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Patho. Hematology
Pathophysiology
| Question | Answer |
|---|---|
| One of the body's major fluid tissues. | Blood |
| Where does the blood circulate through after it is pumped by the heart? | The blood vessels |
| What are the components of the blood? | Liquid component: plasma. Cellular component: erythrocytes, leukocytes, and thrombocytes. |
| What does the plasma do? | Carries antibodies and nutrients to tissues and carries waste away. |
| This blood component has RBCs that carry oxygen to the tissues and removes carbon dioxide from them. | Erythrocytes |
| This blood component has WBCs that participate in the inflammatory and immune response. | Leukocytes |
| This blood component has platelets, along with coagulation factors in plasma that are essential for normal clotting. | Thrombocytes |
| Clear, straw-colored fluid that consists mainly of proteins, globulin, and fibrinogen. | Plasma |
| Characteristics of plasma. | Osmotic pressure, viscosity, suspension qualities. These all depend on protein content. |
| Osmotic pressure | The pressure exerted on a differentially permeable membrane separating a solution from a solvent, the membrane being impermeable to the solutes in the solution and permeable only to the solvent. |
| Viscosity | The ability or inability of a fluid solution to flow easily. |
| Other plasma components | Regulate acid-base balance, regulate immune response, carry nutrients to tissues, and help to mediate coagulation. |
| Glucose, lipids, amino acids, electrolytes, pigments, hormones, oxygen, and carbon dioxide. | Plasma components |
| What are the products of metabolism and where do they circulate? | Urea, uric acid, creatinine, lactic acid. They circulate in the plasma. |
| Where are RBCs usually produced? | In the bone marrow (erythropoesis). Liver and spleen also participate in production. |
| What do RBCs transport? | Oxygen to body tissues and carbon dioxide away from them. |
| What is hemoglobin? | An oxygen-carrying substance that gives RBCs the ability to transport oxygen. |
| What is RBC production regulated by? | Tissue's demand for oxygen and the blood cells' ability to deliver it. |
| Hypoxia | A lack of oxygen to the tissues. |
| What does hypoxia stimulate? | The formation and release of erythropoietin (hormone that activate bone marrow to produce RBCS). |
| What % of EPO is produced by the kidney? | 80-90% |
| Where is the remainder of EPO produced? | The liver |
| What enhances EPO production? | Androgens (any steroid hormone that increases male characteristics). |
| What is the life span for a typical RBC? | 120 days (about 4 months). |
| What formation begins as a stem cell which develops into a RBC? | Erythrocyte. |
| What does the development of RBCs require? | Vitamin B12, folic acid, minerals (copper, cobalt, and iron). |
| Iron | A component of hemoglobin and vital to the blood's oxygen-carrying capacity. |
| Where is iron found? | In food and, once consumed, is absorbed in the duodenum and upper jejunum. |
| What specifically are good food sources of iron? | Poultry, eggs (egg yolk), dried beans, dried fruit, and salmon. |
| What happens to iron once it's absorbed? | It may be transported to the bone marrow for hemoglobin synthesis or to tissues (muscle) for myoglobin synthesis. |
| What is unused iron temporarily stored as? | Ferritin. |
| Where is ferritin most commonly located? | In specialized cells called reticuloendothelial cells (in liver most commonly). |
| Small, colorless, disk-shaped cells that have a life span of 7-10 days. | Platelets |
| What are the platelet functions? | Help constrict damaged blood vessels, form hemostatic plugs in injured blood vessels, and provide substances that accelerate blood clotting. |
| How do platelets form hemostatic plugs? | By becoming swollen, spiky, sticky, and secretory. |
| What substances provided by platelets accelerate blood clotting? | Factors III and XIII and platelet factor 3. |
| How is homeostasis maintained? | Platelets, plasma, and coagulation factors interact to control bleeding. |
| What do blood vessels do when tissue injury occurs? | They constrict at the injury site and platelets mesh or clump to help prevent hemorrhage. |
| An abnormal or pathologic condition of the blood. | Dyscrasia. |
