Heme-Onc Flashcards
Hemoglobin
main component of RBCs; essential protein that combines with and transports O2 to the body
Normal Males: 14-18 g / 100 mL
Normal Females: 12-16 g / 100 mL
Hematocrit
measures the percent of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC mass (RBC concentration)
Normal Males: 40-54%
Normal Females: 37-47%
TIBC: Total Iron Binding Capacity
Normal: 250-450 ug/dL
High in: iron deficiency anemia
Low in: anemia of chronic disease
Serum Iron
Normal: 50-150 u/dL
Low in: iron deficiency anemia, anemia of chronic disease
MCV: Mean Corpuscular Volume
expression of the average VOLUME and SIZE of individual erythrocytes
Normal: 80-100 fl
Microcytic: < 80
Macrocytic: > 100
MCH: Mean Corpuscular Hemoglobin
expression of the average amount and weight of hgb contained in a single erythrocyte
Normal: 26-34 pg
MCHC: Mean Corpuscular Hemoglobin Concentration
expression of the average hgb concentration or proportion of each RBC occupied by hgb as a percentage (more accurate than MCH)
Normal: 32-36%
Hypochromic: < 32%
Hyperchromic: > 36%
Normocytic Anemias
MCV = 80-100
anemia of chronic disease, sickle cell disease, renal failure, blood loss, hemolysis
Macrocytic Anemias
MCV > 100
B12 or folate deficiency, alcoholism, liver failure, drug effects
Microcytic Anemias
MCV < 80
iron deficiency anemia, thalassemia
Acute Anemia Signs & Symptoms
cool, clammy skin tachycardia & tachpnea decreased BP narrowing pulse pressure decreased urine output decreased LOC EARLY: thirst, feeling cold
Acute Anemia Treatment
ABCs supplemental O2 large bore IVs NS/LR blood
Acute Anemia Diagnosis
CBC
type & cross
coags
serum electrolytes
Herbal Agents Decrease Clotting Time
cinnamon
parsley
ginseng
Herbal Agents Increase Clotting Time
evening primrose
garlic
skullcap
Definition: Sickle Cell Anemia
chronic hemolytic anemia that is genetically transmitted
characterized by sickle shaped RBCs
Pathophysiology: Sickle Cell Crisis
RBCs become sickle shaped and cause vessel obstruction
cellular hypoxia results in acidosis and tissue ischemia
pain occurs from tissue ischemia and blood hyperviscosity
Factors Which Precipitate Sickling of RBCs
hypoxia infection high altitudes dehydration physical or emotional stress surgery blood loss acidosis alcohol intoxication pregnancy
Epidemiology: Sickle Cell Disease
AFRICAN descent mainly, but also Mediterranean Indian Middle Eastern Caribbean Central/South American
Sickle Cell Disease Genetics
autosomal recessive
1 hgb S gene = trait
2 hgb S genes = disease
Signs & Symptoms: Sickle Cell Disease
develop in infancy or childhood
delayed growth and development & increased susceptibility to infection are common
in a crisis, patients experience:
- sudden onset of severe pain in extremities, back, chest and abdomen
- aching joint pain
- weakness
- dyspnea
Diagnostics: Sickle Cell Disease
decreased hgb
peripheral smear shows classic distorted sickle-shaped RBCs
cellulose acetate and citrate agar gel electrophoresis confirms hgb genotype
Complications: Sickle Cell Disease
priapism
acute chest syndrome (vaso-occlusion of pulmonary vessels)
stroke
Treatment: Sickle Cell Disease
treat both acute and chronic complications
acute:
- fluids for dehydration
- analgesics for pain
- oxygen for hypoxemia
meds:
- hydroxyurea stimulates production of Hgb F which does not sickle when deoxygenated
Definition & Pathophysiology: Leukemia
neoplasms arising from hematopoietic cells in the bone marrow
uncontrolled increase in immature WBCs decreases the function and production of normal WBCs
bone marrow becomes crowded with immature blood cells, reducing ability to create other precursor cells, such as to RBCs and platelets
Classifications of Leukemia
acute vs. chronic
myelogenous vs. lymphocytic
myelogenous - cancerous growth of granulocytes (eosinophils, basophils, neutrophils)
lymphocytic - cancerous growth of B lymphocyte, T lymphocyte, natural killer cells
Acute Lymphocytic Leukemia
s/s: fatigue, tendency to bruise easily, infections, dyspnea
more difficult to cure in adults than children (90% remission rate in children)
pancytopenia with circulating blasts is hallmark of the disease
can cause leukostasis if WBCs rise above 50,000 > stroke or PE
associated with genetics, radiation & meds
Chronic Lymphocytic Leukemia
s/s: spleen and liver enlargement, fatigue, easy bruising, weight loss, infections
most common leukemia in adults
median survival is 10 years
lymphocytosis (increased B lymphocytes, T lymphocytes and natural killer cells) is the hallmark of the disease
Signs and Symptoms: Leukemia
may be asymptomatic fatigue weakness anorexia generalized lymphadenopathy weight loss fever bone pain liver and spleen enlargement neurologic findings elevated uric acid level
Acute Myelogenous Leukemia
s/s: fever, fatigue, bruising, infections
80% of leukemia in adults
remission rates from 50-85%
long term survival approx 40%
auer rods - formed by aggregation of myeloid granules
increasing prevalence with age
Chronic Myelogenous Leukemia
s/s: weight loss, sweating, fatigue, spleen enlargement, higher risk of tumor lysis syndrome and leukostasis
occurs most often in those aged 40 or older and men
median survival is 3-4 years
philadelphia chromosome is seen in leukemic cells (hallmark of disease)
Diagnostics: Leukemia
CBC with subnormal RBCs and neutrophils
elevated ESR
peripheral blood smear usually distinguishes acute and chronic leukemia, but a bone marrow aspiration is required to CONFIRM the diagnosis
Platelets
150,000-400,000 /uL
< 150,000 is thrombocytopenia
Causes of Thrombocytopenia
decreased bone marrow production increased splenic sequestration peripheral consumption accelerated destruction of platelets menses nutrition severe deficiencies in iron, folate, B12 sepsis tumors medications (such as ASA) bleeding
Definition: Idiopathic (Immune) Thrombocytopenia Purpura
thrombocytopenia (platelets < 150,000) resulting from an autoimmune destruction of platelets with or without suppression of thrombopoiesis
