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NURS 324 Pathophysiology > Hematology Function > Flashcards

Hematology Function Flashcards

1
Q

What kind of tissue is blood?

A

Connective tissue

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2
Q

Main function of blood has to deal with _____ and _____

A

connect and transport

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3
Q

The whole system of blood is referred to as the

A

hematologic system

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4
Q

If we produce more CO2, what does this mean?

A

blood pH will go down

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5
Q

if CO2 goes up, then what is the response of the respiratory system ?

A

The breathing speeds up

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6
Q

The hematologic system connects all parts of the organisms through ________ ________

A

chemical messengers, such as hormones

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7
Q

The main buffer system in the blood is

A

the bicarbonate system

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8
Q

Components of blood

A

92 % water and 8% solutes

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9
Q

If you had a vial of blood, what would happen?

A

The plasma would rise to the top while the formed elements would fall to the bottom

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10
Q

What is plasma ?

A

plasma is 50-55% of the blood volume it is the liquid portion that contains organic, inorganic elements and coagulation factors

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11
Q

What is serum ?

A

This is plasma without the coagulation factors

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12
Q

What is the most abundant plasma protein ?

A

Albumins

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13
Q

What is the function of albumins?

A

Functions as a carrier of iron, hormones, calcium and many drugs controls the plasma oncotic pressure- influences the movement of water into the vessels

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14
Q

Someone presents with liver failure - what would we expect to see ?

A

edema Since albumin plasma proteins are synthesized in the liver, there would be a lack, and hence this would then affect the ability of the blood to keep water within the vessels

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15
Q

With edema, there is not enough ______ ______ to keep the fluid in the blood vessels

A

oncotic pressure

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16
Q

Cellular components of blood

A

erythrocytes, leukocytes platelets

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17
Q

What are erythrocytes ? what is unique about them ?

A

Red blood cells ; they lack a nucleus

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18
Q

Red blood cells transport ……

A

oxygen and carbon dioxide

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19
Q

What is the life cycle of red blood cells ?

A

120 days

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20
Q

this is the most abundant cell in the body

A

red blood cells

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21
Q

What are leukocytes ?

A

white blood cells - these defend the body against infection and disease

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22
Q

__________ constitute 60-70% of all WBC

A

Granulocytes

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23
Q

What are granulocytes ?

A

Membrane-bound granules in their cytoplasm The granules contain enzymes capable of destroying microorganisms Inflammatory and immune functions Capable of amoeboid movement (diapedesis)

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24
Q

Granulocyte cells are

A

neutrophils basophils eosinophils

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25
Q

Agranulocytes are part of the _________ and __________ system

A

inflammatory and immune

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26
Q

3 types of cells in the blood

A

red blood cells white blood cells platelets

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27
Q

These types of WBC are agranulocytes , are part of the mononuclear phagocyte system, and are immature macrophages

A

monocytes

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28
Q

These two types of WBCs make up the _________________ system (MPS)

A

mononuclear phagocyte system

Monocytes and Macrophages

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29
Q

These cells are part of the coagulation process ?

A

Platelets

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30
Q

Do platelets have a nucleus ?

A

No nucleus

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31
Q

Normal values for hemoglobin, hematocrit, RBC count, WBC count and platelet count

A

make sure to know the normal values and to note the normal values pertaining to your clinical site

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32
Q

This is the process of blood cell production

A

Hematopoiesis

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33
Q

Hematopoiesis occurs where?

A

In the bone marrow

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34
Q

concerning the life span of hematological cells, is it long or short ?

A

Short, which means there is constant replacement

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35
Q

True or false ….. we cannot divide platelets or red blood cells into two daughter cells

A

True. They cannot divide. They form through maturation

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36
Q

How long does it take for a RBC to mature ?

A

34 days or so

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37
Q

This term refers to blood cell production in tissues other than bone marrow such as the spleen and liver and is usually a sign of disease

A

Extramedullary hematopoiesis

prior to birth, blood cell production does occur in the spleen and liver. but after birth, blood cell production only occurs in the bone marrow

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38
Q

If we have less RBC than usual, we can become

A

anemic

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39
Q

If we have more RBC than usual, there will be greater

A

viscosity of blood, which will affect blood pressure

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40
Q

The number of circulating red cells in healthy individuals should _______ ________

A

remain constant

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41
Q

This substance stimulates the red cell maturation in bone

A

Erythropoietin

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42
Q

These cells of the kidney produce erythropoietin

A

Peritubular cells

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43
Q

_________ stimulates the production and release of erythropoietin

A

Hypoxia

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44
Q

What is the name of the oxygen carrying protein of the erythrocyte?

