Blood Disorders (CHP 22 + 23 + 24) Flashcards
Describe the pathophysiology and manifestations of disorders of erythrocytes, including anemias (all types), and polycythemia. Describe the pathophysiology and manifestations of non-neoplastic and neoplastic disorders of leukocytes. Differentiate between types of cancer affecting the blood and lymphoid tissue (Hodgkin vs Non-Hodgkin Lymphoma; Multiple Myeloma). Describe the pathophysiology and manifestations of platelet disorders. Differentiate various bleeding disorders (Thrombocytopenia [ITP,
1
Q
hemoglobin
A
protein on RBC that holds O2
2
Q
process for developing RBCs
A
erythropoiesis
3
Q
hematocrit
A
% of RBC in the blood
4
Q
what is the primary function of RBCs?
A
carry or transport O2 to tissues
5
Q
what are the 4 parts needed to make an RBC?
A
protein
iron (heme)
folic acid
vit B12
6
Q
what is the lifespan of RBCs
A
120 days
7
Q
where are RBCs stored?
A
liver
8
Q
where are RBCs broken down?
A
spleen
9
Q
where are RBCs produced?
A
red bone marrow
10
Q
__________: an abnormally low # of circulating RBCs or level of Hbg, or both = diminished O2-carrying capacity
A
anemia
11
Q
what are the 4 causes of anemia?
A
- excessive loss of RBCs from bleeding
- destruction of RBCs (rxn to blood transfusion)
- defective RBC production
- inadequate RBC production due to bone marrow failure
12
Q
normocytic
A
normal and concave
13
Q
microcytic
A
too small
14
Q
macrocytic
A
too big
15
Q
leukopenia
A
deduction of WBCs
16
Q
effects of anemia is dependent on __________, _____ (ulcers vs MVA), _____
A
severity
rate
onset
17
Q
overall main effect of anemia:
A
impaired oxygen transport and compensatory mechanisms
18
Q
why is jaundice a sign of anemia?
A
bilirubin is a byproduct of RBC destruction
19
Q
common signs and symptoms of anemia
A
jaundice (sclera)
pallor skin (cyanotic, distal, babies = lips)
pallor of mucous membrane (ears, eyes, nose, mouth)
lack of circulation manifestations (tachycardia, palpitations, angina)
confusion or headaches (hypoxic brain)
pain and cloticaton (bone pain due to overdrive production of RBCs)
SOB
20
Q
what are the 6 types of anemia?
A
blood loss
hemolytic
iron deficient
megaloblastic
aplastic
chronic disease
21
Q
________ _____ anemia can result from acute (surgery/________) or chronic (___ bleed)
A
blood loss
trauma
GI
22
Q
blood loss anemia is caused by …
A
internal or external hemorrhage
23
Q
hemolytic anemia is caused by … (2)
A
premature destruction of red cells in vascular compartments or outside AND/OR retention of iron or other products of Hgb destruction
24
Q
autoimmune disorders are an example of __________ hemolytic anemia
A
intrinsic
25
chemo and radiation disorders are an example of __________ hemolytic anemia
extrinsic
26
sickle cell disease is an example of _________ anemia
hemolytic
27
with sickle cell disease, CBC values are _______ and we need to look at the blood ________
normal
smear
28
with hemolytic there is an increase in ___________
erythropoiesis
29
what causes iron deficiency anemia?
dietary deficiency
loss of iron via bleeding
increased demands
30
iron deficiency anemia leads to _________ hemoglobin _________ and consequent impaired _______ delivery
decreased
synthesis
oxygen
31
what causes megaloblastic anemia?
impaired DNA synthesis that results in enlarged RBCs
32
what are the 2 most common conditions associated with this anemia?
vitamin B12 deficiencies
folic acid deficiencies
33
megaloblastic anemias have abnormally shaped and large, which means that they cannot do the normal ________ of RBCs
function
34
with aplastic anemia, there is a reduction of ...
