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Questions

HemeOnc - Anatomy
Polycythemia or (Erythrocytosis):
Disease state defined as increased hematocrit.
Anisocytosis = RBCs of varying sizes
Poikilocytosis = RBCs of varying shapes
Life span of RBC = 120 days
Approximately 13 of platelet pool is stored in the spleen.
NORMAL WBC differential from highest to lowest:
Neutrophils (5462%)
Lymphocytes (2533%)
Monocytes (37%)
Eosinophils (13%)
Basophils (00.75%)
What are the 3 granulocytes?
Blood smear shows Hypersegmented neutrophils ("polys"):
Think...
Probable Diagnosis: (2)
Band cells are immature neutrophils.

The presence of band cells in CBC:


Think
Probable Diagnosis

How to calculate Absolute Neutrophil Count:


Range for Neutropenia:
Blood smear:
WBC with:
- large, kidney-shaped nucleus
- "frosted glass cytoplasm"

Causes of eosinophilia: (5)


This cell helps limit allergic reations following mast cell
degranulation.
Cromolyn sodium prevents mast cell degranulation (used for
asthma prophylaxis).
Important CD markers for B Cells: (2)
B cells migrate to the white pulp of the spleen.
The costimulatory signal needed for T-cell activation:
The majority of circulating lymphocytes are T-cells.
Blood smear:
WBC with:
- clock-face chromatin distibution
- abundant RER, well-developed Golgi apparatus
Multiple myeloma is a cancer of the plasma cell.

anti-A and anti-B antibodies (RBCs) are IgM.


Anti-Rh antibodies are IgG.
Hemophilia A is a deficiency of Tissue Factor 8.
Hemophilia B is a deficiency of Tissue Factor 12.
Kallikrein activates bradykinin.
ACE deactivates bradykinin.

Answers

Notes

Neutrophils, Eosinophils, Basophils

- vitamin B12 deficiency


- folate deficiency

(Myeloid Proliferation due to)


Bacterial Infection
Chronic Infection/Inflammation
CML

Absolute Neutrophil Count = 10 * WBC count in 1000s *


(% PMNs + % Bands)
Neutropenia: ANC < 1500 cells / mm3

Monocyte

*When doing a differential WBC count,


neutrophils are usually divided into segs (a
mature neutrophil having a segmented nucleus)
and bands (an immature neutrophil with an
incompletely segmented or banded nucleus).
Band forms normally account for 0% to 4% of the
neutrophils, but during an active infection,
people are generally producing large numbers of
new neutrophils and therefore will have a higher
percentage of the immature band forms. (An
increase in band forms above 8% is referred to as
a "shift to the left"
"Absolute Neutrophil Count (ANC)" is useful
for a variety of things such as monitoring the
administration of colony stimulating factor or
assessing a patient's risk of infection during
administration of chemotherapy.

NAACP
- Neoplasia
- Asthma
- Allergic reactions
- Connective Tissue Disorders
- Parasites (invasive)
Eosinophils

*Produces histaminase and arylsulfatase

- CD19
- CD20
CD28
*80%

*IgM do NOT cross the placenta


*IgG do cross the placenta
**Erythroblastosis fetalis due to Rh antibodies

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Questions
140820.3 Chemotherapy
Hemorrhagic Cystitis is caused by an accumulation of
Acrolein.

How do you prevent hemorrhagic cystitis?


MESNA is indicated for:
MESNA mechamism of action:
Which class of chemo drugs cause myelosuppression?
What is typically the cause of the dose limiting toxicity for
alkylating agents?

Dangerous side effect of Cisplatin


If a patient has impaired renal function, would you give him
Cisplatin or Carboplatin?

Answers

Notes

- Vigorous hydration
- MESNA (mercaptoethane sodium)
*MESNA must be given before chemo treatment
- Cyclophosphamide > 1g/m2/dose
- Ifosfamide (any dose)
Binds acrolein (uroprotectant)
- Alkylating agents

*Must be given before chemo treatment


*Preventative; Too late if hemorrhagic cystitis is
present

Myelosuppression
- Nephrotoxic, but renally cleared
---Positive feedback cycle
- Patient must have good renal function

*Also nausea/ vomiting


"SPLAT" in Cisplatin

Carboplatin

*Cisplatin is very nephrotoxic

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