Hematologic System
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| What test is used to evaluate the red and white blood and platelets. | CBC - complete blood count
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| What is the normal lab value range for red cell count (RBC) | 3.6 -5.4
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| 37 -50% | normal Hematocrit lab range?
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| What is the normal hemoglobin lab range? | 12 -16.5
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| Normal White Blood Count (Total WBC) | 5,000 - 10,000
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| 47-63% | normal lab range for neutrophils
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| 24-40% | Normal lab range for lymphocytes
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| Normal lab range for platelets | 150,000 -400,000
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| What are three reason to to do a CBC? | 1. Help diagnose conditions ( anemia, infection, inflammation, bleeding disorders, Leukemia) 2. Monitor the condition or effectiveness of a treatment. 3. Monitor treatment that is known to effect the blood (chem or radiation)
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| What is the purpose of hemoglobin? | bind to O2 in the lungs and deliver to the body
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| A count of the actual number or RBCs in a person's sample of blood. | Red Blood Cell (RBC) count
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| measures the percentage of a person's blood that consists of red blood cells. | Hematocrit
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| A low Hct level means what? | Person is losing blood (internally or externally)
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| What is the critically low level for Hct and what does it lead to? | Less that 15% leading to heart failure
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| What is a critically high Hct and what does it lead to? | Greater than 60% leading to blood clotting problems
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| Hct can be affected by a persons ______ status. | Fluid
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| High Hct is caused by _________ and low Hct is caused by ______. | Dehydration, Fluid overload
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| Hct is used to assess a persons ____ ____ and how they are responding to treatment. | Fluid status
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| What is a Hct test often ordered with_______ to verify accuracy of the Hct. | hemoglobin test
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| low Hct + low Hgb = | Blood loss
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| _________ measures the amount of the oxygen-carrying protein in the blood. | Hemoglobin
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| ______________measures the absolute count or percentage of immature red blood cells in the blood. | Reticulocyte count
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| What does it mean if reticulocyte count is high? | RBCs are depleted and the body is relying on immature RBCs
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| ___________ are calculation that provide information on the physical characteristics of the RBCs. (MCV, MCH, MCHC, RDW) | red blood cell indices
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| What lab test is used to determine if a person has anemia and the type of anemia? | RBC Indices lab test
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| measurement of the average size of RBCs | MCV - Mean Corpuscular Volume
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| calculation of the average amount of oxygen carrying hemoglobin inside the red blood cells. | MCH - Mean Corpuscular hemoglobin
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| calculation of the average percentage of hemoglobin inside a red cell | MCHC - Mean corpuscular hemoglobin concentration
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| e calculation of the variation in the size of RBCs | RDW - red cell distribution width
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| What is polycythemia? | Elevated Red blood cell count
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| Cardio Vascular Disease, stress, Polycythemia vera, smokers, high altitude, hemoconcentration/ dehydration and renal cell carcinoma would have an elevated or decrease Red blood count? | elevated
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| What conditions have a decrease Red Blood Count? | Anemias, hemolysis, chronic renal failure, hemorrhage and failure of marrow production.
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| What are the 3 groups of Anemias? | 1. Anemia cause by blood loss 2. Anemia due to decreased or faulty red blood cell production 3. Anemia cause by destruction of RBC
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| What are the clinical manifestations common to all anemias? | 1.Low hemoglobin and hematocrit levels in addition to reduced RBC's . 2. Plasma expansion
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| What happens to the blood during plasma expansion? | less viscous blood leading to turbulent blood flow and pale look of blood.
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| What are the S/S symptoms of anemia that result from hypoxia? | fatigue, tachypnea, tachycardia, pallor
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| What is the term for increased respiratory rate? | tachypnea
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| What is the term for increased heart rate in order circulate red blood cells more freely. | tachycardia
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| feeling of pressure in your chest | angina
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| What type of anemia: excessive menstruation or child birth complications, Gastrointestinal conditions (upper or lower GI Bleed) and NSAID over use can result in what type of anemia | Anemia due to blood loss
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| Pts that are in chronic pain are at risk of developing anemia. Why? | overuse of NSAIDs. Causing internal bleeding
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| What are some examples of anemia due to decrease or faulty RBC production? | nutritional deficiencies, sickle cell anemia, bone marrow or stem cell problems.
