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23 Cards in this Set
- Front
- Back
The Hematologic System
• Includes |
– Blood
• Plasma liquid components of blood • Cells/Corpuscles – corpuscle doesn’t have a nucleus – RBC - corpuscle, no nucleus – WBC (B, T, basophils, neutrophils, eosinophils, macrophages, etc) – Platelets – no nucleus • Bone marrow • Lymph system |
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Shock
– • Signs |
– depends on the type
o Tachycardia o Weak pulse o Hypotension • Low blood pressure o Cool, moist skin o Pallor |
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– • shock Types
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o Hypovolemic – blood volume, when someone looses too much blood, heart doesn’t have enough blood to keep their BP up
o Cardiogenic – caused by heart, someone has a heart attack where part of heart stops working, or arythmia o Obstructive - when something is blocking blood flow. Most common is called a pulmonary embolism • More likely to clot in a vein than in an artery • Will get stuck in the lungs pulmonary artery • DVT – deep venous thrombosis • typically in veins of leg o Neurogenic o Septic – overwhelming infection, esp in the blood and possibly other organs. • Inflammation – causes blood vessels to dilate • Get widespread vasodilation • Drops BP |
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Anemia -
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a sx, not a disease!
Have a decrease of red blood cells or oxygen in the blood • Etiology (different causes) – Iron deficiency o Chronic blood loss • GI bleeding, ulcer, gastritis, tumor in colon o NSAIDs, • Contribute to iron deficiency, can cause gastritis – Chronic disease o Inflammatory, infectious, neoplastic – Nutritional o Vit B12, folate, iron, alcoholism – Infectious diseases o AIDS, tuberculosis – Neoplastic o Chemo/radiation – anemia is a common side effect, bc bone marrow is damaged o Bone marrow infiltration (lymphoma, mylemoma) – Other o Splenomegaly, autoimmune, hereditary, etc. Clasifications o size o Normocytic vs. macrocytic vs. microcytic o Color o Normochromic vs. hyperchromic vs. hypochromic o Shape o Anisocytosis, poikilocytosis, etc |
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Vitamin B12 absorption
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o Intrinsic factor
o Binds to VB12 and transports it o Needed to get b12 into the diet o Produced by stomach o Absorbed in the ilium o Causes of b12 malabsorption o Pernicious anemia • Vitamin b deficiency o Bacterial overgrowth in ilium o Surgical resection • Stomach or ilium removed o Dietary deficiency (vegetarians) o Tapeworm infection o Severe crohn’s disease |
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ANEMIA
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o Clinical manifestations – if severe enough
o Fatigue o Weakness o Dyspnea – shortness of breath o Tachycardia o Fatigability o Pallor (skin, palms, fingernails, mucosa, conjuctiva) o Angina in pre-existing CAD o DX (dx is easy but underlying cause is more difficult to find) o CBC (low Hct, Hg) • To find the anemia • Hct is the hematocrit o Peripheral smear • See if there’s abnormal cells o Iron and ferritin/transferrin • Associated with iron storage o Vitamin B12 and folate o Etc o TX o Tx underlying disease o Replace deficiencies o Erythropoietin (Epo, EpoGen – synthetic epo) o Blood transfusion |
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HEMOCHROMATOSIS
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o ET
o Atuosomal resessive o Entirely genetic o Pathophysiology o Excessive iron absorption by small intestine o Presents at 50-60 years old o CM o Iron accumulation in liver, pancreas, skin, heart, and other organs o SX o Weakness, fatigue, abdominal pain, arthritis, hepatomegaly (enlargement of the liver), darkened skin o Can lead to: • cirrhosis, DM, pulmonary fibrosis, cardiac mypoathy, impotence and sterility o TX o iron avoidance o No cure o Phlebotomy – bleeding to help decrease iron stores |
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LEUKOCYTES (WBC)
o Types |
o Granulocytes
• Basophils • Eosinophils • Neutrophils (polymorphonucleocytes) PMN • Monocytes o Lymphocytes • B and T cells o |
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Leukocytosis
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o An increase in WBC
o Eg. Infectious dx, hemorrhage o |
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Leucopenia
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o Decrease in WBC
o Eg, bone marrow failure (lymphoma, leukemia, chemo/rad, ect) o Shock o Nutritional deficiency o Splenomegaly – enlargement of the spleen o |
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Eosinophilia
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o Allergic and parasitic infection
o |
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Neutrophilia
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o Increased WBC and PMN (neutrophils)
o Bacterial infection o |
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Lymphocytosis
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o Increase WBC
o Viral infection o EBV – ebstein barr virus o Lymphocytic leukemia |
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LUKEMIA
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o Malignant neoplasm of blood forming cells
o A liquid tumor bc cells do not form a solid tissue o Two classes o Lymphocytic or myelogenous (monocytes, granulocytes, erythrocytes, platelets) o patho o Bone marrow gradually gets replaced by abnormal clones o Two classes in terms of presentation o Acute and chronic o ALL - most common in children – acute, lymphocytic lukemia o AML – most common among adults – acute, myelogenous lukemia o CLL – chronic, lymphocytic lukemia o CML – chronic, myelogenous lukemia o Common symptoms: o Anemia, infection, bleeding tendencies |
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ACUTE LEUKEMIA
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o Incidence
