Hematology Terminology 2 Flashcards

Terms Definitions

treats acquired hemophilia
Increased RDW
What is epistaxis?
Disseminated intravascular coagulation
Insult results in excessive thrombin generation

Activating both coagulation and anticoagulation

Results in clotting and bleeding

Insults-- infections, cancer, trauma, brain injury, snake bite, burns, etc
List the Alkylating agents
Etiology -Immune (idiopathic) thrombocytopenia purpura (ITP) - autoimmune disorder of platelet consumption - antibodies bind to platelets, phagocytosis - often follows acute viral illness - thrombotyic thrombocytopenia - secondary thrombocytopenia - chemo, radiation, aplastic anemia, drug induced (quinine, sulfa) Lab findings - decreased platelet levels <100,000 Manifestations - bleeding, bruising, petecchiae, palpitations
Agonists of platelet aggregation
Thromboxane A2
mean corpuscular hemoglobin concentration (concentration of hemoglobin); determines normochromic, hypochromic
MCV calculation
HCT x 10
RBC (106/μL)
"plasmaphersis, chemo and rituximab"
Microtubule stabilizers
Paclitaxel: DLT - Myelosuppression,peripheral neuropathy, allergicreactions to injection are aproblem.Ixabepilone: diff binding spot. • Toxicity: Myelosuppression,peripheral neuropathy, hypersensitivityreactions.• Resistance: LOW SUSCEPTIBILITY toaltered tubulin and the P-glycoproteinand MRP1 efflux pumps
abnormal cytologic features and cellular organization that is a premalignant change
Name the stain
Periodic Acid Schiff
Describe acute monocytic leukemia, poorly differentiated in PB.
Binds to heme in vasculature
Preventing iron use by bacteria
Heme-haptoglobin is taken up and disposed of by macrophages

Used to monitor levels of intravascular hemolysis
Gray plt disorder
Absent alpha granules
Polychromatophilic macrocytes in the peripheral smear are defined as:
WBC increased
RBC increased
HGB increased
HCT increased
MCV increased
ESR decreased
platelets increased
polycythemia vera
What is hemarthrosis?
blood in the joint
Plasmin dissolves
"fibrin, factors 1, 5, 7"
Microtubule Destabilizers
Vincristine: DLT – peripheral neuropathy;Vinblastin: DLT – bone marrow suppression
In evaluating red blood cell morphology, this term refers to the blue-gray color of some younger red cells. Increased polychriomasia is a sign of a very active bone marrow.
20 – 50%1.2-3.4 x 10 3rd/μl
What type of anemia?
Iron deficiency
Microcytic anemia
AMoL - M5
DIC and renal insuff.
Neutrophilia define
Too many white blood cells
Symptomatic presentation of AML
Fatigue, dyspnea
Bruising, bleeding

DIC, bone pain, myeloid sarcoma/chloroma, organomegaly, CNS/gingival, cutaneous infilitration
Normal RBC range (women)
4.0-5.5 million/cub mm
Coagulation; maintain blood vessel integrity by beginning repair process
thrombocytes (platelets)
What is the count of erythrocytes
sezary syndrome
a perripherial blood picture dominating by cells that appear convolting with an ovoid nucleus and clefting is seen in
What virus is frequently present in the malignant cells of HL?
Thalassemia Subtypes
Beta Thalassemia - deficient beta chain synthesis; Alpha Thalassemia - deficient alpha chain synthesis
Direct Coombs Test
Looks for immunoglobulin and/or complement on the surface of RBCs (normally neither one is found on the RBC surface); Coombs Reagent - combination of anti-human immunoglobulin and anti-human complement; Reagent is mixed with patient's RBCs and if immunoglobulin or complement are on the surface, the reagent will link cells together and cause agglutination of RBCs
Disorders of heme synthesis. 7 different kinds of porphyrias have been distinguished, representing discrete deficiencies of each of the 7 enzymes beyond the first and rate-limiting step of the synthetic pathway of heme. Porphyrias take 2 major forms: thalassemias and hemoglobinopathies
What RXNs does B12 help
"Homocysteine--> Methionine, Methylmalonyl CoA--> succinyl CoA"
Differentiation agents
Tretinoin, ATRA (Altragen) - Retinoic Acid derivative Uses: acute promyelocytic leukemia (APL) caused by PML/RARα fusion protein. Arsenic trioxide (Trisenox) Uses: Acute promyelocytic leukemia (relapsed or refractory); in trials for multiple myeloma Mechanism: Not fully understood, but damages or degrades the PML/RARα fusion protein to enable partial differentiation and apoptosis;
A form of hemoglobin wherin the ferrous ion (Fe++). This may be due to toxic substances such as aniline dyes, potassium chlorate, or nitrate contaminated water.
iron aborbtion is increased with what vitamine
the average hemoglobin content of a RBC. Normal values: 26-34 pg. (a picogram [pg] = 10-12 gram)
exists when the platelet count is below 100,000 platelets per cubic mm of blood
This RBC form indicates?
Megaloblastic anemia, marrow failure
anemia general etiology
microcytic --> iron deficiency, thalassemia, sideroblastosis, lead poisoning

macrocytic --> folate or B12 deficiency, alcohol, liver disease, methotrexate, AZT, phenytoin

normocytic --> sickle cell, paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis, G6PDH deficiency, drug-induced

