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Pathophysiology > Week 7: Blood, Circulatory, & Lymphatic Disorders > Flashcards

Week 7: Blood, Circulatory, & Lymphatic Disorders Flashcards

1
Q

Blood is a _________ that has fluid and cellular components

A

tissue

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2
Q

Cellular components of the blood are:

A

RBC - erythrocytes
WBC - leukocytes
platelets

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2
Q

________ is the fluid component of blood

A

plasma

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3
Q

RBC are important for

A

oxygen transport

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4
Q

WBC are critical for host _________

A

defense

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5
Q

Platelets function: critical for :

A

hemostasis- blood clotting

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6
Q

Albumins are

A

plasma proteins

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7
Q

Erythropoietin is a glycoprotein hormone, naturally produced by the kidney, that stimulates:

A

red blood cell production.

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8
Q

The circulatory system consists of:

A

cardiovascular system
lymphatic system

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9
Q

Arteries—arterioles
~Transport blood :

A

away from heart

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10
Q

Veins—venules
~Return blood:

A

back to the heart

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11
Q

Capillaries
~Microcirculation within:

A

tissues

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12
Q

Systemic circulation
~Exchange of _________________________ in tissues

A

gases, nutrients, and wastes

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13
Q

Pulmonary circulation
~ ______ exchange in ________

A

~Gas exchange in lungs

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14
Q

Histology of Arteries and Veins

Tunica ____________ —endothelium (simple
squamous epithelium)

Tunica _____________ —middle layer, mostly smooth muscle

Tunica _____________ (externa)—connective
tissue with fibrocytes, collagen (type I), and
elastic fibers

A

Tunica intima—endothelium (simple
squamous epithelium)

Tunica media—middle layer, mostly smooth muscle

Tunica adventitia (externa)—connective
tissue with fibrocytes, collagen (type I), and
elastic fibers

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15
Q

Composition of Blood

A

Plasma- Plasma proteins

Cellular component
-Erythrocytes
-Leukocytes
-Thrombocytes (platelets)

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16
Q

Erythrocytes (Red Blood Cells)
shape:

A

Biconcave flexible discs
~No nucleus in mature state

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17
Q

Erythrocytes (Red Blood Cells)
Contains hemoglobin:

A

~Globin portion
~Heme group

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18
Q

Erythrocytes (Red Blood Cells)
Life span—

A

120 days

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19
Q

Erythropoietin produced in the __________
stimulates : ?

A

kidney

erythrocyte production.

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20
Q

Blood Clotting—Hemostasis

Three steps:
1- _________________________ after injury
2- __________________________
3- __________________ mechanism

A

1- Vasoconstriction or vascular spasm after injury
2- Platelet clot
3- Coagulation mechanism

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21
Q

___________ will eventually break down the blood clot

A

Plasmin

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22
Q

Blood typing is based on __________ in the plasma
membrane of the erythrocytes.

A

antigens

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23
Q

Blood Typing

ABO system
-Based on the presence or absence of:
-___________ in the blood plasma

Rh system
-___________ in plasma membrane: Rh+
-Absence of ____________: Rh-

A

ABO system
-Based on the presence or absence of specific antigens
-Antibodies in the blood plasma

Rh system
-Antigen D in plasma membrane: Rh+
-Absence of antigen D: Rh-

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24
Q

Complete blood count (CBC)

-Includes total :

A

red blood cells (RBCs)
white blood cells (WBCs)
platelets

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25
Q

-Leukocytosis (increased WBCs)
* Associated with:

A

inflammation or infection

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26
Q

Leukopenia (decreased WBCs)
* Associated with some:

A

viral infections, radiation, chemotherapy

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27
Q

Leukocytosis is

A

increased WBC

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28
Q

Increased eosinophils
* Common in:

A

allergic responses

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29
Q

Leukopenia is

A

decreased WBC

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30
Q

Morphology

-Observed with ________1_______
-Shows size, shape, uniformity, maturity of cells
* Different types of ____2______ can be distinguished.

A

1- blood smears

2- anemia

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31
Q

Hematocrit- Percent by volume of

A

cellular elements in blood

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32
Q

Hemoglobin
-Amount of hemoglobin per unit volume of blood
-Mean corpuscular volume (MCV)
* Indicates the : ?

