objective 2: hematopoietic and lymphatic alterations Flashcards
the study of blood and blood forming tissues
hematology
blood cell production that occurs in bone marrow
hematopoiesis
a soft material that fills the central core of bones
bone marrow
what are the 2 types of bone marrow?
yellow (adipose)
red (hematopoietic)
found in flat and irregular bones in adults and actively produces blood cells
red (hematopoietic)
described as an immature blood cell that is capable of self-renewing and differentiating so several different cells can be formed
hematopoietic stem cells
what are the 3 functions of blood?
transportation
regulation
protection
Transport’s gases (O2 and CO2), assisting in maintaining acid/base balance
composed of hemoglobin
erythrocytes
RBC production
erythropoiesis
occurs in the bone marrow, liver, and spleen. It is the destruction of
RBCs by monocytes and macrophages, removing defective RBCs from circulation
thus, increasing levels of bilirubin that must be excreted by the body.
hemolysis
WBCs that originate from stem cells in bone marrow
Five types with different function
leukocytes
primary function is phagocytosis
granulocytes
originate from stem cells within the bone marrow. their function is related to the immune response
agranulocytes
also known as platelets- initiates the clotting process
thrombocytes
how long do RBCs live?
120 days
live longer, stay in
vascular system, no nucleus
RBC
live shorter lives (hours
to weeks), move out of the
vascular system into lymphatic
tissue, spleen, thymus, marrow
WBC
- A deficiency in the number of red blood cells (erythrocytes)
- A deficiency in the quantity or quality of hemoglobin
- A deficiency in the volume of packed red blood cells (RBCs) — also known as
the hematocrit - Or a combination of all three.
anemia
what are the types of anemia?
morphological classification
etiological classification
red blood cell production
erythropoiesis
- Most common worldwide
- Most suspectable are the very young, those with poor diets, and women in
reproductive years
iron deficiency anemia
- Requires intrinsic factor from gastric mucosal cells which binds with B12
allowing it to be absorbed in the ileum. - Normally large stores take a long time to be depleted, even years.
- The most common cause of deficiency is faulty absorption because of Crohn’s
disease or ileal resection. - Inadequate intake is more common in strict vegetarians if care isn’t taken to
prevent this.
pernicious anemia
what are the hyperproliferative anemias?
iron deficiency anemia
pernicious anemia
- Without intrinsic factor, oral supplements cannot be absorbed.
- This leads to a decrease in RBC production and pernicious anemia.
- Pernicious anemia usually runs in families and is seen most in adults,
particularity the elderly
hypo-proliferative anemias
the bone marrow produces immature RBC that are
abnormally large with an abnormal structure
megaloblastic anemia
what are the hypo-proliferative anemias?
folic acid deficiency
what are the features that all hemolytic anemias share?
- Increased reticulocytes
- Increased bilirubin in the blood
- Decrease in haptoglobin which is a binding protein used up as more Hgb.
is released. - If the bone marrow cannot compensate, anemia occurs
the RBC’s have a shortened lifespan which decrease
the number of circulating cells.
* The lower levels of RBC’s stimulate erythropoietin release and thus the
release of more cells, many of which are immature reticulocytes
hemolytic anemias
what are the inherited hemolytic anemias?
sickle cell
thalassemia
what are the acquired hemolytic anemias?
Autoimmune (RA, UC)
Infection
Medication
Cancers
Overactive spleen
Transfusion incompatibility
- A severe genetic hemolytic anemia (inherit the sickle HgS gene)
- Most common in individuals of African descent and lesser the Middle East,
Mediterranean, and aboriginal tribes of India. - Diagnosis confirmed by hemoglobin electrophoresis
sickle cell anemia
what are the sickle cell crises types?
sickle crisis
aplastic crisis
sequestration crises
tissue hypoxia and necrosis. Most common type. Very
painful.
sickle crisis
infection with human parvovirus
* Bone marrow cannot compensate and Hgb drops rapidly
aplastic crisis
organs pool the sickled cells.
* Most commonly the spleen, and most children with sickle cell
anemia have splenic infarction by age 10
* In adults the organs involved may be the liver or lungs.
sequestration crises
- Hereditary anemias with hypochromia,
extreme microcytosis, hemolysis, various
degrees of anemia. - Highest prevalence in Mediterranean,
African and Southeast Asian ancestry - Treated with transfusion of RBCs, bone
marrow transplant
thalassemia
- Is a disease where the patient has peripheral blood pancytopenia
(decrease in all blood cell types including RBCs, WBCs, and platelets) with
hypocellular bone marrow - Can be a chronic condition that is medically managed with erythropoietin
or blood transfusions - Can also be a critical condition leading to hemorrhage and sepsis
aplastic anemia
- Reduction in platelets
- Acute, severe, or prolonged reduction may result in abnormal hemostasis
with prolonged bleeding after minor trauma or spontaneous bleeding
without injury (Lewis, 2019, p. 731). - Can be inherited or acquired
thrombocytopenia
- Uncommon syndrome
- Hemolytic anemia, thrombocytopenia, neurological abnormalities, fever
without infection, and/or renal abnormalities may be present - Primarily in adults 20 – 50 years with slight female predominance
- May be idiopathic (autoimmune)
- May be caused by certain drug toxins, pregnancy, or infection
- Medically emergency bleeding and clotting occurs at the same time
thrombotic thrombocytopenia purpura
- Most common acquired thrombocytopenia
- Destruction of circulating platelets
- Hence, it is an autoimmune disease
- Platelets are covered with antibodies. Platelets that reach the spleen function normally
however, platelets in circulation are seen as foreign and destroyed by macrophages. - Platelets usually live 8-10 days but in ITP platelets last approximately 1-3 days
immune thrombocytopenia purpura
is a risk that is associated with broad and increasing use of heparin
* Thrombocytopenia develops 5 – 10 days after initiating heparin therapy
* should be suspected if platelet count falls below 50%
* DVT and PE most common complication that occurs from thrombus formation
* Arterial vascular infarcts with skin necrosis, stroke, and organ damage may also occur
heparin induced thrombocytopenia
is an X-linked recessive genetic disorder that is caused by
defective or deficient coagulation factor
hemophilia
what are the 2 major classifications of hemophilia?
hemophilia A
hemophilia B
- Factor VIII deficiency or defect.
