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Pathophysiology > Patho Unit 3 > Flashcards

Patho Unit 3 Flashcards

Understand: - Structure, and Function of the Hematologic System (Ch 19) - Alterations of Hematologic Function (Ch 20) - Alteration of Hematologic Function in Children (Ch 21)

1
Q

Blood Plasma

A

Straw colored liquid portion of unclotted blood

- 55-60% of blood volume

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2
Q

Characteristics of Blood

A
  • Composed of formed elements and plasma
  • Viscous
  • Volume: 4-6 L
  • pH: 7.35-7.45
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3
Q

Albumin

A

Low molecular weight plasma protein, made in the liver

  • Contributes to blood viscosity and maintains blood pressure
  • Acts as osmotically-active carrier molecule
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4
Q

Plasma vs. Serum

A
  • Serum is the liquid portion of clotted blood

- Plasma is the liquid portion of unclotted blood

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5
Q

Hematocrit (Hct)

A

Percent of whole blood volume occupied by red blood cells

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6
Q

Hemoglobin (Hgb)

A

Oxygen-carrying molecule in red blood ceels

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7
Q

MCV

A 
Mean Corpuscular (Cell) Volume
  - VOLUME of an average blood cell
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8
Q

MCH

A 
Mean Corpuscular (Cell) Hemoglobin
  - AMOUNT of Hemoglobin in an average RBC
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9
Q

MCHC

A 
Mean Corpuscular (Cell) Hemoglobin Concentration
  - CONCENTRATION of hemoglobin in an average RBC
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10
Q

Leukocytes

A

White Blood Cells

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11
Q

Granulocytes

A

White Blood Cells with Granules

  • Neutrophils, Eosinophils, & Basophils
  • Life span of 0.5-9.0 days
  • Most die doing their job
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12
Q

Agranulocytes

A

White Blood Cells without Granules

  • Monocytes/Macrophages, & Lymphocytes
  • Lymphocytes live from days to decades
  • Monocytes live for several months
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13
Q

Leukocytosis

A

WBC count > 10.0 (10,000/mm3)

  • Occurs in both viral and bacterial infections
  • Normal physiological response to disease, up to certain point
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14
Q

Leukopenia

A

WBC count < 5.0 (5,000/mm3)

- Never a normal response

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15
Q

Neutrophils

A

Fight bacterial infections

  • Phagocytic, respond quickly to disease (dive into pus and die)
  • Segmented nucleus
  • 60-70% of circulating WBCs
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16
Q

Eosinophils

A

Increased in allergies and parasites

  • Target antigen-antibody complexes
  • 1-4% of circulating WBCs
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17
Q

Basophils

A

Participate in inflammatory responses

  • Release histamine and heparin
  • 0-1% of Circulating WBCs
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18
Q

Monocytes/Macrophages

A

Powerful phagocytes

  • Have different names depending on their location (Kupffer cells, histiocytes, microglial, alveolar macrophages, wandering)
  • 3-8% of circulating WBCs
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19
Q

Lymphocytes

A

Fights viral infections and cancer cells

  • Most are contained in the lymph system
  • Release immunoglobulins
  • Major role in adaptive immune response (immunity)
  • 20-30% of circulating WBCs
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20
Q

Primary Lymphoid Organs

A

Thymus and bone marrow

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21
Q

Secondary Lymph Organs

A

Spleen, lymph nodes, tonsils, and Peyer Patches of the small intestine

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22
Q

Lymphatic System

A

Organs and lymph vessels through which lymphatic fluid passes

  • Drains interstitial fluid
  • Transports dietary lipids absorbed by the GI tract into the blood
  • Facilitates an immune response
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23
Q

Spleen

A
  • Filters and cleanses the blood
  • Contains masses of lymphoid tissue
  • Removes old or damaged cells from blood
  • Storage for extra blood to be released during sympathetic stimulation
  • Storage of platelets
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24
Q

Lymph Nodes

A
  • Filters for lymph fluid
  • Foreign objects are trapped and destroyed
  • Enlargement may often indicate a pathological condition
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25
Q

Hematopoiesis

A

Formed element production

  • Cells are formed in red bone marrow from pluripotent stem cells and mature in the bone marrow or lymphoid tissue
  • Active red marrow in adults in pelvis, sternum, vertebrae
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26
Q

