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Pathophysiology > Exam 3 - Alterations Of Hematologic Function Answers > Flashcards

Exam 3 - Alterations Of Hematologic Function Answers Flashcards

1
Q

What is anemia?

A

Reduction in the total circulating red cell count
OR
A decrease in the quality or quantity of hemoglobin

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2
Q

What do anemias commonly result from?

A

Blood loss
Impaired RBC production
Increased RBC destruction

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3
Q

Two categories of anemia

A

Megaloblastic

Microcytic-hypochromic

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4
Q

What occurs in megaloblastic anemias?

A

Cells are challenged to make DNA
RNA continues to be produced at normal speed
RBCs have an abnormal nucleus, and the cell grows larger before the nucleus can accommodate
RBCs prematurely die which causes the anemia

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5
Q

What are microcytic-hypochromic anemias characterized by?

A

Abnormally small erythrocytes that contain unusual amounts of hemoglobin

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6
Q

What type of anemia is iron deficient anemia?

A

Microcytic-hypochromic

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7
Q

What does ‘cytic’ mean?

A

Refers to cell size

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8
Q

What does ‘chromic’ mean?

A

Refers to hemoglobin content

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9
Q

Describe the morphologic differences between Anisocytosis and Poikilocytosis

A

Anisocytosis = RBCs that are developed in various sizes (limiting function)

Poikilocytosis = RBCs that are developed in various shapes (limiting function)

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10
Q

Pathology related to anemia

A

Reduced oxygen carrying capacity of the RBCs (blood) resulting in tissue hypoxia

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11
Q

Symptoms of anemia

A

Vary, depending on body’s ability to compensate for the reduced oxygen-carrying capacity

Mild and develops gradually
May only cause problems during physical exertion

As reduction of RBCs continue to decline, symptoms worsen, and alterations of specific organs and compensatory effects become more apparent

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12
Q

Compensation with anemia generally involves which systems?

A

Cardiovascular
Respiratory
Hematologic

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13
Q

What type of anemia is pernicious anemia (PA)?

A

Megaloblastic

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14
Q

What is Pernicious Anemia caused by?

A

B12 deficiency

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15
Q

What is Pernicious anemia often associated with?

A

Autoimmune issues and gastritis

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16
Q

Pathology related to Pernicious Anemia

A

Benign disorder caused by an absence of the intrinsic factor in the gut
(This factor is secreted by gastric cells and in small intestine)

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17
Q

What causes deficiency of intrinsic factor?

A

Can be genetic, but no pattern of transmission has been identified

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18
Q

Environmental conditions that contribute to chronic gastritis (stomach irritation)

A

Excessive alcohol or hot tea ingestion

Smoking

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19
Q

Characteristics of PA as it develops

A 
Develops slowly (over 20-30 years)
Individuals usually diagnosed at 60 years

Early symptoms often ignored and passed off as other conditions because of slow onset of symptoms

Usually severe by the time it is treated

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20
Q

Clinical manifestations of PA

A 
Weakness
Fatigue
Paresthesias of feet, fingers
Loss of appetite, abdominal pain, weight loss
Sore tongue
Beefy red glossitis
Hepatomegaly (liver enlargement) and right sided heart failure
Splenomegaly
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21
Q

What is Folate Deficiency?

A

Type of anemia caused by deficiency in folic acid (folate)

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22
Q

What is folate?

A

An essential vitamin for genetic synthesis within mature RBCs

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23
Q

What are folates required for?

A

The synthesis of thymine and other naturally occurring chemicals

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24
Q

What happens with deficiency of thymine?

A

Affects cells undergoing rapid division (ex: RBCs in bone marrow)

