hematological disorders Flashcards
What are the function of blood?
delivery of substances for cellular metabolism (esp. glucose and O2), transport waste substances, defense against invading organisms and injury, acid-base balance
Blood is made up of ______ and ________.
Plasma (water portion 50-55%, 91-92% water, 8% solids-clotting factor, proteins, fats, glucose etc.) Formed elements (45-50% cells and platelets)
What are formed elements?
Erythrocytes (RBC’s), Leukocytes (WBC’s) Platelets
______ is the process of growing new formed elements.
hematopoiesis
_____ solition has large particles
colloid
______ solution has much smaller particles than _____ solution
crystoloid: colloid
Where do platelets come from? (three cells that precede it)
Megakaryocyte from erythroid and from hematopoietic stem cell
What types of cells form from myeloid cells?
Immune cells (meutrophils, Eosinophils, basophils, dendritic, mast and macrophage cells)
What cells form from lymphoid cells?
B cells, T cells and natural killer cells
What are the three cells that form from hematopoietic stem cells?
Myeloid, lymphoid, and erythroid cells
How many erythrocytes do normal adults have?
(RBC’s) 5 million
RBC’s have a lifespan of ______. This is important because______.
120 days- if your body isn’t making any new ones, this is a real problem
what do RBC’s mostly do?
responsible for tisuue oxygenation
What are the 4 types of Henoglobin?
Hb A- adult, Hb F- fetal, Hb S sickle cell, Hb A1C glycosolated
What could a low hemoglobin level indicate?
anemia
What could a high hemoglobin indicate?
polycythemia, look flush, viscous blood
There are 3 types of granulocytes _______ predominant phagocyte in early inflamation, _____ ingest antigen antibody complexes, _____ associated with allergic reations
Neutrophils, eosinophils, basophils
What are the 2 types of lymphocytes?
B & T
What is the primary function of platelets?
form blood clots, contain cytoplasmic granules that release in response to enothelial injury
What is the lifespan of a platelet?
7-10 days
What is the normal value for WBC’s?
5,000-10,000/ mm3
What is the normal value for RBC’s?
4.5-5.5 million/mm3 (4-5 for females)
What is the normal value for Hgb?
14-17 g/dl (12-16 females)
What is the normal value for Hct?
42-52% (36-48 females)
What is the normal value for platelets?
140,000-400,000/mm3
What is sickle cell anemia?
changes ability to bind to O2
What is aplatic anemia?
bone marrow doesn’t make RBC
What would a decrease in hydration cause in terms of RBC’s?
polycythemic
What would an increase in hydration cause in terms of RBC’s?
hemodiluted
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
What are the terms to describe the morphology of anemia’s?
Size: normocytic, macrocytic, microcytic Color: normochromo, hypochromo, hyperchromo
What is the normal value for MCV?
84-96fL: Mean corpuscular volume
What is the normal value for MCH?
28-34 pg/cell: Mean corpuscular hemoglobin
What is the normal value for MCHC?
32-36 g/dL: mean corpuscular hemoglobin concentration
What can Iron deficiency( Hgb synthesis) cause?
Decreased production of RBC’s: microcytic, hypochromic (small and reduced Hgb erythrocytes)
What can Vit B deficiency ( DNA defects) cause?
Decreased production of RBC’s: macrocytic, normochromic (defective DNA synthesis resulting in large and fragmented erythrocytes)
What can a folate deficiency ( DNA defects) cause?
Decreased production of RBC’s: macrocytic, normochromic
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
What are extrinsic causes of increased destruction of RBC’s?
physical trauma, antibodies, infectious agents, toxins
What is a description and example of an anemia with macrocytic normochromatic morphology?
Large abnormal shape, normal HgB, pernicious anemia or folate deficiency anemia
What is a description and example of an anemia with microcytic hypochromic morphology?
small abnormal shape, decrease HgB, iron defeciency anemia, thalassemia
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
What is an indication of microcytic anemia?
MCV< 80fl
What is an indication of macrocytic anemia?
