Quiz 6 Flashcards
1) Describe the hematologic system …. it’s anatomy, physiology
2) What is the function of the hematologic system
3) Where is blood developed or created?
3A) How is blood developed, the process? What stimulates blood cell creation?
4) How is blood regulated or controlled?
5) T or F: The hematologic system is closely linked with the lymphatic system
6) What is Hematology
1) The Hematologic system is the blood (RBC’s, WBC’s, Platelets, Plasma), blood vessels, and blood forming organs (bone marrow, spleen, liver, thymus gland).
2) The hematologic system plays an important role in:
- gas exchange (O2 and CO2)
- fighting infections, immune and inflammatory response
- hormone transport
- temperature regulation
- fluid and electrolyte balance
- acid-base balance (pH)
3) Bone marrow.
3A) Kidneys produce erythropotein (EPO) which is a hormone that stimulates blood cells to grow in bone marrow (process called Hematopoiesis).
4) Hormones (feedback loops)
5) True
6) Hematology is the STUDY OF BLOOD in health and disease. It includes problems with the red blood cells, white blood cells, platelets, blood vessels, bone marrow, lymph nodes, spleen, and the proteins involved in bleeding and clotting (hemostasis and thrombosis).
1) What are some hematologic disorders:
2) What are some s/s of these disorders:
1)
- Anemia
- Sickle cell disease
- Excessive bleeding or excessive blood clotting
- Blood cancer (leukemia)
- Leukopenia/Leukophilia conditions (many)
- DVT (Deep vein thrombosis)
- THERE ARE WAY MORE … LISTED BELOW IN OTHER FLASHCARDS. But basically it would be elevated or decreased RBC’s, WBC’s, Platelets, or Plasma.
2)
- Edema (swelling / fluid accumulation)
- Hyper/hypotension
- Lymphadenopathy (lymph nodes get enlarged)
- Lymphedema (swelling from lymph vessel blockage)
- Infarction
- Thrombosis (clotting)
- Embolism
- Bleeding
- Brusing
- Shock
1) What is Shock:
2) What causes shock?
3) What are s/s of shock
4) Types of shock
1) Shock is a life-threatening medical condition of LOW BLOOD PERFUSION (not getting enough blood) to body tissues. Blood doesn’t circulate properly to areas of body (or an injured area pulls more blood to it, so body shuts down to not distribute blood to uninjured areas). Basically the circulatory system can’t maintain adequate pressure to profuse blood to tissues.
2) Uncontrolled bleeding, major injury, spinal injury, a major drop in blood pressure, severe anemia, CHF
3) Panic, rapid heart beat but weak pulse, low BP, (systolic less than 90) confusion, loss of consciousness, cool pale moist skin, dizziness, fainting
4) Septic shock caused by BACTERIA, anaphylactic shock caused by hypersensitivity or ALLERGIC reaction, cardiogenic shock from HEART damage, hypovolemic shock from blood or FLUID / BLOOD PLASMA loss, and neurogenic shock from SPINAL CORD trauma.
What is:
- Edema:
- Lymphedema:
- Lymphadenopathy:
- Congestion (hematology):
- Infarction:
- Thrombosis:
- Embolism:
- Splenomegaly:
- Function of the Spleen:
- Bleeding or bruising:
- Edema: The accumulation of excessive fluid within the interstitial tissues/spaces or within body cavities (due to an injury or cardiovascular issue).
- Lymphedema: chronic swelling of an area from accumulation of interstitial fluid occurring in hematolymphatic disorders secondary to obstruction of lymph vessels or nodes.
- Lymphadenopathy: the disease / condition of abnormal enlargement of lymph nodes.
- Congestion: accumulation of excessive blood within vessels of an organ or tissue. May be localized (venous thrombus) or generalized (congestive heart failure)
- Infarction: Infarction can happen in the heart, brain, GI, kidney, spleen. It is a localized region of cell necrosis (cell death) caused by reduction of arterial perfusion below a level required for cell life … it can occur as a result of atherosclerosis, arterial thrombosis, or embolism.
