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Pathophysiology > Hematology:Anemia, Polycythemia, Thrombocytopenia > Flashcards

Hematology:Anemia, Polycythemia, Thrombocytopenia Flashcards

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1
Q

What are the two tests of WBC and describe each?

A

WBC Total and Differential

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2
Q

low leukopenia (neutropenia) is when?

A

A total WBC count lower than 4 × 10*9/L (leukopenia) is associated with bone marrow depression, severe or chronic illness, and some types of leukemia.

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3
Q

neutropenia is when?

A

Neutropenia is a condition associated with an absolute neutrophil count (ANC) lower than 1 × 109/L to 1.5 × 109/L

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4
Q

What is the terms for when RBC is low and high?

A

RBC total – low anemia, high polycythemia

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5
Q

What does hemoglobin reflect?

A

oxygen carrying capacity

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6
Q

What does hematocrit represent?

A

The % of the blood volume?

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7
Q

Platelet total low is called what?

A

thrombocytopenia

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8
Q

How many percent of the blood is RBC and this percentage is called the what value?

A

45% of the blood is RBCs

This percentage is called the Hematocrit value

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9
Q

Define Erythropoiesis?

A

is the production of RBCs in red bone marrow in response to tissue O2 needs

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10
Q

The kidneys detect ↓O2 levels and secrete the hormone _________ which stimulates the________ to make RBCs

A

The kidneys detect ↓O2 levels and secrete the hormone erythropoietin (EPO) which stimulates the bone marrow to make RBCs

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11
Q

Hct
M ?%
F ? %

A

Hct
M 42-52 %
F 37-47 %

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12
Q

What is the RBC lifespan?

A

120 days

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13
Q

Examples Hematopoietic drugs: (IV, SC) and MOA

A 
epoetin alfa (Eprex) 
– stimulates production and speedy maturation
 – requires iron supply, healthy marrow
Risk HTN
Optimal 100-120 mmol/l Hgb

darbepoetin alfa (Aranesp) (longer-acting form)

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14
Q

Hgb mmol/L
M ?
F ?

A

Hgb mmol/L
M 140-180
F 120-160

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15
Q

How many iron groups does a hemoglobin have and each can bind to?

A

4 x iron-containing hem groups (requires iron supply to make) – each can reversibly bind to one oxygen molecule

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16
Q

What is required in making hemoglobin?

A

Iron

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17
Q

What does oxygen saturation measure and what does it use?

A

Oxygen saturation measures the % of Hgb binding sites in the blood occupied by oxygen (uses light absorption)

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18
Q

when O2 Sat < 90% what condition is that and what are the associated symptoms?

A 
O2 Sat < 90% hypoxemia
→ hypoxia (at tissue)
→ fatigue
→ cyanosis (blue)
→ respiratory distress
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19
Q

RBC indices: on Hematology (CBC) report is used to measure what?

A

(size, content and Hgb concentration)

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20
Q

MCV Mean Corpuscular Volume shows us what?

A

average volume of the RBC
RDW Red cell distribution width – variation in RBC size
Tells us about the development and function of RBC

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21
Q

MCHC MCH Concentration is what?

A

the average weight of hemoglobin per unit volume of red cells. the average content of hemoglobin per red cell – “red” or “pale” cell

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22
Q

During the recycling of RBC what is the most component that must be stored and excreted.

A

Stored- Iron

Excreted- Bilirubin

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23
Q

What is the side effects of excess bilirubin in the blood? and what places in the body does the bilirubin have the highest affinity for?

A

Jaundice and itching

The sclera and the skin

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24
Q

Where is most of the body’s iron stored and the two other places

A

Most-Liver

bone marrow and spleen also.

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25
Q

What is the definition of anemia and it can result in what?

A

Definition: decreased O2-carrying capacity of the blood, which can result in tissue hypoxia.

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26
Q

What kind of anemias fall under this category (Impaired Production of RBCs)

A

Iron Deficiency Anemia
Aplastic Anemia
Anemia of Chronic Illness
Anemia associated with Chronic Alcoholism

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27
Q

What kind of anemias fall under this category (Defective Production of RBCs)

A

Folic Acid Deficient Anemia

Vitamin B12 Deficient Anemia

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28
Q

What kind of anemias fall under this category (Excessive loss or destruction of RBCs)

A

Hemolysis

Blood Loss

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29
Q

Iron-Deficiency Anemia what are the effects on the body?

A

↓ iron impedes synthesis of Hgb→less O2 transported

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30
Q

Describe the characteristics of RBC that is iron-deficient

A

microcytic (small cell), hypochromic (less colour) pale RBCs.