o More common in older adults (AML) o Etiology/patho o Rapidly progressive • Spreads quickly o Blast cells in marrow and blood gets replaced quickly o Risks o Hereditary o Radiation o Benzene – chemical that can cause problem o Chemo o Human leukocyte virus (HTLV-1) o CM o Flu-like acute febrile illiness at first o Bleeding • Gingival – gums • Epistaxis - nose • mid cycle menstrual • heavy menstruation o bone pain • sternum, ribs, tibia o arthralgias • joint pain o weakness o pallor o delirium o DX o Blood and marrow biopsy o Chromosomal studies o Lumbar puncture if involves CNS o TX (medical emergency) o Combination chemo o Supportive care • IV fluids • TX anemia • Tx infection o Bone marrow transplant • After chemo o Prognosis o Untreated, uniformly fatal o Type, age and severity all affect outcome with tx o Overall 5 year survival for adults 44% o Long term disease free 30% |
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LYMPHOMA
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o Malignant neoplasm of lymphatic system
o Most commonly arise from lymph nodes o Nodes are filled with WBC o From more mature WBC in the LN than with leukemia o More solid form of tumor, forms a mass o Classified as: o Hodgkin’s disease and non hodgkins lymphoma o Non hodgkins lymphoma o B and T cell types o Many types |
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HODGKINS DISEASE
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(type of lymphoma)
o Incidence o Increases with age o Peaks at 20s and 60-70 o RF o Age o Male gender o Toxins (benzene, herbicides) o EBV o HIV immunodeficiency o Pathogen o Not completely understood o Probably monoclonal B-cells producing IL-13 • Signaling molecule = interleukin o Reed-sternberg cell • Tumor tissue cells form binucleated cells that look like it is dividing o CM o Lymphatic • Painless swelling of nodes • Contiguous spread o Starts in LN, will spread to other nodes in that region • Fatigue • Fever/night sweats • Pruitis - itchyness • Weight loss/anorexia • Edema (face, neck, arm, legs, etc) • Depending on area of LN tumor tissue • Anemia o Pulmonary • Cough, dyspenia, chest pain, cyanosis o Others • CNS (nerve root/spinal cord compression • Hepatic (jaundice, hepatosplenomegaly) • Renal (renal failure due to ureteral obstruction o DX o Node biopsy o Staging by CT (to determine stage of lymphocyte progression) o lymphangiograp |
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MULTIPLE MYELOMA
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o malignant neoplasm of plasma cells in bone marrow
o similar to leukemia o but you see plasma cells instead – abnormal secreting of Ig’s by B cells o later spread to spleen, liver, kidney o secrete immunoglobulin’s (Abs) o incurable |
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MYELOPROLIFERATIVE DISORDERS
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o neoplastic transformation of a hematopoietic stem cell or precursor cell
o types o polycythemia vera o myelofibrosis o essential thrombocytopenia o all can progress to AML o acute myelogenous lukemia |
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DISORDERS of HEMOSTASIS
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o hemostasis – normal clotting of the blood
o platelets contribute to the clotting o Thrombocytosis o Etiologies • Reactive, increased production or decreased destruction of platelets o CM • Increased viscosity • Thrombosis (fingers, toes, hepatic, mesenteric, pulmonary) o Thrombocytopenia • Inadequate production, increased destruction of splenic sequestration • Common in leukemia, cancers, and after chemo • Other causes • Splenomegaly • Bone marrow failure • Nutritional deficiencies • Prosthetic heart valves • Heparin therapy – a blood thinner that can cause thrombocytopenia • Auto-antibodies (idiopathic thrombocytopenic purpura) • NSAID’s • Permanently inhibits platelet cyclo-oxygenase o Decreases function of thromboxane A2 • Needed for platetlets to clot • Must be stopped before surgical procedures • Disseminated intravascular coagulation (DIC) • Overactivation of coagulation cascade o Diffuse coagulation in small vessels through out the |
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HEMOPHILIA
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o Sex linked recessive trait on X-chromosome
o More likely for male to get it than female o Rare for female to get it o Abnormality of plasma proteins important for coagulation cascade o types o Hemophilia A • Factor VIII abnormality • Most common o Hemophilia B • Factor Ix abnormality o Von willebrand disease o Loss of clotting factor called vWF which carries factor VII in blood and helps its action o Autosomal dominant • Heredity is a little different |
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SICKLE CELLS ANEMIA
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o Etiology/Risk
o Hereditary autosomal recessive hemolytic anemia • Not sex related • One copy they have sickle cell disease, not sickle cells anemia o Protection against malaria? • More common in Africa • Trait protects us somewhat against malaria • If they have this trait they get a much weaker form of malaria • Therefore more common in areas where malaria is more common o Crisis caused by stress of infection o hypoxia (physical exertion, high altitudes, etc) o Pregnancy o Trauma o Dehydration o Emotional disturbance o Extreme temperatures o Fatigue o Patho o Hemoglobin • Made up of four chains (2 alpha, 2 beta chains) • mutated in beta chain • when not bound to oxygen, change form and polymerize into rods o odd shaped RBC’s block blood vessels – chain reaction • get less blood flow, becomes hypoxic, more sickleling • sickleing happens when not Hg is not bound to Oxygen o Spleen, kidney, bone, marrow, eye, and head of femur are very susceptible o CM o |
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THALASSEMIA
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o group of diseases similar to sickle cell in that it hast to do with abnormal Hg chains
o inherited hemolytic anemia’s o primarily Mediterranean and southern Chinese o genetic alteration leads to insufficient numbers of hemoglobin chains o can be alpha or beta (most common) |