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99 Cards in this Set

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hemoglobin
protein molecule in red blood cells that carries oxygen & CO2; iron in hemoglobin gives red color
hematocrit definition
the proportion, by volume, of blood that consists of red blood cells
expressed as a %
reticulocyte
immature red blood cell
mean corpuscular volume
the average volume of RBC
mean corpuscular hemoglobin
the hemoglobin content of the average RBC
mean corpuscular hemoglobin concentration
measurement of the concentration of hemoglobin in a RBC
erythrocyte sedimentation rate definition
The rate at which red blood cells settle in blood with anticoagulant
total iron binding capacity
a test that measures the extent to which iron binding sites in the serum can be saturated
serum ferritin
iron-containing protein complex; primary form of iron storage in the body
% transferrin saturation is ratio of
serum iron to total iron binding capacity (x100)
erythropoietin
a glycoprotein that stimulates production of RBCs
anemia (3 reasons)
decrease in RBCs
-decr production
-incr destruction
-incr loss
polycythemia vera
condition in which there is a net increase in the total circulating erythrocyte mass of the body, caused by a abnormality of the bone marrow
hemoglobin measurement
direct indicator of oxygen transport capacity of the blood
incr in polycythemia vera
decr in anemia
hematocrit measurement (incr & decr)
incr with neg fluid balance
decr with anemia or pos fluid balance
MCV distinguishes between:
microcytic, macrocytic, and normocytic cells
incr in macrocytic patients
decr in microcytic patients with IDA
MCH measurement (incr & decr)
incr in patients with folate or B12 deficiency
decr in IDA
ferritin
storage form of iron
low ferritin levels indicates IDA
sed rate measurement
non-specific test for inflammation (usually incr in inflammatory diseases)
morphology
study of the form and structure or an organism or its parts
hypochromic
decr in ratio of weight of hemoglobin to volume of RBC
iron deficiency anemia
usually microcytic, hypochromic
IDA etiology (4)
inadequate dietary intake
inadequate absorption
increased demand
excessive blood loss or disease
diagnosis of IDA based on
full blood count
peripheral blood smear
bone marrow iron stain
s/s of anemia (14)
fatigue
pallor
icterus
hepatosplenomegaly
tachycardia
wide pulse pressure
pale mucosal membranes
cardiac decompensation
SOB
edema
dizziness
light-headedness
weakness
cold extremities
icterus
yellowing of the skin and whites of the eyes due to the accumulation of bile in the blood
IDA patients: appearance
tired
listlessness
lifeless appearance
IDA patients: skin/hair
pale
inelastic
hair often dry and scanty
IDA patients: mouth (4)
papillary atrophy
erythema of the tongue
glossitis
stomatitis
erythema
Redness of the skin caused by dilatation and congestion of the capillaries
stomatitis
inflammation of the mouth
IDA patients: nails
flattened
longitudinally rigid
concave (koilonychias)
koilonychia
A nail deformity characterized by concavity of the outer surface of the nail
IDA patients: eyes
pearly white sclerae (white of the eye)
IDA patients: CVS (4)
slight cardiomegaly
tachycardia
functional systolic murmur
ankle edema
megaloblastic anemia definition
red cell divisions arrested when B12 and folic acid are deficient; reduced cell divisions; RBC larger than normal
B12 daily requirement
1-5mcg
B12 body stores
2-5mg
B12 in average diet
over 20mcg (animal, dairy, meat, liver, fish, eggs)
megaloblastic anemia - etiologies
inadequate intake
malabsorption
inadequate utilization or incr demand
pernicious anemia
defects in or absense of intrinsic factor can lead to B12 deficiency
possible causes of B12 malabsorption (5)
blind loop syndrome/fish tapeworm infestation
gastrectomy
inflammatory small bowel disease
resection of small bowel
pancreatic disorders
drugs that can cause B12 malabsorption (5)
antibiotics
anticonvulsants
cytotoxic agents
oral contraceptives
high dose vit C
folic acid daily requirement
25-50ug/d
mechanisms of folic acid deficiency (3)
poor intake
increased requirement
poor intestinal absorption
drugs that can cause folic acid deficiency (6)
anticonvulsants,
ethyl alcohol,
oral contraceptive, methotrexate,
trimethoprim,
triamterene
clinical presentation of B12 deficiency (12)
dysphagia
anorexia / weight loss
diarrhea
beefy red tongue
psychosis
forgetfulness
paresthesis
ataxia
+ Romberg's sign
+ Babinski's sign
impaired vibratory sense
impaired position sense
dysphagia
difficulty swallowing
Romberg's sign
A sign indicating loss of proprioceptive control in which increased unsteadiness occurs when standing with the eyes closed compared with standing with the eyes open
The patient can stand with the eyes open; and
The patient falls when the eyes are closed.
