune Rh factor tagging B. Erythropoietin activation C. Iron metabolism D. Tc cell activation

C. Iron metabolism

The normal red blood cell lifespan in a newborn is ______ that of the normal RBC lifespan in an adult. A. Greater than B. Equal to C. Less than

C. Less than

Chromosomal translocation mutation is most frequently associated with the development of: A. Neonatal thrombocytopenia B. Hemophilia A C. Leukemia D. Sickle cell disease

C. Leukemia

Hodgkin lymphoma most typically arises as a result of clonal division of a(n) _______ cell. A. Mature B B. Mature T C. Undifferentiated B D. Undifferentiated T

C. Undifferentiated B

REVIEW: In normal blood vessels, endothelin is a ________ that help maintain blood pressure and flow, whereas prostacyclin is a ________ that inhibits platelets aggregation. A. Vasodilator ; vasoconstrictor B. Vasoconstrictor ; vasoconstrictor C. Vasoconstrictor ; vasodilator D. Protease inhibitor ; vasodilation

C. Vasoconstrictor ; vasodilator

Which of the following genotypes will result in sickle cell anemia? A. DD B. Dd C. dd D. Both A and B

C. dd •Sickle cell anemia is the result of a homozygous recessive genotype because it is an autosomal recessive disease.

Which of the following cells is normally increased during a bacterial infection? A. lymphocytes B. basophils C. neutrophils D. both A and C

C. neutrophils

Coagulation balance

Coagulation and clotting are closely controlled; as soon as a clot is formed, it starts getting broken down

____ is a slow progression involving malignant transformation and progressive accumulation of monoclonal B lymphocytes that rarely involves Philadelphia chromosome translocation. A. ALL B. AML C. CML D. CLL

D. CLL •The "slow progression" indicates that this is chronic and not acute, so A and B can be eliminated. The stem involves B lymphocytes indicating that this is a lymphocytic leukemia and not a myelogenous leukemia, so C can be eliminated, which leaves D as the correct answer.

Hereditary hemochromatosis (HH) is a common inherited autosomal recessive disorder due to mutations in HFE gene, which leads to less ______ and more ______ in the blood. A. TPO, platelets B. EPO, RBCs C. EPO, Iron D. Hepcidin, Iron

D. Hepcidin, Iron •HH is a primary iron overload disorder due to mutation of the HFE gene causing disruption of hepcidin regulated iron absorption. Less hepcidin would lead to more GI iron absorption and therefore more iron in the blood

REVIEW: Which of the following is correctly matched? A. RBC are typically removed every 12 days. B. Hepcidin is produced in the gallbladder. C. Iron is absorbed in the stomach via ferroportin transporters. D. Red blood cells are primarily removed by splenic macrophages. E. Erythropoietin is secreted by liver. F. D & E

D. Red blood cells are primarily removed by splenic macrophages.

Which of the following is true of AML? A. It is the highest prevalence of leukemia type in children B. Involves malignant transformation and progressive accumulation of monoclonal B lymphocytes C. It is often asymptomatic for years before entering a blast crisis phase resulting in rapid and progressive leukocytosis with increased release of immature cells and splenomegaly. D. Immature blasts replace normal myelocytic cells, megakaryocytes and erythrocytes resulting in bleeding, Infections and anemia.

D. Immature blasts replace normal myelocytic cells, megakaryocytes and erythrocytes resulting in bleeding, Infections and anemia. •Abnormal proliferation of myeloid precursor cells, reduced rate of apoptosis and arrested cellular differentiation lead to leukocytosis and predominance of blast cells, a characteristic of Acute myelogenous leukemia.

Acute leukemia is LEAST likely to be associated with: A. Anemia B. Arrest of cellular differentiation C. Increased blast cells in circulation D. Osteoclast activation with hypercalcemia

D. Osteoclast activation with hypercalcemia •Osteoclast activation is primarily a characteristic more specifically of multiple myeloma.

