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136 Cards in this Set

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What is an allergic or hypersensitivity response?
• Result of an exaggerated host immune response to an allergen
List the 4 ways we are exposed to allergens
inhalation, ingestion, injection, and skin contact.
Type I reactions are
allergic reactions & are triggered by allergens
What is the mechanism of a Type 1 hypersensitivity disorder?
Mast cell degeneration that release histamine and acetylcholine
A Type 1 disorder is an immune response that leads to...
of inflammatory mediators from mast cells.
Type I antigens can produce either:
localized or anaphylactic reactions.
What are 2 primary “allergy producing mediators” and what does each cause?
o Histamine

 Vasodilator that increases permeability of capillaries and venules
 Causes smooth muscle contraction
 Causes bronchial constriction

o Acetylcholine
 Produces bronchial smooth muscle contraction
 Dilation of small blood vessels
What are secondary mediators that are generated in the mast cell membrane? What effects do they cause?
o Leukotrienes & Prostaglandins
 Produce similar responses to histamine and acetylcholine, although their effects are delayed and prolonged by comparison
Systemic Anaphylactic Reactions s/s
Symptoms are difficulty breathing and swelling of the face and throat & occur within minutes

o Decreased blood pressure
o Airway constriction
o Vascular permeability-swelling and obstruction of the upper airway
o GI, respiratory, or skin
Localized Atopic Disorders occur when...
the reaction to the antigen is confined to the site related to the route of exposure. There appears to be a genetic connection to these disorders.
What are the symptoms of allergic rhinitis?
o Sneezing
o Itching
o Discharge of eyes and nose
o Malaise
o Fatigue
o Muscle soreness from sneezing
What are the most common agents of allergic rhinitis?
o Pollen-ragweed, grasses, trees, and weeds
o Fungal spores
o House dust mites
o Animal dander
o Feathers
• What are the most common foods that cause food allergies in:
Children?
o Milk
o Eggs
o Peanuts
o Soy
o Tree nuts
o Fish
o Shellfish
common foods that cause food allergies in adults?
o Peanuts
o Shellfish
o Fish
Why is it difficult for very sensitive people to avoid the foods to which they are allergic?
Foods may be contaminated with the protein during processing or handling of the food
What are 2 primary “allergy producing mediators” and what does each cause?
o Histamine

 Vasodilator that increases permeability of capillaries and venules
 Causes smooth muscle contraction
 Causes bronchial constriction

o Acetylcholine
 Produces bronchial smooth muscle contraction
 Dilation of small blood vessels
What are secondary mediators that are generated in the mast cell membrane? What effects do they cause?
o Leukotrienes & Prostaglandins
 Produce similar responses to histamine and acetylcholine, although their effects are delayed and prolonged by comparison
Systemic Anaphylactic Reactions can result from ingestion of some foods, chemicals, pharmeceuticals. (Penicillin, x-ray contrast substances, wasps, and food)
• Symptoms are...
difficulty breathing and swelling of the face and throat & occur within minutes.
List the symptoms of Systemic Anaphylactic Reactions
o Decreased blood pressure
o Airway constriction
o Vascular permeability-swelling and obstruction of the upper airway
o GI, respiratory, or skin
• What are the symptoms of allergic rhinitis?
o Sneezing
o Itching
o Discharge of eyes and nose
o Malaise
o Fatigue
o Muscle soreness from sneezing
What are the most common agents of allergic rhinitis?
o Pollen-ragweed, grasses, trees, and weeds
o Fungal spores
o House dust mites
o Animal dander
o Feathers
• What are the most common foods that cause food allergies in:
Children?
o Milk
o Eggs
o Peanuts
o Soy
o Tree nuts
o Fish
o Shellfish
• What are the most common foods that cause food allergies in: Adults
o Peanuts
o Shellfish
o Fish
Why is it difficult for very sensitive people to avoid the foods to which they are allergic?
o Foods may be contaminated with the protein during processing or handling of the food
TYPE II ANTIBODY MEDIATED CYTOTOXIC DISORDERS
*Describe a Type II disorder.
• Type II reactions are a direct result of interaction of IgG & IgM antibodies with antigens. An example would be rh incompatibility.
TYPE III IMMUNE COMPLEX DISORDERS
*Describe what happens in the body when a Type III reaction occurs.
• Type III reactions result from the formation of immune complexes that activate the complement system.

