Velocity of blood flow is measured in

Centimeters per second.

True or False: Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions.

False

The principle Ig mediator of type I hypersensitivity reactions is

IgE.

Venous obstruction leads to edema because it ________ pressure.

increases capillary hydrostatic

The Philadelphia chromosome is a balanced chromosome translocation that forms a new gene called

bcr-abl.

When a patient is struck in the eye by a baseball, the result is redness and swelling. This increase in blood flow to a localized area is called

hyperemia.

The relationship of blood flow (Q), resistance (R), and pressure (P) in a vessel can be expressed by which equation?

Q = P/R

A 5-year-old patient’s parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk as a result of pain. The child’s most likely diagnosis is

ALL (acute lymphoid leukemia)

What is the correct definition of complete remission (CR) of leukemia?

CR is less than 5% blasts in marrow and normal CBC values.

A primary effector cell of the type I hypersensitivity response is

mast cells.

The hypersensitivity reaction that does not involve antibody production is type

IV.

Myasthenia gravis is a type II hypersensitivity disorder that involves

impaired muscle function.

Patients with immunodeficiency disorders are usually first identified because they

develop recurrent infections

Which form of leukemia demonstrates the presence of the Philadelphia chromosome?

CML (chronic myeloid leukemia)

What laboratory finding is usually found in aplastic anemia?

Pancytopenia

TRUE/FALSE The anemia resulting from a deficiency of either vitamin B₁₂ (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.

True

Pernicious anemia is caused by a lack of

intrinsic factor.

Excessive red cell lysis can be detected by measuring the serum

bilirubin.

Which vessel normally demonstrates the most rapid blood flow?

The vena cava

Red blood cells obtain nearly all their energy from metabolism of

glucose.

The conversion of plasminogen to plasmin results in

fibrinolysis.

The strength of the bond between oxygen and hemoglobin is known as the

oxygen-hemoglobin affinity

A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with

telangiectasia.

What is necessary for red blood cell production?

Iron

The primary source of erythropoietin is provided by the

kidney.

Which causes vasoconstriction?

Norepinephrine

An increase in hemoglobin affinity for oxygen occurs with

shift to the left.

TRUE/FALSE Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia.

False

Thalassemia may be confused with iron-deficiency anemia, because they are both

microcytic.

The final step in clot formation is

clot retraction.

A deficiency of von Willebrand factor impairs

platelet adhesion to injured tissue.

A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia?

Iron deficiency

The most appropriate treatment for secondary polycythemia is

measured to improve oxygenation

A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type
_____ hypersensitivity reaction.

III

group of clinical findings describes the typical presentation of ALL (acute lymphoid leukemia)?

Pain in long bones, infection, fever, bruising

In general, the best prognosis for long-term disease-free survival occurs with

ALL (acute lymphoid leukemia)

Certain autoimmune diseases are associated with the presence of specific proteins on a person’s cells.
These proteins are called ________ proteins.

HLA or MHC

Autologous stem cell transplantation is a procedure in which

Stem cells are harvested from the patient and then returned to the same patient.

A 58-year-old woman is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates
generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium
levels. The most likely diagnosis is

myeloma

The effects of histamine release include

increased vascular permeability

Renal insufficiency is a common complication of which disease?

myeloma

A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn most likely experiencing

vitamin K deficiency bleeding

A laboratory test finding helpful in confirming the diagnosis of iron-deficiency anemia is

elevated total iron-binding capacity

Dysfunction of which organ would lead to clotting factor deficiency?

Liver

The strength of the bond between oxygen and hemoglobin is known as the

oxygen-hemoglobin affinity

The most appropriate treatment for secondary polycythemia is

measure to improve oxygenation

When systemic vascular resistance is decreased, blood flow

decreases

A commonly ingested substance associated with prolongation of the bleeding time is

asprin

TRUE/FALSE Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle
cell anemia.

False, Vaccination for pneumococcal pneumonia should be performed before 2 years of age in patients with
sickle cell anemia and booster vaccinations given 3 to 5 years later.