Enlarged red blood cells are a characteristic of ________ anemias. A. Aplastic and hemolytic B. Aplastic and iron deficiency C. Iron deficiency and pernicious D. Pernicious and folate deficiency

D. Pernicious and folate deficiency

Immune thrombocytopenia purpura is an autoimmune process involving antibodies that primarily attack: A. Eosinophils B. Erythrocytes C. Neutrophils D. Platelets

D. Platelets

Which of the following statements is/are true regarding anemia? A. Anemia results in reduced oxygen carrying capacity leading to hypoxia B. Respiratory compensation due to tissue hypoxia stimulates increased depth of breathing C. Cardiovascular compensation of anemia due to reduced RBC quantities decreases blood flow velocity to allow for increased time for oxygen saturation of tissues D. A & B E. All of the above

D. A & B •Anemia results in decreased oxygen carrying capacity and subsequent hypoxia with symptoms that are based on the body's ability to compensate for hypoxia. •Respiratory compensation will stimulate increased rate and depth of breathing in an effort to increase oxygen supply to the hypoxic tissues.

Epstein-Barr virus infection is associated with the development of: A. Infectious mononucleosis B. Leukemia C. Lymphoma D. All of the above

D. All of the above

BCR

GTPase activating protein

Rh response

IgG crosses placenta and can cause Rh antibodies to form in Rh- mother

Pure red cell aplasia (PRCA)

RBC affected; due from bone marrow disorders or allogenic bone marrow transplant (ABO mismatch)

Anemias of decreased RBC production: normocytic - normochromic

RBC are normal sized and Hb, reduced #

What happens around 8 weeks of gestation?

RBC production shifts to liver

Hodgkin lymphoma

Reed-Sternberg cells; progresses from one group of lymph nodes to another, usually starts as a B cell that did not go through rearrangement

Glucose-6-phosphate dehydrogenase deficiency (G6PD)

X-linked recessive disorder that leads to cell membrane damage -> anemia

Hemophilia B (Christmas disease)

X-linked recessive disorder; factor IX deficiency

Hemophilia A (classic)

X-linked recessive disorder; factor VIII deficiency

-penia

abnormal cell count (too few)

-cytosis

abnormal cell count (too many)

Granulocytosis

abnormal increase of granulocytes (neutrophils, eosinophils, basophils) in the blood

Causes of anemia

acute or chronic blood loss, low RBC production, high RBC destruction

Immune Thrombocytopenic Purpura

acute: secondary to infection, drug response, allergy, or SLE chronic: due to formation of autoautibodies against platelet specific antigens

Postnatal blood changes

all blood cell counts are elevated w/some immature RBC and granulocytes in circulation

Infectious mononucleosis

an acute, viral infection caused by the Epstein-Barr virus that is characterized by fatigue, sore throat, and enlarged lymph nodes; may lead to splenomegaly; B lymphocytes

Immune thrombocytopenia purpura

antiplatelet antibodies bind to platelet plasma membranes

Acute chest syndrome

associated w/sickle cell disease where sickle cells get trapped in the lung and cause inflammation and infarction

Hereditary spherocytosis

autosomal dominant disorder that results in structural irregularities in RBC membrane

Sickle cell disease (SCD)

autosomal recessive disorder due to formation of abnormal Hb

Hereditary hemochromatosis

autosomal recessive disorder of iron metabolism in HFE (High iron FE) -> less hepcidin -> more iron in the blood -> iron deposition in tissues

Thalassemias

autosomal recessive disorder where the synthesis of α or β chain of hemoglobin molecule is slowed or defective

Hemophilia C

autosomal recessive disorder; factor XI deficiency

Sequestration crisis

blood pools in liver and spleen which may lead to shock

Primary thrombocythemia

chronic myeloproliferative disorder die to mutations

Quantitative leukocyte disorders

cell # changes due to decreased WBC production or increased cell destruction

Qualitative leukocyte disorders

cell quality changes due to disroption of leukocyte fxn

Clonal

cells of identical origin and genetics

-chromic

changes in hemoglobin content

Autoimmune thrombocytopenia purpura

immune system destroys platelets

Basophilia

increase in basophils due to inflammation, type I hypersensitivity rxn, chronic myeloid leukemia; occurs with neutropenia