- Thrombosis: development of a thrombus or clot
o thrombus- solid mass of clotted blood within a vessel - Embolism: when an artery gets clotted (typically the clot developed elsewhere and TRAVELS w/in a blood vessel to lodge at a distant site from origin).
- Splenomegaly: enlargement of spleen is present in many hematologic diseases. The spleen is normally involved in removing old or deformed RBCs, producing antibodies, and removing antibody-laden bacteria or cells.
- Function of Spleen: Acts as a filter of blood. It stores platelets and WBC’s, removes old/dead RBC’s, and will fight bacteria for immune purposes.
- Bleeding and bruising: can occur from trauma and are normal consequences of trauma. When this occurs for minor trauma (ie brushing teeth) or if bleeding continues longer than normal→ concern for blood disorder. Often result of platelet abnormalities.
1) A normal platelet count range would be:
2) High number of platelets is called _______ and it would lead to what:
3) Low number of platelets is called __________ and it would lead to:
4) How can you figure out your platelet count?
5) At what level of platelet count are you at an increased risk for bleeding:
6) If a patient has a low platelet count, how might that effect you as a PT
1) 150,000 to 450,000 platelets per microliter (uL) of blood.
2) Having more than 450,000 platelets is a condition called thrombocytosis. Lead to blood clotting.
3) Having less than 150,000 is known as thrombocytopenia. Lead to excessive bleeding.
4) Complete blood count test (CBC)
5) 60,000 uL or less
6) Be careful with exercise … you do NOT want to cause any bleeding, as bleeding with a pt with low platelets is dangerous (spontaneous excess bleeding can occur since they can’t clot with low platelet count).
As a PT, how would you change your exercise program or monitoring of exercise with a pt with any hematologic condition:
- Monitor vital signs (BP, HR, RR, Do a pulse ox check frequently)
- Do more moderate exercise with an anemic pt since they will be weak and fatigue easily
- Ensure a pt does not bleed with a low platelet count
- Be careful of infection spreading with a pt with low WBC count
- High WBC count patients probably have cancer, so will be more weak and fatigue quicker
- Patients with a high platelet count indicate they will clot more easily. Clotting can lead to an embolism somewhere else in the body, a MI, CVA (stroke), etc.
1) What changes occur in the hematologic system with aging?
2) Hematopoiesis is:
1)
- Blood composition changes very little with age ***
- But the amount of hematopoietic tissue (blood-forming, or red marrow) declines progressively with age.
- DECREASED IRON
- INCREASED: fragility of plasma membranes, increase in fibrinogen and platelet adhesiveness, red cell rigidity and early activation of coagulation system
The total WBC count and differential are generally not affected by aging. However, a decrease in humoral antibody response and decrease in T-cell function may occur. During an infection, the older adult may have only a minimal elevation in the total WBC count, suggesting a diminished bone marrow reserve of granulocytes in older adults and reflecting the possible impaired stimulation of hematopoiesis. Platelets are unaffected by the aging process. However, changes in vascular and skin integrity from aging can manifest as easy bruising/bleeding.
2) Formation of new blood cells (triggered by EPO hormone sent from kidney to bone marrow)
1) What is a blood transfusion … and why would you need one?
2) Difference between a ALLOGENIC blood transfusion and AUTOLOGOUS blood transfusion:
(how to remember)
3) What is Erythropoietin (EPO):
4) What is hypoxia:
4AA) Why might someone get hypoxia:
4A) What is recombinant human erythropoietin
4B) Why are recombinant human erythropoietin’s so important?
5) What is a Febrile Nonhemolytic Reaction:
5A) How would you know if someone was having a febrile nonhemolytic reaction?
6) What do you do if someone has a reaction to a bad transfusion?
1) The process of transferring the blood of one person into the veins of another. Typically the person receiving it needs it because they have bad blood, loss of blood (RBC’s, WBC’s, platelets, plasma proteins/electrolytes), body isn’t removing/filtering wastes properly, from an injury, or for a medical procedure/reason.
2) AUTOlogous blood transfusion is the collection of blood from a single patient and retransfusion back to the SAME patient. This is in contrast to ALLOGENIC blood transfusion where blood transfusion comes from an unrelated/anonymous donor and is transfused to the recipient (or SOMEONE ELSE).