• How is tissue damage produced in a Type III reaction?
o Produce damage when they come in contact with the vessel lining or are deposited in tissues, including the glomeruli, skin vessels, or joint synovium
o Causes mast cells to release histamines-inflammatory response in the vessels
TYPE IV CELL MEDIATED HYPERSENSITIVITY DISORDERS

*Identify a common type IV disorder.
Delayed Type IV reactions occur 24-72 hours following exposure.
 TB skin test-must already be sensitized and has antigens in the body to have this reaction

• Reactions are mediated by CD4+ & CD8+ T cells.

• The reaction is initiated by T helper cells releasing cytokines.
Allergic Contact Dermatitis is ...
an inflammatory response confined to the skin of a sensitized person.
What are the most common agents of allergic contact dermatitis?
Poison Ivy or Poison Oak
What are the signs & symptoms of allergic contact dermatitis?
o Rash-vesicles or pustules
o Pustules weeps
o Area is swollen and warm
o Exudation and crusting
o Development of secondary infection
List the symptoms of Systemic Anaphylactic Reactions
difficulty breathing and swelling of the face and throat & occur within minutes.

o Decreased blood pressure
o Airway constriction
o Vascular permeability-swelling and obstruction of the upper airway
o GI, respiratory, or skin
Localized Atopic Disorders occur when ...
the reaction to the antigen is confined to the site related to the route of exposure. There appears to be a genetic connection to these disorders.
• What are the symptoms of allergic rhinitis?
o Sneezing
o Itching
o Discharge of eyes and nose
o Malaise
o Fatigue
o Muscle soreness from sneezing
What are the most common agents of allergic rhinitis?
o Pollen-ragweed, grasses, trees, and weeds
o Fungal spores
o House dust mites
o Animal dander
o Feathers
• Type II reactions are a direct result of interaction of ______ and _______
IgG & IgM antibodies with antigens. An example would be rh incompatibility.
Type III reactions result from the formation of ...
immune complexes that activate the complement system.
• How is tissue damage produced in a Type III reaction?
o Produce damage when they come in contact with the vessel lining or are deposited in tissues, including the glomeruli, skin vessels, or joint synovium
o Causes mast cells to release histamines-inflammatory response in the vessels
• Delayed Type IV reactions occur _________ after exposure
24-72 hrs
Allergic Contact Dermatitis is ...
an inflammatory response confined to the skin of a sensitized person.
What are the most common agents of allergic contact dermatitis
Poison Ivy or Poison Oak
TYPE IV CELL MEDIATED HYPERSENSITIVITY DISORDERS
Reactions are mediated by CD4+ & CD8+ T cells.

• The reaction is initiated by T helper cells releasing cytokines.
• What are the signs & symptoms of allergic contact dermatitis?
o Rash-vesicles or pustules
o Pustules weeps
o Area is swollen and warm
o Exudation and crusting
o Development of secondary infection
Autoimmune disorders are caused by the inability of a person’s immune system to differentiate between ______ and _______
self and non-self antigens. The immune system must tolerate self-cells & only react to non-self cells to function properly.
 Caused by failure of self tolerance
Describe how heredity & gender affect autoimmune disease.
There are genetic links to susceptibility for autoimmune diseases. More women than men have autoimmune disorders suggesting that estrogen may play a role in the development. Environmental factors also may play a role.
 Genetic
 Gender
 Environmental
TRANSPLANTATION IMMUNOPATHOLOGY
• Define:
Allogeneic:
o Donor and recipient are either related or unrelated and have similar HLA types
Synogeneic:
o Donor and recipient are identical twins
Autologous:
o Donor and recipient are the same person
HOST VS. GRAFT DISEASE (HVGD) May develop ....
immediately or within the first 6 months after the transplant
*Summarize the cellular response that occurs in HVGD.
In HVGD, immune cells of the recipient attack donor cells. HVGD occurs most commonly in allogeneic transplants but can occur in synogeneic transplants.

