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114 Cards in this Set
- Front
- Back
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Human body holds how much blood?
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2-6L
46-63% is plasma and remainder is formed elements |
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Red bone marrow contains ________ cells
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Stem cells.
They are precursors for blood cells. |
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Thymus
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Final maturation and differentiation of T lymphocytes occur here
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Plasma
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Include proteins, clotting factors, albumin, globulins
91% is water |
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Plasma is heated via
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Circulating through organs
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RBCs carry
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Oxygen bonded to iron in hemoglobin (Hgb)
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Oxyhemoglobin is formed in
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The pulmonary capillaries where hemoglobin combines with oxygen in lungs
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Once Hemoglobin gives up oxygen to cell body it becomes
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Reduced hemoglobin
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RBC Lab Value
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4.2-6.2
*Increased in chronic hypoxia, decreases in anemia |
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Hematocrit (cellular portion of blood) Lab Value
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38-54%
*Increases in dehydration or chronic hypoxia, decreases in anemia |
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Hemoglobin (reflects oxygen carrying capacity of blood) Lab Value
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12-18g/100ml
*Increases in chronic hypoxia, decreases in anemia or blood loss |
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Reticulocytes (immature circulating RBCs)
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0-1.5%
*Increased in hypoxia or anemia, decreased in RBC maturation defect |
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WBCs
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5,000-10,000
*Increased with infection |
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Neutrophils
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54-75%
*Increase with infection |
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Eosinophils
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1-4%
*Increase with allergic response, some leukemias |
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Basophils
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0.5-1.0%
*Increased in hyperthyroidism, some bone marrow disorders, ulcerative colitis |
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Lymphocytes
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25-40%
*Increased with viral infection, chronic bacterial infection, some leukemias |
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Monocytes
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2-8%
*Increased in chronic inflammatory disorders, some leukemias |
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Thrombocytes/Platelets
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150,000-450,000
*Increase with trauma, decrease with blood disorders, low platelet count causes risk for bleeding |
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Rate of RBC production is influenced by
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Blood oxygen level
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Hypoxia stimulates kidneys to secrete
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Erythropoietin, which increases the rate of RBC production and the oxygen carrying capacity of blood
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Reticulocyte becomes a mature RBC when it...
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Ejects its nucleus
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Vitamin B12
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EXTRINSIC FACTOR
From food |
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Parietal cells of stomach produce
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INTRINSIC FACTOR
chemical that combines with vitamin B12 to promote absorption in small intestine |
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RBC live for
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120 days and become phagocytized by fixed macrophages in the liver, spleen and red bone marrow
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The heme portion of hemoglobin is converted to...
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Bilirubin, a bile pigment that liver excretes into bile for elimination in the feces
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Malaria and Sickle Cell Anemia cause
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Accelerated destruction of RBCs
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When bilirubin is high it
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Discolors skin, sclerae, and mucous membranes bright yellow to dark orange (Jaundice)
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Rh + means
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D Antigen present on RBCs
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Rh - means
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NO D Antigen
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Granular WBCS
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Neutrophils, eosinophils, basophils,
Only produced in red bone marrow |
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Agranular WBCS
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Lymphocytes, monocytes
Also produced in red bone marrow, however the T lymphocytes complete development in THYMUS |
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Monocytes
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Become macrophages that eat dead tissue
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Neutrophils
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More numerous but only eat pathogens
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Eosinophils
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Combat against histamines, detoxify foreign proteins during allergic reaction, respond to parasitic infections
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Basophils
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Release histamine
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T Cells
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Helper, suppressor, killer or memory
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B Cells
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Become plasma cells which produce antibodies to foreign antigens and become memory cells
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Platelets
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Formed in red bone marrow.
Part of large cells called megakaryoxytes. Involved in all mechanisms of hemostatis: vascular spasm, platelet plugs, and chemical clotting. |
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When blood vessels are damaged...
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Platelets release serotonin, which contract smooth muscle and casocontrict artery or vein
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Stage 1 (chemical clotting)
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Platelet factors, clotting factors from liver, tissue factor (thromboplastin), and calcium ions react to form prothrombinase
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Stage 2
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Prothrombinase converts prothrombin (made in liver) into thrombin
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Stage 3
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Thrombin converts soluble fibrinogen (from liver) to insoluable fibrin, strands which form the clot
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Lymph
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Must be returned to blood to maintain blood volume and blood pressure
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Major Pairs of Lymph Nodes
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Cervical, Axillary, Inguinal
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Lymph Nodes are often referred to as
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Mucosa-associated lympahtic tissue (MALT)
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In the fetus, the spleen produces
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RBCs and function assumed by red bone marrow after birth
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Spleen contains
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B and T cells for immune responses.
Stores 1/3 of bodys platelets |
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Heme unit from RBC destruction forms
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Bilirubin
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Person without a spleen is more susceptible to
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Pneumonia and meningitis
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Thymus
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Atrophies with age
Contains T cells that mature here via thymic hormones |
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Petechiae
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Small purple hemorrhagic spots under skin
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Ecchymoses
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Larger areas of discoloration from hemorrhage under skin
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Purpura
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Hemorrhage into the skin, mucous membranes, and organs
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S/S of persons with hematological disorders include...
