Module 10: Alterations Of RBC’s, Platelets, WBC’s And Lymphoid/Hemostatic Function (b) Flashcards
1
Q
Anemia
-Definition
A
- Reduction in total number of erythrocytes in the circulating blood OR in the quality or quantity of hemoglobin
- Impaired Erythrocytes production
- Acute or chronic blood loss
- Increased erythrocytes destruction
- Combination of all the above
2
Q
Anemia
-Classifications
A
- Etiology
- Morphology — Mainly based on MCV -macrocytic, microcytic, normocytic
- Hemoglobin content —Identified by ending in “chromic”
Other Descriptors
- Anisocytosis — RBCs are present in various sizes (RDW) — Accelerated RBC destruction
- Poikilocytosis — RBCs are present in various shapes (Peripheral blood smear) — Possible Blood borne cancers — Ex: SICKLE CELL
3
Q
Anemia
-Manifestations
A
- MAJOR physiologic manifestation is HYPOXIA TEST
2. Classic Sx’s of anemia — Fatigue, weakness, dyspnea, and pallor
4
Q
Anemia
-Compensatory Mechanisms
A
- CV Function — Increased preload, HR, & Stroke volume; reduced Afterload —Vasodilation is hypoxia induced — Lower blood viscosity
- Respiratory Function — Dyspnea
- Nervous System Function — myelin degeneration & Parasthesias
- GI Function — Pain, N/V anorexia
5
Q
Normochromic-Macrocytic Anemias **
-Info
A
- Megaloblastic anemias — RBCs are unusually large
- Defective DNA synthesis — D/t deficiencies in vitamin B12 or folate
- DNA synthesis is altered while RNA processes occur at normal rate — Results in unequal growth of nucleus and cytoplasm
6
Q
Normochromic-Macrocytic Anemias **
-Vitamin B12 Deficiency Anemia
A
- Pernicious anemia is MOST COMMON subtype — Results from lack of INTRINSIC factor from gastric parietal cells
-Main Cause is: Atrophic Gastritis
—Autoimmune forms — Parietal cell antibodies — Intrinsic factor antibodies
-H. Pylori infection destroys parietal cells
-Prolonged PPI and H2 blocker use — Gastric acid is needed to cleave Vit B12
-Gastrectomy — Loss of gastric parietal cells
7
Q
Normochromic-Macrocytic Anemias **
-Pernicious Anemia (Vit B12) Clinical Manifestations
A
- Weakness/Fatigue
- NEUROLOGIC Sx’s from nerve demyelination — NOT reversible even w/ Tx
- Paresthesias of feet and fingers — difficulty walking
- Loss of appetite, abdominal pain and weight loss
- Sore tongue that is smooth and BEEFY RED — Secondary to atrophic glossitis
- Often unrecognized in older adults d/t subtle slow onset and presentation (Develops over 20-30 yrs)
8
Q
Normochromic-Macrocytic Anemias **
-Folate Deficiency Anemia
A
- Folate is essential vitamin for RNA and DNA synthesis
- Absorption of folate occurs in UPPER SMALL INTESTINE; self dependent
- Common in alcoholics and individuals w/ chronic malnourishment —Folate is stored in the liver
- Associated with FETAL NEURAL TUBE DEFECTS
9
Q
Hypochromic-Microcytic Anemias
-Definition/Info
A
- Characterized by red cells that are abnormally small and contain reduced amounts of hemoglobin
R/T
-Disorders of iron metabolism
-Disorders of porphyrin and heme synthesis
-Disorders of globin synthesis
10
Q
Hypochromic-Microcytic Anemias
-Iron-Deficiency Anemia
A
- Most common type of anemia worldwide
- Highest risk — Older adults, women, infants — Black females living in urban poverty HIGHEST RISK
- Associated w/ cognitive impairment in children
- Iron deficiency anemia and folate deficiency anemia are two LEADING causes of anemia in pregnancy
11
Q
Hypochromic-Microcytic Anemias
-Iron-Deficiency Anemia Causes
A
- Inadequate dietary intake
- Chronic blood loss — Most Common in developed countries
- Chronic parasitic infections — Developing countries
- Metabolic or functional iron deficiency
- Menorrhagia — Excessive bleeding during menstruation
Ask Pt’s :: Any blood in stool?
12
Q
Hypochromic-Microcytic Anemias
-Iron-Deficiency Anemia Clinical Manifestations
A
- Fatigue, weakness, SOB
- Pale earlobes, palms, and conjunctivae
- Brittle, thin, coarsly ridged and spoon-shaped nails — Concave or KOILONYCHIA **
- Red, sore, painful tongue — Severity of tongue pain coincides w/ severity of anemia
- Angular stomatitis — Dryness and soreness in corners of the mouth
- Symptomatic when Hgb is 7-8g/dl
13
Q
Hypochromic-Microcytic Anemias
-Sideroblastic Anemia
A
- Group of disorders caused by defect in mitochondrial heme synthesis
—Altered mitochondrial metabolism causes ineffective iron UPTAKE and results in dysfunctional hemoglobin synthesis - Ringed sideroblasts in bone marrow are diagnostic
- Clinical manifestations — Hemochromatosis & Splenomegaly & Hepatomegaly
14
Q
Normochromic-Normocytic Anemias
-Definition/Info
A
- Characterized by RBCs that are relatively normal size and hemoglobin content, but INSUFFICIENT NUMBER
- Least frequent w/ no common cause
15
Q
Normochromic-Normocytic Anemias
-Aplastic Anemia
A
- Pancytopenia — Reduction or absence of ALL 3 types of blood cells (Ex: WBC, RBC, and PLT)
- Most aplastic anemias are AUTOIMMUNE disorders — Some d/t chemical exposure to benzene, arsenic, chemotherapy drugs
- Pure RBC aplasia — Only RBCs are affected
16
Q
Normochromic-Normocytic Anemias
-Aplastic Anemia Patho
A
- AUTOIMMUNE destruction of hematopoietic stem cells or their progenitors at various stages of differentiation by CYTOTOXIC T-CELLS
- Clinical Findings — Characteristic lesion is a hypo cellular bone marrow that has been REPLACED WITH FAT
- Clinical Manifestations
- Hypoxemia, pallor — occasionally brownish pigmentation of the skin
- Weakness w/ FEVER and dyspnea w/ rapidly developing signs of HEMORRHAGING if PLT’s are affected
17
Q
Normochromic-Normocytic Anemias
-Post-Hemorrhagic Anemia
A
- Acute blood loss from vascular space
2. Manifestations depend on severity of blood loss — If blood loss exceeds 2 liters, Shock sets in