The prothrombin time (PT) and INR (international normalized ratio) measure the integrity of

extrinsic pathway

The megakaryocyte is a precursor to

platelets

The most effective therapy for anemia associated with kidney failure is

erythropoietin administration

Which condition is associated with an elevated reticulocyte count?

Hemolytic anemia

What are the two specific immune cells

T-cells & B-cells

What are the Non-Specific immune cells

Eosinophils, monocytes, macrophages, neutrophils, basophils.

What are the two types of alterations in the immune function

Excessive Immune response & Deficient immune response.

Excessive Immune response

Over-or hyper-functioning of immune system

Deficient Immune response

inefective imunne response

What is autoimmunity?

The immune system attacks its own tissues.

What appears to increase the risk of autoimmune disorders?

MHC gene (HLA)

females at higher risk

Hypersensitivity describes...

The mechanism of injury

True or False

Hypersensitivity and autoimmunity will eventually lead to inflammation.

True

Treatment for autoimmunity...

Individualized immunosuppressive therapy

1. Corticosteroids & Cytotoxins (MTX)

2. Tumor necrosis facto inhibitors

3. Therapeutic Plasmaphersis

Treatment for Type 1 hypersensitivity include:

IgE blocker therapy: Inhibits binding of IgE to mast cells; Antihistamines: Block the effects of histamine; Epinephrine: Counter effect of histamine (Epi Pen); Beta-adrenergic: decrease bronchoconstriction; Corticoidsteriods: Decrease inflammation response; Anticholinergics: Block parasympathetic system.

Malignant transformation of B-cell plasma cells

Plasma cell myeloma

Myeloid lineage or Lymphoid lineage?

B cells, T cells, and NK cells.

Lymphoid lineage

Myeloid lineage or Lymphoid lineage?

Red blood cells, platelets, monocytes, granulocytes.

Myeloid lineage

An example of neoplasms from the myeloid lineage include alterations in:

A. Granulocytes

B. B cells

C. T Cells

D. NKA cells

A. Granulocytes

Classification of hematologic neoplasms categories based on...

The cell type of the neoplasm

What are the three most common manifestations of Leukemia?

1. Anemia

2. Thrombocytopenia

3. Leukopenia (neutropenia)

Main typical symptoms of malignant disorders of white blood cells?

Recurrent infections and enlarged, non-tender lymph nodes.

Main treatments for malignant disorders of white blood cells...

Chemotherapy and Stem cell transplant

What type of leukemia:

-Adult
-Philadelphia chromosome (Ph+)
- bcr/abl
-High granulocyte count on the CBC
-does not respond well to chemotherapy

CML (Chronic myeloid leukemia)

What type of leukemia:

-Abrupt onset

-Adults

-Poor prognosis

AML (Acute myeloid leukemia)

What type of leukemia:

-Most common, B cell precursors

-Bone Marrow infiltration: Reduces production of RBC/platlets

-Malignant lymphocytes invade lymphoid tissues and bone marrow-disrupt function

-asymptomatic, Usually found by accident in routine blood examination.

-5% associated with more aggressive T cells.

CLL (chronic lymphoid leukemia)

What type of leukemia:

-Primarily in children

-Better prognosis in children than adults

ALL (Acute lymphoid leukemia)

Hodgkins or Non-Hodgkin?

B cells/ EB virus/ 20-40ys male/ Contiguous lymphatic pathways/ Cervical nodes/ single node or localized node chain/ 85% 5 yr survival rate

Hodgkins

Hodgkins or Non-Hodgkin?

B, T and NK cells/ Burkitt lymphoma, Epstein Barr virus and HIV/ Older male/ Non-predicatable growth/ 50% 5-year survival rate

Non-Hosgkins

Associated with Reed-Sternberg cells, Hodgkins or Non Hodgkins?

Hodgkins

In Hodgkins, where is the most common site for lymph node enlargement?

Cervical nodes

In Non-Hodgkins what are two serious oncological emergencies that can occur

1. Superior vena cava obstruction

2. Spinal cord compression

-Most numerous

-4.2-6.2 million cells/mm3

-Buffer blood Ph-Carbonic anhydrase

Erythrocytes - RBC

Where is erythropoeitin (EPO) made?

