chap 9 Flashcards
cell and cell fragments
plasma (55%), buffy coat, hematocrit (45%)
what is most numerous cell type in blood
erthyrocytes
normal blood production
hematopoiesis
two main lineages
lymphoid and myeloid
lymphoid lineage
becomes a lymphocyte
myeloid lineage
becomes any other cell type then a lymphocyte
red blood cells
erythrocytes
- function = carry oxygen
- hemoglobin = protein
structure
- 2 alpha globin chain
- 2 beta globin chain
- heme-mineral
erythopoiesis
formation and development of RBC
substances needed
- protein
- vitamin b12
- folic acid
- iron
red blood cell production
regulated by oxygen content of arterial blood
- live about 125 days and need to be removed after that
red blood cell removal
spleen and liver
erythropoietin
made and secreted by the kidneys in response to the number of red blood cells
white blood cells
leukocytes
types: granulocytes, monocytes, lymphocytes
granulocytes
full of granules
-> neutrophils (phagocytosis)
-> eosinophil (fighting against parasites), and basophils (allergic reactions)
monocytes
macrophages (phagocytosis and clean-up)
lymphocytes
T cells and B cells
platelets - cell fragments
cytoplasmic fragments of megakaryocyte (found in bone marrow)
- no nucleus and only limited metabolic machinery
contain granules of chemical mediators of clotting and inflammation
- participate in hemostasis
- must be replaced continuously
most frequent and serious problems
anemia, altered WBC count, cancer of immune system
symptoms and signs
most symptoms are nonspecific
- anemia = headache and easily fatigability, loss of appetite and heartburn, shortness of breath, numbness and tingling, pica
lab tests for hematopoietic disease
complete blood count
- analysis of blood cells
- hematocrit
- hemoglobin
blood smear
biopsy of lymph nodes or bone marrow
-osis
increased numbers
-penia
decreased numbers
MCV
mean corpuscle volume
MCHC
mean corpuscle hemoglobin content
normocytic anemia
normal size and appearance but they dont have the normal amount of hemoglobi
normocytic anemia
normal size and appearance but they dont have the normal amount of hemoglobin
macrocytic anemia
cells larger than normal
- folic acid
- vitamin B12 deficiency
microcytic anemia
cells smaller than normal
hypochromic anemia
reduced hemoglobin content
hypochromic microcytic anemia
smaller than normal and reduced hemoglobin content
most common types of anemia
anemia associated with nutrient deficiencies, anemia associated with hemolytic anemia, anemia associated with disorder of the bone marrow
iron deficient anemia
most common type
RBC = hypochromic microcytic anemia
pathogenesis
- inadequate iron intake in diet
- chronic blood loss
treatment
- treat the cause –> administer supplementary iron
macrocytic anemia
deficiency of vitamin b12 or folic acid
- vitamin b12: animal products
- folic acid: green leafy
both required for normal hematopoiesis, DNA replication
- mature red cells formed are larger than normal or macrocytes
pernicious anemia
- lack of intrinsic factor results in macrocytic anemia
- vitamin b12 in food combines with intrinsic factor in stomach
- vitamin B12 intrinsic factor complex absorbed in ileum
causes: - gastric resection and bypass -> vitamin B12 not absorbed
- distal bowel resection or disease
- may develop among elderly
- autoimmune
anemia of chronic disease
mild suppression of bone marrow function
aplastic anemia
atrophy of bone marrow
- injured by chemicals or autoantibodies
myelophthisic anemia
bone marrow infiltrated by tumor or replaced by fibrous tissue
hemolytic anemia
premature destruction of RBC
- characteristics
- active bone marrow, increased EPO, increase reticulocytes
causes
- genetic defects or non-genetic
sickle cell disease
genetic = HbS
- pathogenic = mutation
autosomal recessive
- missense mutation in beta globin chain
- RBC sickle
- microinfarcts
thalassemia
genetic
- effects synthesis of normal adult hemoglobin
autosomal recessive
severe complications include overloading the heart
acquired hemolytic anemia
autoimmune
- attacked and destroyed by antibodies
- destruction of red cells by mechanical trauma
- passing through enlarged spleen
diagnostic evaluation of anemia
- history and physical examination
- Complete blood count to assess degree of anemia, leukopenia, and thrombocytopenia
- Blood smear to determine if normocytic, macrocytic, or hypochromic microcytic
- Reticulocyte count to assess rate of production of new red cells
- Lab tests to determine iron, B12, folic acid levels
- Bone marrow study to study characteristic abnormalities in marrow cells
- Evaluation of blood loss from gastrointestinal tract to localize site of bleeding
types of primary polycythemia
bone marrow malignacy, overproduction of red cells, white cells, and platelets
types of secondary polycythemia
outside of bone marrow, reduced arterial oxygen saturation leads to compensatory increase in red blood cells
- lung cancer
- life at altitude
- increase in EPO
primary polycythemia treatment
treated by drugs that suppress marrow function
secondary polycythemia treatment
periodic removal of excess blood
leukocytosis
higher counts than normal
- normal protective physiologic response to stressors
leukopenia
counts lower than normal
- always abnormal
- low WBC count predisposes to infections
infections of lymphocytes
infectious mononucleosis
- acute, self-limiting infection of B lymphocytes transmitted by saliva through personal contact
- characterized by enlarged, tender lymph nodes
- caused by the epstein-barr virus
leukemias
malignant disease involving WBC precursors in bone marrow
- myeloid
- lymphoid
uncontrolled proliferation of malignant
classification by maturity and cell type
- most common types are granulocytic, lymphocytic, monocytic
clinical features of leukemia
manifestation caused by impairment of bone marrow function
- leukemic cells crowd out normal cells causing
- anemia
- thrombocytopenia
- infections from inadequate number of normal white cells
- usually produce high white blood cells count in peripheral blood = blasts
signs and symptoms of leukemias
recurrent infections, generalized weakness, anemia, bleeding
treatment for leukemias
chemotherapy
diagnosis in leukemia
biopsy of bone marrow
blood smear
types of leukemias
acute lymphocytic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, chronic lymphocytic leukemia
lymphoma
diverse group of cancers affecting B or T lymphocytes
- most have B cell phenotypes
- usually malignant cells not present in blood
often present as solid tumor of lymphoid cells
- affects any age group
- malignant cells often infiltrate lymph nodes, spleen, thymus, or bone marrow, but many also involve other organs
- two categories
non-hodgkin’s lymphoma
risk increases with age, 6th most common cancer in U.S, cancer cells can spill over into blood; present as leukemia
- involve lymph nodes, bone marrow, spleen, thymus, but can be extranodal origin
Hodgkin’s lymphoma
- most common malignant neoplasms of americans 10-30 yrs/age
- characterized by reed-sternberg cells
- B cells gone awry
- epstein barr virus
treatment of leukemia and lymphoma
treatment depends on: age, severity, and specific type
- chemotherapy and radiation often first line of defense
- cancer may become resistant
- HSC stem cell transplantation
- source?
- need to match HLA
myeloma
malignant disease of plasma cells
- the tumor may be solitary or multifocal
- most patients older than 45 years
- malignant plasma cells proliferate in bone marrow
- functionally useless antibodies
- breakdown of antibodies
- light chain toxic to kidneys
- impaired humoral immunity
- hypogammaglobulinemia
- anemia
- most common cause of death infection or renal failure
idiopathic thrombocytopenia purpura (ITP)
primary
- associated with platelet antibodies
- bone marrow produces platelets, but they are rapdily destroyed
secondary thrombocytopenia
damage to bone marrow from drugs or chemicals, bone marrow infiltration by leukemic cells or metastatic carcinoma
