hematological disorders Flashcards
1
Q
What are the function of blood?
A
delivery of substances for cellular metabolism (esp. glucose and O2), transport waste substances, defense against invading organisms and injury, acid-base balance
2
Q
Blood is made up of ______ and ________.
A
Plasma (water portion 50-55%, 91-92% water, 8% solids-clotting factor, proteins, fats, glucose etc.) Formed elements (45-50% cells and platelets)
3
Q
What are formed elements?
A
Erythrocytes (RBC’s), Leukocytes (WBC’s) Platelets
4
Q
______ is the process of growing new formed elements.
A
hematopoiesis
5
Q
_____ solition has large particles
A
colloid
6
Q
______ solution has much smaller particles than _____ solution
A
crystoloid: colloid
7
Q
Where do platelets come from? (three cells that precede it)
A
Megakaryocyte from erythroid and from hematopoietic stem cell
8
Q
What types of cells form from myeloid cells?
A
Immune cells (meutrophils, Eosinophils, basophils, dendritic, mast and macrophage cells)
9
Q
What cells form from lymphoid cells?
A
B cells, T cells and natural killer cells
10
Q
What are the three cells that form from hematopoietic stem cells?
A
Myeloid, lymphoid, and erythroid cells
11
Q
How many erythrocytes do normal adults have?
A
(RBC’s) 5 million
12
Q
RBC’s have a lifespan of ______. This is important because______.
A
120 days- if your body isn’t making any new ones, this is a real problem
13
Q
what do RBC’s mostly do?
A
responsible for tisuue oxygenation
14
Q
What are the 4 types of Henoglobin?
A
Hb A- adult, Hb F- fetal, Hb S sickle cell, Hb A1C glycosolated
15
Q
What could a low hemoglobin level indicate?
A
anemia
16
Q
What could a high hemoglobin indicate?
A
polycythemia, look flush, viscous blood
17
Q
There are 3 types of granulocytes _______ predominant phagocyte in early inflamation, _____ ingest antigen antibody complexes, _____ associated with allergic reations
A
Neutrophils, eosinophils, basophils
18
Q
What are the 2 types of lymphocytes?
A
B & T
19
Q
What is the primary function of platelets?
A
form blood clots, contain cytoplasmic granules that release in response to enothelial injury
20
Q
What is the lifespan of a platelet?
A
7-10 days
21
Q
What is the normal value for WBC’s?
A
5,000-10,000/ mm3
22
Q
What is the normal value for RBC’s?
A
4.5-5.5 million/mm3 (4-5 for females)
23
Q
What is the normal value for Hgb?
A
14-17 g/dl (12-16 females)
24
Q
What is the normal value for Hct?
A
42-52% (36-48 females)
25
What is the normal value for platelets?
140,000-400,000/mm3
26
What is sickle cell anemia?
changes ability to bind to O2
27
What is aplatic anemia?
bone marrow doesn't make RBC
28
What would a decrease in hydration cause in terms of RBC's?
polycythemic
29
What would an increase in hydration cause in terms of RBC's?
hemodiluted
30
Anemia can be caused by an increase in destruction this is ______ to the host an example is_____ or a decrese in production which is ____ to the host an example is ____.
extrinsic ; injury and bleeding ; intrinsic ; bone marrow abnormality
31
What are the terms to describe the morphology of anemia's?
Size: normocytic, macrocytic, microcytic Color: normochromo, hypochromo, hyperchromo
32
What is the normal value for MCV?
84-96fL: Mean corpuscular volume
33
What is the normal value for MCH?
28-34 pg/cell: Mean corpuscular hemoglobin
34
What is the normal value for MCHC?
32-36 g/dL: mean corpuscular hemoglobin concentration
35
What can Iron deficiency( Hgb synthesis) cause?
Decreased production of RBC's: microcytic, hypochromic (small and reduced Hgb erythrocytes)
36
What can Vit B deficiency ( DNA defects) cause?
Decreased production of RBC's: macrocytic, normochromic (defective DNA synthesis resulting in large and fragmented erythrocytes)
37
What can a folate deficiency ( DNA defects) cause?
