2 - hematologic function Flashcards
red blood cells:
purpose
carry oxygen and CO2
red blood cells:
characteristics
round with dent
red blood cells:
building blocks
iron, B12, folic acid and others
red blood cells:
lab values
- hemoglobin: 120-180 g/L
- hematocrit: % of blood that is RBCs
Anemia
- low levels of RBC
- reduction in the total number of erythrocytes in the circulating blood or decrease in the level of hemoglobin
- decreased oxygen-carrying capacity
anemia - needs
02, hemoglobin and functioning heart to be clear of anemia
anemia - effects and manifestations
- vary depending on body system, degree and ability to compensate
- fatigue
- weakness
- dyspnea
- pallor (pale)
anemia - etiology
- impaired production
- blood loss or increased destruction of rbc’s
- combination of above
anemia - size
identified by terms that end in “cystic”
microcytic
small
macrocytic
large
normocytic
normal
anemia - color
- hemoglobin
- identified by terms that end in “-chromic”
anemia due to inadequate production
- iron deficiency anemia
- pernicious anemia
- folate deficiency anemia
- anemia due to chronic disease
iron deficiency anemia - cell
- lacking iron
- RBC will be microcytic and hypochromic
iron deficiency anemia
- most common type
- nutritional iron deficiency
- pregnancy, continous blood loss
iron deficiency anemia - clinical manifestations
- fatigue, weakness, dyspnea, pallor
- spoon-shaped nails
- glossitis (red, sore and painful tongue)
iron deficiency anemia - treatment
- treat cause
- iron supplements
pernicious anemia
- caused by a lack of intrinsic factor from the gastric parietal cells
pernicious anemia - intrinsic factor
- required for vitamin B12 absorption
- lack of B12 leads to anemia
- cells are large and microcytic
pernicious anemia - clinical manifestations
- fatigue
- weakness
- dyspnea
- nerve demyelination
nerve demyelination
- parenthesis of feet
- loss of position sense
- confusion and dementia
pernicious anemia - treatment
- lifelong B12 supplement
Folate deficiency anemia
- folate deficiency
- poor absorption of folate
- increased requirement of folate (pregnancy)
- produces RBC’s similar tot hose of pernicious
- Large RBC “macrocytic”
folate foods
- green leafy vegetables
- fruits
- cereals
- meats
folate deficiency anemia - clinical manifestations
- fatigue
- weakness
- dyspnea
folate deficiency anemia - treatment
- dietary adjustments
- supplements
folate deficiency also linked to
- neural tube defects (mother doesn’t have enough folic acid)
anemia due to chronic disease
- pathologic mechanisms
- associated with systemic lupus erythematous, rheumatoid arthritis and chronic renal failure
pathologic mechanisms
- inadequate production of erythropoietin
- ineffective bone marrow response to erythropoietin
- decreased erythrocyte life span
- depletion of iron stores
erythropoietin made in
the kidney
anemia due to increased loss or destruction
- blood loss anemia
- hemolytic anemia
blood loss anemia
- can be acute or chronic
blood loss anemia - acute
symptoms are usually related to blood loss e.g. hypotension
blood loss anemia - chronic
use up iron stores which lead to iron deficiency
hemolytic anemias
- premature destruction
- sickle cell disease
- hemolytic disease of the newborn
- venoms, infections, mechanical heart valves
sickle cell anemia
- characterized by the production of abnormal hemoglobin
- an autosomal recessive disorder
- most common in persons of african ancestry but also those who live near the equator
- estimated that 1 in 10 african americans
sickle cell pathophysiology
- due to a mutation in hemoglobin molecule
- sickle crises triggered by dehydration and hypoxemia
- HbS can revert to normal or can become irreversibly sickled
sickle cell - 2 major consequences
- chronic hemolytic anemia
- blood vessel occlusion
chronic hemolytic anemia
premature destruction by spleen
blood vessel occlusion
- pain
- organ failure
alterations in leukocytes
- increased white blood cells
- decreased white blood cells
increased white blood cells are called
- leukocytosis
- may be a normal protective physiologic response to physiologic stressors
decreased while blood cells are called
- leukopinea
- NEVER normal
- radiation, immune deficiencies
neoplasia of white blood cells
- leukemia
- lymphoma
- both caused by malignancies of white blood cells
leukemia
- starts in the bone marrow
- malignancy of precursors to white blood cells
- immature white blood cells (leukaemia blasts)
- leukemia blast crowd out bone marrow and causes pancytopenia
- infiltrate spleen, liver etc.
