Multiple Myeloma and Splenic Function Alterations
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Questions and Answers

What condition is characterized by malignant proliferation of plasma cells leading to skeletal pain and renal failure?

  • Lymphadenopathy
  • Multiple Myeloma (correct)
  • Hypersplenism
  • Splenomegaly
  • Which symptom is NOT typically associated with Multiple Myeloma?

  • Pancytopenia
  • Spinal cord compression
  • Hypercalcemia
  • Hepatomegaly (correct)
  • Which of the following is a treatment option for hypersplenism?

  • Chemotherapy
  • Splenectomy (correct)
  • Radiation therapy
  • Bone marrow transplant
  • What does congestive splenomegaly indicate?

    <p>Liver disease involvement</p> Signup and view all the answers

    How is Multiple Myeloma primarily diagnosed?

    <p>Bone marrow biopsy</p> Signup and view all the answers

    What platelet count is classified as thrombocytopenia?

    <p>Less than 150 x 10^9/L</p> Signup and view all the answers

    Which of the following is NOT a clinical manifestation of thrombocytopenia?

    <p>Hypercalcemia</p> Signup and view all the answers

    What is a likely cause of thrombocythemia?

    <p>Primary overproduction of megakaryocyte cells</p> Signup and view all the answers

    In patients with heparin-induced thrombocytopenia (HIT), the primary problem is caused by which mechanism?

    <p>Destruction of platelets by IgG antibodies</p> Signup and view all the answers

    What happens to platelet counts after a splenectomy?

    <p>Platelet counts increase as platelets have nowhere to go</p> Signup and view all the answers

    What is a common cause of impaired hemostasis?

    <p>Inherited defects of clotting factors</p> Signup and view all the answers

    Which of the following is a characteristic of Disseminated Intravascular Coagulation (DIC)?

    <p>Simultaneous clotting and hemorrhage</p> Signup and view all the answers

    What underlying condition can exacerbate bleeding in a person with DIC?

    <p>Consumption of platelets</p> Signup and view all the answers

    Which symptom is commonly associated with Idiopathic Thrombocytopenic Purpura (ITP)?

    <p>Decreased platelet counts</p> Signup and view all the answers

    What is a potential etiology of Disseminated Intravascular Coagulation (DIC)?

    <p>Chronic liver disease</p> Signup and view all the answers

    Which type of anemia is characterized by large stem cells in the bone marrow that result in unusually large red blood cells?

    <p>Macrocytic-Normochromic Anemia</p> Signup and view all the answers

    What is the primary cause of pernicious anemia?

    <p>Absence of intrinsic factor from gastric parietal cells</p> Signup and view all the answers

    Which clinical manifestation is NOT commonly associated with anemia?

    <p>Elevated blood pressure</p> Signup and view all the answers

    Which treatment option is specifically designed to suppress anti-platelet antibodies?

    <p>IVIg infusion</p> Signup and view all the answers

    What term describes the shape of red blood cells that are smaller than normal in microcytic-hypochromic anemia?

    <p>Microcytic</p> Signup and view all the answers

    How does hypoxemia contribute to heart failure?

    <p>Increases heart rate to compensate for low oxygen</p> Signup and view all the answers

    Which vitamin deficiency is primarily responsible for ineffective DNA synthesis in pernicious anemia?

    <p>Vitamin B12</p> Signup and view all the answers

    Which of the following factors is NOT commonly associated with reduced red blood cell production?

    <p>Excessive red blood cell production</p> Signup and view all the answers

    What is the most common type of anemia worldwide?

    <p>Iron Deficiency Anemia</p> Signup and view all the answers

    Which symptom is specifically associated with vitamin B12 deficiency in its late stages?

    <p>Jaundice</p> Signup and view all the answers

    What characterizes microcytic-hypochromic anemias?

    <p>Abnormally small RBCs with insufficient hemoglobin</p> Signup and view all the answers

    What is a common treatment for sideroblastic anemia?

    <p>Increased dietary iron intake</p> Signup and view all the answers

    What condition results from the inability to generate mature blood cells?

    <p>Aplastic Anemia</p> Signup and view all the answers

    Which of the following is NOT a symptom of iron excess conditions like hereditary hemochromatosis?