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| Folate, Vitamin b-12, and iron are necessary components for what? | normal RBC production
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| What is the condition when Red blood cells die quicker than bone marrow can replace them. | Hemolytic anemia
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| Sickle cell anemia cause what type of anemia? | Anemia due to faulty RBC production or anemia due to excessive RBC Destruction (hemolytic anemia)
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| What are some extrinsic factors that lead to hemolytic anemia? | stressors (infection, drugs, snake or spider venom), toxins, autoimmune, Spleen (blood moves more slowly through causing spleen enlargement),
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| Why is hypothyroidism a problem when it comes to RBC production? | causes lower iron levels in the blood
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| Why is chronic inflammation bad in relation to RBC count. | inflammation cause the production of cytokines that destroy all blood cells include RBCs.
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| This hormone is made in the kidney and signals the bone marrow to make RBCs. | EPO - Erythropoietin
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| What can eliminate the need for a blood transfusion? | injection of erythropoietin
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| What are some good sources of iron? | lean red meat, chicken, turkey, eggs, soy beans, lentils, beans, fish, fortified foods
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| Iron deficiencies are cause by what? | diet or blood loss
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| Medications, excess caffeine, Crohns, removal of the stomach or small intestines, excessive menstruation, childbirth, metabolic demands of pregnancy and breast feeding can all lead to what? | iron deficiency
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| lightheaded/ dizzy, stomatitis, difficulty swallowing, headache, confusion and memory are S/S of what? | Iron deficiency
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| Another name for b-12 | Cobalamin
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| ________ helps with memory loss, Alzheimer's disease, boosting mood, energy, concentration, and the immunes system and slowing aging | B-12 (Cobalamin)
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| What can cause low levels of B-12 | Diet and lack of intrinsic factor
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| Intrinsic factor is a protein secreted by the stomach and is need for what? What happens if intrinsic factor is not present? | It is need for the absorption of b-12 and if it is not present to bind to B-12 it gets destroyed in gastric juices.
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| If the stomach/ upper intestine is damaged or removed what is not secreted? Why is this a problem? | Intrinsic Factor and as a result B-12 cannot be absorbed.
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| Crohn's Disease, gastric bypass and cancers are conditions that cause a lack of what? | Intrinsic factor need for B-12 absorption
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| Overcooking or eating to few vegetable, pregnancy, medication, alcohol abuse and intestinal diseases can cause what? | low folate (vit B-9) levels
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| A deficiency in what can cause birth defects of baby's brain and spine during pregnancy. | Folate (B-9)
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| What is aplastic anemia and why does it happen? | When the body stop producing enough red blood cells and develops as a result of bone marrow damage.
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| What is pancytopenia | all blood cells are depressed
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| What could cause damage to Bone Marrow | radiation, chemotherapy, autoimmune disease, toxic chemicals, some drugs and infections
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| hepatitis, epstein-barr, cytomegalovirus, parvovirus b19 and HIV are viruses that have been linked to what? | development of Aplastic anemia
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| What are the S/S of aplastic anemia and do they develop fast or slow? | S/S - fatigue and rapid heart rate, frequent infections, bleeding tendencies ----- theses can present suddenly or slowly
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| Bleeding tendencies are evident by what? | Bleeding gums, nose bleeds, easy bruising, heavy menstrual cycles, GI bleeding.
