[04.13b] Approach to a Patient with a Hematologic Complaint (Part 2) V2.1.pdf

Formation of clots at unusual sites where and when clotting is not needed

What is the definition of thrombosis?

Cerebrovascular infarct

What condition, commonly known as stroke, results from clotting of the vessels in the brain?

Myocardial infarction

What condition results from clotting of the vessels that supply the heart?

Platelet mediated

Arterial thrombosis is usually mediated by what?

Atherosclerosis or damage to the arteries

What underlying issues cause arterial thrombosis?

Less turbulence in the veins, slower flow

What conditions in the veins allow for the formation of stronger fibrin clots?

Disorder of anticoagulants

Venous thrombosis is usually caused by a disorder of what?

Secondary hemostasis

Venous thrombosis is usually secondary to a disorder in what phase of clotting?

Immobility

What factor causing venous thrombosis includes sitting for long periods of time or being bedridden?

Orthopedic surgeries (e.g., hip replacement surgery)

What specific surgery commonly leads to immobility and increased risk of venous thrombosis?

Sepsis

What underlying medical condition can also lead to the formation of clots?

Antiplatelet agent

What type of medication is typically given for arterial thrombosis?

Anticoagulants

What type of medication is typically given for venous thrombosis?

Whether it was provoked or unprovoked

What is the most important predictor if thrombosis would recur?

Acquired with risk factors (e.g., immobility for a prolonged period)

What characterizes provoked thrombosis?

Occurs despite the absence of risk factors

What characterizes unprovoked thrombosis?

Unprovoked Thrombosis

What is the strongest predictor in the recurrence of venous thrombosis?

Unprovoked Thrombosis

What type of thrombosis often requires treatment for a prolonged period?

Deep Vein Thrombosis (DVT)

Unilateral leg swelling is associated with what specific condition?

Unilateral swelling, Painful

What are the usual presentation symptoms of a "blood clot in the legs"?

Thrombosis

What indicates that there is no blood supply going to the organ?

Vascular wall injury, circulatory stasis, and hypercoagulable state

What are the three components of Virchow's Triad?

Smoking, Diet, Exercise

Name three modifiable factors that contribute to thrombosis risk?

Age, Genetics

Name two non-modifiable factors that contribute to thrombosis risk?

Thrombophilia

What is another term for a hypercoagulable state?

Pregnancy

What condition is a hypercoagulable state risk factor because blood vessels are compressed?

Trauma

What event, combined with immobility, puts patients at risk for a hypercoagulable state?

Older patients

Which age group is generally more susceptible to form clotting and thrombosis due to vessel injuries?

Younger patients having thrombosis/stroke

What specific thrombotic event needs to be investigated because it is not normal?

Younger females

Which sex/age group is more prone to "unusual sites" thrombosis due to hormonal changes (e.g., estrogen)?

Estrogen

What hormone is associated with "unusual site thromboses" in females, such as those taking oral contraceptives?

Thrombophilia (e.g., Factor V Leiden, Prothrombin G20210A, Protein S deficiency)

What family history condition should be asked about, especially in unprovoked thrombosis?

Less than 40 years old

At what age must a family member have suffered a stroke to suggest a risk of hereditary thrombophilia?

Antiphospholipid antibody syndrome (APAS)

What specific clinical condition is a risk factor for thrombosis?

Myeloproliferative disorders (e.g., Polycythemia vera, essential thrombocythemia)

What group of hematologic disorders are risk factors for thrombosis?

Protein C, Protein S

Decreased levels of which natural anticoagulants increase the risk of thrombosis and are common in Asians?

Antithrombin III

Decreased levels of which anticoagulant increase thrombosis risk because no one will "fight off" the clotting?

Factor V Leiden

What genetic factor involves resistance to activated protein C and is common in Asians?

Protein C and S deficiency

For what specific deficiencies must anticoagulants be given indefinitely if thrombosis occurs?

After the acute event and off medications

When is it necessary to repeat thrombophilia lab tests?

False

Is it true or false that the most important predictor if thrombosis would recur is age?

False

Is it true or false that provoked thrombosis occurs despite the absence of risk factors?

False

Is it true or false that the Virchow’s Triad involves hypocoagulability states?

B- and T-Lymphocytes, Plasma Cells

Name three cell types produced by the Lymphoid lineage.

Erythrocytes, Megakaryocytes, Granulocytes, Monocytes

Name four cell types produced by the Myeloid lineage.

Myeloblast, Promyelocyte, Myelocyte, Metamyelocyte, Band/Stab Form, Neutrophil

List the stages of granulocyte development in order.

Immature cell, prominent nucleolus

What characterizes a myeloblast?

Largest cells with primary granules

What characterizes promyelocytes?

Kidney bean-shaped nucleus

What characterizes a metamyelocyte?