pancytopenia
decreased cellular proliferation of all typed of blood cells
leukemia - types
- acute lymphocytic leukaemia
- acute myelogenous leukemia
- chronic lymphocytic leukemia
- chronic myelogenous leukemia
leukemia - incidence (more of an FYI)
estimate more than 6000 Canadians - 2nd leading cause of death
leukemia - cause
unknown but likely a combo of environment and genetic condition
leukemia - risk factors
- down syndrome
- previous exposure to chemo and radiation
- smoking
- family genetics
leukemia - manifestations
- recalling the manifestations of neoplasm
- pale
- weakness/fatigue
- bruising
- bleeding
- risk for infections
- bone pain
- enlarged liver and spleen
leukemia - acute
- sudden onset
- rapid deterioration
- rapid progression
leukemia - chronic
- slower onset
- slower deterioration
- slow progress
leukemia - diagnosis
measurement of WBC and bone marrow biopsy
leukemia - treatment
chemotherapy and supportive measures (blood transfusions, fluid replacements etc)
lymphatic system
- links immune and hematological systems
- site where various WBC can mature and function
lymphatic system - primary structures
thymus and bone marrow
lymphatic system - secondary structures
lymph nodes, spleen, tonsils and intestinal tract
lymphadenopathy
- enlarged lymph nodes that become palpable and tender
- can be local or generalized
local lymphadenopathy
typically due to infection
generalized lymphadenopathy
typically due to malignancy
lymphoma
- proliferation of malignant lymphocytes in the lymphatic system
lymphoma - 2 major categories
- hodgkins lymphoma
- non-hodgkin lymphoma
hodgkin lymphoma
- cause is unknown although could be genetic or immune
- bimodal: two separate age groups (15-40 and >55 yrs)
- 5 year survival is 83%
non hodgkin lymphoma
- generic term for neoplasms of B-cells, T-cells, NK-cells
- impairment of immune system and infectious agents
- incidence has almost doubled since 1970
- usually in people > 50 yrs of age
- 5 year survival is 55-60%
lymphoma - manifestations
- lymphadenopathy
- fever
- night sweats
- fatigue
- weight loss
lymphoma - diagnosis
- lymph node biopsy
- reed-sternberg cells in lymph tissue for hodgkin lymphoma
lymphoma - treatment
chemo and radiation
platelets (thrombocytes) - purpose and normal
- to help with clotting
- 140-450x10^9/L
platelet disorders
- thrombocytopenia
- thrombocytosis
thrombocytosis
higher platelet count than normal
thrombocytopenia
- lower than normal platelet count
thrombocytopenia - cause
- decreased production
- increased breakdown or consumption
- or both
thrombocytopenia - types
- immune thrombocytopenia
- heparin induced thrombocytopenia
- other
immune thrombocytopenia purpura (ITP)
- also known as idiopathic thrombocytopenia purpura
- IgG antibody coats platelets
- antibody -platelet combination removed from circulation by the spleen
- acute or chronic
immune thrombocytopenia purpura (ITP) - causes
- following an infection
- autoimmune
immune thrombocytopenia purpura (ITP) - manifestations and diagnosis
- petechiae purpura
- purpura
- brusing
immune thrombocytopenia purpura (ITP) - treatment
corticosteroids for suppression or removal of spleen
petechiar purpura
tiny dots
purpura
a little bit bigger dots
bruising
big spots
heparin-induced thrombocytopenia
- adverse drug reaction to unfractionated heparin
- platelets are used
- thrombocytopenia about 5-10 days after heparin
bleeding disorders due to genetics
- von Hillebrand disease
- hemophilia A
- hemophilia B
- hemophilia C
von Hillebrand disease
- factor VIII (8) deficiency
- autosomal dominant
- 20 variants
hemophilia A
- factor VIII (8) deficiency
- x-linked autosomal recessive
hemophilia B
- factor IX (19) deficiency
- x-linked autosomal recessive
hemophilia C
factor XI (11) deficiency
bleeding disorders affect
- joints
- skin
- muscle
- mouth/gum
- urine/stool
- nosebleeds
