Multiple Myeloma and Splenic Function Changes

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Questions and Answers

What is a common symptom of multiple myeloma?

Swollen peripheral lymph nodes

Ascites

Hypertension

Skeletal pain (correct)

Which test is NOT typically used to diagnose multiple myeloma?

Immunoglobulin levels

Bone marrow biopsy

Serum glucose levels (correct)

Bence Jones protein test

What condition may splenomegaly indicate?

Acute kidney injury

Congestive heart failure

Underlying hepatic cirrhosis (correct)

Malignant growth of plasma cells

What is a possible complication of congestive splenomegaly?

Rupture of the spleen Signup and view all the answers

Which treatment is specific for hypersplenism?

Splenectomy Signup and view all the answers

What is considered thrombocytopenia in terms of platelet count?

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

Which of the following is NOT a common cause of thrombocytopenia?

Bone marrow overproduction Signup and view all the answers

What clinical manifestation may indicate severe thrombocytopenia?

Hematuria Signup and view all the answers

What is the primary treatment for thrombocytopenia?

Platelet transfusion Signup and view all the answers

What characterizes thrombocythemia?

Platelet count greater than 400 x 10^9/L Signup and view all the answers

What is a common cause of impaired hemostasis?

Inadequate synthesis of clotting factors by the liver Signup and view all the answers

Which of the following disorders is characterized by both hemorrhagic and thrombotic findings?

Disseminated Intravascular Coagulation (DIC) Signup and view all the answers

What is NOT a symptom associated with Disseminated Intravascular Coagulation (DIC)?

Elevated blood pressure Signup and view all the answers

Which factor is NOT an etiology of Disseminated Intravascular Coagulation (DIC)?

Vitamin K overdose Signup and view all the answers

What is the primary characteristic of Idiopathic Thrombocytopenic Purpura (ITP)?

Immunologic destruction of platelets Signup and view all the answers

Which of the following are considered late symptoms of vitamin B12 deficiency?

Jaundice & right heart failure symptoms Signup and view all the answers

What characterizes microcytic-hypochromic anemias?

RBCs that are abnormally small and low in hemoglobin Signup and view all the answers

Which condition is the most common type of anemia worldwide?

Iron deficiency anemia Signup and view all the answers

How is sideroblastic anemia primarily characterized?

Insufficient iron uptake and abnormal hemoglobin synthesis Signup and view all the answers

What is a primary manifestation of leukopenia?

Increased risk of infections Signup and view all the answers

What is the likely etiology of polycythemia vera?

Abnormal proliferation of bone marrow stem cells with unknown cause Signup and view all the answers

What dietary recommendation is typically suggested for managing hereditary hemochromatosis?

Reduce intake of red meat Signup and view all the answers

What distinguishes normocytic-normochromic anemias from other types of anemia?

RBCs are normal in size and hemoglobin but insufficient in number Signup and view all the answers

What is the primary cause of Infectious Mononucleosis?

Epstein-Barr Virus Signup and view all the answers

Which condition is characterized by the presence of Reed-Sternberg cells?

Hodgkin's Lymphoma Signup and view all the answers

Which of the following is a common symptom of Leukemia?

Infection Signup and view all the answers

What type of antibodies does the Monospot test detect for diagnosing Infectious Mononucleosis?

Heterophilic antibodies Signup and view all the answers

Which of the following treatments is commonly used for Hodgkin's Lymphoma?

Chemotherapy Signup and view all the answers

What is a defining feature of Non-Hodgkin's Lymphoma?

Chromosome translocations Signup and view all the answers

What term describes a decrease in neutrophils in the blood?

Neutropenia Signup and view all the answers

Which symptom is NOT typically associated with Infectious Mononucleosis?

Weight loss Signup and view all the answers

What is the primary cause of symptoms such as hypercalcemia and skeletal pain in multiple myeloma?

Malignant proliferation of plasma cells Signup and view all the answers

Which diagnostic test is most commonly used to identify the presence of malignant plasma cells in multiple myeloma?

Bone marrow biopsy Signup and view all the answers

What treatment is typically employed to manage splenomegaly caused by hypersplenism?

Splenectomy Signup and view all the answers

Which condition is characterized by an enlarged spleen that may lead to serious complications like rupture?

Congestive splenomegaly Signup and view all the answers

What is a key clinical manifestation of hypersplenism?

