Chapter 3 Flashcards
What is hematopoiesis?
Process of forming blood
What is plasma?
Liquid protein
What are leukocytes?
White blood cells
What are erythrocytes?
red blood cells
What are the 2 components of erythrocytes?
hemoglobin and hematocrit
What is the purpose of hemoglobin?
the oxygen carrying component
What is the purpose of hematrocrit?
amount of blood volume occupied by erythrocytes
What are thrombocytes?
platelets
What is hemostasis?
stops the blood flow
What is normal hemostasis?
Normal when it seals a blood vessel to prevent blood loss and hemorrhage
what is abnormal hemostasis?
Abnormal when it causes inappropriate clotting or when clotting is insufficient to stop blood flow
What are the 5 stages of hemostasis?
- Vessel spasm
- Formation of platelet plug
- Blood coagulation
- Clot retraction
- Clot dissolution
What is the role of leukocytes?
key players in the inflammatory response and in fighting infections
What are the normal ranges of leukocytes?
5,000 to 10,000 cells/mL3 blood
What is leukopenia?
decreased levels of leukocytes
What is leukocytosis?
increased levels of leukocytes
What are neutrophils?
a type of leukocyte and the first to arrive at the site of infection
What is the normal range of neutrophils?
2,000–7,500 cells/mL
What is neutropenia?
When Neutrophils < 1500 cells/mL
What are the causes of neutropenia?
Increased usage Drug suppression Radiation therapy Congenital conditions Bone marrow cancers Spleen destruction Vitamin deficiency
What are the manifestations of neutropenia?
- Depends on severity and cause
- Infections and ulcerations, especially of the respiratory tract, skin, vagina, and gastrointestinal tract
- Signs and symptoms of infection (e.g., fever, malaise, and chills)
How do you diagnose neutropenia?
neutrophil levels and bone marrow biopsy
What is the treatment for Neutropenia?
antibiotic therapy and hematopoietic growth factors
What is infectious mononucleosis?
“Kissing disease”—oral transmission.
What causes infectious mononucleosis?
Caused by Epstein-Barr virus in the herpes family.
Do you have infectious mononucleosis?
yes; Once the disease is eliminated, a few B cells remain altered, giving the individual an asymptomatic infection for life and the potential to occasionally spread the EBV to others.
What are the manifestations of infecticous mononucleosis?
- Insidious onset.
- Incubation = 4–8 weeks.
- Initially see anorexia, malaise, and chills.
- Manifestations intensify to include leukocytosis, fever, chills, sore throat, and lymphopathy.
- Acute illness usually lasts 2–3 weeks; may not fully recover for 2–3 months.
What are the treatments for inefectious mononucleosis?
symptomatic and supportive
What are lymphomas?
Cancers that affect the lymphatic system
What are the 2 main types of lymphoma cancer?
Hodgkins and Non-Hodgkins
Is hodgkins or non-hodgkins more common?
Non-hogdkins
What is hodgkins lymphoma?
Solid tumors with the presence of Reed-Sternberg cells
Where does hodgkins orginate?
Typically originate in the lymph nodes of the upper body
Is hodgkins treatable?
very with treatment
What are the manifestations of hodgkins and non-hodgkins?
painless enlarged nodes, weight loss, fever, night sweats, pruritus, coughing, difficulty breathing, chest pain, recurrent infections, and splenomegaly
How is hodgkins diagnosed?
physical examination, presence of Reed-Sternberg cells in a lymph node biopsy, complete blood count, chest X-rays, diagnostic imaging (CT scan and MRI), and bone marrow biopsy
What is the treatment for hodgkins and non hodgkins?
chemotherapy, radiation, and surgery
Is Non-hodgkins treatable?
yes, but not a good prognosis
Where does non-hodgkins originate from?
Can originate in the T or B cells
Does non-hodkins lymphoma have Reed-Sternberg cells?
NO
How commom is Leukemia?
second most common blood cancer
What is leukemia?
cancer of the leukocytes
What happens with leukemia?
Leukemia cells abnormally proliferate, crowding normal blood cells
What are the risk factors of leukemia?
exposure to chemical, viral, and radiation mutagens; smoking; use of chemotherapies; certain disease conditions (e.g., Down syndrome); and immunodeficiency disorder
What are the types of Leukemia?
