Patho Ch 10 & 11

Front 1

Universal donors

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Type O

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Universal recipients

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Type AB

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Erythrocyetes

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RBC

red blood cells

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__________ or PCV (packed cell volume) is the volume present of RBC's whole blood

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Hematocrit

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Hematocrit:

Adult males:

Adult women:

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42-54% males

38-46% women

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Reduced hematocrit=

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Anemia

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Elevated hematocrit=

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Polycythemia

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Cause a reduction in oxygen transports due to

*Decreased__________

*Decreased__________

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Anemias

Hemoglobin

Erythrocytes

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Oxygen deficit in Anemia leads to a sequence of events:

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*Less cell energy produced

*Metabolism and reproduction diminished

*Mechanisms try to compensate for lack of O2

-Tachycardia

- Vasoconstriction

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Iron Deficiency Anemia may occur due to

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*Insufficient dietary intake

* Chronic blood loss

*Impaired iron absorption (malabsorption) in the intestines

*Severe liver disease

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5-10% ingested iron is absorbed

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dietary intake

Front 12

from ulcer, cancer, menstruation, etc.

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chronic blood loss

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ileitis, achlorhydria

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iron absorption

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iron storage and protein synthesis

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liver

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*Frequently asymptomatic

*General signs (hemoglobin value drops-more apparent)

-pallor of skin and mucus membrane

-fatigue, lethargy, cold intolerance

-irritability

-degenerative changes

-menstrual irregularities

-delayed healing

-tachycardia, heart palpitations, dyspnea and syncope

Back 15

Iron Deficiency Anemia Signs/Symptoms

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due to cutaneous vasoconstriciton

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pallor of skin and mucus membrane

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as cell metabolism decreases

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fatigue, lethargy, cold intolerance

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CNS response to hypoxia

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Irritability

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Brittle hair, spoon shaped (concave) and ridged nails

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Degenerative changes

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Underlying cause must be identified and resolved if possible

*Iron supplements and Iron-rich foods

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Iron Deficiency Anemia Treatment

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*Also known as Vitamin B12 Deficiency (cyanocobalamin)

-A type of Megaloblastic Anemia

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Pernicious Anemia

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Pernicious Anemia is characterized by large, immature (megaloblasts) ________________ erythrocytes.

Back 22

nucleated

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Results from vitamin B12 deficiency

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Pernicious Anemia

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*Another type of Megaloblastic Anemia can result from Vitamin B9 __________ deficiency which is usually diet related.

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folic acid

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Dietary insufficiency in Pernicious Anemia is _____ a factor, small amounts of Vitamin B12 (cyanocobalamin) are needed (food source is animal foods so vegans may be at risk)

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RARELY

Front 26

Main cause of Pernicious Anemia is ___________ (autoimmune) from:

-Gastritis (common in alcoholics)

-Inflammatory condition (ileitis)

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Malabsorption

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Pernicious anemia is _____________ induced from procedures such as gastrectomy or bariatric surgery.

-Removal of part of the stomach in which parietal cells are removed

-Resection of ileum, which is the site of absorption

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Latrogenically

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General signs:

-Fatigue

-Pallor

-Dyspnea

-Tachycardia

*Large red, sore shiny tongue

* Digestive discomfort (nausea, diarrhea)

*Neurological symptoms:

-paresthesia (burning/tingling)

-Ataxia

-Loss of muscle coordiantion

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Signs/Symptoms Pernicious Anemia

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Due to recessive Hbs gene

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Sickle cell anemia

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Very common in black population

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Sickle cell anemia

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May be carrier if both dominant and recessive genes are present, termed the _____________

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sickle cell trait

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less than Hb is type

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HbS

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Signs of anemia may occur in conditions of ________ (high altitude, pneumonia)(sickle cell anemia)

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hypoxia

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In persons with both recessive genes normal hemoglobin (HbA) is replaced with _______(abnormal hemoglobin associated with sickle cell)

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HbS

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1 in 12 ________ may have the sickle cell trait, and 1 in 600 have the disease

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African Americans

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Signs of sickle cell anemia appear around _____ of age because fetal hemoglobin (HbF) is replaced with HbS

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12 months

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*Pallor

*Weakness

*Tachycardia

*Dyspnea

*Jaundice (evident in sclera)

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Signs/symptoms Sickle cell anemia

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*Splenomegaly

*Vascular occlusions leading to stroke

*CHF

*Retarded growth and development

*Infections

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Signs/Symptoms sickle cell anemia

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Drugs to reduce sickling _________ and prolong life

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hydroxyurea

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Treatment sickle cell anemia

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*Avoid strenuous activity and high altitudes