Medullary Hematopoiesis

A

Cellular production in the bone marrow

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27
Q

Extramedullary Hematopoiesis

A

Disease conditions can cause production of cells outside of the bone marrow

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28
Q

Erythropoiesis

A

The production of red blood cells
- Hypoxia stimulates the kidneys to release erythropoietin (EPO) which circulates to the red marrow and speeds up the maturation of immature RBCs

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29
Q

Reticulocyte (retic) Count

A

Measures the rate of Erythropoiesis

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30
Q

Reticulocyte

A

Immature RBC

- Contains hemoglobin, RNA, and mitochondrial remnants

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31
Q

Thrombocytes

A

Platelets

  • Cell fragments
  • Aid in clotting by clumping and the release of biochemical mediators
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32
Q

Thrombocytopenia

A

Low platelet count

  • < 50,000 hemorrhage from minor trauma
  • < 15,000 spontaneous bleeding
  • < 10,000 severe bleeding
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33
Q

Thrombocytosis

A

Increased platelet count

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34
Q

Hemostasis

A

Forming a blood clot

  1. Vascular spasm
  2. Platelet plug formation
  3. Activation of the coagulation cascade
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35
Q

G-CSF

A
  • Originates in Macrophage/Fibroblast

- Stimulates Granulocytes

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36
Q

GM-CSF

A
  • Originates in T cell

- Stimulates Neutrophil, Macrophage

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37
Q

Erythropoietin

A
  • Originates in kidney cells and Kupffer cells

- Stimulates Erythrocytes

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38
Q

Colony Stimulating Factors

A

CYTOKINES that act as hormones to stimulate the proliferation of progenitor (early) cells

  • Originate from one cell to stimulate the proliferation of another
  • G-CSF, GM-CSF, Erythropoietin
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39
Q

Clotting Cascade

A
  • Positive feedback system
  • Begins with activation of several soluble, inactive clotting factors (cascading)
  • 2 pathways (Extrinsic and Intrinsic)
  • Merge at Factor X forming common pathway
  • Coagulation is usually fast and localized
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40
Q

Extrinsic Pathway

A

Activated by tissue factor (tissue thromboplastin)

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41
Q

Intrinsic Pathway

A

Activated by contact with the injured vessel

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42
Q

Stages of Coagulation

A
  • Extrinsic and Intrinsic activation
  • The common pathway begins with the formation of Prothrombinase
  • Prothrombinase activates Prothrombin into Thrombin
  • Thrombin induces the formation of fibrin from fibrinogen
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43
Q

Clot Retraction

A
  • After 30-60 min. platelets contract (actin and myosin proteins squeeze them out into the serum)
  • The clot becomes impacted and the edges of the blood vessel are brought closer together
  • Endothelial cells begin to restore endothelial lining
  • Clot needs to be removed (Fibrinolysis)
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44
Q

Fibrinolytic System

A

Removes blood clots

  • Large amounts of plasminogen are incorporated into clots
  • Endothelial cells produce Tissue Plasminogen Activator (TPA), causing Plasminogen to become its active form Plasmin
  • Factor XII and Thrombin in the coagulation cascade also change Plasminogen into Plasmin
  • Plasmin digests clots
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45
Q

PT/INR

A

Prothrombin Time/International Normalized Ratio

  • Measures the EXTRINSIC pathway
  • Usually used to check status after anticoagulant administration
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46
Q

APTT

A

Activated Partial Thromboplastin Time

- Measures the INTRINSIC pathway

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47
Q

Bleeding Time

A
  • Measures PLATELET FUNCTION, not number

- New instrumentation is replacing this test

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48
Q

Anemia

A

Insufficient RBCs or a decrease in the quality or quantity of hemoglobin

  • Typical symptoms: fatigue, weakness, dyspnea (breathing problems) and pallor (paleness)
  • Classified according to ETIOLOGY (origin) and/or MORPHOLOGY
49
Q

-cytic

A

size of

50
Q

-chromic

A

color

51
Q

Anemia Etiologies

A
  • Fe deficiency anemia
  • Folate/B12 deficiency anemia
  • Hermorrhagic anemia
  • Anemia of chronic disease (ACD)
  • Hemolytic anemia
52
Q