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31
Q

What are the causes of Iron-Deficiency Anemia

A
  • inadequate dietary intake of iron, especially during growth spurts or pregnancy.
  • Chronic blood loss from GI ulcer, hemorrhoids, cancer, or excessive menstrual flow = loss of iron from body as blood is lost (not re-cycled) – results in low iron stores
  • Impaired absorption of iron resulting from gastritis, chronic inflammatory bowel disease, or diarrhea.
  • Severe liver disease (storage and management)
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32
Q

To help with the iron loss, when treating with drugs what is the required daily intake

A 
Iron Supplement (ferrous, coated - duodenum)
Elemental Iron 150-200mg po daily
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33
Q

Iron is absorbed primarily where and what kind of environment improves the absorption.

A

Absorbed primarily in duodenum – Gastric acid lowers pH and improved absorption (Proton Pump Blockers interfere)

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34
Q

What is the best time to give Iron supplement and is it tolerated with food?

A

Before meals, possible Vitamin C, Orange juice

Don’t tolerate → with food

35
Q

What side effects do we expect with Iron supplement?

A

Expect dark stool and constipation (Stool softeners/Laxatives)

36
Q

Aplastic Anemia: results in what?

A

pancytopenia

37
Q

What causes Aplastic anemia

A

caused by impaired bone marrow function, resulting in loss of all blood stem cells (white, red, and platelet forming) and the inability to replace senescent(old) RBCs. The bone marrow contains increased fatty tissue (yellow marrow

38
Q

What is the primary cause of Aplastic anemia

A

Idiopathic: The cause of primary aplastic anemia is unknown.

39
Q

What are the secondary causes of aplastic anemia?

A

Secondary aplastic anemia is caused by bone cancers, radiation and chemotherapy, industrial chemicals, drugs that damage the bone marrow, and some viral infections (mononucleosis, Hepatitis C, AIDS)

40
Q

The early signs of aplastic anemia are?

A

The early signs of aplastic anemia are those due to low platelet and WBC counts

41
Q

Anemia is common in patients with what kind of organ disease?

A

Anemia is common in patients with Chronic Kidney Disease (CKD) where erythropoietin production may be reduced - placing an additional burden on the patient.

42
Q

Anemia associated with Chronic Alcoholism what are the effects?

A

Macrocytic with or without anemia
Leukopenia
Thrombocytopenia.
A direct toxic effect on hematopoietic cells, abnormalities in membrane phospholipids, and interference with folate utilization all may be involved.

43
Q

Nutritional megaloblastic (macrocytic) Anemias: What is the effect?

A

Deficiency causes Impaired DNA formation – results in a larger than normal cell

44
Q

Neuropathy occurs with B12 or Folic acid deficiency?

A

Neuropathy occurs only with B12 deficiency, indicating that additional mechanisms are involved in the CNS
May be a combined problem

45
Q

What is Vitamin B12 required for ?

A

required for DNA synthesis and maturation of cells, especially the rapidly dividing RBCs.

46
Q

What does Vit B12 bind to and where is it absorbed? also name some foods we can get vitamin B12 from

A

In meat, eggs, milk, binds to intrinsic factor (IF) produced by gastric cells and is absorbed in the ileum

47
Q

Is inadequate intake of vitamin B12 a major cause of B12-Deficiency Anemia?

A

can rarely arise from inadequate B12 intake

48
Q

Pernicious anemia occurs with what?

A

Pernicious anemia occurs with impaired secretion of IF related to autoimmune destruction of gastric mucosa and IF.

49
Q

What disorders can impair the absorption of vit B12?

A

Disorders of the stomach or ileum impair absorption. Examples include gastritis, ileostomy or gastrectomy

50
Q

Why is the shape of the RBC megoblastic when suffering from B12 deficiency?

A

megoblastic due to excess ribonucleic acid production of hemoglobin and structural protein

51
Q

B12 Deficiency Treatment:

A

-Nutritional Education, treat underlying condition
-Chronic r/t malabsorption then IM B12
-1000mg B12 IM daily x 2 weeks, then weekly until
Hct Ⓝ, then monthly for life

52
Q

Folic Acid (FA) what is the natural supplement called

A

Folate

53
Q

What do we screen for to determine for folic acid deficiency?

A

Screening: Serum Folate level

54
Q

What do we screen for prior to treatment of folic acid treatment and what are the reasons why?

A

B12 testing prior to treatment, especially empiric treatment – may mask B12 deficiency (neurological concerns)

55
Q

What is the treatment for folic acid deficiency?

