patho II sec 5

hematopoiesis is...

a. erythropoiesis

b. development of the formed elements of blood from bone marrow stem cells

c. production of white blood cells only

d. production of white blood cells only

e. production of platelets only

b. development of the formed elements of blood from bone marrow stem cells

what are red blood cells

most common formed elements carrying oxygen to the cells of the body via their main component hemoglobin

what are white blood cells

mediators of immune responses to infection of other stimuli of inflammation

what are platelets

formed elements that participate in coagulation

what is plasma

largely water, electrolytes, and plasma proteins

what is the half-life of platelets

2-4 days

what is the physiology of RBC

filled with hemoglobin

8 micrometers

biconcave shape (for flexibility)

what is erythropoiesis

red blood cell production

what is the key regulator for red cell production

erythropoietin

what is red cell destruction

hemolysis

what occurs during red cell destruction

amino acids and iron are salvaged and reused

heme is converted to bilirubin and removed in the liver

what is anemia

significant deficit in the mass of circulating red blood cells

how do you determine the presence of anemia

hemoglobin or hematocrit

what is hematocrit

ratio of the volume of red cells in the total volume of blood

what are the general signs and symptoms of anemia

a. fatigue

b. pallor

c. increased respiration

d. increased HR

e. all of the above

e. all of the above

what are the possible causes of anemia

decreased red cell production

increased red cell destruction

blood loss

what are some causes of acute blood loss induced anemia

trauma, ulcer, hemorrhoids

what are some cause of chronic blood loss induced anemia

ulcer, vaginal bleed

what are some causes of nutrition induced anemia

low B12, low folate, low iron

what are some causes of bone marrow induced anemia

cancer, aplastic anemia, chemo, radiation, drugs

what are some causes of chronic anemia

renal, liver, infections, vascular

what are some causes of intrinsic anemia

G6PD deficiency, abnormal hemoglobin

what are some causes of extrinsic anemia

autoimmune, drug, infection

what does macrocytic mean

high cell volume

what does microcytic mean

small cell volume

what does hyperchromic mean

high hemoglobin

what does hypochromic mean

low hemoglobin

what things can cause macrocytic anemia

low B12, low folate

what things can cause microcytic anemia

low iron

what is megaloblastic anemia

enlarged, immature red blood cells

what are the most common causes of megaloblastic anemia

vitamin B12 and folic acid deficiency

phenytoin, methotrexate

what is pernicious anemia

decreased production of intrinsic factor causing B12 malabsorption

what are S/Sx of pernicious anemia

weakness, fatigue, pallor, SOB, tachycardia, neurological deficits, dysphagia, psychosis

how does pernicious anemia present

mild jaundice

elevated MCV

normal MCHC

neurological disorders

what are risk factors for folic acid deficiency

alcoholism, pregnancy, leukemia/lymphoma, malnutrition, Crohn's disease, trimethoprim

how does folic acid deficiency present

anemia, high MCV

what is hepcidin

iron-regulating peptide hormone made in the liver

controls delivery of iron to blood plasma from intestine and other sources

what are S/Sx of iron deficiency

pale nail beds, spooning of the nails, brittle nails, cravings for clay/ice/cornstarch

what are some possible causes of iron deficiency anemia

menstruation, GI loss (hemorrhoids, ulcers, NSAIDs), trauma, medications, malnutrition, pregnancy

what is transferrin

carrier protein for iron

what ferritin level defines iron deficiency

<10-15ng/mL

how does iron deficient anemia present

hypochromic, microcytic

what is the most common form of anemia and its most likely cause in a premenopausal women

a. hemolytic anemia, alcohol consumption

b. iron deficiency anemia, menstrual blood loss

c. anemia of chronic disease, pregnancy

d. vitamin B12 deficiency, diet

b. iron deficiency anemia, menstrual blood loss

where do WBC originate

bone marrow

what is the function of WBC

defense against disease

what are the two groups of WBC

granulocytes-neutrophil, eosinophils, basophils

agranulocytes-lymphocytes and monocytes

what is the function of neutrophils

first cells to go to an area of tissue damage

what is the function of eosinophils

action during allergic and parasitic infections

what is the function of basophils

inflammation

what is the function of lymphocytes

humoral and cell mediated immunity

destroy foreign cells

what is the function of monocytes

chronic inflammation and antigen presentation

what is leukopenia

decrease in the number of WBC

what can cause leukopenia

chemo, cancer, infections, autoimmune disorders, drugs

what is leukocytosis

increase in number of WBC

what can cause luekocytosis

infection, steroids, bone cancer, injury

what will bacterial infection cause

granulocytosis

what will allergic reaction cause

eosinophilia

what will viral infection cause

lymphocytosis

what will parasitic infectino cause

eosinophilia

what are the types of leukemia

chronic lymphocyte leukemia

chronic myelogenous leukemia

acute lymphoblastic leukemia

acute myeloid leukemia

what is the pathophysiology of leukemia

mutations in leukocyte precursor cells cause unregulated cellular proliferation which accumulate in the marrow and eventually spill out into peripheral blood