A

Hemoglobin

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45
Q

When the RBC leave the lungs they are usually _________ saturated? Saturated with what ?

A

100% saturated with oxygen

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46
Q

Hemoglobin consists of

A

two pairs of polypeptide chains Globins-proteins Heme Iron atom

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47
Q

Without a sufficient amount of iron in your diet, you will have __________, which will lead to _______

A

hemoglobin deficiency, anemia

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48
Q

About what percentage of the body;s total iron composition is in hemoglobin and myoglobin ?

A

70%

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49
Q

Besides being stored in Hgb and myoglobin, the rest of iron is stored as …….

A

ferritin or hemosiderin

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50
Q

This is the major storage form of iron….

A

Ferritin

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51
Q

This hormone controls iron absorption and is produced in the liver

A

Hepcidin

Hepcidin is a key regulator of the entry of iron into the circulation

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52
Q

Red blood cell destruction happens where

A

THE SPLEEN! Aged red cells are sequestered and destroyed primarily in the spleen

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53
Q

if bilirubin goes above 2 or 2.5 , the patient looks

A

yellow- there is jaundice

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54
Q

Hemostasis is

A

the stopping of the flow of blood

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55
Q

Who are the main players required in hemostasis ?

A

Platelets

Clotting Factors

Vasculature

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56
Q

Phases of hemostasis

A

Subendothelial exposure

Adhesion

Activation

Aggregation

Platelet plug formation

Clot retraction and clot dissolution

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57
Q

Aspirin is an

A

anti aggregate drug

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58
Q

Heparin is an anti-

A

coagulant

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59
Q

what is the only substance in the body that breaks down the fibrin strands of a clot ?

A

Plasmin

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60
Q

Inactive plasminogen in the circulation is activated by what substance ?

A

t-PA

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61
Q

In Hypercoagulability disorders your blood _______ more than it should

A

clogs

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62
Q

What is this condition called ? And what are some risk factors ?

A

deep vein thrombosis

•Risk factors for DVT:

•Stasis of blood - Bed rest, CHF, obesity

•Increased coagulability - Stress, trauma, pregnancy, BCP, smoking

•Vessel wall injury - Trauma, surgery

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63
Q

What is DVT ?

A

The presence of a clot in a deep vein with the accompanying inflammatory response - common in the extremities

64
Q

A patient with DVT is at risk for

A

Pulmonary embolism

65
Q

Risk factors for DVT

A

Stasis of blood Bed rest, CHF, obesity Increased coagulability Stress, trauma, pregnancy, BCP, smoking Vessel wall injury Trauma, surgery

66
Q

True or false….. DVT prevents blood from going back.

A

True

67
Q

DVT causes a PE but not a heart attack or stroke. True or false.

A

True….. clot becomes lodged within the tiny capillaries of the lungs and cannot make its way any further

68
Q

best treatment for DVT of course is P_ven_t__n

A

prevention

early ambulation after surgery

  • Leg exercises, support stockings, pneumatic compression devices improve venous flow
  • Anticoagulation therapy for treatment and prevention
69
Q

DVT S/S

A

Up to 50% asymptomatic Mostly affected calf and thigh veins Swelling in one or both legs Pain or tenderness in one or both legs, which may occur only while standing or walking Warmth in the skin of the affected leg Red or discolored skin in the affected leg Visible surface veins Leg fatigue Homan’s sign- calf pain with foot dorsiflexion

70
Q

S/S of PE

A

SOB Tachycardia or irregular heart beat, (A.fib) Chest pain, which worsens with a deep breath or coughing Extreme anxiety Coughing up blood Very low BP, lightheadedness, or fainting Acute respiratory failure Shock

71
Q

Blood clotting involves what two processes ….

A

aggregration: platelets coagulation: coagulation factors

72
Q

Anticoagulants inhibit

A

fibrin formation

73
Q

Antiaggregants inhibit

A

platelet aggregration

74
Q

Therapeutic use of anticoagulants:

A

Prevention of deep vein thrombosis (DVT) Prophylaxis in post-surgical patients Patients with a history of DVT Anticoagulation in patients with a likelihood or history of thrombotic stroke Transient ischemic attack (stroke prodrome) Previous thrombotic stroke Patients who are likely to have clot formation in their left heart, (atrial fibrillation or patients with artificial heart valves) For patients with a hyper-coagulability syndromes

75
Q

if you give more heparin than you should you can cause

A

bleeding

76
Q

if you give less heparin than you should you can cause

A

clotting

77
Q

heparin infusion is adjusted based on the _________-

A

activated Partial Thromboplastin Time (aPTT

78
Q

what is aPTT

A

the clotting time from the activation of factor XII, through the formation of fibrin clot

79
Q

can heparin be given during pregnancy and lactation ?