Anemia Morphologies

A 
Volume
  - Microcytic
  - Macrocytic
  - Normocytic 
Chromasia (color)
  - Hypochromic
  - Normochromic
53
Q

Microcytic - Hypochromic Anemia

A
  • Pale, small RBCs

- Usually Fe deficiency anemia

54
Q

Macrocytic - Normochromic Anemia

A
  • Large RBCs

- Usually Folic Acid or vitamin B12 deficiency anemia

55
Q

Normocytic - Normochromic Anemia

A
  • RBCs are normal size and hemoglobin content

- Usually caused by hemorrhage or hemolysis

56
Q

Hemolytic Anemia

A
  • Normocytic-Normochromic
  • Due to red cell lysis
  • Fragile cells, infection drugs, autoimmunity, circulating antibodies
  • Symptoms: enlarged spleen and jaundice
57
Q

Hemorrhagic Anemia

A
  • Normocytic-Normochromic
  • Due to blood loss
  • Surgery or Trauma
  • Symptoms: shock and acidosis
58
Q

Anemia of Chronic Disease

A

ACD

  • Normocytic-Normochromic
  • Bacterial toxins, cytokines from WBCs, supression of progenitor cells - usually mild
59
Q

Aplastic Anemia

A
  • Normocytic-Normochromic
  • Bone marrow hypo- or aplasia
  • Causes: acquired due to drugs, viruses, genetics, and neoplasia
  • Symptoms: petechiae, bleeding, infections, pancytopenia
60
Q

Pernicious Anemia

A
  • Macrocytic-Normochromic
  • Intrinsic factor deficiency leas to insufficient absorption ofB12
  • Autoimmunity - autoantibody to gastric parietal cells
  • Symptoms: digestive symptoms, glossitis, peripheral neuropathy
  • Treatment: replace B12
61
Q

Folic Acid Deficiency

A
  • Macrocytic-Normochromic
  • Inhibits DNA synthesis
  • Alcoholics and malnourished are at risk
  • Symptoms: digestive symptoms, glossitis (similar to Pernicious Anemia but no neurological symptoms)
  • Treatment: replace Folic Acid
62
Q

Iron Deficiency Anemia

A
  • Microcytic-Hypochromic
  • Most commonly caused by excessive bleeding or poor diet
  • High risk: pregnant women, adolescents, children, elderly, anyone with chronic blood loss
  • Symptoms: fatigue, weakness, shortness of breath, paleness, spoon-shaped nails, sore tongue, dry corners of mouth
63
Q

Sideroblastic Anemia

A
  • Microcytic-Hypochromic
  • Dysfunctional iron uptake by erythroblasts producing sideroblasts and resulting in decreased synthesis of heme
  • Causes: lead, ethanol, other drugs
  • heptosplenomegaly, hemochromatosis
64
Q

Vitamin B12

A

Role: DNA synthesis
Deficiency: Macrocytic Anemia

65
Q

Folic Acid

A

Role: DNA and RNA synthesis
Deficiency: Macrocytic Anemia

66
Q

Iron

A

Role: Hgb synthesis
Deficiency: Microcytic Hypochromic Anemia

67
Q

Polycythemia

A

Diseases or conditions that cause excessively large numbers of RBCs in the blood

  • Pathology: increased blood viscosity promotes clotting, and poor oxygenation in distal tissues
  • Symptoms: red color of face, hands, feet, ears, and mucous membranes, high blood pressure, engorgement of retinal and sublingual veins, and hepatosplenomegaly
68
Q

Relative Polycythemia

A

An increase of RBCs due to loss of plasma

69
Q

Absolute Polycythemia

A

Primary
- Polycythemia Vera (not caused by another diagnosis)
Secondary
- Physiologic response to hypoxia

70
Q

Polycythemia Vera

A
  • Primary (not due to another diagnosis)
  • Rare, non-malignant proliferative abnormality of bone marrow
  • Thought to be caused by hypersensitive bone marrow
  • Hct as high as 70-80%
  • Tends to occur in men between 40-60
71
Q