Thinner

What characterizes a Band/Stab form cell?

Segmented

What characterizes a mature neutrophil?

CD33, CD15, CD13

Name three CD markers seen in earlier stages of granulocyte development.

Lymphoid stem cell, Lymphoblast, Prolymphocyte, Lymphocyte

List the stages of lymphocyte development in order.

Plasma cells

What specialized cells do some B lymphocytes mature into?

Spleen

What is the largest lymph node in the body?

Absolute Neutrophil Count

What does ANC stand for?

Less than 1,000 cells per microL

What ANC defines neutropenia?

WBC multiplied by (percent neutrophils plus percent stabs) multiplied by 1000

What is the formula for Absolute Neutrophil Count?

Increased susceptibility to bacterial infections

What risk is associated with ANC less than 1,000 cells per microL?

Endogenous microbial flora

If ANC is less than 500 cells per microL, what may cause infections?

Absent local inflammatory responses

What occurs when ANC is less than 200 cells per microL?

Fever

What is a key clinical manifestation of infection in neutropenic patients?

Oral ulcers (singaw) and boils (pigsa)

Name two signs to examine in neutropenic patients?

Drugs

What is the most notorious cause of neutropenia?

Chemotherapeutic drugs and antithyroid drugs

Name two classes of drugs that are common causes of neutropenia?

Infection

What is the most important cause of neutrophilia?

Persistent WBC greater than 30 x 10 power 9/L

What WBC count is characteristic of leukemoid reaction?

Polyclonal origin

What is the cell origin in a leukemoid reaction?

Left shift

What term describes the presence of immature cells (e.g., metamyelocytes, stab cells) in peripheral blood due to high recruitment?

Bacterial infections

Neutrophilia is particularly caused by what type of infection?

Steroids

What medication causes neutrophilia by causing the release of neutrophils?

Squamous cell malignancies of the lung and ovaries

Name two specific malignancies that can cause neutrophilia.

Kulani

What is the common term for lymphadenopathy?

Benign, reactive, non-specific etiologies

What are the most common etiologies of lymphadenopathy?

Sore throat, cough, fever, night sweats, fatigue, weight loss

Name four concurrent illnesses to ask about when assessing lymphadenopathy?

Pain

What characteristic of lymph nodes is generally considered a good sign because it usually indicates infection?

1 cm

What size (like a monggo seed) or smaller are cervical lymph nodes usually considered benign?

More than 1 cm

What size of cervical lymph nodes warrants investigation?

2 cm

What size or smaller are inguinal lymph nodes usually considered benign?

More than 2 cm

What size of inguinal lymph nodes warrants a biopsy?

Axillary lymph nodes

What lymph nodes can be affected by primary breast tumors or breast cancer spread?

Submandibular cervical lymph nodes

What lymph nodes are often affected by dental infections?

Systemic examination

What type of examination should be performed to avoid missing any lymph nodes in the body?

Supraclavicular nodes

Which lymph nodes are usually malignant because there is typically no local drainage nearby?

Epitrochlear and brachial nodes

Which nodes, if found enlarged, are always considered pathologic?

Mediastinal, para-aortic, and paravertebral nodes

Name three inaccessible nodes that require imaging, and are always pathologic if enlarged (mesenteric/paraaortic).

Age greater than 50

What age group suggests that lymphadenopathy is usually more malignant than benign?

TB and lymphoma

Cough, fever, night sweats, and weight loss can be symptoms of what two diseases?

Large, painless, mobile, firm, rubbery, discrete

What four characteristics describe a suspicious lymph node that needs investigation for malignancy?

Fixed to underlying tissues

What characteristic of a lymph node is alarming and may be due to metastasis or lymphoma?

Supraclavicular or scalene lymphadenopathy

What location of lymphadenopathy is abnormal and most likely points to a metastasis or malignancy?

Sister Mary Joseph’s nodule

What condition involves lymph nodes protruding from the abdomen, usually due to abdominal malignancies?

Virchow’s nodes

What is the term for supraclavicular sentinel lymph nodes commonly affected in gastric cancer?

Complete Blood Count (CBC)

What initial lab test for lymphadenopathy assesses the presence of atypical cells or pancytopenia?

Mediastinal, para-aortic, and paravertebral nodes

What three groups of nodes are checked via imaging studies because they are inaccessible by palpation?

Monospot test

What serological study is used for screening infectious mononucleosis?

Excision biopsy

What type of lymph node biopsy is the definitive way of determining the pathology of lymphadenopathy by extracting the whole node?

Less than 250 grams

What is the normal weight of the spleen?

13 cm in diameter upon ultrasound

What is the normal size of the spleen based on ultrasound?

Removal of senescent red blood cells, Immune functions

What are the two main functions of the spleen?