Hematology Flashcards
Marrow cannot produce adequate numbers of erythrocytes
• decreased reticulocyte count
Hypoproliferative anemia
Premature destruction of a erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma.
• released hemoglobin is converted in large part to billirubin in there for the billirubin concentration rises. Increased our erythrocyte destruction leads to tissue hypoxia which in turn stimulate erythropoietin production
Hemolytic anemia
Iron deficiency
Vitamin b12 deficiency
Folate deficiency
Decreased erythropoietin production
Hypoliferative anemia
Sickle cell anemia Thalassemia Hypersplenism Drug induced anemia Auto immune anemia Mechanical heart valve related anemia
Hemolytic anemia
Mostly seen in young children, pregnant women, menstruation, vegetarians, and the elderly
_*Gastric bypass surgery, removed parts of stomach, cannot absorb iron suff
Iron deficiency Anemia
Chemotherapy, Exposure to certain chemicals: benzenes products,
Poor dietary intake of Folic acid/B12/ iron.
Causes of hypopoliferative anemia
o Fatigue/ weakness – usually in slow blood loss
o Pallor – usually in slow blood loss - Skin and mucous membrane, conjunctiva
o Dyspnea
o Chest pain: in rapid blood loss (hemorrhaging) Tissue hypoxia, angina not enough blood in body
o Muscle pain, Asses mouths, Change in LOC
Clinical manifestation of anemia
o A decrease in circulation RBC will result in
o An increase HR, RR, Increase Cardiac output (compensate by becoming tachycardia)
o Oxyhemoglobin dissociation- what ever hgb is circulating in blood system will be given off O2 at a faster rate
o Redistribution of blood flow to vital organs- shunts to brain, heart, lungs and kidneys when patient is hemorrhaging. Periphery become cold clammy dyapheritic
Compensatory mechanisms of anemia
- beefy red, ulcers and sore.
Peripheral nervous system- numbness, tingling, to extremities, ataxia
B12 megoblastic anemia
- ulcers corner of mouth has two sores. Iron deficiency anemia.
Angular cheiliosis
Heart failure
Parathesias
Confusion
Complications of anemia
To much iron or too little in blood stream
Total iron binding capacity (TIBC).
- protein found inside of the cells to stores iron for body to use later when needed
Ferritin
Bone marrow aspiration- most invasive and last resort. Go threw iliac crest or sternum.
o Ferritin- low, Hgb- low, Serum iron- low, MCV- diminished (very small RBC), when low iron causes small rbc to be made
o TIBC- will be elevated. Red blood cells have open areas for iron to bind to. If you don’t have enough iron you have more open spaces on the RBC and the total iron binding capacity increases
Iron deficiency anemia
- organ meats (Livers), beans (black, pinto, garbonzo), dark green leafy vegetables (spinach, kale, swiss chard, broccoli), raisins, molasses
Food sources high in iron
o B12 or Folic Acid Anemia
o RBC are large (MCV Increased)
o Bone marrow = hyperplasia
▪ Large and bizzare appearance
MEGALOBLASTIC anemia
▪ Green leafy veg ▪ Organ meats ▪ Mushrooms ▪ Oatmeal ▪ peanut butter ▪ beans ▪ soy products ▪ melons
Food sources of folate
o Alcoholics- malnutrition to begin with o Need more folic acid bc not absorbed o Elderly o Pregnant o People who don’t eat uncooked vegetable o Chronic hemolytic anemia’s o sickle cell, o thalassemia o hyperemalisys drugs, autoimmune, mechanical heart valve) o Malabsorptive disease of small bowel o Sprue/celiac disease ▪ genetic disorder with a wheat or gluten sensitivities o Meds o Oral Contraceptive o Sulfar Antibiotic o anti-seizure medication
Risk groups for folic acid deficiency
o Suppresses appetite causing o Anorexia o wt loss o Fatigue/weakness/tiredness o Pale skin o Tachycardia o Glositis o No neuro symptoms like B12
Clinical manifestations of folic acid deficiency
o Pernicious anemia o Weakness, Listlessness, Fatigue o Glossitis o Diarrhea o Paleness to mucus membrane o Mental Changes o Confusion o Memory loss o Neurological impairment o Paresthesias/ numbness tingling of feet and hands o Proprioception loss o Unsteady gate - ataxia ▪ poor balance and coordination - SAFETY
Clinical manifestation of B12 anemia
Condition in which hemaglobin concentration is lower than normal it reflects the presence of fewer than normal erythrocytes within the circulation
As a result the amount of oxygen delivered to body is diminished
Anemia
Heart failure
Parathesia
Delirium
Complications of anemia
- Sudden chest pain
- Asymmetry of chest movement
- Unilateral retractions
- Oxygen desaturation
Pneumothorax
Rare disease caused by a decrease in or damage to marrow stem cells damage to the microenvironment within the marrow, and replacement of the marrow with fat. T-cells mediate an inappropriate attack against the bone marrow, resulting in bone marrow aplasia
• significant neutropenia
Aplastic anemia
Bone marrow aspirate shows an extremely hypoplastic or even aplastic marrow replaced with fat
Aplastic anemia
Smooth sore red tongue Mild diarrhea Pale Confusion Numbness and tingling in feet and lower legs Lose position sense
Pernicious anemia
Classic method of determining the use of vitamin b12 deficiency
Patient receives a small oral dose of radioactive vitamin B12 followed by a few hours by a large non radioactive parent dose of b12
Schilling test
150,000-400,000/mm3
Platelets
5,000-10,000/mm3
WBC
60-70 seconds
Partial Thromboplastin Time (PTT)
30-40 seconds
Activated Partial Thromboplastin Time (aPTT)
11-12.5 seconds
Prothrombin Time (PT)
- 5-2.0 DVT prophylaxis
- 0-3.0 Orthopedic surgery, DVT, AF
- 0-4.0 Prosthetic valve prophylaxis
- 5-3.5 Pulmonary embolism
International Normalized Ratio (INR)
- Male 42-52%
* Female 37-47%
Hematocrit (Hct)
Male: 14-18 g/dL
Female: 12-16 g/dL
Hemoglobin (Hgb)
– Viral infection, aplastic and pernicious anemia, lymphoblastic leukemia, chemo agents destroy stem cells, toxic agents, certain meds, poisons, massive infection, graves or addison’s disease
decrease WBC count
polycythemia. Dehydration. Diarrhea. High altitude. Poisoning. Exercise.
Increase WBC
Stem cell disorder within bone marrow marked by increase platelet production occurs with the platelet count consistently greater than 600,000/mm3
Primary thrombocythemia
Usually Asymptomatic
Symptoms exceed 1 million/mm3
Occlusion may occur in many vessels
Primary thrombocythemia
Low platelet level
Can result from various factors within bone marrow
Increased destruction of platelets
Or increased consumption of platelets
Thrombocytopenia