• Donor’s HLA antigens trigger activation of the recipient’s CD4+ & CD8+ cells.

• The target of the reaction is the vascular structure of the donated tissue.
GRAFT VS. HOST DISEASE (GVHD develops ________
Develops days to weeks after transplantation
*Identify who will develop GVHD most often.
GVHD occurs primarily in persons receiving bone marrow transplants & severely immunocompromised patients who have previously received blood products containing incompatible HLA lymphocytes.
 Disorders of B-cell function
o Impair the ability to produce antibodies and defend against microorganisms and toxins that circulate in body fluids (IgM and IgG) or enter the body through the mucosal surface of the respiratory or GI tract
o Persons with primary B-cell immunodeficiency are particularly prone to infections due to encapsulated organisms
 Disorders of T-cell Function
o Impair the ability to orchestrate the immune response (CD4+) and to protect against fungal, protozoan, viral, and intracellular bacterial infections (CD8+)
 Disorders of B-cell and T-cell immunodeficiency
o Affect all aspects of immune function
o Severe combined immunodeficiency represents a life-threatening absence of immune function that requires bone marrow transplantation for survival
AIDS is:
 Severely compromised immune system with associated opportunistic infections, malignancies, wasting, and central nervous system degeneration
 Caused by RNA retrovirus
 CD4+ cells are destroyed
• In what 4 ways can HIV/AIDS be transmitted?
o Transfer of body fluids:
 Unprotected sex
 Transplacental transmission, labor and delivery, or breastfeeding
 Contaminated blood products
 Contaminated needles
The HIV retrovirus caries its genetic information on _____.
RNA
describe in your own words the life cycle of HIV.
o Step 1
 The virus must bind to the CD4+ T cell
o Step 2
 The virus then uncoats to enter the host cell
o Step 3
 The virus then changes its single-stranded RNA to double-stranded DNA through reverse transcriptase enzyme
o Step 4
 The new DNA then enters the nucleus of the CD4+ T cell, and is inserted into the cell’s DNA with the enzyme integrase
o Step 5
 The viral DNA is then transcribed into mRNA with the instructions for building new viruses
o Step 6
 Includes translation of mRNA to create polyprotein which provides information needed in the construction of new viruses
o Step 7
 The polyprotein chain is then cut to make new viruses
o Step 8
 The new HIV viruses are assembled and released from the CD4+ T cell
• Summarize the 3 phases of the clinical course of HIV:
• Acute/Primary
 2-4 weeks after exposure and lasts for 2 weeks
 Symptoms
• Acute mononucleosis-like syndrome
• Fever
• Fatigue
• Myalgias
• Sore throat
• Night sweats
• Gastrointestinal problems
• Lymphadenopathy
• Macropapular rash
• Headaches
 High viral loads due to increased viral replications
 After several weeks the immune system acts to control viral replication and reduces viral load

• Latency/Asymptomatic
 Median latent period is about 10 years
 No signs or symptoms
 CD4+ cell count diminishes over time
 Lymphadenopathy-(persistent-nodes in at least 2 locations are swollen for more than 3 months)-sore or visible externally

• Overt AIDS
 CD4+ count is less than 200cells/µL
 AIDS defining illness
 Death within 2-3 years
• What are the signs and symptoms of acute HIV ?
o Fever
o Fatigue
o Rash
o Headache
o Lymphadenopathy
o Pharyngitis
o Arthralgia
o Myalgia
o Night sweats
o Gastrointestinal problems
o Aseptic meningitis
o Oral or genital ulcers
type 1 antigens can produce either ______ or ________ reactions
localized or anaphylactic reactions
What is the mechanism of Type I hypersensitivity reaction disorder?
mast cell degeneration that releases histamine and acetylcholine
a type 1 disorder is a disorder that leads to a release of ___________ from mast cells.
inflammatory mediators
Type I reactions are _______ __________ and are triggereged by _________.
allergic reactions

allergens
A Type 1 disorder is an immune response that leads to release of inflammatory mediators from _______
mast cells
An example of type II hypersensitivity
Rh incompatibity
TYPE IV CELL MEDIATED HYPERSENSITIVITY DISORDER mediated by...
CD4+ & CD8+ T cells.

