Hematological System Flashcards
Plasma makes up what percent of total blood volume
55%
Plasma does what
carries the cellular elements of blood through circulation
Plasma is composed of
91% water
7% proteins
2-3% other small molecules
Plasma - electrolytes in plasma do what
determine osmotic pressure and pH balance
these are important for exchange of fluids between capillaries and tissues
Plasma proteins include what
albumin, globulins, and fibrinogen
Serum is plasma without clotting factors
Erythrocytes
RBCs make up 45% of total blood volume and contain oxygen carrying protein hemoglobin responsible for transporting oxygen
RBCs are produced where
in the marrow of the long bones and controlled by hormones (erythropoietin)
RBCs are time limited - survival is what
120 days
Leukocytes
WBCs make up about 1% of total blood volume and circulate through the lymphoid tissue
Leukocytes function in what
immune processes as phagocytes of bacteria, fungi, an viruses
Also aid in capturing toxinc proteins resulting from allergic reactions and cellular injury
Leukocytes are produced where
in the bone marrow
Types of leukocytes
lymphocytes and monocytes (agranulocytes)
neutrophils, basophils, and eosinophils (granulocytes)
Hematopoiesis is what
the normal function and generation of blood cells in the bone marrow
Hematopoiesis - production, differentiation, and function of blood cells is regulated by
cytokines and growth factors (chemical messengers) acting on blood forming cells (pluripotent stem cells)
Disorders of Hematopoiesis include
aplastic anemia and leukemias
Blood screening tests - complete blood count determines
the number of RBCs, WBCs, and platelets per unit of blood
Blood screening tests - white cell differential count determines
the relative percentages of individual white blood cell types
Blood screening tests - erythrocyte sedimentation rate (ESR) is what
the rate of red blood cells that settle out in a tube of unclotted blood - given in mm per hour
Blood screening tests - elevated ESR would indicate
inflammation
Hemostasis is what
the termination or arrest of blood flow by mechanical or chemical processes
Can be vasospasm, platelet aggregation, thrombin, and fibrin synthesis
Hemostasis - blood clotting requires what
platelets produced in bone marrow, von Willebrand’s factor produced by the endothelium of blood vessels and clotting factors produced by the liver using vitamin K
Hemostasis - fibrinolysis is what
clot dissolution that prevents excess clot formation
Hypercoagubility disorders are caused by
Inc platelet function - atherosclerosis, DM, elevated blood lipids and cholesterol
Accelerated activity of the clotting system - CHF, malignant diseases, preganancy, use of oral contraceptives, immobility
Hypocoagulopathy disorders are caused by
Platelet defects as seen in bone marrow dysfunction, thrombocytopenia, thrombocytopathia
Coagulation defects - hemophilia, von Willebrands disease
Vascular disorders - hemorrhagic telangiectasia, vit C def, Cushings, senile purpura
Shock - is what
an abnormal condition of inadequate blood flwo to the body tissues
Associated with hypotension, inadequate CO, changes in peripheral blood flow resistance
Shock - Hypovolemic shock is caused by
hemorrhage, vomiting or diarrhea
Loss of body fluids also occurs with dehydration, Addisons disease, burns, pacreatitis, or peritonitis
Progressive Shock is associated with what
restlessness, and anxiety, weakness, lethargy, pallor with cool moist skin, fall in body temp
S/S of hematological disorders
Easy bruising with spontaneous petechiae and purpura of the skin
External hematomas might be present
RED FLAGS - with PT interventions
Extreme caution with manual therapy and use of some modalities (compression)
Strenuous exercise is contraindicated due to inc risk of hemorrhage
Anemia - characteristics
Dec in hemoglobin levels in the blood
Anemia - etiology
Decrease in RBC production
Destruction of RBC
