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114 Cards in this Set

  • Front
  • Back
Human body holds how much blood?
46-63% is plasma and remainder is formed elements
Red bone marrow contains ________ cells
Stem cells.
They are precursors for blood cells.
Final maturation and differentiation of T lymphocytes occur here
Include proteins, clotting factors, albumin, globulins
91% is water
Plasma is heated via
Circulating through organs
RBCs carry
Oxygen bonded to iron in hemoglobin (Hgb)
Oxyhemoglobin is formed in
The pulmonary capillaries where hemoglobin combines with oxygen in lungs
Once Hemoglobin gives up oxygen to cell body it becomes
Reduced hemoglobin
RBC Lab Value
*Increased in chronic hypoxia, decreases in anemia
Hematocrit (cellular portion of blood) Lab Value
*Increases in dehydration or chronic hypoxia, decreases in anemia
Hemoglobin (reflects oxygen carrying capacity of blood) Lab Value
*Increases in chronic hypoxia, decreases in anemia or blood loss
Reticulocytes (immature circulating RBCs)
*Increased in hypoxia or anemia, decreased in RBC maturation defect
*Increased with infection
*Increase with infection
*Increase with allergic response, some leukemias
*Increased in hyperthyroidism, some bone marrow disorders, ulcerative colitis
*Increased with viral infection, chronic bacterial infection, some leukemias
*Increased in chronic inflammatory disorders, some leukemias
*Increase with trauma, decrease with blood disorders, low platelet count causes risk for bleeding
Rate of RBC production is influenced by
Blood oxygen level
Hypoxia stimulates kidneys to secrete
Erythropoietin, which increases the rate of RBC production and the oxygen carrying capacity of blood
Reticulocyte becomes a mature RBC when it...
Ejects its nucleus
Vitamin B12
From food
Parietal cells of stomach produce
chemical that combines with vitamin B12 to promote absorption in small intestine
RBC live for
120 days and become phagocytized by fixed macrophages in the liver, spleen and red bone marrow
The heme portion of hemoglobin is converted to...
Bilirubin, a bile pigment that liver excretes into bile for elimination in the feces
Malaria and Sickle Cell Anemia cause
Accelerated destruction of RBCs
When bilirubin is high it
Discolors skin, sclerae, and mucous membranes bright yellow to dark orange (Jaundice)
Rh + means
D Antigen present on RBCs
Rh - means
NO D Antigen
Granular WBCS
Neutrophils, eosinophils, basophils,
Only produced in red bone marrow
Agranular WBCS
Lymphocytes, monocytes
Also produced in red bone marrow, however the T lymphocytes complete development in THYMUS
Become macrophages that eat dead tissue
More numerous but only eat pathogens
Combat against histamines, detoxify foreign proteins during allergic reaction, respond to parasitic infections
Release histamine
T Cells
Helper, suppressor, killer or memory
B Cells
Become plasma cells which produce antibodies to foreign antigens and become memory cells
Formed in red bone marrow.
Part of large cells called megakaryoxytes.
Involved in all mechanisms of hemostatis: vascular spasm, platelet plugs, and chemical clotting.
When blood vessels are damaged...
Platelets release serotonin, which contract smooth muscle and casocontrict artery or vein
Stage 1 (chemical clotting)
Platelet factors, clotting factors from liver, tissue factor (thromboplastin), and calcium ions react to form prothrombinase
Stage 2
Prothrombinase converts prothrombin (made in liver) into thrombin
Stage 3
Thrombin converts soluble fibrinogen (from liver) to insoluable fibrin, strands which form the clot
Must be returned to blood to maintain blood volume and blood pressure
Major Pairs of Lymph Nodes
Cervical, Axillary, Inguinal
Lymph Nodes are often referred to as
Mucosa-associated lympahtic tissue (MALT)
In the fetus, the spleen produces
RBCs and function assumed by red bone marrow after birth
Spleen contains
B and T cells for immune responses.
Stores 1/3 of bodys platelets
Heme unit from RBC destruction forms
Person without a spleen is more susceptible to
Pneumonia and meningitis
Atrophies with age
Contains T cells that mature here via thymic hormones
Small purple hemorrhagic spots under skin
Larger areas of discoloration from hemorrhage under skin
Hemorrhage into the skin, mucous membranes, and organs
S/S of persons with hematological disorders include...
Abnormal bleeding, petechiae, ecchymoses, purpura, fatigue, weakness, shortness of breath, fever.
Excess alcohol intake can lead to
Folic acid deficiency anemia
Bleeding may indicate
Low platelet levels or clotting factor deficiency
Physical Exam
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
Nodes that are palpable, with out without lymphedema are
Not usually normal
Sternal tenderness may indicate
Bone marrow packed with abnormal number and type of cells
Bacterial infection causes a rise in
Two types of neutrophils
Segmented (Mature)
Bands (Immature)
Initially mature cells rise then immature cells rise
Lymphocytes fight
Viral infections and are elevated during a virus
If infection is Acute Bacterial vs Viral
Acute bacterial = HIGH Segs HIGH Bands LOW Lymph

