rrd 5 Flashcards
infection
infectious diseases (IDs)
disorders in which tissue damage or dysfunction is produced by a microorganism
endemic
used to describe a disease that exists all the time in certain communities
epidemic
an outbreak of a disease that spreads within a certain time frame to people of one or several communities
pandemic
the disease outbreak spreads from being epidemic (a few communities) to being worldwide
example of endemic
malaria is endemic to parts of Africa
example of epidemic
there is often a yearly flu epidemic in some U.S. communities
example of pandemic
the Spanish flu of 1918 began as an epidemic amongst soldiers at U.S. army bases, then became pandemic when they went to Europe during WW1
infection
- presence & multiplication of a living organism on or in the host
invading organism is a ?
pathogen - an organism that causes harm
types of pathogens
- viruses
- bacteria
- fungi
- protozoan
- nematodes
- microsporidia
factors determining whether a host will be infected and how it will be infected
- immunocompetence of the host
- virulence factors of infecting organism
- its portal of entry
immunocompetence of the host are?
its defense mechanisms adequate, non-defective, fully functional, etc.?
virulence factors of the infecting organism include
- toxins
- adhesion factors
- invasion factors
- evasive factors
portal of entry questions
how does microbe enter host?
the portal of entry usually involves ______. the CDC divides infection risks into 4 _______ precautions that should guide every healthcare workers’ interactions with the public. what are they?
- breach of 1st line of defense
- transmission-based
- standard, contact, droplet, airborne precaution
standard precautions
basic infection prevention measures used during every patient interaction whether a known/suspected infection is present
standard precaution measures include
- hand hygiene
- use of PPE
- resp hygiene and cough etiquette
- safe injection practices
- disinfect soiled surfaces and equipment
example of hand hygiene
wash hands
- before/after every patient contact
- before/after every meal
- after using toilet
use of PPE includes
- gowns
- gloves
- face mask
when anticipating exposure to infectious material
example of when to use PPE
always wear gloves when coming into contact with any blood or body fluids
example of resp hygiene and cough etiquette
cover cough or sneeze w/ arm, not hand
example of safe injection practices
dispose used needles in a special container
example of disinfect soiled surfaces and equipment
disinfect shared equipment, such as BP cuffs, btw each patient use
contact precautions
use when any patient has
- diarrhea
- stool incontinence
- draining wounds or sores
- uncontrolled secretions
- vomiting
- draining body fluids
- skin rashes or sores
to invade the host by direct contact or by contact w. an infected object
(contact with bodily fluids)
examples of when to use contact precautions
- salmonella
- hepatitis
- HIV
- ebola
- MRSA
- VRE
PPE for contact precautions
hand-washing, gown and gloves
droplet cautions
droplets can be generated by an individual during
- coughing
- sneezing or talking (saliva)
droplets contain ____ that travel no more than ____ form the infected individual. can invade the hosts ____, _____, _____.
- microorganism
- 3 ft
- nasal mucosa, conjunctiva, mouth
examples of when to use droplet precautions
- pertussis
- influenza
- diphtheria
- meningitis
- pneumonia
PPE for droplet precautions
hand washing, facemask once in the room
airborne precautions
use when any individual has a suspected or known infection that is transmitted by the airborne route
examples of when to use airborne precautions
- TB
- measles
- chicken pox
- small pox
PPE for airborne precautions
hand washing, N95 face mask prior to entering the room
course of a disease
stages that are pathogen-specific and affected by various factors
what are the stages of the course of a disease?
1). incubation period
2). prodromal stage
3). acute stage
4). convalescent period
5). resolution
incubation period
- phase during which the pathogen begins active replication but doesn’t produce S&S
- varies in length
examples of incubation periods of diseases
- salmonella: 6 to 8 hrs
- hep B: 50-180 days
prodromal stage
- initial appearance of S&Ss
- may be mild
acute stage
- maximum impact
- very pronounced and specific S&Ss
convalescent period
containment of infection and resolution of S&Ss
resolution
total elimination of pathogen w/o remaining S&Ss
exceptions to classic stages of course of a disease
- may become chronic dz; protracted & irregular course
- some dzs progress in subclinical/subacute from start-finish w/o many clinical S&S or less severe S&S
- fulminant/fulminating illness: abrupt onset w/ little or no prodrome
since development of ______ medications, infectious disease in developed countries has lessened.
