alterations of hematologic system CH29

Question 1

Anemia of chronic disease

Answer 1

Due to inflammation
• Present in 50% of people who live in nursing homes
• decreased RBC life span
• Suppressed production of erythropoietin
• Ineffective bone marrow response
• Altered iron metabolism
Clinical manifestations
• Mild to moderate, few complications
• If drop is severe presents as iron deficiency anemia

Question 2

Aplastic Anemia

Answer 2

o Immune mediated injury of progenitors

ineffective production of mature cells by the bone marrow. Causing pancytopenia

• Idiopathic (primary acquired) autoimmune
• Secondary: various exposures, liver disease, viral infections
Clinical manifestation:
• bone marrow replaced by fat.
• Both males and females of any age
• 50% of cases progress rapidly with high risk of death
• Ulcerations of mouth and pharynx

Question 3

Disseminated intravascular coagulation pg. 953

Answer 3

• Widespread coagulation with fibrin clots in microvasculature, disseminated clotting will result in multi organ failure. Consumption of platelets and clotting factors leads to severe bleeding.
• Secondary to:

• Gram neg sepsis, metastatic cancer, severe trauma, placental abruptions, blood transfusion reaction

Clinical manifestations:
• Bleeding at three or more unrelated sites
• Rapid development of hemorrhaging: Venipuncture sites, ecchymosis, hematomas
• Bleeding from eyes, nose, gums
• Blue fingers, toes, possibly nose, breast
• Altered mental status, seizures

Question 4

Fe Deficiency Anemia

Answer 4

Deficiencies affecting hemoglobin synthesis
Most common nutritional disorder World Wide
•Causes : dietary deficiency, impaired absorption, increased requirement, chronic blood loss, such as in menorrhagia
• Most often in females in reproductive years (also in toddlers and adolescent girls)
Clinical manifestation:
• Appears gradually, usually asymptomatic until hgb 7-8
• Weakness, fatigue, shortness of breath; brittle, spoon shaped nails, burning mouth syndrome, angular stomatitis, dysphagia, dry mouth, irritability, headache

Question 5

Fe overload

Answer 5

Primary: hereditary hemochromatosis
Secondary: multi blood transfusions
• Inappropriate iron absorption, iron overload, deposition into tissues
• Can lead to end organ damage such as cirrhosis, Diabetes I., cardiomyopathies, arthritis, bronzed skin,

Question 6

Folate Deficiency

Answer 6

Deficiency of folic acid results in megaloblastic anemia
• Symptoms same as those caused by b12 deficiency
• Folate deficiency more common then b12 deficiency
• Risks EtOH, chronic malnourishment
Clinical manifestations
• Cachectic, malnourished appearance, scales and fissures of the lips and mouth, stomatitis, burning mouth syndrome, dysphagia, watery diarrhea, flatulence
• No neurological symptoms

Question 7

Hemolytic Anemia

Answer 7

accelerated destruction of erythrocytes
episodically or continuously.

• Can be congenital or acquired
• Includes sickle cell anemia, thalassemia, anemia due to HD

Clinical manifestations:
When severe: jaundice, particularly in neonates, enlarged spleen, alterations to bones in children, pathologic fractures, thromboembolism, PE

Question 8

Immune Thrombocytopenia

Answer 8

Most common cause of thrombocytopenia
Immune thrombocytopenic purpura
• May be acute or chronic
• Acute more common in children, chronic most often in women aged 20-40
Clinical manifestations:
• Minor bleeding: bruising, petechiae
• Hemorrhage from mucosal sites: epistaxis, hematuria, menorrhagia, bleeding gums
• Internal bleeding at other sites/ rare
• Weight loss, fever, headache
• PREGNANCY is of concern as ITP can affect fetus.

Question 9

Pernicious Anemia

Answer 9

Caused by b12 deficiency/ end stage of chronic gastritis

o Due to absence of Intrinsic Factor; surgical removal of the stomach, resection of the ilium, tapeworm infection; also, situations that demand more b12 such as pregnancy, hyperthyroidism, chronic infection, disseminated Cancer, EtOH abuse, previous H Pylori infection

Clinical manifestations:
o Cachectic, malnourished appearance
o Develops very slowly over decades, anemia symptoms after hgb reaches 7-8, hepatomegaly, splenomegaly,
neurocognitive disorders r/t b12 deficiency such as encephalopathy, optic neuropathy etc.

Question 10

Polycythemia Vera

Answer 10

Chronic, neoplastic, non-malignant condition. characterized by overproduction of red blood cells
• Frequently with elevated WBC and platelets and splenomegaly

Clinical manifestation
• enlarged spleen
• plethora (red, ruddy color to cheeks, hands, feet, ears),
intense painful itching intensified by heat or exposure to water

neuro changes

Question 11

Thrombocythemia

[AKA Thrombocytosis]

Answer 11

• platelet count >450,000
• may be primary/chronic (excess production due to bone marrow defect) or
secondary (after splenectomy, from inflammation r/t cancer, arthritis
• usually asymptomatic until count >1000,000
• most common between age 50-60

clinical manifestations
• microvascular thrombosis: ischemia of fingers, toes, or cerebrovascular
• headache, paresthesia
burning to hand or >feet. Relieved by elevation
• thrombus/ embolus