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209 Cards in this Set
- Front
- Back
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What is considered a 'true' bruise?
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ecchymosis
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What 'cleans up' a bruise?
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macrophages eat free RBC
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What is released when bruises are cleaned up?
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1) hemoglobin (red) 2) bilirubin (yellow) 3) hemosiderin (brown)
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What is hemostasis?
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Control of bleeding
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What is the immediate reaction to damaged blood vessels?
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vasoconstriction
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What is primary hemostasis?
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platelet activation
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What is secondary hemostasis?
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coagulation
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How are clots regulated?
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Anti-thrombotic counter-regulation
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Name 3 steps of platelet activation
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adhesion, release of intracellular granules, aggregation of platelets
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What is the coagulation cascade?
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Secondary hemostasis
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What is the final product of coagulation?
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fibrin clot
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What is intrinsic initation?
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Blood
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What is extrinsic initiation?
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tissue injury
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What are the 4 types of coagulation blood tests?
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platelet count, Partial Thromoboplastin Time (PTT), Prothrombin Time (PT), Bleeding time
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What is PTT?
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Partial thromboplastin time, it is intrinsic
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What are the clotting factors of the intrinsic pathway we must know?
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VIII, IX, XII
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What are the extrinsic clotting factors we must know?
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VII
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Where can RBC's be damaged?
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At bifurcation of blood vessels "hits the median"
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What is epistaxis?
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nosebleeds
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What is the major cause of BV wall fragility?
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aging
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What are secondary causes of BV wall fragility?
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medications (glucocorticosteroids, penicillin, sulfa), Vit C deficiency
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What is Vit C related BV wall fragility called?
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Scurvy
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What is uncommon with BV wall fragility?
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internal bleeding and anemia, this is usually limited to superficial bleeds
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What are the lab test results for BV wall fragility?
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All normal
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What is the result of Avitaminosis C?
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decreased collagen formation --> weak vessels
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How long does scurvy take to develop?
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4-8 months
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What is a thrombocyte?
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platelets
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What is thrombocytopathia?
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abnormal platelet FUNCTION
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What is primary thrombocytosis often associated with?
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Seen with polycythemia vera
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What is another term for primary thrombocytosis?
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essential thrombocytosis
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What is another term for secondary thrombocytosis?
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reactive thrombocytosis
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What are causes of reactive thrombocytosis?
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trauma, CANCER, blood loss, infections, inflammatory dx
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What are the signs and symptoms of thrombocytopenia?
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Low platelet count, prolonged bleeting times, but normal PT and PTT
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What can cause decreased platelet production?
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infections, drugs, anemia (B12 and folate deficiency)
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What can cause decreased platelet survival/increased destruction?
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drugs, autoimmune
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What is ITP?
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idiopathic thrombocytopenia purpura
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What is the cause of ITP?
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autoimmune, anti-platelet Ab
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What is the tx of ITP?
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steriods, sometimes splenectomy, platelet transfusions
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What are the main demographics of ITP?
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Children 2-6 after a viral infection, women 20-40 years old
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What are the medications that can cause thrombocytopathia?
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aspririn, steroids
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What are the two main types of coagulation disorders?
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Hereditary and acquired
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What is hemarthrosis?
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blood in the joint
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What is hemophilia A?
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A Factor VIII deficiency
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What is an abnormal blood test for hemophilia A
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prolonged PTT, normal Von Willebrand Factor (vWF)
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How is Hem A passed?
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X linked recessive, only seen in males, women only carriers
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What is the treatment of hemophilia A?
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Factor VIII transfusions
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What blood component can be genetically synthesized articficially?
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Factor VIII
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What is vWF?
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Von Willebrand Factor, deficiency is Von Willebrand dx
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What does vWF do?
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Facilitates platelet adhesion to vessel
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What is a blood test sign of vWF?
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prolonged PTT
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How is vWF acquired?
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genetically, autosomal dominant, both sexes equally affected
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What is the most common inherited bleeding disorder?
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vWF dx
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What is vWF dx treatment?
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plasma, factor VIII, vWF transfusions
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What causes hemophilia B?
