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76 Cards in this Set
- Front
- Back
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What does the hematologic system consist of?
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blood and sites where blood is produced (bone marrow, reticuloendothelial system)
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What makes up blood?
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-55% plasma (albumin, globulin, fibrinogen, electrolytes, waste products, nutrients)
-45% cellular erythrocytes (RBC) leukocytes (WBC) thrombocytes (platelets) |
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Define hematopoiesis and where does it occur?
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formation and maturation of blood cells
bone marrow |
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What percentage of body weight is blood and what does the blood do?
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7-10%
carries O2 from lungs and nutrients from GI to body cells for metabolism, carries hormones, antibodies, waste products to and away from cells |
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Define hemostasis?
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balance between thrombus formation and clot dissolution (fibrinolysis)
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What is extramedullary hematopoiesis?
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formation and maturation of blood cells,
when liver and spleen resume production of blood cells after marrow destruction, fibrosis, or scarring |
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What does the bone marrow produce?
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stem cells that are then differentiated into either myeloid or lymphoid stem cells
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What do lymphoid stem cells produce into?
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T or B lymphocytes
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What do myeloid stem cells differentiate into?
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erythrocytes, leukocytes, platelets
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Why is a RBC thin with a large surface area?
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so o2 and co2 can easily diffuse
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What do RBC primarily consist of?
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hemoglobin, which contain iron
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What is the function of hemoglobin?
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transport o2 between lungs and tissues
-hemo binds o2 |
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What is oxyhemoglobin?
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how o2 is carried in the arteral blood
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What is erythropoiesis?
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production of erythrocytes (RBC) from erythroblasts, stimulated by hormone erythropoietin from kidney
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What is normal iron concentration levels?
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men 75-175
women 65-165 |
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Where is iron stored and how it used?
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stored in small intestine as ferritin and reticuloendothelial cells, released into plasma, binds to transferrin and transported into membranes of normoblasts, eventually being incorp into hemoglobin
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What are vit B12 and folic acid required for and where does it come from?
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DNA synthesis
comes from diet |
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What are people with gastrectomies missing?
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have limited amounts of intrinsic factor, therefore vit B12 absorption is limited
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What do Vit b12 and folic acid deficiencies result in?
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megaloblasts- RBC too large to exit bone marrow leading to megaloblastic anemia
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What happens to RBC?
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lose elasticity and get trapped in the liver and spleen, hemoglobin is recycled or excreted
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What are the 2 categories of leukocytes (WBC)?
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granulocytes
lymphocytes |
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What are the 3 groups of granulocytes?
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eosinophils- allergic reaction
basophils- histamines neutrophils- phagocytosis |
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What are monocytes?
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macrophages in spleen, liver, peritoneum and alveoli
-remove debris and bacteria |
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Where are T lymphocytes produced and what do they do?
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thymus
cellular immunity- kill foreign cells directly or release lymphokines (phagocytic), delayed allergic reactions, rejection of foreign material, destruction of tumor cells |
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Where do lymphocytes complete there differentiation?
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lymph nodes, lymphoid tissue of intestine and spleen after exposure to specific antigen
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What do lymphocytes do?
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produce antibodies and identify other cells as "foreign"
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Where are B lymphocytes derived and what do they do?
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marrow
humoral immunity- differentiate into plasma cells, produce antibodies called immunoglobulins, wich destory foreign material |
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What do eosinophils do?
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phagocytosis of parasites, neutralize histamine
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What do basophils do?
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produce and store histamine, provoke allergic reactions
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What are platelets? What regulates them?
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megakaryocytes, regulated by hormone thrombopoietin, collect at the site of injury and form fibrin and stop bleeding
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What is the liquid portion of the blood? What is included in this?
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plasma
plasma proteins, clotting factor, nutrients, enzymes, waste products, gases |
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What are plasma proteins primarily made of and why are these substances important?
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albumin and globulins
albumin- maintains fluids balance with vascular systems globulins- transport other substances |
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What is the reticuloendothelial system?
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complex system of cells thru out body capable of phagocytosis,
macrophages derived from monocytes, which defend against invaders via phagocytosis - spleen is major site of macrophages |
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What is hemostasis?
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stopping of bleeding and preventing of blood loss
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What is primary hemostasis?
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severed blood vessels constrict, circulating platelets aggregate to site and adhere to vessels
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What is secondary hemostasis?
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formation of fibrin which reinforces the platelet plug and anchors to the injury site
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How is fibrin formed?
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tissue is injuried, thromboplastin from tissue is released, prothrombin is converted to thrombin which converts fibrinogen to fibrin
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What breaks down a clot?
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plasmnigen lysis fibrin
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What is an age related factor to RBC?
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bone marrow dec ability to respond to need for blood cells--anemia
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What tests are used for hemological studies?
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CBC, peripheral smear, bone marrow aspiration, biopsy
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What does the CBC and peripheral smear reveal?
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CBC-# of leukocytes, erythrocytes, platelets, hemoglobin, hematocrit
Smear- size and appearance of cells |
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What is anemia?
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few than normal erythrocytes within the circulation
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What are the 3 classifications of anemia?
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hypoproliferative anemia- marrow cannot produce enough erythrocytes
hemolytic anemia- premature distruction of erythrocytes hemolysis-direct injury to the erythrocytes |
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How can you tell the difference between the 3 types of anemias?
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hemolytic- increase in reticulocyte count
hypoproliferation- age at which erythrocytes proliferate hemolysis- increased bilirubin |
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What are the diagnostic tests for anemia?
