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Chapter 30 Hematologic System > Book Notes > Flashcards

Book Notes Flashcards

1
Q

Assessment of the hematologist system is based on:

A

Patients health history, physical examination, and results of diagnostic studies

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2
Q

Hematopoiesis

A

Blood cell production

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3
Q

Where does hematopoiesis occur?

A

Bone marrow

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4
Q

What is bone marrow?

A

Soft material that fills central core of bones

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5
Q

The two types of bone marrow

A

Yellow (adipose) and red (hematopoietic)

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6
Q

Which bone marrow actively produces blood cells?

A

Red marrow

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7
Q

Hematology

A

Study of blood and blood forming tissues; including bone marrow, bone, spleen and lymph system

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8
Q

Where is red marrow found?

A

in flat and irregular bones, like ends of long bones, pelvic bones, vertebrae, sacrum, sternum, ribs, flat cranium bones, and scapulae

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9
Q

What are the 3 types of blood cells?

A

RBC, WBC, platelets

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10
Q

Where do blood cells develop from?

A

from a common hematopoietic stem cell within the bone marrow

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11
Q

What is a stem cell?

A

immature blood cell that is able to self renew and to differentiate into hematopoietic progenitor cells

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12
Q

what is blood?

A

a type of connective tissue

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13
Q

3 major functions of blood

A
  1. transportation
  2. regulation
  3. protection
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14
Q

blood: transportation function defintion

A
  1. O2 from lungs to cell
  2. nutrients from GI tract to cells
  3. hormones from endocrine glands to tissues and cells
  4. waste products from cells to lungs, liver and kidneys
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15
Q

blood: regulation function definition

A
  1. fluid and electrolyte balance
  2. acid-base balance
  3. maintaining oncotic pressure (BP in wall vessels)
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16
Q

2 major components of blood

A

plasma 55%

blood 45%

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17
Q

what is plasma composed of?

A

mostly water, but contains proteins, electrolytes, gases, nutrients and waste

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18
Q

what is serum?

A

plasma minus clotting factors (fibrinogen)

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19
Q

what is plasma protein produced by?

A

liver

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20
Q

what are antibodies produced by?

A

plasma cells

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21
Q

what is albumin?

A

protein that helps maintain oncotic pressure in the blood

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22
Q

primary function of erythrocytes (rbc)

A

transportation of gases (O2 and Co2) and assisting w/ acid-base balance

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23
Q

primary function of leukocytes

A

protecting the body from infection

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24
Q

primary function of platelets

A

promote blood coagulation

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25
Q

shape of RBC

A

flexible cells with biconcave shape; flexibility enables the cell to alter shape so it can pass in small capillaries

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26
Q

what are erythrocytes primarily composed of?

A

hemoglobin

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27
Q

what is hemoglobin?

A

complex protein iron compound composed of heme (iron compound) and globin (simple protein) that binds with o2 and co2

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28
Q

what is oxyhemoglobin?

A

as RBCs circulate through capillaries, o2 attaches to the ironm and becomes oxyhemoglobinm and is what gives blood bright red color

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29
Q

how does oxyhemoglobin work?

A

as rbcs flow to body tissues, o2 detaches from hemoglobin and diffuses from the capillary into tissue cells. co2, diffuses from tissue cells into capillary and attaches to the globin of hemoglobin and transported to lungs for removal

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30
Q

what does hemoglobin act as?

A

a buffer and plays a role in maintaining acid base balance

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31
Q

what is erythropoiesis?

A

process of rbc production

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32
Q

what is erythropoiesis stimulated by?

A

hypoxia (low o2 level)

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33
Q

what is a pTTT for?

A

activated partial thromboplastin time- for continuous IV heparin ( lots of heparin)

34
Q

what is a pTT for?

A

heparin

35
Q

what is a pT w/ INR for?

A

coumadin

36
Q

what is erythropoiesis controlled by?

A

erythropoietin- a glycoprotien made and released by the kidney. it stimulates the bone marrow to increase rbc production

37
Q

lifespan of an erythrocyte

A

120 days

38
Q

nutrients needed for erythropoiesis

A

protein, iron, folic acid, vitamin b12, b2, b6, vitamin e. hypothyroidism is often associated with anemia

39
Q

what is a reticulocyte?

A

immature erythrocyte. this count measures the rate at which rbcs appear in circulation.

40
Q

hemolysis definition

A

destruction of rbc. by monocytes and macrophages removing abnormal, defective, damaged, and old rbcs from circulation.

41
Q

where does hemolysis occur?

A

bone marrow, liver and spleen

42
Q

what are leukocytes?

A

wbcs. provide protection from infections; originates from stem cells within bone marrow

43
Q

what are granulocytes?

A

leukocytes that contain granules within the cytoplasm

44
Q

3 types of granulocytes

A
  1. neutrophils
  2. basophils
  3. eosinophils
45
Q

what are agranulocytes?

A

leukocytes that don’t have granules withing the cytpolasm

46
Q

2 types of agranulocytes

A
  1. lymphocytes

2. monocytes

47
Q

how many nuclei do monocytes and lymphocytes have?

A

one discrete nucleus, referre to as mononuclear cells

48
Q

function of granulocytes

A

phagocytosis, process by which wvcs ingest or engulf any unwanted organism and then digest and kill it

49
Q

granulocyte: neutrophil

A

most common type of granulocyte; 50% to 70%; primary phagocytic cell. die in 1 to 2 days; first to arrive at infection;

50
Q

granulocyte: eosinophil

A

2-4% of all WBCs. engulf antigen-antbody complexes formed during an allergic response. elevated levels is seen in neoplastic disorders like hodgkins lymphoma and other skin/connective tissue disorders. able to defend agains parasitic infections

51
Q

granulocyte: basophils

A

make up less than 2% of all wbcs. allergic and inflammatory reactions

52
Q

mature vs. immature neutrophils

A

segmented / bands; segmented neutrhils more effective at phagocytosis than bands

53
Q

lymphocytes

A

20 to 40% of wbcs; form basis of cellular and humoral immune responses. B cells and T cells; originate in bone marrow and migrate to thymus to differentiate into T cells.

