EXAMS 2 POWERPOINTS Flashcards
Functions of the hematopoietic system
- transport
- communication
- Temperature
- defense
- clotting
Blood is composed of?
- formed elements
- plasma.
what are the formed elements of blood
erythrocytes, leukocytes, and thrombocytes (platelets).
what are the Plasma
contains electrolytes, gases, nutrients, and waste products. Important plasma proteins include albumin, immunoglobulin, complement, and clotting factors.
what is a serum of blood basics
is the result of removing clotting factors from plasma.
what is
represents the volume of blood occupied by red blood cells (RBCs).
Hematocrit
represents the volume of blood occupied by red blood cells (RBCs).
Regulation of erythropoiesis is
through erythropoietin (EPO) that stimulates bone marrow to increase RBC production in response to low oxygen.
what is the oxygen-binding component of hemoglobin
iron. Iron gives blood its red color too
Persons with end stage renal disease (ESRD) may have
anemia as a consequence of decreased erythropoietin (EPO) production by the kidneys.
Nutritional deficiencies can lead
Nutritional deficiencies
anemia.
what stimulates bone marrow to increase RBC production in response to low oxygen.
erythropoietin (EPO)
Erythropoiesis requires
- vitamin B12 (cobalamin)
- folate (folic acid) and iron.
Vitamin B12 absorption requires
intrinsic factor (IF). Lack of IF results in pernicious anemia.
formation of erythropoiesis (red blood cells)
- Red cells are produced in the red bone marrow after birth
- Until 5 years of age, almost all bones produce red cells to meet growth needs; after 5 years, bone marrow activity gradually declines.
- After 20 years, red cell production takes place mainly in the membranous bones of the vertebrae, sternum, ribs, and pelvis.
IRON
- Iron is acquired from the diet.
- A large amount of iron in the body contained within proteins such as hemoglobin and myoglobin.
- The remainder of iron is found in ferritin and hemosiderin.
- Iron transferred bound to transferrin.
Iron is largely recycled and recovered as RBCs are processed in the spleen. - Iron is used to synthesize hemoglobin contained within RBCs
Granulocytes
- neutrophils 50-60%
- basophils = 0.3 -0.5%
- eosinophils = 1 to 3%
neutrophils
abundant, phagocytic, immature band forms.
Basophils
least abundant, mature into mast cells, involved in allergic responses, release histamine.
Eosinophils:
involved in allergic or parasitic infections.
Agranulocytes
monocytes and macrophages = 3 to 8% of total leukocytes
lymphocytes = 20% to 30% of total leukocytes
monocytes
form macrophages, phagocytic, inflammatory response.
Lymphocytes
include B and T cells.
facts about Neutrophils
- Primarily responsible for maintaining normal host defenses against invading substances
- First cells to arrive at the site of infection
- Have their origins in the myeloblasts found in the bone marrow
- Move to the tissue for approximately 1 to 3 days
- Die in the tissue discharging phagocytic function or die of senescence
facts about eosinophils
- Increase in number during allergic reactions and parasitic infections
- The agents associated with allergic reactions
In parasitic infections,
( the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes)
facts about basophils
- Consist of heparin, an anticoagulant, histamine, a vasodilator, and other mediators of inflammation
- Similar to mast cells
Involved in allergic and hypersensitivity reactions
facts about monocytes and macrophages
Monocytes & Macrophages
Cells survive for months to years in the tissues.
- Important role in chronic inflammation
Involved in the immune response - Activating lymphocytes
Presenting antigen to T cells
three types of lymphocytes
B lymphocytes
T lymphocytes & Natural killer cells
plasma proteins
albumin = 54% of plasma proteins
globulins = 38% of the plasma proteins
fibrinogen= 7% of the plasma proteins
what are thrombocytes
function to form the platelet plug to help control bleeding
what is Thrombopoiesis
Thrombopoiesis is the process of forming platelets.
Platelets are derived from fragmentation of MEGAKARYOCYTES and are important in hemostasis
what is thrombopoietin
thrombopoietin is a growth hormone released from the liver that stimulates thrombopoiesis
Thrombocytopenia may give rise to
Thrombocytopenia may give rise to purpura and petechiae (rash or spots due to bleeding).
facts about hematopoiesis
Continual process
Occurs in bone marrow
Original cells are self-renewing stem cells
Pluripotent
Exposure of these stem cells to environmental cues (hormones, growth factors) may give rise to many types of cells
Lineages
lifespan of blood cells
The red blood cell has a life span of approximately 120 days.
RBC are broken down by?
- It is broken down in the spleen.
