Blood Disorders

Question 1

Define anemia and it’s effect

Answer 1

A reduction in total amount of circulating erythrocytes or a decreased quality/quantity of hemoglobin.
It’s effect is decreasing the oxygen carrying capacity of the blood, resulting in tissue hypoxia.

Question 2

Causes of anemia (4 causes)

Answer 2

Altered production of erythrocytes, blood loss, increased erythrocyte destruction, all three

Question 3

Clinical manifestations of anemia

Answer 3

Decrease in viscosity (thickness) of the blood (increased stroke volume/heart rate)
Hypoxemia (reduced oxygen level in blood)
Tissue hypoxia causes the rate and depth of breathing to increase
Dyspnea (shortness of breath)
Fatigue
Dizzyness
Nausea

Question 4

Describe macrocytic normochromic anemia (size of cell/amt of hemoglobin) and describe pernicious anemia (including involvement of intrinsic factor, 3 causes and 3 clinical manifestations)

Answer 4

Large cell, normal hemoglobin.
Pernicious anemia is caused by a Vit B-12 definicency. Lack of intrinsic factor in the gut causes B-12 to not absorb.
Alcohol (heavy), Smoking, complete partial stomach removal
Clinical: paresthesias of feet and fingers, weakness, fatigue

Question 5

Describe microcytic hypochromic anemia (size of cell/amt of hemoglobin) and describe an example (including causes and stages) of this condition.

Answer 5

Small cell size/Less hemoglobin
Iron deficiency anemia. Iron is normally recycled throughout the body and some of it is kept in storage, if there is sufficient blood loss, more iron is taken out than can be replaced, anemia occurs.
1) Iron storage depleated. RBC production is normal with normal amounts of hemoglobin produced.
2) Insufficient amounts of iron are transported to the bone marrow. RBC with not enough hemoglobin are produced.
3) Hemoglobin deficient RBC enter circulation to replace old worn out RBCs.

Replacement of lost iron is the best treatment once the source of blood loss is indentified.

Question 6

Describe normocytic normochromic anemia (size of cell/amt of hemoglobin) and give an example of this condition.

Answer 6

Normal size/normal hemoglobin

Few in number, sickle cell anemia, chronic inflammation

Question 7

Define polycythemia and describe two forms.

Answer 7

Polycythemia is excessive erythrocytes that interferes with heart function (higher viscosity)
Relative: brought through dehydration
Absolute: Primary: overabundance of bone marrow stem cells
Secondary: due to hypoxia, which results in overproduction of erythopoietin to compensate for low oxygen levels

Question 8

Define leukocytosis and leucopenia, and give 2 causes for each.

Answer 8

Leukocytosis is WBC is higher than normal. Caused by infection, surgery, pregnancy, hormones.
Leucopenia is WBC is lower than normal. Caused by radiation, anaphylatic shock

Question 9

Define neutrophilia and neutropenia and give 1 cause for each.

Answer 9

Neutrophilia – High number of neutrophils in blood. Is an early response to infection
Neutropenia – Less number of neutrophils in blood. Severe prolonged infections can’t keep up to demand. (HIV infection, anemia, starvation)

Question 10

Define agranulocytosis and give a cause

Answer 10

Very low counts of granulocytes. Caused by chemo.

Question 11

Give the names and know a possible cause for each of: too many/too few eosinophils, basophils and monocytes.

Answer 11

Eosinophilia – parasitic infection 
Eonsinopenia – Cushing syndrome
Basophilia – chronic myloid leukemia
Basopenia – long term steroid therapy
Monocytosis – chronic infection (TB)
Monocytopenia – predisone therapy

Question 12

Define lymphocytosis and lymphocytopenia and 1 cause for each.

Answer 12

Lymphocytosis (too many) is produced during viral infection.

Lymphocytopenia (too little) is immune deficiencies, drugs, no known cause.

Question 13

Describe transmission, symptoms and pathophysiology of infectious mononucleosis.

Answer 13

Virus invades oropharynx and nasopharynx and salivary cells, then spreads to lymphoid tissue/B cells. Virus infects B cells, multiplying them.
Unaffected B cells produce antibodies and cytotoxic T-cells become activated causing lymph node to swell.
Symptoms: swelling of lymph nodes, fever, sore throat

Question 14

Describe leukemia, in general.