| What is primary blood dyscrasia? | A blood disorder within the blood itself. |
| What is secondary blood dyscrasia? | It results from a cause other than a defect in the blood (side effect of medication). |
| Name 2 RBC disorders. | Anemia and Polycythemia |
| What is anemia? | Too little RBCs. Decreased RBC production, increased RBC destruction. Results in blood loss. |
| What is polycythemia? | Too many RBCs. Results in hypoxia, tumors that secrete EPO, and genetic defects. |
| Name 2 WBC disorders. | Neutropenia and Lymphocytopenia. |
| What is neutropenia? | Decreased number of neutrophils in the blood. |
| What is lymphocytopenia? | Decreased number of lymphocytes in the blood. |
| Name 3 platelet disorders. | Thrombocytopenia, Thrombocytosis, and Thromboctopathy. |
| What is thrombocytopenia? | Too few platelets. |
| What is thrombocytosis? | Too many platelets. |
| What is thromboctopathy? | Dysfunctional platelets. |
| A disorder of oxygen transport in which hemoglobin synthesis is deficient. | Iron-deficiency anemia. |
| How much iron can the body store before iron-deficiency anemia may be diagnosed? | 1/3 to 1/4 of the body's iron. |
| A common disease that affects 10-30% of the adult population, but particularly premenopausal women, infants (esp. premature and low birth rate infants), children, and adolescents. | Iron-deficiency anemia. |
| What is typically the cause of iron-deficiency anemia in children, adolescents, and pregnant women? | Inadequate iron in the diet to keep up with the increased growth. |
| What are risk factors associated with iron-deficiency anemia? | Inadequate intake of iron, vegetarian diet, low intake of fish, meat, poultry, and iron-fortified foods, frequent dieting, substance abuse, malabsorption, pregnancy, and blood loss secondary to GI bleeds. |
| When does iron-deficiency anemia occur? | When the supply of iron is too low for optimal RBC formation. |
| What happens to the cells when iron-deficiency anemia occurs? | They are smaller (microcytic) and contain less color when seen under a microscope. |
| Name the signs and symptoms of iron-deficiency anemia. | Generalized weakness or fatigue, inability to concentrate, dyspnea or exertion, pica (craving for nonnutritive substances), pallor, tachycardia, and increased cardiac output. |
| What occurs if the iron-deficiency anemia is prolonged? | The patient may experience dry, brittle, ridged nails with frequent concave contours; smooth, sore, pale tongue; and angular chelosis (an ulceration of the corner of the mouth). |
| What is the definitive method to identify iron-deficiency anemia? | Bone marrow aspiration. |
| What happens after the iron stores are depleted? | Hemoglobin levels fall. |
| What do diminished iron stores cause? | Small erythrocytes to be produced by the bone marrow, thus as anemia progresses, the MCV, which measures this size of the erythrocytes, also decreases. |
| Patients have a low serum iron and an elevated TIBC when focused on what deficiency? | Iron-deficiency anemia. |
| What does the TIBC (total iron binding capactiy) measure? | The transport protein supplying the marrow with iron. Also known as transferrin. |
| What are the most reliable methods in evaluating iron-deficiency anemia? | Measuring the ferritin and hemoglobin levels. Know normal lab values. |
| Lab tests associated with iron-deficiency anemia. | TIBC increased, serum iron levels decreased, low hemoglobin and hematocrit levels, small (microcytic) RBCs, hypochromic (less color than normal). |
| Folic acid anemia. | A vitamin found in most body tissues and is essential for the formation and maturation of RBCs and synthesis of DNA. |
| What % of folic acid is taken in through diet but is excreted unabsorbed? | 20% |
| What is considered insufficient daily intake of folic acid? | Less than 50mcg/day. Usually induces folic acid deficiency within 4 months, as the liver supplies are depleted. |
| Where is folate found? | In green vegetables and in the liver. |
| Who is prone to folic acid anemia? | People who rarely eat uncooked vegetables and alcoholics. |
| Why is folic acid so easily destroyed? | Because it is water-soluble and heat-liable, thus being destroyed in the cooking process. |
