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Undeleted > 3 Hematological Responses > Flashcards

3 Hematological Responses Flashcards

1
Q

plasma

A

fluid component of blood (clear yellow)

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2
Q

albumin

A

maintains osmotic pressure so plasma doesn’t leak into tissues

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3
Q

globulin

A

helps to transport antibodies

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4
Q

fibrinogen

A

involved in blood clotting

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5
Q

plasma components x3

A

albumin, globulin, fibrinogen

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6
Q

blood cell types x3

A

white blood cells
red blood cells
platelets

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7
Q

white blood cells function

A

protection through inflammation and infection

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8
Q

red blood cells function

A

oxygen and carbon dioxide transport

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9
Q

platelets function

A

important in blood clotting

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10
Q
  • RBC lifespan
A

120 days

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11
Q

immature RBC

A

reticulocyte

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12
Q

mature RBC

A

erythrocyte

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13
Q

RBC production regulated by…

A

erythropoietin (released by kidneys)

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14
Q

erythropoeitin function

A

released by kidneys in response to decreased SpaO2 (hypoxemia)

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15
Q

hemoglobin

A

protein for O2 transport

each heme carries 4 molecules of O2

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16
Q

major Hgb in adult

A

Hgb A

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17
Q

Hgb in fetus

A

Hgb F

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18
Q

what is needed for Hgb to pick up oxygen?

A

heme and iron

- also folic acid and vitamin B12

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19
Q

elderly lifespan considerations (blood cells)

A

decreased blood volume, hemoglobin
aging bone marrow = lower RBC, WBC
aging liver = less protein production, plasma proteins

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20
Q

universal recipient

A

AB

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21
Q

universal donor

A

O negative

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22
Q

blood type classified…

A

according to antigens on cell membrane

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23
Q

anemia

A

NOT A DISEASE (a sign)

  • low Hct, RBC, hgb
  • increased reticulocyte count
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24
Q

*anemia s/s

A
  • fatigue: most common complaint (due to decrease O2 delivery to cells = decrease in cellular work = fatigue)
  • CVS: increased HR & palpitations, orthostatic hypertension
  • resp: dyspnea on exertion (decreased O2 sat)
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25
Q

*anemia in toddlers/young

A

90% due to iron deficiency (nutritional intake)

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26
Q

*anemia in adolescents

A

typically low nutrition

period of rapid growth

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27
Q

*anemia in pregnancy

A

due to decreased blood volume

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28
Q

*anemia in adults

A

GI bleeding most common reason

any adult with iron deficiency anemia should be evaluated for abnormal bleeding

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29
Q

*anemia in elderly

A

chronic disease
GI bleeding
nutritional

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30
Q

*anemia: iron deficiency causes

A

most common anemia worldwide

  • blood loss (GI, menstrual)
  • dietary insufficiency
  • poor GI absorption/malabsorption, post-gastrectomy
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31
Q

*iron deficiency treatment

A

increase dietary intake of iron

supplement: ferrous sulfate

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32
Q

ferrous sulfate supplement…

A

for iron deficiency anemia

can cause nausea, constipation (dark, tarry stool)

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33
Q

anemia: decreased RBC production due to…

A
  • lack of iron, B12, folic acid (prevents DNA synthesis, so RBC production goes down)
  • dysfunctional bone marrow -> aplastic anemia (decrease in circulating RBC) / acquired from exposure to toxins
  • low levels of erythropoetin, thyroid hormone
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34
Q

*aplastic anemia

A

condition in which the bone marrow does not make enough new blood cells; leads to pancytopenia

35
Q

pancytopenia

A

condition with reduction in number of all blood cells

  • requires bone marrow to diagnose
  • 50% idiopathic
  • 50% radiation, chemo, infection, toxin, drug reaction
36
Q

anemia: increased RBC destruction

A

hemolytic anemia

37
Q

anemia types

A

decreased production
increased destruction
blood loss
genetic disorders

38
Q

hemolytic anemia

A

classified according to how hemolysis occurs

acquired vs inherited

39
Q

acquired hemolytic anemia

A

autoimmune, malaria, lead poisoning

40
Q

inherited hemolytic anemia

A
  • defects of RBC membrane production: hereditary spherocytosis (RBC are sphere shaped)
  • defects in hgb production: sickle cell disease, thalassemia
  • defective RBC metabolism: G6PD deficiency (glucose-6-phosphate dehydrogenase)
41
Q

hereditary spherocytosis

A

RBC = sphere shaped

42
Q

*sickle cell disease

A

RBC typically pliable (aged = fragile)

  • genetic disorder: fragile, easily broken, sickle resulting in chronic anemia (pain, disability, organ damage, increased risk for infection, early death)
  • autosomal recessive
  • African American 1:5000 disease, 1:12-15 trait
  • early diagnosis critical: optimum treatment
  • newborn screening mandatory in US
43
Q

*sickle cell disease pathophysiology

A

abnormal hgb chains with HGB S instead of HGB A

  • RBC w/ hgb S lives ~12-15 days
  • hgb S sensitive to changes in O2 leading to sickling, rigidity, clumping
  • vasoocclusive event (VOE)
  • sickle cell crisis
44
Q

