Hematologic Pathologies Flashcards
PART 1
PART 1
- One of the bigger issues as we age, is that there is a progressive decrease in the percentage of the _________ space occupied by hematopoietic (blood-forming) tissue.
- What are the implications of this?
- marrow
- As we age, we are at higher risk for anemia and reduced number of WBCs.
- As we age there is a decrease in _______ serum iron, total iron-_____ capacity, and intestinal iron ____________.
- What are the implications of this?
- total, binding, absorption
- As these abilities decline, the ability to synthesize RBCs declines. Anemia.
- As we age there is a rise in _______ and increased platelet adhesiveness, as well as an increase in red cell ___________.
- What are the implications of this?
- fibrinogen, rigidity
- Increased clot formation risk. Strokes.
Do hemoglobin and hematocrit levels decrease as we age?
Yes, however, the levels remain within the normal adult range.
Collectively, the changes caused by age contribute to _____perfusion and/or aggravation of various circulatory disorders including: ______tension, _________, diabetes and __________ changes.
- hypoperfusion
- hypertension, stroke, cognitive changes
Is blood transfusion an organ transplant?
-YES
Blood transfusion involves inserting _________ proteins into an individual (risk of eliciting an _________ reaction).
- foreign
- adverse
What is the most common blood transfusion related pathology?
Febrile, non-hemolytic transfusion reaction
Febrile, non-hemolytic transfusion reaction is an _______ reaction against the transfused RBCs and occurs in __% to __% of erythrocyte transfusions and __% of platelet transfusions.
- immune
- .5% to 1%
- 30%
- Febrile, non-hemolytic transfusion reaction is characterized by an increase in ____________ by more than 1°F during or soon after the transfusion.
- Is this reaction hemolytic? What does this mean?
- temperature
- No, this means the RBCs survive and are not ruptured.
What is the treatment for a febrile, non-hemolytic transfusion reaction?
- stopping the transfusion
- administering antipyretics or corticosteroids (reduce temp)
What are the S/S of febrile, non-hemolytic reactions?
- fever, chills
- headache
- nausea, vomiting
- hypertension
- tachycardia
What is an acute hemolytic transfusion reaction?
quick acting RBC rupturing
Acute hemolytic transfusion reaction is due to an ABO ______________ between donor and recipient. In this erythrocytes are destroyed intravascularly with resultant red plasma and red urine (___________).
- incompatibility
- hemituria
What is the mortality rate of an acute hemolytic transfusion reaction?
-17-60%
Why can an acute hemolytic transfusion reaction result in renal failure?
Antigen/antibody reaction forms clumps that can get caught at kidney.
What are the S/S of acute hemolytic transfusion reactions?
- fever, chills
- nausea, vomiting
- flank and abdominal pain
- headache
- dyspnea
- hypotension
- tachycardia
- red urine (hematuria)
PART 2
PART 2
- What is erythropoiesis?
- Where does erythropoiesis occur and how many are produced/sec?
- The production of RBCs
- Occurs in the marrow of long bones and produced at a rate of 2.4m/sec (200b/24hrs)
RBC destruction occurs in the ____________ and involves the recovery of _____ and production of ________.
- macrophages
- iron
- bilirubin
RBC production = RBC ________
destruction
What is the most common blood condition in the U.S. and what is it?
Anemia- A condition that develops when one’s blood lacks enough healthy functional RBCs or hemoglobin.
What populations are at increased risk for anemia?
- Women (blood (Fe++) loss during menstruation)
- People with chronic diseases
- Older adults (poor diet, comorbidities)
- The diagnostic criteria for anemia for males is a Hb of what?
- The diagnostic criteria for anemia for females is a Hb of what?
- 14g/100ml, 42%
- 12g/100ml, 35%
Is anemia a disease?
No, but rather a symptom of another disorder.
Causes of Anemia Include:
- Blood loss (acute or chronic)
- Decreased or faulty red blood cell ____________
- Excessive _________ of RBCs
- _______ deficiency (Vitamin B12)
- Congenital defects of hemoglobin (sickle cell disease)
- Exposure to industrial poisons (CCl4)
- Diseases of the bone _____________
- Chronic inflammation, infection or neoplastic disease
- production
- destruction
- dietary
- marrow
Causes of Anemia Resulting from Excessive Blood Loss:
- _________, _______
- Peptic and duodenal ulcers
- Gastritis
- ___ cancers
- Hemorrhoids
- Ulcerative colitis
- Colon polyps
- Parasitic worms (pediatric patients)
- NSAIDS, Aspirin
- GI
How do NSAIDS/Aspirin cause anemia?
