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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

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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)

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3
Q

What are formed elements?

A

Erythrocytes (RBC’s), Leukocytes (WBC’s) Platelets

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4
Q

______ is the process of growing new formed elements.

A

hematopoiesis

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5
Q

_____ solition has large particles

A

colloid

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6
Q

______ solution has much smaller particles than _____ solution

A

crystoloid: colloid

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7
Q

Where do platelets come from? (three cells that precede it)

A

Megakaryocyte from erythroid and from hematopoietic stem cell

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8
Q

What types of cells form from myeloid cells?

A

Immune cells (meutrophils, Eosinophils, basophils, dendritic, mast and macrophage cells)

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9
Q

What cells form from lymphoid cells?

A

B cells, T cells and natural killer cells

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10
Q

What are the three cells that form from hematopoietic stem cells?

A

Myeloid, lymphoid, and erythroid cells

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11
Q

How many erythrocytes do normal adults have?

A

(RBC’s) 5 million

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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

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13
Q

what do RBC’s mostly do?

A

responsible for tisuue oxygenation

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14
Q

What are the 4 types of Henoglobin?

A

Hb A- adult, Hb F- fetal, Hb S sickle cell, Hb A1C glycosolated

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15
Q

What could a low hemoglobin level indicate?

A

anemia

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16
Q

What could a high hemoglobin indicate?

A

polycythemia, look flush, viscous blood

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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

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18
Q

What are the 2 types of lymphocytes?

A

B & T

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19
Q

What is the primary function of platelets?

A

form blood clots, contain cytoplasmic granules that release in response to enothelial injury

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20
Q

What is the lifespan of a platelet?

A

7-10 days

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21
Q

What is the normal value for WBC’s?

A

5,000-10,000/ mm3

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22
Q

What is the normal value for RBC’s?

A

4.5-5.5 million/mm3 (4-5 for females)

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23
Q

What is the normal value for Hgb?

A

14-17 g/dl (12-16 females)

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24
Q

What is the normal value for Hct?

A

42-52% (36-48 females)

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25
Q

What is the normal value for platelets?

A

140,000-400,000/mm3

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26
Q

What is sickle cell anemia?

A

changes ability to bind to O2

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27
Q

What is aplatic anemia?

A

bone marrow doesn’t make RBC

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28
Q

What would a decrease in hydration cause in terms of RBC’s?

A

polycythemic

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29
Q

What would an increase in hydration cause in terms of RBC’s?

A

hemodiluted

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30
Q

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 ____.

A

extrinsic ; injury and bleeding ; intrinsic ; bone marrow abnormality

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31
Q

What are the terms to describe the morphology of anemia’s?

A

Size: normocytic, macrocytic, microcytic Color: normochromo, hypochromo, hyperchromo

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32
Q

What is the normal value for MCV?

A

84-96fL: Mean corpuscular volume

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33
Q

What is the normal value for MCH?

A

28-34 pg/cell: Mean corpuscular hemoglobin

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34
Q

What is the normal value for MCHC?

A

32-36 g/dL: mean corpuscular hemoglobin concentration

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35
Q

What can Iron deficiency( Hgb synthesis) cause?

A

Decreased production of RBC’s: microcytic, hypochromic (small and reduced Hgb erythrocytes)

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36
Q

What can Vit B deficiency ( DNA defects) cause?

A

Decreased production of RBC’s: macrocytic, normochromic (defective DNA synthesis resulting in large and fragmented erythrocytes)

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37
Q

What can a folate deficiency ( DNA defects) cause?

A

Decreased production of RBC’s: macrocytic, normochromic

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38
Q

What are intrinsic causes of increased destruction of RBC’s ?

A

immature cells, old cells, abnormal cells, sickle cell anemia, autoimmune diseases, conditions that speed up apoptosis of RBC’s

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39
Q

What are extrinsic causes of increased destruction of RBC’s?

A

physical trauma, antibodies, infectious agents, toxins

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40
Q

What is a description and example of an anemia with macrocytic normochromatic morphology?

A

Large abnormal shape, normal HgB, pernicious anemia or folate deficiency anemia

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41
Q

What is a description and example of an anemia with microcytic hypochromic morphology?