AOCD can be micro or normocytic
Describe schizocyte.
Red to salmon color. Fragmented erythrocytes; many sizes and shapes are present on a smear; often display pointed extremeties. Aka, schistocyte.
A delayed PTT indicates a deficiency or defect in what?
Sinus histiocytosis
Expansion of macrophages in the sinus

Indicative of adjacent cancer or infections
Lab findings in MDS
Microcytic anemia-- most common
Multiple cytopenias common

Smear -- macrocytes, acanthocytes, elliptocytes, nucleated RBCs, pseudo-pelger-huet, hypogranulated neutrophils
Polycythemia Diagnostic findings
Increased RBCs
Increased Hgb & Hct
Increased uric acid levels (due to increased RBC destruction)
Normal platelet lab value
150,000-400,000/microLiter (uL)
Type A has what kind of antigens?
The amount of time a granulocyte spends in the circulation before migrating into the tissues is normally:
bone marrow (myeloid tissue)
where does erythropoiesis take place?
Who is chronic ITP more common in?
Adult women
General HIV Prevention Strategies
Reducing sexual transmission rates; Most important is reducing RNA levels; Circumcision; Barrier use; Avoiding intercourse during activated immune system times (genital herpes, syphilis and gonorrhea)
Diagnosis Of Hodgkin's Disease
MUST see Reed-Sternberg cells; Reed-Sternberg cells MUST be accompanied by the appropriate cellular background in order to be diagnostic; Background infiltrate - mixture of benign lymphocytes, plasma cells, and eosinophils present in varying numbers, but ALWAYS present
Extra-Nodal Lymphoma
Involvement of sites other than lymph node (solid organs); More common in non-Hodgkin Lymphoma than in Hodgkin's (20-40% vs 4-5%); Common with recurrent disease and AIDS (non-Hodgkin Lymphoma is the most common AIDS-related malignancy); Contrast enhanced CT is the preferred imaging modality for staging, extent of organ involvement, assessment of nodal disease and response to therapy
Most common cause of inherited thrombophilia
Factor V Leiden
Prothrombin time (PT).
extrinsic and common pathways. Isolated prolongation of the prothrombin time is seen primarily in two conditions:i) vitamin K deficiency ii) liver disease.In each disorder Factor VII is low, used to monitor warfarin activity.
Microangiopathic Hemolytic Anemia
A hemolytic process associated with such conditions as TTP, prosthesis, and burns. It is visualized in the peripheral smear by fragmentation of the red cells and other bizarre morphology.
when blood is on the floor, must start administration within how long
General manifestations of anemia
Cardiovascular - chest pain, tachycardia, palpitations, orthostatic hypotension, thready pulse, cool, clammy skin Pulmonary - tachypnea, dyspnea Neuro - headache, vertigo, mental status changes Decreased exercise tolerance, fatigue
Which type of anemia is most prevalent in Mediterranean populations?
Sickle cell patients are susceptible to what infections?
Encapsulated organisms
Streptococcus pneumonia, Haemophilus influenza, and Neisseria meningitides
cold agglutinin anemia presentation
symptoms related to severity
cyanosis in nose, ears, fingers and toes
weakness, pallor
jaundice, dark urine
Describe chronic myeloid leukemia (CML) in PB.
-marked leukocytosis
-spectrum of myeloid cells with predominance of myelocytes and PMNs
-myeloblasts and promyelocytes (1-5%)
-with/without pseudo-Pelger-Huet cells
-eosinophilia and/or basophilia
-platelets are normal to increased
-with/without circulating micromegakaryocytes
-LAP markedly decreased
Where is von Willebrand’s factor located?
Inside platelets (secreted)
Workup for multiple myeloma
Bone marrow biopsy
Indolent lymphomas general course, treatment goals
Slowly progressive
Difficult to cure