Damage to the wall of the stomach, leading to blood loss.
Causes of Anemia Resulting from an Increased Destruction of RBCs:
- ___________ damage (damage by a mechanical heart valves)
- Autoimmune hemolytic anemia (AIHA)
- Parasites (e.g., malaria)
- ____________ (an overactive spleen, spleen degrades RBCs)
- _________________
- mechanical
- hyperspleenism
- thalassemias
Thalassemia is a _________ disorder in which the body makes an abnormal form of _________ resulting in abnormal RBCs. These RBCs are quickly removed, which results in excessive _________ of RBCs.
- genetic
- hemoglobin
- destruction
Causes of Anemia Resulting from a Decreased Production of RBCs:
- __________ deficiency (e.g., iron, vitamin B12, alcohol abuse, folic acid deficiency
- Cytotoxic or antineoplastic drugs
- Decreased _____ ________ stimulation (e.g., -hypothyroidism, decreased erythropoietin production)
- Bone marrow _________ (e.g., leukemia, aplasia)
- ____________ syndromes
- nutritional
- bone marrow
- failure
- myelodysplastic
- Anemias can result from a lack of __________ or loss of responsiveness to ______________.
- It may occur secondary to _________ diseases including RA, TB, cancer.
- erythropoietin (EPO), erythropoietin (EPO)
- chronic
Ways that Anemia is Diagnosed:
- _____
- Low ___ and ____
- Abnormal RBC ______ (mean volume & width) and RBC development
- _______ levels (intracellular protein that stores iron and releases it - low in anemia)
- Serum ____-________ protein levels (binds iron and transports it through the blood, elevated in periods of iron deficiency)
- CBC
- Hb and Hct
- geometry
- Ferritin
- iron-binding
What are the S/S of anemia?
- Pallor
- Fatigue
- Lightheadedness
- Weakness
- Dyspnea
- Angina
- Fainting
What does treatment of anemia look like?
- Understanding the causes and alleviating them
- Relieving the symptoms
- Preventing complications
Prognosis of patients with anemia depends on the ________ factors and potential treatment for the underlying disease.
-etiologic
__________ exercise tolerance and _______ fatigability may be expected in anyone with anemia.
- diminished
- easy
- Prevalence of iron-deficiency anemia is likely to be higher in _______ populations.
- Anticipate anemia in chronic ______ failure patients.
- Anemia may be accompanied by ___ pathology and/or disease.
- athletic
- renal
- CV
Anemia causes a decrease in ____ delivery which affects skin healing, exercise capacity, and functional capacity.
O2
PTs should also monitor for tachycardia, why?
Heart is compensating for low O2 by increasing the cardiac output.
PART 3
PART 3
Leukocytes is a comprehensive term for what?
All WBCs (agranular vs granular)
- What are the 2 agranular WBCs?
- What are the 3 granular WBCs?
- lymphocytes, monocytes
- basophils, neutrophils, eosinophils
Disorders of leukocyte or WBC concentration and in the relative proportions of the leukocyte types are recognized as measures of the reaction of the body to ________, ___________, _________ damage, or degeneration.
- infection
- inflammation
- tissue damage
What is leukocytosis?
An increase in the number of leukocytes in the blood (too many!).
Leukocytosis occurs with ___________ and chronic ____________.
- infections
- inflammation
Is an increase in leukocytes okay?
Yes, it is a normal response to things such as inflammation and infection.
Leukocytosis can also occur in response to physiological ________ and can result from an acute _________.
- stressors
- hemorrhage
Leukocytosis can cause both ______philia and ______philia.
- basophilia
- eosinophilia
Basophilia is involved in inflammatory and ________ reactions. Basophils degranulate when stimulated by an _________ and release _________ and other inflammatory cytokines.
- allergic
- allergen
- histamines
Eosinophils are recruited to areas of __________ and participate in the response. However, they play key roles almost exclusively in fighting ________ infections.
- inflammation
- parasitic
Lymphocytosis is an increase in lymphocytes and is associated with the presence of an _________.
infection
What is lymphocytopenia?
Abnormally low level of lymphocytes in the blood.
- What is the most common cause of temporary lymphocytopenia?
- What are some other causes?
- recent infection
- chemotherapy, corticosteroid use, leukemias and lymphomas, radiation
Neutropenia is a condition associated with the number of neutrophils being fewer than _____ cells/mm³ and results in a reduced capacity to mount an _______ response.