A

oxygen-carrying capacity of blood

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33
Q

Reticulocyte count: Assessment of __________________ function

A

bone marrow

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34
Q

Chemical analysis
-Determines __________ ________ of components, such as iron, vitamin B12, folic acid, cholesterol, urea, glucose

A

serum levels

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35
Q

Bleeding time- Measures __________ function

A

platelet

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36
Q

Prothrombin time (PT) and partial thromboplastin
time (PTT)

-Measure function of various factors in : _____________________
-International normalized ratio (INR) is a
standardized version.

A

coagulation process

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37
Q

Anemia causes a reduction in: ?

A

oxygen transport.

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38
Q

Basic problem of anemia is :

A

hemoglobin deficit

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39
Q

Oxygen deficit leads to:

-Less ____________1___________ in all cells
* Cell metabolism and reproduction diminished

-_______2_________ mechanisms
* Tachycardia and peripheral vasoconstriction

-General signs of _______3_____
* Fatigue, pallor (pale face), dyspnea, tachycardia

-Decreased regeneration of epithelial cells
* Digestive tract becomes inflamed and ulcerated, leading to stomatitis
* Inflamed and cracked lips * Dysphasia
* Hair & skin may show degenerative changes.

-Severe anemia may lead to angina or congestive
heart failure (CHF).

A

1- energy production

2- Compensation

3- anemia

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40
Q

Iron Deficiency Anemia
Insufficient iron impairs :

Microcytic, hypochromic RBCs
* Result of low hemoglobin concentration in cells

A

hemoglobin synthesis.

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41
Q

Iron Deficiency Anemia

Very common
-Ranges from mild to severe
-Occurs in all age groups, but more common in
women of childbearing age
-Estimated that ________ women is affected
* Proportion increases for pregnant women

A

one in five

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42
Q

Iron Deficiency Anemia is Frequently a sign of :

A

an underlying problem

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43
Q

Iron Deficiency Anemia: Causes

-Dietary intake of iron below min. requirement
- ________1____________ [from bleeding, ulcer, hemorrhoids, cancer]
-Impaired __________2____________ of iron
-In many disorders, ______3_________ syndromes
-Severe ____4____ disease
-May affect iron absorption as well as storage

A

1- Chronic blood loss

2- duodenal absorption

3- malabsorption

4- liver

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44
Q

Iron Deficiency Anemia: Signs
and Symptoms

A

-Pallor of skin and mucous membranes
-Fatigue, lethargy, cold intolerance
-Irritability
-Degenerative changes
-Stomatitis and glossitis
-Menstrual irregularities
-Delayed healing
-Tachycardia, heart palpitations, dyspnea, syncope

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45
Q

-Intrinsic factor secreted by gastric mucosa
-Required for intestinal absorption of: ?

A

vitamin B12

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46
Q

Pernicious Anemia: Vitamin B12 Deficiency

Basic problem is lack of absorption of vitamin B12 because of :

A

lack of intrinsic factor

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47
Q

Pernicious Anemia: Vitamin B12 Deficiency

Characterized by ____________________________________ erythrocytes
-Carry less ?
- _______ life span

A

Characterized by very large, immature, nucleated erythrocytes

-Carry less hemoglobin
-Shorter life span

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48
Q

Pernicious Anemia: ______________ Deficiency

A

Vitamin B12

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49
Q

Pernicious Anemia: Vitamin B12 Deficiency
Causes

Dietary insufficiency is very rarely a cause.
- _________ factors have been implicated.
-Often accompanies ?
-May also be an outcome of _______ surgery

A

Dietary insufficiency is very rarely a cause.

-Genetic factors have been implicated.
-More common in light-skinned women of northern European ancestry
-Often accompanies chronic gastritis
-May also be an outcome of gastric surgery

50
Q

Vitamin B12 is needed for the function and maintenance of :

A

neurons.

51
Q

A significant deficit of vitamin B12 will cause
symptoms in the _____________________

-These may be reversible.

A

peripheral nerves.

