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Thrombocytopenia
Too little platelets <100,000
spontaneous bleeding and bruising
Acute (hemorrhage)
Eti:
Rapid loss of blood loss as in hemorrhage caused by trauma, childbirth, or rupture of a major blood vessel or organ
Severe GI bleeding can occur in disorders such as esophageal varices or penetrating peptic ulcer
Patho:
Large numbers of RBCs and plasma volume are lost
Lack of RBCs to carry oxygen causes tissue hypoxia
Fluid lost from bloodstream stimulates sympathetic nervous system, systemic arterial vasoconstriction, fluid shift from tissues into capillaries, stimulation of RAAS, and antidiuretic hormone (ADH) release
all act to increase fluid volume in bloodstream
CM:
Hypotension, tachycardia, tachypnea
Hemoglobinopathy (Sickle Cell)
Etiologies:
Inherited disorder of the structure of the HGB that can lead to destruction of RBC and can’t carry oxygen
Patho:
Under hypoxia, severe stress, infection, or dehydration, the SCA Hgb becomes distorted in shape changing into sickle-cell shape
These abnormal cells have a shortened life span of 10-20 days
Due to being broken down faster by the spleen than the bone marrow can replenish, it leads to hemolytic anemia
Distorted RBCs cannot pass easily through capillaries → become trapped → block blood flow and create obstructions to tissues and organs → cause ischemia and tissue hypoxia → can lead to organ damage and possible infarction
CM:
Fatigue, exercise intolerance
Frequent hemolysis of RBCs → increased heme breakdown in circulation → causes high levels of bilirubin in the bloodstream (hyperbilirubinemia) → jaundice and bile concentration in the gallbladder which can lead to gallstones
Microcytic hypochromic anemia (Iron deficiency anemia)
Low MCV indicates small size of RBCs and low MCHC indicate pale color of RBCs
Increased risk:
women of childbearing age- due to pregnancy, delivery, and breastfeeding use a lot of iron
Infants and children- infants may need more iron because not enough in cows milk & children need extra iron during growth spurts
Vegetarians- Not eating meat so they need to supplement with other iron-rich foods
Elderly adults- poor diet and lack of stomach acid can cause iron deficiency
Individuals with GI bleeding- person with peptic ulcer, esophageal varices, or cancer of GI tract can lose blood in the stool
Patho:
Iron is needed in the diet to synthesize Hgb
Heme portion of Hgb contains iron that carries oxygen atoms
Lack of sufficient iron leads to poor oxygen transport by iron-deficient Hgb molecules
Due to this, the body must used stored iron from ferritin complexes in the reticuloendothelial cells, bone marrow, liver, and spleen
Once circulation transferrin becomes depleted of iron, Hgb synthesis is impaired and iron-deficient erythropoiesis starts to occur
As Hgb synthesis decreases, RBC numbers diminish
RBCs that are synthesized are abnormally small and pale
CM:
Fatigue, weakness, exercise intolerance
Melena
Women may have menorrhagia
Hair loss, cheilitis, glossitis, koilonychias (spoon-shaped nails), and pica (craving for nonfood substances such as ice, clay, starch, chalk, dirt, or other materials)
Cold intolerance and feeling of tingling or numbness in fingers occur
Acute Lymphocytic Leukemia (children, abrupt onset)
T and B cells
T and B cells in the bone marrow do not fx so they don’t mature beyond Blast stage
T and B cells Increase in number leaving no room for healthy WBC, RBC, and platelets in bone marrow
Lack of WBC → neutropenia
Lack of RBC -> anemia
Lack of Platelets → thrombocytopenia
Chronic Lymphocytic Leukemia (adults, slow onset w/ reduced fx (insidious)
B-cells
B cells can’t differentiate from precursor B cells into mature B cells in bone marrow
Release low levels of immunoglobulin, mutated immunoglobulin, or none at all
B cells accumulate in bone marrow results in decreased healthy RBC, WBC, platelets
Risk Factors:
Older Age
White
Herbicides and insecticides (Agent Orange used during Vietnam war)
Males
Family history of Cancer
Eti: Genetic changes like a chromosomal abnormality
CM: No symptoms early
Enlarged, painless lymph nodes
Fatigue, fever, pain in Upper Left Abdomen from enlarged spleen
Night sweats, weight loss
Acute Myelogenous Leukemia
Blast cells
Proliferation of undifferentiated WBCs (excluding lymphocytes) in the myeloblast stage within the bone marrow
Bone marrow will have more than 20% myeloblasts (blast cells) = high → proliferation of Blast cells → decrease in RBC → Anemia (bleeding/bruising)
Proliferation of Blast cells affect spleen → abdominal pain, liver, lungs → pneumonia
Risk factors
Male
Smoking
Childhood ALL or MDS
CM:
Infection, chills, night sweats, fatigue, easy bruising, nosebleeds, low appetite, abdominal pain, pneumonia, swollen lymph nodes, enlarged spleen, loss of appetite, abdominal pain
Eti: Radiation therapy/chemo
Chronic Myelogenous Leukemia
Non-functioning mature cells
Overproduction of “mature” myeloid cells in the bone marrow
Myeloid cells look mature, but they do not function. Affects adults.
