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NUR 803 Pathophysiology > Blood & Cancer > Flashcards

Blood & Cancer Flashcards

1
Q

Normal RBC & HBG for men?

A

RBC 5-6, HGB ~15

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2
Q

Normal RBC for Women?

A

RBC 4-5, HGB ~14

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3
Q

What bones produce RBCs in the older adult?

A

Ribs, Vertebrae, Sternum, Ilia

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4
Q

What would cause RBC number to increase?

A

Tissue hypoxia = stimulates growth inducers and differentiation inducers

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5
Q

What is the essential regulator of red blood cell production?

A

Tissue oxygenation

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6
Q

Anemia is common in what patient populations?

A

Cardiac failure, Lung diseases, high altitudes. (Low oxygen states!).

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7
Q

What hormone stimulates RBC production when oxygen levels are low?

A

Erythropoietin

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8
Q

Where is erythropoietin made?

A

90% in kidneys. 10% in other body tissues (liver).

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9
Q

What are the two effects of erythropoietin?

A
  1. Stimulate production of RBCs from stem cells

2. Develop more rapidly through erythroblastic stages

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10
Q

What are essential for maturation of RBCs?

A

Vitamin B12 and Folic acid.

both used in DNA synthesis

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11
Q

Decreased folic acid or B12 causes what two characteristics?

A
  1. Macrocytes - large, flimsy
  2. Have short life span
    * Can carry oxygen normally!
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12
Q

What causes pernicious anemia?

A

Failure to absorb vitamin B12, usually caused by atrophic gastric mucosa.

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13
Q

Where is B12 stored? How long do that storage last?

A

Stored in liver. Anemias are seen 3-4 years after defective B12 absorption starts.

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14
Q

How many atoms of Iron does each hemoglobin molecule carry? How many molecules of oxygen?

A

4 iron atoms per Hgb molecule. 4 molecules of oxygen (total 8 atoms).

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15
Q

How is iron transported in the plasma?

A

Binds to protein to form transferrin.

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16
Q

In what form is iron stored in the cell?

A

Binds to protein to form ferritin.

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17
Q

Where is excess iron stored?

A

Mostly in the liver, some in the reticuloendothelial cells of bone marrow.

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18
Q

What is the maximum rate of iron absorption from GI system?

A

Only a few milligrams per day. Average loss of women is 1.3mg/day!

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19
Q

Is the body able to increase the rate of iron absorption?

A

Yes! When iron stores are depleted, can accelerate 5x normal.

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20
Q

RBCs contain cytoplasmic enzymes that do these 4 things:

A
  1. Maintain cell membrane
  2. Maintain transport of ions across membrane
  3. keep iron in ferrous form
  4. Prevent oxidation of proteins in RBCs
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21
Q

How is hemoglobin excreted?

A

iron is recycled for use in new RBCs. Proteins are excreted as bilirubin.

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22
Q

What type of anemia is seen in chronic blood loss?

A

Microcytic hypochromic anemia.

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23
Q

What causes megaloblastic anemia?

A

Lack of B12 or folic acid. Seen in atrophic gastric mucosa, intestinal sprue, or total gastrectomy.

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24
Q

What is hemolytic anemia?

A

Fragile RBCs that rupture easily, causing an extremely short lifespan.

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25
Q

What are two common types of hemolytic anemia?

A
  1. Sickle Cell Disease

2. Erythroblastosis Fetalis

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26
Q

What is the MAJOR side effect of anemia?

A

Greatly increased cardiac output! Also causes increased workload on heart.

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27
Q

What could cause acute cardiac failure in an anemic person?

A

Increased tissue demand for oxygen. ie - Exercise!

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28
Q

What is polycythemia vera?

A

RBC 7-8 and HCT 60-70%. Too many RBCs = viscous and plugging.

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29
Q

What is the hemodynamic effect of viscous blood?

A

Decreased venous return to heart, cancels out the increased blood volume = normal CO. BP often normal b/c body compensates!

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30
Q

Normal concentration of platelets?

A

150-450k

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31
Q

What is the role of glycoproteins on platelets?

A

Prevents adherence to normal endothelium but reacts to injured areas

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32
Q

What is thromboxane A2?

A

Vasoconstrictor, reacts with platelets to activate them during clotting process

33
Q

What activates prothrombin activator? What is the next step in the process?

A

Activated Xa -> prothrombin activator -> prothrombin

34
Q

What is the role of thrombin?

A

Enzyme that converts fibrinogen into fibrin fibers to form clot.

35
Q

What electrolyte is required throughout the clotting process?

A

Calcium!

36
Q

What two substances are made in the liver?

A

Vitamin K and fibrinogen

37
Q

What activates the extrinsic pathway?

A

Trauma to the vascular wall or surrounding tissues come into contact with blood.

38
Q

What activates the intrinsic pathway?