Cytopenias Signup and view all the answers

Which of the following statements is true about Disseminated Intravascular Coagulation (DIC)?

DIC involves an imbalance between the coagulant system and the fibrinolytic system. Signup and view all the answers

What is a common cause of impaired hemostasis?

Deficiency in dietary Vitamin K. Signup and view all the answers

Which of the following symptoms is associated with DIC?

Cyanosis of the fingers and toes. Signup and view all the answers

What is the underlying mechanism in Idiopathic Thrombocytopenic Purpura (ITP)?

Immunologic destruction of platelets. Signup and view all the answers

Which of the following conditions is classified as a consumptive thrombohemorrhagic disorder?

Disseminated Intravascular Coagulation (DIC). Signup and view all the answers

What is a common clinical manifestation of polycythemia vera?

Hypercoagulability Signup and view all the answers

Which type of anemia is characterized by insufficient iron uptake and abnormal hemoglobin synthesis?

Sideroblastic anemia Signup and view all the answers

What condition is characterized by abnormally small red blood cells and reduced hemoglobin content?

Microcytic-hypochromic anemia Signup and view all the answers

What primarily characterizes macrocytic-normochromic anemias?

Large stem cells leading to unusually large RBCs Signup and view all the answers

Which of the following is a symptom associated with hereditary hemochromatosis?

Abdominal pain Signup and view all the answers

What is the primary treatment for iron deficiency anemia?

Increased dietary iron intake Signup and view all the answers

Which statement describes pernicious anemia?

It occurs due to a lack of intrinsic factor for B12 absorption. Signup and view all the answers

Which type of anemia is characterized by small, pale red blood cells?

Microcytic-Hypochromic Anemia Signup and view all the answers

Which of the following statements about leukopenia is true?

It predisposes patients to infections. Signup and view all the answers

What symptom is typically associated with late vitamin B12 deficiency?

Loss of appetite Signup and view all the answers

What is a common treatment approach for anemia?

Blood transfusion Signup and view all the answers

What symptom is typically associated with anemia due to reduced oxygen carrying capacity?

Paleness of the skin Signup and view all the answers

Which condition is characterized by reduced production of mature blood cells?

Aplastic anemia Signup and view all the answers

What condition can result from impaired red blood cell production?

Chronic blood loss Signup and view all the answers

What is an important factor in the classification of anemia?

The underlying cause or changes in RBC characteristics Signup and view all the answers

Which of the following can contribute to hypoxemia in anemia?

Decreased RBC count Signup and view all the answers

What is the primary infectious agent commonly responsible for Infectious Mononucleosis?

Epstein-Barr Virus Signup and view all the answers

Which of the following is NOT a symptom associated with Leukemia?

Sore throat Signup and view all the answers

Which type of lymphoma is specifically characterized by the presence of Reed-Sternberg cells?

Hodgkin's Lymphoma Signup and view all the answers

What condition is characterized by both a high level of neutrophils and symptoms of infection?

Neutrophilia Signup and view all the answers

What is a common diagnostic test for confirming Infectious Mononucleosis?

Monospot qualitative test Signup and view all the answers

Which of the following describes a potential complication of Leukemia?

Sepsis Signup and view all the answers

Which treatment is commonly employed for management of Hodgkin's Lymphoma?

Chemotherapy and Radiation Signup and view all the answers

What is a common feature linked to Non-Hodgkin's Lymphoma?

Chromosome translocations Signup and view all the answers

Study Notes

Multiple Myeloma

A malignant proliferation of plasma cells that infiltrate the bone marrow and aggregate into tumor masses in the skeletal system.
Symptoms include skeletal pain, osteoporosis, hypercalcemia, spinal cord compression, pancytopenia, and renal failure.
Diagnosis is confirmed through bone marrow biopsy, immunoglobulin levels (M protein), x-ray (bone erosion), and Bence Jones protein (urine test).
Treatment involves chemotherapy, medications to protect bones, radiation therapy, and pain management.

Alterations of Splenic Function

The spleen plays a crucial role in phagocytosis of blood cells, antibody production, and blood storage.
Splenomegaly refers to an enlarged spleen and can be an early sign of an underlying condition.
Congestive splenomegaly, often seen in hepatic cirrhosis, is characterized by an overfilled spleen, susceptible to rupture. It is accompanied by ascites, portal hypertension, and esophageal varices.
Hypersplenism describes overactive splenic functions, leading to clinical manifestations like cytopenias and splenomegaly.
Treatment for hypersplenism often involves a splenectomy (surgical removal of the spleen).

