Patho Ch 27 N.W

Hypersplenism (spleen becomes overactice) is indicated by what four things?

1) anemia, leukopenia, thrombocytopenia, or combinations of these 2) cellular bone marrow 3) splenomegaly, 4) improvement after splenectomy

Spontaneous bleeding w/out apparent trauma can occur w/ counts between ____ and ____ which results in what symptoms?

10,000 and 15,000/mm3 Petechiae, ecchymoses, larger purpuric spots, or frank bleeding from mucous membranes

Most healthcare providers do not consider the decrease of platelets significant unless it falls below ______.

100,000 platelets/mm3

What is the difference between HL and NHL related to the extent of the disease?

HL is often localized while NHL is rarely localized

What are the most common forms of thrombocytopenia a result of?

Heparin-induced thrombocytopenia, idopathic (immune) thrombocytopenic purpura, and thrombotic thrombocytopenic purpura

What is congestive splenomegly most commonly caused from?

Hepatic cirrhosis Also can be accompanied by ascites, portal htn, and esophageal varices

What is the difference between HL and NHL related to extranodal involvement?

In HL extranodal involvement is rare while it is very common in NHL

What is splenic rupture a complication of?

Infectious mononucleousis

Describe Multiple myeloma (MM).

It is a clonal plasma cell cancer characterized by the slow proliferation of malignant cells as tumor cell masses in the bone marrow that usually result in destruction of the bone. pg. 1037

Conditions that mimic lymphomas include TB, syphilis, SLE, lung Ca, and bone Ca. What is an important distinction between lymphomas and other conditions as these?

Lymphomas usually involve localized lymphadenopathy pg. 1037

What immunoglobulin becomes the most prominent protein in the blood in 80% of myeloma clients?

M protein

Waldenstrom macroglobulinemia (WM) is a rare type of slow-growing plasma tumor that is similar to MM but the overproduction of ______ _______ leads to certain unique clinical characteristics.

Macromolecule IgM

What are the initial manifestations of ITP?

Minor bleeding problems (development of petechiae and purpura) over the course of several days, that progress to major hemorrhage from mucosal sites (epistaxix, hematuria, menorrhagia, bleding gums).

What is the most common and most aggressive plasma cell tumor (remember, plasma cell is a B lymphocyte that secretes immunoglobulin)

Multiple myeloma

What are the common lymph nodes involved in NHL?

Multiple peripheral nodes

How are HL and non-Hodgkin lymphoma (NHL) differentiated from one another?

NHL's lack the Reed-Sternberg cells

What is a major post-operative complication following splenectomy?

Overwhelming Post-operative infection (OPSI)

What is the prognosis for a person with MM?

Poor, 3 year median survival rate

If the spleen is removed, what are the lifelong hematologic abnormalities?

RBCs become thinner, broader, and wrinkled WBC count increases to approximately 40% above normal Platelets increase to above-normal levels

What cells are common and necessary for the diagnosis of HL?

Reed-Sternberg (RS) cells

What are clinical manifestations of hypersplenism (overactivity of the spleen)?

Sequestering of red blood cells, granulocytes, and platelets resulting in a reduction of all circulating blood cells.

What is the most common genetic abnormality seen in CML?

The Philadelphia chromosome which is present in more than 95% of CML

What is a common feature of all forms of leukemia?

The common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells. pg. 1019

What are the clinical manifestations of thrombocythemia?

They vary significantly among individuals. The most common complication is microvasculature thrombosis leading to ischemia in the fingers, toes, or cerebrovascular regions.

What is the hallmark of HIT?

Thrombocytopenia A decrease of approximately 50% in the platelet count is seen in more than 95% of individuals.

How is the diagnosis of acute leukemias made?

Through examination of blood cells and bone marrow

What is the difference between acute and chronic leukemia's?

Unlike cells in acute leukemia, chronic leukemic cells are well differentiated and can be readily identified. Individuals with chronic leukemia have a longer life expectancy.

People with HIT are also at an increased risk of venous and arterial thrombosis. Which is most common and what does it result in?

Venous thrombosis is most common and results in DVTs and PEs. Bleeding rarely occurs in this pathology

What is the treatment for HIT?

Withdrawal of heparin and use of alternative anticoagulants.

What are the four types of leukemia?