The reaction is initiated by T helper cells releasing cytokines.
In HVGD, immune cells of the recipient attack donor cells, how?
• Donor’s HLA antigens trigger activation of the recipient’s CD4+ & CD8+ cells.

• The target of the reaction is the vascular structure of the donated tissue.
• Acute GVHD symptoms include:
o Nausea
o Macropapular rash-on palms and soles to the entire body-leads to sloughing of skin
o GI intestinal symptoms
 Nausea
 Bloody diarrhea
 Abdominal pain
o Liver symptoms
 Jaundice
 Hyperbilirubinemia
 Abnormal liver function
Summarize the 3 phases of the clinical HIV course:
Acute/Primary
 2-4 weeks after exposure and lasts for 2 weeks
 Symptoms
• Acute mononucleosis-like syndrome
• Fever
• Fatigue
• Myalgias
• Sore throat
• Night sweats
• Gastrointestinal problems
• Lymphadenopathy
• Macropapular rash
• Headaches
 High viral loads due to increased viral replications
 After several weeks the immune system acts to control viral replication and reduces viral load

• Latency/Asymptomatic
 Median latent period is about 10 years
 No signs or symptoms
 CD4+ cell count diminishes over time
 Lymphadenopathy-(persistent-nodes in at least 2 locations are swollen for more than 3 months)-sore or visible externally

