Ch 27 Heme Lymph System PPT Flashcards
What are the main components of the hematologic system?
Bone marrow, blood, and blood components
What structures make up the lymphatic system?
Lymph nodes, nodules, lymph vessels
What are the functions of blood?
Transport substances/cells, regulate body temp, pH, fluid balance
What percentage of blood is plasma?
About 55%
What produces the formed elements in blood?
Stem cells in red bone marrow
What is plasma mostly made of?
91% water
Where are plasma proteins synthesized?
In the liver
Name 3 important plasma proteins.
Prothrombin, fibrinogen, albumin
What is the normal blood pH range?
7.35 – 7.45
What is the main function of red blood cells?
Carry oxygen bonded to iron in hemoglobin
What hormone increases RBC production?
Erythropoietin
Where is erythropoietin secreted from?
The kidneys during hypoxia
What does the presence of many reticulocytes indicate?
Insufficient mature RBCs to meet oxygen demand
What nutrients are essential for RBC production?
Protein, iron, folic acid, Vitamin B12
What is required for Vitamin B12 absorption?
Intrinsic factor from stomach parietal cells
How long do RBCs live?
About 120 days
What causes hemolysis?
Diseases like malaria and sickle cell anemia
What does excess hemoglobin in the blood cause?
Elevated bilirubin and jaundice
What determines ABO blood type?
Antigens on RBCs (A or B)
What determines Rh factor?
Presence of D antigen
How are WBCs different from RBCs?
Larger, have nuclei, involved in immune/inflammatory responses
Where are T lymphocytes matured?
Thymus
Where do lymphocytes become activated?
Lymph nodes, spleen, lymphatic nodules
What do monocytes become in tissue?
Macrophages
What is the main function of neutrophils?
Phagocytosis of foreign material
What role do eosinophils play?
Combat histamine, allergic reactions, parasitic infections
What do basophils release?
Heparin and histamine
What are the types of T cells?
Helper, suppressor, killer, memory
What are the types of B cells?
Memory and plasma cells (produce antibodies)
How are platelets formed?
Fragments of megakaryocytes in red bone marrow
What is the lifespan of platelets?
About 10 days
What prevents platelets from sticking to vessels?
Smooth endothelial lining, heparin, antithrombin
What is the role of the spleen in immunity?
Stores lymphocytes, filters pathogens and worn-out cells
Why is the spleen not vital?
Other organs compensate if it’s removed
Where is the spleen located?
LUQ below diaphragm, behind stomach
What does the thymus do?
Matures and proliferates T cells
What happens to the thymus with age?
It atrophies
What is “lymph”?
Tissue fluid that enters lymph capillaries
Why must lymph return to blood?
To maintain blood volume and pressure
Which vein receives lymph from thoracic duct?
Left subclavian vein
What vein receives lymph from right lymphatic duct?
Right subclavian vein
What is the function of lymph nodes?
Filter pathogens, house macrophages and lymphocytes
Where are lymph nodes commonly found?
Cervical, axillary, inguinal regions
What is the difference between lymph nodes and nodules?
Nodes are deeper and larger; nodules are just under mucous membranes
What are tonsils an example of?
Lymphatic nodules
What happens with aging in the lymphatic system?
Decreased immunity due to atrophied thymus and reduced function
What ancestry is associated with sickle cell anemia?
Black, Mediterranean, or Asian
What ancestry is linked to pernicious anemia?
Northern European
What conditions might indicate vitamin B12 deficiency?
Poor diet, alcohol abuse
What are petechiae?
Small hemorrhagic spots under the skin
What are ecchymoses?
Larger areas of hemorrhage (bruises)
What is purpura?
Hemorrhage into skin, mucous membranes, organs
What may pallor, cyanosis, or jaundice indicate?
Blood disorders, oxygenation issues, or hemolysis
What is clubbing of the fingernails a sign of?
Chronic hypoxia or anemia
What may sternal tenderness suggest?
Packed bone marrow
What does a CBC test include?
RBC, WBC, Hgb, Hct, Platelets
What does PT test for?
Activity of clotting factors, liver function
What is INR used to monitor?
Warfarin therapy
What does aPTT assess?
Clotting factors, heparin therapy
What does a Coombs test detect?
Antibodies against RBCs
What is a bone marrow biopsy used for?
Diagnosing cancers, infections, or evaluating treatment
What are common biopsy sites?
Sternum, iliac crest, vertebrae
What is lymphangiography?