*Gene therapy is being investigated

*Many patients do not live past 20 years

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Also called primary polycythemia or __________

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polycythemia vera

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Condition of increased production of erythrocytes (and other cells) by bone marrow

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Polycythemia

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Polycythemia is considered a ______________

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neoplastic disorder

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In polycythemia patients appear _______ (beefy red color due to increased erythrocytes-hypervolemia) and ___________

-Deep bluish-red tone of skin and mucosa

-Resulting from engorged blood vessels and sluggish blood flow

Back 44

plethoric

cyanotic

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Signs/Symptoms Polycythemia

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*Hepatomegaly

*Splenomegaly

*High BP

*CHF often develops due to increased work load of heart

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Hemophilia A (classic) is a deficit or abnormality of _________

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clotting factor VIII

Front 47

*Most common inherited clotting disorder

*90% of patients have type A (classic)

*Defect is transmitted as an X-linked recessive trait

*Manifested in men but is carried by women who are aysmptomatic

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Hemophilia A (classic)

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*prolonged or severe hemorrhage occurs following minor tissue trauma

*Persistent oozing of blood after minor injuries

*Hematomas, Easy bruising (ecchymosis)

*Frequent nosebleeds (epistaxis)

*Spontaneous hemorrhange into joints (hemarthrosis)

-causing painful crippling deformities resulting from recurrent inflammation

*Hematuria or fecal blood because of bleeding in the kidneys or digestive tract

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Signs/Symptoms Hemophillia

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______leukemia's have high numbers of immature, nonfunctional cells (blast cells) in bone marrow and circulation

-Abrupt onset, with marked signs

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Acute

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_____leukemia's have higher proportion of mature cells

-insidious onset, mild signs and better prognosis

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Chronic

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Both can be further classified as to cell type involved and can be quite detailed and specific

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Acute and Chronic Leukemia

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B-Lymphocytes

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Acute lymphocytic leukemia (ALL)

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Granulocytes

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Acute myelogenous leukemia (AML)

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Monocytes

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Acute monocytic leukemia

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Examples of Acute Leukemia

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*Acute lymphocytic leukemia (ALL)

*Acute myelogenous leukemia (AML)

*Acute moncytic leukemia

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Chronic- B-lymphocytes

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Chronic lymphocytic leukemia (CLL)

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Chronic- Granulocytes

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Chronic myelogenous leukemia (CML)

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Examples of Chronic Leukemia

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*Chronic lymphocytic leukemia (CLL)

*Chronic myelogenous leukemia (CML)

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Common in adults

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Chronic leukemia

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common in children and young adults

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Acute leukemia

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_____is most common childhood cancer

-occurs between ages 2-6 cause is unkown

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ALL (acute lymphocytic leukemia)

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____ is common in adults

-Factors include radiation, chemicals, viruses

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AML (acute myelogenous leukemia)

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Some leukemia's have association with chromosomal abnormalities

-Increased leukemia in _________

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Downs Syndrome

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Onset of Acute Leukemia marked by

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*Unresponsive infection or excessive bleeding

*Multiple infections

*Signs of anemia

*Bone pain

*Weight loss/ fatigue

*Fever

*Enlarged lymph nodes/ Spleen

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Chronic leukemia has insidious onset with mild signs

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*Fatigue

*Weakness

*Frequent infections

Front 66

Malignancy initially involves a single lymph node frequently in the neck area

-cancer will later spread to adjacent nodes in an orderly fashion and then to organs via the lymphatics

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Hodgkin's

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The _______ appear to be defective and the lymphocyte count is decreased in Hodgkin's

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T-lymphocyte

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Hodgkin's is subdivided into ____ sub-types based on the cells found at _______

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4

biopsy

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First indicator is usually a cervical lymph node that is large, painless and non-tender

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Hodgkin's signs/symptoms

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Later signs of Hodgkin's

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Splenomegaly and enlarged lymph nodes at other locations may cause pressure effects

-ie. enlarged mediastinal nodes may compress esophagus

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General signs of cancer

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*weight loss

*Low grade fever

*Anemia

*Night seats

*Fatigue

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Recurrent infection is common in Hodgkin's because abnormal lymphocytes interfere with the ______

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immune response

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Increasing in incidence, partly due to the numbers associated with HIV infection

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Non-Hodgkin's Lymphomas

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About 80% of the cases of Non-Hodgkin's involve_________

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B-lymphocytes

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Non-Hodgkin's is only similar to Hodgkin's lymphomas in some ways:

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*Initial manifestation is an enlarged, painless lymph node

*Clinical signs, staging and treatment are similar

Front 76

Spontaneous bleeding or excessive bleeding following minor tissue trauma often indicates a _______________

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blood-clotting disorder