Hematology Oncology Study Questions

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Hematology Oncology Study Questions for Medical School

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<p>BasicQuestionsAnswersNotesNormal RangesNormal % of Myeloblasts5%Normal range for ANC1.5 to 8 (1000's)Normal range for WBC4,500 to 10,000Normal range for Platelets150,000 to 400,000AnemiaSickle cell disease patients up to age 5 need are given what prophylaxis?Penicillin for susceptibility to infectionLeukemiaAML is a cancer of which type?MyeloblastsWhat is leukostasis?Myeloblasts aggregating in the peripheral blood -&gt; Sludging*Seen in advanced AML (and others)Least common leukemia in children:CLL ( myelosuppressionClass of drugs that end in "ib"i.e. Imatinib (Gleevac)</p> <p>DiseasesQuestionsAnswersNotesAcute Myeloid Leukemia (AML)AML is a...</p> <p>Neoplastic accumulation of myeloblast (cell).AML:</p> <p>Age Group: ?Older (50's and 60's)AML:</p> <p>Dx: ?Bone marrow biopsy -&gt; Myeloblasts -&gt; 20 % (Auer Rods)Lineage confirmation w/ FLOW if needed -&gt; MPO+</p> <p>Secondary AML can arise from the following: (3)- Prior chemo- Radiotherapy- MDSTreatment for AML:Induction: "7+3+3" or "7+3"Cytarabine - 7 daysDaunorubicin - 3 days(Etoposide) - 3 days</p> <p>Consolidation (Booster)3 boosters</p> <p>Bone marrow transplant*85% relapse after remissionSymptoms of AML:Anemia -&gt; fatigue and dyspneaThrombocytopenia -&gt; pethechia and bleedingNeutropenia -&gt; infectionDiffuse bone pain -&gt; microscopic periosteal stretchingWhich blood malignancy is associated with MDR as a bad prognostic factor?AMLBad prognostic genetics for AML:-5, -711q23 (MLL gene)Good prognostic genetics for AML:Inversion with Chromosome 16t(8,21)*Better to have translocation than have normal cytogeneticsIn which blood malignancy does having a translocation have a better prognosis than having normal cytogenetics?AMLWhich genetic syndromes increase the likelihood of AML?Down's and Neurofibromatosus </p> <p>Acute Promyelocytic Leukemia (APL)Age range for APL:23's and 30'sThis blood malignancy has a disrupted Retinoic Acid Receptor (RAR).</p> <p>Which blood malignancy?APL</p> <p>Chronic Lymphocytic LeukemiaDefinitive diagnosis for CLL:Peripheral blood FLOW cytometry: </p> <p>CD5 (abberrant T-cell marker) plus CD5,19,20 (normal B-cell marker)CLL patient has thrombocytopenia:</p> <p>How can you tell if it's from immune-mediated thrombocytopenia (ITP) or Stage 4 CLL disease?Bone marrow biopsy -&gt; Look for megakaryocytesWhat is Richter's transformation?CLL progression to Diffuse Large B-Cell Lymphoma</p> <p>Week 1QuestionsAnswersNotes140811.1 Intro and Normal HematopoiesisInfants have hematopoiesis in which bones?All of themAs we mature, hematopoiesis gets restricted to these bones: (3)- breast bones- pelvic bones- proximal part of long bonesWhen does hematopoeisis start in utero?3 weeks*When the yolk sac developsWhere does hematopoeisis take place at 3 weeks?Yolk sac*First 6 weeksWhere does hematopoeisis take place at 12 weeks?Liver*6-18 weeksWhere does hematopoeisis take place at 27 weeks?Liver and Spleen*18-30 weeksWhere does hematopoeisis take place at 34 weeks?Liver, Spleen, and Bone Marrow*30 weeks - 8 weeks after birthWhere does hematopoeisis take place 3 weeks after birth?Liver, Spleen, and Bone Marrow*30 weeks - 8 weeks after birthWhere does hematopoeisis take place 12 weeks post-partum?Bone marrow only*After 10 weeks after birth6 stages of RBC development:- Pronormoblast- Basophilic normoblast- Polychromatophilic normoblast- Orthochromatic normoblast- Reticulocyte- RBCMean diameter of RBC8 umCentral pallor of RBC should be _____ of cell diameter1/3What are the 3 granulocytes?Neutrophils, eosinophils, and basophilsWhich granulocytes have pink granules?EosinophilsWhich granulocytes have blue granules?BasophilsWhat are the 6 stages of neutrophil development?