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PATHO > EXAMS 2 POWERPOINTS > Flashcards

EXAMS 2 POWERPOINTS Flashcards

1
Q

Functions of the hematopoietic system

A
  • transport
  • communication
  • Temperature
  • defense
  • clotting
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2
Q

Blood is composed of?

A
  • formed elements

- plasma.

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3
Q

what are the formed elements of blood

A

erythrocytes, leukocytes, and thrombocytes (platelets).

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4
Q

what are the Plasma

A

contains electrolytes, gases, nutrients, and waste products. Important plasma proteins include albumin, immunoglobulin, complement, and clotting factors.

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5
Q

what is a serum of blood basics

A

is the result of removing clotting factors from plasma.

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6
Q

what is

A

represents the volume of blood occupied by red blood cells (RBCs).

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7
Q

Hematocrit

A

represents the volume of blood occupied by red blood cells (RBCs).

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8
Q

Regulation of erythropoiesis is

A

through erythropoietin (EPO) that stimulates bone marrow to increase RBC production in response to low oxygen.

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9
Q

what is the oxygen-binding component of hemoglobin

A

iron. Iron gives blood its red color too

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10
Q

Persons with end stage renal disease (ESRD) may have

A

anemia as a consequence of decreased erythropoietin (EPO) production by the kidneys.

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11
Q

Nutritional deficiencies can lead

A

Nutritional deficiencies

anemia.

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12
Q

what stimulates bone marrow to increase RBC production in response to low oxygen.

A

erythropoietin (EPO)

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13
Q

Erythropoiesis requires

A
  • vitamin B12 (cobalamin)

- folate (folic acid) and iron.

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14
Q

Vitamin B12 absorption requires

A

intrinsic factor (IF). Lack of IF results in pernicious anemia.

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15
Q

formation of erythropoiesis (red blood cells)

A
  • 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.
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16
Q

IRON

A
  • 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
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17
Q

Granulocytes

A
  • neutrophils 50-60%
  • basophils = 0.3 -0.5%
  • eosinophils = 1 to 3%
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18
Q

neutrophils

A

abundant, phagocytic, immature band forms.

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19
Q

Basophils

A

least abundant, mature into mast cells, involved in allergic responses, release histamine.

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20
Q

Eosinophils:

A

involved in allergic or parasitic infections.

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21
Q

Agranulocytes

A

monocytes and macrophages = 3 to 8% of total leukocytes

lymphocytes = 20% to 30% of total leukocytes

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22
Q

monocytes

A

form macrophages, phagocytic, inflammatory response.

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23
Q

Lymphocytes

A

include B and T cells.

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24
Q

facts about Neutrophils

A
  • 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
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25
Q

facts about eosinophils

A
  • 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)
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26
Q

facts about basophils

A
  • Consist of heparin, an anticoagulant, histamine, a vasodilator, and other mediators of inflammation
  • Similar to mast cells
    Involved in allergic and hypersensitivity reactions
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27
Q

facts about monocytes and macrophages

A

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
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28
Q

three types of lymphocytes

A

B lymphocytes

T lymphocytes & Natural killer cells

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29
Q

plasma proteins

A

albumin = 54% of plasma proteins

globulins = 38% of the plasma proteins

fibrinogen= 7% of the plasma proteins

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30
Q

what are thrombocytes

A

function to form the platelet plug to help control bleeding

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31
Q

what is Thrombopoiesis

A

Thrombopoiesis is the process of forming platelets.

Platelets are derived from fragmentation of MEGAKARYOCYTES and are important in hemostasis

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32
Q

what is thrombopoietin

A

thrombopoietin is a growth hormone released from the liver that stimulates thrombopoiesis

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33
Q

Thrombocytopenia may give rise to

A

Thrombocytopenia may give rise to purpura and petechiae (rash or spots due to bleeding).

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34
Q

facts about hematopoiesis

A

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

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35
Q

lifespan of blood cells

A

The red blood cell has a life span of approximately 120 days.

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36
Q

RBC are broken down by?

A
  • It is broken down in the spleen.

The degradation products (iron and amino acids) are recycled.

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37
Q

The heme molecule of RBC destruction is converted to?

A
  • The heme molecule is converted to bilirubin and transported to the liver.
  • It is removed and rendered water soluble for elimination in the bile
38
Q

what is unconjugated bilirubin

A

Bilirubin is insoluble in plasma and attaches to plasma proteins for transport.

39
Q

what is Conjugated bilirubin

A

Removed from the blood by the liver and conjugated with glucuronide to render it water soluble

bilirubin= associated with jaundice

40
Q

the complete blood count

A
  • 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
41
Q

Percentage of reticulocytes

A

normally approximately 1%

42
Q

Red blood cell count (RBC) test

A

Measures the total number of red blood cells in 1 mm3 of blood

43
Q

Hemoglobin test

A

(grams per 100 mL of blood)

Measures the hemoglobin content of the blood

44
Q

Hematocrit test

A

Measures the volume of red cell mass in 100 mL of plasma volume

45
Q

Alterations in Erythrocytes

A

Polycythemias = Too many cells

Anemias = Too few cells

Sickle Cell = Normal number of cells with altered components

46
Q

explain anemia

A

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
47
Q

causes of anemia

A
  • decreased RBC production
  • blood loss
  • increased RBC destruction
48
Q

morphologic classifications of anemia

A
  • normocytic/normochronic = normal size and color
  • Microcytic, hypochromic = small size, pale color
  • Macrocytic (megaloblastic) = large size, normal color
49
Q

etiology of normocytic/normochronic

A

Acute blood loss, hemolysis, chronic kidney disease, chronic disease, cancers, sideroblastic anemia, endocrine disorders, starvation, aplastic anemia, pregnancy