Eosinophilia

increase in eosinophils due to type I allergy, hayfever, allergic asthma, parasites, drug rxn

Lymphocytosis

increase in lymphocytes (B and T cells) due to acute viral infection

Splenomegaly causes

increase in splenic workload, congestive splenomegaly, infiltrative splenomegaly

Thrombophilia

increased clot formation due to defects in clot inhibiting factors

Hyperhemolytic crisis

increased rate of RBC destruction which leads to anemia, jaundice, and reticulocytosis

IL-6 function

increases hepatocyte release of hepcidin -> reduces ferroportin transporter activity -> reduces iron release into blood

Iron overload (secondary)

inefficient erythropoiesis, dietary overload, blood transfusion conditions

Cholecystitis

inflammation of the gallbladder

Autoimmune vascular purpura

inflammatory rxn to foreign particles or chemicals in blood

Virchow triad

injury, abnormalities of flow, hypercoaguability of blood

Type of microcytic-hypochromic anemia

iron deficiency anemia

Leukopenia

low WBC count due to radiation, chemo, autoimmune, immune

Hypoxemia

low blood oxygen -> results in vasodilation

Thrombocytopenia

low platelet count due to reduced platelet production, increased platelet destruction or both

Lymphoma

malignant tumor of lymph nodes and lymph tissue

Vaso-occlusive crisis

obstruction of blood flow causes painful tissue hypoxia

Thrombocythemia

overproduction of platelets; microvascular thrombosis

Types of macrocytic (megaloblastic)-normochromic anemia

pernicious anemiua folate deficiency anemia

-cytic

pertaining to cell size

Absolute polycythemia (primary)

primary: polycythemia vera (PV) due to overproduction of RBCs and ususally WBCs and platelets

IL-6

pro-inflammatory cytokine/mediator

Fanconi anemia

rare genetic anemia from defects in DNA repair

Purpura

red-purple skin discoloration due to blood in tissues from hemorrhage

Why is reduced blood volume bad?

reduced blood volume leads to reduced systemic BP -> increased venous return -> stimulation of SNS -> increased HR, CO, RAAS, EPO -> (may accelerate the release of immature RBC&WBC into circulation) -> heart failure

Anemia

reduction in number of RBC

Aplastic anemia

reduction in or absence of all three blood cell types due to inadequate bone marrow fxn (pancytopenia)

Hemolytic anemia symptoms

release of reticulocytes and schistocytes - reduced O2 delivery jaundice

Lactoferrin

released from neutrophils to bind iron and keep it away from pathogens

Post hemmorhagic anemia

results from excessive bleeding -> reduced volume issues

Absolute polycythemia (secondary)

secondary more common: increased EPO secretion in response to chronic hypoxia

BCR-ABL1

selectively increases transformation of WBC into leukemic cells (increases proliferation and decreases sensitivity to apoptosis)

Genetic risk factors for leukemia

sibling w/leukemia = increased risk

Glomerular disease

sickled RBC damage glomerular membranes

Non-Hodgkin lymphoma (NHL)

similar to Hodgkin lymphoma, but with no Reed-Sternberg cells; usually B cell origin

Thromboembolic disease

spontaneous clot development

Thromboembolitic disease

spontaneous clotting

Thrombus

stationary blood clot

Aplastic crisis

temporary cessation of RBC production

ABL1

tyrosine kinase in signaling pathway that promotes cell proliferation

Von Willebrand Disease

usually autosomal dominant; deficiency of vWF production leads to decreased platelet activation

Burkitt lymphoma

very rapidly growing B cell non-Hodgkins lymphoma; EBV infection especially if there are other illnesses that suppress immune function

Disseminated intravascular coagulation (DIC)

widespread activation of coagulation -> blood flow blocked; most commonly seen w/sepsis