Acute lymphoblastic leukemia, Acute myeloid leukemia, Chronic lymphoid leukemia, Chronic myeloid leukemia
Facts about Acute lymphoblastic leukemia
- Affects primarily children
- Responds well to therapy
- Good prognosis
Facts about Acute myeloid leukemia
- Affects primarily adults
- Responds fairly well to treatment
- Prognosis somewhat worse than that of acute lymphoblastic leukemia
Facts about Chronic lymphoid leukemia
- Affects primarily adults
- Responds poorly to therapy, yet most patients live many years after diagnosis
Facts about Chronic myeloid leukemia
- Affects primarily adults
- Responds poorly to chemotherapy, but the prognosis is improved with allogeneic bone marrow transplant
What are the manifestations of leukemia?
leukopenia, anemia, thrombocytopenia, lymphadenopathy, joint swelling, bone pain, weight loss, anorexia, hepatomegaly, splenomegaly, and central nervous system dysfunction
How do you diagnose Leukemia?
a history, physical examination, complete blood count, and bone marrow biopsy
What is the treatment for Leukemia?
chemotherapy and bone marrow transplant
What is Multiple Myeloma?
- Plasma cell cancer (third most common)
- Excessive numbers of abnormal plasma cells in the bone marrow, crowding the blood-forming cells and causing Bence Jones proteins to be excreted in the urine
- Bone destruction leads to hypercalcemia and pathologic fractures
Is multiple myeloma caught early?
NO, often well advanced upon diagnosis
What are the manifestations of multiple myeloma?
Silent onset
Include: anemia, thrombocytopenia, leukopenia, decreased bone density, bone pain, hypercalcemia, and renal impairment
How is Multiple Myeloma diagnosed?
serum and urine protein, calcium, renal function tests, complete blood count, biopsy, X-rays, CT scan and MRI
What is the treatment for multiple myeloma?
chemotherapy and complication management
What is erythropoiesis?
red blood cell disorder;
- Production of erythrocytes
- Regulated by erythropoietin
- Occurs in bone marrow
What is anemia?
Insufficient numbers of RBC’s or an Insufficient amount of hemoglobin in the blood
What are the normal ranges of RBC?
Men 4.5-6 x 106/L
Women 4-5.5 x 106/L
What are the normal ranges of Hemoglobin?
Men 14-18 g/dl
Women 12.0-16 g/dl
What are the normal ranges of hematocrit?
Men 40-50 %
Women 35-45 %
What does anemia result from?
Results from a decreased number of erythrocytes, reduction of hemoglobin, or presence of abnormal hemoglobin
What does anemia do?
Decreases O2-carrying capacity, leading to tissue hypoxia
What are the manifestations of anemia?
weakness, fatigue, pallor, syncope, dyspnea, and tachycardia
What causes iron-deficiency anemia?
decreased iron consumption, decreased iron absorption, or increased bleeding
What are the manifestations of iron-deficiency anemia?
cyanosis to sclera, brittle nails, decreased appetite, headache, irritability, stomatitis, pica, and delayed healing
How is Iron- Deficiency diagnosed?
complete blood count (low hemoglobin, hematocrit, MCV, and MCHC), serum ferritin, serum iron, and transferrin saturation
What is the treatment for Iron-deficiency anemia?
identify and treat cause, increase dietary intake, and administer iron supplements
What is pernicious anemia?
Vitamin B12 deficiency usually caused by a lack of intrinsic factor.
What is the cause of pernicious anemia?
autoimmune.
What is required for DNA synthesis?
Vitamin B12 is required for DNA synthesis.
What does pernicious anemia lead to?
Leads to decreased maturation and cell division.
What may we see with pernicious anemia?
May see myelin breakdown and neurological complications.
What are the manifestations of pernicious anemia?
bleeding gums, diarrhea, impaired sense of smell, loss of deep tendon reflexes, anorexia, personality or memory changes, positive Babinski’s sign, stomatitis, paresthesia, and unsteady gait
How is pernicious anemia diagnosed?
serum B12 levels, Schilling’s test, complete blood count, gastric analysis, and bone marrow biopsy
What is the treatment for pernicious anemia?
injectable B12
What is aplastic anemia?
Bone marrow depression of all blood cells (pancytopenia).
What are the causes of aplastic anemia?
idiopathic, autoimmune, medications, medical treatments, viruses, and genetic abnormalities.
What is the onset of aplastic anemia like?