Alteration in Platelet Count - Thrombocytopenia

A platelet count below 150 x 10^9/L is considered thrombocytopenia.
Symptoms typically appear when the platelet count falls below 100 x 10^9/L, leading to abnormal bleeding even with minor trauma.
Severe thrombocytopenia (below 20 x 10^9/L) can cause spontaneous major bleeding episodes.
Causes include hypersplenism, autoimmune disease, hypothermia, and viral or bacterial infections leading to disseminated intravascular coagulation (DIC).
Clinical manifestations include spontaneous petechiae and purpura, bleeding from the GI, GU and pulmonary mucosa, and gum bleeding.
Treatment includes addressing the underlying cause and platelet transfusions.

Heparin-Induced Thrombocytopenia (HIT)

A potentially severe adverse reaction caused by heparin, usually IV heparin, but may occur with LMWH.
It is an immune-mediated reaction where IgG antibodies destroy platelets.
Clinical manifestations include venous and arterial thrombosis. It also presents similar symptoms to thrombocytopenia, such as bleeding.
PTT and INR measures are used to monitor coagulation times, PTT for heparin and INR for warfarin.

Thrombocythemia

A disease where the bone marrow produces too many platelets, leading to difficulty in normal blood clotting.
Microvascular thrombosis or hemorrhage can occur.
Characterized by platelet counts greater than 400 x 10^9/L.
Primary thrombocythemia is due to overproduction of megakaryocyte cells.
Secondary thrombocythemia can occur after splenectomy due to the lack of a platelet storage area.

Disorders of Coagulation

Impaired Hemostasis

Resulting from defects or deficiencies in one or more clotting factors.
Can be inherited, like hemophilia and von Willebrand's disease.
Acquired defects include deficient synthesis of clotting factors by the liver, associated with liver disease or dietary deficiency of vitamin K.

Consumptive Thrombohemorrhagic Disorders

Characterized by both hemorrhagic and thrombotic pathological findings.
Disseminated Intravascular Coagulation (DIC) is a primary example.

Disseminated Intravascular Coagulation (DIC)

A complex, acquired disorder where clotting and hemorrhage occur simultaneously.
Damage to the vascular endothelium triggers clot formation to repair the damage.
Fibrin clots form in medium and small vessels, obstructing blood flow to organs and leading to multiple organ failure, particularly in the kidneys and lungs.
Consumption of platelets exacerbates bleeding from other sources.
Etiology includes sepsis, pregnancy complications, infections, trauma, liver disease, and hypoxia.
Symptoms include bleeding from venipuncture sites and arterial lines, purpura, petechiae, hematomas, symmetrical cyanosis of the fingers and toes, and hypovolemic shock.
Treatment aims to address the underlying cause, control ongoing thrombosis, and maintain organ function.

Thromboembolic Disorders

Arterial or venous thrombi formation.
Virchow's Triad outlines the key factors contributing to thrombosis:
- Endothelial damage
- Abnormalities of blood flow
- Hypercoagulability

Idiopathic Thrombocytopenic Purpura (ITP)

Thrombocytopenia caused by immunologic platelet destruction.
Can be acute (following viral infection) or chronic (linked to immunological disorders).
Symptoms are similar to thrombocytopenia, often leading to a vitamin B12 deficiency.
Early symptoms are nonspecific and vague.
Late symptoms, when hemoglobin levels are 70 to 80 g/L, include weakness, fatigue, paresthesia, loss of appetite, abdominal pain, weight loss, sore tongue, jaundice, and symptoms of right heart failure.
Treatment involves high oral doses of vitamin B12 and potentially lifelong treatment.

Microcytic-Hypochromic Anemias

Characterized by abnormally small RBCs with reduced hemoglobin content.
Associated with disorders of iron metabolism and decreased oxygen-carrying capacity.
Iron deficiency anemia is the most common type worldwide.
Symptoms include fatigue, weakness, shortness of breath, pale palms, and conjunctiva.
Sideroblastic anemia, due to insufficient iron uptake, presents with similar symptoms.
Treatment focuses on increased dietary iron intake or IV iron infusions.

