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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
Q

Daily requirement of dietary folate intake

A

50-200 mcg/day

Humans are totally dependent on dietary folate

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26
Q

Why is folate deficiency so common?

A

The body does not store folate for later use

More common than B12 deficiency

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27
Q

Individuals who are more likely to have folate deficiency

A

Those with chronic conditions such as alcoholism and chronic malnourishment

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28
Q

Morphology of folate deficiency

A

Deficient production of thymine, which affects cells that undergo rapid division (bone marrow cells producing RBCs)

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29
Q

Clinical manifestations of folate deficiency

A 
(Like PA, but paresthesia is not seen)
Severe cheilosis
Stomatitis
Painful ulcerations of buccal mucosa and tongue (burning mouth)
Dysphagia
Flatulence
Diarrhea
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30
Q

Who in the US is iron deficiency anemia common in?

A

Toddlers
Adolescent girls
Childbearing women

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31
Q

Populations at risk for IDA

A

Poverty
Infants consuming cows milk
Older individuals with restricted diets
Teenagers eating junk food

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32
Q

Daily requirement of iron

A

7-10 mg for men

7-20 mg for women

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33
Q

Causes of IDA

A

Dietary deficiency
Impaired absorption
Increased need/demand
Blood loss

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34
Q

What type of anemia is IDA

A

Hypochromic-microcytic (abnormally small RBCs)

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35
Q

What causes IDA?

A

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

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36
Q

Three stages of IDA

A

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

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37
Q

When do clinical manifestations of IDA begin?

A

During stage 3

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38
Q

What are clinical manifestations of IDA related to?

A

Inadequate levels of hemoglobin

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39
Q

When do individuals seek medical attention for IDA?

A

Not until hemoglobin levels have decreased to 7-8 g/dL

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40
Q

Early symptoms of IDA

A 
Non-specific and vague:
Fatigue
Weakness
SOB
Pale earlobes, palms, and conjunctiva
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41
Q

Progressive symptoms of IDA

A

Brittle, thin, coarsely ridged and spoon shaped fingernails
Burning mouth syndrome
Soreness along with redness of tongue and burning
Difficulty swallowing

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42
Q

What type of anemia is posthemorrhagic anemia?

A

Normocytic-normochromic

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43
Q

What causes posthemorrhagic anemia?

A

Acute blood loss

44
Q

Describe the morphology of posthemorrhagic anemia

A

Normal RBC that is consistent in production and fully operational

45
Q

What usually causes acute blood loss?

A

Loss of intra vascular volume, usually trauma

46
Q

Effects of acute blood loss (with Posthemorrhagic anemia)

A

Effects depend on rate of hemorrhage leading to cardiac collapse, shock, and death

Blood volume loss reduces BP, resulting in decreased venous return

47
Q

Clinical manifestations of blood loss

A 
Low blood pressure
Low cardiac output
Low central venous pressure (CVP)
Increased heart rate
Dyspnea
Low oxygen saturation
Fatigue
48
Q

What is hemolytic anemia associated with?

A

Premature accelerated destruction of RBCs either episodically or continuously

49
Q

Where do a large majority of hemolytic anemias occur?

A

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
Q

What is hemolysis caused by?

A

Mechanical injury
Complement fixation
Intracellular parasites or toxins

51
Q

Consequences of hemolytic anemia

A

Elevated levels of erythropoietin to stimulate RBC production
Increase in products of hemoglobin breakdown

52
Q

How does someone get hemolytic anemia?

A

Congenital - intrinsic defects in RBCs
Acquired - immunologic related (RBC destruction by autoimmune disorders, artificial heart valve, or stress in narrowed small vessels)

53
Q

Pathophysiology of hemolytic anemia includes:

A

Intra vascular and extra vascular hemolysis

54
Q

What is extravascular hemolysis initiated by?

A

Age-related changes on surface of RBCs

While passing through spleen, macrophages break down and ingest deformed RBCs

55
Q

What is intravascular hemolysis caused by?

A

Physical destruction of RBCs in circulating blood

56
Q

Symptoms of hemolytic anemia

A

Some have no symptoms

General symptoms of any anemia, along with jaundice

57
Q

What is Anemia of chronic inflammation (ACD)?

A

Mild to moderate anemia from decreased RBC production and impaired iron utilization in people with chronic systemic disease

58
Q

Conditions where someone would be likely to have anemia of chronic inflammation

A 
Infections
Cancer 
AIDS
Chronic inflammation
Autoimmune diseases
59
Q

What does ACD result from?

A 
A combination of:
Decreased RBC lifespan,
Suppressed production of erythropoietin,
Ineffective bone marrow response to erythropoietin,
Altered iron metabolism
60
Q

With ACD, what is RBC destruction a result of?

A

Eryptosis

61
Q

Clinical manifestations of ACD

A

Mild to moderate

Look like general anemia

62
Q

Two reasons RBC disorders could result from an overproduction of cells

A 
In response to exogenous (toxins/drugs)
Or endogenous (compensatory responses, immune disorders)
63
Q

Term for excessive RBC production

A

Polycythemia

64
Q

Two forms of polycythemia

A

Relative

Absolute

65
Q

What does polycythemia result from?

