Hematologic Systems Flashcards
1
Q
Describe effect of aging on percentage of marrow space occupied by hematopoietic tissue -
A
Decrease in % of marrow space occupied by hematopoietic tissue (blood forming tissue) -> risk for anemia and WBC
2
Q
Describe effect of aging on total serum iron, iron-bonding capacity, intestinal iron absorption -
A
Decreased -> decreased ability to synthesize RBC -> anemia
3
Q
Describe effect of aging on fibrinogen and platelet adhesion/red cell rigidity -
A
Rise in fibrinogen and increase platelet adhesion/red cell rigidity -> clot formation
4
Q
Describe effect of aging on Hg and Hct levels -
A
slight decrease (but stay within normal adult ranges)
5
Q
T/F a blood transfusion is not an organ transplant
A
False, it is! Insert foreign proteins into and individual
- Risk of adverse reaction (rejection)
6
Q
Febrile (fever), non-hemolytic transfusion reaction -
A
- Most common transfusion related reaction
- Immune reaction against the transfused RBCs
7
Q
Febrile (fever), non-hemolytic transfusion reaction characterized by -
A
Increase in temp by more than 1 F during or soon after transfusion
8
Q
Treatment for Febrile (fever), non-hemolytic transfusion reaction
A
- Stopping transfusion
2. Administering antipyretics or corticosteroids
9
Q
S/S of Febrile (fever), non-hemolytic transfusion reaction
A
- Fever/chills
- Headache
- N&V
- Hypertension
- Tachycardia
10
Q
Acute Hemolytic (cells rupture) Transfusion reaction -
A
- Not common
- Due to ABO incompatibility between donor and recipient
- Erythrocytes destroyed intravascularly (red plasma/urine - hematuria)
- Cells clump, hemolysis (cell rupture) and release of cellular elements
11
Q
Acute Hemolytic (cells rupture) Transfusion reaction can result in what type of failure?
A
Renal failure - antigen/antibody reaction forms clumps that get to the kidney and get stuck
12
Q
T/F PT Treatments are always administered during a blood transfusion
A
False, rarely
13
Q
3 Reasons Pt’s said they wouldn’t administer pt to individual receiving RBC transfusion:
A
- Fear of dislodging intravenous line
- Excessive bleeding
- Causing unstable vitals
14
Q
Erythropoiesis and where it occurs?
A
Production of RBC in the marrow of the long bones
15
Q
RBC destruction by what for recovery of what?
A
By macrophages for recovery of iron/production of bilirubin
16
Q
Anemia -
A
Blood lacks enough healthy functional RBC or hemoglobin (most common blood condition in US)
17
Q
Populations at risk of anemia (3)
A
- Women (blood loss during menstruation)
- People with chronic disease
- Older adults (poor diets/comorbidities)
18
Q
Hb and Hct diagnostic criteria for anemia: (men/women)
A
HB <14 for men and <12 for females
Hct <42% men and <35% women
19
Q
T/F Anemia is a disease
A
False, rather a symptom of another disorder
20
Q
Causes of anemia (8)
A
- Blood loss (acute/chronic)
- Decreased/faulty RBC production
- Excessive destruction of RBC
- Dietary deficiency (B12)
- Sickle cell disease
- Exposure to industrial poisons
- Diseases on bone marrow
- CHronic inflammation/infection/neoplastic disease
21
Q
Anemia resulting from increased destruction of erythrocytes: (5)
A
- Mechanical damage
- Autoimmune hemolytic anemia (AIHA)
- Parasite (malaria)
- Hypersplenism - spleen degrades RBCS
- Thalassemias - abnormal form of Hg -> abnormal RBC
22
Q
Anemia resulting from decreased production of RBCs (4)
A
- Nutritional deficiency
- Antineopalstic drugs
- Decreased bone marrow stimulation (hypothyroidism, decreased erythropoietin production)
- Bone marrow failure (leukemia, aplasia)
23
Q
Anemia resulting from lack of erythropoietin (1)
A
- May occur secondary to chronic disease (RA, tuberculosis, cancer)
24
Q
Diagnosis of anemia:
A
- Low Hb and Hct
- Abnormal RBC geometry and development
- Ferritin levels low (intracellular protein that stores iron and releases it)
- Serum iron-binding levels (binds iron and transports it through blood) elevated in periods of iron deficiency
25
Treatment of anemia -
Understand the cause -> alleviate/control the cause -> relieve the symptoms -> prevent complications
26
Exercise tolerance expected in patient with anemia -
Diminished tolerance and easy fatigability due to decreased O2 delivery
27
T/F Iron-deficiency anemia likely higher in geriatric populations
False, athletic populations
28
T/F Can anticipate anemia in chronic renal failure patients
True
29
Must monitor what during exercise with anemic patient?