Secondary Polycythemia

A

Common because it is a physiologic response to hypoxia

  • COPD
  • High altitude
  • Smoking
  • Sleep apnea
72
Q

Treatment of Polycythemia

A
  • Reduction of cells and blood volume achieved by therapeutic phlebotomy (bloodletting), which helps prevent the hyperviscosity and thrombus formation
  • Treat the cause of the hypoxia and the number of red blood cells will decrease
73
Q

Neutropenia

A

Too few Neutrophils

  • Prolonged severe infection (depletes cellular numbers)
  • Decreased production (starvation, aplastic bone marrow, chemo)
  • Reduced survival (autoimmune diseases: lupus and rheumatoid arthritis)
74
Q

-philia

A

Too many

75
Q

Eosinophilia

A

Too many Eosinophils

- Increased in allergic disorders and parasitic invasions

76
Q

-penia

A

Too few

77
Q

Neutrophilia

A

Too many Neutrophils

  • Evident in the first stages of an infection or inflammation
  • Immature Neutrophils (bands) are released into the blood
  • Premature release is called a “shift to the left”
78
Q

Lymphocytopenia

A

Too few Lymphocytes

- Immune deficiencies, drug destruction, viral destruction

79
Q

Infectious Mononucleosis

A
  • Characterized by fever, sore throat, lymphadenopathy and hepatosplenomegaly
  • Transmitted by saliva
  • Caused by Epstein-Barr Virus
  • Bcells have EBV receptor sites making them a primary site of the infection
  • Monospot test
80
Q

Monocytosis

A

Too many Monocytes

  • Measurement in blood has poor correlation with disease
  • Usually occurs with Neutropenia in later stages of infections
81
Q

Lymphocytosis

A

Too many Lymphocytes

  • Acute viral infections
  • Malignancies
82
Q

Chronic Leukemia

A
  • Well differentiated cells that don’t function normally
  • Gradual onset
  • Chronic Myeloid (CML) and Chronic Lymphoid (CLL)
83
Q

Leukemia Symptoms

A
  • Asymptomatic (19%)
  • Splenomegaly
  • Infections
  • Night sweats
  • Fatigue
  • Weight loss
  • Anemia
  • Bleeding
84
Q

Leukemia

A

Malignant disorder of the blood-forming cells, most commonly WBCs and blood forming organs

85
Q

Acute Leukemia

A
  • Undifferentiated or immature cells, usually “blasts”
  • Sudden onset
  • Acute Myeloid (AML) and Acute Lymphoid (ALL)
86
Q

AML

A

Acute Myeloid Leukemia

  • Acute onset
  • Myeloblasts
  • Poor survival rate
87
Q

CML

A

Chronic Myeloid Leukemia

  • Gradual onset
  • Most demonstrate the Philadelphia Chromosome (t9:22)
88
Q

Adult Leukemia

A

AML and CLL

89
Q

Child Leukemia

A

ALL

90
Q

Multiple Myeloma

A

B cell cancer of bone marrow

  • Plasma cells proliferate to predominate the marrow
  • > 50 years
  • Involved in the bone marrow and multiple other sites
  • Destruction of bone (myeloma cells infiltrate bone and stimulate osteoclastic activity)
  • Abnormal protein production (Bence-Jones)
91
Q

Lymphomas

A

Proliferation of lymphocytes and lymphoid tissues

- Hodgkin and Non-Hodgkin

92
Q

ALL

A

Acute Lymphoid Leukemia

  • Acute
  • B&T cells
  • Lymphoblasts
93
Q

CLL

A

Chronic Lymphoid Leukemia

  • Chronic and lengthy survival
  • Primarily a diagnosed in elderly
  • Usually B cells
94
Q

Hodgkin Disease

A
  • Characterized by presence of Reed-Sternberg cells in lymph nodes, which are usually localized in a single or chain of nodes
  • Bimodal Age distribution (19-35 & >50)
  • Signs: fever, weight loss, night sweats, pruritis (itching), lymphadenopathy in neck
  • Treatment: radiation and chemo
95
Q

Non-Hodgkin Lymphomas

A
  • No Reed-Sternberg cells
  • Onset usually >50
  • Disseminated (multiple node and organ involvement)
  • Prognosis is worse than Hodgkins
96
Q