(REmember: AUTO is same, ALL is everyone)
3) Erythropoietin is a protein secreted by the kidney in response to cellular hypoxia; it stimulates red blood cell production in the bone marrow (a process called Hematopoiesis). EPO is produced naturally in the body by the kidneys. It stimulates the bone marrow to produce red blood cells. If the body does not produce enough EPO, severe anemia can occur.
4) Hypoxia is low amounts oxygen being perfused to and delivered to body tissues … either from a low RBC count, RBC’s getting destroyed, excessive bleeding, EPO isn’t being produced by Kidney, pulmonary disfunction from low ventilation or perfusion, etc.
4AA) All the reasons listed above … but also could be from kidney dysfunction … so EPO can’t be produced properly.
4A) A way to inject EPO into someone so EPO can create formation of new RBC’s. Recombinant erythropoietin drugs are known as erythropoietin-stimulating agents (ESAs). These drugs are given by injection (shot) and work by stimulating the production of more red blood cells. These cells are then released from the bone marrow into the bloodstream.
4B) They replace the need for many blood transfusions … the drugs stimulate production of erythropoiesis and thus elevates RBCs production (vs. doing a transfusion and having more RBC’s from some donor injected into you). You need RBC’s :)
5) Febrile non-hemolytic transfusion reaction is a type of TRANSFUSION REACTION you get (reaction from the transfusion). People get reactions from a blood transfusion (since they are getting someone else’s blood … and their blood doesn’t recognize it). It is associated with fever but not directly with hemolysis. It is most commonly caused by antibodies directed against donor leukocytes and antigens.
5A) Patients present with an unexpected temperature rise of even 1 degree or more (≥38ºC or ≥1ºC above baseline, if baseline ≥37ºC) during or shortly after transfusion. This is usually an isolated finding. Occasionally the FEVER is accompanied by chills.
6)
- STOP TRANSFUSION as soon as a reaction is suspected.
- Replace the donor blood with normal saline.
- Examine the blood to determine if the patient was the intended recipient and then send the unit back to the blood bank.
- Checking for direct hemolytic process in the lab, and administering antipyretics or corticosteroids
1) What is bloodless medicine … why would someone do it:
1A) So what are those patients options?
2) Advantages and disadvantages of bloodless medicine / bloodless surgery:
3) Does bloodless medicine mean no transfusion happens then?
1) For many patients, a blood transfusion is not an option, whether for religious reasons or safety concerns (Jehovah Witnesses, or afraid to get a blood bourn pathogen). Either they don’t believe in it, or are fearful of some blood bourn pathogen might be passed through the transfusion of another person’s blood (so patients what to avoid allogenic blood transfusions).
1A) Not do surgery, do minimally invasive surgery, or do a Normovolemic hemodilution / AUTOlogous transfusion (which is where they drain and dilute a person’s OWN blood and retransfuse it back in). Or even try taking EPO meds.
2) Advantages: stay true to beliefs, less recovery time, less risk for bad transfusion, avoid possibility of disease being spread.
Disadvantages: it may not work, can’t get another person’s healthy blood.
3) The expression does not mean surgery that makes no use of blood or blood transfusion. Rather, it refers to surgery performed without transfusion of allogeneic blood (someone else’s).
1) What is hemochromatosis?
(how to remember)
1A) Why is too much iron bad?
2) Hemochromatosis can lead to what?
3) Clinical manifestations:
4) Most commonly effected organ for hemochromatosis?
5) When do you start seeing s/s
6) Do men or women get hemochromatosis more?
(how to remember)
7) How do you diagnose it?
8) How do you treat it?
1) Too much IRON in the blood. There are several types of hemochromatosis. Type 1, also called Classic Hemochromatosis (HHC), is a leading cause of iron overload disease. People with HHC (too much iron) absorb extra amounts of iron from the daily diet.
(I think of “chrome” as iron … hemo = blood, so too
much iron in blood).
1A) The human body canNOT rid itself of extra iron. Over time, these excesses build up in major organs such as the heart, liver, pancreas, joints, and pituitary. If the extra iron is not removed, these organs can become diseased. Untreated hemochromatosis can be fatal.