52
Q

Pernicious Anemia: Vitamin B12 Deficiency

Manifestations in addition to those typical for anemias

-Tongue is :
-Digestive :
-Feeling of :

A

-Tongue is typically enlarged, red, sore, and shiny.
-Digestive discomfort, often w/ nausea & diarrhea
-Feeling of pins and needles, tingling in limbs

53
Q

Pernicious Anemia: Vitamin B12 Deficiency

Diagnostic tests

A
  • Microscopic examination (erythrocytes)
  • Bone marrow examination (hyperactive)
  • Vitamin B12 serum levels below normal
  • Presence of hypochlorhydria or achlorhydria
  • Presence of gastric atrophy
54
Q

Aplastic Anemia

-Impairment or failure of ________________
~May be temporary or permanent

A

bone marrow

55
Q

Aplastic Anemia is often idiopathic but possible causes include:

Myelotoxins
Viruses
Genetic abnormalities

examples?

A

Myelotoxins
* Radiation, industrial chemicals, drugs

Viruses
* Particularly hepatitis C

Genetic abnormalities
* Myelodysplastic syndrome
* Fanconi’s anemia

56
Q

Aplastic Anemia

Blood counts indicate _____________
-Anemia, leukopenia, thrombocytopenia
-Bone marrow biopsy may be required.
-Erythrocytes often appear normal.

A

pancytopenia.

57
Q

Aplastic Anemia

Identification of cause and prompt treatment
needed for : _________________________
-Removal of any bone marrow suppressants
-Failure to identify cause and treat effectively is
life-threatening!

A

bone marrow recovery

58
Q

Hemolytic Anemia results from excessive:

A

destruction of RBCs

59
Q

Hemolytic Anemia
Causes

A

-Genetic defects
-Immune reactions
- Changes in blood chemistry
-Infections such as malaria
- Toxins in the blood
- Antigen-antibody reactions
* Incompatible blood transfusion
* Erythroblastosis fetalis

60
Q

Sickle Cell Anemia is a

A

Genetic condition

61
Q

Sickle Cell Anemia

-Autosomal
- _____________ dominance
-Anemia occurs in ____________ recessive.
-Diagnostic testing is available.
-More common in individuals of _________ ancestry
* Heterozygous condition is somewhat protective against __________.
* 1/10 African Americans heterozygous for trait.

A

-Autosomal
-Incomplete dominance
-Anemia occurs in homozygous recessive.
-Diagnostic testing is available.
-More common in individuals of African ancestry
* Heterozygous condition is somewhat protective against malaria.
* One in ten African Americans is heterozygous for the trait.

62
Q

Sickle cell crisis occurs whenever oxygen
levels are:

A

lowered

63
Q

Sickle Cell Anemia

-Abnormal hemoglobin (HbS)
-Altered hemoglobin is unstable and changes shape in hypoxemia.
-Sickle-shaped cells are too _________ to pass through the microcirculation.
-Obstruction leads to ____________________________________________________________

A

-Abnormal hemoglobin (HbS)
-Altered hemoglobin is unstable and changes shape in hypoxemia.
-Sickle-shaped cells are too large to pass through the microcirculation.
-Obstruction leads to multiple infarctions and areas of necrosis

64
Q

Sickle Cell Anemia

Multiple infarctions affect :

A

brain, bones, organs

65
Q

Clinical signs of Sickle Cell Anemia do not usually appear until the child is:

A

about 1 year old

66
Q

Sickle Cell Anemia: Signs and
Symptoms

A

-Severe pain due to ischemia of tissues & infarction
-Pallor, weakness, tachycardia, dyspnea
-Hyperbilirubinemia—jaundice
-Splenomegaly

-Vascular occlusions and infarctions
»>In lungs
* Acute chest syndrome
»>Smaller blood vessels
* Hand-foot syndrome

-Delay of growth and development
- Congestive heart failure

67
Q

Sickle Cell Anemia
Diagnostic tests

A
  • Blood test
  • Hemoglobin electrophoresis
  • Prenatal DNA analysis
68
Q

Sickle Cell Anemia Treatment

A

-Hydroxyurea reduced the frequency of this crisis.
- Dietary supplementation with folic acid
- Bone marrow transplantation
- Immunization in children
* Against pneumonia, influenza, meningitis

69
Q

Primary polycythemia—polycythemia vera

-Increased production of __________ and other
cells in the bone marrow
- ___________ disorder
- Serum erythropoietin levels are low.