- Myeloblast- Promyelocyte- Myelocyte- Metamyelocyte- Band- NeutrophilHow many lobes in a normal neutrophil?3 to 6 lobesHow many lobes in a normal eosinophil?2 lobes (bi-lobed)High eosinophil count might indication what type of infection?Parasite or helminth infection*Could also be season allergies or allergic reactionAllergens can bind to IgE on a basophil, which leads to a release of histamines.Monocytes circulate in the blood for 24 hours.Monocytes are white blood cells that are like "vacuum cleaners" because they eat up fungi, pyogenic bacteria, mycobacteria, and old or defective RBCs.2 morphological stages for lympocytes:Lymphoblast and lymphocyte*Cell surface markers need to be identified to further differentiate** Can't do it morphologicallyThe nucleus of a lymphocyte is about the same size as a RBC.NK cell surface markers:CD 16CD 56B-cell surface markers:CD 10CD 19CD 20CD 79asIg k/dT-cell surface markers:CD 3CD 4CD 5CD 7CD 8Plasma (memory) cell surface marker:CD 38Megakaryocytes rarely get out into peripheral circulation, but if they do, they get caught up.</p> <p>Where?Lung microvasculature*Smallest capillariesWhat is the largest collection of lymphoid tissue in a person?Spleen25% of our lymphocytes are where in the body?White pulp of the spleenT cells form PALS (Periarterial lymphatic sheaths) around the central arteries of the spleen.The red pulp of the spleen is composed of these 2 structural components and this very important cell:- Sinusoids- Splenic Cords ("Billroths" cords)</p> <p>- Monocytes/macrophages*Dark alley analogy where new cells can squeeze through small windows to escape monocytes but old cells get stuck and are destroyed**Extensive RBC damage leads to blood getting trapped in spleen140811.3 Laboratory Evaluation of hematologic parametersIf a patient's WBC count is too high or too low, what should you look at next?WBC differential</p> <p>Check "NLMEB" and make sure percentages are okay.When in life is RBC (red blood count) the highest?At birthAt what age does HbF decrease to a normal level?3 monthsNormal % for HbF:2%# of RBCs decreases with age. </p> <p>T/F?FALSE*Anemia is not a normal finding in the elderlyMCV tells you:Mean corpuscular volume</p> <p>Tells you the size of the RBCWhat is MCH and MCHC?MCH - Mean corpuscular hemoglobin- Avg. Weight of Hb / Cell</p> <p>MCHC - Mean corpuscular hemoglobin concentration- Avg. Concentration of Hb / CellNormal range for MCV:60-80 fLNormal range for RDW:Less than 12%Reticulocyte morphology:- Larger than an RBC- Less central pallor (Giemsa stain)- Pricipitated RNA (methylene blue stain)*Reticulocyte count not part of CBC - Need to order separatelyBasophilic stippling in RBCs is actually the precipitation of undegraded RNA and seen in (condition) lead toxicity.*It's a sign of ineffective hematopoiesisYou see basophilic stippling in a patient's peripheral blood smear:</p> <p>Immediately think: --&gt; (Dx)Lead toxicity*Basophilic stippling in RBCs is actually the precipitation of undegraded RNA and seen in (condition) lead toxicity.You see Target cells in a patient's peripheral blood smear:</p> <p>Possible Dx's (4):Anything that results in extra membrane or decreased cell volume</p> <p>- Hemoglobinopathies/Thalassemias - Iron deficiency anemia- Drug-induced hemolytic anemia- Liver diseaseYou see Schistocytes (helmet cells) in a patient's peripheral blood smear:</p> <p>You should think these Dx's: (2)Conditions w/ increased fibrin:</p> <p>- DIC / MAHA- TTPYou see Acanthocytes (thorn cells) in a patient's peripheral blood smear:</p> <p>Immediately think: --&gt; (Dx)Liver disease</p> <p>(Or something else that would affect the membrane morphology)*Liver dysfunction -&gt; decreased synthesis of cholesterol, which is needed for normal cell membraneIn Rouleaux, RBCs abnormally adhere to each other due to increased plasma protein production.You see Rouleaux in a