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Nursing 172 > Week 9: Chp 34: Assessment of Hematological function pg 684-690 > Flashcards

Week 9: Chp 34: Assessment of Hematological function pg 684-690 Flashcards

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1
Q

Hematology

A

study of the blood and lymphatic system

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2
Q

Hematological system consists of?

A

the blood, blood cells, lymph, and organs involved with blood formation or blood storage

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3
Q

Blood

A

is a specialized connective tissue that acts as a transport vehicle of materials between the external environment and the body’s cells

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4
Q

Blood consists of?

A

plasma (a clear yellow, protein rich fluid), solutes (proteins, electrolytes, and organic elements), red blood cells (RBCs), white blood cells (WBCs), and platelets (fragments of cells)

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5
Q

Job of the Hematological System?

A

helping the body by circulating oxygen, nutrients, hormones, and metabolic wastes; protecting against invasion of pathogens; and regulating fluids, electrolytes, acids, bases, and body temperature

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6
Q

Hematopoiesis

A

the production of blood cells in the bone marrow located in flat and irregular bones
-blood cells are RBCs, WBCs, and Platelets

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7
Q

Total volume of blood

A

5 to 6 L

-circulates throughout the body within the circulatory system

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8
Q

Bone Marrow

A

the primary site for blood formation and maturation (hematopoiesis)

  • involved in the bodys immune response and is one of the largest organs in the body
  • network of flexible connective tissue that produces stem cells (pluripotent or precursor stem cells)
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9
Q

Stem Cells

A

immature, undifferentiated cells that have the ability to become any one of the several types of blood cells
-depending on the bodys needs, stem cells begin multilineage differentiation into mature myeloid or lymphoid stem cells

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10
Q

T or B Lymphocytes

A

lymphoid stem cells produce wither T or B lymphocytes; main functional cells of the immune system

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11
Q

Myeloid Stem Cells

A

into 3 cell types:

-RBCs (erythrocytes), WBC (leukocytes), and platelets (thrombocytes)

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12
Q

Why do we call it the Red Bone Marrow?

A

at sites where hematopoietically active, numerous erythrocytes are produced that make it red, hence red bone marrow

  • red marrow regresses after birth until late adolescence (during active skeletal growth) after which it is located in the lower skull, vertebrae, shoulder + pelvic girdles, ribs, and sternum
  • red marrow is gradually replaced by yellow marrow (fat cells) in most of the long bones, including the hands, feet, legs, and arms; when the demand for RBC replacement increases, as in chronic hemolytic anemia (low RBC count), substitution of red marrow for yellow marrow can occur
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13
Q

Self-renewal and differentiation of stem cells

A

a highly regulated process to ensure homeostasis

-disruption of these processes inevitably leads to abnormal cell growth in the marrow or bone marrow failure

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14
Q

What happens when there is a disruption of self-renewal and differentiation of stem cells?

A

leads to abnormal cell growth in the marrow or bone marrow failure

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15
Q

Where does blood cell formation occur?

A

mostly in the marrow found in flat bones such as the sternum, ribs, and pelvis

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16
Q

Blood Cells: Hematopoiesis

A

the process of formation, development, and differentiation of the formed elements of blood
-all blood cells originate from cells in the bone marrow called pluripotential stem cells

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17
Q

All cells originate from what?

A

originate from cells in the bone marrow called pluripotential stem cells

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18
Q

Regulatory mechanisms do what to stem cells?

A

cause stem cells to differentiate into families of parent cells, each of which gives rise to one of the mature, formed elements that are released into the circulation: RBCs (erythrocytes), WBCs (leukocytes), or Platelets (thrombocytes)

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19
Q

Blood Cells/ Formed elements are not all true cells

A

lack characteristics and structures of most cells

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20
Q

Red Blood Cells (RBCs/ erythrocytes)

A

are the most abundant of the formed elements formed in the bone marrow

  • small, biconcave disk with no nucleus (cant direct cell function and division)
  • large surface area, and is so flexible that it can move through small capillaries of the circulatory system)
  • membrane is very thin so oxygen and carbon dioxide gases easily diffuse across
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21
Q

2 Principle Functions of RBCs

A
  1. Pick up oxygen from the lungs and transport it to systemic tissues
  2. Pick up Carbon dioxide from the tissues and deliver it to the lungs
    >shifts in the amount, size, shape, or composition of the erythrocyte affect their ability to successfully carry out their functions
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22
Q

Erythropoiesis

A

selective maturation of stem cells into mature erythrocytes

  • the number of erythrocytes is controlled through erythropoiesis
  • varies with gender, age, and general health
  • normal range: 3.61-5.81 million/mm3
  • Formation: pluripotent stem cell–> erythrocyte colony-forming unit (ECFU)–>erythroblast –> reticulocyte–> erythrocyte
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23
Q

