1
Q
what are leukocytes?
A
basophils eosinophils neutrophils monocytes lymphocytes
2
Q
granulocytes (polymorphonuclear leukocytes)
PMNs
A
basophils
eosinophils
neutrophils
3
Q
alterations of leukocyte function
- deficiencies occur in the quality and quantity of leukocytes counts are low (leukopenia)
- numbers of leukocytes are increased, counts are high (leukocytosis)
- reasons affecting leukocyte production:
- -many _____ are _____
- -many nonhematologic malignancies metastasize to the _____, affecting _____ production
A
hematologic disorders
malignancies
bone marrow
leukocyte production
4
Q
granulocytosis (neutrophilia)
- is evident in the first stages of infection or inflammation
- if the need for neutrophils increases beyond the supply, then immature neutrophils (banded neutrophils) are released into the blood
- premature release of _____ is termed a _____
- -_____
A
immature leukocytes
shift-to-the-left
leukemoid reaction
5
Q
infectious mononucleosis
- acute, self-limiting viral infection of _____
- commonly caused by the _____-_____
- transmission: usually by saliva through personal contact (e.g., kissing, hence the term kissing disease)
A
b lymphocytes
EBV-85%
6
Q
infectious mononucleosis in _____ is
-an acute viral infection of lymphocytes: infectious mononucleosis is a lymphoproliferative clinical syndrome produced by acute viral infection of B lymphocytes
-causative agents include _____, CMV, adenovirus, hepatitis, HIV, and influenza A and B
A
children
epstein-barr
7
Q
infectious mononucleosis clinical manifestations- malaise, arthralgia -classic triad of symptoms --\_\_\_\_\_ --\_\_\_\_\_ --\_\_\_\_\_ of the \_\_\_\_\_
- diagnostic test
- -_____ test for _____ detects _____
A
fever pharyngitis lymphadenopathy cervical lymph nodes monospot qualitative heterophillic antibody immunoglobulin M (IgM)
8
Q
leukemias
- are malignant disorders of the blood and blood-forming organs
- exhibit uncontrolled proliferation of malignant leukocytes
- -overcrowding of bone marrow
- -decreased production and function of normal hematopoietic cells
- classification:
- -predominant cell of origin: _____ or _____
- -rate of progression: _____ or _____
A
myeloid
lymphoid
acute
chronic
9
Q
leukemia classification
predominant cell of origin: _____ or _____
rate of progression: _____ or _____
- _____: occurs in both children and adults
- _____: most common type of leukemia in children. also affects adults
- _____: mainly affects adults
- _____: most often in people over age 55
A
myeloid lymphoid acute chronic acute myelogenous leukemia (AML) acute lymphocytic leukemia (ALL) chronic myelogenous leukemia (CML) chronic lymphocytic leukemia (CLL)
10
Q
leukemias
acute leukemia:
- presence of undifferentiated or immature cells, usually blast cells
- disease from the _____
chronic leukemia
- predominant cell is mature but does not function normally
- slow progression
- disease starts _____
A
bone marrow
outside the bone marrow
11
Q
for acute and chronic leukemias
- the current classification of leukemia is based on:
1. the _____ (either _____ or _____)
2. the _____ which usually reflects the degree at which cell differentiation was arrested when the cell became malignant (_____ or _____)
A
predominant cell type myeloid lymphoid rate of progression acute chronic
12
Q
acute lymphocytic leukemia
disease from the _____!! so…
-is defined as greater than 30% _____ in blood or bone marrow
-ALL is an increase in _____ to more than 30%
-ALL is the most common leukemia in children
-most common childhood leukemia
-ALL is a _____ defined by the presence of _____ in the _____ or _____
A
bone marrow lymphoblasts lymphoblasts progressive neoplasm greater than 30% lymphoblasts bone marrow blood
13
Q
acute myelogenous leukemia (AML)
disease from the _____!! so…
-acute myelogenous leukemia (AML) is caused by an abnormal proliferation of _____
A
bone marrow
myeloid precursor cells