- 1500 cells/mm³
- immune
Causes of Neutropenia:
- Viral ________
- _____ abuse
- __________ deficiencies
- ____________ disorders (e.g., SLE), chemotherapy agents
- Radiation therapy
- Overwhelming infections
- infections
- ETOH
- nutritional
- connective tissue (CT)
Is leukopenia ever beneficial?
NO, in contrast to leukocytosis
Neutropenia Numbers of Interest:
- 4000-10000 WBC/mm³
- > 10000 WBC/mm³ (_________)
- <2500 WBC/mm³ (_________)
- <500 neutrophils/mm³ is abnormal placing patient at significant risk of infection
- neutrophilia
- neutropenia
Neutropenia Implications for PT?
- hand hygeine
- cleanliness of the facility
- patient restrictions (family/community contact, no large gatherings, avoid fresh fruits and vegetables)
Patients with neutropenia may not present in a manner consistent with an infection or inflammation (stem cell recipients), why?
Neutrophils are largely responsible for the S/S of an inflammatory response. Neutrophils are in short supply in neutropenia which may reduce S/S of inflammation.
PART 4
PART 4
What is cancer?
Uncontrolled cell growth
Both RBCs and WBCs are constanly being ___________ and remain within predictable ranges suggesting careful regulation of blood cell production and removal. This suggests that over/under production of blood cells may be __________.
- replenished
- pathologic
What gives rise to all adult blood cells in our bodies?
Hemopoietic Stem Cells
Hemopoietic stem cells undergo steps of __________ to become blood cells.
maturation
Some hemopoietic stem cells intermediate cells develop gene defects which can cause what?
Lock the cells into an intermediate stage while still allowing them to reproduce, resulting in non-functioning cells.
Leukemia is a disease of _______. It occurs when an intermediate blood-forming cell line that gives rise to adult/mature _______ is replaced with a malignant clone of an intermediate lymphocytic or myelogenous cells.
- WBCs
- WBCs
What is malignant?
Very virulent or infectious mass of cells that often has spread
What is neoplasm?
A new and abnormal growth of tissue in some part of the body (especially as a characteristic of cancer).
Cells arising from the malignant cells (clones) are ___-__________ and prevent/limit the development of healthy/normal replicating intermediate stage blood cells.
non-functional
As malignant cells (clones) increase in number, they physically crowd out normal blood cells in the ______ and prevent/limit normal blood cell production.
marrow
Leukemia may be ______ or ________ based on its natural course.
acute or chronic
Classifying Leukemia Acording to Morphology:
- ________-:, for leukemias arising from lymphoid stem cells or progenitor cells
- ______-: for leukemias arising from defective myeloid stem cells or progenitor cells
- ________-: for leukemia involving large, immature (functionless) cells [these cells are often called blast cells]
- _______-: for leukemia involving mature, smaller cells.
- lympho-
- myelo-
- blastic-
- cytic-
______ leukemia is a rapid accumulation of neoplastic, immature lymphoid or myeloid cells in the bone marrow and peripheral blood. It is defined as more than __% of the bone marrow cells are blasts cells.
- Acute
- 30%
_______ leukemia is a slower accumulation of defective mature lymphoid or myeloid elements of the blood than with acute leukemia neoplastic, immature lymphoid or myeloid cells in the bone marrow and peripheral blood.
chronic
What are the 3 primary symptoms of leukemia?
- anemia/dyspnea or SOB
- infection (neutropenia)
- bleeding tendencies/ easy bruising
The diagnosis of leukemia is predicated on:
- Medical _______
- _________ examination
- ___
- Bone _______ aspiration
- Cyto_______ (Blood cells are stained allowing for the identification of leukemic cells)
- Cyto________ (Visualization of chromosomes)
- history
- physical
- CBC
- marrow
- cytochemistry
- cytogenetics
Treatments for leukemia include what 3 things?
- Chemotherapy
- Radiation
- Bone marrow transplant
PART 5
PART 5
- Acute Myelogenous (myeloid) Leukemia (AML) is a cancer of immature cells in the _________ line of WBCs.
- AML makes up __% of all leukemias (__% adults).
- The mean age at Dx is __ yo.
- Cure rates are between __ and __%.
- myeloid
- 40%, (80%)
- 63yo
- 20-45%
- Acute Lymphocytic (lymphoblastic) Leukemia (ALL) makes up __% of all leukemias (__% of pediatrics)
- With ALL, pediatrics has a __% chance of survival while adults have __%.
- ALL is ________ progressing and patients will present with _____/______ pain from leukemic infiltration.