The degradation products (iron and amino acids) are recycled.
The heme molecule of RBC destruction is converted to?
- The heme molecule is converted to bilirubin and transported to the liver.
- It is removed and rendered water soluble for elimination in the bile
what is unconjugated bilirubin
Bilirubin is insoluble in plasma and attaches to plasma proteins for transport.
what is Conjugated bilirubin
Removed from the blood by the liver and conjugated with glucuronide to render it water soluble
bilirubin= associated with jaundice
the complete blood count
- A complete blood count provides information regarding the number of blood cells and their structural and functional characteristics.
- The white cell differential count is the determination of the relative proportions (percentages) of individual white cell types.
- A complete blood count (CBC) is a commonly performed screening test that determines the number of red blood cells, white blood cells, and platelets per unit of blood
Percentage of reticulocytes
normally approximately 1%
Red blood cell count (RBC) test
Measures the total number of red blood cells in 1 mm3 of blood
Hemoglobin test
(grams per 100 mL of blood)
Measures the hemoglobin content of the blood
Hematocrit test
Measures the volume of red cell mass in 100 mL of plasma volume
Alterations in Erythrocytes
Polycythemias = Too many cells
Anemias = Too few cells
Sickle Cell = Normal number of cells with altered components
explain anemia
Reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin
- Impaired erythrocyte production
- Acute or chronic blood loss
- Increased erythrocyte destruction
- Combination of the above
causes of anemia
- decreased RBC production
- blood loss
- increased RBC destruction
morphologic classifications of anemia
- normocytic/normochronic = normal size and color
- Microcytic, hypochromic = small size, pale color
- Macrocytic (megaloblastic) = large size, normal color
etiology of normocytic/normochronic
Acute blood loss, hemolysis, chronic kidney disease, chronic disease, cancers, sideroblastic anemia, endocrine disorders, starvation, aplastic anemia, pregnancy
etiology of Microcytic, hypochromic
Iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, lead poisoning
etiology of Macrocytic (megaloblastic),
Cobalamin (vitamin B12) deficiency, folic acid deficiency, liver disease (including effects of alcohol abuse)
symptoms of anemia in heart
- chest pain
- angina
- heart attack
symptons of anemia in central NS
fainting
Assessments of anemia
- History: diet, heredity, drug use
- Signs/symptoms
Skin color: pallor, jaundice
Cardiovascular: tachycardia, hypotension, high-output failure
Urinary: dark urine from excretion of bilirubin
GI: stool test for occult blood;
Labs
- Low hemoglobin/hematocrit
- Low serum iron and total iron-binding capacity
- Elevated serum ferritin
Nursing Care of the anemic patient
- Safe administration of blood/blood products
- Observe for signs/symptoms of decreased perfusion
- Decrease oxygen demands
- ABA standard transfuse only for HCT < 30 unless justification such as CAD
- Observe for occlusive problems
- Pain control
- Supplemental oxygen
- Administration/monitoring medications to improve anemia
pernicious anemia
Caused by a lack of intrinsic factor made by the gastric parietal cells and is required for vitamin B12 absorption
RESULTS IN VITAMIN B12 DEFICIENCY
pernicious can also occur….
- after GI surgery (i.e., gastrectomy, gastric bypass, small bowel resection involving the ileum)
- In strict vegetarians since most of vitamin B12 come from meat
- Excessive alcohol or smoking
pernicious anemia is more common in
More common in elderly than in younger patients
neurologic manifestations due to nerve demyelination
Weakness, paresthesias of feet and hands, ↓ vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
symptoms of pernicious anemia
Loss of appetite, abdominal pain, beefy red tongue (atrophic glossitis), icterus, splenic enlargement
treatment of pernicious anemia
Parenteral or high oral doses of vitamin B12
increasing dietary cobalamin as treatment for pernicious anemia
Increasing dietary cobalamin does not correct this anemia if intrinsic factor is lacking or if there is impaired absorption in the ileum
Folic Acid Deficiency Anemia
- Folic acid is required for DNA synthesis
- RBC formation and maturation
clinical manifestations of folic acid deficiency anemia
- Similar to cobalamin deficiency, but absence of neurologic problems
- Develops Insidiously
- Symptoms may be attributed to other coexisting problems (e.g., cirrhosis, esophageal varices).