Vital signs
30
Symptoms accompanied by anemia:
1. Tachycardia - heart beating faster to pump more blood
2. Sense of fatigue
3. Weakness
4. Loss of stamina
5. Exertional dyspnea
31
Alterations to Leukocyte/WBC [ ] measure reaction of body to -
Infection, inflammation, tissue damage, or degeneration
32
Leukocytosis -
Increase in number of leukocytes in blood
33
Leukocytosis occurs with ____ but can also occur in response to ______
1. infections and chronic inflammation (leukemia, lymphoma)
| 2. Physiologic stressors (strenuous exercise, anesthesia, surgery, glucocorticoids)
34
Basophilia -
| If not mediated -
Degranulate when stimulated by allergen and release histamine and other inflammatory cytokines
- May not be mediated leaded to anaphylaxis, asthma, hives
35
Eosinophilia -
- Recruited to areas of inflammation and participate in the inflammatory response
- ALmost exclusively fight parasitic infections
36
Lymphocytosis -
- Increased number of lymphocytes
| - Presence of infection
37
WBC implications for PT (2)
1. Be aware of WBC but does not necessarily mean pathology
| 2. Hand hygiene
38
Lymphocytopenia -
Most common causes:
Other causes:
- abnormally low level of lymphocytes in blood
- Most common cause is recent infection
1. Chemotherapy
2. Corticosteroid use
3. LEukemias and lymphomas
4. Radiation
39
Neutropenia -
- Number of neutrophils being less than 500
| - reduced capacity to mount immune response
40
Causes of neutropenia - (6)
1. Viral infection
2. ETOH abuse
3. Nutritional def
4. Chemo agents
5. Radiation therapy
6. Overwhelming infections
41
T/F Leukocytosis (increase WBC) and leukopenia (decrease WBC) are both beneficial
FALSE, leukopenia is never beneficial
42
Absolute neutrophil count (ANC):
normal =
phys not pathologic =
abnormal (sig risk of infection) =
normal = 4000-10,000
phys not pathologic = > 10,000
abnormal (sig risk of infection) = <500
43
Describe why patients with neutropenia may not present in a manner consistent with an infection/inflammation.
What should we rely on?
Neutrophils responsible for inflammatory response -> neutrophils short supply in neutropenia -> inflammation signs not present
-> must rely on body temp
44
Cancer defined as -
uncontrolled growth of cells that undergo complex maturation and defects arise along the pathway
45
Leukemia is a disease of
WBC
| Occurs when intermediate blood-forming cell line that gives rise to adult WBC is replaced with malignant clone
46
Malignant -
Virulent or infectious mass of cells that has spread
47
Neoplasm -
new and abnormal growth of tissue in some part of the body (characteristic of cancer)
48
Cells arising from malignant cells are
1. Non-functional
2. Prevent/limit development of healthy/normal replicating intermediate stage blood cells
3. As they increase in number, crow out normal blood cells present in marrow and prevent normal production
49
T/F Leukemia can be acute/chronic and causes are generally unknown
True
50
Lympho -
Myelo -
Blastic -
Cytic -
Lympho - arising from lymphoid stem cells/progenitor cells
Myelo - arising from defective myeloid stem cells/progenitor cells
Blastic - large, immature (functionless) cells
Cytic - mature, smaller cells
51
Acute leukemia -
- Rapid accumulation of neoplastic, immature lymphoid or myeloid cells in bone marrow and peripheral blood
- More than 30% of bone marrow cells are blast cells
52
Chronic leukemia -
- Slower accumulation of defective immature lymphoid/myeloid elements of the blood
53
Primary symptoms of leukemia -
1. Anemia/dyspnea
2. Infection (neutropenia)
3. Bleeding/bruising
54
Cytochemistry -
Blood cells stained allowing for the identification of leukemic cells
55
Cytogenetics -
Visualization of chromosome
56
Therapy for leukemia -
1. Chemo (targeted)
2. Radiation
3. Bone marrow transplantation
(treating management of comorbidities as well)
57
Acute Myelogenous (myeloid) Leukemia (AML) -
What % of all leukemia?