• Overt AIDS
 CD4+ count is less than 200cells/µL
 AIDS defining illness
 Death within 2-3 years
 Disorders of B-cell and T-cell immunodeficiency
o Affect all aspects of immune function
o Severe combined immunodeficiency represents a life-threatening absence of immune function that requires bone marrow transplantation for survival
 Disorders of T-cell Function
o Impair the ability to orchestrate the immune response (CD4+) and to protect against fungal, protozoan, viral, and intracellular bacterial infections (CD8+)
Primary immunodeficiency disorders are congenital or inherited disorders that are grouped by whether....
B cells, T cells or both B & T cells are involved.
• Secondary immunodeficiency disorders arise from ...
a previously normal immune system.
 Disorders of B-cell function....
o Impair the ability to produce antibodies and defend against microorganisms and toxins that circulate in body fluids (IgM and IgG) or enter the body through the mucosal surface of the respiratory or GI tract
o Persons with primary B-cell immunodeficiency are particularly prone to infections due to encapsulated organisms
• What are the most common opportunistic infections that attack HIV pts in the U.S.?
o Pneumocystis carinii pneumonia
o Oropharyngeal or esophageal candidiasis (thrush)
o Cytomegalovirus infections
o Mycobacterium avium-intracellulare complex
Other than respiratory infections, what infection is one of the most common complications of HIV/AIDS?
o GI infections
What cancers & malignancies are most common for HIV pts?
o Kaposi sarcoma
o non-Hodgkin lymphoma
• What increases the risk of transmission of HIV?
o The lower the count of CD4+
o Increased viral load
o Long delivery after membranes are ruptured
Why is perinatal diagnosis of HIV difficult?
o The infant will have mom’s antibodies (generally false positives range up to 18 months of age)
• How can the risk of perinatal transmission of HIV be reduced?
o Zidovudine therapy and HAART
White blood cells (WBC) constitute only ____%
1% of the total blood volume but and are very important !
Which WBC constitutes the largest percentage of total WBC count?
neutrophils
Regarding neutrophils, what’s the difference between band cells and segs?
Bands are immature neutrophils and segs are just another name for neutrophils
Most cases of neutropenia are
drug related, ie chemo
Leukopenia (low WBC count) refers to a WBC count
less than 5000
neutropenia refers to a neutrophil count of
1500 (severe)
Signs and Symptoms of acquired neutropenia
o Infections by gram-positive and gram-negative bacteria
o Infections by fungi
o Skin infections and ulcerative necrotizing lesions of the mouth
o Infection of the respiratory tract (bacterial or fungal)
*Describe the pathogenesis and clinical course of infectious mononucleosis.
Acute infection of B-lymphocytes. Virus associates with B-cell genome, producing heterophil antibodies. Cytotoxic CD8+ T cells and natural killer cells control proliferation.
Briefly describe the clinical course of mono:
o Incubation period lasts for 4 to 8 weeks
o Prodromal period lasts for several days
 Characterized by:
• Malaise
• Anorexia
• Chills
o The prodromal period is followed by:
 Fever (occasionally abruptly and high)
 Pharyngitis
 Lymphadenopathy
o Lymph nodes are typically enlarged (cervical, axillary, and groin areas)
o Hepatitis and splenomegaly are common
o Complications of the central nervous system develop
 Cranial nerve palsies
 Encephalitis
 Meningitis
 Transverse myelitis
 Guillain-Barré syndrome
o Peripheral blood shows an increase in the number of leukocytes during weeks 1-3 and returns to normal during week 4
o Heterophil antibodies appear during weeks 2 or 3 and decline after the acute illness has subsided
o Acute phase lasts for 2-3 weeks
o Lethargy and degree of debility may persist for 2-3 months
Malignant Lymphomas: cancer of the lymphatic system, is ____ most common in US
7th
• What are the clinical manifestations of Hodgkin’s disease?
o Painless lymph node enlargement involving a single or group of lymph nodes (cervical or mediastinal nodes typically)
o Accompanying constitutional symptoms include:
 Fevers
 Night sweats
 Chills
 Weight loss
 Pain with consumption of alcohol
o Stages
 Stage A-no symptoms
 Stage B-constitutional symptoms are present
o Advanced stage manifestations may include:
 Liver
 Digestive tract
 CNS
 Increased susceptibility to viral, fungal, and protozoal infections
Prognosis of Hodgkins disease?
o With proper treatment 70% are cured
o Delivery of radiation and combination chemotherapy has improved the survival rate for a 5-year cure at 85%
Non-Hodgkin’s Lymphomas occur ___ times more commonly than Hodgkin’s Disease.
3
Non-Hodgkin’s Lymphomas ...
tends to spread more than Hodgkins
• What are the clinical manifestations of Non-Hodgkin’s disease?
o Painless, superficial lymphadenopathy
o Noncontiguous nodal spread of the disease involving the GI tract, lung, liver, testes, and bone marrow
o Increased susceptibility to bacterial, viral, and fungal infections
• Prognosis of Non-Hodgkin’s disease?
o 60%-80% of cases result in remission with intensive combination chemotherapy
o About 30%-60% have a relapse after standard-dose chemotherapy
Leukemias are malignant neoplasms of cells derived from hematopoietic stem cells; bone marrow replaced with unregulated, proliferating, immature neoplastic cells. In other words...
undifferentiated, immature, nonfunctional WBC’s that multiply uncontrollably.
leukemia is the leading cause of death for kids 3-14 yrs old, but strikes more
adults than kids.
• What might be some causes of Leukemia...
o High levels of radiation
o Chemotherapy
o Genetic predisposition
Acute Lymphocytic Leukemia strikes...
Children between 2 & 4
AML strikes
Adult between 60 & 65
CML strikes...
adults between 30-50 who have the Philadelphia chromsome
CLL strikes...
Adult > 50
Men > Women
Multiple myeloma is a plasma cell cancer of the ______
bone tissue
B cells produce abnormally large amount of one immunoglobulin, usually IgG, occasionally IgA. Originates in bone marrow and move through the circulation to
lymph nodes