A

Nutritional Education, treat underlying condition
Folic acid 1mg po Daily
For malabsorption up to 5 mg po Daily

56
Q

Hemolytic Anemia is caused by what?

A

Caused by premature destruction of RBCs (ie. hemolysis)

57
Q

What are the four effects of Hemolytic Anemia

A

Regardless of the cause, result in:
↓Hct, Hgb, ↑in reticulocyte count without recent bleeding or correction of iron/B12/folate deficiency
↑bilirubin, which could result in jaundice
↑enzyme lactate dehydrogenase (LDH)
Can potentially can cause acute renal failure, as Hgb causes inflammation within nephrons.

58
Q

What are a few causes of hemolytic anemia?

A

Many varied causes – we will look at a few
Intravascular hemolysis is characterized by pink or brown serum and dark urine with free serum and urine hemoglobin
Extravascular hemolysis refers to hemolysis that occurs primarily via macrophages of the liver, spleen, bone marrow, and lymph nodes

59
Q

What are the three things that determine the degree of hemolytic anemia

A

Severity/location/duration all determine degree of Anemia

60
Q

What is a normal erythrocyte level?

A

RBC Male 4.7-6.1 x 1012/L

Female 4.2-5.4 x 1012/L

61
Q

What is an immature erythrocyte?

A

Reticulocyte – immature RBC 0.5-2% of RBC

62
Q

What are some causes of hemolytic anemia

A
  • Transfusion reactions: When blood of different AB types is mixed, antibodies destroy RBCs.
  • DIC, TTP-DIC=disseminated intravascular coagulation; TTP=thrombotic thrombocytopenic purpura.
  • Hemolytic disease of the newborn: Rh- mother carries an Rh+ infant. Maternal antibodies cross placenta and cause hemolysis in the neonate. Much more severe with the second Rh+ infant.
  • Infections: Malaria, and certain strains of streptococcus and E.coli can cause hemolysis (Hemolytic-Uremic syndrome).
  • Autoimmune destruction of erythrocytes: autoimmune disorders or drug reactions
  • Genetic disorders (eg. Sickle cell anemia and Thalassemia)
  • Mechanical: heart valve disease, dialysis
  • Osmotic lysis from hypotonic infusion
63
Q

When someone has Acute and Chronic Blood Loss they are said to be?

A

Normocytic

64
Q

Internal bleeding may go unnoticed but what are the symptoms that are associated with this? and it my be first noticed with?

A

Internal bleed may go unnoticed – abdominal pain, back pain, hidden in bowel.
May first be noticed with ↓BP ↑HR

65
Q

What does rapid, acute blood loss do to the Hgb and HCT and what can we use to treat this?

A

Rapid, acute blood loss: delay for dilution of Hgb and Hct – quicker dilution if fluid loss replaced with crystalloid IV fluids

66
Q

When the blood loss is chronic what might it use up?

A

Chronically - may ‘use up’ iron stores – appears as an iron deficiency anemia

67
Q

Bleeding from bowel may be slow and unnoticed, how can we test for it?

A

Bleeding from bowel may be slow and unnoticed – FOBT

fecal occult blood test

68
Q

Anemia Critical Values in men and women?

A

Anemia: <135 in men, <120 in women

69
Q 
Hct >30-35%  \_\_\_\_\_\_\_\_\_
Hct 25-30%  \_\_\_\_\_\_\_\_\_
Hct 20-25%  \_\_\_\_\_\_\_\_\_
Hct 15-20% \_\_\_\_\_\_\_\_\_
Hct <15%  ~ \_\_\_\_\_\_\_\_
A 
Hct >30-35%  no symptoms
Hct 25-30%  fatigue, malaise
Hct 20-25%  SOBOE, dyspnea
Hct 15-20%  light-headed, confusion
Hct <15%  ~ death, MI, etc.
70
Q

Hemoglobin, hematocrit (HCT), and red blood cell (RBC) count are all concentrations and are dependent on two things and what are they?

A

Hemoglobin, hematocrit (HCT), and red blood cell (RBC) count are all concentrations and dependent on the red blood cell mass (RCM) as well as the plasma volume.

71
Q

As a result, values for all three parameters will be reduced if the RCM is ________and/or if the plasma volume is _________.

A

As a result, values for all three parameters will be reduced if the RCM is decreased and/or if the plasma volume is increased (dilutional).

72
Q

Similarly, values for all three will be increased if the plasma volume is _______ (ie, hemoconcentration).

A

Similarly, values for all three will be increased if the plasma volume is decreased (ie, hemoconcentration).