A

Yes because it does not cross placenta easily as it is such a big molecule

80
Q

what is the antidote of heparin?

A

Protamine Sulfate

81
Q

Therapeutic uses of heparin

A

Heparin can be administered to prevent DVT after surgery because of its rapid acting During open heart surgery or dialysis During an evolving MI

82
Q

Side effects of heparin

A

Bleeding in 10% of cases. Maybe severe. Monitor pt. for low BP, tachycardia, oozing in puncture sites, bleeding gums, red or dark stools, hematuria, headache, syncope. Risk increases when given with antiaggregants Spinal/epidural hematoma. Stop heparin before epidural catheter placement or removal HIT-Immune reaction against PLT factor 4 and heparin

83
Q

Low molecular weight heparin

A

: heparin molecules that have a lower molecular weight than “unfractionated” heparin Abdominal surgery, knee and hip replacement Treatment of DVT Post MI, Non Q-wave MI, unstable angina

84
Q

benefits of molecular weight heparin

A

They don’t need monitoring with lab tests (aPTT) like IV unfractionated heparin They can be given by the patient or caregiver at home. These preparations are almost as effective as unfractionated heparin They inhibit the activation of factor X but not that of thrombin The have the same contraindications as heparin but they do cause less HIT

85
Q

Can heparin and coumadin be given at the same time ?

A

Yes

86
Q

Warfarin/Coumadin Therapeutic Uses

A

Prevention of venous thrombosis and PE Prevention of thromboembolism in pt. with prosthetic heart valves and A.fib

87
Q

MOA for Warfarin/Coumadin

A

Inhibits the synthesis of vit. K dependent clotting factors: (II (prothrombin) VII, IX, and X) by inhibiting Vitamin K activation in liver Takes days for the full effect hence the pt. needing anticoagulation must remain on heparin until the full effect of Coumadin takes place Because its long half-life coagulation remains inhibited for 2-5 days after its discontinuation

88
Q

Side effects of Warfarin/Coumadin

A

Bleeding

89
Q

Antidote for Warfarin/Coumadin

A

Vitamin K through IV or PO

90
Q

t-PA

A

tissue plasminogen activator

91
Q

t-PA activates plasminogen to

A

plasmin

92
Q

Nursing interventions for pt. taking anticoagulents

A

avoid IM injections use electric razors Use soft brushes Use paper tape Use stool softeners Implement protocols to prevent falls

93
Q

A patient is taking anticoagulents and you are about to shave him and perform hygiene- you pick up a razor and shaving cream and are using a hard, old toothbrush you found in the supply room …. what are the issues here ?

A

Should not use razor due to risk of cutting and bleeding instead use electric razors use soft brushes to prevent bleeding in the gums as you brush teeth

94
Q

What is thrombocytopenia?

A

A deficiency of platelets

95
Q

Thrombocytopenia increases the risk for

A

bleeding

96
Q

platelet count indicating thrombocytopenia

A

<150,000/mm3

97
Q

Thrombocytosis

A

excessive amount of platelets in the blood

98
Q

platelet count indicating Thrombocytosis

A

>400,000/mm3

99
Q

What is heparin induced Thrombocytopenia ?

A

Immune reaction against heparin and Plt Factor 4

100
Q

Hemophilias are serious ___________ disorders

A

bleeding

101
Q

DIC

A

Disseminated Intravascular Coagulation A complication of other conditions like sepsis, trauma, cancers, obstetric disorders Inflammation or immune mediated with release of cytokines, IL-1, TNF Massive thrombin and fibrin formation-excessive clotting Micro thrombi, vessel occlusion, tissue ischemia, organ failure All coagulation proteins and platelets are consumed and massive hemorrhage ensues

102
Q

What is the hematocrit (HCT)