Viral= LOW segs LOW bands HIGH Lymph
PT and INR (Coumadin)
PT= 9.5-11.8 secs (Therapeutic range= 1.5-2 for coum)
INR= <1.3 (Thera range= 2-3)
PTT (Hep)
30-45 secs
Therap range 1.5-2
Injection of dye into lymph vessels of hand or foot.
Skin urine and feces may turn blue.
Packed Red Blood cells given to
Severe anemia/blood loss pts
Frozen red blood cells
Blood taken from pt before surgery to prevent reaction
Platelets given to
Pts who have bleeding caused by thrombocytopenia or low latelet
Albumin given to patients with
Hypovolemia caused by hypoalbuminemia
Fresh frozen plasma given to pts
To procide clotting factors for bleeding disorders.
Sometimes used for volume replacement
Given to pts bleeding caused by specific missing clotting factors
Blood admin
18-20 gauge needle
2-4 hours tops
Febrile Reaction to Blood transfusion
Most common reaction is fever.
Chance goes up after each transfusion.
Can occur after transfusion.
S/S: fever, chills, headache, back pain
Tylenol ordered
Urticarial Reaction
Give benadryl
Hemolytic Reaction
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
Anaphylactic Reaction
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.
Circulatory Overload
Caused by rapid transfusion
S/S: Chest pain, cough, frothy sputum, distended neck veins, crackles, wheezes, increased heart rate

Anticipate giving diuretics
Deficiency of RBCs, hemoglobin, or both in circulating blood
Decrease in RBC is from
1) Impaired RBC production
2) Increased destruction of RBC in hemolytic or sickle cell anemia
3) Massive or chronic blood loss
Pernicious Anemia is associated with
Lack of intrinsic factor in stomach, necessary for absorption of B12
Destruction or lysis or RBCs
Destruction of RBC = hemolytic anemia
Thalassemia anemia
Doesnt synthesize hemoglobin normally
S/S of Anemia
Pallor, tachycardia, tachypnea, irritability, fatigue, shortness of breath

Pernicious anemia= numbness of hands and feet b/c b12 needed for neurological function
Pernicious anemia is also associated with
Sore, beefy red tongue
Pts with iron def. may have
fissures at corners of mouth and inflamed tongue (glossitis) and spoon shaped nails
Sources of Iron
Red meat, dark green leafy veggies, dried fruits, enriched/fortified/whole grain products
Microcytic Anemia
Smaller than normal RBCs from iron def
Macrocytic Anemia
Folic acid or b12
Larger than normal RBCs
Aplastic Anemia (Hypoplastic anemia)
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
Sickle Cell Anemia
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
Thick blood, blood hard to circulate
Hgb= >18mg
RBC= > 6million
Hematocrit= >55%
Polycythemia Vera (PV)
RBCs, platelets, WBCs overproduced, bone marrow packed with cells
Congests organs
Secondary polycythemia
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
S/S of Polycythemia
HTN, visual changes, ha, vertigo, dizziness, tinnitus, elevated bone marrow components (panmyelosis), nose/gum bleeds, dark flushed complexion
Treat Polycythemia with
Teach patient with polycythemia to
Drink atleast 3L of water a day
Disseminated Intravascular Coagulation (DIC)
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
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)
Idiopathic Thrombocytopenia Purpura
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
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
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
Acute Leukemias
Usually affect children under 15
Abnormal growth of lymphocyte precursors
Acute Myelogenous Leukemias
Affects older than 20
Poor prognosis
High fever, abnormal bleeding from mucous mem, petechiae, ecchymoses, easy bruising
Death from infection is common
Chronic Leukemias
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
4 Stages of treating Leukemia
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
Multiple Myeloma
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)
Hodgkins Disease
Cancer of lymph sys
Presence of Reed-Sternberg cells
Most curable type of cancer
DX with painlessly enlarged nodes
Biopsy finds Reed and confirms
Stage 1 Hodgkins
Single lymph node
Stage 2 Hodgkins
Two or more nodes involved on same side of diaphragm, limited organ involvement
Stage 3 Hodgkins
Nodes on both sides of diaphragm with or without organ involvement
Stage 4 Hodgkins
Least curable, several organs with out without lymph node involvement
Non-Hodgkins Lymphomas
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
Overwhelming postsplenectomy infection