Answer 14

A malignant disorder of blood and blood forming organs.

Question 15

What is the common pathological feature of all leukemias?

Answer 15

Uncontrolled proliferation of malignant leukocytes causing crowding in the bone marrow causing production of other cell lines to cease, resulting in panacytopenia. (reduction of all celluar components of blood)

Question 16

Identify 3 risk factors for leukemia.

Answer 16

Cigarettes, HIV infections, drugs, appear in families who have heriditary abnormalites

Question 17

Define the type of cells that have become malignant in ALL, AML, CLL, CML.

Answer 17

ALL (Acute lymphocytic leukemia) – lymphocytes
AML (Acute mylogenous leukemia) – everything except lymphocytes
CLL (Chronic lymphocytic leukemia) – affects B cells (refuse to respond to apoptosis commands, accummulate while becoming inactive)
CML (Chronic mylogenous leukemia) – slow growth of mature cells

Question 18

What are blast cells?

Answer 18

Less differentiated cells involved in acute leukemias.

Question 19

Which of the leukemias tend to be manifested in children / older individuals?

Answer 19

Children – acute, Adults – chronic

Question 20

Describe four characteristics, the evaluation and treatment of acute leukemias, in general.

Answer 20

Fatigue, anorexia, fever caused by infection, bleeding caused by thrombocytopenia,
Difficult to detect early, blood tests/bone marrow biopsy
Chemo along with blood tranfusions

Question 21

Describe four characteristics, evaluation and treatment of chronic leukemias, in general.

Answer 21

Fatigue, weight loss, low-grade fever, splenomegaly (spleen enlargement)
Blood tests/bone marrow biopsy
Bone marrow transplant and chemo.

Question 22

What is the significance of the Philadelphia chromosome?

Answer 22

Philadelphia chromosome is observed in 95% of those with CML

Question 23

Which of the leukemias can be sufficiently slow such that an individual may die of an unrelated disease?

Answer 23

CLL

Question 24

Define thrombocytopenia, effect, and two causes.

Answer 24

Too little platelets, either decreased platelet production or increased consumption.
Risk hemorrhage with minor trauma if too low. Spontaneous bleeding may occur without trauma.
Platelet consumption can be caused by Heparin, drug given during surgury to decreased platelet production.
Idiopathic, no known caused, suspected to be immune in nature.

Question 25

Define petechiae, purpura.

Answer 25

Petechiae – small red or purple spot on body caused by minor hemorrhage (pinpoint)
Purpura – small red or purple spot on body caused by bleeding underneath skin. (larger areas)

Question 26

Define primary and secondary thrombocythemia, and their causes.

Answer 26

Primary: platelet production increases, due to defects in thrombopoietin receptor on platelets. Defection receptor cannot bind and remove thrombopoietin from blood.
Secondary:
May occur after partial or full spleen removal. Platelet normally stored in spleen now remain circulating in blood.

Question 27

What is the overall effect on individuals of thrombocythemia?

Answer 27

At risk for large-vessel thrombosis or ischemia in extremities.

Question 28

What characterizes an alteration in platelet function (quality)? Give two causes for the acquired variety.

Answer 28

Increased bleeding time in presence of a normal platelet count.
Aspirin causes decreased platelet aggregation
Blood cell formation structures in leukemia – low quality platelets produces.

Question 29

What usually causes a coagulation disorder?

Answer 29

Defects or deficiencies in one or more clotting factors.

Question 30

Give four causes for coagulation disorders.

Answer 30

Changes in blood flow, stimulation from released tissue factors from damaged/dead tissues, inherited or acquired.

Question 31

Define and describe DIC and two problems that it can cause.

Answer 31

DIC is widespread activation of coagulation, resulting in formation of fibrin clots in medium and small vessels throughout the body. May block organs leading to organ failure, may cause consumption of platelets and clotting factors leaving to severe bleeding.

Question 32

What is the direct cause of DIC and what is one circumstance that can bring about this direct cause?

Answer 32

Widespread exposure to thromboplasin. Can occur from widespread damage to endothelium, inflammation or TF expression by tumors.

Question 33

How does DIC present and how can it be treated?

Answer 33

Slow leaking at lesions, bleeding at eyes, nose, gums, bleeding at three or more unrelated sites.
Treatment includes eliminating underlying cause, control of thrombosis, replacement of fluid for maintenance of organ function.