patient's peripheral blood smear:</p> <p>Immediately think: --&gt; (Dx)Multiple myelomaHowell Jolly Bodies are remnants of nuclear chormatin normally removed by macrophages in the spleen.You see Howell Jolly Bodies in a patient's peripheral blood smear:</p> <p>Immediately think: --&gt; (Condition)Patient is functionally/surgically asplenic.You see Spherocytes in a patient's peripheral blood smear:</p> <p>Immediately think: --&gt; (Dx)Heriditary spherocytosis(Can also be acquired: physical damage of RBCs)What part of the body do you take a bone marrow biopsy?Flatter part of Posterior Superior Iliac CrestWhat is the normal range for myeloblast percentage?Less than 5%What do you do with a bone marrow aspirate? (Tests)Smear, FLOW, Cytogenetics (karyotype), FISHWhat do you use from a patient to run a metabolic panel?SerumWhat is SPEP?Serum Protein ElectrophoresisWhat is a sickle cell screen?RBCs are mixed with a reducing agen in a tube</p> <p>Turbidity = Hemolysis = Sickle CellAdd picture140811.4 Synthesis &amp; catabolism of Normal HemoglobinHeme molecules have a ring structure called:Protoporhyrin IXWhat is the charge of iron in a heme molecule?2+ (ferrous state)Globin chains:</p> <p>Alterations in the amino acid sequences result in different globin chains.Globin genes:</p> <p>The alpha genes are on chromosome 16.Globin genes:</p> <p>The beta, delta, and gamma genes are on chromosome 11:Humans have 2 copies of these hemoglobin chains per chromosome: (2)Alpha and gamma</p> <p>(Hemoglobin A and Hemoglobin F)*Because they are more importantHemoglobin A:</p> <p>Which globin chains?2 alpha2 betaHemoglobin A2:</p> <p>Which globin chains?2 alpha2 deltaHemoglobin F:</p> <p>Which globin chains?2 alpha2 gammaNormal % range for:- HbA2 - HbFHbA2: 3.5% HbF: 1-2%What is hemoglobin A1C?Glycated (Glycosylated) hemoglobin as a result of glucose being added to the beta chain*Used to monitor diabetic patients</p> <p>**Example of post-translational modification of hemoglobinBohr Effect:</p> <p>Low pH (acidic environment) shifts oxygen curve L/R?Shifts right (Oxygen more easily released into tissues)*Oxygen saturation (y-axis) is decreasing for any given partial pressure (x-axis)</p> <p>**Think lactic acid build up in muscles -&gt; Want more oxygen unloadedHigher relative levels of 2,3-BPG (bisphosphoglycerate) shifts oxygen curve L/R?Shifts right (Oxygen more easily released into tissues)*2,3-BPG causes Hb molecule to tense up and deoxygenateFever and acidosis:</p> <p>Oxygen curve shifts L or R?Shifts right (Oxygen more easily released into tissues)Hb values for newborns: </p> <p>Higher or Lower? Why?Higher</p> <p>Because they have fetal hemoglobin, which binds oxygen more tightly. Therefore need higher concentrations to unload oxygen to tissues.What is the Embden-Meyerhof pathway?Anaerobic glycolytic pathways for RBCs</p> <p>- Glucose gets metabolized to lactic acid- Input 2 ATP to get 4 ATP = Net gain of 2 ATP*Also generates 2,3-BPG!What are 2 important functions of 2,3-BPG for RBCs?- Shifts oxygen curve right -&gt; better oxygen delivery to tissues</p> <p>- Reduces methemoglobin (Fe3+) to hemoglobin (Fe2+)What is methemoglobin?Hemoglobin with iron in a Fe3+ state*CAN'T Bind Oxygen!Without the enzyme, G6PD, no NADPH is formed, which is needed for to metabolize glutathione.*Glutathione converts H202 (damaging oxidant), to waterThis enzyme deficiency, which can cause hemolysis, is the most common enzye deficiency in the world.G6PD deficiency*G6PD is essential to prevent oxidative stress, cell death, and lysis.G6PD deficiency puts the patient at risk for hemolysis when his cells are exposed to oxidative stress.*Example: AntibioticsWhat 3 important things should you know about the Embden-Meyerhof Pathway?