OTH: Hematological System Flashcards by Katherine Nadelberg

Plasma is ____ of total blood volume

_____ part of blood and lymph

55%

Liquid

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Plasma proteins include what? (3)

Albumin
Globulin
Fibrinogen

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What makes up 45% of total blood volume?

Erythrocytes (RBCs)

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RBCs contain _______, which transport O2

Hemoglobin

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RBC is produced in ______ of long bones, and controlled by _____

Marrow

Hormones

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How long do RBC survive?

120 days

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What makes up 1% of TBV?

Leukocytes (WBCs)

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WBCs function in immune process as __________

Produced in ___ ______

Phagocytes

Bone marrow

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5 types of WBCs?

Lymphocytes
Monocytes
Neutrophils
Basophils
Eosinophils

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The normal function and generation of blood cells in bone marrow is called what?

Hematopoeisis

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Disorders of hematopoiesis include what 2 things?

Aplastic anemia

Leukemia

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CBC will determine the # of what?

WBC
RBC
Platelets

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ESR is the rate of ____ settling out in tube of unclotted blood
Increased with what?

RBC

Inflammation

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The termination or arrest of blood flow by mechanical or chemical process is called?

Hemostasis

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Blood clotting requires:
______ produced in bone marrow,
____ _____ factor produced by endothelium of blood vessels, and
____ factors produced by the liver (vit k)

Platelets
von Willebrands
Clot

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When you have hypercoagulation disorders, it is because yo have increased _____ function

Platelet

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Name some conditions in which you have hypercoagulation disorders?

CHF
CA
Pregnancy
Birth control
Immobility

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Hypocoagulation (bleeding) seen in ______ defects seen in bone marrow dysfunction and thrombocytopenia (low platelets)

Platelet

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Hypocoagulation is seen in ______ and ____ ____ disease

Hemophilia

Von willebrands

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Hypocoagulation is also seen in ______ disorders such as having hemorrhagic spider veins, vitamin __ deficiency, ______ disease, senile pupura

Vascular
C
Cushing’s

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Shock: is when you have decreased ___ ___ to tissues
Associated with ______
Inadequate ____ _____
Changes in peripheral blood resistance

Blood flow
Hypotension
Cardiac output

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Hypovolemic shock can be due to ____, ____, _____

Hemorrhage, vomiting, diarrhea

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Hypovolemic shock:
Loss of body \_\_\_\_\_\_ with dehydration
\_\_\_\_\_\_ disease
Burns
Pancreatitis
Peritonitis

Fluid

Addison’s

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Shock: Orthostatic changes = drop in BP of _____ mmHg or more
Pulse and RR (inc/dec?)

10-20

Increase

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When a pt is in shock, how should you position them?

SUPINE Or MOD TRENDELENBERG To allow for venous return

Symptoms of hematologist disorders include: Easy ________ Spontaneous ________ External _______

Bruising Petechiae Hematomas

Long term use of certain drugs (______, ________) can cause bleeding and anemia

NSAIDS | Steroids

Hematological disorders: | Red Flag: extreme caution with ______ _____ and _______ (mechanical compression)

Manual therapy | Modalities

Hematological Disorders: What kind of exercise is CONTRA?

STRENUOUS Inc risk for hemorrhage

Anemia: Decreased ____ in blood Decreased _____ production: nutritional deficiency Decreased ____ ____ stimulation: bone marrow failure, genetic Destruction of ____ from autoimmune, sickle cell, parasites, RA, TB, CA Loss of _____: due to trauma, wound, bleeding, peptic ulcer, inc period

``` Hgl RBC Bone marrow RBC Blood ```

Anemia: Decreased bone marrow stimulation is a sign of ________

HYPO thyroidism

``` Anemia: Sx: Fatigue, weak with ___ exertion DOE _____/_____ face, nails beds, lips Tachy/Brady? Cardia Bleeding of gums/skin without _____ Severe: ____ and ______ damage, HF ```

``` MINIMAL Pallor/yellow TACHYcardia Trauma LIVER and KIDNEY ```

Anemia: might need a ________ | Nutritional support

Transfusion

Anemia: _______ exercise tolerance. Institute gradually and need ___ approval. Use _____

Decreased MD RPE

Sickle Cell Disease: How does a pt get SCD? What kind of blood cell disorder?

It is INHERITED (autosomal recessive) RBC disorder Hgl is abnormal

Sickle Cell Disease: RBC are what shape?

Crescent or sickle shaped, not biconcave like they should be

Sickle Cell Disease: sickle cell anemia: Hgl is released into ______ with decreased ____ delivery to tissues d/t bone marrow aplasia.... spleen involvement

Plasma | O2

Sickle Cell Disease: May have vasoocclusion due to the misshaped RBCs, which can result in _______

Ischemia

Sickle Cell Disease: Sickle Cell Crisis: | Acute episodic condition in ____ with SCA

KIDS

Sickle Cell Disease: Sickle Cell Crisis: Sx’s: ______: acute to severe from sickle cell clots formed in any organ, bone, joint Acute ______ pain with visceral hypoxia Pain and swelling of soft tissues of _____ and _____ Persistent _____ Bone and joint crisis in _____ and _____ pain

``` PAIN Abdominal Hands and feet Headache Extremities, back ```

Sickle Cell Disease: Sickle Cell Crisis: | Neuro Sx’s include?