54
Q

Monocytes

A

4 to 8% of total wbcs; ingest small or large masses or matter, like bacteria, dead cells. only present in blood for short time before they migrate to tissues and become macrophages.

55
Q

main function of thrombocytes

A

(platelets) promote blood coagulation in response to injury or disease; initiate clotting process; produces a plug at site of injury; 1/3 of platelets reside in spleen; maintain capillary integrity; life span of 8-11 days; pt with history of splenectomy may have difficulty with blood clotting

56
Q

what is platelet production regulated by?

A

thrombopoietin- a growth factor that acts on bone marrow to stimulate platelet production

57
Q

what is platelet count?

A

number of platelets per microliter of blood.

58
Q

normal platelet count?

A

150,000 and 400,000; 250,000 is good number

59
Q

thrombocytopenia

A

platelet count have fallen below 100,000u/L; bleeding precautions; spontaneous hemorrhage with numbers 10,000 to 20,000

60
Q

thrombocytosis

A

excessive platelets, disorder that occurs with inflammation and some malignant disorders, complications = excessive clotting

61
Q

Spleen location

A

upper left quadrant next to kidney; highly vascular organ (storage of blood); bleeds easily with traumatic event

62
Q

4 functions of spleen

A
  1. hematopoietic
  2. filtration
  3. immunologic
  4. storage
63
Q

spleen: hematopoietic function

A

spleens ability to produce rbcs during fetal development

64
Q

spleen: filtration function

A

spleens ability to remove old and defective rbcs from circulation; removes hemoglobin from rbcs and returns iron component to bone marrow for reuse; filters out bacteria, esp gram positive cocci

65
Q

spleen: immunologic function

A

contains rich supply of lumpocytes anf stored immunoglobulins (antibodies)

66
Q

spleen: storage function

A

storage site for RBCs and platelets; 1/3 of platelets are stored here; patients who have had splenectomy are at higher risk for infection, encourage to keep up with immunizations

67
Q

Liver

A
  • acts as filter
  • produces clotting factors
  • produces all initial coagulants for hemostasis and blood coagulation
  • produces bile from rbc breakdown
  • detoxifies substances in blood
  • healthy functioning essential for hemostasis and metabolism
  • stores excess iron
  • hepcidin-produced by liver key regulator of iron balance (reduces the release of stored iron from enterocytes)
68
Q

what does the lymph system consist of?

A
  • lymph fluid
  • lymphatic capillaries
  • lymphatic ducts
  • lymph nodes
  • it carries fluid from the interstitial spaces to the blood (how proteins and fat from GI tract, and hormones are able to return to circulatory system
69
Q

how to lymph nodes?

A

-found throughout body
-deep ones not palpable
-assess symmetrically from top of head/neck to bottom (note size in cm should be 0.5 to 1cm, mobile and nontender)
-

70
Q

lymph nodes

A
  • small clumps of lymphatic tissue found in groups along lymph vessels
  • storage sites for lymphocytes
  • more than 200 lymph nodes
  • filter pathogens and foreign particles (carried out of body by lymph fluid)
71
Q

lymph nodes assessment

A

a tender, hard, fixed, or enlarged (whether tender or not) node is considered abnormal; warrants further evaluation

  • tender nodes are usually result of inflammation
  • hard fixed nodes may suggest malignancy
72
Q

hemoglobin normal count

A
  • female: 11.7 to 16

- male: 13.2 to 17.3

73
Q

hematocrit normal count

A
  • female 35% to 47% (0.35- 0.47)

- male 39% to 50% (0.39-0.50)

74
Q

Bone Marrow examination

A

preferred site for bone marroy aspiration and biopsy is the posterior iliac crest

  • anterior iliac crest and sternum are alternatives
  • sternum is only for aspiration
  • must be performed by physician or credentialed nurse
75
Q

end of bone marrow examination

A

monitor VS till stable, and assess site for excess drainage or bleeding.
-if bleeding is present advise pt to lie on side for 30 to 60min to maintain pressure

76
Q

elder consideration

A
  • decrease in bone marrow reserve
  • limited reserve capacity of blood cell levels leaving elder more vulnerable to issues with clotting, transporting oxyen, and fighting infections.
  • decrease t-cell function and number
  • thymus organ atrophy
77
Q

elderly considerations cont

A
  • changes in vascular integrity with age leads to > bruising
  • ineffective erythropoiesis, esp after blood loss
  • increased prevalence and incidence of infection with age
  • lower hemoglobin levels present
  • total iron, iron binding capacity and intestinal iron absorption decrease (iron loss may be cause for low hemoglobin levels)
78
Q

physical assessment

A
  • elimination pattern: ask of patient has blood in urine or stool, ask about recent colonoscopy
  • sleep/rest pattern: question if patient fells rested after nights sleep/fatigue with hematologic disorder does not resolve after sleep
79
Q

nutritional pattern questions

A
  • dietary review gives info about causes of anemia
  • obtain patients current weight
  • ask if pt has experienced any anorexia, nausea, emesis, oral discomfort
80
Q

foods to help develop rbcs

A

iron, cobalamin, folic acid; liver, meat, eggs, whole-grain, enriched breads, cereals, potatoes, leafy green veggies

Chapter 30 Hematologic System (1 decks)

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