| What does folic acid deficiency inhibit? | Cell growth, particularly RBCs, leading to production of few, deformed RBCs. Megaloblastic cells (enlarged red cells) havea shortened life span; weeks. |
| What are risk factors associated with folic acid anemia? | Alcohol abuse, poor diet, pregnancy and breast feeding, and malignant or intestinal disease. |
| Signs and symptoms of folic acid anemia. | Weakness, progressive fatigue, shortness of breath, palpitations, forgetfulness, glossitis, heachache, irritability, and pallor. |
| What is pernicious anemia characterized by? | Decreased production of HCL in the stomach acid. Also recognized as a deficiency of intinstic factor. |
| Intrinsic factor. | Normally secreted by the parietal cells of the gastric mucosa and is essential for vitamin B12 absorption in the ileum. |
| Anemia caued by malabsorption of vitamin B12. | Pernicious anemia. |
| Even if adequate vitamin B12 and intrinsic are present, can a deficiency still occur? Why or why not? | Yes, because the disease involving the pancreas or ileum impairs absorption. |
| Primarily a disorder of adults that tends to run in families. | Prenicious anemia. |
| What does vitamin B12 deficiency inhibit? | Cell growth, particularly RBCs, leading to produciton of few, deformed RBCs with poor oxygen-carrying capacity. It also causes neurologic damage by impairing myelin formation. |
| Who is most prone to pernicious anemia? | Strict vegetarians who do not consume any meat or dairy products. |
| Neurologic signs and symptoms of pernicious anemia. | Weakness on extremites, fatigue, peripheral numbness, disturbed positions sense, lack of coordination, altered vision, altered tase and smell, tinnitus, loss of bowel & bladder control, impotence in males, irritability, poor memory, headache. |
| GI signs and symptoms of pernicious anemia. | Nausea, vomiting, anorexia, diarrhea, constipation, flatulence, gingival bleeding and tongue inflammation. |
| Cardiovascular signs and symptoms of pernicious anemia. | Low hemoglobin, palpitations, and tachycardia. |
| Respiratory signs and symptoms of pernicious anemia. | Dyspnea, orthopnea. |
| Sickle cell anemia/disease | Hemolytic anemia that results from inheritance of the sickle hemoglobin gene (HbS). |
| What happens when cells are exposed to low oxygen levels? | The erythrocytes will lose its round, pliable, biconcave disk shape and become rigid, deformed, and sickle-shaped. Effects are seen in larger blood vessels. |
| How does the sickling process work? | It takes time, so if the sickled cell is again exposed to adequate amounts of oxygen, before the membrane becomes too rigid, it can revert to a normal shape. Sickling crisis are intermittent. |
| In what race is sickle cell anemia most prevelant? | Inherited in people of African descent and to a lesser degree in people from the Middle East (Mediterranean). |
| What is the most benign state of sickle cell disease? | The carrier state of sickle cell. |
| What % of the erythrocyte is hemoglobin? | 50% |
| How many genes will a child birthed from 2 people with the trait have? | 2 abnormal genes. These children will only produce hemoglobin and therefore will have sickle cells anemia. |
| Signs and symptoms of sickle cell anemia. | Range from chronic hemolysis to thrombosis, erythrocytes have a shortened life span, anemia is always present and Hgb is 7-10g/dL, jaundice, bone marrow expansion, and chronic anemia (tachycardia, cardiac murmurs, and enlarged heart). |
| Which organ(s) can be affected by thrombosis (an abnormal condition where a clot develops in the blood vessel)? | Any organ can be affected but primarily the sites with lower circulation: spleen, lungs, CNS |
| What are complications associated with sickle cell anemia? | Infection, stroke, renal failure, impotence, heart failure, pulmonary hypertension. |
| Results from tissue hypoxia and necrosis due to inadequate blood flow to a specific region of tissue or organ. | Sickle cell crisis; very painful. |
| Results from infection with the human parvovirus. | Aplastic crisis; hemoglobin falls rapidly and marrow can't compensate; absence of RBCs. |
| Results when other organs pool the sickled cells. | Sequestration crisis; most children by 10 years have a nonfunctioning spleen. The liver and lungs are affected in adults. |
Created by:
shanhaup
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