Subject: PATHOPHYSIOLOGY

Place: Department of General and Experimental Pathology, room 371

Division: FACULTY OF MEDICINE

YEAR: 3

CLASS no: 7

Pathophysiology of the hematopoietic system disorders.

Goal: to explain the etiology, pathogenesis and consequences of selected disorders of the hematopoietic system

Time: 4 hours

Didactic tools: multimedia presentation

Before the classes, students should revise the physiology of blood cells and the hematopoietic system,
as well as laboratory tests for blood disorders (complete blood count, bone marrow aspiration and biopsy).

Topics

I. Red blood cell pathology

1. Anemia:

- Aplastic anemia

- Anemia of blood loss

- Iron deficiency anemia (IDA)

- Anemia of chronic disease (ACD)

- Megaloblastic anemias

- Sideroblastic anemia

- Hemolytic anemias

2. Polycythemia (primary, secondary, relative)

II. White blood cell pathology and hematologic neoplasms

1. Changes of white blood cell count

- leukocytosis, neutrophilia, eosinophilia, basophilia, lymphocytosis, monocytosis

- leukopenia, neutropenia, eosinopenia, basopenia, agranulocytosis, lymphopenia, monocytopenia

2. Myeloid neoplasms

- Myelodysplastic syndromes (MDSs)

- Chronic myeloid leukemia (CML) and other chronic myeloid neoplasms

- Acute myeloid leukemia (AML)

3. Lymphoid neoplasms

- Chronic lymphocytic leukemia (CLL)

- Acute lymphoblastic leukemia (ALL)

- Hodgkin (HL) and non-Hodgkin (NHL) lymphomas

- Multiple myeloma (MM)

References:

Porth's Pathophysiology: Concepts of Altered Health States – Tommie L Norris; Wolters Kluwer; 10th Edition, International, 2018, chapter 21, 23, 24

Robbins and Cotran Pathologic Basis of Disease – Kumar, Vinay, et al., 9th Edition (or later ones),

Saunders Elsevier, 2015, chapter 13, 14

Color Atlas of Pathophysiology – Stefan Silbernagl, Florian Lang, Thieme; 3rd Edition, 2016.

Diseases (causes, pathogenesis, clinical manifestations/complications, main laboratory abnormalities)

Iron deficiency anemia (IDA)

Anemia of chronic disease  (ACD)

Aplastic anemia

Folate deficiency anemia

Vitamin B12 deficiency anemia

Addison-Biermer anemia (pernicious anemia)

Sickle cell disease (SCD)

Thalassemia

Hereditary spherocytosis

Glucose-6-phosphate dehydrogenase deficiency

Sideroblastic anemia

Polycythemia vera (PV)

Myelodysplastic syndromes (MDSs)

Chronic myeloid leukemia (CML)

Acute myeloid leukemia (AML)

Chronic lymphocytic leukemia (CLL)

Acute lymphoblastic leukemia (ALL)

Hodgkin lymphoma (HL)

Non-Hodgkin (NHL) lymphomas

Multiple myeloma (MM)

Problems:

1. List general symptoms of anemia.
2. Classify anemia based on pathogenesis.
3. Classify anemia based on mean corpuscular volume (MCV).
4. Explain why iron deficiency leads to anemia.
5. Explain why lack of vitamin B12 leads to anemia.
6. Explain why lack of folate leads to anemia.
7. Describe changes in laboratory tests of iron status in iron deficiency anemia.
8. Compare megaloblastic anemias due to deficiency of vitamin B12 and folate.
9. Explain the difference between the terms megaloblastic anemia and macrocytic anemia.
10.  Compare anemia due to acute and chronic blood loss.
11.  List laboratory features of intravascular and extravascular hemolysis.
12.  List causes of intravascular and extravascular hemolysis.
13.  List causes of intrinsic and extrinsic hemolytic anemias.
14.  Compare primary, secondary, and pseudopolycythemia.
15.  List examples of myeloid neoplasms.
16.  List examples of lymphoid neoplasms.
17.  List examples of chronic myeloproliferative disorders.
18.  Give the definition and examples of leukemia.
19.  Explain the difference between leukemia and lymphoma.
20.  Compare Hodgkin lymphoma and non-Hodgkin lymphomas.
21.  Compare the main changes in complete blood count in main types of leukemias (CML, CLL, AML, ALL).
22.  What is leukostasis and what are its causes and symptoms?
23.  What is the Philadelphia chromosome and what is its role in the development of leukemias?
24.  What are CRAB symptoms of multiple myeloma?
25.  What is Bence Jones proteinuria?
26.  List main causes of disorders: pancytopenia, agranulocytosis, leukocytosis, leukopenia, neutrophilia, neutropenia, eosinophilia, basophilia, monocytosis, lymphocytosis, lymphopenia.