MCV> 95 fl
What are classic signs of anemia?
pallor, fatigue, dyspnea on exertion, dizziness
What are two conditions that would contribute to less symptomatic forms of anemia?
gradual onset and less severe (Hgb of 8 g)
What happens in the cardiovascular system in anemia?
tachycardia, palpations, vasoconstriction
What happens in the respiratory system in anemia?
tachypnea, increased breathing depth
What are other manifestations of anemia?
increased plasma volume, salt and water retention
How does one manage anemia?
provide O2, blood products, nutrition supplements, bone marrow stimulation
What is whole blood?
given with more volume is needed- provides all factors including platelets and coagulation factor
What is packed cells (PRBCs)?
provies RBC’s only, indicated in anemia, slow blood loss, CHF, RF
What is leukocyte poor, washed, frozen RBC blood product?
prevent sensitivity reaction
What is platelet concentrate?
Low volume 35-50 ml, raises platelet about 10,000/unit/m2
What is fresh frozen plasma (FFP)?
provides all clotting factors except platelets, low volume
What type of blood factor is specific to certain clotting factors?
cyroprecipitate
When would you give volume expanders?
shock patient, hypovolemic, burn patient
when would you give intravascular to restore oncotic pressure?
shock, burns, cerebral edema, hypoproteinemia, but NOT dehydration!
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
What is the numberone treatment for sickle cell anemia?
isotonic fluids
For a patient with sickle cell anemia a drop in oxygen levels will cause:
sickling of RBC’s
Acidosis is an issue for a person with sickle cell anemia because:
It causes healthy cells to become lysed
What role does erythrostasis play in a sickle cell crisis?
will enhance the effects of the sickling crisis
A sickle cell crisis becomes more severe when the RBC blockage occurs in:
the brain (stroke-like) the heart, or the kidneys-renal failure
What are two chronic (long-term) effects of sickle cells anemia
hepatomegaly, splenomegaly
A person with sickle cell anemia is at an increased risk for_____________
infections
In the heart, a sickle crisis can cause:
infarctions, thrombosis ischemia (from occlusion)
The main clinical manifestation of a sickle cell attack is:
severe pain
Sickle cell crisis effects the joints by causing:
arthralgias (severe joint pain)
A sickle cell crisis can effect the GI tract by:
causing severe abdominal pain
Poor circulation in a patient with sickle cell anemia can cause:
skin, peripheral ulcers that do not heal
Before treating sickle cell anemia, one must:
identify trigger factors as they vary from person to person
What is the number one reason for a sickle cell patient to go into crisis?
dehydration
T or F: A change in lifestyle or emotional stressors can cause a sickle cell patient to go into crisis.
TRUE
T or F: Sickle cell anemia is cureable.
FALSE. It can be managed, but not cured.
Supportive treatments for sickle cell anemia include:
rest, oxygen, hydration
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
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
Define Aplastic Anemia:
Deficiency of all types of blood cells caused by failure of bone marrow development.
When RBC, WBC, and platelet counts are all low this is referred to as:
pancytopenia
T or F: pure red cells aplasia affects all types of blood cells.
FALSE. PRCA only affects red blood cells
____________ is an associated condition of sickle cell anemia
Pure Red Cell Aplasia
What is pancytopenia?
Deficiency of all three cellular components of the blood (red cells, white cells, and platelets)
What are the two classic signs of anemia?
Low WBC’s and low platelets
What can you expect if WBC’s are low?
infections
What can you expect if platelets are low?
bleeding
What are two ways to evaluate the possiblity of anemia?
CBC, bone marrow biopsy analysis
T or F: Prevention is a treatment for anemia.
TRUE
What are three treatments for anemia administered in the clinical setting?
Give EPO, blood transfusion, bone marrow transplant
Define Polycythemia:
excessive increase in RBC’s
Primary Polycythemia is caused by:
neoplastic disease, cell defects that result in abnormal regulation of the multipotent hematopoietic stem cells
Secondary Polycythemia is caused by:
an increase in erythropoietin as a physiologic response to chronic hypoxia
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
How would you treat a patient with polycythemia?
decrease blood volume and viscosity through hydration and phlebotomy
Define leukocytosis:
increase in # of WBC’s
An increase in WBC may be caused by:
infection, leukemia, neoplasms, trauma, stress
T or F: A WBC count of >10,000 is considered leukocytosis.
TRUE
Define leukopenia:
decrease in WBC count
Leukopenia may be caused by:
bone marrow failure, autoimmune disease, mass infection
T or F: Leukopenia is defined as having <7000 WBC.
FALSE. Leukopenia =<5000 WBC
T or F: Neutropenia refers to a decrease in basophils.
