Ch. 21 Hematologic function Flashcards
Reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin
Anemia
Anemia can be classified by size and identified by terms that end in….
-cytic (macrocytic, microcytic, and normocytic)
Anemia can be classified by hemoglobin content. Identified by terms that end in…
-chromic (normochromic and hypochromic)
Classic anemia symptoms
Fatigue, weakness, dyspnea, pallor
Tx of anemia?
Correction of nutritional deficits, supplementation, and transfusion
Megaloblastic anemias is also termed
Macrocytic-normochromic anemia
Characterized by unusually large stem cells and result of defective DNA synthesis
Macrocytic normochromic anemias
Macro/normo anemia results in defective DNA synthesis…this is caused by
deficiencies in B12 or folate
Caused by a lack of intrinsic factor from the gastric parietal cells
Pernicious anemia
Risk factors for pernicious anemia
Congenital, autoimmune gastritis, excessive alcohol and tea intake, and smoking
Are the early symptoms of pernicious anemia specific?
no, they are nonspecific and vague
With pernicious, what are the hemoglobin levels usually at?
7-8g/dl
What is the normal range of hemoglobin for males and females?
M: 14-18
F: 12-16
Symptoms of pernicious anemia
- Weakness, fatigue
- paresthesia, diff. walking
- loss of appetite
- Sore tongue (beefy and red)
What are the neurologic manifestations of pernicious anemia? and why do they manifest?
Manifest due to nerve demyelination. Loss of position and vibration sense. Ataxia and spasticity
Tx of pernicious anemia?
Parenteral or high doses of B12. Lifelong tx.
Folate deficiency anemia is less common than pernicious
False
Absorption of folate occurs where?
Upper small intestine
___ ____ anemia is not dependent on any other factor. Similar to pernicious except there are not generally _______ manifestations
Folate deficiency; neurologic
Tx of folate deficiency anemia?
Daily oral medication of folate
At risk/causes of folate deficiency anemia?
Chronically malnourished, alcoholics, and stomatitis
Characterized by red cells that are abnormally small and contain reduced amounts of hemoglobin
Microcytic-hypochromic anemias
Most common type of anemia in the world?
Iron deficiency anemia
_____ ___ anemia is a nutritional deficiency or blood loss
Iron deficiency
Manifestations of iron deficiency occur when…
When serum Hgb decreases to 7 or 8gm/dl
Early symptoms of iron deficiency?
Fatigue, weakness, shortness of breath, pale earlobes and palms, and conjunctiva
Who is at risk for iron deficiency anemia?
Malnourished children, pregnant women, and women during menstruation
Progression of iron deficiency
Brittle, thin, coarsely ridged and spoon shaped nails (koilonychia)
A red, sore, and painful tongue
Tx of iron deficiency anemia
Iron replacement therapy: IV or PO
Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number
Normocytic Normochromic anemias
Damage to bone marrow, affecting erythropoiesis. (normo/normo)
Aplastic anemia
Acute blood loss is known as ______ (normo/norm)
Post-hemorrhagic
______: abnormal immune destruction of RBC’s (acquired and hereditary)
hemolytic
Anemia of _____ _____: occurs in many chronic diseases
chronic inflammation
Splenomegaly
Enlargement of the spine
Splenomegaly is caused by ______: overactivity, leading to anemia, leukopenia, and/or thrombocytopenia
Hypersplenism
Thrombocytopenia is when your platelet count is
< 150,000/mm^3
<50,000 platelets
Hemorrhage from minor trauma
<15,000 platelets
Spontaneous bleeding
<10,000 platelets
Severe bleeding
Thrombocytopenia can be congenital or acquired. T or F
True
Thrombocytopenia can be acquired through autoimmune disorders such as ___ and ___
EBV or HIV
Thrombocytopenia can be acquired through ____ or ____ infections
viral or bacterial
Another way thrombocytopenia is acquired is if platelet consumption is increased. This can be _____-induced
heparin
What is DIC?
a condition in which blood clots form throughout the body, blocking small blood vessels.
What is typically seen in HIT?
50% drop in platelet count
What is the HIT paradox?
People with HIT can experience venous thrombosis
Chronic form of ITP
Platelet-specific IgG autoantibodies that target platelet glycoproteins. Progressively worsens, exacerbates, and then goes in remission.
Acute form of ITP
Develops after a viral infections. Platelets are damaged and destroyed in the spleen.
Which form of ITP is one of the most common childhood bleeding disorders
acute ITP
Acute ITP resolves in….
1-2 months
Manifestation of ITP
Petechiae and purpura. Progresses to major hemorrage
Dx of ITP?
H&P, blood counts
Tx of ITP (chronic)
Prednisone, IV immune globulin, or a splenectomy
Thrombotic thrombocytopenic purpura
blood clots in smaller vessels such as the arterioles and capillaries
TTP causes ____ with target organ damage
ischemia
Chronic relapsing TTP is common
false, very rare
Tx of TTP
Steroids, plasma, and plasmapheresis
Essential (primary) thrombocythemia (thrombocytosis) is characterized by
platelet counts >400,000
Megakaryocytes in the bone marrow are produced in excess with
Thrombocythemia
Clinical manifestations of thrombocythemia
Ischemia of fingers and toes
Tx of thrombocythemia
Hydroxyurea and Anegrelide
What is necessary for synthesis and regulation of prothrombin, the procoagulant factors, and proteins C and S (anticoagulants)
Vitamin K
What hemostasis disorders does liver disease cause
- Defects in coagulation
- Fibrinolysis
- Platelet number and function
Complex, acquired disorder in which clotting and hemorrhage simultaneously occur
Disseminated Intravascular coagulation (DIC)
Possible cause of DIC?
result of increased protease activity in the blood caused by unregulated release of thrombin.
Endothelial damage is the primary initiator of DIC. T or F
true
_____ is the most common condition associated with DIC
Sepsis
Sepsis is usually caused by ____ ___ organisms; endotoxins damage endothelium
gram negative
With DIC, coagulation results from abnormally widespread and ongoing activation of clotting. T or F
True
With DIC, the thrombosis activates plasmin and triggers _______
Fibrinolysis
With DIC, thrombosis triggers fibrinolysis. THe fibrin degradation products resulting from fibrinolysis actually have _______ properties
Anticoagulant
With DIC, clotting leads to deposition of _____ in the microcirculation that leads to _____, _____, and organ failure
Fibrin; obstruction, and organ failure
Patient presents with purpura, petechiae, and hematomas. Bleeding from venipuncture sites and arterial lines. Patient goes into shock and eventually has internal hemorrhaging. Patient has…
DIC
Tx of DIC
eliminate the cause so the liver can restore clotting factors. Infuse clotting factors. In some cases, heparin.