Myeloma cells return to bone marrow or soft tissues sites. Usually strikes...
men age 40 and older
What are the main sites involved in myeloma?
Bones and bone marrow
What is the first myeloma symptom to occur?
back pain
Manifestations of myeloma
• Manifestations
o Bone pain while at rest
o Predisposes the individual to pathologic bone fractures
o Hypercalcemia-increased renal disease
o Frequent infections
o Anemia
o Bleeding tendency
o Neurologic manifestations include: neuropathy or spinal cord compression
*Describe the conditions and mechanisms associated with hypercoagulability.
• Conditions:
o Increased platelet function
 Atherosclerosis
• Disrupts flow
• Causes endothelial damage
• Promotes platelet adherence
 Diabetes mellitus
 Smoking
 Elevated blood lipid and cholesterol levels
 Increased platelet levels
o Accelerate the activity of the coagulation system
 Pregnancy and the puerperium
 Oral contraceptives
 Postsurgical state
 Immobility
 Congestive heart failure
 Malignant diseases
• Mechanisms:
o Trigger increased platelet function
 Predisposes to platelet adhesion, formation of platelet clots, and disruption of blood flow
 Causes:
• Increase in platelet numbers
• Disturbances in blood flow
• Damage to the vascular endothelium
• Increased sensitivity of platelets to factors that cause adhesiveness and aggregation
o Accelerate the activity of the coagulation system
 Blood flow stasis (accumulation of coagulation factors)
 Alterations in the components of the coagulation system (an increase in procoagulation factors or a decrease in anticoagulation factors)
Thrombocytopenia refers to a decrease in platelets, usually <
100,000
Thrombotic Thrombocytopenic Purpura is a combination of?
a. Thrombocytopenia, hemolytic anemia, and vascular occlusions (in arterioles of heart, lungs, kidneys)
manifestations of drug induced thrombocutyopenia?
thrombosis, stroke and myocardial infarction
Thrombotic Thrombocytopenic Purpura manifestations
• Pupura
• Petechiae
• Vaginal bleeding
• Neruological symptoms ranging from headaches to seizures
• Fever
*Identify the common causes and mechanisms of impaired platelet function
• Causes
o Inherited disorders of adhesion (von Willebrand disease)
o Acquired defects caused by drugs
o Extracorporeal circulation-coronary pulmonary bypass
• Mechanisms
o Aspirin-produces irreversible acetylation of platelet cyclooxygenase activity and consequently the synthesis of the prostaglandin TXA2, which is required for platelet aggregation
 Commonly used to prevent formation of arterial thrombi therefore reducing the risk of heart attack or stroke
o Nonsteroidal anti-inflammatory drugs (NSAIDs)-produces reversible inhibition of platelet clyclooxygenase activity
explain Hemophilia A:
Factor VIII (clotting factor) deficiency, X-linked recessive disorder. Where does bleeding normally occur?
• Soft tissues in the GI tract, hip, knee, elbow, and ankle joints
• Walking age
explain Von Willebrand disease
Factor VIII (clotting factor) deficiency, autosomal trait. What kind of symptoms occur?
• Bruising
• Excessive menstrual flow
• Bleeding from the nose, mouth, and GI tract
• GI bleeding and joint hemorrhage
explain Disseminated Intravascular Coagulation
Characterized by widespread coagulation and bleeding.
Brief patho stuff: Look at Figure 10-4. Can be initiated by endothelial injury (intrinsic pathway) or tissue destruction (extrinsic pathway). Massive coagulation – due to unregulated thrombin. All coagulation proteins and platelets are consumed, and then severe hemorrhage ensues. Not a pretty picture! Has a high mortality rate.
• What are some things that can cause DIC?
o Infection from a gram negative bacteria
o Endothelial damage
o Sepsis
• Clotting and hemorrhage at the same time
• Predisoposition: OB complications, infection, shock, trauma, cancer
Anemia is defined as ...
an abnormally low hemoglobin level, number of circulating red blood cells, or both, resulting in diminished oxygen-carrying capacity of the blood
manifestations anemia
• Reduced oxygen carrying ability
o Hypoxia
 Fatigue
 Weakness
 Dyspnea
 Angina
 Headache
 Faintness
• Decreased hemoglobin in blood and redistribution of the blood
o Pallor of the:
 skin
 Mucous membranes
 Conjunctiva and nail beds
• Compensation to increase cardiac output
o Tachycardia
o Palpitations
• Decreased blood viscosity
o Flow-type systolic heart murmur
Blood loss
hemolytic anemias:
sickle cell disease, the thalassemias, and inherited deficiency of G6PD.
Sickle cell disease
• Autosomal recessive disorder, leads to formation of hemoglobin S.
• 8% of black Americans carry the trait.
• Precipating factors of ‘sickling’ include:
• Deoxygenation-hypoxia
• Dehydration
• Infection When removed-return to normal
• Cold Over time cellular changes occur
• Stress & physical exertion
• Vasooclusive crisis: occlusion of microcirculation = very painful
• Fingers, joints, chest, abdomen
• Chronic respiratory syndrome
• Pallor, fatigue, jaundice, irritability
• Occlusions in the brain-stroke
Thalassemias
• Autosomal recessive disorder resulting in impaired rate of synthesis of hemoglobin
• Most common with Mediterranean, Asians
• Symptoms range from mild anemias to bone problems to still birth
G6PD deficiency
• X-linked disorder.
• What does G6PD do?
• Protects red blood cells from oxidation
• Red cell metabolism
• Hemoglobin oxidation
• So without it, red blood cells are more vulnerable to oxidants … hemolysis.
• Results in hemoglobinemia, hemoglobinuria, and jaundice.
Iron-deficiency anemia results from
dietary deficiency, loss of iron through bleeding, or increased demand
• What are the manifestations of iron-deficiency anemia?
o Fatigue
o Palpitations
o Dyspnea
o Angina
o Tachycardia
o Epithelial atrophy
 Waxy pallor
 Brittle hair and nails
 Smooth tongue
 Sores in the corners of the mouth
 Dysphagia
 Decreased acid secretion
o Pica
 Compulsive eating of ice and dirt
o Neurological
 Developmental delay, stroke, and cranial nerve palsies
Vitamin B12 Deficiency (Pernicious) Anemia.
The parietal cells in the stomach secrete intrinsic factor that’s essential for Vitamin B12 absorption. NO INTRINSIC FACTOR = NO VITAMIN B12.