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Factor IX deficiency
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What are the abnormal blood tests with Hem B?
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prolonged PTT
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How is hem b passed?
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x-linked recessive trait, females are carriers, males affected
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How is Hem B treated?
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factor IX replacement
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Where are vit K dependent factors made?
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liver
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What are the blood test abnormalities of vit K deficiency?
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prolonged PTT and PT
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What can cause Vit K deficiency?
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diet, malabsorption or liver failure
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How to treat Vit K deficiency?
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fresh frozen plasma, vit K
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What does rattlesnake venom cause?
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hemotoxin, neurotoxin, coagulopathy
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What is coagulopathy?
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fibrinogen deficiency
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What is Virchow's Triad?
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Blood clot: Vessel wall injury, blood flow, hypercoagulability
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What is the major cause of thrombosis?
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vessel wall injury
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What initiates a thrombosis in BV?
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Endothelial injury exposes collagen
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What is DVT?
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Deep Vein thrombosis
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What are risk factors for DVT?
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elderly, recent surgery, bedridden, cancer
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What is one way to find a DVT?
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doppler ultrasound
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What are common thrombus treatments?
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platelet inhibitors, anticoagulants, thrombolytics
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What are common platelet inhibitors?
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Aspririn, NSAID's, ASA, Plavix
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What are anticoagulants?
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heparin
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What does Heparin affect?
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PTT (intrinsic pathway)
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What is DIC?
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Disseminated intravascular coagulation
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What does DIC cause?
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clotting AND bleeding at the same time, hard to treat
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What is a clinical sign of DIC?
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increased fibrin degradation products (FDP)
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What is Polycythemia Vera?
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Stemm cell abnormality, myeloproliferative Disorder "Cancer"
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What is another term for Polycythemia?
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Erythrocytosis
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What are granulocytes?
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WBC with granules in cytoplasm
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What are the 3 types of granulocytes?
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Neutrophils, basophils, eosinohils
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What are agranuclocytes?
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WBC with no granules in cytoplasm
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What are the main types of agranulocytes?
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monocytes, lymphocytes (T and B cells, plasma cells)
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What are the normal levels of neutrophils?
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30-75%
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What are the normal levels of eosinophils?
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0-6%
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What is the myelocytic cell line?
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phagocytes
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What are the 5 subtypes of phagocytes?
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neutrophils, basophils, eosinophils, monocytes, macrophages
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What is neutrophilia?
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An increased number of neutrophils
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What is neutropenia?
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A decreased number of neutrophils
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What is eosinophila?
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increased number of eosinophils
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What are 3 common causes of eosinophila?
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allergic response, parasite infestation, cancers
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What are the granules in eosinophils?
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major basic proteins (MBP) that are toxic to various parasites
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What is the lifespan of a RBC?
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3-4 months
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What is the lifespan of a WBC?
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7 hours
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What is the lifespan of a platelet?
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7 days
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What is are thrombocytes?
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Platelets
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What are the primary constituents of plasma?
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water, fibrinogen, albumin
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In an embryo, where does hematopoiesis occur?
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yolk, then liver/spleen, then in bone marrow
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Are hematologic stem cells pluripotent?
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Yes
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Are hematologic stem cells self reproducing?
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Yes
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Where are hematologic stem cells found?
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Bone marrow
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in an embryo, where does hematopoiesis occur?
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hemopoietic growth factors, colony stimulating factors, erythropoietin, thrombopoietin and cytokines (interleukins, TNF)
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What % of RBC's is hemoglobin?
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95%
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What is the structure of hemoglobin?
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4 hemes; each consisting of 2 alpha and 2 beta globin strands
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What is a reticulocyte?
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immature RBC's, about 1% of RBC in body. The nucleus has already been ejected.
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What is the MCV?
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MCV = mean cell (corpuscular) volume
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What is the MCH?
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MCH = mean cell (corpuscular) hemoglobin, average content (mass) of hemoglobin/cell
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What is erythropenia?
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Too few RBC's or enough RBC's but with reduced function
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What is polycythemia?
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Too many RBC's. Also called erythrocytosis
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What is hemolysis?