Acute lymphocytic (ALL), Acute myelogenous (AML), Chronic lymphocytic (CLL), and Chronic myelogenous (CML)

Are leukemia's more common in adults or children?

Adults

Most cases of AML occur in .....

Adults with a mean age of 67.

Infiltrative splenomegaly is caused by what?

Engorgement by the macrophages with indigestible materials associated w/ various "storage diseases"

The primary presenting symptoms of microvasculature thrombosis are what?

Erythromyalgia, headache, and paresthesias Erythromyalgia is characterized by unilateral or bilateral warm, congested, red hands and feet w/ painful burning sensations, particularly in the forefoot sole and one or more toes.

What are the signs and symptoms of bone marrow suppression?

Fatigue (r/t anemia), bleeding (r/t thrombocytopenia), and fever (r/t infection, low healthy white counts)

Essential thrombocythemia is dianosed by what?

A platelet count greater than 600,000/mm3 and remains elevated and remains elevated, with no other indicated cause.

What is thrombocytopenia?

A platelet count less than 150,000 platelets/mm3 of blood

What is the most common type of leukemia in children?

ALL

What is the most common type of leukemia in adults?

AML is the most common adult leukemia: p. 1023 The chronic leukemias account for the majority of cases in adults: CLL and AML are the most common types in adults. CML is found mostly in adults. p. 1019

What is Burkitt lymphoma?

A B-cell tumor w/ unique clinical and epidemiologic features that accounts for 30% of childhood lymphomas worldwide. Primarily grows in the jaw and facial bones. Abdominal swelling is the most common presentation in non-African cases.

What can cause pseudothrombocytopenia?

A blood sample analyzed by an automated cell counter r/t platelet agglutination which are not counted and r/t the dilutional affect of massive transfusions of platelet-poor packed cells to treat hemorrhage. Splenic sequestering can cause pseudothrombocytopenia as well.

What is Essential (primary) thrombocythemia?

A chronic myeloproliferative disorder characterized by excessive platelet production resulting from a defect in bone marrow megakaryocyte progenitor cells.

What is leukemia?

A clonal malignant disorder of leukocytes in the blood and blood-forming organs.

What is Immune Thrombocytopenic Purpura?

An immune mediated thrombocytopenia. It is the most common cause of thrombocytopenia second to increased platelet destruction. It can be acute (mostly in children) or chronic (mainly in adults).

What is Heparin-induced thrombocytopenia (HIT)?

An immune-mediated, adverse drug reaction caused by IgG antibodies against heparin-platelet factor 4 complex leading to platelet activation through platelet Fc yIIa receptors.

What is the most common translocation in Acute myelogenic leukemia?

Between chromosomes 8 and 21 which disrupts the normal hematopoiesis process for myeloid cells and directly leads to AML malignant phenotype.

How is MM diagnosed?

By symptoms, radiographic and laboratory studies, and bone marrow biopsy

How are acute leukemias characterized?

By undifferentiated or immature cells, usually a blast cell, and the onset of disease is abrupt and rapid with a short survival time.

What are the common lymph nodes involved in Hodgkin lymphoma?

Cervical, axillary, inguinal and retroperitoneal nodes (located behind the peritoneum)

Most cases of ALL occur in ......

Children, 80%

How is leukemia classified?

Classified based on (1) the predominant cell of origin (myeloid or lymphoid) and (2) the rate of progression (acute or chronic)

What is purpura?

Diffuse hemorrhage into skin tissue that is visible through the skin as a red-purple discoloration.

When is splenomegaly (enlargement of the spleen) normal?

During acute inflamatory or infectious processes b/c there is an increased demand for defensive activities.

What virus is highly associated with almost all cases of Burkitt lymphomas?

EBV

What are the common clinical manifestations of MM?

Elevated levels of calcium in the blood (13% of persons), renal failure (19%), ANEMIA (72%), and BONE LESIONS (80%)

What happens to the bone marrow in leukemia?

The leukemia blasts "crowd out" the marrow and cause cellular proliferation of the other cell lines to cease causing pancytopenia.

How are chronic leukemia's characterized?

The predominant cell is more differentiated but does not function normally, with a relatively slow progression.

What is the most common genetic abnormality found in leukemia cells?

The reciprocal translocation between chromosomes 9 and 22 t(9;22), the Philadelphia chromosome. This carries the worst prognosis of all types of ALL. pg. 1020