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25
Daily requirement of dietary folate intake
50-200 mcg/day | Humans are totally dependent on dietary folate
26
Why is folate deficiency so common?
The body does not store folate for later use | More common than B12 deficiency
27
Individuals who are more likely to have folate deficiency
Those with chronic conditions such as alcoholism and chronic malnourishment
28
Morphology of folate deficiency
Deficient production of thymine, which affects cells that undergo rapid division (bone marrow cells producing RBCs)
29
Clinical manifestations of folate deficiency
``` (Like PA, but paresthesia is not seen) Severe cheilosis Stomatitis Painful ulcerations of buccal mucosa and tongue (burning mouth) Dysphagia Flatulence Diarrhea ```
30
Who in the US is iron deficiency anemia common in?
Toddlers Adolescent girls Childbearing women
31
Populations at risk for IDA
Poverty Infants consuming cows milk Older individuals with restricted diets Teenagers eating junk food
32
Daily requirement of iron
7-10 mg for men | 7-20 mg for women
33
Causes of IDA
Dietary deficiency Impaired absorption Increased need/demand Blood loss
34
What type of anemia is IDA
Hypochromic-microcytic (abnormally small RBCs)
35
What causes IDA?
Occurs when iron stores are depleted. With inadequate dietary intake or excessive blood loss, there is no intrinsic dysfunction in iron metabolism. This depletes iron stores and causes a reduction of hemoglobin synthesis
36
Three stages of IDA
1- Iron stores depleted but RBC production remains normal 2- Iron transportation to bone marrow is diminished, resulting in iron-deficient RBC production 3- Begins when the small hemoglobin deficient cells enter circulation to replace normal aged RBCs
37
When do clinical manifestations of IDA begin?
During stage 3
38
What are clinical manifestations of IDA related to?
Inadequate levels of hemoglobin
39
When do individuals seek medical attention for IDA?
Not until hemoglobin levels have decreased to 7-8 g/dL
40
Early symptoms of IDA
``` Non-specific and vague: Fatigue Weakness SOB Pale earlobes, palms, and conjunctiva ```
41
Progressive symptoms of IDA
Brittle, thin, coarsely ridged and spoon shaped fingernails Burning mouth syndrome Soreness along with redness of tongue and burning Difficulty swallowing
42
What type of anemia is posthemorrhagic anemia?
Normocytic-normochromic
43
What causes posthemorrhagic anemia?
Acute blood loss
44
Describe the morphology of posthemorrhagic anemia
Normal RBC that is consistent in production and fully operational
45
What usually causes acute blood loss?
Loss of intra vascular volume, usually trauma
46
Effects of acute blood loss (with Posthemorrhagic anemia)
Effects depend on rate of hemorrhage leading to cardiac collapse, shock, and death Blood volume loss reduces BP, resulting in decreased venous return
47
Clinical manifestations of blood loss
``` Low blood pressure Low cardiac output Low central venous pressure (CVP) Increased heart rate Dyspnea Low oxygen saturation Fatigue ```
48
What is hemolytic anemia associated with?
Premature accelerated destruction of RBCs either episodically or continuously
49
Where do a large majority of hemolytic anemias occur?
Within phagocytes in lymphoid tissue, called extra vascular hemolysis Destruction of RBCs takes place within macrophages typically abundant in the spleen, bone marrow, and liver Less common in intra vascular spaces
50
What is hemolysis caused by?
Mechanical injury Complement fixation Intracellular parasites or toxins
51
Consequences of hemolytic anemia
Elevated levels of erythropoietin to stimulate RBC production Increase in products of hemoglobin breakdown
52
How does someone get hemolytic anemia?
Congenital - intrinsic defects in RBCs Acquired - immunologic related (RBC destruction by autoimmune disorders, artificial heart valve, or stress in narrowed small vessels)
53
Pathophysiology of hemolytic anemia includes:
Intra vascular and extra vascular hemolysis
54
What is extravascular hemolysis initiated by?
Age-related changes on surface of RBCs | While passing through spleen, macrophages break down and ingest deformed RBCs
55
What is intravascular hemolysis caused by?
Physical destruction of RBCs in circulating blood
56
Symptoms of hemolytic anemia
Some have no symptoms General symptoms of any anemia, along with jaundice
57
What is Anemia of chronic inflammation (ACD)?
Mild to moderate anemia from decreased RBC production and impaired iron utilization in people with chronic systemic disease
58
Conditions where someone would be likely to have anemia of chronic inflammation
``` Infections Cancer AIDS Chronic inflammation Autoimmune diseases ```
59
What does ACD result from?
``` A combination of: Decreased RBC lifespan, Suppressed production of erythropoietin, Ineffective bone marrow response to erythropoietin, Altered iron metabolism ```
60
With ACD, what is RBC destruction a result of?
Eryptosis
61
Clinical manifestations of ACD
Mild to moderate | Look like general anemia
62
Two reasons RBC disorders could result from an overproduction of cells