antibiotic/anti-infective
despite antibiotic/anti-infective, ______ are adept at _____ and now many are _____ to the anti-infective drugs that used to kill or disable them.
microorganisms, changing, resistant
examples of antibiotic (anti-bacterial) resistance
- beta lactam antibiotics
- vancomycin
penicillin and its derivatives are called?
beta-lactam antibiotics
why are penicillin and its derivatives called beta-lactam antibiotics?
they all have a molecular structure called beta-lactam ring
example of penicillins
- methicillin
- amoxicillin
beta lactams _____ to be effective against a wide spectrum of microbe. then certain microbes _____ and developed an enzyme called _______.
used, mutated, beta-lactamase
what does beta-lactamase do?
destroy beta-lactam antibiotics by dismantling the beta lactam ring
specific beta-lactamase microbes
MRSA and resistant Streptococcus pneumoniae
MRSA
methicillin- resistant Staphylococcus aureas
fomite
an inanimate vector
staphylococcus aureus is a ____ skin flora and occasionally, can cause infections such as _____ and ____ in ______ people.
- normal
- boils and cellulitis
- immunocompetent
MRSA developed in 1960s in hospitalized patients that had been on _____ so long that one strain of the _____ bacteria _____ and became ______.
- methicillin
- staph
- mutated
- resistant
MRSA is now rampant in?
- some hospital settings
- nursing homes
MRSA is generally known as a ?
nosocomial disease
how is MRSA spread?
- direct patient to hands to patient contact
- colonization of nares of healthcare workers
- occasionally fomites such as stethoscopes
MRSA usually invades ____ but “likes” ______ such as ? which can take it to a site to _____ such as?
- wounds
- fomites
- urinary catheters, IV catheters
- colonize
- bladder, blood
community-acquired MRSA
found in wounds of people who haven’t been in a hospital setting
what drug is now one of the few that will destroy MRSA?
vancomycin
resistant Streptococcus pneumoniae
most common microbe causing otitis media (inner ear infection)
resistant Streptococcus pneumonia used to be easily treated with _____ until ear infections became?
- penicillin
- overtreated or treated inappropriately (antibiotics don’t cure viral ear infections)
new strain of strep developed that makes _____ and now many ear infections are?
- beta lactamase
- much harder to get rid of
VRE
vancomycin-resistant enterococcus
VRE is another _____ infection
hospital associated
enterococci faecalis is a normal _____ flora, but in hospitalized people/nursing home residents, it will often migrate to ______ and other areas.
bowel, urinary tract
VRE used to be easily dealt with using _____, but then ______ developed due to mutated gene that changed one small part of a _____ on the enterococcus cell wall. now ____ won’t ____ to the microbe cell wall to destroy it.
- vancomycin
- resistance
- protein
- vancomycin
- bind
what is used to treat VRE?
only very heavy-duty alternative antibx are effective now
example of infectious diseases whose portal of entry is breach of skin and/or mucous membranes integrity
- cellulitis
- botulism
- tetanus
- rabies
- malaria
- zika
cellulitis
infection of the dermis and subcutaneous tissue
pathogenesis of cellulitis
- organisms (like Staphylococcus aureus) that normally dwells on TOP of skin (epidermis) gains deeper entry after injury (laceration, puncture, microscopic breach, etc.)
OR - cellulitis follows milder staph infection of skin like impetigo: blister eruption around nose/mouth that are itchy, crusty, contagious
cellulitis infected area is
erythematous, swollen, painful
tx for cellulitis
abx (antibiotics)
botulism
caused by toxin of Clostridium botulinum, bacillus that can invade body via food or soil (dirt to wound)
toxin of Clostridium botulinum heads for _________ nerve synapses and blocks _________ receptor cells.
neuromuscular, ACh muscle
typical S&S for botulism
- descending, symmetric paralysis including resp
- floppy baby syndrome in kids that eat honey contaminated w/ C. botulinum
botulism is considered what?
top candidates for bioterrorism use
tx for botulism
- temporary mechanical ventilation
- other supportive tx
tetanus vaccination as part of ____ (______) but immunity ____. so must?