Onset may be insidious, sudden, and severe.
What are the manifestations of aplastic anemia?
Anemia (e.g., weakness, pallor, dyspnea)
Leukocytopenia (e.g., recurrent infections)
Thrombocytopenia (e.g., bleeding)
How is aplastic anemia diagnosed?
complete blood count and bone marrow biopsy
What is the treatment for aplastic anemia?
identify and manage underlying cause, oxygen therapy, infection control, infection treatment, bleeding precautions, blood transfusions, and bone marrow transplants
What is hemolytic anemia?
Excessive erythrocyte destruction
What are the causes of hemolytic anemia?
idiopathic, autoimmune, genetics, infections, blood transfusion reactions, and blood incompatibility in the neonate
What are the types of hemolytic anemia?
Several types including sickle cell anemia, thalassemia, and erythroblastosis fetalis
Is sickle cell anemia recessive or dominant?
neither; its co dominant
What is sickle cell anemia?
Hemoglobin S causes erythrocytes to be abnormally shaped.
What is the problem with abnormal erythroctyes?
Abnormal erythrocytes carry less oxygen and clog vessels, causing hypoxia and tissue ischemia.
Is is more likely to have sickle cell anemia?
More common in people of African and Mediterranean descent.
Also seen in people from South and Central America, the Caribbean, and the Middle East
What is the pathogenisis of sickle cell disease?
HgbS and low oxygen conditions
Aggregation of HgbS into larger molecules
Change in shape and rigidity of RBC’s
Hemolysis of sickled cells
Vascular occlusion
What are the 3 forms of sickle cell anemia?
Sickle cell trait.
Heterozygous.
Less than half of erythrocytes are sickled
What is sickle cell disease?
Homozygous.
Most severe.
Almost all erythrocytes are sickled.
When does sickle cell anemia appear?
around 4 months old
What is sickle cell crisis?
Painful episodes that can last for hours to days
Pain caused by tissue ischemia and necrosis
Triggered by dehydration, stress, high altitudes, and fever
What are the manifestations of sickle cell anemia?
include abdominal pain, bone pain, dyspnea, delayed growth and development, fatigue, fever, jaundice, pallor, tachycardia, skin ulcers, angina, excessive thirst, frequent urination, and vision impairment
how is sickle cell anemia diagnosed?
complete blood count and bilirubin test
What is the treatment for sickle cell anemia?
No cure, palliative Stem cell research showing promise Medications Avoid sickling triggers Other strategies: oxygen therapy, hydration, pain management, infection control, vaccinations, blood transfusions, bone marrow transplants, genetic counseling
What is Thalassemia?
Autosomal dominant inheritance
Abnormal hemoglobin from a lack of one of two proteins that make up hemoglobin (alpha and beta globin)
How is mostly seen with thalassemia?
Most common in people of Mediterranean descent
Also seen in those of Asian, Indian, and African descent
What are the manifestations of thalassemia?
abortion, delayed growth and development, fatigue, dyspnea, heart failure, hepatomegaly, splenomegaly, bone deformities, jaundice
What can severe cases of thalassemia lead to?
Severe cases can lead to death in childhood.
How can the life expectancy of someone with thalassemia increase?
Life expectancy can improve with effective management.
How is thalassemia diagnosed?
complete blood count and iron levels.
What is the treatment for thalassemia?
blood transfusion and splenectomy.
What is polycythemia?
Abnormally high erythrocytes
Increased blood volume and viscosity, leading to tissue ischemia and necrosis
Is polycythemia rare or common?
rare
What is polycythemia considered?
Considered a neoplastic disease
What are the complications of polycythemia?
thrombosis, hypertension, heart failure, hemorrhage, splenomegaly, hepatomegaly, and acute myeloblastic leukemia
What are the manifestations of polycythemia?
cyanotic or ruddy skin, high blood pressure, tachycardia, dyspnea, headaches, visual abnormalities
How is polycythemia diagnosed?
complete blood counts, bone marrow biopsy, and uric acid levels
What is the treatment for polycythemia?
chemotherapy, radiation, phlebotomy
What is the normal range of platelets?
Normal platelet levels range from 150,000 to 400,000 cells/mL3
What is thrombocytosis?
increased levels of platelets
What is thrombocytopenia?
decreased levels of platelets
What happens when there is a decrease in platelet levels?