Prognosis?
- Cancer of immature cells in the myeloid line of blood cells (WBCs)
- 40% of all leukemias (80 for adults, rare in children)
- Cure rates 20-45%
58
Acute Lymphocytic (lymphoblastic) Leukemia (ALL) -
What % of all leukemia?
Prognosis?
Where do they feel pain?
- 20% of all leukemias (70% of pediatric, 30% adult)
- 80% survival in kids
- Joint and bone pain from leukemic infiltration
59
Chronic Lymphocytic Leukemia (CLL) -
What does it affect?
What % of all leukemia?
Prognosis?
- 25% of all leukemias (0 pediatrics)
- Affects B-lymphocytes (out of control growth)
- Associated with chromosomal abnormalities
- Overall survival 10-14 years
60
Chronic myeloid leukemia (CML) -
What cells does it affect?
% of cases?
- Affects cells in the myeloid cell line (grow slowly at first)
- 20% of cases
- Very rare in kids
61
PT implications of leukemia:
1. Usually geriatric patients with comorbidities
2. Patient tends to be inactive
3. Chemo has systemic AE
62
T/F Leukemia is a reason not to treat
FALSE
63
Lymphoma -
Cancers that develop in the lymphocytes (lymph nodes, spleen, thymus, bone marrow)
64
Hodgkin's lymphoma (HL) -
Presence of Reed-Sternberg cell (abnormal large owl eye cells)
65
Non-hodgkin's Lymphoma (NHL) -
90% of all lymphoma cases
66
HL:
| Curable?
- B-Cell type malignancy
| - Highly curable (dependent on staging of disease)
67
Clinical manifestations of HL: (6)
1. Lymph enlargement
2. Lymph nodes are typically non-tender and firm
3. Fever
4. Night sweats
5. Weight Loss
6. Fatigue/Dyspenia
68
HL implications for PT (6):
1. Impaired posture (bone pain)
2. Impaired muscle performance
3. Impaired aerobic capacity
4. Infection control
5. Monitor Lymph nodes
6. Assess and address impairments, functional limitations, disabilities
69
NHL:
- Solid tumors arising from cells of lymphatic system
| - Lymph nodes usually involved first
70
Clinical presentations of NHL:
1. Painless enlargement of lymph nodes
2. Extranodal = GI tract, bone pain, testes, soft tissue
3. Abdominal NHL = abdominal pain/fullness, Gi bleeding, back pain, leg swelling
71
Treatment of Lymphoma:
1. Chemo
2. Antibody therapy/targeted
3. Radiation
4. Stem cell transplantation
5. Steroids (for inflammation)
6. Surgery (removal of spleen/organs containing lymphoma)
72
Multiple Myeloma -
Primary malignant neoplasm (an abnormal growth of tissue) of plasma cells (precursor lymphocytes) arising in the bone marrow -> can turn into tumor
73
Multiple myeloma tumor initially affects what?
Bones and bone marrow of the vert, ribs, skull, pelvis, and femur
74
Primary presenting symptom of Multiple Myeloma
Bone pain
75
T/F Multiple Myeloma is a bone tumor.