    <p>Pallor</p> Signup and view all the answers

    Which leukocyte condition is associated with a low white blood cell count?

    <p>Leukopenia</p> Signup and view all the answers

    What is the primary etiology of Polycythemia Vera?

    <p>Abnormal bone marrow proliferation</p> Signup and view all the answers

    Study Notes

    Multiple Myeloma

    • Malignant proliferation of plasma cells, leading to bone marrow infiltration and tumor masses in the skeletal system
    • S/S: Skeletal pain, progressing to osteoporosis, hypercalcemia, spinal cord compression, pancytopenia, and renal failure
    • Diagnosis: Bone marrow biopsy, immunoglobulin levels (M protein), X-ray (bone erosion), and Bence Jones protein (urine test)
    • Treatment: Chemotherapy, bone-protecting medications, radiation therapy, and pain management

    Alterations of Splenic Function

    • Functions: Phagocytosis of blood cells, antibody production, and blood storage
    • Splenomegaly: Enlarged spleen, potential early indicator of underlying conditions; can be filled with blood, increasing rupture risk
      • Congestive Splenomegaly: Associated with ascites, portal hypertension, and esophageal varices in cases of hepatic cirrhosis
    • Hypersplenism: Overactive splenic functions
      • Clinical Manifestations: Cytopenias and splenomegaly
    • Treatment: Splenectomy (surgical removal of the spleen)

    Alterations of Hematological Function: Thrombocytopenia

    • Normal platelet count: 150-400 x 10^9/L
    • Thrombocytopenia: Platelet count less than 150 x 10^9/L, usually asymptomatic until below 100; minor trauma can trigger abnormal bleeding
      • Severe Thrombocytopenia (less than 20 x 10^9/L): Spontaneous major bleeding episodes
    • Causes: Hypersplenism, autoimmune disease, hypothermia, viral/bacterial infections (DIC)
    • Clinical Manifestations: Spontaneous petechiae, purpura, GI bleeding, GU bleeding, pulmonary mucosa bleeding, gum bleeding
    • Treatment: Address the underlying cause and platelet transfusions

    Heparin-Induced Thrombocytopenia (HIT)

    • Adverse reaction to heparin (IV or LMWH), immune-mediated destruction of platelets by IgG antibodies
    • Clinical Manifestations: Venous and arterial thrombosis, thrombocytopenia-related bleeding
    • Lab Values: PTT (for heparin) and INR (for warfarin)

    Thrombocythemia

    • Excessive platelet production by the bone marrow
      • Primary Thrombocythemia: Overproduction of megakaryocyte cells
      • Secondary Thrombocythemia: Occurs after a splenectomy
    • Characteristics: Platelet count >400 x 10^9/L
    • Complications: Microvascular thrombosis or hemorrhage

    Disorders of Coagulation: Impaired Hemostasis

    • Defects or deficiencies in clotting factors
      • Inherited: Hemophilias and von Willebrand's disease
      • Acquired: Deficient clotting factor synthesis by the liver (liver disease, Vitamin K deficiency)

    Consumptive Thrombohemorrhagic Disorders

    • Hemorrhage and thrombosis occur simultaneously.
    • Disseminated Intravascular Coagulation (DIC)

    Disseminated Intravascular Coagulation (DIC)

    • Complex disorder involving simultaneous clotting and hemorrhage.
    • Pathogenesis: Vascular endothelium damage triggers clot formation, fibrin clots block blood flow, leading to organ failure (kidney and lungs), platelet depletion and bleeding. Imbalance between coagulation and fibrinolytic systems.
    • Etiology: Sepsis, pregnancy complications, infections, trauma, liver disease, hypoxia
    • S/S: Bleeding from venipuncture sites, arterial lines, purpura, petechiae, hematomas, symmetrical cyanosis, hypovolemic shock.
    • Treatment: Address the underlying cause, control ongoing thrombosis, and maintain organ function

    Thromboembolic Disorders

    • Arterial or venous thrombi
    • Virchow's Triad:
      • Endothelial damage
      • Abnormal blood flow
      • Hypercoagulability
    • Lab Value:
      • D-dimer (for thrombin)
    • Signs & Symptoms:
      • Pain
      • Swelling
      • Redness
      • Warmth
      • Tenderness