A

Trauma to the blood or exposure to endothelial collagen.

39
Q

Where does the common pathway start?

A

With the activation of factor x.

40
Q

Which is faster - the intrinsic or extrinsic clotting pathway?

A

Extrinsic.

41
Q

The production of what substances are decreased when endothelial cells are damaged?

A

Prostaglandin and Nitric Oxide. Both usually inhibit plt aggregation and start of blood clotting.

42
Q

What is the role of plasmin?

A

Digests fibrin fibers, fibrinogen, several clotting factors. Breaks down clot!

43
Q

What activates plasminogen to create plasmin?

A

Tissue plasminogen activator (t-PA).

44
Q

What patient populations are deficient in vitamin K and are at increased risk of bleeding?

A

Liver patients, obstruction of bile ducts, gastrointestinal disease preventing absorption.

45
Q

What is the inheritance pattern of hemophilia?

A

Genetically transmitted, X-linked, recessive. Therefore usually only occurs in males.

46
Q

What are the 5 major causes of thrombocytopenia?

A
  1. Decreased production in bone marrow
  2. Antibody destruction of plts
  3. Pooling of plts in spleen
  4. Thrombi consuming clotting factors
  5. Dilution of blood
47
Q

If a clot forms in the venous system and breaks off it causes? What does it NOT cause?

A

PE. it does NOT cause stroke!

48
Q

If a clot forms in the arterial system or left side of heart, where does it go?

A

Stroke.

49
Q

What are two causes of thromboembolic conditions?

A
  1. Roughened endothelial surface

2. Slow blood flow

50
Q

What causes DIC?

A

Endotoxins from bacterial sepsis.

51
Q

In what form is iron stored in the cell? How is it trasnported?

A

Stored as ferritin. Transported as transferritin.

52
Q

What is the MCV?

A

Mean corpuscular volume. Average size of RBCs in sample (determines microcytic vs. macrocytic)

53
Q

What is a normal MCV?

A

80-96

54
Q

What is MCHC?

A

mean corpuscular hemoglobin concentration. Determines color of RBCs. (hypochromic vs. hyperchromic)

55
Q

What is a normal MCHC?

A

31-36

56
Q

What is TiBC?

A

Total iron binding capacity. Higher numbers = not enough iron.

57
Q

What is normal TiBC?

A

240-450

58
Q

What is normal iron levels?

A

60-170

59
Q

What is ferritin?

A

Storage of iron in the cell.

60
Q

What is a normal ferritin level?

A

Male 12-300

Female 12-150

61
Q

What causes microcytic hypochromic RBCs?

A

Iron deficiency anemia

62
Q

What causes megaloblastic RBCs?

A

B12 deficiency anemia

63
Q

What are the characteristics of hemolytic anemia?

A

High bilirubin, low hgb/hct, high reticulocyte count, high RDW

64
Q

What is Virchow’s triad?

A
  1. Endothelial Injury
  2. Venous stasis
  3. Hypercoagulability
65
Q

What medications do you use in athersclerosis?

A

Anti-platelets (Asa, plavix)

66
Q

What medications do you use for venous stasis and Afib?

A

Anticoagulants

67
Q

What are the phases of interphase? What happens during interphase?

A

G1, S, and G2.

DNA duplication, duplication of organelles

68
Q

List the 4 phases of mitosis

A
  1. Prophase
  2. Metaphase
  3. Anaphase
  4. Telophase
69
Q

What happens during metaphase?

A

Centromeres line up in the MIDDLE

70
Q

What do cyclin, cyclin-dependent kinases, and cyclin-dependent kinase inhibitors do?

A

Control the cell cycle and mitosis.

71
Q

What is the P53?

A

Tumor suppression gene

72
Q

What is carcinoma in situ?

A

Abnormal cells that have not breached the basement membrane. Known as pre-invasive and non malignant.

73
Q

What are proto-onco genes?

A

They are genes that encode proteins that promote cell division. Normal in childhood, mutations can reactivate them.

74
Q

What are the 6 cancer cell hallmarks?

A
  1. Immortality
  2. Resist apoptosis
  3. Evade growth suppressors (p53)
  4. Genomic instability
  5. Angiogenesis
  6. Uncontrolled proliferative signaling
75
Q

What are the characteristics of transformation from normal cell to cancer cell?

A

Autonomy from cellular controls, lack contact inhibition, anchorage independent, and are immortal

76
Q

What is the most common leukemia in children? Adults?

A 
Children = ALL
Adults = AML
77
Q

When there are more than 30% lymphoblast in blood or BM, what is that diagnostic of?

A

ALL

78
Q

Binucleate Reed-Steinburg cells are diagnostic of what type of cancer?

A

Hodgkin’s Lymphoma

79
Q

What do you need to be careful of in Multiple Myeloma?

A

Kidney Function - can cause renal failure!

NUR 803 Pathophysiology (5 decks)

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