14
Q
chronic leukemia
-disease starts outside the _____
A
bone marrow
15
Q
leukemias
chronic myelogenous leukemia (CML)
-is usually diagnosed in adults
-is a myeloproliferative disorder that also includes polycythemia vera, primary thrombocytosis, and idiopathic myelofibrosis
-_____ is often present and _____ causes initiation of CML
A
philadelphia chromosome
BCR-ABL1
16
Q
chronic myelogenous leukemia (CML)
- _____ is often present and _____ causes initiation of CML
- the Philadelphia chromosome is present in more than _____ of those with CML, and the presence of the _____ protein is responsible for the initiation of CML
A
philadelphia chromosome
BCR-ABL1
95%
BCR-ABL1
17
Q
leukemias clinical manifestations CML -\_\_\_\_\_, \_\_\_\_\_, and \_\_\_\_\_ -\_\_\_\_\_ phase --lasts \_\_\_\_\_ years --symptoms: may not be apparent -\_\_\_\_\_ phase --lasts \_\_\_\_\_ months --primary symptoms develop: \_\_\_\_\_ -\_\_\_\_\_ phase --"\_\_\_\_\_ crisis" --survival: only \_\_\_\_\_ months
A
infections fever weight loss chronic 2 to 5 accelerated 6 to 18 splenomegaly terminal blast blast 3 to 6
18
Q
CML
- _____ cure for CML
- combined _____
- _____ modifiers
- _____
A
no
chemotherapy
biologic response
allogenic stem cell transplantation
19
Q
chronic lymphocytic leukemia (CLL)
- affects monoclonal B lymphocytes
- _____ fail to mature into _____ that synthesize _____. CLL is derived from transformation of a _____ that has not yet encountered _____
- has familial tendency
- is common in adults older than 50 years
A
B cells plasma cells immunoglobulins partially mature B cell antigen
20
Q
malignant lymphomas
- two major categories
- -_____
- -_____
- results from genetic mutations or a viral infection
A
hodgkin lymphoma
non-hodgkin lymphoma
21
Q
hodgkin lymphoma
- _____ in the _____
- -are necessary for the _____ but not specific to _____
- -are derived from _____ that usually become _____
- types
- -classic Hodgkin lymphoma
- -nodular lymphocyte-predominant hodgkin
A
Reed-Sternberg cells lymph nodes diagnosis hodgkin lymphoma malignant B cells binucleate
22
Q
hodgkin lymphoma
-_____ cells represent _____ and _____ of _____
A
reed-sternberg (RS)
malignant transformation
proliferation
B cells
23
Q
hodgkin lymphoma
clinical manifestations:
-enlarged painless neck lymph nodes
-_____, causing _____ and _____. local symptoms caused by _____ and _____ of the _____ are the result of _____
-mediastinal mass
-fever, weight loss, night sweats, pruritus, fatigue,
tests:
-chest x-rays, lymphangiography, and biopsy (biopsy most indicative of Hodgkin lymphomas)
A
lymphadenopathy pressure obstruction pressure obstruction lymph nodes lymphadenopathy
24
Q
non-hodgkin lymphoma
treatment
-survival: extended periods but less than the survival rate for Hodgkins lymphoma
-dependent on the type (B cell or T cell), tumor stage histologic status (low, intermediate, high grade), symptoms, age, and any co-morbidities
-_____ or _____
-combination of _____ and _____
-_____
A
chemotherapy radiation chemotherapy radiation monoclonal antibody: rituximab
25
burkitt lymphoma
- highly aggressive B-cell non-hodgkin lymphoma
- very fast growing tumor of the jaw and facial bones (Africa); rare in the US
- _____ in _____ of cases. the Epstein-barr virus, found in _____, is associated with burkitt lymphoma in _____ children
- in non-african burkitt lymphoma, the most common presentation is _____, _____, _____, and _____
```
EBV
90%
nasopharyngeal secretions
african
abdominal swelling
night sweats
fever
weight loss
```
26
alterations of splenic function
- splenomegaly: may be classified as pathologic
- hypersplenism: overactive spleen
- congestive splenomegaly: engorgement by macrophages with indigestible material from various "storage diseases"
- manifestation: anemia from red blood cells (RBC) destruction
- treatment: _____
removal of the spleen
27
what is a plasma cell?