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An elevated rate of RBC destruction
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What are the 3 types of anemia morphology
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microcytic, macrocytic, normocytic
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Where is hypochromicity found?
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In microcytic anemia
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Where is normochromicity found?
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In normocytic anemia
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What is a sideroblast?
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A ringed, abnormal
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What kind of anemia is sideroblastic?
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microcytic
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Folic acid deficiency can be seen in what dx?
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Macrocytic anemia
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B12 deficiency can be seen in what disease?
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Macrocytic anemia
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Pernicious anemia is seen in what kind of anemia?
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Macrocytic anemia
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What is thalassemia?
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abnormal hemoglobin production due to genetic disorder
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How is thalassemia passed?
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Genetically, automsomal recessively
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What anemia has thalassemia as a sign?
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microcytic anemia
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If you have anemia due to iron deficiencey, what type is it?
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microcytic anemia
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What is deficient in hemolytic anemia?
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G-6-PD
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What form of anemia is also called sickle cell?
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hemolytic anemia
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What is hereditary spherocystosis?
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Abnornal RBC morphology, spherical instead of biconcave disk
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What kind of anemia presents spherocytosis
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hemolytic anemia
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What is normocytic anemia?
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anemia due to chronic disease, acute blood loss, or aplastic anemia
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What is aplastic anemia?
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A lack of bone marrow RBC production
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What is a pale conjunctiva an early sign of?
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anemia
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What is pica?
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compulsive eating often seen with anemia
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What is microcytosis?
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Abnormally small cells
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what is hypochromia?
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decreased hemoglobin
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What is sideroblastic anemia?
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Abnormal hemoglobin production due to inability to use iron, iron present systemically in normal amounts
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If iron is seen accumulating in the mitochondria of RBC precursors, what disease is this?
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Sideroblastic anemia
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Can thalassemia present with varying degrees of symptoms?
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Yes.
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What anemia is mild and has normal lifespans?
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beta-thalassemia
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What is the treatment for thalassemia?
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Transfusion
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What is the most common anemia?
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microcytic-hypochromic; both in U.S. and worldwide
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What does normochromic
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Hemoglobin/RBC are within normal range
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What is hypochromic?
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Low amount of hemoglobin/RBC
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What dx can be seen in 20% of U.S. women?
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iron deficient anemia (microcytic-hypochromic)
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What can cause iron deficiency?
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blood loss (gastrointestinal or menstrual); dietary deficiency, hookworms
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What is the #1 cause of iron deficiency worldwide?
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Hookworms
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What is the ferritin level?
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The measure of iron/protein complexes that store iron in intestinal cells
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What does a low ferritin level mean?
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iron deficiency
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How do you treat iron deficiency?
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Stop the blood loss, then replace the iron
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What are two signs of a good response to iron replacemtn therapy?
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An increase in reticulocytes at 1 week; hemoglobin back to normal by week 6
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What does it mean if reticulocytes are normal?
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bone marrow is functional
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When are reticulocyte levels increased?
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acute blood loss or iron therapy
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What is macrocytic anemia?
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Large celled (megaloblastic) anemia
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What abnormal biologic process causes macrocytic anemia?
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impaired DNA synthesis
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What causes nonmegaloblastic macrocytic anemia?
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alcoholism, hypothyroidism, chronic liver disease
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How long does the body's folic acid supply last?
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4-5 months
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What 4 things can cause folic acid deficiency?
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pregnancy, diet, alcoholism*, inflammatory bowel disease
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How long do B12 supplies last?
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3-5 years
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What can cause B12 malabsporption?
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Diet, veganism, being elderly, alcoholism
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What is the most common side affect of Vit B12 malabsorption?
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Pernicious anemia
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What are basic B12 deficiency symptoms?
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neurologic problems, atrophic glossitis (tongue inflammation)
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What is the cascade of events that cause pernicious anemia?
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autoimmune attack of gastric parietal cells leads to loss of intrinsic factor which leads to B12 malabsorption
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A lack of intrinsic factor is a hallmark of what disease?
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Pernicious anemia
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What disease presents anti-parietal cell antibodies?
