Hematologic System Flashcards
what is relationship between aging and blood forming tissues?
as we age there is a progressive decrease in the % of marrow space occupied by hematopoietic tissue and reduced iron absorption in the intestine
overall decreased ability to manufacture RBCs and WBCs
T/F: there is an increased risk for clot formation as we age? Why/why not?
TRUE
a rise in fibrinogen and increased platelet adhesiveness and an increased RBC rigidity
what impact does aging have on hematocrit and hemoglobin levels?
they slightly decrease but remain within normal limits
List some transfusion related disorders
- Febril, non-hemolytic transfusion reaction
- Acute Hemolytic Transfusion reaction
what is the most common transfusion related reaction?
febrile, non-hemolytic transfusion reaction
(an immune reaction against transfused RBC)
characterized by an increase in temp by >1º but no hemolysis
how are febrile non-hemolytic transfusion reactions treated?
stop the transfuion
administer antipyretics and corticosteroids
what are the s/s of febrile, non-hemolytic transfusion reactions?
- fever, chills
- HA
- N/V
- HTN
- tachycardia
what causes acute hemolytic transfusion reactions?
due to an ABO incompatibility between a donor and recipient
Erythroctyes are destroyed intravascularly with resultant red plasma and red urine (hematuria)
renal failure
what causes renal failure in acute hemolytic transfusion reactions?
the antigen/antibody rxn forms clumps and when they get to the kidney they get caught in the glomerulus of the kidney
List the S/S of acute hemolytic transfusion rxns
- fever, chills
- N/V
- flank and abdominal pain
- HA
- Dyspnea
- HTN
- Tachycardia
- Hematuria
T/F: it is safe to provide PT to a patient during an RBC transfusion?
True
some studies suggest that if vital signs and signs of medical AE are monitored PT can safely be administered
define erthyropoiesis
the production of RBCs
occurs in marrow of long bones
why is the destruction of RBCs important?
it allows for the recovery of iron and production of bilirubin
define anemia
a condition that develops when one’s blood lacks enough healthy functional red cells or hemoglobin
List the diagnostic criteria for anemia
Hb < (14 g/100 ml for men) and (12 g/100 ml for females)
Hct < (42% for men) and (35% for females)
T/F: anemia is a disease
FALSE
it is a symptom of another disorder
List several causes of anemia
- blood loss (acute or chronic)
- decreased or faulty RBC production
- excessive destruction of RBCs
- dietary deficiency (Vitamin B12)
- congenital defects of hemoglobin (sickle cell disease)
- Exposure to industrial poisons (CCl4)
- Disease of the bone marrow (and presence of tumors)
- Chronic inflammation, infection or neoplastic disease
List several causes of anemia resulting from excessive blood loss
- NSAIDs, Aspirin (can cause ulcer formation in stomach)
- Peptic and duodenal ulcers
- Gastritis
- GI cancers
- Hemorrhoids
- Ulcerative colitis
- Colon polyps
- Parastic worms (pediatric patients)
list several causes of anemia resulting from an increased destruction of RBCs
- mechanical damage (damage by a mechanical heart valves)
- autoimmune hemolytic anemia (AIHA)
- parasites (e.g. malaria)
- hyperspleenism (overactive spleen)
- thalassemia
What are thalassemias?
genetic disorders in which the body makes an abnormal form of hemoglobin → abnormal RBCs which are quickly removed
this results in excessive destruction of RBCs
list causes of anemia resulting from a decreased production of RBCs (5)
- nutritional deficiency (iron, vitamin B12, alcohol abuse, folid acid deficiency)
- cytotoxic or antineoplastic drugs
- decreased bone marrow stimulation (hypothyroidism, decreased erythropoietin production)
- Bone marrow failure (leukemia, aplasia)
- Myelodysplastic syndromes
how is anemia diagnosed?
look at:
- CBC
- Low Hb and Hct
- Abnormal RBC geometry and development
- Ferritin levels
- Serum iron-binding proteins
- binds iron and transports it through the blood
- elevated in periods of iron deficiency
List s/s of anemia
- Pallor
- fatigue
- lightheadedness
- weakness
- dyspnea
- angina
- fainting
how is anemia treated?
understand the cause
alleviate or control the causes
relieve symtpoms
prevent complications
List some implications for PT for anemic patients
- exercise must be approved by physcian
- expect diminished exercise tolerance and increase fatigability
- iron-deficiency anemia higher in athletic populations
- anticipate anemia in chronic renal failure patients
- anemia is often accompanied by CV pathology
how can decreased O2 delivery resulting from anemia, impact PT?
impacts skin healing, exercise capacity, and functional capacity
must monitor vital signs
looking for tachycardia
usually acoompanied by a sense of fatigue, generalized weakness, loss of stamina, and exertional dyspnea
what is leukocytosis?
an increase in the number of leukocytes in the blood
what are some physiologic causes of leukocytosis?
- strenuous exercise
- anesthesia
- surgery
List some PT implications for leukocytosis
- be aware of WBC count
- understand how these numbers have changed over time
- proper hand hygiene is essential
what is lymphocytopenia?
the condition of having an abnormally low level of lymphocytes in the blood
most commonly caused by a recent infection
what can cause lymphocytopenia?