- DPT (diphtheria, pertussis, tetanus)
- weakens
- boosters every 10 years
pathogenesis of tetanus disease
- caused by Clostridium tetanii, bacillus which can live in soil as a spore
- when deposited in would, germinate as becomes active, release tetanospasmin
- block inhibitory NTs
- cause uninterrupted nerve impulses to muscle cells
uninterrupted nerve impulses to muscle cells due to Clostridium tetanii causes? (S&S)
- trismus/lockjaw (jaw musc tightening)
- severe tetany: muscle twitch, cramps, convulsions
tx of tetanus
antibx + TIG
what grps most likely to not have been fully vax?
- very elderly (vaccinations not around til 1950s)
- immigrants
- home-schooled kids
rabies
virus transmitted in saliva of infected host, usually by bit to skin (most common vector is bat)
vector-borne disease
transmitted via bite/sting/puncture of a host creature that then transmit microscopic disease - causing organism into new body
examples of vectors
- mosquitos
- ticks
- fleas
- rats
- bats
- dogs
rabies virus travels via ______ to the brain and spinal cord (___) can causes _________.
PNS, CNS, brain inflammation
S&S of rabies
- anxiety
- agitation
- confusion
- convulsions
^ caused by brain inflammation - production of large amt saliva
- dysphagia (foam at mouth)
- hydrophobia (can’t swallow water)
tx of rabies
- tx needs to begin w/in first 14 days post-exposure prophylaxis (PEP)
- 1 dose of rabies immunoglobulin + 4 doses of rabies vax
if rabies not treated w/in first 14 days, rabies virus will _____ its trip all way up to ____ - once _____ infected…..
- continue
- CNS
- CNS, no cure
- no tx = almost always fatal
malaria
- resp for 2 mil deaths in world yearly
- caused by protozoa that is transmitted via mosquito vector
protozoa of malaria reproduces in _______ (____) and then is released into blood, where it infects ____ and caused them to _____ (______). as _______ ____, they trigger ___ ___ ___ into blood and cause S&S.
- liver cells (hepatocytes)
- RBCs
- rupture (hemolysis)
- RBCs rupture
- acute phase reactants
S&s of rabies
- high fever
- chills
- arthralgia
- anemia
- splenomegaly
- cerebral ischemia
- heart failure
tx of malaria
- prevention w/ malaria vax in children or with quinine-based drugs
- mosquito nests
- use of iscent repellant that contains DEET
- antiparasitic or IV antimalaria drugs once diagnosed
Zika
cased by Zika virus, spread to people primarily through bite of infected mosquito
S&S for Zika
- may be mild and similar to S/S seen with flu
- usually don’t get sick enuf to go to hospital
- rarely die from Zika
Zika infection during pregnancy can cause birth defects such as?
microcephaly (brain and head smaller than normal)
transmission of Zika occurs from?
- mosquito bites or person-to-mosquito-to-person
- pregnant woman to fetus
- sexual transmission
prevent Zika by?
- use insect repellants w/ DEET
- light-colored clothing when outdoors
- window/door screens + mosquito nets
- remove standing water where mosquitos reproduce
- sex abstinence or condom use considered for 8 wks to 6 months
- preg. women or prospective should avoid areas w/ known Zika outbreaks
diagnosis of Zika
blood or urine test can confirm diagnosis
tx of Zika
supportive care = fluids, rest, acetaminophen
examples of infectious diseases whose portal of entry is invasion of respiratory tract
- strep throat
- diphtheria
- pertussis
- mumps
- measles
- “pox” diseases
- influenza or flu
respiratory tract includes
- nose
- pharynx
- larynx
- trachea
- bronchi
- alveoli
strep throat
- caused by streptococcus pyogenes
- invades via coughing, sneezing
S&S strep throat
- red, sore throat
- white patches on tonsils
with certain strains of strep, can get ______ (______) along with usual S&S. what is that?
- scarlet fever “scarlatina”
- fever and rash that can cover whole body
with strep throat, important for infected person to get _____ early on. why?
- antibx
- getting an early/thorough treatment of antibx lessen chance of autoimmune disease like rheumatic fever
diphtheria
very contagious URI caused by bacterium transmitted by cough, sneeze, etc.