- Most common; 80% of all cases
hemophilia A
- Factor IX deficiency
hemophilia B
a serious bleeding and thrombotic disorder that results from the
abnormal accelerated clotting and anticlotting process that occurs in
response to disease or injury (Lewis, 2023, p. 724).
* Profuse bleeding occurs due to the depletion of platelets and clotting
factors
* An underlying condition or disease is always the etiology
disseminated intravascular coagulation (DIC)
refers to a decrease in the total WBC count
leukopenia
defined as a neutrophil count of 1,000 – 1,500/mcL, and
occurs because of other conditions
neutropenia
what are the 4 types of leukemia?
lymphocytic
myelogenous
acute or chronic
ALL or CLL
arises from lymphoid stem cells and affect lymphocytes
lymphocytic leukemia
arises from myeloid stem cells
myelogenous leukemia
a broad term associated with a group of malignant diseases
that affect blood and blood-forming tissue of the bone marrow, lymph
system, and spleen
leukemia
- Proliferation of immature hematopoietic cells
- Malignant transformation and cellular replication of the malignant clone
occurs
acute leukemia
- Involves more mature WBCs and the disease process is more gradual
- Leukemia can also be classified by identifying the type of leukocyte involved:
chronic leukemia
what are the 4 types of chronic leukemia?
ALL
AML
CML
CLL
- Affects the stem cell of all myeloid cells, including monocytes,
granulocytes (neutrophils, basophils, and eosinophils), erythrocytes and
platelets. - More common over 40 and increases with age with a peak at 67 years.
- More men than women affected
- Most common non-lymphocytic leukemia
- Prognosis is variable
acute myeloid leukemia
a disease in which the bone marrow makes too many white
blood cells (leukocytosis). It is a slowly progressing blood and bone
marrow disease that usually occurs during or after middle age, and
rarely occurs in children.
* Often asymptomatic, the leukocytosis is detected by a CBC performed
for other reasons
chronic myelogenous leukemia
what are the 3 stages of CML?
chronic, transformation, accelerated or blast crisis
- Most common type of leukemia in children and found in 20% of
leukemia’s diagnosed in adults - Often diagnosed around age four, predominately in male children
- Older at the time of diagnosis correlates with diminished survival rates
- Abrupt bleeding and/or fever may be present at time of diagnosis or
- Progressive fatigue, weakness, and bleeding tendencies may be
present - Leukemic meningitis secondary to arachnoid infiltration occur in many
patients diagnosed with ALL
acute lymphocytic leukemia
- Most common type of leukemia in children and found in 20% of
leukemia’s diagnosed in adults - Often diagnosed around age four, predominately in male children
- Older at the time of diagnosis correlates with diminished survival rates
- Abrupt bleeding and/or fever may be present at time of diagnosis or
- Progressive fatigue, weakness, and bleeding tendencies may be
present - Leukemic meningitis secondary to arachnoid infiltration occur in many
patients diagnosed with ALL
chronic lymphocytic leukemia
Occur as a result of abnormal overgrowth of one type of lymphocyte
Differ from leukemias in the degree of maturation of the affected cells and
the location of cell production
* Proliferation of lymphocytes, not stem cells
* Proliferation doesn’t occur in bone marrow but in other lymphoid
tissues especially lymph nodes & spleen
* Solid tumors rather than suspensions of cells in blood & bone marrow
malignant lymphoma
are malignant neoplasms that originate in the bone marrow
and lymphatic structures which results in proliferation of lymphocytes
lymphomas
what are the 2 major types of lymphoma
hodgkins
non-hodgkins
- Accounts for 11% of all lymphomas
- Characterized by proliferation of abnormal, giant, multinucleated cells
(Reed-Sternberg Cells) located in the lymph nodes - Fragments of the Epstein Barr virus have been found in the Reed-
Sternberg cells, but its effect is unknown. - Prevalence in persons 15-30 and over 55 years
- Twice as prevalent in adult males
hodgkins lymphoma
what are the stages of hodkins lymphoma?
stage I
stage II
stage III
stage IV
- Lacks the Reed-Sternberg cells and the lymph tissue involved are largely infiltrated with
malignant cells. - The spread of the cancer cells is unpredictable and usually more widespread (not localized
like Hodgkin’s). - Lymph nodes from multiple sites, as well as sites outside the lymph system may be
infiltrated
non-hodgkins lymphoma
- Neoplastic plasma cells infiltrate the bone marrow and destroy bone
- More common in men then women
- Usually presents after 40 years with average age of onset age 69
- Higher incidence in Black ethnic groups
multiple myeloma
- Caused by the Epstein – Barr virus (remains in the
body for life and believed to trigger Hodgkin’s
lymphoma) - Affects lymphoid tissues such as tonsils and
spleen - Spread mainly through saliva
- Kissing, sneezing, coughing, sharing food
- Most commonly affects young adults (15-25
years) living in close quarters
infectious mononucleosis