Normocytic-Normochromic Anemias

Characterized by RBCs of normal size and hemoglobin content, but insufficient in number.
Includes aplastic anemia, where the bone marrow fails to produce mature blood cells,
Insufficient erythropoiesis is often autoimmune in nature.
Clinical manifestations include hypoxemia, pallor, weakness, fever, GI bleeding, and purpura.

Erythrocyte Excess

Polycythemia, characterized by excessive RBC production.
Relative polycythemia is caused by an underlying condition.
Absolute polycythemia, also known as polycythemia vera, involves abnormal proliferation of bone marrow stem cells.

Polycythemia Vera

Characterized by an overproduction of bone marrow stem cells.
Increases hypercoagulability, rendering patients more prone to blood clots.
Etiology remains unknown.

Iron Excess

Hereditary Hemochromatosis: an autosomal recessive disorder of iron metabolism leading to iron overload.
Excess iron accumulation in the skin, heart, liver, pancreas, pituitary gland, and joints can damage tissues and organs.
Symptoms include fatigue, malaise, abdominal pain, hepatomegaly, abnormal liver enzymes, and cardiomegaly.
Treatment involves dietary management, limiting red meat consumption.

Alterations of Leukocyte Function

Leukocytosis: high white blood cell count, commonly associated with infection.
Leukopenia: low white blood cell count, increasing susceptibility to infections.
"-philia" indicates an increase in a specific type of granulocyte, while "-penia" indicates a decrease.
For example, neutrophilia refers to an elevated neutrophil count, while neutropenia refers to a decreased neutrophil count.

Infectious Mononucleosis (IM) "Mono"

An acute, self-limiting infection of B-lymphocytes, transmitted through saliva via personal contact.
Primarily caused by Epstein-Barr virus (EBV).
Symptoms include fever, sore throat, swollen cervical lymph nodes, and increased lymphocyte count.
Serious complications are uncommon (splenic rupture).
Diagnosed through the Monospot qualitative test for heterophilic antibodies.
Treatment is supportive, focusing on rest, analgesics, and antipyretics.

Leukemias

Malignant disorders of the blood characterized by irregular production of white blood cells, obstructing the bone marrow and inhibiting hematopoiesis.
Pancytopenia, a decrease in all three cell lines (RBCs, platelets, and WBCs), is characteristic.
Classified based on cell maturation at disease onset (acute vs. chronic), type of leukocyte involved, and origin (myelogenous or lymphocytic).

Signs and Symptoms of Leukemia

Anemia, bleeding (petechiae, purpura, ecchymosis, hemorrhage), and infections.
Additional symptoms include weight loss, bone pain, and elevated uric acid due to increased protein and nucleic acid catabolism and dehydration.
Liver, spleen, and lymph node enlargement are common findings.
Treatment involves chemotherapy, supportive management (blood transfusions, antibiotics), stem cell transplants, and bone marrow transplants.

Lymphadenopathy

Enlarged lymph nodes that become palpable and tender.
Localized lymphadenopathy: drainage from an area associated with inflammation or infection, indicating a reactive lymph node.
Generalized lymphadenopathy: associated with both malignant and non-malignant diseases.
A relevant finding in both Hodgkin's and Non-Hodgkin's lymphoma.

Hodgkin’s Lymphoma

Characterized by the presence of Reed-Sternberg cells in lymph nodes.
Reed-Sternberg cells are essential for diagnosis but are not specific to Hodgkin's lymphoma.
Physical findings include adenopathy, mediastinal mass, splenomegaly, and abdominal mass.
Symptoms: fever, weight loss, night sweats, and pruritus (itching).
Early diagnosis and treatment offer a high cure rate for adult Hodgkin's lymphoma.
Treatment options include chemotherapy, radiation, and surgery.

Non-Hodgkin's Lymphoma

A broad category of lymphomas classified based on cell type (T, B, NK).
Linked to chromosome translocations.
Risk factors include older age, male sex, white race, certain immune disorders, HIV/AIDS, immunosuppression, environmental exposures, certain viruses, and diet high in meats and fats.

