Hematopoietic Function Flashcards
A transport medium that carries the blood cells as well as antibodies, nutrients, electrolytes, lipids, and waste products
Plasma
These cells are key players in the inflammatory response and infectious process
Leukocytes
What are the five main types of WBCs?
- Neutrophils
- Eosinophils
- Basophils
- Lymphocytes
- Monocytes
Which WBC is used in general response or as a quick immune response?
Neutrophils
These WBC are known as target cells and target a specific antigen
Lymphocytes
In infants, which WBCs are most abundant?
Monocytes and Eosinophils
In adults, which WBCs are most abundant?
Neutrophils and lymphocytes
What binds to the oxygen on RBCs and gives it its red color
Hemoglobin
Refers to how much blood volume consists of erythrocytes
Hematocrit
Which cells, along with clotting factors, control coagulation?
Thrombocytes
This enzyme dissolves clots once healing has occured
Plasmin
The process of blood formation that begins during the first weeks of embryonic development
Hematopoiesis
This system produces lymphocytes
The lymph system (particularly the spleen, lymph nodes, and thymus)
In response to reduced oxygen supply (hypoxia or ischemia), the kidneys produce a growth factor called…
Erythropoietin
______ is a protein in erythrocytes that carries oxygen, but _____ must be present in this protein in the form of heme for oxygen to be transported and released
Hemoglobin, iron
This is also present in the spleen, where old erythrocytes are broken down by macrophages, releasing this to be recycled
Iron
The process that stops bleeding resulting from an injury
Hemostasis
Describes states characterized by increased WBC levels and can indicate an active infectious process
Leukocytosis
Refers to decreased WBC levels and can indicate an immune deficiency state
Leukocytopenia
This refers to a decrease in circulating neutrophils - the degree to which the body can fight infections, especially bacterial infections, reflects the severity of this disease.
May be a result of decreased overall neutrophil production, production of immature or abnormal neutrophils, or increased utilization or destruction of neutrophils.
Clinical manifestations reflect a state of immunodeficiency - initially include signs and symptoms of bacterial and fungal infections.
Respiratory tract is the most common site of infection - mouth, skin, vagina, and gastrointestinal ulcerations are also often associated.
Neutropenia
An infection most often caused by the Epstein-Barr virus (EBV) infecting oropharyngeal and epithelial cells.
EBV infects B cells by either killing the cells or being incorporated into their genome - once the disease is eliminated, a few B cells remain altered, giving the individual an asymptomatic infection for like and the potential to spread EBV to others if the virus becomes reactivated.
Saliva is the primary method, but transmission can also occur through coughing or sneezing.
Flu-like symptoms, fever, lymphadenopathy - causes inflammation and enlarged spleen that can rupture.
Infectious Mononucleosis
Cancers that develop from lymphatic cells in the lymphatic system - most common blood cancers
Lymphomas
What are the two main types of lymphomas?
Hodgkin and non-Hodgkin lymphoma
Which type of lymphoma is more common?
Non-Hodgkin lymphoma
Cancer of the lymphatic system; most commonly lymph nodes of the upper body.
Hallmark of the disease is the presence of Reed-Sternberg cells, abnormal B-lymphocytes
Nodular sclerosis is the most common type of lymphoma - arises in a single node or chain of nodes
Etiology: may be genetic, exposure to viruses, carcinogens
Manifestations include one or more enlarged lymph nodes, persistent fatigue, fever, anemia, night sweats, unexplained weight loss, itchy skin, and occasional pain in lymph nodes
Hodgkin Lymphoma
Lymphoma originates at extranodal sites and spreads to anatomically contiguous nodes.
Metastasizes in an unorganized manner.
More difficult to treat and the Reed-Sternberg cells are not present.
Non-Hodgkin Lymphoma
Malignant neoplasms arising from the transformation of a single blood cell line derived from hematopoietic stem cells.
Characterized by uncontrolled proliferation of white blood cells in the marrow.
Can spread to different parts of the body, including lymph nodes, liver, spleen, and CNS.
Leukemias
What are the classifications according to cell lineage of leukemias?