- 20%, (70%)
- 80%, 40%
- rapidly, bone/joint
- Chronic Lymphocytic Leukemia (CLL) makes up __% of all leukemias with adults making up 100% of the cases.
- CLL is associated with __________ abnormalities.
- The overall medual survival is between __-__ years.
- 25%
- chromosomal
- 10-14 years
-Chronic Myeloid Leukemia (CML) makes up __% of all new leukemias with adults accounting for most-all cases.
-What chromosomal abnormality will be present in patients with CML?
CML is _____ to _______ progressive.
- 20%
- Philadelphia (reciprocal translocation between chromosome 9 and 22)
- slow to moderate
Leukemia Subtypes General:
- What are the 4 subtypes of leukemia?
- Which affects children more?
- Which subtype is associated with Philadelphia chromosome defect?
- AML, ALL, CLL, CML
- ALL
- CML
Leukemia patients tend to be _______ (both adult and children), this _____ a reason to not treat. Chemotherapy for these patients tends to be _______ as opposed to being local.
- inactive, isn’t
- systemic
What is lymphoma?
General term for cancers that develop in the lymphocytes. These cells are found in the lymph system ie. lymph nodes, spleen, thymus, bone marrow.
- What are the 2 main types of lymphoma?
- Which is the most common?
- Hodgkin’s Lymphoma (HL), Non-Hodgkin’s Lymphoma (NHL)
- Non-Hodgkin’s Lymphoma (90% of all cases)
Are Reed-Sternberg Cells associated with Hodgkin’s Lymphoma or Non-Hodgkin’s Lymphoma?
Hodgkin’s Lymphoma
- What is the main sign of lymphoma?
- What are the most common locations?
- Enlarged lymph nodes
- Cervical, axillary, para-aortic
HL is a __-cell type malignancy with clonal expansion of a malignant B cell. It occurs in both children and adults (rarely in kids) and is _______ curable. The prognosis depends on the ________ of the disease.
- B
- highly
- staging
Splenic involvement is seen with __-__% of people with HL.
30-40%
Hodgkin’s Lymphoma PT Implications:
- Impaired _______ (bone pain)
- Impaired _________ Performance
- Impaired __________ Capacity/Endurance Associated with Deconditioning
- Infection control
- Monitor lymph nodes for changes in size, shape, tenderness, consistency
- Assessing and addressing impairments, functional limitations, and disabilities
- posture
- muscle
- aerobic
Non-Hodgkin’s Lymphoma is a large group (about 30 specific types described) of lymphoid malignancies (excludes HL) that present as solid _______ arising from cells of the lymphatic system.
tumors
NHL Clinical Presentation:
- _________ enlargement of isolated or generalized lymph nodes (Lymphadenopathy) of the cervical, axillary, supraclavicular, inguinal, and femoral (pelvic) chains
- Extranodal sites: nasopharynx, GI tract, bone (accompanied by bone pain), thyroid, testes, and soft tissue
- Abdominal NHL: abdominal pain and fullness, ____ obstruction or bleeding, ascites, back pain, and leg swelling.
- painless
- GI
What are some treatment strategies for Lymphoma?
- Chemotherapy
- Antibody therapy/ targeted therapy
- Radiation therapy
- Stem Cell transplantation
- Steroids
- Surgery (removal of spleen/other organs)
Multiple Myeloma is a primary malignant neoplasm (an abnormal growth of tissue) of ________ cells (precursor lymphocytes) arising in the bone marrow which can then turn into a tumor
plasma
Weight Bearing for Patients with Bone Tumors:
- > 50% cortical metastatic involvement = _____
- 25-50% = _____
- 0-25% = ______
- NWB (non)
- PWB (partial)
- FWB (full)
With multiple myeloma, the tumor initially affects the _______ and bone __________ of the vertebrae, ribs, skill, pelvis, and femur.
bones and bone marrow
- What is the primary presenting symptom of multiple myeloma?
- Multiple myeloma is a ________ tumor.
- bone pain
- BLOOD
Normal cell growth results in cell ______ while myeloma cell growth results in ________ cell growth.
- death
- uncontrolled
The onset of multiple myeloma is gradual and _________. The presenting features include ______, ____ pain, and recurrent _________.
- insidiouos
- fatigue, bone pain, recurrent infections
What are patients with multiple myeloma at increased risk for?
- pathological fractures
- bone destruction/osteoporosis
- life threatening hypercalcemia
- muscular weakness and atrophy
What is the first line of treatment for patients with multiple myeloma?
Chemotherapy
Is multiple myeloma curable?