2) Diabetes, Arthritis, Some cancers, Parkinsons, Alzheimers, Depression, Infertility, Impotence (erectile dysfunction), darkened skin
3) Weakness, chronic fatigue, joint pain, abdominal pain, hepatomegaly, elevated Hb, and elevated liver enzymes, darkened skin
4) most commonly effected organ: LIVER
5) Asymptomatic till about age 40-60
6) Men are 5-10x more likely to get it
(remember: men are more IRON like)
7) Genetic testing
8) Avoid iron-rich foods and drinks (alcohol, vitamin C)
1) What is Anemia:
1A) how is it caused?
2) Is Anemia a disease?
3) Hematocrit and hemoglobin counts (normal and concerning) for men vs women:
4) s/s of anemia
5) Medical management of anemia
6) PT implications for pt’s with anemia
1) Low RBC count = less O2 to tissues = fatigued
1A) From excessive blood loss, destruction of RBCs, decreased production of RBCs, kidney damage so EPO not produced.
2) No. It is a manifestation of many other disorders
3)
Men
Hemoglobin: Normal is 13-17. So < 13 is bad
Hematocrit < 41% = anemic (Normal = 37-49%)
Women
Hemoglobin: Normal 12-15. So < 12 is bad.
Hematocrit < 37% = anemic (Normal = 36-46%)
4) weakness, dyspnea on exertion, fatigue, pallor/yellow skin, tachycardia, increased angina
5) Do lab tests (CBC, iron levels) … take EPO medications, blood transfusion
6) Monitor vital signs (HR, RR, BP, pulse ox), do more moderate exercise so they don’t fatigue too easily, monitor closely so they don’t pass out from low stamina.
What is the MOST COMMON HEMATOLOGIC disorder?
Anemia
1) What is Leukocytosis … why would you get it?
2) What is Leukopenia … why would you get it?
3) Types of Leukocytosis or Leukopenia
4) Types of WBC’s
(how to remember)
5) Lymphocytosis vs. Lymphocytopenia
6) Implications for the PT with patients with issues of WBC’s
7) As Leukocyte count decreases, risk of infection for the pt will decrease or increase:
1) Elevated WBC’s (usually as a result of fighting a virus, infection, disease, drugs)
2) Reduction of WBC’s (usually due to cancer and chemotherapy treatmemnts)
3) Basophilia Neutrophilia Neutropenia Eosinophilia Monocytosis Lymphocytosis Lymphocytopenia Etc.
4)
Basophils (histamines)
Neutrophils (most abundent, first on seen)
Eosinophils (parasitic worms)
Monocytes (phagocytize)
Lymphocytes (most abundent agranulits … B and T cells)
(remember: because nobody enjoys more
lymphocytes)
5)
- Lymphocytosis: more lymphocytes in blood as a result of fighting an infection
- Lymphocytopenia: Low levels of lymphocytes in blood, as a result of cancer, chemo, AIDS, autoimmune disease, drugs, etc.
6) The PT needs to be aware so that they can protect themselves from infection. PT and pt should wear a mask, gloves, etc. Protect against spreading of infections. And pt will be weak.
7) Increase
1) What does NSAID’s stand for:
2) What do NSAID’s do:
3) Most common NSAID:
4) What is aspirin and what does it do
5) Effects of Aspirin and Other NSAIDs on Platelet Function
1) Nonsteroid anti inflammatory drugs
2) Reduce pain, decrease fever, prevent blood clots (blood thinner) and, in higher doses, decrease inflammation
3) Aspirin
4) Aspirin is used to reduce fever and relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches. It may also be used to reduce pain and swelling in conditions such as arthritis. Aspirin is known as a salicylate and a nonsteroidal anti-inflammatory drug (NSAID).
5) These are BLOOD THINNERS (so platelets won’t form/clot or be restricted/reduced). But prolonged use of these drugs impacts the amount of platelets forming in blood (or inactivate platelets).
1) Hemostasis:
2) Remember:
- cytosis =
- philia =
- penia =
3) Review … what are:
- Hemoglobin =
- Hematocrit =
4) Hemoglobin and Hematocrit values for normal and anemic patients:
5) So if your patient has a hemoglobin of 7 and a hematocrit of 20%, is the patient anemic?
