Human Pathology Exam 2

Hematocrit

volume of packed RBCs expressed as percentage of total peripheral blood

(Only includes RBCs)

Mean corpuscular volume/MCV

denotes mean volume of RBCs

Mean corpuscular hemoglobin/MCH

denotes content of hemoglobin per RBC

Mean corpuscular hemoglobin concentration/MCHC

denotes concentration of hemoglobin in RBC

Anemia

reduction of hemoglobin in blood to below-normal levels

Iron deficiency anemia

Dietary lack of iron or blood loss

Aplastic anemia

bone marrow is depleted of hematopoietic stem cells, only consisting of fibroblasts, fat cells, scattered lymphocytes

Pernicious anemia

autoimmune disease due to autoantibodies against parietal cells and intrinsic factor (B12 binds to IF for absorption, lack could be stomach cancer, gastric bypass surgery), with the most common cause being deficiency in B12

Macrocytic (megaloblastic) anemia

consequence of folate acid deficiency or vitamin B deficiency with fatigue, shortness of breath, weakness, and neurological symptoms

Sickle cell anemia

substitution of glutamic acid to valine (point mutation) resulting in synthesis of abnormal beta chains of globin

Thalassemia

genetic defect in synthesis of HbA that reduces rate of globin chain synthesis (no abnormal globin produced)

a-thalassemia

reduced synthesis of alpha chain of globin

b-thalassemia

reduced synthesis of beta chain of globin

Beta thalassemia minor/thalassemia trait

heterozygotes with mild, nonspecific symptoms

Beta thalassemia major

homozygotes with severe/serious disease needing chronic transfusions

Immune hemolytic anemia

antibody-mediated (IgG, IgM) destruction of RBCs

IgG Immune hemolytic anemia

Extravascular hemolysis (outside blood vessels)

Binds to RBCs at warm temperature (37 C, warm agglutinin)

Membrane antibody-coated RBC consumed by splenic macrophages resulting in spherocytes

Associated with SLE, and certain drugs (penicillin, cephalosporins)

Treatment: stoppage of drug, steroids, possible splenectomy

IgM Immune hemolytic anemia

Intravascular hemolysis (inside blood vessel)

Binds to RBCs at cold temperature, fixes complement (4 C, cold agglutinins)

Associated with Mycoplasma and infectious mononucleosis

Polycythemia/erythrocytosis

increase level of RBCs

Primary polycythemia/polycythemia vera

uncontrolled clonal proliferation of hematopoietic stem cells/RBCs due to mutation and decreased EPO

Secondary polycythemia

acquired increase RBC volume due to bone marrow hyperplasia from increased EPO

Leukopenia

decrease WBCs

Neutropenia/agranulocytosis

decreased neutrophils

Lymphopenia

decrease circulating lymphocytes

Leukocytosis

increase WBCs

Granulocytosis/neutrophilia

increase neutrophils/granulocytes

Eosinophilic leukocytosis/eosinophilia

increase eosinophils

Lymphocytosis

increase lymphocytes

Leukemia

malignant disease involving uncontrolled proliferation of abnormal white blood cell precursors in bone marrow and peripheral blood (acute, chronic; Myeloid or lymphoid); bone marrow infiltrated with malignant cells (>20% blasts)

Acute lymphoblastic leukemia/ALL

massive infiltration of bone marrow and peripheral blood with immature lymphoid cells (blasts)

Acute myeloid leukemia/AML

Clonal proliferation of myeloblasts in bone marrow (20% myeloblasts)

Chronic lymphocytic leukemia/CLL

malignant disease of lymphoid cells, involving lymph nodes (small lymphocytic lymphoma), resulting in lymphadenopathy

Chronic myeloid leukemia/CML

malignant disease of pluripotent hematopoietic stem cells; bone marrow and peripheral blood overgrown with malignant stem cells

Lymphoma

lymphoid cell malignant diseases predominantly involving/infiltrate lymph nodes, spleen, thymus, or bone marrow (Hodgkin's, non-Hodgkin's); can possibly involve other organs (extranodal spread of lymphoma)

Hodgkin's lymphoma

A malignancy of the lymphatic system that is distinguished by the presence of large, cancerous lymphocytes and reed-sternberg cells/owl eye cells

Non-Hodgkin's lymphoma

a malignant cancer that starts in the lymphocytes; includes diffuse large-cell lymphoma and follciular lymphoma

NHL Follicular

Slow growing with long-standing enlargement of lymph nodes, mild constitutional symptoms

NHL Diffuse

Common aggressive NHL, high-grade, with large lymphoid cells with irregular nuclear outlines and prominent nucleoli