No, median survival is about 3 years.
Multiple Myeloma PT Implications:
-Primary Prevention/Risk Reduction for __________ Demineralization (bone loss and osteoporosis)
-Impaired _________ (skeletal deformity; bone pain)
-Impaired Joint Mobility, Muscle Performance, and
Range of Motion Associated with Fracture
-Pathologic __________
- skeletal
- posture
- fractures
PART 6
PART 6
Hemostatis involves the arrest of _______ after blood vessel injury. It involves initiating ____ formation to stop hemorrhaging. It also involves the interaction of components of the blood vessel wall, platelets and plasma coagulation proteins and a number of signaling molecules and intermediates.
- bleeding
- clot
- Von Willebrand’s Disease is caused by a lack of or dysfunction of _____.
- vWF is released from __________ following vascular injury and mediated the adhesion of platelets to sites of ________ injury. It binds and stabilizes the procoagulant protein _______.
- vWF (Von Willebrand’s Factor)
- platelets, vascular, Factor VIII
- Von Willebrand’s Disease causes a reduced concentration of vWF which results in ______ and ____ bleeding.
- It can give rise to petechiae, what is this?
- It can also lead to frequent nose bleeds (__________), gum bleeding, and GI bleeding.
- mucosal and skin
- Red or purple spot on the skin caused by a minor hemorrhage.
- epistaxis
Both purpura and petachiae reflect a bleeding disorder, which is larger?
Purpura > Petachiae (pinpoint)
- What medication stimulates the release of Willebrand factor stores cells in the lining of blood vessels?
- _________ therapies are also ways to treat Von Willebrand’s Disease by infusion of concentrated blood clotting factors (vWF/ Factor VIII)
- Desmopressin
- Replacement
What is hemophilia?
A bleeding disorder inherited as a sex-linked autosomal recessive trait.
The genes for hemophilia are carried on the _ chromosome. Therefore females often present as _______ while males present with ________.
- X
- carriers
- disease
Hemophilia is caused by what?
Lack/deficiency of/in 1 or more clotting factor
How is hemophilia classified?
According to the percentage of clotting factor present in plasma:
- Mild = 6-30% of normal factor VIII activity
- Moderate = 1-5% of normal factor VIII activity
- Severe = less than 1% of normal factor VIII activity
25-30% of all hemophilia cases are ____________.
spontaneous
Hemophilia Clinical Manifestations:
- Occurrences of __________
- Newborns- occur with heel sticks, immunizations, blood draws, circumcision
- Bruising, bleeding from the mouth or frenulum, intracranial bleeding, hematomas of the head, and hemarthrosis with ambulation
bleeding
What is hematoma?
Collection of blood outside of blood vessels (bruise)
Patients with hemophilia have an increased risk of bleeding into _________.
joints
Women with hemophilia will present with excessive uterine bleeding during their ________ cycle, and may be the first symptom.
menstrual
Bleeding into the _______ spaces (_________) is one of the most common clinical manifestations of hemophlia.
- joint
- hemarthrosis
List the sites of hemarthrosis from most common to least.
Knee>ankle>elbow>hip>shoulder
If patients have hemophilia, ___________ may further damage the synovium.
weight bearing
- Can muscles hemorrhage?
- This often involves _______ muscle groups and results in _____ and limited ____.
- Yes, and the blood may remain in the confines of that muscle.
- flexor, pain and limited ROM
- Hemophilia A is a lack of clotting factor ___ and constitutes __% of all cases of hemophilia.
- Hemophilia B is a lack of factor ___ and affects __% of all people with hemophilia.
- VIII, 80%
- IX, 15%
A regular ________ program is an important part of the comprehensive care of patients with hemophilia. Strength training is of benifit, but they want to avoid _______ sports.
- exercise
- contact
Signs of Early Bleeding:
- Stiffening into the position of comfort (usually flexion, shortened position)
- Decreased _____
- Pain/tenderness
- Joint swelling with increased ______
- Gradually intensifying pain
- Loss of _________
- ROM
- warmth
- sensation
Sickle cell disease is an autosomal __________ disorder characterized by the presence of an abnormal form of Hb S which causes the RBC to “sickle”.
recessive
In sickle cell disease, when too many cells “sickle” vaso_________occurs and the individual has a ______.
- vasoocclusion
- crisis
Sickle Cell Diseasse Management:
- _____ management/inpatient care, opioids, analgesics & blood transfusions
- Exercise
- _________
- Teaching joint protection/prescribing assistive devices
- pain
- depression