Multiple Myeloma

Malignant proliferation of plasma cells infiltrating bone marrow and aggregating in the skeletal system
Symptoms include skeletal pain progressing to osteoporosis, hypercalcemia, and spinal cord compression, pancytopenia, and renal failure
Diagnosis through bone marrow biopsy, immunoglobulin levels (M protein), x-ray (bone erosion), and Bence Jones protein (urine test)
Treatment includes chemotherapy, bone-protecting medications, radiation therapy, and pain management

Alterations of Splenic Function

The spleen phagocytizes blood cells, produces antibodies, and stores blood
Splenomegaly is an enlarged spleen, often an early sign of an underlying condition, susceptible to rupture if overfilled with blood
Congestive splenomegaly in hepatic cirrhosis presents with ascites, portal hypertension, and esophageal varices
Hypersplenism is overactive splenic function resulting in cytopenias and splenomegaly
Treatment for hypersplenism may include splenectomy (surgical spleen removal)

Impaired Hemostasis

Caused by defects or deficiencies in clotting factors
Hemophilias and von Willebrand's disease are inherited
Acquired defects include deficient clotting factor synthesis in the liver due to liver disease or vitamin K deficiency (from insufficient green leafy vegetables)

Consumptive Thrombohemorrhagic Disorders

Hemorrhagic and thrombotic pathological findings
Disseminated Intravascular Coagulation (DIC) is a complex acquired disorder with simultaneous clotting and hemorrhage

Disseminated Intravascular Coagulation (DIC)

Damage to vascular endothelium leads to clot formation to repair the damage, creating fibrin clots in small and medium vessels
These clots block blood flow to organs causing multiple organ failure (kidney and lungs)
Platelet consumption exacerbates bleeding from other sources
Imbalance between the coagulant system and the fibrinolytic system
Etiology: sepsis, pregnancy complications, infections, trauma, liver disease, hypoxia
Symptoms include bleeding from venipuncture sites and arterial lines, purpura, petechiae, hematomas, symmetrical cyanosis of fingers and toes, and hypovolemic shock
Treatment focuses on correcting the underlying cause, controlling ongoing thrombosis, and maintaining organ function

Thromboembolic Disorders

Arterial or venous thrombi formation
Virchow's Triad (factors contributing to thrombosis): (1) Endothelial damage, (2) Abnormal blood flow (stasis), (3) Hypercoagulability

Idiopathic Thrombocytopenic Purpura (ITP)

Thrombocytopenia caused by immune-mediated platelet destruction
Acute ITP follows viral infections, while chronic ITP is linked to immunological disorders
Symptoms relate to decreased platelets
Diagnostic tests include platelet count and bone marrow study
Treatment involves IV immunoglobulin (IVIg) infusion to suppress anti-platelet antibodies

Erythrocyte Deficiencies - Anemia

Anemia is a reduction in circulating RBC, or decreased hemoglobin quality/quantity
Causes: impaired RBC production, blood loss (acute/chronic), increased RBC destruction, or combinations of these factors
Classified by cause, RBC size (-cytic), or hemoglobin content (-chromic)
Macrocytic-normochromic anemia (pernicious anemia), microcytic-hypochromic anemia, sideroblastic anemia, and normocytic-normochromic anemia are discussed

Clinical Manifestations and Treatment of Anemias

Reduced oxygen carrying capacity leading to tissue hypoxia and potential complications like heart failure and respiratory symptoms
Classic anemia symptoms include fatigue, weakness, dyspnea, and pallor
Treatment addresses the underlying cause, provides symptom relief, and may include blood transfusions, dietary correction, or supplemental vitamins/iron

Macrocytic-Normochromic Anemias

Characterized by large stem cells maturing into unusually large RBCs
Defective DNA synthesis in RBCs due to vitamin B12 deficiency leads to premature RBC death (eryptosis) and bilirubin release causing jaundice

Pernicious Anemia

Lack of intrinsic factor (from gastric parietal cells) required for vitamin B12 absorption
Results from autoimmune gastritis or previous H. pylori infection
Early symptoms are nonspecific and vague
Late symptoms (hemoglobin 70-80 g/L) include weakness, fatigue, paresthesia, loss of appetite, abdominal pain, weight loss, sore tongue, jaundice, and right heart failure symptoms
Treatment involves high oral doses of vitamin B12 and lifelong maintenance therapy

Microcytic-Hypochromic Anemias

Characterized by abnormally small RBCs with low hemoglobin content
Related to iron metabolism disorders
Decreased oxygen carrying ability

Iron Deficiency Anemia

Most common anemia worldwide
Symptoms include fatigue, weakness, shortness of breath, and pale palms/conjunctiva

Sideroblastic Anemia

Insufficient iron uptake leads to abnormal hemoglobin synthesis
Symptoms are similar to iron deficiency anemia
Treatment includes increased dietary iron intake or IV iron infusions