S&S of diphtheria
- sore throat
- fever
- pseudo membrane across tonsils and throat
pertussis
highly contagious disease that is leading cause of vaccine-preventable deaths in underdeveloped countries
pertussis is also known as? why?
- whooping cough
- S/S include horrible, violent coughing fits that can be bad to the point person cannot eat, becomes malnourished
DPT vaccine includes vax for?
diphtheria, pertussis, tetanus
mumps
- virus that invades parotid glands - swelling + fever
- main complication is infertility in males
- vaccine MMR - rarely seen in developed countries
measles nickname
- rubeola (2 wk or just measles)
- rubella (3 day or german measles)
rubeola and S/S
- virus passed by coughing and sneezing
- dense red maculopapular rash starting on head and going down body
- fever, cough, runny nose, conjunctivitis
rubeola can have serious complications such as?
encephalitis (brain inflammation from microorganism)
rubeola is _____ seen in developed counties except in? still endemic in certain ______ areas.
- rarely
- immunocompromised or those not vax w/ MMR
- underdeveloped
rubella
milder virus and mild S/S include fever, rash, swollen glands
main concern w/ rubella is when?
woman contracts disease in early pregnancy
why is a woman contracting rubella during early pregnancy a concern?
- can cause baby to be born w/ problems like mental retardation, hearing problems, eye problems, etc.
child-bearing age women should always have a _____ titer done and if low, need to be _______
titer, vaccinated
titer
- done to measure level of antibodies to specific diseases
- high titer = lots of antibodies = had disease b4 or vaccinated
vaccine _____ has eradicated rubella in US and certain other countries.
MMR
pox diseases are also _____ diseases.
herpetic
herpetic diseases are all caused by some version of the?
herpes virus
a ______ virus, once in the body, ______ leaves the body.
- herpes, never
- hides out in the nerves and doesn’t come back out most of the time
herpes viruses that DO come back out (the exceptions)
- genital and oral herpes
- shingles
varicella (chicken pox)
- very contagious - spread via direct inhalation of virus from infected person exhaling, sneezing, etc.
varicella manifests as _______ (______) that begin on _____ and move ____ and have diff stages of development. they appear, break, and crust in _____ at _____ times.
- vesicles (fluid-filled blisters)
- trunk, outward
- clusters
- different
person is contagious with varicella until?
the last lesion crusts
mortality in varicella
very low unless immunocompromised
_____ vaccine for varicella now part of?
chicken pox, normal immunization schedule
pox and pox diseases developed because?
they leave pockmarks - scars from pustular lesions
variola (small pox)
very contagious, inhaled virus, manifests as vesicles but diff look/pattern than chicken pox
variola/small pox lesions are _______ that are all _____ stage, start in ______ and _____ and move toward _____.
- dense clusters
- the same
- face and extremities
- trunk
depending on type of small pox virus, a person may get?
- high fever
- severe flu-like S&S
- painful pustules in moth and esophagus
- sometimes hemorrhage from virulence of variola virus toxin
variola state in world
eradicated (except in certain labs - possible bioterrorist use)
after having chicken pox, varicella virus remains in system _____, becoming _____ in nervous system like _____.
- for life
- dormant
- herpes simplex
zoster (herpes zoster, shingles)
in some people, especially elderly and/or immunocompromised peeps, varicella virus will pop out as painful lesions of skin along a dermatome
- single episode
tx of zoster
antiviral meds and creams
arthralgia
joint soreness
myalgia
muscle soreness
influenza (flu)
acute viral illness of upper/lower resp system w/ S/S of fever, chills, myalgia, malaise, dry cough, headaches
flu is _____ and usually ___ serious except in certain people of ______, who are?
- self-limiting
- not
- high-risk
- very young, elderly, chronically ill and debilitated, immunocompromised persons
epidemiology of flu (transmission and time of occurrence)
- transmitted airborne resp droplets + occurs primarily in winter months
epidemiology of flu - type A
- circulates yearly
- epidemics every 3-5 yrs
- major pandemics every 25-35 yrs due to major mutations
epidemiology: _____ flu outbreaks almost always being in ____ countries that have ____ of people that live close to _____, such _____ such as pigs/birds are the _______ _____ for the flu.