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Pernicious anemia
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What disease presents anti-Intrinsic Factor antibodies
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Only pernicious anemia
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What are treatments for macrocytic anemia (3)?
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remove/treat the cause if you can, B12 supplementation, Folate
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What is anemia of chronic disease?
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anemia caused by chronic inflammation
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What 2 diseases often cause anemia of chronic disease?
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rheumatoid arthritis and renal disease
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How to you treat anemia of chronic disease?
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Erythropoietin (EPO)
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What is the primary mechanism of anemia of chronic disease?
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inability to metabolize iron in the bone marrow
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What is erythropoietin?
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a glycoprotein that causes RBC synthesis
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Where is EPO produced?
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Kidneys
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What induces EPO production?
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Hypoxia
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What drug is often used in end-stage renal failure?
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Erythropoietin (EPO)
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What causes aplastic anemia?
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Hematopoietic stem cell failure
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What is pancytopenia?
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A reduction of WBC, RBC, and platelet production
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What is thrombocytopenia?
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Low platelet levels
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What is leukopenia?
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Low levels of WBC
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What is erythropenia?
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low levels of RBC
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What is the main cause of primary aplastic anemia?
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unknown, idiopathic
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What are 2 common causes of secondary aplastic anemia?
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chemotherapy, infections
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What are signs/symptoms of leukopenia?
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increased infections
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What are signs/symptoms of thrombocytopenia?
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bleeding, petechiae, purpura, ecchymosis
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What is ecchymosis?
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bruises greater than 1cm in size
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What is petechiae?
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bruises less than 3mm in size
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What are purpura?
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bruises between 3mm and 1cm in size
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What are 4 ways to treat aplastic anemia?
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RBC transfusion, antibiotics if infection present, platelet transfusions, bone marrow transplant
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What Is the survival of aplastic anemia if untreated?
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2-6 months
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What type of anemia is blood loss anemia?
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normocytic, normochromic
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Is reticulosytosis seen with acute blood loss anemia?
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yes
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What are two signs of acute blood loss anemia?
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low blood pressure, tachycardia
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What are the 4 treatments for acute blood loss anemia?
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Prevent shock, give fluids,control bleeding, blood transfusions
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What is hypvolemia?
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Shock due to low blood volume
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What is the prevalance of the sickle cell gene in blacks?
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25%
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What is the prevalence of sickle cell anemia in blacks?
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1%
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What is abnormal in sickle cell anemia?
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hemoglobin S
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What hemoglobin protects against malaria?
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hemoglobin S (affected in sickle cell anemia)
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What are the 3 main characteristics of sickle cell anemia?
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chronic hemolysis, acute vaso-occlusive crises, increased susceptibility to infection
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What causes the sickling of RBC's in sickle cell crisis?
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Hypoxia
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What triggers sickle cell crisis?
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cold exposure, pregnancy, infections, gallbladder disease, stimulant drugs (cocaine, meth, nicotine)
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What is the mechanism of jaundice?
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heme breakdown produces bilirubin
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What can present jaundice as a symptom?
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sickle cell crisis and hereditary spherocytosis
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What can cause splenomegaly?
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sickle cell crisis
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What are the 4 ocular signs of sickle cell?
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retinopathy, vitreous hemorrhage, retinal detachments, neovascularization
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What is the most important treatment for sickle cell anemia?
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oxygen
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What are treatments for sickle cell anemia
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Oxygen, Fluids and transfusions, treat infections, hydroxyurea
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What is hydroxyurea?
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a sickle cell anemia med that increases Hb F which inhibits the sickling effect
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What disease presents with fragile, less pliable cells?
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hereditary spherocytosis
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What disease can present with splenomegaly?
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hereditary spherocytosis
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How do you treat hereditary spherocytosis?
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splenectomy
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What is a G-6-PD deficiency?
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deficiency of G-6-P dehydrogenase; an antioxidant that protects RBC's
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What is the primary demographic w/ G-6-PD deficiency?
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black males
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What are meds that can trigger G-6-PD deficiency (3)
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sulfa, aspirin, antimalarials
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