A

small abnormal shape, decrease HgB, iron defeciency anemia, thalassemia

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42
Q

What is a description and example of an anemia with normocytic normochromic morphology?

A

destruction of normal erythroblasts or mature erythrocytes, aplastic anemia, sickle cell anemia, hemolytic anemia

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43
Q

What is an indication of microcytic anemia?

A

MCV< 80fl

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44
Q

What is an indication of macrocytic anemia?

A

MCV> 95 fl

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45
Q

What are classic signs of anemia?

A

pallor, fatigue, dyspnea on exertion, dizziness

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46
Q

What are two conditions that would contribute to less symptomatic forms of anemia?

A

gradual onset and less severe (Hgb of 8 g)

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47
Q

What happens in the cardiovascular system in anemia?

A

tachycardia, palpations, vasoconstriction

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48
Q

What happens in the respiratory system in anemia?

A

tachypnea, increased breathing depth

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49
Q

What are other manifestations of anemia?

A

increased plasma volume, salt and water retention

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50
Q

How does one manage anemia?

A

provide O2, blood products, nutrition supplements, bone marrow stimulation

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51
Q

What is whole blood?

A

given with more volume is needed- provides all factors including platelets and coagulation factor

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52
Q

What is packed cells (PRBCs)?

A

provies RBC’s only, indicated in anemia, slow blood loss, CHF, RF

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53
Q

What is leukocyte poor, washed, frozen RBC blood product?

A

prevent sensitivity reaction

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54
Q

What is platelet concentrate?

A

Low volume 35-50 ml, raises platelet about 10,000/unit/m2

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55
Q

What is fresh frozen plasma (FFP)?

A

provides all clotting factors except platelets, low volume

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56
Q

What type of blood factor is specific to certain clotting factors?

A

cyroprecipitate

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57
Q

When would you give volume expanders?

A

shock patient, hypovolemic, burn patient

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58
Q

when would you give intravascular to restore oncotic pressure?

A

shock, burns, cerebral edema, hypoproteinemia, but NOT dehydration!

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59
Q

How does one get sickel cell anemia?

A

both parents must be carriers or have the disease- recessive replacing the Hb A with Hb S, primary to african and mediteranian descent

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60
Q

What is the numberone treatment for sickle cell anemia?

A

isotonic fluids

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61
Q

For a patient with sickle cell anemia a drop in oxygen levels will cause:

A

sickling of RBC’s

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62
Q

Acidosis is an issue for a person with sickle cell anemia because:

A

It causes healthy cells to become lysed

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63
Q

What role does erythrostasis play in a sickle cell crisis?

A

will enhance the effects of the sickling crisis

64
Q

A sickle cell crisis becomes more severe when the RBC blockage occurs in:

A

the brain (stroke-like) the heart, or the kidneys-renal failure

65
Q

What are two chronic (long-term) effects of sickle cells anemia

A

hepatomegaly, splenomegaly

66
Q

A person with sickle cell anemia is at an increased risk for_____________

A

infections

67
Q

In the heart, a sickle crisis can cause:

A

infarctions, thrombosis ischemia (from occlusion)

68
Q

The main clinical manifestation of a sickle cell attack is:

A

severe pain

69
Q

Sickle cell crisis effects the joints by causing:

A

arthralgias (severe joint pain)

70
Q

A sickle cell crisis can effect the GI tract by:

A

causing severe abdominal pain

71
Q

Poor circulation in a patient with sickle cell anemia can cause:

A

skin, peripheral ulcers that do not heal

72
Q

Before treating sickle cell anemia, one must:

A

identify trigger factors as they vary from person to person

73
Q

What is the number one reason for a sickle cell patient to go into crisis?

A

dehydration

74
Q

T or F: A change in lifestyle or emotional stressors can cause a sickle cell patient to go into crisis.

A

TRUE

75
Q

T or F: Sickle cell anemia is cureable.

A

FALSE. It can be managed, but not cured.

76
Q

Supportive treatments for sickle cell anemia include:

A

rest, oxygen, hydration

77
Q

Besides hydration, what is the other main factor to consider when treating a patient in the middle of a sickle cell crisis?

A

pain management! And sedatives

78
Q

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:

A

staying hydrated, eating a proper diet, getting adequate rest

79
Q

Define Aplastic Anemia:

A

Deficiency of all types of blood cells caused by failure of bone marrow development.