Kidneys (only) in adults

newborns: LIver and kidneys

Nutritional requirements for erythropoiesis

requires adequate amounts of iron, protein, vitamins, and minerals

What is anemia?

Deficiency of red cells

What is polycythemia?

excess red cells

Absorption of B12 in the small intestine requires _______ _______, which is produced by the ______ ______ __ __ ________.

intrinsic factor

parietal cells of the stomach

Intestinal bacteria convert conjugated bilirubin into urobilinogen; execreted primarily in the stool but also in the urine is apart of what?

red cell destruction

What are the compensatory mechanisms to restore tissue oxygenation?

Increase HR, cardiac output, circulatory rate, and flow to vital organs. Increase in erythropoietin production/activity

SNS (sympathetic nervous system) activation:

Hypertension, HF, dyshythmia

Low oxygen-carying capacity leads to...

hypoxia

Stem cell disorder characterized by the reductio of hematopoietic tissue, fatty marrow replacement, and pancytopenia.

Aplastic anemia

Low RBC, WBC, and platelets

pancytopenia

How do you diagnosis aplastic anemia?

Diagnosed with bone marrow biopsy

Treatment for aplastic anemia

bone marrow transplantation

Failure of the renal endocrine function impairs erythropoietin production and bone marrow compensation.

Anemia of chronic renal failure.

Treatment for anemia of chronic renal failure

Diayalis, administration of erythropoietin, replacement of iron, folate and B12

Disruption in DNA synthesis of blast cells produces megaloblasts (macrocytic).

Anemia related to vitamin B12 (cobalamin) or folate deficiency

Due to lack of intrisic factors leading to vitamin B12 deficiency

Pernicious anemia

Clinical manifestations of pernicious anemia

Increase MCV, low RBC, WBC, and platelet count.

megaloblastic dysplasia.

Most common nutritional deficiency in the world.

Iron deficiency anemia.

In which anemia does serum ferritin level decrease

serum iron level decreased,

total iron binding capacity (TIBC) increased.

-microcytic

iron deficiency anemia

True or false;

Does iron deficiency cause Pica?

True

Treatment for iron deficiency anemia

Oral administration of ferrous sulfate or IV ferric gluconate (only in severe cases) Used for 4-6months

Increased RBC destruction (hemolysis) resulting in decreased RBC survival rates.

microcytic

Thalassemia

In Thalassemia,

associated with the mutant gene that suppresses the rate of globin chain synthesis

Autosomal recessive

term meaning: red blood cell size is smaller than the normal range

microcytic

Genetically determined defect of hemoglobin synthesis resulting in hemoglobin instability and insolubility.

Sickle cell anemia

Sickle cell anemia causes...

vascular occlusion

In what race is sickle cell almost exclusively in?

Black race

what cures sickle cell anemia

stem cell transplant

Maternal antibodies against Rh+ antigen on fetal RBC not inherited from mother causes...

from Rh incompatibility

Hemolytic disease of the newborn

What is the treatment for hemolytic disease of the newborn>

A standard dose of anti-RH immune globulin (RhoGAm) is given to the mother before or after delivery.

Initial response to a vascular injury involving the interaction between platelets and the endothelium of the injured vessel is....

the primary stage of hemostasis

Involves the formation of a fibrin clot through intrinsic and extrinsic pathways; coagulation

secondary stage of hemostasis

clot retraction

final stage of hemostasis

What is fibrinolysis?

Clot dissolution

When does fibrinolysis occur?

as fibrin clot is forming

What is the process of fibrinolysis?

Plasminogen activators

Plasmin digests fibrinogen and fibrin and inactivates factors V and VIII

What are critical for hemostasis?

Ca++ and Vit K

How do we evaluate primary and secondary hemostasis?

Laboratory test: CBC; Bleeding time: evaluates the vascular status and platelet function; PT/INR: assesses the extrinsic pathway of coagulation; aPTT assesses the intrinsic pathway.

