Ch 34 hematology disorders Flashcards
Wbc
Basophils-(bone marrow) release histamine in inflammatoryreactions
Esinnophils- (bone marrow) respond during allergic reaction to detoxify he foreign proteins
Neutophils- (bone marrow) fight off infection by destroying pathogens
Monocytes-(lymphatic tissue) eat dead tissue and pathogens
Lymphocytes-(lymhatic tissue) B cells-produce antibodies to foreign substances
T cells-helper (thymus) mature the immune system
Natural killer
thymus is larger in children
because it shrinks with age
thrombocytopenia
is a reduction in the number of platelets
-less than 150,000
Risk Factors
-infection
-sulfa drugs
-tumors
dic
-Heparin-induced thrombocytopenia
Immune response to heparin
-Glucocorticoids are beneficial increases platelet count
thrombocytosis
is an increase in platelet production
-more than 450,000
Iron deficiency anemia risk factors
Highest among non Caucasian mostly Mexican and African American women in us
-Lower socioeconomic (lead exposure) status children, pregnant women
-Females because of blood loss during period
-Gastrointestinal problems (gastric bypass-can lead to poor absorption of iron
-Hemorrhage
Daily iron requirement for men 8mg women18-22mg
Pica-causing the iron depleted individual to ingest nonnutritive substances- paint, dirt, clay,ice ,laundry starch
-Certain types of cancers (esophageal colon stomach)
Iron deficiency anemia (clinical manifestations)
fatigue
pallor
tachypnea
tachycardia
hypoxia
*Glossitis
*koilonychias
IDA treatment
increase iron intake
-foods Meat especially red meat
Dark green leafy vegetables Spinach ,broccoli,peas cereals, cream of wheat
Beets, dried beans legumes oranges grapefruit vitamin c improves absorption of iron
-iron supplements-(orally,im,iv monitor for nausea constipation or diarrhea)
-dextran should only be used if patient can’t take by mouth known cardiac and allergic reactions
IDA complications
Heart failure
Renal failure
Impaired thermoregulation
Impaired immune function
Psychomotor and cognitive impairment – occur in children
-IDA in pregnancy effects low birth weight,preterm labor, or mortality of mother or infant
Vitamin B12 (Cobalamin) Anemia risk factors
Older adults
G I resections
Autoimmune disorders
Crohn’s disease
Celiac disease
Long-term use of medications that decrease gastric acid
-vegetarians
-aids
-chronic alcohol abuse
Vitamin B12 is required for
normal function of the central nervous system,formation of rbcs, synthesis and regulation of DNA
-Vitamin b12 is also used for conversion of methylmalonyl
Vitamin B12 Anemia clinical manifestations
Clinical manifestations may take years to develop
-Can cause neuro- can worsen and be irreversible and psychiatric dysfunction
-Lhermittes sign rare but is shown in neck with someone with vitamin b12 defiency
Severe cases of vitamin b 12 cause dementia
-Visual changes-distinguish yellows and blues
-Spinal cord degeneration
-Tachycardia
-Shortness of breath
-Dizziness
-Fatigue
vitamin b12 diagnosis
labs
cbc
Vitamin b12 normal range 200-1000 patients with liver disease might have false negatives
-Excess of mma indicates lack of vitamin b12 urine sample needed because of possible false elevated serum mma levels
-Schilling test 24hr urine test intrinsic factor
treatment for vitamin b12
B12 injections-severe deficiency weekly injections
-prevention
impaired functional ability and orthostatic hypotension are complications of?
Vitamin b12 anemia
Folic Acid Deficiency (vitamin b9) risk factors
Older adults
Chronic illness
Alcohol abuse- can cause pancytopenia decreases rbc,wbc,platelets
Extreme diets
-Need foods dark green vegetables, dried beans,cereal,nuts,yeast,bran
-Pregnancy has been linked to fetal neural tube defects oroalfacial abnormalities
-take 400mcg daily of folic acid recommendation
Folic acid is necessary for?
cell maturation and replication
side note-Oral contraceptives, meteformin interfere with folic acid absorption
*Phenytonin may increase the incidence of seizure activity
Folic Acid Deficiency clinical manifestations
Pallor, tachycardia, tachypnea, dizziness, and fatigue
-increase risk of bleeding
-
Give orange juice with iron to help with?
absorption
iron replacement can take how long?
minimum 3-4 months
symptoms of anemia
-weakness
-fatigue
-headache
-irritability
-exercise intolerance
labs for anemia (normal levels
-hemoglobin Males-14-17.3
Females-11.7-15.5
-Hematocrit Males 42-52% Females 36-48%
-RBC males- 4.21-5.81
females 3.61-5.11
RBC size =(mean corpuscular volume)
Microcytic less than 80, normocytic 80-96 macrocytic greater than 96
RBC color- (mean corpuscular hemoglobin)
Hypochromic (low in color) less than 27 , Normochromic (normal color) 27-33, Hyperchromic too much color greater than 33
IDA and Thalassemia (genetic disorder) are both
microcytic, hypochromic
Thalassemia alpha known in Asians- both alpha and beta avoid too much exposure to iron can lead to hepatoxcity – liver not working
Normocytic diseases
Diabetes and chronic kidney disease
Macrocytic diseases
b12 deficiency, folate deficiency
polycythemia
overproduction of rbc
primary mutation in jak2 gene
-Difficulty breathing when lying flat
-gum and nosebleeds
-Splenomegaly-Feeling of fullness in left upper abdomen because of spleen
-Blurred vision
blood thick
complication
-hemorrhage
Avoid tight, restrictive clothing
Avoid extreme temperatures
Acute lymphoblastic leukemia
most common in children
-down syndrome risk factor
Acute myelogenous leukemia
exposure to radiation
Chronic myelogenous leukemia
Philadelphia chromosome 22
Hodgkin’s lymphoma
Reed Sternberg cells
Hodgkins higher rate for survival
-More in Caucasians higher socioeconomic
Multiple Myeloma
african americans average age 62
pernicious anemia
decreases in red blood cells can’t absorb vitamin b12 lack of intrinsic factor
-weight loss
-sob during exercise
-swollen tongue bleeding gums