80
Q

When RBC, WBC, and platelet counts are all low this is referred to as:

A

pancytopenia

81
Q

T or F: pure red cells aplasia affects all types of blood cells.

A

FALSE. PRCA only affects red blood cells

82
Q

____________ is an associated condition of sickle cell anemia

A

Pure Red Cell Aplasia

83
Q

What is pancytopenia?

A

Deficiency of all three cellular components of the blood (red cells, white cells, and platelets)

84
Q

What are the two classic signs of anemia?

A

Low WBC’s and low platelets

85
Q

What can you expect if WBC’s are low?

A

infections

86
Q

What can you expect if platelets are low?

A

bleeding

87
Q

What are two ways to evaluate the possiblity of anemia?

A

CBC, bone marrow biopsy analysis

88
Q

T or F: Prevention is a treatment for anemia.

A

TRUE

89
Q

What are three treatments for anemia administered in the clinical setting?

A

Give EPO, blood transfusion, bone marrow transplant

90
Q

Define Polycythemia:

A

excessive increase in RBC’s

91
Q

Primary Polycythemia is caused by:

A

neoplastic disease, cell defects that result in abnormal regulation of the multipotent hematopoietic stem cells

92
Q

Secondary Polycythemia is caused by:

A

an increase in erythropoietin as a physiologic response to chronic hypoxia

93
Q

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:

A

polycythemia

94
Q

How would you treat a patient with polycythemia?

A

decrease blood volume and viscosity through hydration and phlebotomy

95
Q

Define leukocytosis:

A

increase in # of WBC’s

96
Q

An increase in WBC may be caused by:

A

infection, leukemia, neoplasms, trauma, stress

97
Q

T or F: A WBC count of >10,000 is considered leukocytosis.

A

TRUE

98
Q

Define leukopenia:

A

decrease in WBC count

99
Q

Leukopenia may be caused by:

A

bone marrow failure, autoimmune disease, mass infection

100
Q

T or F: Leukopenia is defined as having <7000 WBC.

A

FALSE. Leukopenia =<5000 WBC

101
Q

T or F: Neutropenia refers to a decrease in basophils.

A

FALSE Neutropenia is a decrease in neutrophils

102
Q

Granulocytopenia is defined as a WBC count of:

A

< 1500 cells/L

103
Q

Agranulocytosis is defined as a WBC count of:

A

<500

104
Q

_____________, _______________, and ______________ may be caused by acute infection, sepsis, toxins, chemicals, drugs, anaphylaxis, and underproduction of WBC’s.

A

neutropenia, granulocytopenia, agranulocytosis

105
Q

Leukemia, lymphomas, and multiple myelomas are all:

A

blood cell cancers

106
Q

A disease caused by uncontrolled proliferation of abnormal immature BC precursors is:

A

leukemia

107
Q

The most common leukemias originate from which type of blood cells?

A

WBC

108
Q

In this disorder immature cells infiltrate circulation, crowd out mature normal cells, and release inhibitory factors causing anemia and thrombocytopenia.

A

Leukemia

109
Q

What are the two types of leukemia?

A

myeloid, lymphoid

110
Q

What is the difference between acute and chronic leukemia?

A

acute: rapid division, less differentiation chronic: slower, more mature

111
Q

ALL stands for

A

Acute Lymphocytic Leukemia

112
Q

CLL stands for

A

Chronic Lymphocytic Leukemia

113
Q

A virus, radiation, chemical exposure, and genetics (chromosomes) are all possible causes of:

A

leukemia

114
Q

A patient comes into the clinic complaining of fatigue, infection, fever, weight loss, bone/joint pain and bleeding. These are all clinical manifestations of:

A

leukemia

115
Q

Leukemia can be managed through:

A

chemotherapy, radiation, bone marrow transplants, transfusions, and prevention of infections

116
Q

Cancers of the lymph tissue are called:

A

lymphomas

117
Q

T or F: Lymphomas only involve the lymph nodes.