False, blood tumor not a bone tumor (bone tumor changes are secondary to blood tumor)
76
clinical presentation of Multiple Myeloma:
1. Onset gradual
2. Fatigue, bone pain, recurrent infections (anemia and high level of cytokines)
3. Bone destruction/osteoporosis
4. Life threatening hypercalcemia
5. Muscular weakness and atrophy
77
Treatment of Multiple Myeloma:
1. CHemo
2. Remains incurable disease
3. Median survival = 3 yrs
78
Implications for PTs:
1. Prevention/risk reduction for bone loss
2. Impaired posture (skeletal deformity/bone pain)
3. Impaired joint mobility, muscle performance, ROM associated with fracture
79
Hemostasis -
- arrests bleeding after blood vessel injury
| - initiating clot formation to stop bleeding
80
von Willebrand's factor (vWF) -
- released from platelets following vascular injury
- mediates adhesion of platelets to sites of vascular injury
- binds procoagulant protein factor VIII
81
vWF Disease -
| S&S -
- decrease vWF factor giving rise to petechiae (red/purple spot on skin causes by minor hemorrhage)
- Frequent nose bleeds (epistaxis), gum bleeding, GI bleeding
82
Purpura -
red/purple discolorations on skin caused by bleeding
83
Petechiae -
pinpoint, round spots that appear on skin as a result of bleeding
84
T/F Purpura >> petechiae
True
85
Desmopressin -
medication ys synthetic hormone that controls bleeding by stimulating the release of vWF stored in cells in lining of blood vessels
86
Replacement therapies -
Infusions of [ ] blood-clotting factors containing vWF and factor VIII
87
Hemophilia -
| Male vs female
- bleeding disorder inherited as a sex-linked autosomal recessive trait
- Lack/deficiency of 1 or more clotting factor
- Female (carrier)
- Males (present with disease)
88
Hematoma -
collection of blood outside blood vessels
89
General Clinical manifestations of hemophilia -
Occurance of bleeding, bruising, hematomas of head, hemarthrosis with ambulation
90
Hemophilia in newborns -
Occur with heel sticks
immunizations
blood draws
circumcision
91
Hemophilia in women -
Excessive menstrual cycle
92
Hemophilia in joint -
1. Hemarthrosis - bleeding into the joint is one of most common
2. Knee > ankle > elbow > hip > shoulder
3. Causes swelling, pain, warmth, stiffness
93
How does hemophilia affect the synovial membrane of a joint?
1. Membrane undergoes vascular hyperplasia (increase in size)
2. Blood is irritant cause synovial hypertrophy
3. Synovium attempts to cleanse the joint of blood and debris -> more hypertrophic and further bleeding
94
What are the chronic effects of hemophilia on the joint capsule?
Erosive damage of cartilage with narrowing of joint space and subchondral cyst formation
95
Hemophilia on muscle -
1. Muscle hemorrhages
2. Often flexor muscle groups
3. Pain and limited ROM
96
Iliopsoas hemorrhage -
Groin pain, pain on hip extension -> reflexive flexion of hip and thigh
97
Compression of neurovascular bundle/femoral nerve-weakness ->
decreased sensation, decreased knee reflex -> perm injury
98
Hemophilia A -
- Lack clotting factor VIII
| - 80% of all cases
99
Hemophilia B -
- 15%
| - Deficiency of factor IX
100
PT implications for patients with hemophilia: (6)
1. Regular program important
2. Greater BMI, increased risk of joint injury
3. Avoid contact sports
4. strength training is benefit (stabilize joints, improves circulation)
5. Use pain free ROM and good breathing tech
6. No max lifts or 1RM
101
Be able to recognize signs of early bleeding: (5)
1. Stiffening into position of comfort (flexion, shortened position)
2. Decreased ROM
3. Pain/tenderness
4. Joint swelling/warmth
5. Loss of sensation
102
Hemoglobinopathies -
sickle cell disease
103
Sickle cell disease:
- autosomal recessive disorder characterized by presence of an abnormal form of Hb shape
- Causes RBC to sickle = low O2 environment
104
What occurs when too many RBC sickle?
Vaso-occlusion = localized ischemia = crisis
105
Management of sickle cell disease: (4)
1. Pain management/inpatient care, opioids, analgesics and blood transfusions
2. Exercise
3. Depression
4. Teach joint protection/prescribe assistive devices
