Nx 102 Hematological Function Flashcards
Test 1
hematologic system is composed of…
blood and blood forming sites
blood forming sites
bone marrow - primary; red; ribs; pelvis; vertebrae; and sternum
reticuloendothelial system - liver and spleen
3 primary types of blood cells
erythrocytes
leukocytes
thrombocytes
5 types of luekocytes
neutrophils (granulocyte) basophils (granulocyte) eosinophils (granulocyte) monocytes lymphocytes (T & B)
hematopoiesis
blood cell production
hematostasis
maintaining proper blood level esp when faced w/ trauma
- clot (thrombus) formation
- clot dissolution (fibrinolysis)
extramedullary hematopoiesis
reticuloendothelial cells of the liver and spleen
reticulocyte
immature erythrocyte (RBC); nucleated
under conditions of _____ _______, reticulocytes and other immature cells may be prematurely released into circulation
rapid erythopoiesis
erythopoietin
hormone produced by kidney; stimulated myeloid stem cells to produce RBCs
2 types of blood forming stem cells
myeloid - RBC, WBCs (most), and platelets
lymphoid - T and B lymphocytes
dietary requirements for erythopoiesis
iron, B12, and folic acid
iron is stores as
ferritin
average lifespan for RBC
120 days
old/damaged RBCs are removed by…
reticuloendothelial cells in the liver and spleen
most hemoglobin is _____, while small amounts are broken down to ____ and secreted in the ______
recycled, bilirubin, bile
normal RBC count (MALE)
4.7 - 6.1 mm3
normal RBC count (FEMALE)
4.2 - 5.4 mm3
normal Hgb (MALES)
14 - 18 g/dL
normal Hgb (FEMALE)
12 - 16 g/dL
normal Hct (MALE)
42 - 52%
normal Hct (FEMALE)
37 - 47%
mean corpuscular volume (MCV)
volume or size of the RBC
normocytic
normal MCV = normal size
microcytic
decreased MCV = small size
macrocytic
increased MCV = larger size
mean corpuscular hemoglobin concentration (MCHC)
a measure of the CONCENTRATION of hemoglobin in each cell
normochromic
normal MCHC = normal color
normal MCH = normal color
hypochromic
lower MCHC = less color
lower MCH = less color
mean corpuscular hemoglobin (MCH)
the AMOUNT of hemoglobin per RBC
risk of bone marrow aspiration and biopsy
bleeding and infection (needs signed consent)
common sites for bone marrow aspiration/biopsy
posterior illiac crest (sometimes sternum)
anemia is…
lower than normal hemoglobin and fewer circulating erythrocytes
anemia is not…
a specific disorder
hypoproliferative anema
defective RBC production due to iron, B12, or folate deficiency, decreased erythropoietin production, cancer
- iron deficiency, aplastic, or megaloblastic
hemolytic anemia
excessive destruction of RBCs due to altered RBC production, hypersplenism, drug, autoimmune processes, mechanical heart valves
-characterized by increased numbers of reticulocytes & hyperactive bone marrow
the more rapid the onset of anemia….
the more sever it is
pica
eating extreme “foods”; often a sign of anemia
“smooth tongue”
a sign of iron deficiency/anemia
“beefy, red tongue”
a sign of megaloplastic anemia
cheilosis
sores at the side of the mouth; may be a sign of anemia
signs of anemia
fatigue/malaise/weakness pallor or jaundice cardiac/resp problems (dyspnea/orthopnea) tongues changes (beefy/smooth) nail changes angular cheilosis pica
In anemia, the O2 carrying capacity of hemoglobin is _____, causing ____ ____ which can give rise to ____, weakness, ____ and sometimes angina
reduced, tissue hypoxia, fatigue, dyspnea
mild anemia Hgb levels
10 - 12 g/dL
normal male: 14 -18 g/dL
normal female: 12 - 16 g/dL
moderate anemia Hgb levels
6 - 10 g/dL
normal male: 14 -18 g/dL
normal female: 12 - 16 g/dL
severe anemia Hgb levels
< 6 g/dL
normal male: 14 - 18 g/dL
normal female: 12 - 16 g/dL
hemolytic anemias are often accompanied by ____ caused by increased blood levels of ____.