1) Stoppage of bleeding or hemorrhage … clotting
2)
- cytosis = increase in number
- philia = increase in number
- penia = decrease
3)
- Hemoglobin = Hemoglobin is a protein inside red blood cells that carries oxygen throughout the body
- Hematocrit = A hematocrit is measure of red blood cells (erythrocytes) in a sample of blood; number and size.
4)
Men
Hemoglobin: Normal is 13-17. So < 13 is bad
Hematocrit < 41% = anemic (Normal = 37-49%)
Women
Hemoglobin: Normal 12-15. So < 12 is bad.
Hematocrit < 37% = anemic (Normal = 36-46%)
5) YES
1) What is a malignant lymphoma (or hodgkins disease)
1A) HOW TO REMEMBER Hodgkins
2) What is Hodgkins disease (or Hodgkins lymphoma) … and how is it different from Non-hodgkins lymphoma?
3) Which of these two is more common?
4) So what is main way you tell these two apart?
5) What are stages of Hodgkins disease
5AA) s/s of Hodgkin’s
5A) Risk factors:
6) Treatment for it?
7) Prognosis:
8) So what are Reed-Sternberg cells
9) Review the difference between B and T Lymphocytes:
10) Review differences between cell-mediated and humoral response to fighting an infection:
1) Cancer of the lymph system.
1A) How Deep to the SKIN … lymph vessels are right below skin often.
2) Both Hodgkin and non-Hodgkin lymphoma are malignancies of the WBC’s called lymphocytes, which help the body fight off infections and other diseases in the lymphatic system. Leading to cancer of lymphocyte cells, then lymph nodes, then lymph vessels, etc.
- Hodgkins lymphoma is marked by the presence of Reed-Sternberg cells, which are mature B cells that have become malignant, and are unusually large. The first sign of the disease is often the appearance of enlarged lymph nodes.
- Non-Hodgkin lymphoma, by contrast, can be derived from B cells or T cells and can arise in the lymph nodes as well as other organs. (B cells and T cells play different roles in the body’s immune response to disease.)
3) Both diseases are relatively rare, but non-Hodgkin lymphoma is more common in the United States, with more than 70,000 new cases diagnosed each year, compared to about 8,000 for Hodgkin lymphoma.
4) Through a microscope of a biopsy of the cancerous lymph tissue … and then the presence of Reed-Sternberg cells (which have 2 nuclei, so looks like owl eyes). Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.
5)
- Stage 1: one or few lymph nodes effected
- Stage 2: Two or more regions effected (same side of diaphragm … meaning ABOVE or BELOW diapragm)
- Stage 3: Both sides of diaphragm (opposite sides of diaphragm means ABOVE or BELOW).
- Stage 4: Widespread through lymph system … metastasize to spleen, liver, bone marrow, lungs
5AA) Enlarged lymph nodes, fatigue, weight loss, weakness, can’t fight infections (sick). Lymph nodes in the neck, armpits, or groin may swell.
5A) age, environmental factors, HIV/AIDS, etiology unknown, drug abuse, obesity, SLE
6) Chemo, radiation
7) Typically high survival (85%) for hodgkins lymphoma.
8) How you tell Hodgkins and Non-Hodgkins disease apart. A biopsy revealing these cells = Reed-Sternberg cells, the 2 nuclei OWL eye cells, which are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.
9) T cells (thymus cells) and B cells (bone marrow- or bursa-derived cells) are the major cellular components of the adaptive immune response. T cells ATTACK, and are involved in cell-mediated immunity, whereas B cells (antiBodies) are primarily responsible for humoral immunity (relating to antibodies).
10)
- The humoral response (or antibody‐mediated response) involves B cells that recognize antigens or pathogens that are circulating in the lymph or blood (“humor” is a medieval term for body fluid).
- The cell mediated immunity is an immune response that does not involve antibodies, but rather involves the activation of phagocytes (cells vs. antibodies), antigen-specific cytotoxic T-lymphocytes.