Lymphocytic (lymphocytes are affected)
Myelocytic (monocytes or neutrophils are affected)
Acute
Chronic
These types of leukemias involve the pluripotent myeloid stem cells in bone marrow and interfere with the maturation of all blood cells.
Acute myelogenous (myeloblastic) leukemia (AML)
Chronic myelogenous (myeloblastic) leukemia (CML)
This disease is characterized by excessive numbers of abnormal plasma cells in bone marrow crowding the blood forming cells - often associated with chromosomal abnormalities.
+ proto-oncogenes and - tumor suppressor genes
- This leads to abnormal B-cell development in bone marrow
- These B-cells become activated as they circulate, return to bone marrow, and destroy bone marrow by increasing osteoclast activity
- Osteoclast activity also cause bone lesions and hypercalcemia leading to pathologic fractures and decreased hematopoiesis
Common symptoms include:
- Weakness, malaise
- Bone pain
- Renal failure
- Pathologic fracture
- Infection (often pneumococcal)
- Spinal cord compression
- Hypercalcemia
- Anemia
Multiple Myeloma
This laboratory test measures the total number of red blood cells in 1 mm3 of blood (normally 4.7-6.1 million in men, 4.2-5.4 in women)
Red blood cell count (RBC)
This laboratory test provides an index of the rate of red cell production
Percentage of reticulocytes
This laboratory test measures the volume of red cell mass in 100 mL of plasma volume
Hematocrit (40-54% for men, 36-48% for women)
An abnormally low number of circulating red blood cells or level of hemoglobin, or both. Results in diminished oxygen-carrying capacity
Caused by excessive loss or destruction of red blood cells and deficient red blood cell production because of a lack of nutritional elements or bone marrow failure
Anemia
What are the manifestations of anemia?
- Impaired oxygen transport with the resulting compensatory mechanisms
- Reduction in red cell indices and hemoglobin levels
- Signs and symptoms associated with the pathologic process that is causing the anemia
This type of anemia is caused by a lack of iron, which is required for hematopoiesis and characterized by small, pale erythrocytes (hypovolemic and hypochromic).
Iron supplies are low due to:
- inadequate intake
- inadequate absorption (celiac disease, atrophic gastritis, bariatric surgery)
- increased loss of iron (menstruation or some cancer)
Iron-deficiency anemia
This type of anemia is caused from a lack of B12 - which is required for DNA synthesis
Characterized by large, immature erythrocytes (hypervolemic)
The lack of B12 also causes the breakdown of myelin and neuro effects
Pernicious Anemia
What are the causes of low B12 levels?
- Lack of B12 consumption
- Lack of absorption, often due to a lack of intrinsic factor in the stomach (this may result from having auto antibodies that cause atrophy of gastric mucosa and glands, or by surgery that affects the stomach).
This type of anemia is due to a general bone marrow problem where it doesn’t make enough cells (Pancytopenia: lack of erythrocytes, leukocytes, platelets (the number of all cells will be lower than it should be)
Multiple causes: most often from toxins, genetic abnormalities, medications, or autoimmune
Aplastic Anemia
This type of anemia is characterized by excessive hemolysis (such as in sickle cell anemia, thalassemia, and erythroblastosis fetalis)
Hemolytic Anemia
Genetic disorder in which abnormality in blood protein hemoglobin causes an inadequate amount of O2 to be carried throughout the body (cell is misshapen, causing a low surface area to carry oxygen).
Crescent moon shape to RBCs
- Cells become rigid, sticky causing blockages in vessels
- Cells are weak, so they break apart and have shorter lifespan
- Clumps of cells act like a clot and can’t pass through capillaries as easily
Sickle Cell Anemia
What are the manifestations of Sickle Cell Anemia?
- Pain, prone to infection, cardiomegaly (iron deposits from frequent transfusions), bone and organ infarction, shortened life span
Infants don’t show signs due to HbF, which will not sickle but this decreases over the first year
In early childhood, known as chronic hemolytic anemia where signs of fatigue, weakness, slow growth development, pale, jaundice, low BP, heart palpitations, increased HR, and spleen enlargement.