jaundice, bilirubin
reduced platelet function can cause…
aplastic anemia, petechiae, and purpura
the most common hematologic condition affecting elderly patients
anemia
40% of hospital admissions, 47% in long-term care
anemia in the elderly can result in…
increased fragility, decreased mobility and exercise, increased risk of falling, diminished cognitive function, increased risk for dementia, major depression, decrease muscle mass and bone density
the most common type of anemia
iron deficiency (a type of hyperproliferative anemia) - blood loss, inadequate diet, poor absorption
pathology of iron deficiency anemia
- microcytic, hypochromic RBCs
- fewer RBCs
- decreased Hgb & Hct
- low serm iron & ferritin levels
- decreased O2 carrying capacity
foods high in iron
fish, meats (esp organ), green leafy veggies, enriched breads, cereals & pasta, whole grains, dried fruits (raisins & apricots), egg yolks
aplastic anemia
a type of hypoproliferative anemia; rare; insidious; caused by decrease in or damage to marrow stem cells; may be congenital or acquired; most are idiopathic
pathology of aplastic anemia
- RBCs normocytic, normochromic
- neutropenia (low neutrophil count)
- throbocytopenia (low platelet count)
- Hgb/Hct low
- RBC count low
- prolonged bleeding time
normal platelet count
150000 - 450000/uL
normal prothrombin (bleeding) time
11 - 14 seconds
signs of iron deficiency anemia
waxy pallor, fatigue, dyspnea, tachycardia, brittle hair and ridged nails, smooth tongue, cheilosis, pica, neurologic manifestations in children
signs of aplastic anemia
(often insidious) weakness, fatigue, pallor, dyspnea, signs of infection, purpura, altered level of consciousness, bleeding from the retina
megaloblastic anemia
B12 or folic acid deficiency leading to impaired erythopoiesis; characterized by megaloblastic RBCs; brought on by deficiency of B12 or folic acid
pathology of folic acid deficiency anemia
- megaloblastic RBCs
- low serum folate levels
signs of folic acid deficiency anemia
weakness, fatigue, smooth tongue, mild diarrhea, very pale, confused, paresthesias in extremities, balance issues, irritablility, poor memory, tachycardia, systolic murmur
signs of B12 deficiency (pernicious)
weakness, fatigue, smooth tongue, mild diarrhea, very pale, confused, paresthesias in extremities, balance issues, irritablility, poor memory, tachycardia, systolic murmur
pathology of B12 deficiency anemia (pernicious)
- decreased stomach HCL and intrinsic factor
- fatal if not treated
- lack of B12 inhibits myelin formation
Schilling test
the definitive test for B12 (pernicious) anemia, measures exrection of radiolabled B12 (24 hour urine collection)
In the majority of hemolytic anemias, the premature destruction occurs in the ____
spleen
sickle cell anemia
- a type of hemolytic anemia
- chronic disorder resulting in anemia, pain, and organ failure
- RBCs sickle when hypoxic
sickle cell hypoxic threshold
- varies between patients
- illness, cold, stress, infection, dehydration
lifespan of a sickle cell
10 - 12 days
Hgb level of sickle cell patient
7 - 10 g/dL
polycythemia
an abnormal high RBC count with a Hct>50% in females, 55% in males
relative polycythemia
- Hct rises due to loss of plasma volume without RBC loss
- dehydration, diuretics, diarrhea
absolute polycythemia
Hct rises due to increase in total RBCs and is classified as primary or secondary
polycythemia vera
increased levels of all blood cells due to uncontrolled and rapid cell reproduction, maturation, and proliferation or hyperplasia of the myeloid stem cells
signs of polycythemia vera
ruddy cyanosis (flushed) nose, prurititis, headache, dizziness, fatigue, blurred vision, increased BP, erythromyalgia, splenogemaly, gout, renal stones, dyspnea
the most common hematologic condition affecting elderly patients
anemia
40% of hospital admissions, 47% in long-term care
anemia in the elderly can result in…
increased fragility, decreased mobility and exercise, increased risk of falling, diminished cognitive function, increased risk for dementia, major depression, decrease muscle mass and bone density
the most common type of anemia
iron deficiency (a type of hyperproliferative anemia) - blood loss, inadequate diet, poor absorption
pathology of iron deficiency anemia
- microcytic, hypochromic RBCs
- fewer RBCs
- decreased Hgb & Hct
- low serm iron & ferritin levels
- decreased O2 carrying capacity
foods high in iron