A

FALSE. Lymphomas involve lymph nodes, vessels, T and B cells

118
Q

T or F: Supraclavicular nodes, axillary nodes, retroperitoneal nodes, and inguinal nodes are all common cites for developing lymphomas

A

TRUE

119
Q

Cancer of plasma cells is referred to as:

A

multiple myeloma

120
Q

Thrombocytopenia, thrombocytosis, anticoagulation, and hemophilia are all:

A

platelet and clotting factor disorders

121
Q

Thrombocytopenia is defined as platelet counts of <_____________/mm3

A

150,000

122
Q

A platelet count of < 50,000/mm3 is considered

A

bleeding potential

123
Q

A platelet count of < 20,000/mm3 is considered

A

high risk for spontaneous bleeding

124
Q

Defective platelet production, disordered platelet distribution, and accelerated platelet destruction are all possible causes for:

A

thrombocytopenia

125
Q

A platelet count of >400,000/mm3 is considered:

A

thrombocytosis

126
Q

A disorder in which megakaryocytes in bone marrow overproduce is called:

A

Primary hemmaohagic thrombocytosis

128
Q

____________________ are caused by defects or deficiencies in one or more clotting factors

A

coagulation disorders

129
Q

Vitamin K deficiencies, thromboembolic disease, and hemophilia are all examples of:

A

coagulation disorders

130
Q

______________ is necessary for the production of prothrombin, factors II, VII, IX, and X

A

vitamin K

131
Q

T or F: Vitamin K is a water soluable vitamin.

A

FALSE- it is a fat soluable vitamin

132
Q

Which population is at increased risk for vit. K deficiency?

A

neonates because they have an immature liver and lack of normal intestinal flora

133
Q

We can get vitamin K from eating:

A

green leafy vegetables

134
Q

Insufficient dietary intake, absence of bile salts, intestinal malabsorption syndromes, and use of oral antibiotics that kill resident intestinal bacteria are all causes of:

A

vit. K deficieny

135
Q

Abnormal blood clotting is called:

A

Thromboembolic disease

136
Q

What is a thrombus?

A

A stationary clot adhering to the vessel wall

137
Q

What is an embolus?

A

A floating clot within the blood

138
Q

Virchow’s triad outlines:

A

factors favoring clot formation

139
Q

What three factors can lead to clot formation?

A

loss of integrity of vessel wall (atherosclerosis), abnormalities in blood flow (sluggish or turbulent), alterations in blood constituents (thrombocytosis)

140
Q

What is anticoagulant therapy?

A

The theraputic use of anticoagulants to discourage the formation of blood clots. It’s main purpose is preventative

141
Q

Patients with these issues can benefit from therapeutic anticoagulation:

A

cardioangioplasty, CV disease and hypertension (CAD, PVD), dialysis, venous stasis (DVT), and patients who must be immobilzed for long periods of time

142
Q

T or F: Coagulation disorders may cause abnormal clotting test results.

A

TRUE

143
Q

T or F: Coagulation disorders may cause abnormal clotting test results, but theraputic anticoagulation will not.

A

FALSE- they both have the potential to result in abnormal test results.

144
Q

What is the difference bewteen theraputic and pathological anticoagulation?

A

Theraputic anticoagulation will keep clotting factor numbers within acceptable parameters, pathological won’t necessarily

145
Q

Partial thromboplastic time (PTT) is a test of:

A

the intrinsic and common pathway of blood coagulation

146
Q

PTT is used as a screening test and to monitor ___________therapy.

A

heparin

147
Q

How long is PTT?

A

25-35 seconds

148
Q

How long is prothrombin time?

A

12-15 seconds

149
Q

PT is useful when using which drug?

A

Warfarin

150
Q

INR(1), heptest-LMW heparin, and fibrinogen are all used to test the__________

A

PTT-Partial Thromboplastin time

151
Q

Plasminogen is used to test for____________

A

anticoagulation

152
Q

What is Purpura?

A

A disorder that occurs when small blood vessels join together or leak blood under the skin

153
Q

What are the clinical manifestations of Purpura?

A

red or purple spots on skin that do not blanch on applying pressure

154
Q

What are the clinical manefestations of anticoagulation?

A

bleeding-petechiae, purpura, ecchymosis

155
Q

__________ and__________ work together to make clots

A

platelets and clotting factors

156
Q

What three categories can promote inappropriate clotting?

A

arterial inflammation, slowed blood flow, and inflammatory disorders

Pathopharm (11 decks)

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