Hem-Onc

Question Answer
Neutrophils > Lymphocytes > Monocytes > Eosinophils >
WBC Differential
Basophils
Anisocytosis Varying sizes
Poikilocytosis Varying shape
NAACP: Neoplasia, Asthma, Allergies, Collagen vascular
Eosinophilia Cause
diseases (Churg-Straus), Parasites
INF-Gamma Activates macrophages
Phospholipid & Ca++
Mediated Factor Factors 5(10), 7, 9, 11
Activity
Vitamin-K Dependent
Factors 2, 7, 9, 10, Prot S, C.
Factors
Activated Protein C
Factor 8a, 5a (10a synthesis & effector co-factors)
Targets
Antithrombin III
Factor 9a, 10a, 11a (Intrinsic focus)
Targets
Kalikrein Function HMWK->Bradykinin & Plasminogen->Plasmin
Plasmin Function Cross-link Fibrin & C3->C3a
Platelet Aggregation
Pro: TXA2, Anti:PGI (prostacyclin) & NO
Regulation
HALT, said the hunter to his target: HbC, Asplenia, Liver
Target Cell DDx
disease, Thalasemia
MCV>100. High Retic Ct. Megaloblastic (DNA synthesis
Macrocytic Anemia problem). 1)B12,Folate Def 2)Sulfa drugs, AZT, Phenytoin
3)Reticulocytosis(secondary)
MCV<80. Etiology: 1)Iron Deficiency: Low Fe, High TIBC, Low
Microcytic Anemia Ferritin 2)Thalassemias Target cells 3)Lead
poisoning:dimorphic,sideroblastic cells
1)Hemorrhage, AI hemolytic anemia 2)G6PD (X-
linked),Pyruvate Kinase Def (AR) 3)Hereditary spherocytosis
Normocytic Anemia 4)Aplastic anemia/leukemia 5)Chronic Disease
(reticuloendothelial macrophages hide iron from potential
pathogens)
Transferrin FE/TIBC
TIBC Indicates the “need for iron”
Ferritin Indicates how much iron a person has
1)Radiation 2)Chemicals: Benzene, chloramphenicol, alkylating
Aplastic Anemia
agents, antimetabolites 3)Viral:ParvoB19, EBV, HIV
Etiology
4)Fanconi’s Anemia 5)Idiopathic.
Allogenic bone marrow xplant. RBC & platelet transfusion. G-
Aplastic Anemia Tx CSF, GM-CSF: Granulocyte (+Macrophage) Colony
Stimulating Factor
Low O2, H20-> Aplastic crisis (ParvoB19 infx), Spleen
Sickle Cell sequestration, Increased risk for encapsulated organism infx,
Complications, Tx Salmonella osteomyelitis, pain crisis (vaso-occlusion), renal
papillary necrosis. Tx: Hydroxyurea increases HBF production.
Hb H Beta tetramers. Only 1 functional Alpha gene. Thalassemia
Gamma Tetramers. No functional alpha gene. Hydrops Fetalis-
Hb Barts
fetal death. Thalassemia.
Major: Crazy hepatosplenomegaly. Crew cut skull. Frequent
Beta Thalassemia blood transfusions -> Hemachromatosis, heart failure. Minor:
Meh.
Warm Agglutinin IgG-mediated Chronic Immune Anemia: SLE, CLL, methyldopa
IgM-mediated Acute Immune Anemia: Mono, Mycoplasma
Cold Agglutinin
Pneumoniae
Rh negative mother’s serum antibodies attack newborn’s Rh+
Erythroblastosis Fetalis
RBCs
Determines Autoimmune cause of hemolytic anemias. Direct:
Coombs Test Anti-Ig antibodies agglutinate Ig-bound RBCs. Indirect: Pt’s
anti-RBC Igs attack & agglutinate normal RBCs
Paroxysmal Nocturnal Membrane defect(GP1 def)-> more susceptible to complement
Hemoglobinuria lysis. Elevated Urine Hemosiderin.
Microangiopathic “Fragmentation” hemolytic anemia. DIC, TTP, HUS, SLE, HTN-
Anemia > schistocytes.
STOP Making New Thrombi! Sepsis, Trauma, Obstetric
complications, acute Pancreatitis, Malignancy, Nephrotic
DIC Etiology
syndrome, Transfusion. Depletes coagulation cascade &
platelets.
Idiopathic v.
Idiopathic: Antiplatelet antibodies, more megakaryocytes.
Thrombotic
Thrombotic: Vascular damage-> thrombosis. Elevated LDH,
Thrombocytopenic
neuro & renal sx.
Purpura
Hemophilia A vs B A:Factor 8 deficiency. B: Factor 9 Deficiency. Both X-linked.
Bleeding Time, PT, Bleeding Time: Marker for platelets only, PT: Extrinsic PWY,
PTT PTT: Intrinsic PWY
Bernard-Soulier Low GP1b, low platelet ct.
Glanzmann’s
Low GP IIb-IIIa. Poor aggregation
Thrombasthenia
t(9;22) CML- Philadelphia Chromosome
t(8;14) Burkitt’s Lymphoma. C-myc
t(14,18) Follicular Lymphoma. bcl-2
Acute promyelocytic (M3-type) AML. Tx w/ all-trans retinoic
t(15,17)
acid
t(11;22) Ewing’s Sarcoma
t(11;14) Mantle Cell Lymphoma
Lagerhans macrophages w/ Birbeck Granules “Tennis rackets”
Histiocytosis X
->-> Restrictive Pulm Dz
Extrinsic Pathway 7, 10, 5, 2, 1
Intrinsic Pathway 12, 11, 9, 8, 10, 5, 2, 1
Most common heritable coagulopathy-> prolonged bleeding
vWF Disease time. Autosomal DOMINANT > Hemophilia A > B(XR). Normal
bleeding time.
AT3 Deficiency 1) Estrogen use 2)congenital