50
Q

etiology of Microcytic, hypochromic

A

Iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, lead poisoning

51
Q

etiology of Macrocytic (megaloblastic),

A

Cobalamin (vitamin B12) deficiency, folic acid deficiency, liver disease (including effects of alcohol abuse)

52
Q

symptoms of anemia in heart

A
  • chest pain
  • angina
  • heart attack
53
Q

symptons of anemia in central NS

A

fainting

54
Q

Assessments of anemia

A
  • 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
55
Q

Nursing Care of the anemic patient

A
  • 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
56
Q

pernicious anemia

A

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

57
Q

pernicious can also occur….

A
  • 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
58
Q

pernicious anemia is more common in

A

More common in elderly than in younger patients

59
Q

neurologic manifestations due to nerve demyelination

A

Weakness, paresthesias of feet and hands, ↓ vibratory and position senses, ataxia, muscle weakness, and impaired thought processes

60
Q

symptoms of pernicious anemia

A

Loss of appetite, abdominal pain, beefy red tongue (atrophic glossitis), icterus, splenic enlargement

61
Q

treatment of pernicious anemia

A

Parenteral or high oral doses of vitamin B12

62
Q

increasing dietary cobalamin as treatment for pernicious anemia

A

Increasing dietary cobalamin does not correct this anemia if intrinsic factor is lacking or if there is impaired absorption in the ileum

63
Q

Folic Acid Deficiency Anemia

A
  • Folic acid is required for DNA synthesis

- RBC formation and maturation

64
Q

clinical manifestations of folic acid deficiency anemia

A
  • 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.
65
Q

common causes of folic acid deficiency

A
  • Common causes are Dietary deficiency Malabsorption syndromes. Increased requirement (i.e., pregnancy)
  • Alcohol abuse and anorexia
    Loss during hemodialysis
66
Q

malabsorption syndromes of folic acid deficiency

A
  • 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
67
Q

normal serum folate level

A

Normal is 3 to 16 mg/mL (7 to 36 mol/L)

68
Q

treatment of low serum folate level (folate level is low but vitamin b12 is normal)

A

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.
69
Q

what is the most common type of anemia?

A

iron deficiency anemia

70
Q

progression of iron deficiency causes

A
  • Brittle, thin, coarsely ridged, spoon-shaped nails

- A red, sore, painful tongue

71
Q

what is iron deficiency anemia

A
  • Most common type of anemia worldwide
  • Nutritional iron deficiency
  • Metabolic or functional deficiency
72
Q

symptomatic iron anemia figure

A

Hgb 7-8 g/dl

73
Q

treatments of iron deficiency anemia

A
  • Nutritional therapy
  • Oral iron supplements if adequate nutrition
  • Transfusion of packed RBCs
74
Q

goal of iron deficiency treatment

A

Treat underlying disease that is causing reduced intake or absorption of iron

75
Q

Normocytic anemia:

Acute and chronic Blood Loss

A

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
76
Q

gradual acute blood loss

A
  • 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.
77
Q

causes of acute blood loss

A
  • Trauma
  • Complications of surgery
  • Conditions or diseases that disrupt vascular integrity.

SUDDEN REDUCTION IN TOTAL BLOOD VOLUME THAT CAN LEAD TO HYPOVOLEMIC SHOCK

78
Q

Retroperitoneal bleeding as a result of acute blood loss

A

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

79
Q

clinical manifestations of acute blood loss

A
  • Pain

- Major complication is shock

80
Q

Internal hemorrhage

of acute blood loss

A

Tissue distention, organ displacement, nerve compression

81
Q

acute blood loss treatment

A
  • 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.
82
Q

causes of chronic blood loss

A
  • Bleeding ulcer
  • Hemorrhoids
  • Menstrual and postmenopausal blood loss
83
Q

managements involving in chronic blood loss

A
  • Identifying the source
  • Stopping the bleeding
  • Providing supplemental iron as needed
84
Q

blood transfusion

A
  • Benefits/risk weighed

- Not linked into one baseline hemoglobin level but recommended for HCT < 30

85
Q

complications of fluid overload

A
  • Fluid overload
  • Blood-borne infection
  • Exposure to donor leukocytes
86
Q

blood transfusion reactions

A
  • Incompatibility, Major - Acute hemolytic transfusion reaction
  • Febrile reaction
  • Allergic reaction
  • Hypocalcemia
  • Bleeding
  • Hypothermia – ventricular dysrhythmias
87
Q

sickle cell disease

A

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
88
Q

clinical presentation of sickle cell disease

A
  • Severe bone pain
  • Microinfarcts in many organs, leading to cardiomegaly, renal failure, and chronic leg ulcers
  • Pulmonary infarction leading to HTN and possible ARDS
89
Q

sickel cell disease pathophysiology

A

NORMAL
-A—->GLU (normal protein)

SICKLE CELL
T—->VAL (mutant protein)

90
Q

shapes of normal hemoglobin compared to sickle cell hemoglobin

A

sickle cell hemoglobin forms long, inflexible chains

91
Q

treatment of sickle cell crisis

A
  • 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

PATHO (6 decks)

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