Hematology 1 Flashcards
Hematology and Medicine
-it is a specialty in internal medicine
-deals with diseases of the blood/forming units
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common components of blood
- RBC,Platelets,WBC
- after a centrifuge the hematocrit (RBC) is at the bottom, the plasma will be the top and the buffy coat (platelets and WBC) are in the middle
The functions of blood
- respiration (transport of O2 and CO2)
- nutrition (transport of ingested nutrients)
- transportation of waste products
- Transport of heat (heating and cooling)
- Acid-base balance
- Water balance
- Thermoregulation
- Immunity
- Transport of hormones (signals), vitamins and trace elements
- Hemocoagulation (hemostasis)
Hematopoiesis
blood cell development
what does differentiation refer to in hematopoiese
the process of cell development from origin into specific types of cells
proliferation
the increase of cell number (cell division)
potency
ability of cell/tissue to develop into other branches of tissues/cell types
- totipotent
- pluripotent
- mulipotent
totipotent
- this is a zygote or fertilized eggs
- can become three germ layers and the placenta
- asically can give rise to any cell type
pluripotent
- embryonic stem cells
- basically able to give rise to several cell types
multipotent
- adult type stem cells in skin, blood, and gut
- these can be made from all three germ layers
- have the capacity to self-renew by dividing and to develop into multiple specialised cell types present in a specific tissue or organ
organs involved in blood function and disease
- bone marrow
- spleen
- lymphatic tissue
- liver
- thymus
- others
describe erthrocytes (RBC)
- biconcave disc (7.8 micrometer diameter and 2.6 micrometer thick)
- no nucleus
- they have a life span of 120 days
- highly deformable (can pass through capillaries)
- contain hemoglobin for gas exchange
- help maintain acid base balance
platelets (thrombocytes)
- ten day lifespan (even shorter when removed from body)
- made from megakaryocytic
- they survey the blood vessels and are in contact with the vessel walls due to RBC pressure
what happens when Platelets get acticated
- this leads to blood clot formation
- can take anticoagulants (a antithrombotic medicine) to inhibit function
what would a hematologic patient present with?
- anemia symptoms
- bleeding tendency
- infection tendency
- tumors/skin lesions
- b symptoms
- eye pallor
physical exam for hematologic patient
- look for eye pallor
- check skin for lesions, pallor, and jaundice
- look at lymph nodes
- lungs
- abdomen (the spleen and liver)
what workup would you do for a hematologic patient
- blood work!
- CT/PET CT (radiology)
what does blood work entail for a hematologic patient?
- biochemical (look for Hgb, RBC (size, Hgb vol. etc), WBC, platelet, vitamin/iron status, carrier proteins, arterial blood gas)
- smears biopsies (lymph nodes and bone marrow)
- fluorescence/immunological (characteristics and function)
hemostasis
- the process of creating a functional blood clot when there is bleeding
- there will be vasoconstriction to decrease the amount lost into extracellular space
primary hemostasis
-platlets are activated and will congregate in these areas and make a meshwork where platelets and red blood cells will cover area
secondary hemostasis
reinforcement of clot with fiber
thrombus and fibrinolisis
this is the degeneration of the clot formed
fibrinogenesis
- this is a coagulation cascade
- this is the formation of fibrin (a protein in the blood responsible for the meshwork in blood clot formation
- this requires lots of cofactors to activate thrombin
- the factors are produced in the liver
what is understanding coagulation good for?
-patients with blood clots
surgical/trauma/bleeding patients
-patients with blood, liver or endothelial diseases
anemia
low hemoglobin in normohydrated normovolemic patient
symptoms of anemia
- fatigue
- dizziness
- fainting **
- low blood pressure
- skin paleness
- skin coldness
- skin yellowing
- shortness of breath
- chest pain
- angina
- heart attack
- spleen enlargement
what are important investigations to do for anemia?
-hemoglobin
-mean ELL volume
-mean hemoglobin concentration
-iron and vitamin B levels
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sickle cell anemia
- this is autosomal recessive inheritance, heterozygous carriers out there and can have sickle cell traits
- caused by a mutation in the beta globulin of hemoglobin
- prevalent in African populations (evolutionary because helps agains malaria)
- low oxygen because of the sickling formation and it holds less O2
- they do not bend as well in vessels and can cause clots
why is so dangerous
if there is a concomitant disease that causes a decrease in hematopoiesis (ex. viral infection/ vitamin b deficiency) then it becomes life threatening
how does sickle cell anemia present
-often at an early age
-low energy/poor general condition/poor stamina
-fatigue/dizzyness/palpations
-Jaundice
-gall stones
-local/general painful episdoes
aplastic crisis
what is an aplastic crisis
this is when the RBCs have decreased
-pallor
-trachycardia
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management of sickle cell anemia
-blood transfusion
RBCX (red blood cell exchange, total)
-hydroxyrea (increase production of fetal hemoglobin)
-immunication due to asplenic (absence of spleen) status (vaccines)
-vit B sustitution
prognosis for sickle cell anemia
- typical debut 6 months
- highest mortality rate is 6-12 months
- with time develops chronic multi organ disease
- most patients die from organ failure
- mean life expectancy is 40-50 years old