- Energy (Input 2 ATP to get 4 ATP = Net 2 ATP- 2,3-BPG reduces methemoglobin into hemoglobin- G6PD from hexose monophosphate shunt prevents oxidative damage (hemolysis)Causes of Hemolysis:Intracorpuscular Hemolysis VS Extracorpuscular Hemolysis</p> <p>(Just Click and Read)Intra:RBC membrane disorders- heriditary spherocytosis or elliptocytosisRBC enzyme disorders- G6PD deficiency- Pyruvate kinase deficiencyHemoglobin Disorders- Methemoglobinemia- Thalassemia- Sickle Cell Disease</p> <p>Extra:- Antibodies- Sludging, trapping, destruction in spleen- Trauma (prosthetic valces, DIC, etc)- Chemicals (w/ oxidant properties)- Infectious destruction (malaria, babesiosis, etc)Free hemoglobin binds to haptoglobin and the complex is removed by the liver.Hemosiderin in the urine can indicate what type of hemolysis?Intravascular Hemolysis</p> <p>- Hb breaks down into alpha-beta dimers, which are small enough to be filtered by the glomerulus. - Some dimers are taken up into the renal tubular cells and the iron is stored as hemosiderin. - Renal tubular cells slough off into urine -&gt; can be detected.Which cells break down RBCs in the spleen (extravascularly)?MacrophagesWithin the splenic macrophage cytoplasm, RBC hemoglobin is broken down into 3 parts:</p> <p>Globin: --&gt; ExplainIron: --&gt; ExplainProtoporphyrin --&gt; ExplainGlobin: --&gt; Amino Acids (recycled)Iron: --&gt; Binds to Transferrin -&gt; Goes to Liver, Spleen, Bone Marrow (recycled)Protoporphyrin --&gt; Unconjugated Bilirubin -&gt; Binds to Albumin and sent to Liver -&gt; Eventually excretedEvaluating for Hemolysis:</p> <p>Increase of Decrease?LDH (Lactate Dehydogenase): Haptoglobin:Reticulocyte Count:Total Bilirubin:Indirect Bilirubin:Coomb's Test: (+/-)?LDH (Lactate Dehydogenase): IncreaseHaptoglobin: DecreaseReticulocyte Count: IncreaseTotal Bilirubin: IncreaseIndirect Bilirubin: IncreaseCoomb's Test: (+/-)? PositiveNutritional requirements for Chronic Hemolysis:Folic Acid: Supplementation requiredVitamin B12: Usually not required (Body has 10 yr store)Iron: Not required (iron gets recycled and stored)What is the purpose of a Direct (or Indirect) Coomb's Test?Test for Autoimmune Hemolytic Anemia- Agglutination = Positive Test</p> <p>Direct test uses patient's RBCs (antigen already stuck on them)Indirect uses store bought RBCs and patient's serum (which should have antibodies in it)</p> <p>Week 2QuestionsAnswersNotes140818.4 Myeloid Disorders - Beaty</p> <p>Pathoma Chap 5What protein is iron bound to when stored intracellularly?FerritinWhat protein is iron bound to when traveling in the blood?TransferrinEnterocytes transport iron into the bloodstream via ferroportin.What is the role of the acute phase reactant, hepcidin, when it comes to anemia of chronic diseaseSequesters iron into storage sites, preventing use by erythroid precursorsSuppresses EPO productionThe congenital defect that causes sideroblastic anemia most commonly involves the enzyme Aminolevulinic synthase (ALAS)What are the lab findings for sideroblastic anemia?FerratinTIBCSerum Iron% SaturationFerratin - IncreaseTIBC - DecreaseSerum Iron - Increase% Saturation - Increase</p> <p>Pathoma Chapter 6QuestionsAnswersNotesChapter 6.1 Leukopenia and LeukocytosisCD marker for Hematopoietic Stem Cells:Chapter 6.2 Acute LeukemiaAcute leukemia is a neoplastic proliferation of blasts (cell type).Acute leukemia is defined as a greater than 20% blasts in the bone marrow.Acute Leukemia</p> <p>Why is the WBC (in the blood) high?Overproduction of blasts -&gt; Leaks out into bloodWhat is the phenotypic marker for lymphoblasts?TdT*TdT is a DNA polymerase**TdT is absent in myeloid blasts and mature lymphcytesWhat is the phenotypic marker for myeloblasts?Myeloperoxidase (MPO)You see Auer Rods in a blood smear.</p> <p>What kind of cell are you looking at?Myeloblast -&gt; Probably looking at AML*Auer Rods are crystallized MPO (seen only in Myeloblasts)Presence of Auer rods indicates that your probably dea...</p>

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