    Idiopathic Thrombocytopenic Purpura (ITP)

    • Immunologic platelet destruction leading to thrombocytopenia
    • Types: Acute (post-viral infection), chronic (immunological disorders)
    • S/S: Thrombocytopenia-related bleeding
    • Diagnostic Tests: Platelet count, bone marrow study
    • Treatment: IVIg infusion to suppress anti-platelet antibodies

    Erythrocyte Deficiencies: Anemia

    • Reduced RBC count, hemoglobin quality/quantity in circulating blood
    • Causes: Impaired RBC production (blood loss, increased RBC destruction, or a combination)
    • Classification:
      • -cytic: Cell size
      • -chromic: Hemoglobin content
    • Key Types: Macrocytic-Normochromic (Pernicious Anemia), Microcytic-Hypochromic Anemia, Sideroblastic Anemia, Normocytic-Normochromic Anemia

    Clinical Manifestations & Treatment of Anemias

    • Main Alteration: Reduced oxygen-carrying capacity, leading to tissue hypoxia
      • Hypoxia Complications: Heart failure, respiratory symptoms, impaired wound healing
    • Classic Symptoms: Fatigue, weakness, dyspnea, pallor.
    • Treatment: Address underlying cause, relieve symptoms, blood transfusions, dietary correction, vitamin/iron supplements

    Macrocytic-Normochromic Anemias

    • Large RBCs due to ineffective DNA synthesis (vitamin B12 deficiency)
      • Premature RBC Death (Eryptrosis): Release of bilirubin, leading to jaundice

    Pernicious Anemia

    • Lack of intrinsic factor (gastric) for vitamin B12 absorption, due to autoimmune gastritis or previous H. pylori infection
    • Early Symptoms: Nonspecific and vague
    • Late Symptoms (hemoglobin 70-80 g/L): Weakness, fatigue, paresthesia, loss of appetite, abdominal pain, weight loss, sore tongue, jaundice, right heart failure symptoms
    • Treatment: High oral doses of vitamin B12, lifelong treatment

    Microcytic-Hypochromic Anemias

    • Small, pale RBCs with reduced hemoglobin
      • Disorders of Iron Metabolism
      • Decreased Oxygen-Carrying Capacity

    Iron Deficiency Anemia

    • Most common anemia
    • S/S: Fatigue, weakness, shortness of breath, pale palms and conjunctiva

    Sideroblastic Anemia

    • Insufficient iron uptake, abnormal hemoglobin synthesis
    • S/S: Similar to iron deficiency anemia

    Treatment

    • Increase dietary iron intake, IV iron infusions

    Normocytic-Normochromic Anemias

    • Normal size and hemoglobin content, insufficient RBC count
      • Aplastic Anemia: Inability to produce mature blood cells
      • Insufficient Erythropoiesis: Often autoimmune in nature
    • Clinical Manifestations: Hypoxemia, pallor, weakness, fever, GI bleeding, purpura.

    Erythrocyte Excess: Polycythemia

    • Relative Polycythemia: Due to an underlying condition
    • Absolute Polycythemia (Polycythemia Vera)

    Polycythemia Vera

    • Abnormal proliferation of bone marrow stem cells
    • Increased Coagulability: Increased risk of blood clots
    • Etiology: Unknown

    Iron Excess

    • Hereditary Hemochromatosis: Autosomal recessive disorder of iron metabolism, leading to iron overload
      • Complications: Iron toxicity, tissue and organ damage (skin, heart, liver, pancreas, pituitary gland, joints)
    • S/S: Fatigue, malaise, abdominal pain, hepatomegaly, abnormal liver enzymes, cardiomegaly
    • Treatment: Dietary management (reduced red meat intake)

    Alterations of Leukocyte Function

    • Leukocytosis: High WBC count, often associated with infection
    • Leukopenia: Low WBC count, increased susceptibility to infections
      • -philia: Increased
      • -penia: Reduced

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    Description

    Explore the critical aspects of Multiple Myeloma, including its symptoms, diagnosis, and treatment options. Additionally, learn about the functions and alterations of the spleen, such as splenomegaly and hypersplenism. This quiz provides insights into hematologic and splenic disorders.

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