- yearly
- Asian
- animals, animals
- natural reservoir
pathogenesis of Type A flu
1). single stranded RNA virus w/ proteins on viral cell envelope called neuraminidase + hemagglutinin
2). proteins catalyze process of viral invasion of resp cells, replication, and release of new viral progeny
3). each time new progeny released, host cell dies
4). necrosis of superficial resp cells and inflammation
5). S/S and host susceptible to bacterial pneumonia
it is the _____ and ____ viral proteins that mutate and cause yearly changes in Type A viral makeup - what is this change called?
- neuraminidase and hemagglutinin
- antigenic drift or shift, depending on how major the change is
usually, an ____ designation is given according to the type of mutation. give example of nomenclature based on mutation.
- HN
- H5N1: avian flu
each year, _____ _____ is made according to the new designation.
new vaccine
infectious diseases of GI tract also called? why?
- infectious enterocolitis or infectious diarrhea
- microbe causes varied degrees of diarrhea and sometimes inflammation and ulcerations of the intestines
in developed countries, GI infectious diseases usually _________ except in?
- mild, self-limiting
- young, elderly, immunocompromised patientsG
GI infectious diarrhea transmitted by?
- oral/fecal route
- pathogens excreted from infected person’s gut and enter GI tract of another person through mouth
example of transmission of infectious diarrhea
ingesting contaminated food or by touching contaminated surfaces and then touching mouth
tx of infectious diarrhea
abx and fluid replacement
viral etiology of infectious diarrhea
- mild S/S of vomiting + watery diarrhea
- sometimes “stomach flu” but is not true influenza
bacterial etiology of infectious diarrhea
- causing non-bloody (watery) diarrhea
- spectrum of severity
examples of organisms causing bacterial enteritis
- E. coli
- salmonella
E. coli
- certain strains can be ingested in undercooked meats and other foods
- certain forms normally found in intestines do not cause diarrhea
salmonella
- cows/chickens reservoir and carry it in guts - spread in their stool
- transmitted thru feces-contaminated beef or chicken that is not cooked properly (milk and eggs also)
dysentery
infectious diarrhea when it is bloody and severe
types of dysentery
- bacillary dysentery
- amoebic dysentery
bacillary dysentery
etiology is bacillus - most common is shigella
amoebic dysentery
etiology is protozoa found in water
patho/S&S of dysentery
- microbes cause damage to mucosal surface of the gut
- diarrhea has blood + mucous and pain w/ bowel movements bc infection/inflammation of intestinal lining
other S/S of dysentery
fever and dehydration
giardiasis transmission
- caused by giardia protozoa
- usually contacted by drinking contaminated water (well-water, river water, etc.)
- can be transmitted person to person by oral/fecal route
patho and S/S of giardia infection
after ingestion, giardia adheres to intestinal wall and interferes w/ fat absorption - fat goes to stool
giardiasis diarrhea is?
greasy, frothy, full of fat, foul smelling, but NAWT bloody (no blood bc doesn’t invade intestinal wall)
giardiasis can last _____ to ____, but once identified, what tx?
- months to years
- easily fixable w/ antibx
antibiotic-associated diarrhea also called
pseudomembranous colitis
colitis
inflammation of colon
pseudomembranous
as part of infection, causes internal lining of intestines to develop yellowish membrane-like debris
antibx-associated diarrhea caused by?
- long-term antibiotics
- wipes out normal gut flora -> Clostridium difficile (C-diff) moves in and cause inflamed intestines
antibx associated diarrhea most common cause of?
iatrogenic/nosocomial diarrhea
tx for antibx associated diarrhea
- stop antibiotics
- IV fluids
- put on other c-diff specific antibx
antibx associated diarrhea: infection can _____, no _____
reoccur, prevention
leukemia
type of cancer of hematopoietic system in which there is uncontrolled proliferation of leukocytes, causing over-crowding of bone marrow and decreased production of normal hematopoietic cells
S/S of leukemia
- leukocytosis: WBC count high (50000 when norm is 6 to 10000)
- thrombocytopenia: easy bleeding + bruising
- anemia: fatigue, SOB
- ease of infection bc WBC immunocyte fxn impaired
leukemia is classified according to _______ (____ vs ____) and the _____ (either ____ or ____).
- predominant cell (myeloid vs lymphoid)
- onset (acute or chronic)
multiple myeloma
type of cancer that is mostly idiopathic etiologically, but may also have genetic component
multiple myeloma: predominant cell involved in becoming cancerous is?