- recent infection
- chemotherapy
- corticosteroid use
- leukemias or lymphomas
- radiation
what is neutropenia?
condition associated with the number of neutrophils being fewer than 1500 cells/mm3
neutrophil count is >500
thus reduced capacity to mount an immune response
List some causes of Neutropenia
- viral infections
- ETOH abuse
- nutritional deficiencies (look at albumin levels)
- CT disorders
- radiation therapy
- overwhelming infections
T/F: WBC count is the same as a neutrophil count?
FALSE
similiar, but a neutrophil count is best determined by an ANC
what ANC would be concerning and why?
<500 neutrophils/mm3
low and places the pt at significant risk of infection
T/F: neutropenic pts should avoid fresh fruits and veggies?
TRUE
they have a greater risk of carrying bacteria
why would a neutropenic pt not present like a normal pt with an infection?
neutrophils are largely responsible for the SxS of an inflammatory response
only real sign would be fever
define cancer
uncontrolled cell growth
describe the disease process for Leukemia
occurs when an intermediate blood-forming cell line that gives rise to adult/mature WBCs is replaced with a malignant clone of an intermediate lymphocyte or myelogenous cells
define malignant
very virulent or infectious mass of cells that often has spread
define neoplasm
a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer
what is the impact of malignant cell formation during Leukemia?
these are non-functinal, space filling cells
prevent/limit the development of healthy/normal replicating intermediate stage blood cells
crowding of these cells limit normal blood cell production
what are the 4 classifications of leukemias based on morphology?
- Lympho- = arise from lymphoid stem cells
- Myelo- = arise from myeloid stem cells
- Blastic- = involve large, immature (functionless) cells (often called blast cells)
- Cytic- = involving mature, smaller cells
What is acute leukemia?
rapid accumulation of neoplastic, immature lymhoid or myeloid cells in the bone marrow and peripheral blood.
defined as more than 30% of the bone marrow are blast cells
what is chronic leukemia?
a slower accumulation of defective mature lymphoid or myeloid elements of the blood than with acute leukemia neoplastic, immature lymphoid or meyloid cells in the bone marrow and peripheral blood
overcrowding results in expulsion of cells and accumulation of cells in the marrow slowing blood cell production
List the primary symptoms of Leukemia
- anemia/dyspnea or SOB
- infection (neutropenia)
- bleeding tendencies/easy bruising
diagnostic factors for leukemia
- medical history
- physical exam
- CBC
- bone marrow aspiration
- Cytochemistry
- blood cells are stained allowing for the ID of leukemic cells
- Cytogenetics
- visualization of chromosomes
list the Trxs for Leukemia
- Chemotherapy
- Radiation
- Bone marrow transplantation
List the specific subtypes of leukemia
- acute myelogenous (myeloid) leukemia (AML)
- acute lymphocytic (lymphoblastic) leukemia (ALL)
- chronic lymphocyctic leukemia (CLL)
- chronic myeloid lekumia (CML)
describe AML
- A cancer of immature cells in the myeloid line of blood cells (WBCs)
- 40% of all leukemias; 80% of adult leukemia dx.; very rare in children
- Mean age at dx: 63 YOA with incidence increasing with increasing age.
- Cure rates: 20-45%
describe ALL
- 20% of all leukemias
- 30% of adult leukemias, 70% of pediatric leukemias
- Peak: Pediatric- 3-7 yrs; adult – 65+
- Prognosis: Pediatric – 80% survival, Adult – 40%
- Rapidly progressing (hence acute)
- Bone and joint pain from leukemic infiltration
describe CLL
- 25% of all leukemias
- Pediatric – 0 %; adult – 100% of all cases
- Age at Dx-50+
- Associated with chromosomal abnormalities
- Affects B-lymphocytes; out of control growth
- Prognosis: Overall medial survival – 10 – 14 yrs
- Poor cytogenetics- median survival of 8 yrs, Good cytogenetics – median survival of 25 yrs
Describe CML
- CML affects cells in the myeloid cell line and these genetically abnormal usually grow slowly at first
- 20% of all new leukemia cases
- Adults account for 95-100% of all cases; children 2% of new cases (very rare in kids)
- Average age at onset: 66 YOA
- Philadelphia chromosome (reciprocal translocation between chromosome 9 and 22), XRT
- Slow progressing, moderately progressive
T/F: Leukemia is a reason for no PT
FALSE can still treat
define lymphoma
a general term for cancers that develop in the lymphocytes
these cells are found in the lymph system (lymph nodes, spleen, thymus, bone marrow)
what are the 2 main types of lymphoma?
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
what is the distinguishing feature of Hodgkin’s Lymphoma?
presence of Reed-Sternberg cells
(these cells have owl eyes and are very large)
List the clinical manifestations of HL
- Fever
- Night Sweats
- Weight loss
- Loss of appetite or anorexia
- Inappropriate fatigue
- Inappropriate dyspnea
- enlarged lymph nodes
list some implications for PT in pts with HL
- Impaired Posture (bone pain)
- Impaired Muscle Performance
- Impaired Aerobic 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
what is the clinical presentation of NHL?