A) What is leukemia
B) Blood cells form in bone marrow. Difference between red bone marrow and yellow:
C) Difference between acute and chronic with regards to cancer
D) 2 Types of Leukemia:
1) What is Acute (or chronic) Myelogenous Leukemia (AML)
1A) What is myelo tissue
2) What is Acute (or chronic) Lymphoblastic Leukemia (ALL)
5) What is Multiple Myeloma
6) What is Polycythemia Vera
(how to remember)
7) What is Essential Thrombocythemia
BELOW ARE DISORDERS OF HEMOSTASIS:
8) What is Hemophilia
9) What is Thrombocytopenia
10) What is Sickle cell trait
11) What is sickle cell disease
12) What is von Willebrand Disease
(how to remember)
13) What is The Thalassemias
(how to remember)
A) Cancer of blood (specifically the WBC’s). Cancer that starts in the bone marrow and spreads to the blood and other organs.
B) RED marrow contains BLOOD stem cells that can become red blood cells, white blood cells, or platelets. YELLOW marrow is made mostly of FAT.
C) Acute is new and fast growing. Chronic is slow developing and long term. With Leukemia … acute is probably bone marrow, and chronic gets into blood and other organs. Acute conditions are severe and sudden in onset. This could describe anything from a broken bone to an asthma attack. A chronic condition, by contrast is a long-developing syndrome, such as osteoporosis or asthma. Note that osteoporosis, a chronic condition, may cause a broken bone, an acute condition.
Acute Leukemia
Bone marrow cells cannot mature, immature cells reproduce and build up – without treatment, survival is only a few months
Chronic Leukemia
Bone marrow cells partially mature. Cells survive longer and build up in system. Progresses over a longer period of time compared to acute leukemia with ability to survive longer without treatment.
More difficult to treat than acute leukemia
ACUTE is a new sudden onset of a tumor, it is very severe, fast growing, and immature cells replicate quickly. Can be treated and cured if diagnosed early on.
CHRONIC is a slower onset of a tumor, where it develops slowly, is more long-term, and cells partially develop into maturity. Despite it being slower to develop, it is harder to treat and cure.
D) Myeloid, and Lymphocytic ….. AML or ALL
1) A type of cancer that starts in BONE MARROW with excess immature WBC’s, and it spreads to blood, liver, spleen, etc. Acute = newer and fast growing. Chronic is older and slow growing. AML is caused by uncontrolled growth of myeloid cells.
1A) Myelo = bone marrow
2) Type of cancer in which the bone marrow makes too many LYMPHOCYTES (a type of white blood cell). Acute = newer and fast growing. Chronic is older and slow growing. ALL is caused by the uncontrolled growth of lymphoid cells.
5) Cancer of PLASMA cells (in BONE MARROW). Plasma cells help you fight infections by making antibodies that recognize and attack germs. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Blacks more likely to get it than whites. Peaks around 50-70 yrs old.
Multiple myeloma is a hematological (blood) cancer that develops in the PLASMA cells found in the soft, spongy tissue at the center of your bones, called bone marrow. Plasma cells are a type of white blood cell responsible for producing antibodies (immunoglobulins) which are critical for maintaining the body’s immune system.
6) A slow-growing blood cancer in which your bone marrow makes TOO MANY RBC’s. These excess cells thicken your blood, slowing its flow. They also cause complications, such as blood clots, which can lead to a heart attack or stroke.
(remember: Vera is pretty RED girl, poly = many … so
too many RBC’s)
7) Body produces TOO MANY PLATELETS (platelet count above 600,000). You see red blotches on skin.
8) Overarching term of … Blood won’t clot properly, so EXCESS prolonged BLEEDING occurs (internal or external) as a result of injury. (Hemophilia = lots of blood = lots of bleeding)
9) Is a condition characterized by decreased or abnormally low levels of thrombocytes, also known as platelets, in the blood. A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.
10) A condition in which a child inherits the sickle cell gene mutation from one parent. (Not a disease). You are a carrier, but may not have symptoms.
11) You have 2 gene mutations and thus have symptoms. Where sickle cell trait is you are a carrier but don’t experience symptoms. A group of disorders that cause red blood cells to become misshapen and break down. RBC’s change from biconcave to sickle cell shape, so they clog, can’t carry as much O2. Results in anemia.