fish, meats (esp organ), green leafy veggies, enriched breads, cereals & pasta, whole grains, dried fruits (raisins & apricots), egg yolks
aplastic anemia
a type of hypoproliferative anemia; rare; insidious; caused by decrease in or damage to marrow stem cells; may be congenital or acquired; most are idiopathic
pathology of aplastic anemia
- RBCs normocytic, normochromic
- neutropenia (low neutrophil count)
- throbocytopenia (low platelet count)
- Hgb/Hct low
- RBC count low
- prolonged bleeding time
normal platelet count
150000 - 450000 mm3
normal prothrombin (bleeding) time
11 - 14 seconds
signs of iron deficiency anemia
waxy pallor, fatigue, dyspnea, tachycardia, brittle hair and ridged nails, smooth tongue, cheilosis, pica, neurologic manifestations in children
signs of aplastic anemia
(often insidious) weakness, fatigue, pallor, dyspnea, signs of infection, purpura, altered level of consciousness, bleeding from the retina
megaloblastic anemia
B12 or folic acid deficiency leading to impaired erythopoiesis; characterized by megaloblastic RBCs; brought on by deficiency of B12 or folic acid
pathology of folic acid deficiency anemia
- megaloblastic RBCs
- low serum folate levels
signs of folic acid deficiency anemia
weakness, fatigue, smooth tongue, mild diarrhea, very pale, confused, paresthesias in extremities, balance issues, irritablility, poor memory, tachycardia, systolic murmur
signs of B12 deficiency (pernicious)
weakness, fatigue, smooth tongue, mild diarrhea, very pale, confused, paresthesias in extremities, balance issues, irritablility, poor memory, tachycardia, systolic murmur
pathology of B12 deficiency anemia (pernicious)
- decreased stomach HCL and intrinsic factor
- fatal if not treated
- lack of B12 inhibits myelin formation
Schilling test
the definitive test for B12 (pernicious) anemia, measures exrection of radiolabled B12 (24 hour urine collection)
In the majority of hemolytic anemias, the premature destruction occurs in the ____
spleen
sickle cell anemia
- a type of hemolytic anemia
- chronic disorder resulting in anemia, pain, and organ failure
- RBCs sickle when hypoxic
sickle cell hypoxic threshold
- varies between patients
- illness, cold, stress, infection, dehydration
lifespan of a sickle cell
10 - 12 days
Hgb level of sickle cell patient
7 - 10 g/dL
polycythemia
an abnormal high RBC count with a Hct>50% in females, 55% in males
relative polycythemia
- Hct rises due to loss of plasma volume without RBC loss
- dehydration, diuretics, diarrhea
absolute polycythemia
Hct rises due to increase in total RBCs and is classified as primary or secondary
polycythemia vera
increased levels of all blood cells due to uncontrolled and rapid cell reproduction, maturation, and proliferation or hyperplasia of the myeloid stem cells
signs of polycythemia vera
ruddy cyanosis (flushed) nose, prurititis, headache, dizziness, fatigue, blurred vision, increased BP, erythromyalgia, splenogemaly, gout, renal stones, dyspnea
secondary polycythemia
-excessive RBCs due to excessive erythopoietin due to hypoxia, renal tumors, heavy smoking, disease, or any condition that causes prolonged hypoxia
thrombocytopenia
- bleeding disorder; platelet levels <100000/uL
- caused by platelet destruction or consumption
pathology of throbocytopenia
- platelets <100000/uL
- prolonged bleeding time
- megakaryocytes in bone marrow
- clumping on blood smear
idiopathic thrombocytopenic purpura
- platelet deficiency
- immune system destroys platelets
- acute (children) or chronic (adults)
normal lifespan of platelets
7 to 10 days
lifespan of platelets in idiopathic thrombocytopenia purpura
1 to 3 days or less
signs of idiopathic thrombocytopenia purpura
- easy bruising (wet or dry)
- heavy menses
- petechiae on extremities and trunk
- nose bleeds
pathology of idiopathic thrombocytopenia purpura
- platelet count <20000/uL
- prolonged bleeding time
- abnormal platelets
- increased numbers of megakaryocytes in bone marrow
- possible H. pylori infection
hemophilia
x-linked, recessive bleeding disorder; prolonged coagulation time
-primarily affects males
pathology of hemophila
-platelet plug forms at bleeding site but clotting factor deficiency impairs stable clot formation
signs of hemophilia
- hemorrhages (75% in joints)
- spontaneous GI bleed and hematuria
- intracranial or extracranial hemorrhages dangerous
- excessive bleeding w/ surgery or dentistry
hemophilia A (classic)
no to low clotting factor VIII
hemophilia B (christmas)
no to low clotting factor IX