RBCs
WBCs
platelets
35
thrombocytopenia
reduction of platelets
36
what causes aplastic anemia
exposure to high doses of radiation, chemicals, and toxins that suppress hematopoiesis
37
aplastic anemia is caused by _______ factors
extrinsic
38
with aplastic anemia, there is a _______ onset of fatigue and bleeding gums
gradual
39
what causes chronic disease anemias
chronic infections, inflammation, cancer and chronic renal failure
40
what kind of anemia is common in the ICU?
chronic disease anemia
41
the ________ are the primary site of erythropoietin synthesis which stimulates __________ and increases _____ production: which is why chronic renal disease can cause anemia
kidneys
erythropoiesis
RBC
42
sickle cell anemia cells are pointess because ...
they can't carry O2 and they clog movements because of abnormal shape
43
what is polycythemia?
abnormally hihg total red blood cell mass with a hematocrit greater than 54% in males and 47% in females
44
what is absolute polycythemia?
rise in hematocrit due to a rise in RBC mass
45
S/S of polycythemia
cardiac dysfunction and vascular obstrution, hypoxia
46
with relative polycythemia, hematocrit increases because of ...
loss of plasma
47
causes of relative polycythemia
GI loss
lots of diuretics
dehydration
48
what is primary absolute polycythemia?
absolute increase in total RBC mass and elevated WBC, platelet
49
primary absolute polycythemia can also be called
polycythemia vera
50
primary absolute polycythemia can interfere with cardiac ______, impeding blood _____ and ____ BP
output
flow
high
51
secondary absolute polycythemia there is an increase __________ (only _____)
RBCs
erythropoietin
52
people run marathons at high elevation to increase their capacity for ____
O2
53
Non-Neoplastic Disorders of White Blood Cells (2)
neutropenia
infectious mononucleosis
54
Neoplastic Disorders
Non-Hodgkin lymphomas*
Hodgkin lymphoma*
Lymphoid leukemia
Plasma cell dyscrasias
55
people with neutropenia are at tisk for ________
infection because of ANC
56
neutropenia can be ________ or ________
congenital or acquired
57
what is mono caused by
epstein-barr virus
58
mono is usually ________ (quick)
insidious
59
manifestations of mono (4)
malaise
anorexia
chills
enlarged lymph nodes
60
what are 2 complications of mono
splenomegaly
hepatitis
61
people with neoplastic disorder are at risk for bleeding because ....
platelets and RBCs are overcrowded (no clotting and anemia)
62
what is the origin of non-hodgkin lymphoma?
B-cell, T-cell, NK cell
63
alterations in the developmental process of these cells can lead to
any of the subtypes of lymphoid neoplasm
lymphocytes
64
what are the 4 characterizations of non-Hodgkin lymphoma?
cellular morphology (main)
immunophenotype
clinical symptoms
level of aggression
65
non-hodgkin lymphomas are _____ growing and have __________ lymph nodes and they don't hurt
slow
enlarged
66
non-hodgkin lymphoma affects which body parts? (3)
spleen
liver
bone marrow
67
Specialized form of lymphoma that features the presence of an abnormal cell called a Reed-Sternberg cell, with ....
hodgkin lymphoma
68
hodgkin lymphoma arises in a single _____ or chain of nodes and and then spread systemically
node
69
clinical manifestations of hodgkin lymphoma (6)
1. painless enlargement of nodes (above the diaphragm)
2. chest discomfort with cough
3. fevers
4. chills
5. night sweats
6. pruritus
70
spread of hodgkin lymphoma to ... (5)
liver
spleen
lungs
digestive tract
CNS
71
destruction of bone from the inside out
multiple myeloma
72
increase in IgG in the cytoplasm around the nucleus in _______ ______
multiple myeloma
73
what are the 4 major categories of neoplastic disorders?
non-Hodgkin lymphomas
Hodgkin lymphoma
lymphoid leukemia
plasma cell dyscrasias
74
risk factors of multiple myeloma (4)
1. chronic immune stimulation
2. autoimmune disorders
3. ionizing radiation exposure
4. exposure to pesticides/herbicides
75
treatment for multiple myeloma?
stem cell transplant
high dose chemo
76
manifestations of multiple myeloma (9)
bone pain
hypercalcemia
fractures
thrombocytopenia
renal failure
increase in fluid viscosity
infections
anemia
neutropenia
77
_________ are malignant neoplasms of cells originally derived from hematopoietic precursor cells
leukemias
78
leukemia is characterized by ...
replacement of bone marrow with unregulated, proliferating, immature neoplastic cells (chromosomal changes)
79
how is leukemia classified?
cell type (lymphocytic or myelocytic)
acute (ALL, AML)
chronic (CLL, CML)
80
what is the most common type of childhood cancer?
acute lymphoblastic leukemia (ALL)
81
what is the patho of ALL?
rapid production of immature lymphocytes (B lymphocytes usually)
82
______ _______ leukemia is when there are so many blasts (immature cells) that is crowds out normal WBCs
acute lymphoblastic
83
manifestations of ALL?