In evaluating primary and secondary hemostasis, what does D-dimer reflect?

fibrinolysis

Caused by:Bone marrow suppression from chemotherapy; recent immunizations; alcohol ingestion

Thrombocytopenia

What is thrombocytopenia

Low platelet count. Prolonged bleeding time, petechiae, purpura.

What is the most common coagulation disorder?

Hemophilia

In laboratory test for the evaluation of primary and secondary hemostasis what foes PT/INR asses?

The extrinsic pathway of coagulation

What results from hemophilia?

excessive bleeding

Hemophilia is inherited by....

x linked recesisve (male dominant)

Hemophilia A is...

factor VII deficiency

Hemophilia B is...

(Christmas disease) factor IX deficiency

In hemophilia what is hallmark?

hemarthrosis

Autosomal dominant (equally make and female populaiton) caused by excessive bleeding.

Von Willebrand Disease

What are the causes of excessive bleeding in Von Willebrand Disease?

Prolonged bleeding time; prolonged aPTT

Normal platelet count, normal PT/INR

Acquired hemorrhagic syndrome in which clotting and bleeding occur simultaneouslt

(DIC) Disseminated Intravascular coagulation

Causes of DIC

trauma, malignancy, burns, shock and abruptio placentae

What happens to fibrinogen levels and platelet count in DIC

Decreases

Does bleeding time increase or decrease in DIC?

Increase

What happens to PT/INR/aPTT in DIC?

It is elevated

What happens to D-dimer/fibrin split products in DIC?

it is elevated

Treatment for DIC?

Fresh frozen plasma, packed RBC, platelets, or cryoprecipitate.

What is the treatment for hepatic disease?

Vitamin K administration and Platelet transfusion, fresh frozen plasma or whole/packed blood.

A stationary blood clot formed within a vessel or a chamber of the heart

Thrombus

Treatment for thrombus

anticoagulant therapy

thrombolytic drugs

surgery to remove thrombus

In a blood vessel obstruction, the arterial system obstruction manifests as...

distal ischemia

in a blood vessel obstruction, the venous system obstruction manifests as...

edema

An obstruction that results in reduced flow beyond the obstruction is....

downstream, ischemia

An obstruction that results in increased pressure before the obstruction

upstream, congestion

A traveling clot is a ....

embilus

An embolus leaving L ventricle is

Ischemia stroke

An embolus leaving R ventricle

pulmonary embolus

Hardening and narrowing in medium and large-sized arteries

Arteriosclerosis/atherosclerosis

In Arteriosclerosis/atherosclerosis

________ breach intimal layer; leukocytes and endothelial cells oxidize the lipids producing further damage.

Low-density lipoproteins

In Arteriosclerosis/atherosclerosis

Process______ to the arterial intima, initiating an inflammatory response and an increase in the vessel wall permeability.

initiated by endothelial surface damage.

In Arteriosclerosis/atherosclerosis

__________ normally confined to the other tunicas, drawn to the intima where they proliferate (hardening)

Media smooth muscle cells

In Arteriosclerosis/atherosclerosis

Excess lipid and debris accumulate within vessel wall and coalesce into lipid core.

Narrowing

In Arteriosclerosis/atherosclerosis, macrophages engulf the

lipids; foam cells

Arteriosclerosis/atherosclerosis, can lead to...

hypertension, cardiac and renal disease, peripheral arterial disease, stroke and myocardial infraction

what are nonmodifiable risk factors of Arteriosclerosis/atherosclerosis?

Age, gender, family history of CAD, ethnicity

what are modifiable risk factors of Arteriosclerosis/atherosclerosis?

physical activity, stress and mental health, tobacco usage, hypertension, cholesterol, obesity, glucose intolerance

Extreme vasoconstriction producing cessation of flow to fingers and toes.

Raynaud Syndrome

Localized arterial dilations, bulge otward

Aneurysms

Clinical manifestation of aneurysms

Aortic: sudden severe tearing pain, radiates into back/abdomen, shock

Classical signs of acute arterial occlusion (6P'S)

Pallor, paresthesia, paralysis, pain, polar, pulseless

Treatment for acute arterial occlusion

Medically and surgically