Babinski's sign
An extension of the great toe, sometimes with fanning of the other toes, in response to stroking of the sole of the foot
clinical presentation of folic acid deficiency (8)
dysphagia
anorexia / weight loss
malnourished
beefy red tongue
personality changes
pupura
ecchymoses
early graying of the hair
purpura
condition characterized by hemorrhages in the skin and mucous membranes that result in the appearance of purplish spots or patches.
ecchymoses
The passage of blood from ruptured blood vessels into subcutaneous tissue, marked by a purple discoloration of the skin
4 clinical presentation of megalobastic anemia (organs)
atrophic glossitis
mild hepatosplenomegaly
enlarged heart
gastric cancer
normocytic anemia
normocytic and normochromic hypoproliferative RBCs
adequate iron availability but ineffective utilization
bone marrow less active
normocytic anemia usually seen in patients with:
lupus
rheumatoid arthritis
normocytic anemia
RBC Hgb Hct concentrations
decreased
normocytic anemia
MCV MCH MCHC
usually within normal limits
normocytic anemia
ESR
increased
what is bleeding time
a measure of platelet aggregation and capillary contraction; often taken prior to surgery
relative thrombocytopenia
150,000/mm^3
absolute thrombocytopenia
20,000/mm^3
at risk for spontaneous bleeding
prothrombin time reflects?
alterations in the extrinsic system and in the common clotting pathway, but not in the intrinsic system
protrombin time is prolonged by?
deficiences in clotting factors II, V, VII, IX, X
low levels of fibrinogen
very high levels of heparin
what drug can cause an increase in prothrombin time?
heparin
goal of oral anticoagulation therapy is to maintain the ratio of PT/control between
1.3 to 1.5 times the control
why was the international normalization ratio developed
to standardize PT ratios generated by different laboratories
an INR of ____ = PT of 1.3-1.5
2 to 3
activated partial thromboplastin time is used to monitor:
heparin therapy
aPTT measures activity of all factors except:
VII
during anticoagulation therapy, the goal is the maintain an aPTT of
1.5 to 2.0
fibrinogen is the circulating precursor of
the clot material fibrin
decr levels of fibrinogen suggests
a state of active coagulation
increase in FDP caused by
excessive degradation of fibrin and fibrinogen
when does elevated FDP occur
in states of fibrinolytic activity (disseminated intravascular coagulation
or use of fibrinolytics)
disseminated intravascular coagulation
a pathological process in the body where the blood starts to coagulate throughout the whole body. (This depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of haemorrhage. It occurs in critically ill patients, especially those with Gram-negative sepsis (particularly meningococcal sepsis) and acute promyelocytic leukemia.)
what are the 15 risk factors for developing thromboembolism?
antithrombin II deficiency
dysfibrinogenemia
heart disease
immobility / paralysis
obesity
protein C or S deficiency
lupus anticoagulant
trauma
estrogen use
inflammatory bowel disease
sickle cell anemia
malignancy
surgery
peripartum period
varicose veins
thromboembolism
The blocking of a blood vessel by a blood clot dislodged from its site of origin.
what is venous stasis?
an alteration or decr in blood flow in the deep veins of the lower extremities that can lead to formation of thrombi
what may cause venous stasis? (6)
immobility
prolonged bed rest
massive obesity
late-stage pregnancy
shock
severe MI
mechanical causes of vascular wall injury
venipuncture
indwelling cannulas or catheters
factured bones
surgery
chemical causes of vascular wall injury
parental admin of potassium or hypertonic glucose
hypercoagulability
occurs when activation of the coagulation system exceeds the ability of the intrinsic fibrinolytic system to prevent thrombus formation
physical findings associated with deep vein thrombosis (7)
pain or tenderness
leg swelling
discoloration
incr skin temp
palpable cord
homan's sign
leg ulcer/infection
commonly employed lab studies done for deep vein thrombosis (5)
doppler ultrasonography
impedance plethysmography
real time ultrasonograpy
125I-fibrinogen leg scan
venography
doppler ultrasonography
noninvasive
measures changes in sound waves to detect changes in venous flow
impedance plethysmography
noninvasive
measures changes in electrical resistance which accompanies changes in blood volume
real time ultrasonography
noninvasive
provides a 3D picture of the deep veins though the use of a transducer
125I-fibrinogen leg scan
screening tool in high risk patients
adjunctive test to impedance plethsymography
125I-fibrinogen leg scan can detect __% of calf-vein thrombi & ___% of proximal vein thrombi
over 90%
60 to 80%
venography
most reliable, radio opaque contrast dye is injected into dorsal foot vein or femoral vein providing an outline of the deep venous system of lower limbs
pulmonary embolism
a condition in which a blood clot usually formed in of the leg veins becomes detached and lodges in the lung artery or one of its branches
clinical presentation of pulmonary embolism (11)
dyspnea
cough
tachypnea
tachycardia
anxiety
sense of impeding doom
pleuritic chest pain
hemoptysis
acute right heart failure
cardiovascular collapse
fever
diagnostic findings of a pulmonary embolism CXR (4)
atelectasis
infiltrates
pleural effusions
elevated diaphragm
diagnostic findings for a pulmonary embolism EKG
tachycardia
right ventricular strain
non specific ST wave changes
diagnostic findings for a pulmonary embolism ABGs
decr pO2
decr pCO2
diagnostic techniques for PE
ventilation/perfusion (V/Q) scan
pulmonary angiography
V/Q scan
noninvasive
based on anatomic patterns of injected and inhaled radioactive materials
pulmonary angiography
gold standard!
detects filling defects
used when v/q scan not conclusive