Goals of chemo are extension of life with good quality

Only cure is allogenic HSCT
Five stages of hemostasis
1. Vasoconstriction
2. Formation of platelet plug
3. Thrombus formation via coagulation cascade
4. Termination of thrombus formation by control mechanisms
5. Removal of clot by fibrinolysis
Aplastic Anemia Diagnostic findings
Decreased RBCs, WBCs and platelets
Decreased reticulocyte count (immature RBCs)
Bone marrow examination
Decrease activity of bone marrow/no cell activity
what should not be given in thalassemia?
iron supplementation
The alpha thalassemic condition that is incompatible with life is:
Hydrops Barts Fetalis
5 liters
normal value for the total volume of blood
Hemophilia is a def. of what clotting factor?
Factor VIII
How much B12 does the typical western diet contain?
5-15ug/ day
Laboratory Diagnosis of Folate Deficiency Anemia
Decreased serum folate levels; Decreased RBC folate levels (more accurate than serum folate levels b/c serum levels are more diet-dependent); Elevated formiminoglutamic acid; Resolution of S/S following folate administration
Prolymphocytic Leukemia
A CLL variant that usually occurs in the elderly; Associated with massive splenomegaly, marked lymphocytosis (usually greater than 100,000 per microliter) and minimal lymph node enlargement; Peripheral blood reveals larger lymphocytes than are found in classical CLL
CLL may transform to
Richter's syndrome (Large B cell lymphoma)
Caused by a factor IX deficiency
Hemophilia B (Christmas disease)
Pernicous Anemia
A type of megaloblastic anemia due to a deficiency of vitamin B that is directly linked to absence of intrinsic factor (IF).
Names and examples of integral and peripheral proteins
integral: glycophorin A,B,Cperipheral: spectrin, band 4/1, Actin, Ankyrin
number (in millions) of erthyrocytes per microliter of blood

Detects altered erthyropoiesis, anemias, hemorrhage, Hodgkin disease, leukemia
RBC test
(red cell count)
What is a warm agglutinin?
IgG autoantibody that causes anemia
Hodgkin disease treatment
stage I and II --> radiotherapy
B symptoms or stage III or IV --> ABVD chemo (adriamycin, bleomycin, vinblastine, dacarbazine) has less side effects than MOPP chemo (meclorethamine, oncovin/vincristine, prednisone, procarbazine)

potential side effects --> permanent sterility, cancer, leukemia, aplastic anemia, peripheral neuropathy
Describe acute myelomonocytic leukemia in PB.
-myeloblasts and other immature myeloid cells
-monocytoid cells
-with/without auer rods
Precursor T cell lymphomas
Origin: immature T cells of thymus
Diffuse infilitration of thymus
Disease of teenagers, boys>girls
Aggressive and curable (70%)
Bone marrow sites (children)
tibia (there is still hematopoetic action in long bones in children)
What do macrophages do?
They bind phagocytize and kill pathogens opsonized by the antibody secreted from B cells that are activated
what anemia will cause microcytic hypochromic? (2)
1. iron deficiency
2. thalassemia
Features of the lymphatic system:
Blood filtration, antibody generation, lymphopoiesis
Prenatal Anemia: Fetal-maternal hemorrhage
acute or chronic; frequently occurs; diagnosed with kleihauer-betke test
Name 3 expected clinical manifestations of vWD? Are spontaneous hemathroses expected findings?
Epitaxis, gum bleeding, menorrhagia. No - rare.
Morphology of Iron Deficiency Anemia
Peripheral Blood Smear - hypochromia, microcytosis; Bone Marrow - decreased to absent stores of iron
Natural History of P.vera
Median survival of 10 years; Spent phase (resembles myeloid metaplasia with myelofibrosis); Rare progression to AML
What are Examples of Protease Inhibitors?
Aptivus, Invirase, Lexiva, Prezista, Reyataz, Viracept, Crixivan, Kaletra, Norvir
What 2 diseases associated with cold autoimmune HA
mycoplasma pneumonia and mono
Signs of this condition include a 'beefy' tongue (atrophic glositis), "intestinalization" of the stomach, and spinal cord degeneration
Signs of Pernicious Anemia
what leads to the pheripheal neuropathy found with pernicious anemia
decreased myelin, decreased potential of cells
pressure effects on oxygen release from hemoglobin
increase in pressure=higher affinity (more bound)decrease in pressure=lower affinity (more released)
What conversions require Calcium?
Activation of factor IX, factor X, factor XIII, Prothrombin & Fibrinogen
What are the characteristics of polymorphonuclear neutrophils (segs)?
-10-15 micrometers
-nucleus has 2-5 lobes connected by thin filaments without visible chromatin
-coarsely clumped chromatin
-pale blue to pink cytoplasm
-rare primary granules
-abundant secondary granules
-50-70% in PB
Marginal zone lymphoma treatment paradigm
Same as follicular
Watch and wait until meets criteria
Pathogenesis of increased white blood cell counts
Acute - demargination
Chronic -- changes in production and release from storage pools
Hemophilia Diagnostic Findings
Assays for factors VIII, IX and vWF
PTT is prolonged due to the intrinsic pathway problem
Normal platelets and PT
Where does differentiation and maturation of lymphocytes occur
The central Lymphoid organs (Bone Marrow/Thymus) Then encounter antigen and migrate to peripheral lymphoid oragans( Lymph nodes, spleen and peyers patches)
A dry tap is a characteristic of myeloid fibrosis wmyeloid metaplasia due to:
Increased fibrotic elements
4 tx for TACO?
1) Upright posture 2) O2 3) IV diuretics 4) Therapeutic phlebotomy in 250ml increments (if d/t RBCs)
Since MAHA is non-immune mediated hemolysis, what causes RBC destruction?
Shear stresses imposed by obstructive thrombi in the microvasculature damage RBCs as they pass through capillaries
What causes most megaloblastic anemias?
A deficiency in folic acid and/or cobalamin (vit. B12)
What are the 4 types of coagulation blood tests?
platelet count, Partial Thromoboplastin Time (PTT), Prothrombin Time (PT), Bleeding time
What does anemia of chronic disease occur from?
failure of renal/endocrine fxn (impaired erythropoetin prod. and BM compensation) or of renal excretory fxn (leads to hemolysis, BM cell depression and blood loss)
intracellular to extracellular ratios of Na, K, Ca, MG
I ENa 5.4-7 135-145K 98-106 3.6-5.0Ca .0059-.019 21-26.5Mg 3.06 .65-1.05
What molecule becomes built up if you are deficient of folate?
Homocysteine(converted to methionine by methyl THF)
Labs in Vit K deficiency
Prolonged PT and PTT, correct with mixing
Normal plt studies
Low II, VII, IX, X with preserved V
What is the cell-mediated response based on?
involves T Cells (Lymphocytes and macrophages_
basophils will respond to what kind of situations?
allergic and inflammatory rxn
Tx for bacterial sepsis?
1) Broad spectrum Abx 2) Tx shock 3) Inc. UOP if HUS
What is the hallmark finding in hemophilia A? What is critical complication of hemophilia A?
Hemarthrosis (knees, ankles, elbows). ICH.
Categorization of HIV/ AIDS
HIV: I - CD4>500, II - CD4 200-499, III - CD4
This condition is due to a failure of the bone marrow, leading to pancytopenia, and may be due to benzene, chloramphenicol, alkylating agents, radiation or vincristine (also caused by Parvovirus B19 in people with Sickle Cell anemia)
Causes of aplastic anemia
Colony-Forming Unit Committed to Erythropoiesis (CFU-E)
A stem cell that is committed to forming cells of the red blood cell series.
Where is the Alpha globin gene?
Chrom 16; 2 copies on each chromosome
Where are erythrocytes made Post natal in mammals
Extravasculary (bone marrow) and are anucleated
who is at risk for cobalamin deficiency?
pt who have had gastrectomy