Dizzy Convulsion Nystagmus

Sickle Cell Disease: Sickle Cell Crisis: | Pulm Sx’s include?

Chest pain Cough Dyspnea Tachypnea

``` Sickle Cell Disease: Complications: Vascular: Stroke Chronic ____ ____ Bone ______ AVN of ____ ____ ____ ____ syndrome ```

Leg ulcers Bone infarcts Fem head Hand foot (sausage fingers)

Sickle Cell Disease: Complications: | Pulmonary: ____

Htn

Sickle Cell Disease: Complications: Neuro: Parasthesias, CN palsy, blindness, _______

Hemiplegia

Sickle Cell Disease: Complications: Renal issues Anemic crisis: rapid drop in _____ Aplastic crisis: severe anemia associated with acute viral, bacteria, or fungal infection, increased susceptibility to _________ Splenic: _____ and _____ enlarge; also spleen ______

Hgl Infection Liver and spleen, atrophy

Sickle Cell Disease: Meds: 1. Transfusions of packed ___ cells in acute anemic crisis/severe 2. Meds that stim _____ production 3. Analgesics/narcotics 4. Short term ___ therapy 5. Hydration, electrolyte replacement 6. Antibiotics, infection control 7. Oral _______ to relief pain of vaso-occlusion; however this will inc bleeding risk 8. Splenectomy maybe 9. Bone marrow transplant 10. Renal transfusion/_________ 11. ____ cell transfusion

1. Red 2. HbF 4. O2 7. Anticoagulants 10. Dialysis 11. Stem cell

Sickle Cell Disease: PT: | During sickle cell event, ___ control

Pain

Sickle Cell Disease: PT: | What is contraindicated?

COLD — because it will increase vasoconstriction and sickling

Sickle Cell Disease: PT: Exercise ______ common Will have exaggerated ____ response to exercise ___ to ____ exercise

Intolerance HR Low to mod

Hemophilia: group of bleeding disorders inherited as ____ ____ ___ disorder

Sex linked recessive

Hemophilia: affects what gender?

Males

Hemophilia: _____ _____ VIII deficiency (hemophilia A) - most common _____ _____ IX deficiency (hemo B)

CLOTTING FACTOR

Hemophilia: bleeding is spontaneous OR a result of _____

Trauma

Hemophilia: hemarthrosis is bleeding into the ____ space, specifically where (4 places)?

Joint Elbow, hip, knee, ankle

Hemophilia: Hemarthrosis: Joint will be _____ and _____, ______ with dec ROM Long term: chronic synovial and arthropathy

SWOLLEN and WARM, and PAIN

Hemophilia: Hemorrhage into muscles is common where (3 places)

Forearm flexors Gastroc-soleus complex Iliopsoas

Hemophilia: Med management Blood _____, factor replacement therapy _________ - NOT _________ No ____ during acute bleed

Infusion Acetaminophen (Tylenol), NOT aspirin —> inc bleeding no WB

Hemophilia: Complications: 1. Joint contractures in what areas? 2. Muscle weakness 3. Leg ____ _______ 4. Postural _____ 5. Dec aerobic fitness 6. Gait deviations including what 2 things? 7. ADL decreased

1. Hip, knee, elbow flexors, PFs 3. Leg length discrepancy 4. Scoliosis 6. Equinus gait, decreased knee extension torque

Hemophilia: PT exam: | Always look for clinical symptoms of acute bleeding which include what?

``` Dec ROM Stiffness Pain Swelling Tender Heat ```

Hemophilia: What is the PT interventions for ACUTE?

RICE | Prevent deformity

Hemophilia: What are the PT interventions for SUBACUTE? 1. _____ ____ before therapy 2. _____ exercise and _____ therapy early 3. _____ management (TENS, etc) 4. Active assisted exercise progressing to active, isokinetic, ____ chain Ex 5. Contracture mngmt 6. Functional and gait training — _____/____ for young boys

1. Factor replacement 2. Isometric, aquatic 3. Pain 4. Open 6. Helmet/pads

Hemophilia: What is the PT interventions for CHRONIC?

Daily HEP OP PT Adaptive PE maybe for kids

Hemophilia: What is the PT interventions SUBACUTE? | What muscles do you want to strengthen?

Hip, knee, elbow extensors, and DF