Formation of a erythrocyte; Erythropoiesis

A

pluripotent stem cell–> erythrocyte colony-forming unit (ECFU)–> erythroblast–> reticulocyte–> erythrocyte
>differentiation into an erythrocyte begins when the pluripotent stem cell of the marrow becomes an erythrocyte colony forming unit (ECFU), which has receptors for the hormone erythropoietin (EPO); an ECFU then transforms into an erythroblast when stimulated by EPO; the cell is called a reticulocyte when the nucleus shrinks and is discharged from the cell; reticulocytes (a temporary network of ribosome clusters) leave the bone marrow and enter the circulating blood; in approximately 2 days, the last of ribosome clusters disappear and the cell is a mature erythrocyte

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24
Q

For Normal Erythrocyte formation, the bone marrow alos requires?

A

iron, vitamin B12, folic acid, vitamin B6 (pyridoxine), protein and other factors

25
Q

Hematocrit

A

the volume of blood composed of erythrocytes (RBCs)

-Normal range: 36-48% females, 42-52% males

26
Q

Hemglobin

A

oxygen carrying component

  • RBCs produce this
  • composed of pigment (Heme) that contains iron (Fe) and a protein (globin)
  • iron is a significant component of hemoglobin (Hgb)
27
Q

Why are erythrocytes critical to survival?

A

a severe deficiency of erythrocytes in the case of major trauma or hemorrhage can be fatal within a few minutes because of a lack of oxygen

28
Q

What is the role of erythropoietin in the regulation of RBCs?

A

to stimulate RBC production

29
Q

White Blood Cells (Leukocytes)

A

components of the bodys defense system against infection and disease

  • least abundant but required for life to provide protection against infectious microorganisms and other pathogens
  • travel through the circulatory system and can migrate out of blood vessels to other tissues unlike RBCs which remain within blood vessels
  • retain their organelles for protein synthesis throughout life, including the nucleus, rough endoplasmic reticulum, ribosomes, and Golgi complex
30
Q

WBCs are resonsible for?

A

the immune responses that protect against harmful microorganisms, including identification and destruction of cancer cells and involvement in the inflammatory response and wound healing

31
Q

What is essential for Leukocytes to carry out their function?

A

protein

  • retain their organelles for protein synthesis throughout life, including the nucleus, rough endoplasmic reticulum, ribosomes, and Golgi complex
  • appears as granules in the cytoplasm that distinguish one WBC type from another
32
Q

2 Types of WBCs

A

based on absence or presence of specific cytoplasmic granules

  1. Granulocyte leukocytes
  2. Agranular leukocytes
33
Q

WBC: Granulocytes

A

those containing specific granules (neutrophils, eosinophils, basophils)
-play a key role in protecting the body from harmful microorganisms during acute inflammation and infection by means of their individual function

34
Q

WBC: Granulocytes: Neutrophils

A

responsible for sustaining normal host defenses against invading bacteria and fungi, cell debris, and foreign substances

  • phagocytic and are responsible for engulfing and destroying foreign matter
  • first cells to arrive at the site of invasion
  • once the neutrophil matures (segmentation), it is released into the circulation from the marrow to perform its function of phagocytosis
  • immature neutrophils are called “bands”
  • Left shift: an increase in band level which occurs with acute infection, inflammation, or some other significant physical stress; because bands are immature, they are not very effective in combating infection
35
Q

Safety Alert: Decreased neutrophil counts

A

decreased neutrophil counts significantly increase the risk of infection because of a decreased immune response
-protect patient by using and teaching proper hand hygiene, frequent oral care, and limiting visitors

36
Q

Which Granulocyte arrives first at the site of infection?

A

neutrophil

37
Q

Left Shift

A

an increase in “band” (immature neutrophil) level which occurs with acute infection, inflammation, or some other significant physical stress
-because bands are immature, they are not very effective in combating infection

38
Q

WBC: Granulocytes: Eosinophils

A

abundant in the mucous membranes of the respiratory, digestive, and urinary systems

  • exact functions unknown
  • have granules that contain vasoactive amines that may be used to destroy foreign cells invading the body
  • involved in hypersensitivity reactions, inactivating some of the inflammatory chemicals released during the inflammatory responses
39
Q

When do the number of eosinophils increase?