Decreased production of RBC's: macrocytic, normochromic
38
What are intrinsic causes of increased destruction of RBC's ?
immature cells, old cells, abnormal cells, sickle cell anemia, autoimmune diseases, conditions that speed up apoptosis of RBC's
39
What are extrinsic causes of increased destruction of RBC's?
physical trauma, antibodies, infectious agents, toxins
40
What is a description and example of an anemia with macrocytic normochromatic morphology?
Large abnormal shape, normal HgB, pernicious anemia or folate deficiency anemia
41
What is a description and example of an anemia with microcytic hypochromic morphology?
small abnormal shape, decrease HgB, iron defeciency anemia, thalassemia
42
What is a description and example of an anemia with normocytic normochromic morphology?
destruction of normal erythroblasts or mature erythrocytes, aplastic anemia, sickle cell anemia, hemolytic anemia
43
What is an indication of microcytic anemia?
MCV< 80fl
44
What is an indication of macrocytic anemia?
MCV> 95 fl
45
What are classic signs of anemia?
pallor, fatigue, dyspnea on exertion, dizziness
46
What are two conditions that would contribute to less symptomatic forms of anemia?
gradual onset and less severe (Hgb of 8 g)
47
What happens in the cardiovascular system in anemia?
tachycardia, palpations, vasoconstriction
48
What happens in the respiratory system in anemia?
tachypnea, increased breathing depth
49
What are other manifestations of anemia?
increased plasma volume, salt and water retention
50
How does one manage anemia?
provide O2, blood products, nutrition supplements, bone marrow stimulation
51
What is whole blood?
given with more volume is needed- provides all factors including platelets and coagulation factor
52
What is packed cells (PRBCs)?
provies RBC's only, indicated in anemia, slow blood loss, CHF, RF
53
What is leukocyte poor, washed, frozen RBC blood product?
prevent sensitivity reaction
54
What is platelet concentrate?
Low volume 35-50 ml, raises platelet about 10,000/unit/m2
55
What is fresh frozen plasma (FFP)?
provides all clotting factors except platelets, low volume
56
What type of blood factor is specific to certain clotting factors?
cyroprecipitate
57
When would you give volume expanders?
shock patient, hypovolemic, burn patient
58
when would you give intravascular to restore oncotic pressure?
shock, burns, cerebral edema, hypoproteinemia, but NOT dehydration!
59
How does one get sickel cell anemia?
both parents must be carriers or have the disease- recessive replacing the Hb A with Hb S, primary to african and mediteranian descent
60
What is the numberone treatment for sickle cell anemia?
isotonic fluids
61
For a patient with sickle cell anemia a drop in oxygen levels will cause:
sickling of RBC's
62
Acidosis is an issue for a person with sickle cell anemia because:
It causes healthy cells to become lysed
63
What role does erythrostasis play in a sickle cell crisis?
will enhance the effects of the sickling crisis
64
A sickle cell crisis becomes more severe when the RBC blockage occurs in:
the brain (stroke-like) the heart, or the kidneys-renal failure
65
What are two chronic (long-term) effects of sickle cells anemia
hepatomegaly, splenomegaly
66
A person with sickle cell anemia is at an increased risk for_____________
infections
67
In the heart, a sickle crisis can cause:
infarctions, thrombosis ischemia (from occlusion)
68
The main clinical manifestation of a sickle cell attack is:
severe pain
69
Sickle cell crisis effects the joints by causing:
arthralgias (severe joint pain)
70
A sickle cell crisis can effect the GI tract by:
causing severe abdominal pain
71
Poor circulation in a patient with sickle cell anemia can cause:
skin, peripheral ulcers that do not heal
72
Before treating sickle cell anemia, one must:
identify trigger factors as they vary from person to person
73
What is the number one reason for a sickle cell patient to go into crisis?
dehydration
74
T or F: A change in lifestyle or emotional stressors can cause a sickle cell patient to go into crisis.
TRUE
75
T or F: Sickle cell anemia is cureable.
FALSE. It can be managed, but not cured.