*tired, weak, pale, bruising, splenomegaly and hepatomegaly
*fever, night sweats, large
lymph nodes (large WBCs but no infection to treat)
84
______ _________ is more common in adults
chronic lymphocytic
85
what is the patho of CLL
gradual production of malignant B lymphocytes
86
LYMPHOCITIC: attacks the __________ immune system
adaptive
87
manifestations of CLL (5)
fever, anemia, increase risk of infection, splenomegaly, or hepatomegaly
88
MYELOGENOUS: attacks the __________ immune system
innate
89
what is the patho of AML?
*affects cells of myeloid line (originates in bone marrow)
*rapid production of immature cells
90
AML and ALL have the same clinical manifestations, so they have to look at ...
blood smears and shapes
91
_____ affects elderly more often
CML
92
what is the diagnostic marker of CML
Philadelphia chromosome (translocation of 9 and 22)
93
what is the patho of CML?
affects cells of myeloid line (OG in BM)
94
manifestations of leukemia: (8)
1. bone marrow depression
2. malaise
3. fever
4. bleeding
5. bone pain
6. anemia (A)
7. vulnerable to infections (low neutropenia) (N)
8. thrombocytopenia (T)
95
excessive everything in the blood, NON malignant
polycythemia vera
96
what causes polycythemia vera
increase response to growth factors
97
manifestations of polycythemia vera (
headaches
hypervolemic state
BV distention
spleno/hepatomegaly
98
Bleeding Associated with Platelet
Disorders
Can be due to decrease in
platelet numbers d/t
production decrease,
increased destruction, or
impaired function
99
Common sites of bleeding are (w platelet disorders)
mucous membranes (nose, mouth, GI tract, uterine cavity); can also see
petechiae* or purpura*
100
___________ caused by decreased platelet production (less than 150,000), increased sequesterian of decreased platelet survival
thrombocytopenia
101
what are the 3 types of thrombocytopenia?
1. immune thrombocytopenic purpura (ITP)
2. thrombotic thrombocytopenia purpura (TTP)
3. drug-induced thrombocytopenia
102
_____ Results in platelet antibody formation and excess destruction of platelets, also referred to as idiopathic
ITP
103
what causes secondary ITP?
autoimmune disorders and chronic infections (H pylori, hep C, HIV)
*infections help immune systems attack platelets
104
what causes primary ITP
autoimmune diseases (immune function destroys platelets)
105
newly diagnosed ITP: time?
diagnosis to 3 months
106
persistent ITP: time?
3 to 12 months
107
chronic ITP: time?
1 year and more
108
incidence highest in __________ 30 - 59 and older persons older than 60
females
109
patho of ITP
D/t antiplatelet antibodies in the platelet membrane (platelets are more susceptible to phagocytosis d/t this antibody) destroyed
in the spleen
110
manifestations of ITP
Bruising, bleeding from gums, epistaxis, melena, abnormal menstrual bleeding, splenic enlargement
111
TTP is the combination of (5)
Combination of thrombocytopenia, hemolytic anemia, renal failure, fever, and neurologic
abnormalities
112
what is the onset for Thrombotic Thrombocytopenic Purpura (TTP)
abrupt (rare overall)
113
______: Likely results from introduction of platelet-aggregating substances into the circulation
TTP
lack of enzyme
114
patho of TTP
Plt aggregation results in microvascular occlusions, leading to end-organ failure
115
manifestations of TTP (4)
Purpura, petechiae, vaginal bleeding, neurologic symptoms (ranging from headaches-seizures-
altered consciousness)
116
TTP is 99% _______
acquired (blood transfusions, IV meds)
117
what kinds of drugs can induce thrombocytopenia
aspirin, atorvastatin, some antibiotics
118
drug- induced thrombocytopenia: Induce an antigen-antibody response and formation of
____________ _______ that cause plt destruction by lysis
immune complexes
119
Will see a rapid fall in the plt count within 2-3 days of _______ a drug or 7+ days after starting a drug for the ____ ____; plt count will rapidly increase after the drug is discontinued
resuming
first time
120
Characterized by widespread
coagulation and bleeding in the
vascular compartment
Disseminated intravascular coagulation (DIC)
121
what is caused by DIC caused by?
treatment (AND treatment has many complications)
122
conditions associated with DIC (6)
obstetric
cancers
infections
shock
trauma/surgery
blood transfusion rxns
123
manifestations of DIC (
blood
*bleeding
*brusiing
*hematuria
* hypovolemic
clot
*tissue necrosis
*acrocyanosis
* confusion