*vasooclusive event (VOE)

A

hgb s makes cells fragile, sticky, can block blood flow

- characteristic of sickle cell disease

45
Q

*sickle cell crisis

A

extensive sickling

46
Q

*sickle cell trait

A

often asymptomatic, maybe mild symptoms

47
Q

*causes of sickling

A
  • hypoxia
  • dehydration
  • infection
  • venous stasis
  • pregnancy
  • alcohol consumption
  • low/high environmental of body temp
  • strenuous exercise
  • emotional stress
  • acidosis
  • anesthesia
  • high altitude
48
Q

sickle cell disease lab values

A

low hematocrit (shorter RBC life)
reticulolyte count increase
WBC high due to chronic inflammation (hypoxia, ischemia)

49
Q

sickle cell disease presentation

A

PAIN - most common problem due to obstructed blood flow from hypoxia (mild to severe, requiring hospitalization)

  • acute pain episode: sudden onset. chest, back, abdomen, extremities
  • chronic pain: common, can require high doses of opioids (addiction rare with SCD)
50
Q

sickle cell crisis treatment

A

EARLY TREATMENT

  • oxygen (even if oxygen is normal)
  • pain: likely IV opioids
  • hydration: IV
  • rest: decrease stress, promote venous return
  • treat infection
  • close monitoring
  • possible blood transfusion
51
Q

prevention of sickle crisis

A
  • risk for infection higher due to spleen damage during anoxic events (contact provider at first sign!)
  • genetic counseling
  • hydration, avoid EtOH, tobacco, temp extremes, strenuous physical activity, high altitudes
52
Q

thalassemia

A

genetic defect in hgb synthesis (Asians, Middle Eastern, Mediterranean, African)
- asymptomatic to incompatible with life

53
Q

thalassemia diagnosis

A

blood smear shows microcytic hypochromic anemia with misshapen RBC

54
Q

thalassemia treatment

A

only for severe: frequent blood transfusion, possible bone marrow transplant

55
Q

hemolytic anemia

A

hereditary spherocytosis: N European ancestry (autosomal dominant)

  • mild to severe
  • treatment: severe = frequent transfusions
56
Q

platelet disorders causes

A
  • inherited (autoimmune disorder)
  • acquired (viral)
  • temporarily induced by drugs
57
Q

platelet disorders tests

A
  • lab test for coagulation: measures ability to clot and time taken
  • platelet count
  • prothrombin time (PT)
58
Q

thrombocytopenia

A

platelet # below that which is needed for clotting

59
Q

thrombocytosis

A

elevated platelet count

- risk for deep vein thrombosis, pulmonary embolism

60
Q

idiopathic thrombocytopenia purpura (ITP)

A

autoimmune disorder with high platelet destruction by spleen

  • pre-existing immune disorder such as lupus
  • can be triggered by viral infection
  • seen most often in 2-5yo, women 20-40
  • prognosis: excellent with 75% spontaneous recovery within 3 months
61
Q

ITP presentation

A

mucosal bleeding
large bruising (ecchymosis)
petechial rash

62
Q

ITP treatment

A

protection from trauma, maintain safe environment

platelet transfusion if < 20k

63
Q

clotting factor disorders

A

genetic or acquired from liver damage

64
Q

hemophilia

A

hereditary clotting factor disorder

  • 80% have deficiency in factor VIII
  • recessive X linked (women are carriers, sons affected)
65
Q

hemophilia presentation

A

abnormal bleeding in response to trauma

- excessive, bruise easily, joint pain/edema

66
Q

hemophilia treatment

A

replacement of missing factor (EXPENSIVE)
prevention with safe environment
coordinated care: physical + psychosocial support

67
Q

leukemia

A

cancer (WBC disorder)

uncontrolled production of immature WBC

68
Q

bone marrow disease or autoimmune disorder

A

(WBC disorders)

69
Q

neutropenia

A

abnormally few neutrophils in blood leading to increased susceptibility to infection

70
Q
  • typical RBC count
A

4.2 - 6.1 million/ul

71
Q
  • typical hgb
A

female: 12 - 16 g/dl
male: 14 - 18 g/dl

72
Q
  • typical hct
A

female: 37 - 47%
male: 42 - 52%

73
Q
  • typical WBC count
A

5000 - 10000 /mm^3

74
Q
  • typical platelet
A

150k - 400k /mm^3

75
Q

typical mean corpuscular volume

A

80 - 95 fL

76
Q

low MCV

A

microcytic

77
Q

high MCV

A

macrocytic

78
Q

mean corpuscular hemoglobin

A

27 - 31

not as important in real world practice

79
Q

mean corpuscular hemoglobin concentration

A

32 - 36 g/dl

it’s all about the color!

80
Q

low MCHC

A

hypochromic

81
Q

high MCHC

A

hyperchromic

82
Q
  • typical reticulocyte count
A

0.5% - 2.0%

bone marrow functioning

83
Q

most common complaint of anemia (+ due to)

A

fatigue

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