Nurs 2005: Hematology Disorder Flashcards
Bone Marrow
- blood forming tissue
- produces cell components of blood
- all development of common stem cell
What are the 3 types of blood cells?
- erythocytes = RBC
- leukocytes
- platelets
What is the func of eythrocyes?
- oxygenation
- hemoglobin transports O2
What is the production of erythrocytes?
- regulated by cellular O2 requirements and general metabolic activity
- Erythropoiesis*
- Reticulocyte - immature erythrocytes
- nutrition = folic acid, iron, vit b12
Anemia
- dec in RBC
- dec hemoglobin and hematocrit
- blood cells are destroyed
- not disease but manifestation
What are the clinical man of Anemia?
- mild anemia
Hb = 10-14
- SOB during exercise
- palpations
- external dyspnea
- moderate anemia
Hb= 6-10
- SOB at rest
- inc palpations
- dyspnea
- severe anemia
Hb = <6
- tachycardia
- affects all body systems
What are the severe clinical man of anemia?
- CV
- Resp
- Neuro
- GI
- MS
- Skin
- CV
- inc HR
- angina
- MI, CHF - Resp
- inc RR
- dyspnea - Neuro
- h/a
- dizziness - GI
- spinomegaly = large spleen
- hetomegaly = large liver - MS
- bone pain - Skin
- pale yellow
- “cytic”
a. macro/micro - “chromic”
a. hypo
b. normo
- “cytic”
- cell size
a. macro/micro
- large/small
- “chromic”
- hemoglobin content
a. hypo = less than normal
b. normo = normal
Macrocytic- Normochomic Anemias
A. Pernicious Anemia aka megaloblastic
- impaired Vit B 12 absoption
- vit b 12 = DNA synthesis
- lack of folic acid
- cells mature quickly but quickly die
Pernicious Anemia PATHO
- defective secretion of intrinsic factor
- needed for absorption of vit 12
Pernicious Anemia ETIOLOGY
- gastic atrophy
- surgery
Pernicious Anemia Clinical Man
- weakness, fatigue
- GI problems
- neuro
- general problems
Pernicious Anemia DIAGNOSTIC TEST
a. serum B 12
- low
b. RBC = big
H&G =
c. Shillings test
- drink Vit 12 solution
- look at amount absorbed in urine
Pernicious Anemia TREATMENT
- vit b 12 injections
B. Folic acid
- lack of vit folate (folic acid)
Folic acid PATHO
- folate needed for DNA synthesis
- RBC formation and maturation
Folic acid ETIOLOGY
- poor diet
- poor absorption
- alcohol abuse
Folic acid CLINICAL MAN
- weakness, fatigue
- GI problems
- general problems
similar to PA BUT NO NEURO problems
Folic acid TX
- folic acid
Microcystic- Hypochormic Anemia
A. Iron Deficiency Anemia
- depletion of iron in body
- ddec supply of iron for hemoglobin
Iron Deficiency Anemia PATHO
a. iron stoes for RBC production depleted
b. insufficient iron transported to bone marrow
- alter RBC production starts
c. hemo deficit RBC’s enter circulation
- replace normal response
Iron Deficiency Anemia ETIOLOGY
- inadequate intake
- malabsorption
- blood loss
- GI bleeding
- heavy bleeding
d. preggo
- iron go goes to fetus
Iron Deficiency Anemia CLINICAL MAN
- tongue and lips
- sore and inflamed mucosa
- beeft red - H/A
- numbness, tingling
- confusion
- lack of O2 in brain
Iron Deficiency Anemia TESTS
a. RBC = small
H&H = less
b. serum Fe
Iron Deficiency Anemia TX
- stool sample then treat cause
- iron supplements
B. Polycythemia
- inc RBC
- thick blood
- excess vol
- inc BP and work of heart
Polycythemia PATHO
- primary
- chronic problem
- poor circulation/perfusion
- caused by excessive proliferation of erythrocyte precursors in marrow.
- myloproliferate disorder
- seen > 50 years old
Polycythemia PATHO
- secondary
- caused by hypoxia
- compensatory mechanism
- inc RBC d/t underlying system disorder
Polycythemia CLINICAL MAN
- plethora
- red hands, feet, d/t vasoconstriction - enlarged retinal and cerrebral veins
- d/t blood pooling - liver and speel enlargement
- headache
- confusion
- visual disturbances
- painful itching
- poor blood flow in mass cells
polycythemia TESTS
- blood test
- RBC and WBC high - bone marrow biopsy
Polycythemia TX
- reduce blood vol
- RBC phlebotomy
- fluids
. meds
WBC: Leukocytes
Leukocytes FUNC
- inc name
- dec name
- phagocytosis of bacteria and foreign particles
inc: LEUKOCYTOSIS
dec: LEUKOPENIA
Types of WBC
- Granulocytes:
a. neutrophils- neutrophilia = ?