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Abnormal bleeding, petechiae, ecchymoses, purpura, fatigue, weakness, shortness of breath, fever.
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Excess alcohol intake can lead to
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Folic acid deficiency anemia
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Bleeding may indicate
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Low platelet levels or clotting factor deficiency
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Physical Exam
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1)Vital signs
2) LOC 3) Skin color 4) Look for inflammation 5) Long striated nails/spoon nails= anemia 6)Clubbing=hypoxia caused by heart disease or anemia 7)Palpate lymph nodes |
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Nodes that are palpable, with out without lymphedema are
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Not usually normal
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Sternal tenderness may indicate
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Bone marrow packed with abnormal number and type of cells
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Bacterial infection causes a rise in
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Neutrophils
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Two types of neutrophils
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Segmented (Mature)
Bands (Immature) Initially mature cells rise then immature cells rise |
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Lymphocytes fight
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Viral infections and are elevated during a virus
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If infection is Acute Bacterial vs Viral
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Acute bacterial = HIGH Segs HIGH Bands LOW Lymph
Viral= LOW segs LOW bands HIGH Lymph |
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PT and INR (Coumadin)
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PT= 9.5-11.8 secs (Therapeutic range= 1.5-2 for coum)
INR= <1.3 (Thera range= 2-3) |
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PTT (Hep)
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30-45 secs
Therap range 1.5-2 |
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Lymphangiography
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Injection of dye into lymph vessels of hand or foot.
Skin urine and feces may turn blue. |
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Packed Red Blood cells given to
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Severe anemia/blood loss pts
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Frozen red blood cells
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Blood taken from pt before surgery to prevent reaction
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Platelets given to
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Pts who have bleeding caused by thrombocytopenia or low latelet
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Albumin given to patients with
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Hypovolemia caused by hypoalbuminemia
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Fresh frozen plasma given to pts
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To procide clotting factors for bleeding disorders.
Sometimes used for volume replacement |
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Cryoprecipitates/Hemophilia
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Given to pts bleeding caused by specific missing clotting factors
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Blood admin
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18-20 gauge needle
2-4 hours tops |
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Febrile Reaction to Blood transfusion
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Most common reaction is fever.
Chance goes up after each transfusion. Can occur after transfusion. S/S: fever, chills, headache, back pain Tylenol ordered |
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Urticarial Reaction
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Hives
Give benadryl |
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Hemolytic Reaction
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Most deadly (rarest)
Incompatiable blood S/S: back pain, chest pain, chills, fever, shortness of breath, N&V -Pt will later have signs of shock, oliguria, decreased LOC -Late signs= DIC: uncontrolled bleeding from everywhere -Keep vein open with NS -High volume fluids/Diuretics |
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Anaphylactic Reaction
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Common in pregnancies
Can cause resp or cardivascular collapse Other S/S: GI cramping, vomitting, uncontrollable diarrhea Pt needs intubated and oxygen, steroids and other life support. |
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Circulatory Overload
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Caused by rapid transfusion
S/S: Chest pain, cough, frothy sputum, distended neck veins, crackles, wheezes, increased heart rate Anticipate giving diuretics |
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Anemias
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Deficiency of RBCs, hemoglobin, or both in circulating blood
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Decrease in RBC is from
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1) Impaired RBC production
2) Increased destruction of RBC in hemolytic or sickle cell anemia 3) Massive or chronic blood loss |
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Pernicious Anemia is associated with
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Lack of intrinsic factor in stomach, necessary for absorption of B12
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Hemolysis
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Destruction or lysis or RBCs
Destruction of RBC = hemolytic anemia |
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Thalassemia anemia
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Hereditary
Doesnt synthesize hemoglobin normally |
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S/S of Anemia
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Pallor, tachycardia, tachypnea, irritability, fatigue, shortness of breath
Pernicious anemia= numbness of hands and feet b/c b12 needed for neurological function |
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Pernicious anemia is also associated with
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Sore, beefy red tongue
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Pts with iron def. may have
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fissures at corners of mouth and inflamed tongue (glossitis) and spoon shaped nails
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Sources of Iron
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Red meat, dark green leafy veggies, dried fruits, enriched/fortified/whole grain products
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Microcytic Anemia
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Smaller than normal RBCs from iron def
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Macrocytic Anemia
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Folic acid or b12
Larger than normal RBCs |
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Aplastic Anemia (Hypoplastic anemia)
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Bone marrow becomes fatty and cant produce sufficient amounts of RBCs
Pancytopenia (reduced formed elements, rbcs, wbcs, platelets) INDICATEDS SOMETHING WRONG WITH BONE MARROW -Can be born with or congenital -Can be caused by exposure to chemo meds, cardio bypass during surgery -S/S: petechiae and ecchymoses from reduced platelets, blood ooze from mucous mem, infection from low WBC -Pt usually dies -Bone marrow biopsy best test -Bone marrow transplant -Epogen/Neupogen stimulates production of RBC/WBC -Platelet below 20,000 put on bleeding precautions |
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Sickle Cell Anemia
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RBC have mutation that makes hemoglobin in the red cells sensitive to oxygen changes.