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| What are some treatments for aplastic/hypoplastic anemia? | medications, blood transfusions and stem cell transplants
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| What are the 3 types of sickle cell crisis? | 1. Vaso-occlusive 2. sequestration 3. Aplastic
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| What type of sickle cell crisis - sickled RBC trigger the formation of blood clots. Tissues damage is mirror can resolve within weeks. Dehydration and infection initiate it. In serious cases stroke, heart attack, pulmonary infarction, Gangrene may result. | Vaso- occlusive
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| What type of sickle cell crisis - sickled RBC removed by spleen. damage depends on the amount of blood removed and held in spleen and liver which affect volume of circulating blood. - can result in hypovolemic shock. | sequestration
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| What type of sickle cell crisis - exhaustion of the bone marrow. EPO cannot keep up with the demand for red blood cells. Constant stress on bone marrow stem cell can lead to bone marrow failure. | Aplastic
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| What is the life span of a sickled RBC? | 10-12 days
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| What are 3 treatments for sickle cell crisis? | 1. give oxygen (reduce hypoxia) 2. IV fluid (dehydration treatment and prevent sickled clots) 3. Pain meds (painful clotting throughout the body and can result in shock)
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| Pain during SC crisis is considered physiological or psychsocial? | physiological
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| SC crisis is a ______ issue? | Circulation
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| What is Polycythemia? | too many red blood cells
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| what is polycythemia cause by? | Hyperviscosity or thrombosis
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| _____(absolute) polycythemia - polycythemia vera is an inherited condition affection Caucasians with ______ ______ ancestry. | Primary, European Jewish
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| ______ (relative polycythemia - physiologic response to ______ _____ that triggers the body to make more RBCs for O2 transport in an effort to get more O2 to the cells of the body. | Secondary, chronic hypoxia
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| What are some cause of polycythemia? | Sleep Apnea or central sleep apnea, COPD, Heart Failure, pulmonary disease, high altitude, EPO shots
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| Why does heart failure cause Polycythemia | reduces tissue profusion creating hypoxic tissue even if blood volume and concentration are normal. Low oxygenation will trigger an increase RBC production.
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| s/s of polycythemia that are cause by reduced blood flow or viscous blood and clotting. | Plethora, ruddy complexion, fatigue, dizziness, headaches
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| What are some treatments for polycythemia? | regular blood removal and radioactive phosphate
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| what is caused by systemic inflammation? | increase WBC,increased CRP and fevers/chills/
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| Neutrophils are increased in ____ _____ infection. | Acute bacteria
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| Eosinophils are increased in _______ ______ and _____ ______. | Allergic reactions or parasitic infection
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| Basophils are increased during _____/_____. | stress/ allergic
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| Lymphocytes are increase in _____ ______ or _____ infections | Chronic bacteria or viral
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| These become macrophages when needed to fight infection in tissue | monocytes
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| White blood cell (WBC) count is a count of the ______ number of white blood cells in a sample of blood. | total
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| White blood cell differential shows the levels of what WBC. (Nobody Likes Mites Except Bats) | Neutrophils, Lymphocytes, monocytes, eosinophils, basophils
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| Term for elevated WBCs. Term for decrease . | Luekocytosis. Leukopenia
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| When is WBC count decreased? | chemotherapy, steroids (medications contain them), bone marrow failure and use of antiseizure meds like Tegretol
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| What are the three general type of blood cancer? | Leukemias, Lymphoma, Myelomas
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| Cancer of white blood cells | luekemias
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| cancer originating in the lymphatic system | lymphoma
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| cancer that affects types of B-Cell | Myelomas
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| What two type Luekemias are classified by the speed of progression? | Acute and chronic luekemia
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| What are blast | immature blood cells that cant carry out their normal function.
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| What type of treatment does Acute Leukemia require? | aggressive and timely
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| how is chronic leukemia different from acute leukemia? | In chronic leukemia blood cell replicate and accumulate more slowly. They can function normally for a period of time. In acute cells cant carry out normal function and multiply rapidly (blast - immature blood cells). Disease worsens quickly.
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| How is the 2nd type of luekemia classified? What are the two Leukemia in this classification? | by the type of white blood cell affected - Lymphocytic and Myelogenous
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| Lymphocytic leukemia affects ________ cells. | lymphoid (lymphocytes)
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| ______ tissue make up you immature immune system. | lymphatic
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| Mylelogenous leukemia affects the myeloid cells. Myloid cells give rise to ______, _____ and ______. | RBCs, WBCs, and platelet-producing cells.
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| What are S/S of leukemia? | 1. Lymphadenopathy (swelling of lymph nodes)
2. Anemia, infection, bleeding problems (due to bone marrow damage effecting all blood cells.
3. Pallor
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| What causes pallor | Malignant luekocytes crowding bone marrow leading to decreased RBCs and platelet production resulting in pale skin color.
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| Blood cancer that affect the lymphatic system can cause an over production of what? Why is it a problem? | Malfunctioning lymphocytes. The overload of cells compromises the immune system.