A

A ration between the cells and the plasma

103
Q

Hematocrit is increased with

A

increase of RBC decreased plasma volume

104
Q

Hematocrit is decreased with

A

decreased RBC increased plasma volume

105
Q

cytic

A

size

106
Q

MCV

A

mean corpuscular volume - this is a measurement of the size of the RBC

107
Q

small MCV is called

A

microcytic anemia

108
Q

large MCG

A

macrocytic anemia

109
Q

normal MCV

A

normocytic anemia

110
Q

if you don’t have iron, you don’t form a lot of

A

hemoglobin

111
Q

different types of anemia

A

iron deficiency anemia megaloblastic anemia sickle cell disease

112
Q

Two groups of disorders for RBC

A

Anemia Polycythemia

113
Q

Anemia is a reduced

A

oxygen carrying capacity of the blood, resulting in tissue hypoxia

114
Q

Physiologic manifestation of anemia

A

Hypoxemia

115
Q

Anemia can be the result of

A

Abnormally low # RBC, Hg, or both

116
Q

What is polycythemia ?

A

Excessive number of RBC with hct greater than 50%

117
Q

Classic anemia symptoms

A

Fatigue Weakness Dyspnea Pallor

118
Q

Several of the clotting factors need which vitamin for synthesis ?

A

Vitamin K

119
Q

•Antiplatelets/Antiaggregants : Aspirin

A

•blocks irreversibly the formation of TxA2

120
Q

the medications Plavix and Ticlid block the ADP receptor, thus preventing what during the clotting process

A

Aggregation

121
Q

•ReoPro and Integriline inhibit GpIIb /IIIa receptor- this is the receptor for

A

fibrinogen

122
Q

Clotting Cascade Picture

A
123
Q

Warfarin inhibits what in the clotting cascade process

A

•Warfarin inhibits vit. K dependent factors , II, VII, IX, X

124
Q

What process of the clotting cascade suffers if there is a low platelet number ?

A

Clot retraction - this is when the clot retracts to brings the edges of the wound closer together. This is facilitated by large numbers of platelets within the clot

•Fibrin strands shorten; become denser and stronger to approximate the edges of the injured vessel and site of injury

125
Q

What happens in the clot retraction phase of the clotting cascade process ?

A

The clot retracts to brings the wound edges closer together

•Fibrin strands shorten; become denser and stronger to approximate the edges of the injured vessel and site of injury

126
Q

What does plasmin digest ?

A

Fibronogen, fibrin strands, factor V and factor VIII

127
Q

What is a D-Dimer ?

A

D-dimer (D dimer, DDimer) is a specific fibrin degradation product (or FDP), a small protein fragment present in the blood, generated after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrin protein

128
Q

Xarelto is a medication that inhibits

A

factor X

129
Q

•Pradaxa, Eliquis are both

A

direct Thrombin inhibitors

130
Q

In what instances is there an accelerated activity of coagulation ?

A
  • Pregnancy
  • Oral birth control
  • Postoperative
  • Immobility
  • CHF
  • Malignant dx
131
Q

There is increased platelet function in what conditions ?

A
  • Atherosclerosis
  • Diabetes Mellitus
  • Smoking
  • ­Lipids/ Cholesterol
  • ­Platelets
132
Q

DVT causes a ________ but not a heart attack or stroke….

A

pulmonary embolism. This can happen without any signs/symptoms of DVT

one or more arteries in the lungs becomes blocked by a blood clot

  • leads to sudden shortness of breath and chest pain
133
Q

To help prevent DVT, in post surgery patients we should especially encourage

A

ambulation

134
Q

What can we do to prevent DVT ?

A
  • Early ambulation after surgery
  • Leg exercises, support stockings, pneumatic compression devices improve venous flow
  • Anticoagulation therapy for treatment and prevention
135
Q

Anticoagulents help to

A

prevent clots by reducing fibrin formation

136
Q

Heparin infusion is adjusted based on the aPTT? What is the aPTT time?

A

•activated Partial Thromboplastin Time (aPTT)

aPTT is the clotting time from the activation of factor XII, through the formation of fibrin clot

137
Q

Heparin is administed through what routes …..

When does it take effect ?

What is the goal with heparin therapy?