FALSE Neutropenia is a decrease in neutrophils
Granulocytopenia is defined as a WBC count of:
< 1500 cells/L
Agranulocytosis is defined as a WBC count of:
<500
_____________, _______________, and ______________ may be caused by acute infection, sepsis, toxins, chemicals, drugs, anaphylaxis, and underproduction of WBC’s.
neutropenia, granulocytopenia, agranulocytosis
Leukemia, lymphomas, and multiple myelomas are all:
blood cell cancers
A disease caused by uncontrolled proliferation of abnormal immature BC precursors is:
leukemia
The most common leukemias originate from which type of blood cells?
WBC
In this disorder immature cells infiltrate circulation, crowd out mature normal cells, and release inhibitory factors causing anemia and thrombocytopenia.
Leukemia
What are the two types of leukemia?
myeloid, lymphoid
What is the difference between acute and chronic leukemia?
acute: rapid division, less differentiation chronic: slower, more mature
ALL stands for
Acute Lymphocytic Leukemia
CLL stands for
Chronic Lymphocytic Leukemia
A virus, radiation, chemical exposure, and genetics (chromosomes) are all possible causes of:
leukemia
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
Leukemia can be managed through:
chemotherapy, radiation, bone marrow transplants, transfusions, and prevention of infections
Cancers of the lymph tissue are called:
lymphomas
T or F: Lymphomas only involve the lymph nodes.
FALSE. Lymphomas involve lymph nodes, vessels, T and B cells
T or F: Supraclavicular nodes, axillary nodes, retroperitoneal nodes, and inguinal nodes are all common cites for developing lymphomas
TRUE
Cancer of plasma cells is referred to as:
multiple myeloma
Thrombocytopenia, thrombocytosis, anticoagulation, and hemophilia are all:
platelet and clotting factor disorders
Thrombocytopenia is defined as platelet counts of <_____________/mm3
150,000
A platelet count of < 50,000/mm3 is considered
bleeding potential
A platelet count of < 20,000/mm3 is considered
high risk for spontaneous bleeding
Defective platelet production, disordered platelet distribution, and accelerated platelet destruction are all possible causes for:
thrombocytopenia
A platelet count of >400,000/mm3 is considered:
thrombocytosis
A disorder in which megakaryocytes in bone marrow overproduce is called:
Primary hemmaohagic thrombocytosis
____________________ are caused by defects or deficiencies in one or more clotting factors
coagulation disorders
Vitamin K deficiencies, thromboembolic disease, and hemophilia are all examples of:
coagulation disorders
______________ is necessary for the production of prothrombin, factors II, VII, IX, and X
vitamin K
T or F: Vitamin K is a water soluable vitamin.
FALSE- it is a fat soluable vitamin
Which population is at increased risk for vit. K deficiency?
neonates because they have an immature liver and lack of normal intestinal flora
We can get vitamin K from eating:
green leafy vegetables
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
Abnormal blood clotting is called:
Thromboembolic disease
What is a thrombus?
A stationary clot adhering to the vessel wall
What is an embolus?
A floating clot within the blood
Virchow’s triad outlines:
factors favoring clot formation
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)
What is anticoagulant therapy?
The theraputic use of anticoagulants to discourage the formation of blood clots. It’s main purpose is preventative
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
T or F: Coagulation disorders may cause abnormal clotting test results.
TRUE
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.
What is the difference bewteen theraputic and pathological anticoagulation?
Theraputic anticoagulation will keep clotting factor numbers within acceptable parameters, pathological won’t necessarily
Partial thromboplastic time (PTT) is a test of:
the intrinsic and common pathway of blood coagulation
PTT is used as a screening test and to monitor ___________therapy.
heparin
How long is PTT?
25-35 seconds
How long is prothrombin time?
12-15 seconds
PT is useful when using which drug?
Warfarin
INR(1), heptest-LMW heparin, and fibrinogen are all used to test the__________
PTT-Partial Thromboplastin time
Plasminogen is used to test for____________
anticoagulation
What is Purpura?
A disorder that occurs when small blood vessels join together or leak blood under the skin
What are the clinical manifestations of Purpura?
red or purple spots on skin that do not blanch on applying pressure
What are the clinical manefestations of anticoagulation?
bleeding-petechiae, purpura, ecchymosis
__________ and__________ work together to make clots
platelets and clotting factors
What three categories can promote inappropriate clotting?
arterial inflammation, slowed blood flow, and inflammatory disorders