Symptoms:
• Nuclear maturation and cell division (red cells) fail to occur
• Neurologic changes-parasthesias-tingling in hands and feet
What body system really loves Vitamin B12?
neurological system
Folic acid anemia. What’s the most common cause?
• Diet deficient in green leafy vegetables, cereals, and meats
• Alcoholics cannot absorb folic acid
Aplastic anemia.
a reduction in red blood cells, white blood cells, and platelets
Aplastic anemia. Since this is a reduction in red blood cells, white blood cells, and platelets, what kind of manifestations will you see?
• Cardiovascular and respiratory
• Hemorrhage
• Infection
• Weakness, fatigue, and pallor caused by anemia
• Petechiae and bruising
• Bleeding from the nose, gums, vagina, or GI tract
• Tachycardia
• Recurrent infection
Primary polycythmia is a
rare, neoplastic disorder, overproduction of all cells in bone marrow.
Secondary polycythmia is
more common, physiological response to hypoxia.
What symptoms occur with polycythmia?
• Tissue ischemia
• Infarction
• Dusky red (and cyanotic) color to hands and feet (lips, fingernails, and mucous membranes)
• Splenomegaly
• Hepatomegaly
• Increased blood volume
• Increased blood pressure
• Headache
• Bounding pulse
• Confusion
• Visual disability
• Painful itching
• Night sweats
• Weight loss
• Thrombosis