B-lymphocytes, specifically plasma cells
normally, plasma cells (__________) selectively produce immunoglobulins on ___________.
- cells that develop from B-cells and secrete immunoglobulins
- as-needed basis
multiple myeloma pathogenesis
1). some plasma cells become malignant and begin overproducing immunoglobulins
2). immunoglob. infiltrate bones mainly
3). cause multiple malignant tumors that increase osteoclastic activity
osteoclasts are ____ cells that normally migrate along _______ walls and _____ bone cells when _____ is needed in the body.
- hematopoietic
- bone capillary
- chew up
- calcium
in multiple myeloma, osteoclasts go into _____ and chew up _____ bone cells than normal.
overdrive, more
w/ multiple myeloma, bones get ____ and pathologically _____ amt of calcium in the blood (_____).
weaker, high, hypercalcemia
S/S of multiple myeloma
- osteoporosis
- hypercalcemia
osteoporosis
pathological fractures (bone breakage from minimal stimulus)
hypercalcemia
s/s of confusion, lethargy, weakness, kidney stones + failure
tx of multiple myeloma
- chemotherapy
- radiation
- bone marrow transplantation
problems with erythrocyte fxn can be _____ or _____, or both.
- quantitative (alterations in numbers)
- qualitative (defect in quality of fxn)
general causes of alterations and defects of erythrocyte
- qualitative: genetic abnormalities like sickle cell
- quantitative: too few vs too many
anemias
disorder due to pathologically decreased number of RBCs (too few)
anemia definition
less than normal # of total circulating erythrocytes and/or decreased in quality/quantity of Hgb
anemia is the ____ of a disease process; ____ or ____ and/or can be considered a ____ of a disease. only certain cases it is considered a _________.
- RESULT
- state or condition
- SIGN
- disease process in itself
general etiologies of anemia
- decrease in erythropoiesis (bone marrow dysfxn, leukemias, hypersplenism)
- loss of RBCs (via hemorrhage and/or pathologic hemolysis)
classification of anemias are according to changes in?
- shape
- substance
- size
of RBCs
shape of RBCs anemia class
several anemia disorders which are caused by abnormalities in shape
ex: sickle cell anemia
substance of RBCs anemia class
reduced hemoglobin content - hypochromic anemia (less color)
size of RBCs anemia class
microcytic, normocytic, macrocytic anemias
diagnosis of an anemia and its classification by what test?
CBC (complete blood count)
CBC:
1). look at ____ count, norm is _______ in males. patient has anemia when ___ count is?
2). to name anemia, next look at ______ (____) which is the _____ of the RBC, normal range is?
1). RBC, 4-6 mil/L, <4 mil
2). MCV (mean corpuscular volume), size, 80-95
MCV count for
1). microcytic anemia
2). normocytic anemia
3). macrocytic anemia
1). MCV <80
2). MCV in norm range of 80-95
3). MCV >95
other #s you might see in anemic person’s CBC
- low Hgb is <14 (norm is 14-18 gm/L)
- low hematocrit (Hct) is <42% (percentage of RBCs in blood) (norm is 42-52%)
polycythemias
- disorders due to pathologically increased number of RBCs (too many)
- disorder in which more than norm number of total circulating RBCs (erythrocytosis)
- 2 forms: primary and secondary
primary polycythemia
- aka: polycythemia vera
- rare condition in which there is slow development of hyperproliferation of bone marrow stem cells
tx of primary polycythemia
removal of 300 to 500 mL of blood 3-4 times per month
secondary polycythemia
compensatory increase in RBCs in resp to hypoxic conditions
hypoxic conditions that cause secondary polycythemia
- living in higher altitudes (>10000 feet)
- smoking (increased CO2 level)
- chronic low-O2 conditions (COPD)
mechanism of compensation of secondary polycythemia
1). low O2
2). body increases erythropoietin secretion
3). more RBCs made
on CBC, polycythemia is characterized by
1). RBCs > 6 million
2). hematocrit > 52%
problems related to over proliferation of RBCS most often are due to?
thickness of blood
- extra RBCs = sludge-like blood
sequelae of thick blood is?
high risk for distal tissue ischemia bc blood that is thick and slow moving (stasis) can increase chance of clots forming + blocking blood vessels
thickened blood can cause what on heart/lungs?
extra workload = higher risk for failure in these organs
S/S polycythemia
- ischemic pain
- heart and lung failure related issues
microcytic anemia
- anemia where size/MCV smaller than normal
- RBCs <4 mil and MCV <80
for microc. anemia, something causes body to ____, _____ ____ RBCs and being to ______ on material to make enough _____ replacement RBCs.