Burkitt's lymphoma (8:14)

malignant tumor of small B cells associated with EBV

Extranodal masses more often than enlarged lymph nodes and starry night cells

Infectious mononucleosis/IM

EBV infection resulting in lymphocytic leukocytosis comprised of reactive CD8+ T cells

Multiple myeloma

malignant disease of plasma cells; malignant plasma cells proliferate, producing monoclonal M protein in bone marrow and destroy surrounding bone (bone fractures)

Hemophilia

sex-linked congenital clotting factor defect (inadequate production of clotting factors resulting in uncontrollable blood loss from injury requiring surgical intervention) along with subcutaneous hematomas (collection of blood in tissues under skin)

Hemophilia A

deficiency in clotting factor VIII (8; Antihemophilic factor)

Hemophilia B

deficiency in clotting factor IX (9; Plasma thromboplastin component)

P wave

atrial depolarization (contraction)

PR interval

AV nodal delay

QRS complex

ventricular depolarization (contraction) and atrial repolarization (relaxation)

ST segment

time where ventricles contract and empty

T wave

ventricular repolarization (relaxation)

R-R interval

Time between 2 ventricular depolarizations

Depolarization

contraction, systole

Repolarization

relaxation, diastole

Negative electrode

reference point anatomically, downward

Positive electrode

record electrical activity, upward

Blood pressure

highest reached during ventricular contraction/systolic pressure/contraction, lowest pressure when ventricles relaxed

Pre-load

pressure in ventricles at end of diastole/relaxing (results in filling)

After load

arterial resistance at end of diastole/relax ventricle overcomes to eject/pump/systole/contraction begins

Chronotropic

heart rate

Iontropic

cardiac contractile force (rate of contraction)

Dromotropic

speed of impulse transmission

Atrial septal defect/ASD

failure of proper closure of foramen ovale or defect in septum between the two atrium, resulting in blood from left atrium into right atrium due to pressure difference causing recurrent chest infections, heart failure, arrhythmias, and fixed widely split second heart sound

Ventricular septal defect/VSD

failure of fusion of interventricular septum, resulting in blood shunting through hole in interventricular septum resulting in heart failure, failure to thrive, and recurrent chest infections

Tetralogy of Fallot

unknown cause resulting in 1-4 characteristics; stenosis of right ventricular outflow tract, right ventricular hypertrophy, ventricular septal defect, and overriding aorta resulting in right-to-left shunt causing boot-shaped heart, a cyanotic episodes

Acute rheumatic fever

systemic compilation of pharyngitis due to group A (-hemolytic) streptococci affecting children 2-3 weeks after episode of streptococcal pharyngitis/strep throat, must be treated with antibiotics promptly or results in another condition

Chronic rheumatic heart disease

valve scarring as a result of rheumatic fever usually seen 20+ years after ARF causing mitral stenosis/fish mouth, affect aortic valve, and potentially infectious endocarditis

Nonrheumatic aortic stenosis

caused by congenital bicuspid aortic valve abnormality or calcified aortic stenosis placing strain on left ventricle with eventual heart failure; Aortic stenosis caused by degenerative changes in valve leaflet connective tissue followed by calcification, restricting valve mobility

Endocarditis

inflammation of heart layer affecting surface of cardiac cells, usually due to bacterial infection (streptococcus viridans, Group D) and has 2 types

Subacute infective endocarditis

caused by organisms of low virulence (mainly streptococci viridans), small vegetations, and do not destroy valve causing low-grade fever, mild symptoms of infection and treated with broad-spectrum antibiotics

Acute infective endocarditis

caused by highly virulent organisms (staphylococcus aureus), infecting normal valves (mostly tricuspid), resulting in large vegetations that destroy valve causing sudden high fever with chills, new onset of murmur and is treated with broad-spectrum antibiotics

Pericarditis

Inflammation of heart layer caused by viruses, COVID, traveling overseas, bacteria, and open heart surgery resulting in chest pain worsening with inspiration or supine position, diffuse concave ST elevations with PR depressions, and normal creatinine kinase

Myocarditis

inflammation of heart layer caused by viruses (coxsackievirus A/B), parasites, protozoa (trypanosoma cruzi) resulting in abrupt onset, possibly acute heart failure, diffuse myocardial degeneration, and necrosis with mononuclear inflammatory infiltrate

Dilated cardiomyopathy

dilation of all four chambers of heart resulting in systolic/contraction dysfunction of ventricles caused by idiopathic, genetic, myocarditis, pregnancy, alcohol abuse

Hypertrophic cardiomyopathy

massive hypertrophy of left ventricle due to genetic mutations of sarcomere proteins (needed for muscle contraction) causing diastolic/relaxation failure due to decreased cardiac output, sudden death via ventricular arrhythmia, and myofiber hypertrophy with disarray, common in young athletes