Loss of blood (hemorrhage)
Anemia - etiology - Dec in RBC production
Nutritional deficiency (iron, vit B, folic acid)
Cellular maturation defects
Dec bone marrow stimulation (hypothyroid)
Bone marrow failure (leukemia, aplasia, neoplasm)
Genetic defect
Anemia - etiology - RBC destruction
Autoimmune hemolysis Sickle cell disease Enzyme defects Parasites (malaria) Hyersplenism Chronic diseases (RA, TB, CA)
Anemia - etiology - loss of blood
Tauma Wound Bleeding Peptic ulcer Excessive menstruation
Anemia - Clinical s/s
Fatigue and weak with min exertion
Dyspnea on exertion
Pallor or yellow skin of face, hands, nail beds, lips
Tachycardia
Bleeding of gums, mucous mem, or skin w/o trauma
Severe anemia can see hypoxic damage to liver, kidney, and maybe heart failure
Anemia - PT RED FLAGS
Pt with anemia exhibit dec exercisee tolerance
Exercise should be instituted gradually with physician approval
RPE should be used
Sickle cell disease - what is it
Groupd of inherited, autosomal recessive RBC disorders
Erythrocytes, specifically hemoglobin, are abnormal
RBCs are crescent or sickle shaped instead of biconcave
Sickle cell disease - types
HbSS (most severe) HbSC HbS beta thalassemia HbSD HbSE HbSO
Sickle cell disease - sickle cell trait
Heterozygous form of sickle cell anemia characterizes by abnormal RBCs
Individuals are carriers and do not develop the disease
Sickle cell disease - Chronic hemolytic anemia (sickle cell anemia)
Hemoglobin is released into plasma with resultant reduced oxygen delivery to tissues
Results from bone marrow aplasia, hemolysis, folate deficiency, or splenic involvement
Sickle cell disease - Vasooclusion from misshapen erythrocytes
Results in ischemia, occlusion, and infarction of adjacent tissue
Sickle cell disease - Sickle cell crisis
Acute episodic condition occurring in children with sickle cell anemia
Sickle cell disease - Sickle cell crisis s/s
Pain - acute abdominal pain, painful swelling in hands and feet, persistent HA
Bone and joint crises - extremity and back pain
Naurologic - dizzy, convulsions, coma, nystagmus
Pulmonary - chest pain, cough, dyspnea, tachypnea
Sickle cell disease - complications
Vascular - stroke, ulcers, infarcts
Pulmonary hypertension
Neuro - paresthesias, CN palsies, hemiplegia, blind
Renal - enuresis, nocturia, hamturia, renal failure
Anemic crisis - rapid drop in hemoglobin
Aplastic crisis - severe anemia
Splenic - liver and spleen enlargement
Sickle cell disease - PT interventions
Application of warmth is soothing (hydrotherapy)
Relaxation techniques
Exercise intolerance is common - exaggerated HR response
Low to mod exercise is okay
Sickle cell disease - PT RED FLAGS
Cold is contraindicated as it increased VC and sickling
Hemophilia is what
A group of hereditary bleeding disorders
Inherited as a sex linked recessive disorder of blood coagulation - affects males, females are carriers
Hemophilia - Clotting factor VIII deficiency
Hemophilia A
most common - classic hemophilia
Hemophilia - Clotting factor IX deficiency
Hemophilia B
Christmas disease
Hemophilia - Hemarthrosis
bleeding into joint spaces
most common in synovial like knees, ankle, elbow, hips
Hemophilia - hemorrhage into mm often impacts
forearm flexors
gastroc/soleus
iliopsoas
Hemophilia - complications
Joint contractures Mm weakness Leg length changes Postural scoliosis Dec aerobic fitness Gait deviations - equinus, lack knee extensor torque ADL deficiency
Hemophilia - common s/s seen in PT exam
acute bleeding episodes dec ROM stiffening pain swelling tenderness heat prickling or tingling sensations
Hemophilia - PT interventions
Acute - RICE, prevent deformity
Subacute - Isometrics and aquatics, pain management, AAROM, open chain (closed may put pressure into joint), contracture management
Chronic - HEP for inc joint function, aerobic fitness, and strength
Hemophilia - PT interventions - RED FLAG
passive stretching is rarely used due to risk of myositis ossificans