Imaging test for lymph blockages or cancers using dye
Why is patient education important after lymphangiography?
Dye may cause skin, urine, stool discoloration
What is a lymph node biopsy for?
Checking if lymph enlargement is due to cancer or infection
What is autologous transfusion?
Patient’s own blood is transfused
What is allogeneic transfusion?
Donated blood from someone else
What are PRBCs used for?
Anemia or blood loss
What is FFP used for?
Clotting factor replacement
What is albumin used for?
Hypovolemia from low albumin
What are cryoprecipitates?
Used for missing clotting factors
How soon must transfusions be started after receiving blood?
Within 30 minutes
How long can a transfusion last?
No longer than 4 hours
What type of tubing is needed for transfusion?
Y tubing with a filter
Who verifies blood before transfusion?
Two nurses
What is a febrile reaction?
Fever, chills, back pain — usually mild, common
How to prevent febrile reactions?
Use leukocyte-depleted blood if there’s history
What is a urticarial reaction?
Hives from plasma antigens, mild allergic response
What should be done if a hive reaction occurs?
Stop transfusion, notify HCP, may restart if stable
What is a hemolytic reaction?
Destruction of RBCs from incompatible blood
What are signs of hemolytic reaction?
Chest/back pain, chills, fever, nausea, shock
What is the first step for a hemolytic reaction?
Stop transfusion immediately
What organ is most at risk in hemolytic reactions?
Kidneys
What is an anaphylactic reaction to transfusion?
Severe allergy to donor immunoglobulins
What are signs of anaphylactic reaction?
GI cramping, respiratory failure, vomiting
What is TRALI?
Transfusion-related acute lung injury
What are signs of TRALI?
Hypoxia, crackles, fever, hypotension
What is TACO?
Transfusion-associated circulatory overload
Who is most at risk for TACO?
Elderly or debilitated patients
What are signs of TACO?
Cough, chest pain, crackles, frothy sputum
What is the volume range of blood in the human body?
4–6 liters
What are the two main categories of blood components?
Plasma and formed elements
What are the three formed elements in blood?
RBCs, WBCs, Platelets
What is the function of albumin in plasma?
Maintains oncotic pressure and fluid balance
What is the role of globulins?
Include antibodies and transport proteins
What is the purpose of clotting factors in plasma?
Facilitate blood coagulation
What happens to plasma temperature as it circulates?
It is warmed in the liver and skeletal muscle, then distributes heat
What structure in the stomach produces intrinsic factor?
Parietal cells
What is a reticulocyte?
An immature red blood cell
What condition triggers erythropoietin secretion?
Hypoxia
What happens when there is excess destruction of RBCs?
Hemolysis → elevated bilirubin → jaundice
What are macrophages responsible for in blood breakdown?
Phagocytize old RBCs and recycle hemoglobin
What is bilirubin a byproduct of?
Hemoglobin breakdown
Which antigen determines the Rh factor?
D antigen
What is the function of leukocytes?
Defense against infection and injury
Which WBCs respond first to bacterial infection?
Neutrophils
Which WBCs are elevated in parasitic infection?
Eosinophils
Which cells are involved in allergic response?
Basophils and eosinophils
What type of immunity involves T and B lymphocytes?
Adaptive immunity
Where do B cells mature?
Bone marrow
What is the primary immune organ during childhood?
Thymus
What are memory cells?
Long-lived lymphocytes that respond to previously encountered antigens
What structure prevents spontaneous platelet activation?
Smooth endothelial lining of blood vessels
What substances inhibit platelet aggregation?
Heparin and antithrombin
What are petechiae often associated with?
Thrombocytopenia or capillary fragility
What is a clinical sign of anemia visible on skin or nails?
Pallor or spoon-shaped nails
What are signs of blood-related disorders in vital signs?
Tachycardia, fever, hypotension
What does jaundice suggest in a hematologic disorder?
Hemolysis or liver dysfunction
What is indicated by sternal tenderness?
Overactive bone marrow
What does elevated HR suggest in a blood disorder?
Compensation for anemia or hypoxia
What are common lymph node regions assessed?
Cervical, axillary, inguinal
What size of lymph node enlargement is clinically significant?
Greater than 1 cm
What does lymphadenopathy potentially indicate?
Inflammation, cancer, infection
What might be found in a lymph node biopsy?
Infection, malignancy, granulomas
What lab test measures RBC volume percentage?
Hematocrit (Hct)
What does a low hemoglobin (Hgb) indicate?
Anemia
What does platelet count evaluate?