- slowly, chronically, lose
- run low
- full-sized
bc body runs low of materials to make full-sized RBCs in microc. anemia, the bone marrow tries to catch up by?
- churning out RBCs that are smaller/less mature
- compensatory resp not enough to bring up RBC #s, but better than nothing
examples of chronic, steady loss of RBCs
- women with heavy menses
- occult (hidden) GI bleeding
sometimes, microc. anemia is called _____ because _____ is an essential part of _____ molecules which are lost w/ RBCs.
- iron deficiency anemia
- iron (Fe)
- Hgb
S/S microcytic anemia
- RBC <4 mil
- fatigue
- weakness
- sometimes SOB and dull mentation
^ common in most anemias - specific to class: low MCV and low Hgb
tx of microcytic anemia
stop blood loss if possible and give iron supplements
normocytic anemia
- an anemia where size of RBC is normal
- RBC <4 mil and normal MCV
patho of normocytic anemia
- something cause RAPID blood blood loss, no time for compensatory resp of smaller RBCs (ex traumatic hemorrhage)
OR - chronic dz cause slow-down production of RBCs - produced in norm size, but more slow and less in #s (ex AIDS, lupus, chronic renal failure)
S/S normocytic anemia
- common in most anemias: RBC <4 mil, fatigue, weakness, sometimes SOB and dull mentation
- specific to class: normal MCV
tx for normocytic anemia
- acute blood loss: stop loss if possible and give units of blood as needed to replace
- chronic disease: give GH erythropoietin to stimulate bone marrow to make more RBCs
macrocytic anemia
- aka megaloblastic anemias
- anemia where size larger than normal
- CBC: RBCs <4 mil, MCV >95
patho of macroc. anemia
- certain dz processes cause faulty DNA coding of RBC size
- RBCs larger than normal (don’t fxn right)
- most common example if pernicious anemia
pernicious anemia
- most seen in elderly, patients w/ GI absorption disorders, ppl w/ inadequate nutrition (eg, alcoholics)
1). beings w/ diminished intrinsic factor (hormone made by parietal cell in stomach)
2). w/o intrinsic factor: vit. B12 cannot be adequately absorbed from digested food
3). w/o vit. B12: DNA malfxns and makes coding error in RBC creation
4). too few RBCs made + larger than normal
S/S of macrocytic anemia
- common: RBC <4 mil, fatigue, weakness, sometimes SOB and dull mentation
- class specific: MCV> 4mil, glossitis, neuropathies
glossitis
- tongue inflammation
- swollen, beefy red, smooth, painful tongue
neuropathies associated w/ macroc. anemia are most often seen in ____. example? caused by?
- legs
- paresthesia: pins/needles or burning
- lack of B12 as important nerve modulator
tx of macroc. anemia
usually B12 injection
fewer and/or deranged RBCs or Hgb means ____ in effectiveness of ____ getting to cells of tissues and organs for cellular metabolism.
disruption, O2
anemic patient will usually have S/S related to?
hypoxemia (lack of oxygen in blood)
type of S/S of anemic patient w/ hypoxemia
- slow/subtle if slow process and body able to compensate
OR - immediate and severe if cause if sudden
reduced blood O2 (hypoxemia) causes ___ hypoxia, which can lead to?
- tissue
- SOB, weakness & fatigue, muscle cramps
- CNS effects: slow mentation, dizziness, lethargy, syncope (fainting)
- pallor of skin bc less RBCs traveling in skin capillaries - less pinkness
for any kind of bleeding deficiency, S/S will be similar, relating to ______, which can be ______ or _____.