- neutropenia = ?
- neutrophilia = ?
- strong phagocyctic activity
- primary phagocytic cell = inflam - - -
- neutrophilia = infection, inflam, necrosis
- neutropenia = prolong infection
Types of WBC
- Granulocytes:
b. esinophils
- eosinophilia = ?
- eosiniopena = ?
- allergic response in parasitic infections
- eosinophilia = allergies, infections
- eosiniopena = surgergy stress
Types of WBC
- Granulocytes
c. basophils
- basophilia
- basopenia
- limited role in phagocytosis
- contain heparin, serotonin, histamine
- basophilia = allergic rx, infection
- basopenia = preg, shock, hyperthyroidism
- Lymphocytes function
- lymphocytosis
- lympocytopenia
- cellular and humoral responses
- lymphocytosis = viral infection, hepatitis, leukemia
- lympocytopenia = AIDS, renal failure, steriods
Lymphocytes :
a. B cells
b. T cells
a. B cells:
- stim by antigens = antibodies
b. T cells:
- cellular immune response
- Monocytes func
- monocytosis
- monocytopenia
- large, slow moving potent pahgocyes = macrophages
- monocytosis = late infection, chronic infection
- monocytopenia = rare
Platelets
- Thrombocytes FUNC
- normal range
- blood coagulation
- control bleeding
normal range
140 k - 340 k
- Thrombocytopenia
< 100 k platelets
<10 k severe bleeding
Thrombocytopenia ETIOLOGY
- viral infection
- nutritional deficits
- meds
- ITP = autoimmune destruction of platelets
- TIP = platelets aggregate = occlusion
Thrombocytopenia CLIN MAN
a. petechiae
b. purpura
c. ecchymosis
d. ?
a. petechiae = red dots on skin
b. purpura = bigger red dots together
c. ecchymosis = bruise
d. prolong bleeding
Thrombocytopenia TESTS
- platelet count
- dec amount - bleeding time
- punc skin and see how long it’ll take to clot
Thrombocytopenia TX
- dec platelets = platelets
ITP = steroids
TIP = plasma
Thrombocythemia
- elevated count >400k
Thrombocythemia ETIOLOGY
- accelerated production
- splenectomy
Thrombocythemia CLIN MAN
- thrombosis formation
- headache
- transient ischemic attacks
- GI hemorrhage
Thrombocythemia TX
- meds to suppress bone marrow
- pheresis = remove platelets
Clotting Mechanism:
- Vascular response
- vasoconstriction after blood vessel injurty
Clotting Mechanism
- Platelets
- activated after injury
- form clumps, plug
- facilitates rx of clotting factors
Clotting Mechanism
- Clotting factors
- activated after injury and thromboplastin
- thrombin –> fibrinogen –> fibrin
Coagulation Disorders:
A. Impaired Hemostasis
- vit K
- liver disease
Coagulation Disorders:
B. Thrombohemmorrhagic Disorder: Disseminated Intravascular Coagluation
thornosis and hemorrhage
Coagulation Disorders:
B .DIC ETIOLOGY
- underlying disease
- shock
- infection
- obsetric accident
- burns]
- trauma
- liver disease
B. DIC PATHO
- enhanced coagulation mech
- activation of fibronlytic system
- depletion of clotting factors
B. DIC Clin MAN
a. Bleeding
b. Thrombosis
a. Bleeding:
- pallor
- petechia, bruising
- inv RR and HR
- hemoptysis
- dec BP
- GI bleeding
- HA = change in mental status
b. Thrombosis
- dyspnea
- PE
- tissue necrosis
- ARDS
- kidney damage
Coagulation Disorders:
B. DIC Test
- platelet count
- fibrin split products
- bleeding time
Coagulation Disorders:
B. DIC TX
- treat cause
- blood products
- anticoagulants
Spleen FUNC
- hematopoietic
- fllter
- immune
- storage
Spleen Alt in Func:
- Overactive spleen
- underactive spleen
- hypersplenism
- reduc all circulating blood cells - Removal of spleen
- dec immune sys
- inc leukocytes
- more defective blood cells
Lymph System FUNC
- prevent edema
- carries fluid from interstitial spaces and returns excess fluids
- transport protein and fat
Lymph nodes contain lymphocytes, monocytes and macrophages which cleanse lymph of foreign particles and microorganisms.
Alternations in Func
Lymphadenopathy
a. localized
b. general
a. localized
- infection in that area
b. generalized
- lymphs enlarged everywhere = cancer