A

-Increased production of erythrocytes and other
cells in the bone marrow
- Neoplastic disorder
- Serum erythropoietin levels are low.

70
Q

Secondary polycythemia—erythrocytosis

  • Increased _____ in response to prolonged hypoxia
  • Increased erythropoietin secretion
  • Compensation mechanism to provide increased
    ___________________
A
  • Increased RBCs in response to prolonged hypoxia
  • Increased erythropoietin secretion
  • Compensation mechanism to provide increased
    oxygen transport
71
Q

Polycythemia: Signs and Symptoms

A

-Distended blood vessels, sluggish blood flow
-Increased blood pressure
-Hypertrophied heart
-Hepatomegaly
- Splenomegaly
- Dyspnea
- Headaches
- Visual disturbances
- Thromboses and infarctions

72
Q

Polycythemia Diagnostic tests show

Increased_____ counts
Increased ____________________________________________ values
Hypercellular _________________
Hyperuricemia

A
  • Increased cell counts
  • Increased hemoglobin and hematocrit values
  • Hypercellular bone marrow
  • Hyperuricemia
73
Q

Polycythemia Treatment

A
  • Identify cause
  • Drugs or radiation
  • Suppression of bone marrow activity
  • Periodic phlebotomy
74
Q

Indications of Blood-Clotting Disorders

A

-Persistent bleeding from gums
-Repeated epistaxis
-Petechiae
-Pinpoint, flat, red spots on skin & mucous membrane
-Frequent purpura and ecchymosis
-More than normal bleeding in trauma
-Bleeding into joint—hemarthroses
-Swollen, red, painful
-Hemoptysis

75
Q

Hemophilia A

Classic hemophilia- Deficit or abnormality of ______________

A

Classic hemophilia
~Deficit or abnormality of factor VIII

76
Q

Hemophilia A

trait?
Manifested in?
Carried by?

A

Most common inherited clotting disorder
- X-linked recessive trait
- Manifested in men, carried by women

77
Q

Hemophilia A

  • Prolonged bleeding after ___________________
  • Spontaneous bleeding into _______
  • Possible hematuria or ________________
A
  • Prolonged bleeding after minor tissue trauma
  • Spontaneous bleeding into joints
  • Possible hematuria or blood in feces
78
Q

Hemophilia A Diagnostic tests

A

-Bleeding time and PT normal
-PTT, activated PTT (aPTT), coagulation time prolonged
-Serum levels of factor VIII are low

79
Q

Hemophilia A Treatment

A

Desmopressin (DDAVP)

Replacement therapy for factor VIII

80
Q

Von Willebrand’s Disease is the most common __________ _____________ disorder

A

hereditary clotting

81
Q

Von Willebrand’s Disease has ____ major types

A

3

82
Q

Von Willebrand’s Disease

Signs and symptoms include:

A
  • Skin rashes
  • Frequent nosebleeds
  • Easy bruising
  • Bleeding of gums
  • Abnormal menstrual bleeding
83
Q

Disseminated Intravascular Coagulation involves both :

A

excessive bleeding and clotting

84
Q

Disseminated Intravascular Coagulation

Excessive ___________________
- Thrombi and infarcts occur.

A

clotting in circulation

85
Q

Disseminated Intravascular Coagulation

Clotting factors are : ____________________________

A

reduced to a dangerous level.

86
Q

Disseminated Intravascular Coagulation

leads to:

A

Widespread, uncontrollable hemorrhage results.