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hemoglobin (>12-13), hematocrit (>36-40), reticulocyte count, RBC indices, mean corpuscular volume, red cell distribution width, iron studies, vit B12, folate
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What are complications of anemia?
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HF, paresthesias, confusion, angina
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What are s/s of anemia?
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weakness, fatigue, jaundice, pica, red smooth tongue, side mouth ulcers, brittle nails
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What are some common hypoproliferative anemias?
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iron deficiency, aplastic anemia, renal disease anemia, megaloblastic anemias, myelodysplastic syndrome
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What are some patient education pointers for taking iron supplements?
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should be taken on an empty stomach (esp not after diary or antacids), increase vit c intake to increase absorption, liquid forms might stain the teeth, enteric coating may dec absorption
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Why does ESRD cause anemia?
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shortened life span of erythrocytes, dec production of erythropoietin, long term dialysis causes folic acid deficiency
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How is ESRD anemia treated and what should be watched for?
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treated with recombinant erythropoietin and oral iron supplements, HYN may result so hematocrit levels must be monitored closely
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What type of anemia is associated with chronic disease?
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normochromic/normocytic
-erthyropoietin levels are low, iron use is blocked by erythroid cells -usually not severe enough to be treated |
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What is aplastic anemia?
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damage to bone marrow stem cells with it being replaced with fat
-impairment in production of erthrocytes, leukocytes, platelets |
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What is the cause of aplastic anemia, the s/s, and the treatment?
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cause- idiopatic, toxic chemicals/materials
s/s- bruising, throat infections, lymphadenopathy, splenomegaly, retinal hemorrhage Treatment- bone marrow transplant, peripherla blood stem cell transplant |
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What is megaloblastic anemia?
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myeloid cells are abnormal so they do not leave the marrow, hemoglobin, leukocytes, platelets are all decreased
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What causes megaloblatic anemia?
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folic acid and vit B12 deficiencies
-or lack of intrinsic factor (often due to abn in gastric mucosa) |
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What are the s/s, diagnostic tests, and treatment for megaloblastic anemia?
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s/s-sore, red tongue, mild diarrhea, pale, confused, paresthesias in extremeties, HR
Test- Schilling Test Treatment- supplementation of vit B12, folic acid, or intrinsic factor |
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Why might a blood transfusion not be used for metaloblastic anemia?
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body has compensated for anemia so a tranfusion might can fluid vol overload --pulm edema, cardiac dysfunction--if given transfused slowly
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What is myelodysplastic syndrome?
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dysplasia-bone marrow is hypercellular but cells die before being released and those that do get released are dysfunctional
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What are s/s of MDS?
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neutrophils cannot destroy bacteria and platelets cannot clot as well--fatigue, infection, bleeding, asymptomatic
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How is MDL diagnosed and treated?
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diagnosed- CBC, erthropoietin levels
treatment- bone marrow transplant, RBC transfusions/chelation therapy, growth factor, G-CSF, erthropoietin |
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What are hemolytic anemias?
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erythrocytes have shortened life spans (inc in rbc destruction), increase erythropoietin release, high bilirubin levels, reticulocyte level is increased, low haptoglobin levels
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What are the types of hemolytic anemias?
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sickle cell anemia, thalassemia, G-6-PD deficiency, spherocytosis, autoimmune hemolytic anemia, immune-mediated parxysmal noctural hemoglobiniuria, miroangiopathic hemolytic anemia, hypersplenism, heart valve hemolysis
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What is sickle cell anemia?
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erythrocyte becomes rigid and deformed with limited o2, then adheres to each other and small vessels causing reduced blood flow
-can be caused by cold, increased blood viscosity |
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What are the s/s of sickle cell anemia?
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anemia, jaundice, enlargement of bones, tachycardia, cardiac murmurs, cardiomegaly, dysrythmias, HR
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What happens to the organs from sickle cell anemia?
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hypoxic damage can cause necrosis esp in spleen, lungs, central venous system, liver
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What are complicationsof sickle cell anemia and what do most people die from?
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infection, stroke, renal failure, impotence, HF, pulmonary HYN
-die from pulmonary HYN or chronic lung disease |
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What is sickel crisis, aplastic crisis, sequestration crisis?
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sickle- tissue hypoxia/necrosis
aplastic-infection with parvovirus sequestration- pooling of cells in organs |
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What is acute chest syndrome in sickle cell anemia?
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rapidly decreasing hemoglobin levels- tachycardia, fever, infiltrates, infarction within pulmonary vascularture, pulmonary fat embolism
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What test is used to diagnose sickle cell anemia?
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low hematocrit and sickled cells on the smear
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How is sickle cell anemia treated?
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bone marrow transplant, hydorxyurea (chemo), arginine (vasodilator), blood transfusions, daily folic acid supplementation, antibiotics for infections
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What are some of the nursing considerations for sickle cell anemia?
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pain management (asprin, NSAIDS, morphine), fluid balance, pulmonary function assessments, incentive spirometry, O2, hypoxia or ischemia, signs of infection
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What is thalassemia?
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hereditary anemia (alpha or beta) characterized by abn dec in hemoglobin, smaller than normal erythrocytes, destruction of blood elements
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What is thalassemia major?
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Cooley's anemia, severe anemia, marked hemolysis, ineffective erythropoiesis
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What is the treatment for thalassemia?
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transfusion and chelation therapy, bone marrow transplant
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What is G-6-phosphate dehydrogenase deficiency?
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inherited enzyme is defective and causes chronic hemolysis
-caused by certain medications -treatment is to stop meds |