76
Supportive treatments for sickle cell anemia include:
rest, oxygen, hydration
77
Besides hydration, what is the other main factor to consider when treating a patient in the middle of a sickle cell crisis?
pain management! And sedatives
78
You are treating a patient who has recently recovered from a sickle cell crisis and are going to be discharged soon. In educating your patient about avoiding sickle cell crises you will want to stress:
staying hydrated, eating a proper diet, getting adequate rest
79
Define Aplastic Anemia:
Deficiency of all types of blood cells caused by failure of bone marrow development.
80
When RBC, WBC, and platelet counts are all low this is referred to as:
pancytopenia
81
T or F: pure red cells aplasia affects all types of blood cells.
FALSE. PRCA only affects red blood cells
82
____________ is an associated condition of sickle cell anemia
Pure Red Cell Aplasia
83
What is pancytopenia?
Deficiency of all three cellular components of the blood (red cells, white cells, and platelets)
84
What are the two classic signs of anemia?
Low WBC's and low platelets
85
What can you expect if WBC's are low?
infections
86
What can you expect if platelets are low?
bleeding
87
What are two ways to evaluate the possiblity of anemia?
CBC, bone marrow biopsy analysis
88
T or F: Prevention is a treatment for anemia.
TRUE
89
What are three treatments for anemia administered in the clinical setting?
Give EPO, blood transfusion, bone marrow transplant
90
Define Polycythemia:
excessive increase in RBC's
91
Primary Polycythemia is caused by:
neoplastic disease, cell defects that result in abnormal regulation of the multipotent hematopoietic stem cells
92
Secondary Polycythemia is caused by:
an increase in erythropoietin as a physiologic response to chronic hypoxia
93
A patient comes in complaining of headaches, vertigo, and angina. Further investigation reveals they have HTN and CHF, hyperuricemia, and hepato-splenomegaly. You predict that this patient has:
polycythemia
94
How would you treat a patient with polycythemia?
decrease blood volume and viscosity through hydration and phlebotomy
95
Define leukocytosis:
increase in # of WBC's
96
An increase in WBC may be caused by:
infection, leukemia, neoplasms, trauma, stress
97
T or F: A WBC count of >10,000 is considered leukocytosis.
TRUE
98
Define leukopenia:
decrease in WBC count
99
Leukopenia may be caused by:
bone marrow failure, autoimmune disease, mass infection
100
T or F: Leukopenia is defined as having <7000 WBC.
FALSE. Leukopenia =<5000 WBC
101
T or F: Neutropenia refers to a decrease in basophils.
FALSE Neutropenia is a decrease in neutrophils
102
Granulocytopenia is defined as a WBC count of:
< 1500 cells/L
103
Agranulocytosis is defined as a WBC count of:
<500
104
_____________, _______________, and ______________ may be caused by acute infection, sepsis, toxins, chemicals, drugs, anaphylaxis, and underproduction of WBC's.
neutropenia, granulocytopenia, agranulocytosis
105
Leukemia, lymphomas, and multiple myelomas are all:
blood cell cancers
106
A disease caused by uncontrolled proliferation of abnormal immature BC precursors is:
leukemia
107
The most common leukemias originate from which type of blood cells?
WBC
108
In this disorder immature cells infiltrate circulation, crowd out mature normal cells, and release inhibitory factors causing anemia and thrombocytopenia.
Leukemia
109
What are the two types of leukemia?
myeloid, lymphoid
110
What is the difference between acute and chronic leukemia?
acute: rapid division, less differentiation chronic: slower, more mature
111
ALL stands for
Acute Lymphocytic Leukemia
112
CLL stands for
Chronic Lymphocytic Leukemia
113
A virus, radiation, chemical exposure, and genetics (chromosomes) are all possible causes of:
leukemia
114
A patient comes into the clinic complaining of fatigue, infection, fever, weight loss, bone/joint pain and bleeding. These are all clinical manifestations of:
leukemia
115
Leukemia can be managed through:
chemotherapy, radiation, bone marrow transplants, transfusions, and prevention of infections
116
Cancers of the lymph tissue are called:
lymphomas
117
T or F: Lymphomas only involve the lymph nodes.