Risk factors
Old Age
Biological gender
Radiation
CM:
Fatigue, weakness – anemia
Infection, night sweats – leukopenia
Bleeding & bruising – thrombocytopenia
Full abdomen/pain in upper left quadrant – hepatomegaly/splenomegaly
Intrinsic (contact/damaged surface)
aPTT
Extrinsic (tissue factor/trauma)
PT
coagulation cascade
Coagulation factors → synthesized by the liver = form a clot
Two different pathways can activate the coagulation cascade: the intrinsic and extrinsic pathways → both end in a final common pathway → stimulates prothrombin to form thrombin and fibrinogen to form fibrin.
The intrinsic pathway is stimulated by any damage to the endothelial surface of a blood vessel, as in arteriosclerosis, or any turbulence in blood flow, as in atrial fibrillation.
The extrinsic pathway is stimulated by external trauma to a blood vessel, as happens in a laceration.
aPTT
30-40 seconds
Measures time to clot; evaluates intrinsic pathway of coagulation cascade
Prolonged aPTT suggests need for further tests. May indicate
coagulation factor deficiency
inhibitor of factor VIII
Nonspecific inhibitor, such as lupus anticoagulant
patient on heparin
PT
10-14 seconds
Measure time to clot, evaluates extrinsic pathway of coagulation cascade
Most common use is monitoring warfarin anticoagulant therapy
INR
1 second
Time for patients blood to clot compared to normal time for blood to clot
Any result >1 indicates prolonged time of clotting of blood
Breast Cancer
Eti:
Prolonged reproductive life (late menopause)
50 or older
Obesity
Increased estrogen in fat deposits
History and having no children
Patho:
EPITHELIAL cell tumors develop from cells lining the ducts or lobules of the breast → invade tissue of breasts
Estrogen receptors promote DNA replication & cell division → ER positive = breast cancer)
CM:
Single tumor- nontender, firm with irregular borders.
Most common place is the upper, outer quadrant.
Nipple discharge, swelling
Peau d’orange (thickening of skin that resembles an orange peel)
Paget’s disease- redness, crusting, pruritus, and tenderness in breast
Prevention:
Healthy weight, physical activity, no alcohol
Colon Cancer
Eti:
Genetic
Familial adenomatous polyposis (FAP) = predisposed to polyps
IBD-Ulceratice colitis and Crohn’s disease
Patho:
Begins as a polyp → becomes cancerous
Genetic changes result in defective tumor suppressor genes → activated oncogenes or mismatched gene repair
Normal colonic cells → benign adenoma → adenomatous polyp → adenocarcinoma (cancerous)
CM: Affects bowels
Fatigue, weakness, abdominal cramping, weight loss, changes in bowel habits, diarrhea, and constipation,
Iron deficiency anemia a sign of slow GI blood loss that occurs in colon cancer
Melena
Prostate Cancer
Eti:
Father or bro who had it increases your risk
Consumption of fat, red meat, fried foods, and dairy
High calcium intake → increase proliferation of cells
Alc & smoking
Prevention:
Eat lots of veggies
Moderate exercise
Increase Vitamin D → vitamin D regulates growth of tumor cells
Patho:
Adenocarcinoma mutations
Tumor suppressor genetic defect → uncontrolled cell growth in the gland → metastasis (spread of cancer throughout body)
CM:
Prostate gland can obstruct urine flow
Decrease urine in the stream
Incomplete bladder emptying
Back pain
How are Malignant tumors graded?
Grade I indicates that the cells are well-differentiated (normal)
Grade II cells are moderately differentiated
Grade III indicates poorly differentiated or anaplastic (abnormal)
Grading & Staging predict?
The disease course and assist in the formulation of a treatment plan
Staging uses the TNM system
T = tumor size, N = lymph node involvement, and M = metastasis to distant organs
Staging classifies the tumor according to size, invasiveness, and spread.
Difference between staging and grading?
The stage of cancer describes the size of a tumor and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.