A

Hemoconcentration of the blood associated with dehydration

66
Q

Two forms of absolute polycythemia

A

Primary

Secondary

67
Q

What is secondary polycythemia?

A

Most common type

Results form increased erythropoietin secretion in response to chronic hypoxia

68
Q

Another name for polycythemia Vera

A

Primary polycythemia

69
Q

What is PV categorized as

A

Chronic myeloproliferative

70
Q

What is PV?

A

Chronic, neoplasticism, nonmalignant condition characterized by over production of RBCs

71
Q

What do pts with PV often have?

A

Increased level of WBCs, platelets, and splenomegaly

72
Q

Clinical manifestations of PV

A 
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
Q

What is leukocytosis?

A

Leukocyte count that is higher than normal

74
Q

What is leukopenia?

A

Leukocyte count that is lower than normal

75
Q

What causes leukocytosis?

A 
Supportive response to physiologic stressors such as:
Infection
Strenuous exercise
Emotional changes
Temperature changes
Drugs
Hormones
Toxins
76
Q

What causes leukopenia?

A 
Radiation
Anaphylactic shock
Autoimmune disease (systemic lupus)
Immune deficiencies
Exposure to certain drugs (chemotherapy, glucocorticoids - steroids)
77
Q

What is neutropenia?

A

A condition associated with a reduction in number of circulating neutrophils

78
Q

Number associated with neutropenia

A

Neutrophil count less than 2000/uL

79
Q

What does the absolute neutrophil count reflect?

A

Degree of neutropenia

Risk for infection

80
Q

When does a reduction in number of neutrophils occur?

A

Severe, prolonged infection

Or with chemotherapeutic agents used in various cancers

81
Q

Why is neutropenia so bad?

A

Can be life threatening because it leaves pt without natural immune responses
(Pt at huge risk for infection)

82
Q

Nursing considerations for pts with neutropenia

A 
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
Q

What is leukemia?

A

Malignant disorder of the blood and blood-forming organs; excessive accumulation of leukemic cells

84
Q

Types of leukemia

A

Acute

Chronic

85
Q

What is acute leukemia?

A

Presence of undifferentiated or immature cells (usually blast cells)

86
Q

What is chronic leukemia?

A

Predominant cell is mature but does not function properly

87
Q

Types of acute leukemia

A

Acute lymphocytic leukemia (ALL)

Acute myelogenous leukemia (AML)

88
Q

Types of chronic leukemia

A

Chronic lymphocytic leukemia (CLL)

Chronic myelogenous leukemia (CML)

89
Q

Risk factors for leukemia

A 
Family history
Environmental factors:
- cigarette smoke
- exposure benzene
- ionizing radiation
90
Q

Clinical manifestations of acute leukemia

A
  • 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
Q

Clinical manifestations of chronic leukemia

A

Bone marrow depression

  • splenomegaly
  • extreme fatigue
  • weight loss
  • night sweats
  • low-grade fever
92
Q

What is lymphadenopathy?

A

Characterized by enlarged lymph nodes that become palpable and tender

93
Q

What is local lymphadenopathy a result of?

A

Drainage of an inflammatory lesion near enlarged lymph node

94
Q

What is general lymphadenopathy a result of?

A

Occurs in presence of malignant or nonmalignant disease

95
Q

What is thrombocytopenia characterized by?

A

Disorders of platelts

96
Q

Platelet count of thrombocytopenia

A

<150,000/mm^3

97
Q

Etiology of thrombocytopenia

A

Hypersplenism
Autoimmune disease
Hypothermia
Viral or bacterial infections that cause disseminated intravascular coagulation (DIC)

98
Q

Clinical manifestations of thrombocytopenia

A

Petechiae and purpura

Progressing to major hemorrhage

99
Q

Function of vitamin K

A

Necessary for the synthesis and regulation of prothrombin and Pt factors (II, VII, XI, X) and proteins

100
Q

What causes vitamin K deficiency

A

Lack of dietary intake or excessive urination

101
Q

Clinical manifestations of vitamin K deficiency

A 
Easy bruising
Oozing of blood from any orifice
Excessive bleeding from wounds
Bleeding from GI tract
Blood in urine or stool
102
Q

Lab counts for hemoglobin in men and women

A

Male: 4.53-5.65 trillion cells / L
Female: 3.92-5.13 trillion cells / L

103
Q

Lab counts for hematocrit for men and women

A

Male: 13.2-16.6 grams/dL
Female: 11.6-15 grams/dL

104
Q

Platelet lab counts for men and women

A

Male: 135-317 billion/L
Female: 157-371 billion/L

105
Q

WBC lab count

A

<11,000/mm^3

106
Q

Iron lab count

A

60-70 mcg/dL

Pathophysiology (14 decks)

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