Decreased platelet function
Decreased platelets in circulation
Platelets used up in clotting
What happens when there is impaired coagulation?
Impaired platelet function
What are the signs of blood loss?
Fatigue Weakness Fainting Dizziness Tachycardia – increased heart rate Hypotension – low blood pressure
What is hemophilia A?
X-linked recessive bleeding disorder
Deficiency or abnormality of clotting factor VIII
What are the manifestations of Hemophilia A?
Manifestations: bleeding or indications of bleeding (e.g., bruising, petechia, etc.)
How is Hemophilia A diagnosed?
clotting studies and serum factor VIII levels
What is the treatment for Hemophilia A?
clotting factor transfusions, clotting factors, and bleeding precautions
How common is it to have a factor 8 deficiency?
90%
How common is it for factor 8 to be deffective?
10%
What is the most common hereditary bleeding disorder?
Von Willebrands disorder
What is Von willedbrands?
Decreased platelet adhesion and aggregation
What are the manifestations of von willebrands?
bleeding or indications of bleeding (e.g., bruising, petechia, etc.)
How many types of von willebrands are there?
3
What are the charateristics of type 1 von willebrands?
-Most common and mildest form
-Follows autosomal dominant
Reduced von Willebrand’s factor levels
-Can cause significant bleeding with trauma or surgery
What are the charateristics of type 2 von willebrands?
- Either autosomal dominant or recessive.
- Five subtypes.
- von Willebrand’s factor building blocks are smaller than usual or break down easily.
What are the charateristics of type 3 von willebrands?
- Follows autosomal recessive
- No measurable von Willebrand’s factor or factor VIII
- Causes severe bleeding problems
What is acquired type von willebrand?
Occurs with congenital heart disease, systemic lupus erythematosus, and hypothyroidism
How is von willebrands diagnosed?
bleeding studies and factor VIII levels
What is the treatment for von willebrands?
- Mild cases usually do not require treatment
- Clotting factor infusions
- Administration of medication to release vW factor
- Bleeding precautions
- Measures to control bleeding
What is Disseminated Intravascular Coagulation (DIC)?
- Life-threatening complication of many conditions
- Widespread coagulation followed by massive bleeding because of the depletion of clotting factors
What does DIC result from?
Results from an inappropriate immune response
What are the manifestations of DIC?
tissue ischemia and abnormal bleeding
What are the complications of DIC?
shock and multisystem organ failure
How is DIC diagnosed?
complete blood count and bleeding studies
What is the treatment for DIC?
identify and treat underlying cause, replace clotting components, and prevent activation of clotting mechanisms
What are the manifestations of thrombocytopenia?
Petechiae – pinpoint bleed
Ecchymosis – bruising
Purpura – purple rash
Prolonged bleeding
What is Idiopathic Thrombocytopenia Purpura (ITP)?
Hypocoagulation resulting from an autoimmune destruction of platelets
What is the acute form of ITP like?
- More common in children
- Sudden onset
- Self-limiting
What is the chronic form of ITP like?
- More common in adults age 20–50
- More common in women
What are the causes of ITP?
idiopathic, autoimmune diseases, immunizations with a live vaccine, immunodeficiency disorders, and viral infections
What are the manifestations of ITP?
bleeding or indications of bleeding (e.g., bruising, petechia, etc.)
How is ITP diagnosed?
complete blood count (platelet levels < 20,000/mL) and bleeding studies
What is the treatment for ITP?
Acute ITP: steroids, immunoglobulins, plasmapheresis
Chronic ITP: steroids, immunoglobulins, splenectomy, blood transfusions, and immunosuppressant therapy
What is Thrombotic Thrombocytopenic Purpura (TTP)?
Deficiency of enzyme necessary for cleaving von Willebrand’s factor, leading to hypercoagulation.
Hypercoagulation depletes platelet levels.
How is TTP characterized?
Characterized by thromboses, thrombocytopenia, and bleeding
What are the causes of TTP?
idiopathic causes, heredity, bone marrow transplants, cancer, medications, pregnancy, and HIV.
What are the manifestations of TTP?
purpura, changes in consciousness, confusion, fatigue, fever, headache, tachycardia, pallor, dyspnea on exertion, speech changes, weakness, and jaundice
How is TTP diagnosed?
complete blood counts, blood smears, and lactate dehydrogenase levels
What is the treatment for TTP?
plasmapheresis, splenectomy, and steroids