Restrictive cardiomyopathy

decreased compliance of ventricular endomyocardium that restricts filling during diastole/relaxation caused by amyloidosis resulting in congestive heart failure and decreased QRS amplitude

Nonrheumatic aortic stenosis

caused by congenital bicuspid aortic valve abnormality or calcified aortic stenosis placing strain on left ventricle (cor pulmonale on rigt ventricle) with eventual heart failure

Cor pulmonale

overload of right ventricle of heart from pulmonary hypertension due to abnormality putting strain on left ventricle

Atherosclerosis

chronic inflammation due to plaque build-up on artery walls

Tissue plasminogen activator/TPA

from endothelial cells to dissolve plaque

Coronary artery disease/CAD

due to atherosclerosis of large coronary arteries (accumulation of fatty materials containing cholesterol); also called ischemic heart disease (decreased O2) resulting in symptoms related to decreased blood supply to heart muscle

Treatment of CAD , stable angina and MI (4)

-Oxygen (for myocytes)

-baby aspirin (stops platelet sticking)

-nitroglycerin (vasodilation for blood flow)

-morphine (decreases pain and O2 demand of heart)

Angina pectoris

pain caused by myocardial ischemia

Stable angina

-Pain on exertion, subsides with rest, relieved by nitroglycerin (vasodilator)

-Due to atherosclerosis of coronary arteries with stenosis resulting in decreased blood flow that is unable to meet metabolic demand of myocardium during exertion

-No necrosis of myocytes

-Presents as chest pain (few minutes) that radiates down left arm or jaw, diaphoresis, shortness of breath

-EKG shows ST-segment depression due to subendocardial ischemia

-Treatment: Oxygen (for myocytes), baby aspirin (stops platelet sticking), nitroglycerin (vasodilation for blood flow), morphine (decreases pain and O2 demand of heart)

Unstable angina/NSTEMI

-Pain more frequently, lasting longer, less relieved by nitroglycerin

-Usually due to rupture of atherosclerotic plaque with thrombosis and incomplete occlusion of coronary artery

-Plaque + thrombus

-High chance of myocardial infarction

-NSTEMI, ST segment depression

Prinzmetal's/variable angina

-Occurs at rest, relieved by nitroglycerin or calcium channel blockers

-Due to coronary artery spasm

-ST segment elevation during episodes of chest pain but disappears as chest pain resolves

-STEMI

-Genetic condition

Myocardial infarction/MI

irreversible necrosis of myocardium due to prolonged ischemia (loss of O2)

Sudden cardiac death

unexpected death due to cardiac disease without symptoms or < 1 hour after symptoms arise due to fatal ventricular arrhythmia (VT/VF)

Ventricular tachycardia/VT

-High HR

-Regular rhythm

-Ventricle

-P wave non present or not apart of QRS

-No PRI

-Bizarre QRS

Ventricular fibrillation/VF

-No organized rythm

-Ventricle

-P wave absent

-No PRI

-No QRS

Atrial fibrillation/AF

-#1 cause of stroke

-High rate

-Irregular rhythm

-Atria

-No discernible P wave

-No PRI

-Normal QRS

Occlusion of left anterior descending artery/LAD

infarction of anterior wall, anterior septum of left ventricle (1st most common)

Occlusion of right coronary artery/RCA

infarction of posterior wall, posterior septum, papillary muscles of right ventricle (2nd most common)

Occlusion of left circumflex artery

infarction of lateral wall of left ventricle

STEMI

-ST elevation

-Complete occlusion of major coronary artery previously affected by atherosclerosis

-Full thickness damage of heart muscle

-Chest pain, nausea, vomiting, sweating, breathing difficulty

NSTEMI

-No ST elevation

-Complete occlusion of minor coronary artery or partial occlusion of major coronary artery previously affected by atherosclerosis

-Partial thickness damage to heart muscle

-Chest pain, nausea, vomiting, sweating, breathing difficulty

-ST segment depression or T wave inversion, does not progress to Q-wave (non-Q wave myocardial infarction/NQMI)

1) Zone of ischemia (loss of O2)

Myocardial ischemia causes ST segment depression, with/without T wave inversion resulting from altered repolarization (relax)

Outer

2) Zone of injury

Myocardial injury causing ST segment elevation, with/without loss of R wave

Middle

3) Zone of infarction

Myocardial infarction causing deep Q waves resulting from absence of depolarization (contraction) from current dead tissue, receding currents from opposite side of heart

Damage from lactic acid buildup in muscle

Inner

raised plaque deposit in artery

Atheroma

dilation of wall of artery or outpouching of portion of arterial wall

Aneurysms

atherosclerotic clot/plaque causes weakening of vessel wall

Atherosclerotic aneurysm