12) Von Willebrand disease is most common INHERITED/GENETIC bleeding disorder .. is a lifelong bleeding disorder in which your blood doesn’t clot well. Most people with the disease are born with it, though its warning signs may not show up for years.
(remember: This is some German guy with Hollocaust,
so made people bleed a lot who had a genetic issue)
13) Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia.
(remember: Bad A family that destroys hemoglobin …
leaving everyone breathless)
1) Most common form of cancer in children (and is it acute or chronic)
2) Is AML or ALL more common among children
3) Does AML or ALL lead to damage of CNS, tiredness, slurring of speech
4) Which one has a better survival rate
5) Treatment for kids with ALL and AML
6) Why would someone experience pain in feet as a result of chemo?
7) What is neuropathy
8) Kids with leukemia (in a hospital or anywhere) are going to be very very fatigued. Why would they need PT?
9) Can kids with leukemia play with other kids?
1) Leukemia (acute)
2) ALL
3) AML (even though myelo is bone marrow, think mylenated nerves)
4) ALL
5) Chemo drugs
6) Some neuropothy as a result of the chemo drug
7) Pathology of nerves or nerve damage leading to nerve weakness, numbness, and pain from nerve damage, usually in the hands and feet.
8) Have to get them up and moving … prevent bed ulcers, improve strength, stretch muscles, prevent contractures, blood flow / circulation, regain ability to do ADL’s.
9) Not usually. They are at such a higher risk of infection, it is important to protect them from areas that are unclean. Usually they have to avoid public places, other kids, wear a mask, etc.
1) Pancytopenia =
(how to remember)
1A) What would pancytopenia lead to:
2) When would someone experience pancytopenia:
1) Pancytopenia = decreased RBC, WBC, and platelets
(remember: pan is ALL the blood types thrown in a pan,
penia is low, so ALL blood counts are low)
1A) Weakness (anemia), increased risk of infection (WBC’s), and risk of bleeding excessively (Platelets)
2) During chemotherapy, or lost a lot of blood.
1) What does PRAFO stand for
2) What is it
1) Pressure relief ankle fracture orthosis
2) Ankle boot
1) Diseases of Iron Absorption
2) Disorders of Erythrocytes
3) Disorders of Leukocytes
4) Disorders of Hemostasis
5) Neoplastic Disease of the Blood and Lymph System
6) What are the Leukemias
7) What are the Malignant Lymphomas
8) Do these conditions only fall into one category?
1)
- Hereditary Hemochromatosis
2)
- Anemia
- Polycythemia Vera
3)
- Basophilia
- Neutrophilia
- Neutropenia
- Eosinophilia
- Monocytosis
- Lymphocytosis
- Lymphocytopenia
- Leukocytosis
- Leukopenia
4)
- Sickle cell trait
- Sickle cell disease
- The Thalassemias
- Disseminated Intravascular Coagulation
- Effects of NSAID’s / Aspirin
- Thrombocytopenia
- Hemophilia
- Von Willebrand’s Disease
5)
- Multiple Myeloma
- Essential Thrombocythemia
- Polycythemia Vera
- Chronic Myeloid Leukemia
6)
- Acute Myelogenous Leukemia
- Acute Lymphoblastic Leukemia
- Chronic Myelogenous Leukemia
- Chronic Lymphoblastic Leukemia
7)
- Hodgkin’s lymphoma
- Non-hodgkin’s lymphoma
8) *** Keep in mind it is not that they all fit into one box. There is overlap for many. The above lists are just helpful to know generally what category they fall into.
What is Disseminated Intravascular Coagulation?
Excess of coagulation cascade (excessive clotting)
1) WBC’s are elevated (cytosis or philia) when what happens:
2) WBC’s decreased (penia) when what happens:
1) Fighting an infection
2) Cancer (from Chemo), Bacteria, virus, drug or something is effecting or fighting the WBC’s
What is Petechiae:
What causes it:
(how to remember)
Purple spots on skin, from capillaries bursting … so you have bleeding under the skin (looks like red/purple dots on skin).
