Disorders of blood part 1 Flashcards
Anemia definition
Reduction in total number of circulating erythrocytes hematocrit <38% OR
Decrease in quality or quantity of hemoglobin
M13.5 - 18.0 g/dl
F 12.0-16.0 g/dl
Hematocrit
Proportion by volume of RBCs
Hemoglobin
Protein in RBCs that carries oxygen
Anemia is classified by
Etiology ( 2 groups) morphology (4 groups)
Etiology 1st group anemia
Decreased production
- iron deficiency
- pernicious anemia (b12 from altered DNA synthesis)
- stem cell dysfunction (aplastic anemia) bone marrow infiltration (carcinoma, lymphoma)
Etiology classification of anemia 2nd group
Increase destruction Blood loss acute or chronic hemorrhage Hemolysis intracorpuscular (sickle cell) Hemolysis extracorpuscular (malaria, immune mechanism)
Morphology anemia classification
A combination of RBC size (cytic) normo, micro, macro
and hemoglobin content (chromic) normo,hypo
Normocytic, normochromic
Microcytic, hypochromic etc
Blood loss anemia
Acute is a decrease in RBCs and remaining ones will be normal
Chronic depletes iron, depletes hemoglobin which causes microcytic/hypochromic
RBCs take 5 days to differentiate from stem cells
Inherited (membrane) anemia.
A type of hemolytic anemia
Called spherocytosis.
Gene for spectrin (cytoskeleton protein) is defective. RBC loss of shape, destroyed in spleen
Causes Jaundice, Splenomegaly, bilirubin gallstones
Sickle cell anemia
A type of hemolytic anemia
RBC has abnormal shape and hemoglobin synthesis
RBC is susceptible to damage, lysis and phagocytosis.
Multiple infarcts in various organs with S&S of chronic anemia
Thalassemia
A type of hemolytic anemia
Alpha and Beta each have major and minor forms. Genetic.
Pathophysiology is defective B HGB precipitates in bone marrow which damages membrane and creates lysis
Microcytic/Hypochromic anemia
Inherited (Enzyme) a type of hemolytic anemia
Glucose-6-phosphate dehydrogenase deficiency
Males manifest bitches carry
350 variants
African, asian, mediterranean
Defect makes Hb more subjective to oxidative agents such as oxidant drugs, acidosis, ingesting fava beans or infection.
Once oxidized Hb loses ability to maintain it’s affinity for O2 and can lead to hemolysis
Acquired hemolytic anemia
Toxins and drug (G6PD) infection, trauma/burns/autoimmune DIC
Types of impaired RBC production anemia
Iron deficiency
Megaloblastic
Aplastic
Other
Iron deficiency (impaired RBC production)
Dietary intake, blood loss, increased demand.
Microcytic/hypochromic hemoglobin with changes in shape.
Shape changes lead to splenic breakdown, jaundice, bilirubin gallstones
Megaloblastic (impaired RBC production) pernicious anemia causes
Defective GI secretion of intrinsic factor needed to absorb (autoimmune destruction of gastric mucosa) Lack of B12 (alcoholics/malnourished) Intestinal disorder (Chron's or infection)
Megaloblastic (impaired RBC production) pernicious anemia
B12 for DNA synthesis of cells and formation of myelin sheaths
Leads macrocytic/normochromic
Highly injurious (used to be fatal)
Neurologic symptoms are common from myelin sheath deficits
Megaloblastic (impaired RBC production) pernicious anemia S&S
Infection Mood alterations GI problems Cardiac/renal dysfunction Hb reaches 7-8 classic S&S of anemia Death from heart failure
Types of hemolytic anemias
Inherited spherocytosis Sickle Cell Thalassemia G6PD deficiency Acquired
Folic acid (megalosblastic impaired RBC production)
Also involved in DNA synthesis (like pernicious anemia) commonly caused by decreased dietary intake with similar S&S to pernicious anemia but no neurologic S&S
Aplastic anemia (impaired RBC production)
Affects all hematopoietic products (RBC’s WBC’s and platelets anemia, neutropenia, thrombocytopenia-low platelets)
From radiation, chemo, infection, drugs, toxins, autoimmune
A plastic anemia S&S
Anemia S&S and increase infection susceptibility and coagulative disorders
Other causes of impaired RBC production
Inflammation –> cytokines
Renal failure –> EPO
Cancer –> Iron deficiency/leukemia
Clinical manifestations of anemia
Pale skin/membranes/nail beds and lips from reduced hB
CNS = Pissiness, vertigo, syncope
Tachycardia
SOB
Stomatitis and glossitis (mucous membrane/gum inflammation)
Period problems
Delayed healing
Unique S&S to hemolytic anemia
Splenomegalia and jaundice
infarctions (sickle cell)
Polycythemia
Erythrocytosis or increased RBC
hB over 15.5g/dl
Hematocrit over 55%
Primary polycythemia
Neoplastic disorder of bone marrow
Increase in WBC RBC and platelets
Increased viscosity
Decreased iron stores
Secondary polycythemia
Increased EPO from prolonged hypoxia (high altitude, COPD, heart disease) or
Blood doping or
Renal disease or neoplasms secreting EPO
Polycythemia S&S
Viscous blood
High tendency to clot
Hypertension
Dark, flushed face, headaches, vision problems, neurologic symptoms and splenomegaly
Non neoplastic altered leukocyte function causes
Leukopenia, leukocytosis, Mono
Leukopenia
Rare, low WBC count. Neutropenia is most common form.
Neutropenia
Most common form of leukopenia, may be congenital or acquired
Three forms - autoimmune, infection, and drug induced
S&S are related to increased susceptibility to infections, particularly of GI tract and skin
Autoimmune Etiology
RA and Systemic Lupus Erythremia cause formation of auto-antibodies which attack neutrophils
Drugs Etiology
Certain drugs act as antigens (haptens) which stimulate production of antibodies which attack neutrophils, most common are chemo drugs and DMARDS
Leukocytosis
Increased number of WBC (>10,000/microliter)
May be an increase in all or some forms
Can occur in response to acute infection, allergies, skin diseases, parasitic infections, TB etc. Usually benign
May be assosicated with splenomegaly and lymph node enlargement
Infection mononucleosis
Mono or lymphocytosis
Generally acute infection of B lymphocytes by Epstein-Barr virus
Affected B cells produce antibodies against virus, and T cells attack virus directionly
More fun mono facts
Fever, malaise, pharyngitis, headaches, lymphadenopathy (swollen lymph nodes) and possibly splenomegaly and hepatitis
Disease usually self-limiting 2 weeks, can be fatal or result in malignant lymphoma