- plasma develop from _____, a type of white blood cell that is made in the _____
- normally when bacteria or viruses enter the body some of the _____ will change into _____
- the plasma cells make _____ to fight _____ and _____, to stop infection and disease
```
B lymphocytes (B cells)
bone marrow
B cells
plasma cells
antibodies
bacteria
viruses
```
28
multiple myeloma
- in multiple myeloma, cells are _____ ( a the of white blood cell) that build up in the bone marrow and form _____ in many bones of the body
- normal plasma cells make _____ to help the body fight _____ and _____
- as the number of multiple myeloma cells increases, more antibodies are made
- this can cause the blood to _____ and keep the bone marrow from making enough healthy blood cells
- multiple myeloma cells also damage and weaken the _____
```
abnormal plasma cells
tumors
antibodies
infection
disease
thicken
bone
```
29
multiple myeloma
- plasma cell: end-stage cell of the humoral immune response
- examples:
- -_____
- -waldenstrom macroglobulinemia
multiple myeloma
30
multiple myeloma
-plasma cells proliferate in the bone marrow
-primary translocation involves immunoglobulin heavy chain on chromosome 14
-malignant plasma cells produce abnormally large amounts of one class of immunoglobulin
--M protein: abnormal antibody molecule
--_____ of the _____
(_____ proteins) can pass through the _____ and damage the _____ cells
```
unattached light chains
immunoglobulins
bence jones
glomerulus
renal tubular cells
```
31
```
multiple myeloma
clinical manifestations
-_____, renal failure
-anemia
-lytic lesions (round, "punched out" regions of bone)
-skeletal pain
-hyperviscosity syndrome
-recurring infections due to loss of the humoral immune response
```
tests
-radiographic and laboratory studies; bone marrow biopsy
hypercalcemia
32
multiple myeloma
the myeloma cells, (the cancer cells), in the bone marrow directly secrete _____ and stick to _____, inducing their production of several cytokines, one of them is _____
parathyroid hormone-related peptide
stromal cells
IL6
33
multiple myeloma and hypercalcemia
- _____ acts on an _____ and stimulates _____ to reabsorb _____
- this process results in _____ and _____ (high calcium in the blood) result from release calcium from the bone breakdown of bone
```
IL6
osteoclastic activating factor
osteoclasts
bone
bone lesions
hypercalcemia
```
34
why does your blood clot a lot?
thromboembolic disease
- certain conditions within the blood vessels predispose an individual to develop _____ spontaneously
- _____: a stationary clot attached to the vessel wall (made up of _____ and _____)
- _____: from under conditions of high blood flow and are composed mostly of platelets aggregates held together by _____
- _____: form in conditions of low flow and are composed mostly of red cells with larger amounts of fibrin and few platelets
```
clots
thrombus
fibrin
blood cells
arterial thrombi
fibrin strands
venous thrombi
```
35
tx of thromboembolic disease
- therapy consists of _____ or _____ of the _____
- anticoagulants (heparin, Coumadin) is effective in treating or preventing venous thrombosis, it is not useful in treating or preventing arterial thrombosis
- thrombolytic (streptokinase, urokinase) is are administered to accelerate the lysis of known thrombi
removal
lysis
clot
36
thromboembolic disease
- the risk of developing spontaneous thrombi is related to several factors below referred as the:
- _____:
1. _____ to _____
2. _____
3. _____ of the _____
4. _____
```
virchow triad
endothelial injury
blood vessels
turbulent arterial blood flow
rapid coagulation
blood
stagnant venous blood flow
```
37
thromboembolic disease
hypercoagulability (thrombophilia)
-is a condition in which a individual is at risk for thrombosis
-_____ (hereditary):
--results are the defects in proteins that are involved in hemostasis
- _____ (acquired)
- -causes include a variety of clinical disorder
primary
| secondary
38
why does your blood not clot?