Genetic defect that causes abnormal hemoglobin produced due to an absence of either the alpha or beta globin protein that make up hemoglobin
Reduction in the number and ability of red blood cells to carry oxygen throughout the body
Can cause symptoms such as fatigue
Results in hypercoagulability, ineffective erythropoiesis, and hemolysis (red blood cell destruction)
Thalassemia
A condition in which the red blood cell mass is increased (red blood cell cancer - too many red blood cells).
Doesn’t seem to affect other tissues or cells.
Extra fluid can be given to balance the level of RBCs.
Polycythemia Vera
Type of polycythemia vera that results from a loss of vascular fluid and is corrected by replacing the fluid
Relative polycythemia
A proliferative disease of the bone marrow with an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts
Primary polycythemia
Results from increased erythropoietin levels cause by hypoxic conditions such as chronic heart and lung disease
Secondary polycythemia
What are the manifestations of polycythemia?
Manifestations are variable and related to an increase in RBCs, hemoglobin level, and hematocrit with increased blood volume and viscosity
- Splenomegaly
- Disrupted cardiac output
- Hypertension
- Decreased cerebral blood flow
- Venous stasis
- Thromboembolism and hemorrhage
The stoppage of blood flow
Hemostasis
What are the five stages of hemostasis?
- Vessel spasm (temporary)
- Formation of the platelet plug (platelets attracted to damaged area)
- Blood coagulation or development of an insoluble fibrin clot (prothrombin & thrombin)
- Clot retraction
- Clot dissolution
The inappropriate formation of clots within the vascular system (too much)
Thrombosis
Failure of blood clot in response to appropriate stimulus (not enough)
Hemorrhage
Blood test that measures how long it takes the blood to clot (also known as INR). Measures specific clotting factors - used most often to detect Warfarin therapy levels
Prothrombin Time (PT)
Blood test that measures how long it takes the blood to clot - but focuses on coagulation pathways. Used most often to detect Heparin therapy levels
Partial Thromboplastin Time (PTT)
What are the requirements for blood clotting process?
- Presence of platelets produced in the bone marrow
- Von Willebrand factor generated by the vessel endothelium
- Clotting factors synthesized in the liver using Vitamin K
Which conditions create increased platelet function (hypercoagulation)?
- Atherosclerosis
- Diabetes mellitus
- Smoking
- Elevated blood lipid and cholesterol levels
- Increased platelet levels
Which conditions cause accelerated activity of the coagulation system?
- Pregnancy and postpartum
- Use of oral contraceptives
- Postsurgical state
- Immobility
- Congestive heart failure
- Malignant diseases
What are the causes of excessive bleeding?
- Decrease in the number of circulating platelets (depletion of platelets must by relatively severe before hemorrhagic tendencies of spontaneous bleeding occur)
- Impaired platelet function (bleeding resulting from platelet deficiency commonly occurs in small vessels and is characterized by petechiae and purpura)
Genetic blood disorder in which blood doesn’t clot normally (clotting factors are absent).
Diagnosis occurs usually at birth, or acquired (antibodies attack blood cells and destroy them)
X-linked recessive disorder (affecting factor VIII gene on X chromosome)
1/3 of cases caused by spontaneous mutation
Majority of cases are males
Hemophilia A (Factor VIII Disorder)
What are the manifestations of Hemophilia A?
- Excessive unstoppable bleeding
- Spontaneous bleeding
- Goose eggs on heads (infants)
- Bruises easily
- Joint pain
- Joint swelling
- Internal bleeding
This is considered an emergency and is caused by obstetric conditions, cancers, infections, shock, trauma or surgery, and hematologic conditions
Considered a disease of hypercoagulation that bleeds - clotting occurs all over the body and uses up all of the clotting factors needed for forming clots when a bleed does occur.
Disseminated Intravascular Coagulation (DIC)
Hypocoagulopathy from autoantibodies destroying its own platelets
- IgG reacts with platelets which are then destroyed in the spleen and liver
- Destructive platelet disease
Immune Thrombocytopenic Purpura
Loose platelet and fibrin strands are deposited in small vessels. These can damage passing platelets and erythrocytes.
Platelets can collect as multiple small thrombi
Characterized by thrombi, thrombocytopenia, and bleeding
Thrombocytopenia is non-immunologic, however many are acquired by autoantibodies against the ADAMTS13 gene
Thrombotic Thrombocytopenic Purpura