Causes clumping, congestion and clotting of RBCs As RBCs are broken they spill into circulation causing jaundice, gallstones may result from increased bile pigments Spleen and liver englarge from retaining cells -Autosomal recessive hereditary disorder -S/S dont appear till 6 months of age -Factors contributing to SCA cold, diabetic acidosis, infection -Sever pain and swelling of joints b/c impeded circulation -Abdominal pain from swelling of spleen -Hypoxia, hand/foot syndome (unequal growth), painful long erections in males (priapism) -Blood smear test, Sickledex |
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Polycythemia
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Thick blood, blood hard to circulate
Hgb= >18mg RBC= > 6million Hematocrit= >55% |
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Polycythemia Vera (PV)
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Primary
RBCs, platelets, WBCs overproduced, bone marrow packed with cells Congests organs |
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Secondary polycythemia
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Result of long term hypoxia
COPD, cardiovasc probs, living in high altitudes, chronic heart fail, smoking Body makes more red cells in response to low oxygen |
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S/S of Polycythemia
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HTN, visual changes, ha, vertigo, dizziness, tinnitus, elevated bone marrow components (panmyelosis), nose/gum bleeds, dark flushed complexion
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Treat Polycythemia with
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Phlebotomy
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Teach patient with polycythemia to
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Drink atleast 3L of water a day
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Disseminated Intravascular Coagulation (DIC)
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Series of events that result in hemorrhage
Clotting factors and platelet supplies are exhausted and clots aren't formed. Massive clotting in blood vessels leads to organ and limb necrosis HIGH MORTALITY RATE Can develop from any trauma Abnormal bleeding without history of serious hemorrhagic disorder is cardinal sign -Prolonged Pt and PTT, decreased platelet count, increased evidence of fibrin degradation products -Treat with cryoprecipitate (has clotting factors) |
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Idiopathic Thrombocytopenia Purpura
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ITP
Increased platelet destruction by immune sys Usually occurs after viral like rubella or chickenpox S/S: Thrombocytopenia, petechiae, ecchymoses, bleeding nose mouth... -DX: Platelet count less than 20,000 -Resolve spontaneously, or give steroids |
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Hemophilia
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Severe lack of clotting factors
Hemophilia A=80% Hemophilia B=Christmas Disease=15% Forms platelet plug instead of clot Hemophilia A&B have X-linked recessive traits which means female carrier has 50% of passing -S/S: Hemarthrosis (bleeding into jts), jt deformities, -DX: prolonged PTT -Treat Hemo A with Factor VIII -Treat Hemo B with factor IX |
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Leukemia
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Lots of immature WBCs, can't fight infection, cause sluggish circulation due to high amounts of immature WBCs
Pt becomes anemic bc lack of RBC production Dont respond to antibiotics |
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Acute Leukemias
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Usually affect children under 15
Abnormal growth of lymphocyte precursors |
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Acute Myelogenous Leukemias
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Affects older than 20
Poor prognosis High fever, abnormal bleeding from mucous mem, petechiae, ecchymoses, easy bruising Death from infection is common |
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Chronic Leukemias
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Affects B and T lymphocytes
Occurs in 40+ age group Characterized by Philadelphia chromosome Develops in three stage process 1)Insidious phase= anemia and mild bleeding abnorm Pt feels fine, years laters have s/s like acute leukemias Almost always fatal -S/S: Sternal tenderness, pain tenderness GOAL IS REMISSION |
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4 Stages of treating Leukemia
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Induction, Intensification, Consolidation, Maintainence
1)Induction= Attempt to get pt to remission 2) Intensification=Higher doses of drugs 3) Consolidation= Ensure leukemia cells leave body 4) Maintainence= Pt kept free of cells |
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Multiple Myeloma
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Cancer of plasma cells in bone marrow
Produce hundreds of tumors Swiss cheese looking bone Usually affects skull, pelvis, ribs, vertebrae Then affects organs like liver spleen lymph nodes, lungs adrenal glands, kidneys, skin and gi tract. People working in rubber, leather, farming or petroleum industries more likely to get MM Skeletal pain most common Bence-Jones proteins in urine Aredia (drug) |
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Hodgkins Disease
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Cancer of lymph sys
Presence of Reed-Sternberg cells Most curable type of cancer DX with painlessly enlarged nodes Biopsy finds Reed and confirms |
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Stage 1 Hodgkins
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Single lymph node
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Stage 2 Hodgkins
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Two or more nodes involved on same side of diaphragm, limited organ involvement
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Stage 3 Hodgkins
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Nodes on both sides of diaphragm with or without organ involvement
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Stage 4 Hodgkins
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Least curable, several organs with out without lymph node involvement
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Non-Hodgkins Lymphomas
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NO Reed cells
Arise from B and T cells (mostly B cell orgin) Progresses faster than HD Painless rubbery nodes in cervial or supraclavicular area |
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OPSI
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Overwhelming postsplenectomy infection
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