73
Q

Effects of Anemia

A
  • Altered cell metabolism with decreased ATP production, proliferation and impaired healing.
  • Compensations of tachycardia and increased contractility, and ventricular hypertrophy can eventually cause heart failure (HF). Angina (ischemic pain from the heart muscle) occurs more readily.
  • Hypoxia and diversion of blood from mucous membranes and skin impairs the regeneration of epithelial cells. This can cause inflammation and ulceration including: gastritis, inflamed and cracked lips, dysphagia, dry and thinning skin with hair loss. Other signs include pale skin or pallor, particularly in the nail beds, palms, and lips.
74
Q

What are some questions you ask a patient when conducting a Health History Interview, for a patient diagnosed with Anemia, Polycythemia, Thrombocytopenia.

A

Have you had any previous problems with anemia, bleeding disorders, recent bleeding, blood diseases or cancers such as leukemia, any other cancers? GI disorders? (Gastritis, Crohn’s)
Have you ever had a blood transfusion?
Do you have a history of kidney disease?
Family history of the same?
Have you ever had an occupational exposure to a hazardous substance or radiation?
Do you drink alcohol?

75
Q

What Surgeries are we going to be concerned about if a patient is suffering from Anemia, Polycythemia, Thrombocytopenia.

A

Gastrectomy (IF – B12, acid for Iron)

Small bowel resection (iron duodenum, B12 Ileum)

76
Q

What medications are we going to be concerned about if a patient is suffering from Anemia, Polycythemia, Thrombocytopenia.

A

Vitamin and/or Iron supplements
NSAIDS, anticoagulants (bleeding risk)
Erythropoietin
Heparin (HIT)

77
Q

System changes : Eyes

A

Jaundiced sclera, Conjunctival pallor

Visual changes

78
Q

CNS (Neurological):

(B12) anemia causes?

A

Sensory or motor deficiencies (absent reflexes, diminished vibration or soft touch sensation)

79
Q

For Anemia, Polycythemia, Thrombocytopenia we assess for what in the Skin, Hair, Nails:

A
  • Pallor in skin, nail beds, conjunctiva (anemia)
  • Cyanosis (poor saturation may be combined with anemia)
  • Transient skin flushing or painful redness in hands and feet (polycythemia)
  • Jaundice, (~icterus) (hemolytic)
  • Pruritis (hemolytic)
  • Cheilitis, atrophic glossitis, smooth tongue, stomatitis (anemia, especially iron defic.)
  • Gingival bleeding (anemia, thrombocytopenia)
  • Purpura (petichiae, ecchymosis) (thrombocytopenia, DIC)
  • Hematoma (thrombocytopenia)
  • Spoon-shaped nails (iron)
80
Q

For Anemia, Polycythemia, Thrombocytopenia we assess for what in the Nose:

A

Nose:

Epistaxis (thrombocytopenia)

81
Q

For Anemia, Polycythemia, Thrombocytopenia we assess for what in Cardiovascular

A 
Tachycardia
Palpitations
Hypertension/Hypotension
Orthostatic Hypotension
Angina (ischemic heart muscle)
DVT (deep vein thrombosis)
Hypertension/Hypervolemia with polycythemia
Hypotension with bleeding due to thrombocytopenia/blood loss anemia  
- Reflex tachycardia
82
Q

For Anemia, Polycythemia, Thrombocytopenia we assess for what in Respiratory

A

Tachypnea
Orthopnea
Dyspnea (increasingly worse with worsening anemia)
Increased Work of Breathing (WOB) – accessory muscle use
Low oxygen saturation (cyanosis)
Hemoptysis

83
Q

For Anemia, Polycythemia, Thrombocytopenia we assess for what in Gastrointestinal:

A

Diet – “foliage” (folate, iron) , vegetarian (Iron, B12, folate)
Active gastritis or disorders of the small bowel (IF-B12 & ileum, folate, iron acid & duodenum)
Anorexia, weight loss (difficulty swallowing, sore mouth)
Gastrointestinal Bleeding
Hematemesis
Melena
overt/frank or occult blood (FOBT)
Black, tarry (not to confuse with iron in stool)
Hepatomegaly (iron overload)
Splenomegaly (hemolytic anemia, thrombocytopenia)

84
Q

For Anemia, Polycythemia, Thrombocytopenia we assess for what in Genitourinary:

A

decreased urinary output – renal damage
Hemoconcentrated/Hemodilute Volume states
Chronic Kidney Disease – EPO production
Hematuria – varying degrees of blood loss
Menorrhagia (↑volume/length menstrual bleeding)
Metorrhagia (irregular menstrual bleeding)
Pregnancy or recent pregnancy

Pathophysiology (6 decks)

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