(think anything that removes and impairs the ileum <lower end of the stomach>)
Name the 4 pathologic variants of pathologic subtype of HL. which is the most common?
1) Nodular Sclerosis (most common) 2) Mixed cellularity 3) Lymphocyte rich 4) Lymphocyte depletion (rare)
What is the glucose transporter in RBCs?
GLUT 1, which is not insulin sensitive
What are the main demographics of ITP?
Children 2-6 after a viral infection, women 20-40 years old
Name 3 types of anemia caused by impaired production of RBCs by the BM.
1) Normocytic 2) Macrocytic 3) Microcytic
What are the unique features of TTP/HUS?
Fewer neuro sequelae, but more renal manifestations
Usually precipitated by diarrheal illness, esp E. coli O157:H7 or Shigella
Seen more in pediatric patients
May respond less well to plasma exchange
how is absolute neutrophil count calculated?
by multiplying the total wbc by the percentage of neutrophils
Other than petechia and purpura, what additional clinical findings are expected in a pt w/ TTP?
1) Anemia 2) Fever 3) HA, confusion, ALOC
What is the Purpose/ Goal of primary hemostasis?
Formation of a platelet plug - involves the vascular endothelium, vonWillenbrand factor (vWF) and platelets
What values in a CBC are normal in a pt w/ anemia of chronic dz?
WBC, differential cell count, platelets, RBC indices
What are 3 types of T cells
T helper cells, T effector cells, T memory cells
What is the structure of a hemoglobin molecule?
a tetramer consisting of 2 pairs (4 total) similar polypeptide chains and to each of the 4 chains is attached a heme (iron and protoporphyrin)
What are the effects of aging on the hematologic system?
- RBCs are replenished more slowly after bleeding

- hemoglobin decreases

- serum iron and total iron binding capacity decreases

- lymphocyte function decreases

- platelet # and structure are not affected; however, adhesiveness probably increases
Why is there a Black Box Warning on Erythropoietin?
Because you shouldn't try to bring the Hg all the way back up to normal (14-18), you should just try to get it in the 10-12 range or people will develop DVTs
if bleeding is present after a bone marrow biopsy, what should the nurse do?
tell the pt to lie on their for 30 to 60 min
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