Clotting ability and bleeding risk
What coagulation test assesses intrinsic pathway?
aPTT
What does bleeding time measure?
Time it takes small puncture to stop bleeding
What is capillary fragility testing for?
Susceptibility of capillaries to rupture
What is type and screen used for?
Blood compatibility before transfusion
What does a positive Coombs test indicate?
Autoimmune hemolytic anemia
What is the main risk of bone marrow aspiration?
Bleeding or infection at the site
What type of dye is used in lymphangiography?
Blue dye (e.g., isosulfan blue)
What symptom should be monitored after lymphangiography?
Limb swelling or sensory changes
What can discoloration of skin/urine after lymphangiography indicate?
Dye excretion (normal)
What is standard transfusion blood compatibility matched by?
ABO and Rh factor
What is the most common transfusion product?
PRBCs (packed red blood cells)
What condition is treated with platelet transfusion?
Thrombocytopenia
What should be done if transfusion is delayed?
Return blood to bank if not used within 30 minutes
Why is a 20G or larger IV needed for transfusion?
To prevent hemolysis and allow proper flow rate
How often are vitals checked during transfusion?
Before, at 15 min, hourly, and at the end
Why is leukocyte-reduced blood used?
To reduce febrile non-hemolytic reactions
What does washed blood help prevent?
Severe allergic transfusion reactions
What does warming transfusion blood help prevent?
Hypothermia and arrhythmias during massive transfusions
What are early symptoms of febrile transfusion reaction?
Chills, fever, backache, headache
How should a febrile transfusion reaction be managed?
Stop transfusion, give antipyretics, notify HCP
What characterizes a urticarial transfusion reaction?
Hives, itching, sometimes mild fever
What is the treatment for a mild urticarial reaction?
Benadryl, possibly restart transfusion
What is the hallmark sign of hemolytic reaction?
Sudden back/chest pain with fever/chills
What test is used after suspected hemolytic reaction?
Direct Coombs and crossmatching
What happens to BP in hemolytic reaction?
It drops (hypotension)
What is the role of diuretics in hemolytic reaction?
Prevent kidney damage from hemoglobin
What immune product triggers anaphylaxis in transfusions?
Donor immunoglobulins
Who is most at risk for anaphylactic transfusion reactions?
Patients with multiple transfusions or pregnancies
What are signs of anaphylactic reaction?
Respiratory distress, GI symptoms, cardiovascular collapse
What is the emergency response to anaphylactic reaction?
Stop transfusion, start CPR if needed
What respiratory disorder is linked to donor antibodies?
TRALI
What are early signs of TRALI?
Shortness of breath, low oxygen, crackles
What does TRALI look like on a chest X-ray?
Bilateral pulmonary infiltrates
What population is at highest TRALI risk?
Critically ill or ventilated patients
How is TRALI managed?
Stop transfusion, ICU care, oxygen or ventilation
What causes TACO?
Fluid overload from too rapid transfusion
What are signs of TACO?
Frothy sputum, JVD, crackles, HTN, tachycardia
How is TACO treated?
Diuretics, stop transfusion, slow rate if resumed
Why is older age a risk for TACO?
Reduced cardiac and renal reserve
What distinguishes TACO from TRALI?
TACO = fluid overload, TRALI = immune response
What is the most serious transfusion complication?
Hemolytic reaction
Why is staying with the patient the first 15 min crucial?
Most severe reactions happen early
When do delayed transfusion reactions typically occur?
Hours to days after transfusion
What is alloimmunization?
Immune response to foreign antigens from transfused blood
What are symptoms of a delayed hemolytic reaction?
Mild fever, low Hgb, jaundice
What does washed PRBCs remove?
Plasma proteins
What does leukoreduction remove?
White blood cells
Why might immunocompromised patients need irradiated blood?
To prevent graft-versus-host disease
What is GVHD in transfusions?
Donor T cells attack recipient tissues
What is the lifespan of a transfused RBC?
About 120 days (same as natural RBCs)
What does MCV measure?
Average volume of RBCs
What is MCH?
Mean corpuscular hemoglobin (average Hgb per RBC)
What condition shows low MCV and MCH?
Iron-deficiency anemia
What shows elevated MCV?
Vitamin B12 or folate deficiency
What test screens for iron stores?
Ferritin
What is transferrin?
Iron transport protein
What does high TIBC suggest?
Iron-deficiency anemia
What causes low reticulocyte count in anemia?
Bone marrow suppression