- Painless 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, GI obstruction or bleeding, ascites, back pain, and leg swelling.
how are lymphoma’s treated?
- Chemotherapy
- Antibody therapy/targeted therapy
- Radiation therapy
- Stem Cell Transplantation
- Steroids
- Surgery
- Removal of the spleen
- Removal of other organs containing a lymphoma
what is a multiple myeloma?
a primary malignant neoplasm of plasma cells arising in the bone marrow which can then turn into a tumor which initially affects bones and bone marrow of the vertebrae, ribs, skull, pelvis and femur
this is a blood tumor not a bone tumor!
what is the weight bearing status for pt’s with multiple myelomas?
0-25% → full WB; avoid lifting or straining
25-50% → partial WB; avoid twisting or stretching
>50% → non-WB w/crutches or walking; touch down permitted
describe the clinical presentation for a multiple myeloma
- gradual and insidious onset
- presenting features of fatigue, bone pain, and recurrent infections (anemia and elevated levels of cytokines)
- pathological fxs
- bone destruction/osteoporosis
- life threatening hypercalcemia
- muscular weakness and atrophy
- kidney involvement
what is the trx for multiple myeloma?
chemotherapy
but it is incurable
median survival ~3 yrs
list some multiple myeloma implications for PT
- Primary Prevention/Risk Reduction for Skeletal Demineralization (bone loss and osteoporosis)
- Impaired Posture (skeletal deformity; bone pain)
- Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture
- Pathologic Fxs.
List 3 disorders of hemostasis
- von Willebrand’s disease
- Hemophilia
- sickle cell anemia
what is von Willebrand’s disease?
hemostatic disease in which there is reduced concentration of vWF resulting in mucosal and skin bleeding
what is von Willebrand factor?
a factor released by platelets following vascular injury
it’s role it mediate adhesion of platelets to sites of vascualr injury and bind and stabilize the procoagulant protein factor VIII
what is a key sign/symptom of von Willebrand’s disease?
- petechiae → red or purple spot on the skin caused by a minor hemorrhage
- frequent nose bleeds (epistaxis), gum bleeding, and GI bleeding
what is the difference between purpura and petachiae?
purpura → the appearance of red/purple discolorations on the skin caused by bleeding
petachiae → pinpoint, round spots that apear on the skin as a result of bleeding
purpura >> than petachie
how is von Willebrand’s disease treated?
- desmopressin → synthetic hormone that stimualtes release of vWF stored in cells in the lining of blood vessels
- replacement therapies → include transfusion of concentrated blood-clotting factors containing vWF and factor VIII
what is hemophilia?
a bleeding disorder inherited as a sex-linked autosomal recessive trait
caused by a lack/deficiency of/in 1 or more clotting factor
how is hemophilia classified?
by the % of clotting factor present in plasma:
- mild = 6-30% of normal clotting factor activity
- moderate = 1-5% of normal clotting factor activity
- severe = less than 1% of normal clotting factor activity
describe the clinical manifestation of hemophilia
- occurences of bleeding
- newborns ⇒ occur with heel sticks, immunizations, blood draws, circumcision
- bruising, bleeding from the mouth or frenulum, intracranial bleeding, hematomas of the head, and hemathrosis with ambulation
how can hemophilia impact joints?
- bleeding into the joint space is one of the most common clinical manifestations of hemophilia
- synovial membrane undergoes vascualar hyperplasia
- blood is an irritant to the synovium causing synovial hypertrophy
- weight bearing may further damage the synovium
how does hemophilia impact muscle?
- muscle hemorrhages/space occupying
- pain and limited ROM of affected group
- bleeding can often occur in the flexor muscle groups
- can lead to compartment syndrome
what is the difference between hemophilia A and B?
hemophilia A = lack of clotting factor VIII (makes up 80% of all cases)
hemophilia B = deficiency of factor IX (affects about 15% of all cases)
PT implications for patients with hemophilia
- regular exercise is important for these pts
- greater BMI increases risk of joint injury
- avoid contact sports, rock climbing, wrestling
- strength training is beneficial
- avoid valsava maneuver
- use pain free ROM, no max lifts no 1RM testing
- recognize signs of early bleeding
list the signs of early bleeding you may observe in a hemophilic pt.
- stiffening into the position of comfort
- decreased ROM
- pain/tenderness
- joint swelling w/increased warmth
- gradually intensifying pain
- loss of sensation
what is sickle cell anemia?
autosomal recessive disorder characterized by presense of abnormal form of Hb S → causes the RBC to “sickle”
what is the impact of sickle cell disease on normal physiology?
too many sickle cells cause vaso-occulsion → localize ischemia and the individual has a crisis
over all shortened life expectancy
how is sickle cell disease managed?
- pain management/inpatient care, opioids, analgesics and blood transfusions
- exercise
- depression
- teaching joint protection/prescribing assistive devices