FALSE. Lymphomas involve lymph nodes, vessels, T and B cells
118
T or F: Supraclavicular nodes, axillary nodes, retroperitoneal nodes, and inguinal nodes are all common cites for developing lymphomas
TRUE
119
Cancer of plasma cells is referred to as:
multiple myeloma
120
Thrombocytopenia, thrombocytosis, anticoagulation, and hemophilia are all:
platelet and clotting factor disorders
121
Thrombocytopenia is defined as platelet counts of <_____________/mm3
150,000
122
A platelet count of < 50,000/mm3 is considered
bleeding potential
123
A platelet count of < 20,000/mm3 is considered
high risk for spontaneous bleeding
124
Defective platelet production, disordered platelet distribution, and accelerated platelet destruction are all possible causes for:
thrombocytopenia
125
A platelet count of >400,000/mm3 is considered:
thrombocytosis
126
A disorder in which megakaryocytes in bone marrow overproduce is called:
Primary hemmaohagic thrombocytosis
128
____________________ are caused by defects or deficiencies in one or more clotting factors
coagulation disorders
129
Vitamin K deficiencies, thromboembolic disease, and hemophilia are all examples of:
coagulation disorders
130
______________ is necessary for the production of prothrombin, factors II, VII, IX, and X
vitamin K
131
T or F: Vitamin K is a water soluable vitamin.
FALSE- it is a fat soluable vitamin
132
Which population is at increased risk for vit. K deficiency?
neonates because they have an immature liver and lack of normal intestinal flora
133
We can get vitamin K from eating:
green leafy vegetables
134
Insufficient dietary intake, absence of bile salts, intestinal malabsorption syndromes, and use of oral antibiotics that kill resident intestinal bacteria are all causes of:
vit. K deficieny
135
Abnormal blood clotting is called:
Thromboembolic disease
136
What is a thrombus?
A stationary clot adhering to the vessel wall
137
What is an embolus?
A floating clot within the blood
138
Virchow's triad outlines:
factors favoring clot formation
139
What three factors can lead to clot formation?
loss of integrity of vessel wall (atherosclerosis), abnormalities in blood flow (sluggish or turbulent), alterations in blood constituents (thrombocytosis)
140
What is anticoagulant therapy?
The theraputic use of anticoagulants to discourage the formation of blood clots. It's main purpose is preventative
141
Patients with these issues can benefit from therapeutic anticoagulation:
cardioangioplasty, CV disease and hypertension (CAD, PVD), dialysis, venous stasis (DVT), and patients who must be immobilzed for long periods of time
142
T or F: Coagulation disorders may cause abnormal clotting test results.
TRUE
143
T or F: Coagulation disorders may cause abnormal clotting test results, but theraputic anticoagulation will not.
FALSE- they both have the potential to result in abnormal test results.
144
What is the difference bewteen theraputic and pathological anticoagulation?
Theraputic anticoagulation will keep clotting factor numbers within acceptable parameters, pathological won't necessarily
145
Partial thromboplastic time (PTT) is a test of:
the intrinsic and common pathway of blood coagulation
146
PTT is used as a screening test and to monitor ___________therapy.
heparin
147
How long is PTT?
25-35 seconds
148
How long is prothrombin time?
12-15 seconds
149
PT is useful when using which drug?
Warfarin
150
INR(1), heptest-LMW heparin, and fibrinogen are all used to test the__________
PTT-Partial Thromboplastin time
151
Plasminogen is used to test for____________
anticoagulation
152
What is Purpura?
A disorder that occurs when small blood vessels join together or leak blood under the skin
153
What are the clinical manifestations of Purpura?
red or purple spots on skin that do not blanch on applying pressure
154
What are the clinical manefestations of anticoagulation?
bleeding-petechiae, purpura, ecchymosis
155
__________ and__________ work together to make clots
platelets and clotting factors
156
What three categories can promote inappropriate clotting?
arterial inflammation, slowed blood flow, and inflammatory disorders
