Red Blood Cell and Bleeding Disorders

• anemia
  • iron deficiency
• thalassemia
• sickle cell anemia

 

• blood loss
• shock

Clotting Disorders

• thrombosis
• deep vein thrombosis
• disseminated intravascular coagulation (DIC)

 

Leukemias and Lymphomas

• acute myeloid leukemia
• chronic myelogenous leukemia
• Burkitt's lymphoma
• follicular lymphoma

 

Leukemias are malignancies beginning in a hematopoietic stem cell.

 

leukemias contain one or more somatic mutations leading to their transformation.

Leukemias are white cells located in the blood or bone marrow

• acute leukemias tend to involve blast cells or their equivalents
• chronic leukemias are more mature cells

acute myelogenous leukemia (AML) - 40%

chronic myelogenous leukemia (CML) - 15%

acute lymphocytic leukemia (ALL) - 11%

chronic lymphocytic leukemia (CLL) - 30%

other - 4%

 

pediatrics

• ALL
• AML

 

Lymphomas are lymphocyte proliferations which originate in a solid tumour of the reticuloendothelial system.They can begin in the lymph nodes, spleen, liver, or bone marrow.

• Hodgkin's lymphoma
• non-Hodgkin's lymphoma

 

lymphoma staging:

Stage I: single nodal region or lymphoid structure

Stage II: 2 or more node regions, on the same side of diaphragm

Stage III: nodes on both sides of diaphragm

Stage IV: extralymphatic involvment

 

A: no B symptoms

B: fever, night sweats, >10% weight loss in past 6 months

 

 

Monoclonal gammopathy

monoclonal protein = paraprotein

• may be in serum or urine
• intact Ig or light chain
• caused by clonal expansion of plasma cells or B lymphocytes

MGUS (monoclonal gammopathy of unknown significance)

• fairly common
• relatively low M protein
• no lytic lesions or problems with bone marrow
• no immunosuppression
• asymptomatic, other than rare peripheral neuropathy

multiple myeloma

Waldenstrom's macroglobulinemia

• IgM, with marrow infiltration of lymphoplasmacystoid cells
• can cause hyperviscosity syndrome: fatigue, HA, decreased LOC, visual change, Raynaud's

Hemolytic Disorders

• disseminated intravascular coagulation (DIC)
• throbotic thrombocytopenic purpura (TTP)
• hemolytic uremic syndrome (HUS)
• HELLP syndrome - hemolysis, elevevated liver enzymes, low platelets

Hemolysis workup:

• indirect bilirubin
• haptoglobin
• reticulocyte %
• peripheral smear

Platelet Disorders

• thrombocytopenia
• thrombocytosis

Bone Marrow Disorders

Myeloproliferative disorders, along with other space-occupying lesions, can have a tendency to push cells out before they are ready. This could lead to blasts present.

 

• chronic myelogenous leukemia
• myelofibrosis
• essential thrombocytosis
• polycythemia

Other Disorders

• post-splenectomy complications
• Rh disease

Basophilia

• infection, especially parasites
• myeloproliferative disorders
• endocrinopathy
• allergy

• malignancies
• ulcerative colitis
• hemolysis