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| What are some places lymphoma can develop | lymph nodes, bone marrow, blood, spleen and other organs
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| What are the two main types of lymphomas? | Hodgkin's and Non-Hodgkin's
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| Hodgkin's vs Non-Hodgkin's: Cell affected | H: B
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| Hodgkin's vs Non-Hodgkin's: Age of onset | H: 20-30 (more common in younger populations) and 60-70 ------- NH: Greater than 50 years (95% are adults)
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| Hodgkin's vs Non-Hodgkin's: Node involvement | H: cervical, inguinal, axillary and retroperitoneal --------- NH: cervical, inguinal, axillary, femoral
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| Hodgkin's vs Non-Hodgkin's: Extra node involvement | H: uncommon -----NH: Common
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| Hodgkin's vs Non-Hodgkin's: S/S | H: painful swollen lymph nodes, general weakness, fever and night sweats, weight loss, bone marrow damage (dyscrasias) ------NH: Same as Hodgkin's plus Pleural effusion, abdominal pain and splenomegaly
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| Hodgkin's vs Non-Hodgkin's: Curability | H: approximately 90% ------- NH: less than 25%
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| Hodgkin's vs Non-Hodgkin's: Treatment | H: radiation therapy (localized), Chemotherapy (generalized), Immunotherapy (MAB drugs), Bone marrow (stem cell) transplants ------ NH: same general treatment as Hodgkin's but specific chem and drugs are different.
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| Multiple myelomas is cancer that starts in a type of B-Cell Lymphocyte called ______ cells in the bone marrow. These are protein making cell responsible for what? | Plasma, Protein making cells are responsible different kinds of proteins that comprise the antibodies (immunoglobilins) of the immune system.
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| How are Myelomas classified? | by the type of immunoglobulin being attacked
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| What doe myeloma proteins do? Who is more effected by this and when | Crowd out normally functioning immunoglobins resulting in high level of protein in the blood. Men are more effected after 40 years of age.
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| What is a single abnormal type of protein that form during MM? | monoclonal or M-protein
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| What is a collection of MM cells and what do they do? | plasmacytomas - erode the hard out shell or cortex of the bone that normally surround the marrow.
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| Lesion and bone thinning cause by MM may result in pain and _________ _______ of the bones affected by the cancer. | Pathological (spontaneous) fractures
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| What are the S/S of MM (crab) | Increase calcium (due to bone break down), Renal failure, anemia (BM not functioning and kidney not producing EPO), Bone Pain (1st symptom)
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| What is the prognosis for MM PTs? | Early - 3 to 5 years with treatment ---- Late 50% die within 3 months and 90% within 2 years.
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| Platelet production is regulated by______ which is made in the liver. | Thrombopoietin
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| Renal failure (myeloma nephrosis) cause by damage to the kidneys by what? | Paraproteins that cause hyperviscosity of body fluids.
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| meats and dairy products are good sources of what | B-12
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| Green leafy vegetables are good sources of What | Folate
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| M-proteins (found in serum) and "Bence-Jones proteins ( found it urine) are distinctive feature of ______ tumors. | Myelomas
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| What are 3 general reasons for low platelet count? | 1. BM doesn't make enough 2. BM makes enough but body destroys them or uses them up. 3. The spleen holds to many platelets.
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| terms for increase and decrease platelet count. | Thrombocytosis, Thrombocytopenia
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| When might you see an increase in platelet count? | Some cancers, inflammatory conditions, Birth control Pills, recovery phase of trauma/ surgery
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| When might you see a decrease in platelet count? | Autoimmune disorder, medications such aspirin, ibuprofen, acetaminophen (damage liver ---> bleeding problems), "G" herbs (garlic, ginger, ginkoba, ginseng), Chemotherapy/ radiation, Cancer that damages bone marrow (leukemia/lymphoma), DIC
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| What does DIC stand for | Disseminated intravascular coagulation
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| Blood leaving the blood vessel (internal or external bleeding) | Hemorrhage
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| Heavier than normal menstrual bleeding | Menorrhagia
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| Bleeding from the nose | Epistaxis
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| pinpoint hemorrage of small capillaries in the skin, conjunctiva of the eyes, or mucous membrane | Petechiae
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| red or purple discoloration on the skin that does not blanch on applying pressure | Purpura
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| Blood leaks into tissues under the skin causing bruising | Ecchymosis
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| Collection of blood, usually clotted in organs, Body spaces or under the skin | Hematoma
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| Autoimmune disorder that causes an IgG antibody to bind with platelets, destroying their function. Results in low platelet count and s/s of bleeding. | Idiopathic Thrombocytopenia Purpura (ITP)
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| Thought to be caused by widespread endothelia damage that triggers thrombosis and platelet destruction. S/s are: Fever, hemolytic anemia, renal failure, neurologic decline. | Thrombotic Thrombocytopenia Purpura (TTP)
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| A hypersensitivity reaction causes platelet destruction. Heparin can induce a Type III Hypersensitivity reaction that can quickly be resolved after eliminating drug. | Drug induced thrombocytopenia
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| S/S of Thrombocytopenia | Epistaxis, Purpura, GI bleeding, Meorrhagia, Bleeding Gums, Petechiae
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| Thrombocytopenia treatment | • Immunosuppression Treatments (Treatment for TTP)
• Plasmapheresis* (Treatment for TTP)
• Eliminate the causative drug
• Platelet infusion
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| blood purification procedure used to treat several autoimmune diseases. Blood is removed from the body and spun in a centrifuge to filter out the plasma. The RBCs are returned to the body & the plasma may be treated and reintroduced, or replaced. | Plasmapheresis
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| Why can clot form during high and low blood pressure situations? | High -Clots develop in arteries due to increased turbulence. turbulent flow of blood causes damage to vessel walls or blood cells - resulting inflammation then triggers the clotting cascade.