A

Administered IV by a continuous infusion or SQ injection

it takes effect promptly (within 20-0 minutes)

  • Infusion is adjusted based on the activated Partial Thromboplastin Time (aPTT)
  • The goal is usually to achieve an aPTT that is 1.5 to 2 times the normal value (~35 seconds)
  • The aPTT should be drawn 6 hours after a change in the rate of infusion and daily if the infusion rate is stable
138
Q

HIT

A

Heparin induced cytopenia

•HIT-Immune reaction against PLT factor 4 and heparin

139
Q

Low molecular weight hepain causes less

A

HIT

140
Q

Increased Platelet Function occurs

A

atherosclerosis

diabetes mellitus

smoking

high lipids/cholesterol

high platelets

141
Q

Accelerated Activity of Coagulation occurs

A

pregnancy

oral birth control

postoperative

immobility

CHF

malignant dx

142
Q

Rivaroxaban (Xarelto) inhibits what clotting factor ?

A

binds to factor X and inhibits the formation of thrombin

143
Q

Xarelto is an alternative for

indications

A

Warfarin

  • Prevention of DVT after knee or hip replacement surgery
  • Prevention of stroke in pt. with atrial fibrillation
144
Q

Dabigatran (Pradaxa), Apixaban (Eliquis) both inhibit

it is only approved for patients with

A

thrombin and its ability to convert fibrinogen into fibrin

•Only approved for patients with atrial fibrillation to prevent stroke

145
Q

Alteplase (Activase) and related drugs Tenecteplase (TNKase) and Reteplase (Retavase)

are all

when should they be given for most effect ?

Indications ?

A

t-PA activators

They must be given shortly after the onset of symptoms to be most effective. This is a major constraint to their use

  • Indications
  • Ischemic stroke
  • Acute MI
  • PE
146
Q

•Can t-PA therapy be given intra-arterially into a clotted blood vessel (coronary artery, pulmonary artery, carotid artery) or IV ?

A

Yes it can

•If given directly into a clotted area, the dose is much lower and therefore safer

147
Q

what kind of heparin causes less HIT ?

A

Low molecular weight heparin

148
Q

ITP - what is it ?

A

Immune Thrombocytopenic Purpura (ITP)

•Autoimmune disorder -Antiplatelet antibody formation and excess destruction of plts

•

  • Antibodies against IIb / IIIa receptor
  • Half cases occur as acute primary disorder in children (5yrs) following viral infection – lasts about 1-2 months with petechiae & purpura -> self-limiting
  • Primary ITP -> chronic disorder in adults (no Hx of infection); onset 18-40 years of age, 3:1 female to males
  • Insidious onset of bruising, bleeding gums, epistaxis, melena. Later, splenomegaly, internal hemorrhage
  • Rx: depends on severity, steroids, IgG, splenectomy
149
Q

Von Willebrand Disease

A
  • Autosomal dominant -> deficiency or defect in vWF à affects plt function & coagulation pathway
  • Spontaneous bleeding with normal plt count
  • Bleeding usually mild
  • TX: Avoid ASA; DDAVP with surgical & dental procedures to stimulate endothelial cells to release stored vWF
150
Q

Macrocytic-Normochromic Anemias is also termed

A

•megaloblastic anemias

characterized by unusually large stem cells, a result of defective DNA synthesis

  • Caused by deficiencies in vitamin B12 or folate
  • Coenzymes for nuclear maturation and the DNA synthesis pathway
151
Q

most common type of megaloblastic anemia

A

vitamin B12 deficiency - can be caused by Pernicious anemia (intrinsic factor is missing)

152
Q

normal hemoglobin count

A

For men, 13.5 to 17.5 grams per deciliter.

For women, 12.0 to 15.5 grams per deciliter.

153
Q

manifestations of megalblastic anemia

A
  • When hemoglobin at 7-8 g/dl:
  • Weakness
  • Fatigue
  • Loss of appetite
  • Abdominal pain
  • Weight loss
  • Sore tongue

MCV increased while

MCHC is normal

  • Neurologic manifestations
  • Deranged myelin formation
  • Paresthesia

Difficulty walking

154
Q

Folate deficiency anemia - this is similiar to pernicious anemia except that what manifestations are not seen

also where is folate absorbed? Is it dependent on anything for absorption?

A
  • neurologic manifestations generally not seen
  • Absorption of folate occurs in the upper small intestine
  • Not dependent on any other factor
155
Q

Folic acid and pregnancy - is there an increased need? what are deficiencies associated with ?

recommended daily amounts for women of CB age and those pregnant

A
  • Increased need for folic acid 5-10x
  • Result of poor dietary habits, anorexia, nausea
  • Folate deficiency associated with neural tube defects
  • All women of CB age should take 400mcg daily; pregnant women 600 mcg daily
156
Q
A

NURS 324 Pathophysiology (6 decks)

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