disorders of coagulation
causes:
-defects or deficiencies of one or more clotting factors _____
-impaired hemostasis: inability to promote coagulation and the development of a stable fibrin clot. _____ of _____
-consumptive thrombohemorrhagic disorders _____
hemophilias
dietary deficiency
vitamin K
disseminated intravascular coagulation
39
why does the blood not clot properly??
- some clotting factors defects are inherited and usually involve a single factor such as _____ or von willebrand disease
- other coagulation defects are acquired and rend to result from deficient synthesis of clotting factors by the liver. causes include _____ and _____ of _____
hemophilias
liver disease
dietary deficiency
vitamin K
40
vitamin K deficiency
- impaired _____
- _____ is required for normal clotting factor synthesis by the _____
- -necessary for synthesis and regulation of prothrombin, procoagulant factors (VII, IX, X), and proteins C and S (anticoagulants)
- -deficiency: leads to bleeding
- -treatment: parenteral administration of vitamin K
most common cause of vitamin K deficiency is _____ with _____
```
hemostasis
vitamin K
liver
total parenteral nutrition
antibiotic therapy
```
41
disseminated intravascular coagulation consumptive thrombohemorrhagic disorders
- the description of DIC an _____ of _____ with subsequent _____ and accelerated _____
- DIC is an acquired clinical syndrome characterized by widespread activation of coagulation resulting in the formation of fibrin clots in medium and small vessels throughout the body
unregulated release
thrombin
fibrin formation
fibrinolysis
42
disseminated intravascular coagulation
clinical manifestations demonstrate wide variability
-bleeding from venipuncture sites
-bleeding from arterial lines
-bleeding from surgical wounds
-purpura, petechiae, and hematomas
-symmetric cyanosis of the fingers and toes
-diagnosis:
--most reliable and specific test for diagnosing _____- is a molecule produced by _____. the test measures a specific _____ related product
D-dimer
fibrin clots
DIC
43
```
thrombocytopenia (low platelets)
may cause these signs:
-petechiae
-purpura
-mucosal bleeding
-gingival bleeding
-spontaneous bruising
```
two diseases:
- _____
- _____
immune thrombocytopenic purpura (ITP)
| thrombotic thrombocytopenic purpura (TTP)
44
disorders of platelets
- immune thrombocytopenia purpura (ITP)
- -_____ antibody targets _____. antibody-coated platelets are sequestered and removed from _____. (_____ in the spleen remove _____ from circulation
- -acute form develops after viral infections.
- --is one of the most common childhood bleeding disorders
- -chronic form usually is found in adults
- bottom line point ITP is a
- -_____ with _____
```
IgG
platelet glycoproteins
circulation
mononuclear phagocytes
antibody-coated platelets
autoimmune disease
anti-platelet antibodies
```
45
purpura
| -a _____ discoloration caused by _____ into the _____
red-purple
diffuse hemorrhage
skin
46
disorders of platelets
thrombotic thrombocytopenic purpura (TTP)
-a thrombotic microangiopathy
--platelets aggregate and cause occlusion of arterioles and capillaries
- types
- -familial: is chronic, relapsing, and observed in children.
- -acquired idiopathic: is more acute and severe; observed mostly in women in their 30s
- TPP is:
- -_____ react with _____ to cause _____
platelets
endothelial cells
arterial occlusions
47
disorders of platelets
- IN TTP:
- _____ of symptoms
1. extreme _____
2. intravascular _____
3. _____ and _____ most often involving the CNS (approximately 65% exhibit memory disturbances, behavioral irregularities, headaches, or coma)
4. _____
5. _____
```
pathognomonic pentad
thrombocytopenia
hemolytic anemia
ischemic signs and symptoms
kidney failure
fever
```