A

eosinophils increase and migrate to the site of inflammation during allergic reactions, parasitic infections, collagen diseases, and diseases of the spleen and central nervous system (CNS)

  • containing proteolytic substances that protect the body from parasitic worms in parasitic infections, eosinophils use surface markers to attach themselves to the parasite and then release toxic hydrolytic enzymes that kill the invading organism
  • eosinophil counts can increase to more than 30% of baseline in parasitic infections
40
Q

Eosinophil Counts decrease when

A

in conditions such as aplastic anemia (because of bone marrow failure), and infections (because of significant production of neutrophils)

41
Q

WBC: Granulocytes: Basophils

A

least numerous of WBCs

  • not phagocytic
  • cytoplasmic granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation
  • these chemicals aid in defense mechanisms by making the blood vessels more permeable for neutrophils and clotting proteins to enter the injured site more quickly and efficiently
  • believed to be an integral part of both hypersensitivity and stress response
42
Q

When do Basophils increase

A

increase in circulation because of pathologic conditions such as inflammatory disorders, all types of infections, and anemias
-also increase as a result of normal physiological and environmental conditions such as exposure to extreme heat or cold, acute stress, and strenuous exercise

43
Q

When do basophils decrease?

A

in alcoholism, anemias, malnutrition, and viral infections

44
Q

WBC: Agranulocytes

A

lymphocytes and monocytes

45
Q

WBC: Agranulocytes: Lymphocytes

A

essential elements in the immune response and function to produce substances that aid in attacking foreign material
-differentiation and maturation occur in lymph nodes and in lymphoid tissue of the intestine and spleen after exposure to a specific antigen

46
Q

Where does differentiation and maturation occur for lymphocytes?

A

in the lymph nodes and in lymphoid tissue of the intestine and spleen after exposure to a specific antigen

47
Q

The Job of the lymphocytes

A

the ability of lymphocytes to produce antibodies (B lymphocytes), or cell surface receptors (T lymphocytes) that are specific for one of the many millions of foreign entities that may invade the body is essential to acquired immunity

48
Q

B lymphocytes

A

antibodies
-have the ability to differentiate into plasma cells; plasma cells produce antibodies called immunoglobulins (Igs); which attack and neutralize antigens produced by bacterial infections

49
Q

T lymphocytes

A

cell surface receptors

  • kill foreign cells directly or release a variety of substances that enhance the activity of phagocytosis by other cells
  • responsible for delayed allergic reactions, rejection of transplants of foreign tissue (transplanted organs), and destruction of tumor cells
50
Q

WBC: Agranulocytes: Monocytes

A
  • single lobed nucleus, with no granules
  • largest of leukocytes
  • enter the blood from the bone marrow and circulate for a short time before they enter the tissues and become tissue macrophages
  • active in spleen, liver, peritoneum, and alveoli
  • macrophages activated by cytokines released from T lymphocytes and migrate in response to stimuli from bacterial cells
  • macrophages remove debris and phagocytize bacteria within the tissues
51
Q

Platelets (Thrombocytes)

A

circulating cell fragments of the cytoplasm of large cells in the bone marrow called megakaryocytes

52
Q

Thrombopoiesis

A

production of platelets; division of hematopoiesis
-regulated by the hormone thrombopoietin, some pluripotent stem cells become megakaryoblasts, cells committed to the platelet producing line

53
Q

When are platelets beneficial?

A

platelets circulate freely in the blood in an inactive state

  • after a vascular injury occurs, platelets play an essential part in the control of bleeding
  • platelets collect at the damaged site and are activated to begin adhesion and formation of a temporary plug
  • their cytoplasmic granules release mediators to activate coagulation factors in the blood plasma and initiate the formation of a stable clot composed of fibrin (a fibrous protein)
  • platelets cannot replicate
  • stored in spleen and released as needed
54
Q

Plasma

A

blood is made up of plasma

  • clear yellow, protein rich fluid
  • RBCs, WBCs, and Platelets
  • complex mixture of water, proteins, nutrients, electrolytes, nitrogenous wastes, hormones, and gasses
  • part of bodys extracellular fluid
  • serves as transport vehicle for materials carried in blood
55
Q

What is plasmas most abundant solute?

A

Protein

  • roles are: clotting, immune defense, and transport of other solutes that contribute to osmotic regulation of body fluids
  • 3 major proteins: albumin, globulin, and fibrinogen
56
Q

Protein: Albumin

A

synthesized in the liver

  • serves to transport various solutes and buffer the pH of plasma
  • fluid balance; increasing the osmotic pressure of the blood, which prevents the plasma from leaking into the tissues
  • low levels may result of inadequate intake (malnutrition), inadequate production (liver damage), or excessive loss (burns, hemorrhage)
57
Q

Protein: Globulins

A

-solute transport
-clotting
-immunity
-main proteins of antibodies
-3 types: alpha, beta, gamma
>alpha + beta are made in the liver, and important in transport and clotting
>gamma important in immune defense

58
Q

Protein: Fibrinogen

A

inactive protein that is activated by thrombin ( a vitamin k-dependent enzyme) to form fibrin ( a sticky protein that forms the framework of a blood clot)

Nursing 172 (120 decks)

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