Low - Platelet party!!
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| What are 4 things that can contribute to thrombosis formation? | High blood pressure. Low blood pressure, injured vessel walls, Altered blood constituents
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| Deep vein Thrombi in the legs break off to create ____ emboli. | Pulmonary
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| what is the increased/ abnormal production of platelets that may be a marker for cancer. | Thrombocytosis
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| What are three types of drugs that effect platelets (used for treating thrombosis) | Anti-coagulant drugs, Thrombolytic drugs, Acetaminophen
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| 3 types of anti-coagulant drugs | Heparin, Coumadin, Aspirin
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| What drug? (injected -fast acting) | Heparin
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| To much of this drug cause bleeding problems | Heparin
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| What drug? (oral med - long acting) | Coumadin
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| To much of this drug cause bleeding tendencies | Coumadin
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| what drug? (oral - small dose everyday prophylaxis to prevent clotting) | Aspirin
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| This drug can cause GI Bleeding | Aspirin
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| What do thrombolytic drugs do and list some examples? | Break up or dissolve existing clots. Examples: TPA and Streptokinase
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| Do anti- coagulants effect existing clots? | No - They only stop future clot formation
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| what is a major concern with the use of Acetaminophen? | Liver damage - with out the liver clotting factors are not available to combine with platelets and blood cannot clot.
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| PT and INR (international normalized ratio) are used to test patients on _______ blood thinning medications/ | Coumadin
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| ____ test are used to test bleeding for patients on heparin blood thinning medications. | PTT
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| Why is a D-Dimer test done? | to determine the extent of clotting in the body and is done for DVT, Pulmonary embolism and DIC
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| What does DIC stand for? | Disseminated Intravascular Coagulopathy
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| DIC is a coagulation disorder that results in both ______ and ______. | Blood clotting and hemorrhaging
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| DIC is always ______ to an underlying disorder. | Secondary
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| What happens in DIC? | The body overproduces many small blood clots -depleting the body of clotting factors & platelets -> small clots interfere w/ blood supply to organs--> dysfunction & failure --> then massive bleeding occurs due to lack of clotting factors & platelets
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| What are 6 known triggers for the inflammatory process that can lead to DIC? (BOTH Ss) | B: Blood Transfusions
O: Obstetric complications
T: Trauma
H: Hematologic Disease
S: Some Cancers
S : Sepsis and Septic Shock
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| What types of trauma are especially know as triggers of DIC | Burns and head injuries
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| What is a big red flag s/s for DIC? | Bleeding form at least 3 unrelated sites
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| What are the two phases of DIC | 1. Clotting phase
2. Hemorrhage phase
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| What are the pertinent lab test for DIC? | Platelet count less than 100,000 and abnormal D-Dimer
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| What are the 4 treatments for DIC? | 1. Life support (oxygen, give fluids/meds to maintain BP, probable drug induced coma)
2. Treat the underlying cause
3. give heparin (to stop clotting process)
4. Platelet transfusions (restore lost platelets)
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| What are some things that happen during the hemorrhage phase of DIC? | blood oozing form IV cite, bleeding gums, GI bleeding, petchiae, purpura, ecchymosis
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