``` In response to exogenous (toxins/drugs) Or endogenous (compensatory responses, immune disorders) ```
63
Term for excessive RBC production
Polycythemia
64
Two forms of polycythemia
Relative | Absolute
65
What does polycythemia result from?
Hemoconcentration of the blood associated with dehydration
66
Two forms of absolute polycythemia
Primary | Secondary
67
What is secondary polycythemia?
Most common type | Results form increased erythropoietin secretion in response to chronic hypoxia
68
Another name for polycythemia Vera
Primary polycythemia
69
What is PV categorized as
Chronic myeloproliferative
70
What is PV?
Chronic, neoplasticism, nonmalignant condition characterized by over production of RBCs
71
What do pts with PV often have?
Increased level of WBCs, platelets, and splenomegaly
72
Clinical manifestations of PV
``` Splenomegaly Abdominal pain Venous and arterial thrombosis Vessel occlusion Ruddy color of face, hands, feet, ears Headache Drowsiness Delirium Mania Depression Visual disturbances High BP (due to increased blood volume) Painful itching intensified by heat or exposure to water ```
73
What is leukocytosis?
Leukocyte count that is higher than normal
74
What is leukopenia?
Leukocyte count that is lower than normal
75
What causes leukocytosis?
``` Supportive response to physiologic stressors such as: Infection Strenuous exercise Emotional changes Temperature changes Drugs Hormones Toxins ```
76
What causes leukopenia?
``` Radiation Anaphylactic shock Autoimmune disease (systemic lupus) Immune deficiencies Exposure to certain drugs (chemotherapy, glucocorticoids - steroids) ```
77
What is neutropenia?
A condition associated with a reduction in number of circulating neutrophils
78
Number associated with neutropenia
Neutrophil count less than 2000/uL
79
What does the absolute neutrophil count reflect?
Degree of neutropenia | Risk for infection
80
When does a reduction in number of neutrophils occur?
Severe, prolonged infection | Or with chemotherapeutic agents used in various cancers
81
Why is neutropenia so bad?
Can be life threatening because it leaves pt without natural immune responses (Pt at huge risk for infection)
82
Nursing considerations for pts with neutropenia
``` Limit visitors Keep door closed Wash hands often (before and after care) Avoid anyone who has illness Use reusable equipment and leave in room Promote oral care Prevent skin breakdown Promote nutrition ```
83
What is leukemia?
Malignant disorder of the blood and blood-forming organs; excessive accumulation of leukemic cells
84
Types of leukemia
Acute | Chronic
85
What is acute leukemia?
Presence of undifferentiated or immature cells (usually blast cells)
86
What is chronic leukemia?
Predominant cell is mature but does not function properly
87
Types of acute leukemia
Acute lymphocytic leukemia (ALL) | Acute myelogenous leukemia (AML)
88
Types of chronic leukemia
Chronic lymphocytic leukemia (CLL) | Chronic myelogenous leukemia (CML)
89
Risk factors for leukemia
``` Family history Environmental factors: - cigarette smoke - exposure benzene - ionizing radiation ```
90
Clinical manifestations of acute leukemia
- bone marrow depression - anemia (fatigue) - thrombocytopenia - bleeding purport - petechiae - ecchymosis - thrombosis - hemorrhage - DIC - infection - weight loss - bone pain - elevated Uric acid - liver, spleen, lymph node enlargement
91
Clinical manifestations of chronic leukemia
Bone marrow depression - splenomegaly - extreme fatigue - weight loss - night sweats - low-grade fever
92
What is lymphadenopathy?
Characterized by enlarged lymph nodes that become palpable and tender
93
What is local lymphadenopathy a result of?
Drainage of an inflammatory lesion near enlarged lymph node
94
What is general lymphadenopathy a result of?
Occurs in presence of malignant or nonmalignant disease
95
What is thrombocytopenia characterized by?
Disorders of platelts
96
Platelet count of thrombocytopenia
<150,000/mm^3
97
Etiology of thrombocytopenia
Hypersplenism Autoimmune disease Hypothermia Viral or bacterial infections that cause disseminated intravascular coagulation (DIC)
98
Clinical manifestations of thrombocytopenia
Petechiae and purpura | Progressing to major hemorrhage
99
Function of vitamin K
Necessary for the synthesis and regulation of prothrombin and Pt factors (II, VII, XI, X) and proteins
100
What causes vitamin K deficiency
Lack of dietary intake or excessive urination
101
Clinical manifestations of vitamin K deficiency
``` Easy bruising Oozing of blood from any orifice Excessive bleeding from wounds Bleeding from GI tract Blood in urine or stool ```
102
Lab counts for hemoglobin in men and women
Male: 4.53-5.65 trillion cells / L Female: 3.92-5.13 trillion cells / L
103
Lab counts for hematocrit for men and women
Male: 13.2-16.6 grams/dL Female: 11.6-15 grams/dL
104
Platelet lab counts for men and women
Male: 135-317 billion/L Female: 157-371 billion/L
105
WBC lab count
<11,000/mm^3
106
Iron lab count
60-70 mcg/dL

Pathophysiology (14 decks)

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