Very poor prognosis, with high fatality rate

Complication of many primary problems
-Obstetrical complications, such as abruptio placentae
-Infections, Carcinomas, Major trauma

87
Q

Thrombophilia

  • Group of inherited or acquired disorders
  • Risk of _________________ in veins or arteries
  • Blood testing for _________________ levels and
    abnormal antibody levels
  • Causative condition should be treated.
A
  • Group of inherited or acquired disorders
  • Risk of abnormal clots in veins or arteries
  • Blood testing for clotting factor levels and
    abnormal antibody levels
  • Causative condition should be treated.
88
Q

Myelodysplastic Syndromes

Diseases that involve inadequate production of cells by:

A

the bone marrow

89
Q

Myelodysplastic Syndromes

Signs and symptoms include anemia;
dependent on type of ____________ that occur

May be idiopathic or occur after
chemotherapy or radiation treatment

A

deficiencies

90
Q

The Leukemias

Group of neoplastic disorders involving:

A

white blood cells

90
Q

Myelodysplastic Syndromes

Treatment measures depend on deficiency
type;

A

Treatment measures depend on deficiency
type.

  • Transfusion replacement
  • Chelation therapy to reduce iron overload
  • Bone marrow transplantation
91
Q

Leukemias

Uncontrolled WBC production in :

A

bone or lymph nodes

92
Q

The Leukemias

  • One or more types of leukocytes are
    _______________________________________
  • Large numbers released into ____________________
  • Infiltrate lymph nodes, spleen, liver, brain, other
    organs
A
  • One or more types of leukocytes are
    undifferentiated, immature, and nonfunctional.
  • Large numbers released into general circulation
  • Infiltrate lymph nodes, spleen, liver, brain, other
    organs
93
Q

Acute leukemias (ALL and AML)

  • High proportion of immature _______________ cells in bone marrow and peripheral circulation
  • Onset usually __________, marked signs of complications
  • Occurs primarily in :
A
  • High proportion of immature nonfunctional cells in bone marrow and peripheral circulation
  • Onset usually abrupt , marked signs of complications
  • Occurs primarily in children and younger adults
94
Q

Chronic leukemias (CLL and CML)

  • Higher proportion of ________ cells
  • Insidious onset
  • Mild signs and better prognosis
  • Common in :
A
  • Higher proportion of mature cells
  • Insidious onset
  • Mild signs and better prognosis
  • Common in older adults
95
Q

Signs and Symptoms of Acute Leukemia

A

Usual signs at onset
-Frequent or uncontrolled infections
-Petechiae and purpura
-Signs of anemia

Severe and steady bone pain

Weight loss, fatigue, possible fever

Enlarged lymph nodes, spleen, liver

Headache, visual disturbances, drowsiness,
vomiting

96
Q

The Leukemias Diagnostic tests

A

Peripheral blood smears
* Immature leukocytes and altered numbers of WBCs
* Numbers of RBCs and platelets decreased
* Bone marrow biopsy for confirmation

97
Q

The Leukemias Treatment

A

-Chemotherapy
-ALL in young children responds well to drugs
-Biological therapy (interferon)
* May be used to stimulate the immune system

98
Q

Complications of Leukemia

-Opportunistic infections, including ________________
-Sepsis
-Congestive _______ failure
-Hemorrhage
-_______ failure
-_______ failure
-CNS depression and coma

A

-Opportunistic infections, including pneumonia
-Sepsis
-Congestive heart failure
-Hemorrhage
-Liver failure
-Renal failure
-CNS depression and coma

99
Q

Multiple Myeloma

Neoplastic disease that involves increased
production of ______________ in bone marrow

A

plasma cells

100
Q

Multiple Myeloma

-_________ cause
-Occurs in:
-Production of other blood cells is impaired
- Multiple tumors in _____
-Loss of bone
-Severe bone pain
-Prognosis poor, with short life expectancy

A

-Unknown cause
-Occurs in older adults
-Production of other blood cells is impaired
- Multiple tumors in bone
-Loss of bone
-Severe bone pain
-Prognosis poor, with short life expectancy

101
Q

Lymphatic Structures

A

Lymphatic vessels
Lymphoid tissue
Lymphatic nodules
Tonsils
Lymph nodes
Spleen
Thymus gland
Red bone marrow

102
Q

Function of lymphatic system

Return of excess interstitial fluid to:

Filter and destroy foreign material > Initiate the immune response

Absorb lipids from:

A

Return of excess interstitial fluid to the
cardiovascular system

Filter and destroy foreign material > Initiate the immune response

Absorb lipids from the GI tract

103
Q

Lymphatic Vessels Originate as __________ in contact with blood capillary bed in tissues