Many things can cause it, but typically it is from:
Thrombocytopenia (not enough platelets).
(Remember: chia pets are PURPLE)
“BIG HORSE” topic she covered is Anemia:
1) What is anemia
2) T or F: anemia is a disease
3) What do taking NSAID’s or ASPIRIN lead to:
4) Can pt’s who abuse alcohol, or are under-nourished become anemic?
5) Can AIDS or cancer lead to anemia
1) Reduction in oxygen-carrying capacity of blood due to abnormality in quantity and/or quality of RBC’s
2) FALSE. It is a manifestation of many other disorders
3) It is a blood thinner, so leads to bleeding if injured, so can lead to anemia. It also reduces pain and inflammation.
4) YES
5) YES
1) Hemolytic or hemolysis is:
2) Most common disorder of blood system (a HORSE)
3) How does a pt appear to us if they are anemic
4) How is anemia diagnosed?
5) Why is knowing about anemia important to a PT
1) RBC’s destroyed
2) ANEMIA
3) Weak, fatigued, pale or yellow skin, tachycardia (but weak pulse … tachycardia because heart pumps more to get more O2 to tissues).
4) CBC test (complete blood count test to know Hematocrit), or physical exam through observation
5) Because these patients are fatigued, will get fatigued easily, are experiencing tachycardia (and it will get worse with exercise) … so we need to monitor all vitals frequently.
CLL:
ITP:
Idiopathic means:
Koilonychia:
Chronic lymphocytic leukemia
Idiopathic Thrombocytopenic (I don’t know why you have a low platelet count)
Cause is unknown
Indentation of finger nail beds
HODGKIN’S DISEASE (a BIG HORSE)
1) Another general term for cancer of lymph system
2) Opposite of aggressive progression
3) Which form of hodgkin’s is more prevelant
4) What ages is hodgkin’s seen in **
5) When it metastacizes, it goes where?
6) How is it staged / graded?
7) how is it staged
8) What causes hodgkin’s … what are risk factors?
9) Do Hodkin’s patients get a fever? What is unique about it.
10) What are examples of people who are more at risk of hodgkins?
11) T or F: women who are child bearing age are more prone to get hodgkins?
12) Treatment for hodgkin’s
13) Survival rate?
14) Why is this important to PT’s
1) Malignant lymphomas, hodgkins lymphoma, hodgkins disease
2) Indolent
3) non-hodgkin’s is more prevelant
4) 25-30 yrs old, and then age 55
5) Spleen, liver, lungs
6) it is NOT graded like the TNM system like other tumors because it is in lymph system. But stagine system is above (based on how many lymph nodes and where those lymph nodes get cancer).
7)
- Stage 1: single node, or group of nodes
- Stage 2: 2 or more nodes, on one side of diaphragm
- Stage 3: Nodes on BOTH sides of diaphragm
- Stage 4: Widespread extralymphatic involvement
8) We don’t really know. Possibly environmental, chemo, SLE, HIV/AIDS, drug abuse, obesity
9) YES. But it is irregular, it goes up and down and up and down.
10) Pregnant women, AIDS pt’s
11) Yes, true
12) Chemo or radiation (or both)
13) 85% (dependent on age, stage of cancer, condition of pt, etc.)
14) Because you often PALPATE patients and could feel a SWELLING LYMPH NODE. Doesn’t mean if you find one they have hodgkin’s lymphoma, but it is a red flag to refer person to physician. AND - of course any exercise will help pt’s who are fatigued from chemo.
1) What is Pruritus:
1) ITCHING
1) Will pregnancy possibly cause a sickle cell crisis?
2) Will dehydration cause a sickle cell crisis?
3) Will nasal cannula cause a sickle cell crisis?
1) It can yes. Pregnancy will because a fluctuation of hormones (associated). It is not cause and effect, it triggers it (more likely if pregnant than not pregnant)
2) It can yes. If dehydrated, you lose water, so RBC’s lose biconcave - and lose more fluid in the blood. Dehydration doesn’t cause it, just can trigger it.
3) NO. Nasal cannula gives you more O2, so you will NOT have sickle cell