what is the presentation of ALL

more common in children

presents with recurrent infections, anemia, thrombocytopenia

what is the presentation of AML

more common in adults

presents with recurrent infections, anemia, thrombocytopenia, anorexia, and neurologic symptoms

what mutation causes CML

philadelphia chromosome contains BRC-ABL mutation

what causes CLL

neoplastic proliferation of B lymphocyte precursor

what defines hodgkin vs. non-hodgkin lymphoma

non-hodgkin lymphoma does not have reed-steenberg cell

hodgkin lymphoma does have reed-steenberg cells

what type of lymphoma is usually associated with epstein barr virus

burkitt lymphoma

what is the cell of origin of hodgkin lymphoma

B cells

what are the cells of origin of non-hodgkin lymphooma

B cells, T cells, NK cells

what does platelet production depend on

IL3, IL6, IL11, thrombopoietin

what is the function of platelets

coagulation

what is thrombocytopenia

low platelets

what are symptoms of thrombocytopenia

bleeding, bruising, fatigue

what are some causes of thormbocytopenia

hypersplenism, autoimmune disease, hypothermia, infection

what is HIT

autoimmune disorder that results in intravascular aggregation of platelets in response to administartion of heparin

what is ITP

idiopathic thormbocytopenic purpura

form of type II hypersensitivity with antibody formation against platelet antigens

when does ITP often present

after a viral infection

what is TTP

thrombotic thrombocytopenic purpura

platelet aggregation without activation of coag cascaded

who most often gets TTP

women in their thirties

what two things increase cancer risk

increased rate of cell proliferation

decreased cell differentiation

what differs in the way cancer cells vs. normal cells through

normal cells can only divide a limited amount of times before becoming senescent and undergoing apoptosis

cancer cells have some sort of mutation that stops them from undergoing apoptosis and it can multiply unchecked

what are characteristics of benign tumors

lost control of proliferation

remain localized

generally harmless

develop fibrous capsule

what are characteristics of malignant tumors

uncontrolled proliferation and loss of differentiation

rapid and uncontrollable growth

metastasis

frequently cause death

which of the following is a typical characteristic of benign tumors

a. benign tumors frequently metastasize to distant organs

b. benign tumors invade surrounding tissues aggressively

c. benign tumors remain localized and are generally harmless

d. benign tumors typically cause death

c. benign tumors remain localized and are generally harmless

what are carcinomas

malignant epithelial cells

what are adenocarcinomas

malignancy of glandular epithelial tissue

what are sarcomas

malignant connective tissue tumors

what are lymphomas

cancers of lymphatic tissue

what are leukemias

cancers of blood-forming cells

malignant tumors arising from connective tissue are classified as

a. adenocarcinomas

b. carcinomas

c. lymphomas

d. sarcomas

d. sarcomas

what happens as cells differentiate

they become more specialized and lose their capacity for proliferation or migration

what two qualities do cancer cells exhibit

autonomy: independent of normal cellular control

anaplasia: loss of differentiation-reverts to less mature form

what is: abnormal, proliferating cells possessing a higher degree of autonomy than normal cells

neoplasia

what is: lack of cellular differentiation or specialization; primitive cells

anaplasia

what is: a slow growing mass of cells that remains at the original site

benign

what is: cancer cells' independence from normal cellular controls

autonomy

what type of morphologic changes occur in neoplasia

hypertrophy- cells become large

hyperplasia- increased number of cells

dysplasia- cells lose shape/function

what is clonal evolution

repeated cycles of mutation and selection that progressively generate cells with greater proliferative potential

what is a genetic field defect

pre-malignant, genetically altered, or epigenetically modified area of tissue, often appearing histologically normal, that predisposes an entire tissue surface or organ to develop cancer

typically, how many genetic hits does it take to develop cancer

4-7