- GI disturbances: dyspepsia and a smooth, beefy red tongue.
common causes of folic acid deficiency
- Common causes are Dietary deficiency Malabsorption syndromes. Increased requirement (i.e., pregnancy)
- Alcohol abuse and anorexia
Loss during hemodialysis
malabsorption syndromes of folic acid deficiency
- Celiac disease = Celiac disease is an immune disease in which people can’t eat gluten because it will damage their small intestine. TREATMENT IS DIET FREE OF GLUTTEN
- Crohn’s disease
- Small bowel resection
normal serum folate level
Normal is 3 to 16 mg/mL (7 to 36 mol/L)
treatment of low serum folate level (folate level is low but vitamin b12 is normal)
TREATED BY REPLACEMENT THERAPY
- Usual dose is Folate 1mg per day by mouth
- Encourage patient to eat foods with large amounts of folic acid
- In malabsorption states or with chronic alcoholism, up to 5mg per day may be required.
- Duration of treatment depends on the cause of deficiency.
what is the most common type of anemia?
iron deficiency anemia
progression of iron deficiency causes
- Brittle, thin, coarsely ridged, spoon-shaped nails
- A red, sore, painful tongue
what is iron deficiency anemia
- Most common type of anemia worldwide
- Nutritional iron deficiency
- Metabolic or functional deficiency
symptomatic iron anemia figure
Hgb 7-8 g/dl
treatments of iron deficiency anemia
- Nutritional therapy
- Oral iron supplements if adequate nutrition
- Transfusion of packed RBCs
goal of iron deficiency treatment
Treat underlying disease that is causing reduced intake or absorption of iron
Normocytic anemia:
Acute and chronic Blood Loss
Anemia resulting from blood loss may be caused by either acute or chronic problems
- Acute blood loss occurs as a result of sudden hemorrhage
- Sources of chronic blood loss are similar to those of iron-deficiency anemia
gradual acute blood loss
- When acute blood loss is more gradual, the body maintains its blood volume by slowly increasing the plasma volume, but then the number of RBCs is significantly diminished.
causes of acute blood loss
- Trauma
- Complications of surgery
- Conditions or diseases that disrupt vascular integrity.
SUDDEN REDUCTION IN TOTAL BLOOD VOLUME THAT CAN LEAD TO HYPOVOLEMIC SHOCK
Retroperitoneal bleeding as a result of acute blood loss
In the case of retroperitoneal bleeding, the patient MAY NOT experience abdominal pain. Instead, the patient may have numbness and pain in a lower extremity secondary to compression of the lateral cutaneous nerve, which is located in the region of the first to third lumbar vertebrae
clinical manifestations of acute blood loss
- Pain
- Major complication is shock
Internal hemorrhage
of acute blood loss
Tissue distention, organ displacement, nerve compression
acute blood loss treatment
- Replace blood volume
- Identify source of hemorrhage and stop blood loss
- Correct RBC loss once volume replacement is established
- Provide supplemental iron
- The anemia should begin to correct itself once the source of hemorrhage is identified, blood loss is controlled, and fluid and blood volumes are replaced.
causes of chronic blood loss
- Bleeding ulcer
- Hemorrhoids
- Menstrual and postmenopausal blood loss
managements involving in chronic blood loss
- Identifying the source
- Stopping the bleeding
- Providing supplemental iron as needed
blood transfusion
- Benefits/risk weighed
- Not linked into one baseline hemoglobin level but recommended for HCT < 30
complications of fluid overload
- Fluid overload
- Blood-borne infection
- Exposure to donor leukocytes
blood transfusion reactions
- Incompatibility, Major - Acute hemolytic transfusion reaction
- Febrile reaction
- Allergic reaction
- Hypocalcemia
- Bleeding
- Hypothermia – ventricular dysrhythmias
sickle cell disease
Inherited structural abnormality in the hemoglobin
- Crystal-like, elongated, rigid cell causes occlusion in the microcirculation
- Sickling in response to cold, dehydration, hypoxia, infection, and acidosis
clinical presentation of sickle cell disease
- Severe bone pain
- Microinfarcts in many organs, leading to cardiomegaly, renal failure, and chronic leg ulcers
- Pulmonary infarction leading to HTN and possible ARDS
sickel cell disease pathophysiology
NORMAL
-A—->GLU (normal protein)
SICKLE CELL
T—->VAL (mutant protein)
shapes of normal hemoglobin compared to sickle cell hemoglobin
sickle cell hemoglobin forms long, inflexible chains
treatment of sickle cell crisis
- Oxygen administration
- Aggressive intravenous fluid hydration
- Prompt treatment of infection with broad-spectrum antibiotics
- RBC transfusions are not usually required
- Pain control with around-the-clock narcotics
- Folic acid supplementation
- Hydroxyurea
- Hematopoietic stem cell transplantation (HSCT) is promising towards finding a cure for Sickle Cell Disease