- easy bleeding
- frank bleeding (obvious)
- occult bleeding (hidden)
where frank bleeding can happen
- under the skin
- GI bleeding
- mucous membranes
under the skin frank bleeding
- petechiae: pinpoint red spots that don’t blanche
- purpura: larger areas that look purplish
- ecchymosis: collection of blood under skin greater than 1cm
frank GI bleeding
stools can be blood or black/tarry
frank mucous membrane bleeds
nose bleeds
thrombocytopenia
platelets (thrombocytes) deficient in number
causes of thrombocytopenia
- congenital problems (rare)
- nutritional
- certain drugs and chronic diseases
- autoimmune
autoimmune cause of thrombocytopenia
- IgG attacks platelets, diminish their effectiveness
- idiopathic thrombocytopenia purpura (ITP)
S/S thrombocytopenia
- platelet count on CBC <100,000 (norm is 150,000-400,000)
- easy bleeding
diseases that causes clotting factors to be defective or deficient in amount
- hemophilia
- von Willebrand disease (vWD)
- liver disease (cirrhosis)
hemophilia
refers to several possible different hereditary deficiencies of coagulation factors, usually X-linked recessive problem
S/S hemophilia
- spontaneous bleeding or bleeding that is out of proportion to amt of trauma
txs of hemophilia
- transfuse plasma - plasma has clotting factors
- transfuse concentrates of whichever clotting factor is deficient
von Willebrand disease (vWD)
- inherited disorder and most common clotting disease
- every 1 in 10 person has variation of it
example of von Willebrand factor
a type of vWF released by injured tissue that calls platelets and binds to them + to fibrinogen to promote clotting (platelet plug)
von Willebrand Factor (vWF) is found in the ____ and in the _____in ___forms
blood, tissue, various
S/S von Willebrand disease
- various types causes varied severity of S/S
- mostly very mild clotting deficiency w/ mild incidences of easy bleeding
example of S/S of vWD
some women manifest very heavy periods due to type of vWD
tx of vWD
usually none needed, or symptomatic
- certain more severe forms receive vWF transfusions
liver disease (cirrhosis)
- liver is site of protein synthesis including coagulation factors
- liver disease -> coagulation factors -> decreased ability to clot -> easy bleeding
thrombocytosis
- platelet greater than 400,000
- can be genetic myeloproliferative disorder or from secondary cause (RA, cancer, or after splenectomy)
thrombocytosis causes ______, which can manifest as ______ disorder, which is?
- hypercoagulation
- thrombotic
- proliferation of blood clot formation
thromboembolic disorders
- any combination of thrombocytosis and clotting factor overactivity
- thrombus and embolus
thrombus
an arterial or venous clot attached to vessel wall
embolus
an arterial or venous thrombus that has broken loose and travels in the circulator system
splenomegaly
enlargement of spleen
splenomegaly causes can be categorized as?
- hematologic
- infectious
- malignancies
- physiologic
hematologic splenomegaly
any time there is increased hemolysis of RBCs, the spleen can enlarge bc more RBC debris to process
examples of when hematologic splenomegaly occurs
- Rh blood type incompatibility (erythroblastosis fetalis)
- ABO blood type incompatibility
- hemolytic problems from drug rxns/autoimmune diseases that trigger antibody attack on RBCs or infections in which RBCs are attacked (malaria)
infection/inflammation splenomegaly
- viral: hepatitis, mononucleosis (epstein-barr virus), CMV
- bacterial: TB
malignancies splenomegaly
- esp leukemia
- huge #s of WBCs come thru spleen, cause it to swell
physiologic splenomegaly
- usually individualistic quirk
- idiopathic etiology
- no S/S
S/S splenomegaly
- palpably large spleen (normally can’t palpate)
- may have pain
- may have hypersplenism
spleen is part of ____________, which phagocytizes old, damaged, or dead blood cells so parts can be ________; also _______ come through and are _______ of blood.
- mononuclear phagocytic system (MPS)
- recycled
- microorganisms
- filtered out
hypersplenism
- condition that results from splenomegaly
- due to enlarged spleen, RBCs+ WBCs + thrombocytes trapped there (sequestered)
all the cells trapped in the spleen (hypersplenism) begin to be _______, _______ en masse. what are the two sequelae from this?
- chewed up, destroyed
- spleen more engorged and enlarged
- pancytopenia: low #s of all cells in blood
S/S hypersplenism
- anemia
- increased risk of infection
- easy bleeding