Disorders of Platelet NUMBERS

A

Thrombocythemia & Thrombocytopenia

97
Q

Disorders of Platelet FUNCTION

A

Adhesion, Aggregation, & Secretion

98
Q

Essential (Primary) Thrombocythemia

A
  • > 600,000/mm3
  • Myeloproliferative Disorder
  • More common in ages 50-60
99
Q

Myeloproliferative Disorder

A

Stem cell disorder in which excess platelets are produced

- Risk of microvascular thrombosis

100
Q

Normal Platelet Count/Increased Bleeding Time

A

Platelets aren’t functioning normally

- Symptoms: petechiae, mucosal bleeding, and gingival bleeding

101
Q

Acquired Platelet Function Disorders

A
  • Drugs: Aspirin & NSAIDS
  • Systemic conditions: renal failure, TTP (Throbotic Thrombocytopenia Purpura)
  • Hematologic alterations: leukemias
102
Q

Congenital Platelet Function Disorders

A

Disorders of platelet adhesion, aggregation secretion and procoagulant activity

103
Q

Vitamin K

A
  • Dependent clotting factors: IX, VII, X, & II

- Warfarin (Coumadin) causes temporary, reversible deficiency

104
Q

Disseminate Intravascular Coagulation (DIC)

A

Disorder in which CLOTTING and HEMORRHAGE occur simultaneously

  • Caused by anything that can activate widespread coagulation
  • Acquired, deadly and fairly common
105
Q

DIC (in detail)

A
  • Amount of active thrombin exceeds anti-thrombin, clotting becomes systemic
  • Widespread thromoses cause widespread ischemia, infarction, and organ hypoperfusion
  • Fibrinolytic System also activated increasing Fibrin Degradation Products (FDP) resulting in consumptive coagulopathy
106
Q

DIC (activation of pathways)

A
  • Intrinsic: gram-negative sepsis, hypoxia, low blood flow
  • Extrinsic: gram-positive toxins, burns, infarctions, surgeries, obstetric accidents, malignancies
  • Common: activated by substances that enter bloodstream (enzymes, snake venom)
107
Q

Hemolytic Diseases of Newborns (HDN)

A
  • ABO incompatibility: most common, but usually mild

- Rh factor incompatibility: life threatening

108
Q

ABO Incompatibility

A

Difference in the fetal and maternal blood types

  • Occurs in 20% of pregnancies but only 1 in 10 results in HDN
  • More mild because A and B antigens are poorly developed at birth, and antibodies typically don’t cross the placenta
109
Q

Rh Factor Incompatibility

A

Occurs when and Rh- mother is carrying an Rh+ baby (2nd pregnancy)

  • Anti-Rh antibodies cross the placenta and attach to fetal erythrocytes
  • Can lead to severe anemia, edema, CNS damage and fetal death
110
Q

Sickle Cell Anemia

A
  • Autosomal recessive
  • Characterized by abnormal Hgb (Hgb S)
  • Valine replaces Glutamic Acid in Hgb molecule (Valine side chain is hydrophobic, Glutamic Acid is hydrophilic)
  • Deoxygenation and dehydration cause erythrocytes to stretch and solidify (sickle
  • Can cause Vasoocclusive Crisis (Sickle Cell Crisis)
111
Q

Thalassemia

A

Inherited autosomal recessive disorders that casue an impared rate of synthesis of alpha or beta hemoglobin chains

112
Q

Beta Thalassemia

A
  • Defect in beta-chain formation
  • Results in to many alpha-chains which become unstable and precipitate inside the cells
  • Most common
  • Macrophages and spleen destroy these cells
113
Q

Thalassemia Minor

A
  • Heterozygous
  • Usually asymptomatic
  • Sometimes an enlarged spleen and small RBCs
114
Q

Thalassemia Major

A
  • Homozygous
  • Severe anemia
  • Regular transfusions required
115
Q

Congenital Alterations of the Coagulation Cascade

A

Hemophilia A & B

  • The most common of the inherited disorders of the coagulation system
  • X-linked
116
Q

Hemophilia A

A
  • Classic hemophilia
  • X-linked recessive deficiency of factor VIII
  • More common
117
Q

Hemophilia B

A
  • X-linked recessive deficiency of factor IX

- Less common

118
Q

-osis

A

Too many

Pathophysiology (11 decks)

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