A

capillaries

104
Q

Lymphatic trunks empty into:

Ducts empty into the :

A

ducts

subclavian veins

105
Q

Lymph

-Clear, watery, ____________________
-Circulates in lymphatic vessels
-Resembles _______________, with a lower protein content
-Returned to:

A

-Clear, watery, isotonic fluid
-Circulates in lymphatic vessels
-Resembles blood plasma, with a lower protein content
-Returned to the cardiovascular system

106
Q

Lymphomas

Malignant neoplasms involving lymphocyte
proliferation in _______________

A

lymph nodes

107
Q

Lymphomas

Specific causes not identified
-Higher risk in adults who received __________ during childhood

A

radiation

108
Q

Lymphomas

Two main disorders

A
  1. Hodgkin’s lymphoma
  2. Non-Hodgkin’s lymphoma
    * Distinguished by multiple node involvement
    * Nonorganized, with widespread metastases
109
Q

Hodgkin’s Lymphoma
Initially involves a single __________________

A

lymph node

110
Q

Hodgkin’s Lymphoma

Cancer spreads to _________________
- To organs via lymphatics
- T lymphocytes seem to be defective; lymphocyte
count decreased
- Presence of Reed-Sternberg cells
* _____________ present in lymph node
- Four subtypes
* Based on cell found at biopsy

A

Cancer spreads to adjacent nodes
- To organs via lymphatics
- T lymphocytes seem to be defective; lymphocyte
count decreased
- Presence of Reed-Sternberg cells
* Giant cells present in lymph node
- Four subtypes
* Based on cell found at biopsy

111
Q

Hodgkin’s Lymphoma Symptoms

First-
Later-
General-

A

-First indicator—usually a painless enlarged lymph
node

-Later—splenomegaly and enlarged lymph nodes

  • General signs of cancer
  • Weight loss, anemia, low-grade fever, night sweats; fatigue may develop.
112
Q

Hodgkin’s Lymphoma Treatment

A

Radiation, chemotherapy, surgery

113
Q

Hodgkin’s Lymphoma

Staging and prognosis dependent on:

A

Number of nodes involved

Location of nodes involved

114
Q

Non-Hodgkin’s Lymphoma

A

Increasing in incidence
- Partially caused by HIV infection
- Similar to Hodgkin’s lymphoma
- Clinical signs and symptoms are similar.

  • More difficult to treat when tumors are not
    localized
  • Initial manifestation—enlarged, painless
    lymph node
115
Q

Signs and Symptoms of Multiple Myeloma

Pain caused by ______________________

Anemia and___________________________

Impaired __________ function; eventually failure

Chemotherapy to encourage remission
Median survival, ___ years

A
  • Pain caused by bone involvement
  • Anemia and bleeding tendency
  • Impaired kidney function; eventually failure
  • Chemotherapy to encourage remission
  • Median survival, 3 years
116
Q

Lymphedema

  • Obstruction of _______________________
  • Most common form is ________
  • Extremities swell because of lymph accumulation
A
  • Obstruction of lymphatic vessels
  • Most common form is congenital
  • Extremities swell because of lymph accumulation
117
Q

Lymphedema
Treatment:

A
  • Diuretics
  • Bed rest
  • Massage of affected area
  • Elevation of affected extremity
118
Q

Elephantiasis

A
  • Lymphedema caused by blockage because of parasitic infection
  • Significant swelling of affected extremity
    –Extreme swelling of legs, breast, and/or genitalia
    –Thickening of subcutaneous tissue
    –Frequent infections
    –Skin ulcerations
    –Fever
119
Q

Treatment of Elephantiasis

A

medication regimen to kill parasite

120
Q

Castleman’s Disease is a Rare illness that Involves overgrowth of:

A

lymphoid tissue

121
Q

Castleman’s Disease

Two types:

  1. ____________ form
    * Affects a single lymph node
  2. _____________ form
    * Affects multiple lymph nodes and tissue—may have severe effects on the immune system
A
  1. Unicentric form
    * Affects a single lymph node
  2. Multicentric form
    * Affects multiple lymph nodes and tissue—may have severe effects on the immune system

Pathophysiology (23 decks)

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