Hematological Problems

Name the 3 main studies of the hematological system.

• CBC

• clotting studies

• blood typing and Rh Factor

What does the CBC encompass?

• platelets

• RBCs

• WBCs

Role of RBCs?

transport O2 throughout the body to the organs

Normal total RBC count for females?

4.2 - 5.4 × 10¹²/L

Normal total RBC count for males?

4.7 - 6.2 × 10¹²/L

Name the 4 main categories of RBC tests.

• HGB

• HCT

• Total RBC

• RBC indices

Name the 5 sub-categories of RBC indices test.

• MCV

• MCH

• MCHC

• RBC morphology

• Reticulocyte count

What is increased RBCs called?

polycythemia

What is decreased RBCs called?

anemia

What does the hemoglobin test measure?

gas carrying capacity of RBC

What causes a decreased Hgb value?

• bleeding

• low RBC production: aplastic anemia

• RBC destruction: sickle cell anemia

• hemodilution

• dehydration

Normal Hgb range for females.

120 - 160 g/L

Normal Hgb range for males.

140 - 180 g/L

Critical value for Hgb?

<70 g/L

Symptoms of low Hgb?

tired, weak, lethargic, pale skin, general malaise

What does the Hct measure?

measures packed cell volume of RBCs expressed as a percentage of the total blood volume

Normal Hct range for females.

37 - 47%

Normal Hct range for males.

42 - 52%

What does the Mean Corpus Volume (MCV) measure?

size of the RBC

What does the Mean Corpuscular Hemoglobin (MCH) measure?

average weight of Hb/RBC

What does the Mean Corpuscular Hemoglobin Concentration (MCHC) measure?

concentration of hgb in RBC

What does the RBC Morphology measure?

examination of the size and shape of the RBC

What does the Reticulocyte count measure?

number of immature RBC released from the bone marrow into the blood

Name the 2 types of WBC tests.

• total count of WBC

• WBC Differential

What does the WBC Differential measure?

percentage of each type of leukocyte

What is leukocytosis?

increased WBC

What is leukocytosis caused by?

infection, leukemia, extreme stress

Leukocytosis is indicated when above _________.

10 × 10⁹ /L

What is leukopenia?

decreased WBC

What is leukopenia caused by?

autoimmune conditions, immunocompromising medications, sepsis, HIV/AIDS, cancer

Leukopenia is indicated when below _________.

4 × 10⁹ /L

Name the 5 different WBCs.

• Neutrophils

• Eosinophils

• Basophils

• Lymphocytes

• Monocytes

What role do neutrophils play?

combatting bacterial infections

What role do eosinophils play?

allergic response, asthma, parasitic infections

What role do basophils play?

inflammatory and allergy response

What role do lymphocytes play?

combatting viral infection

What role do monocytes play?

fighting infection

Normal range of neutrophils?

3 - 5.8 × 10⁹ /L

Normal range of eosinophils?

3 - 5.8 × 10⁹ /L

Normal range of basinophils?

0.01 - 0.05 × 10⁹ /L

Normal range of lymphocytes?

1.5 - 3 × 10⁹ /L

Normal range of monocytes?

0.3 - 0.5 × 10⁹ /L

What is neutropenia?

bone marrow does not produce enough neutrophils

How is neutropenia caused?

leukemia, bone marrow suppression; increased risk for sepsis-related death

Neutropenia is diagnosed when the count is lower than _________.

1 × 10⁹ /L

What is thrombocytopenia?

low platelet count; <150 × 10⁹ /L

What is thrombocytosis?

high platelet count; >400 × 10⁹ /L

What are the 2 main tests used to measure clotting factors?

• Prothrombin Time

• International Normalized Ratio

Normal PT range?

11 - 12.5 seconds

Normal INR range?

0.9-1.1

Name all 7 other diagnostic blood tests.

• Bilirubin

• Coombs test

• Erythropoietin

• Ferritin

• Folate

• Haptoglobin

• Iron

What is anemia?

• NOT a disease, but a manifestation of pathological process

• deficiency in…

  • the number of RBCs

  • quality/quantity of hgb

  • volume of RBC

What causes anemia?

• blood loss

• impaired production of RBCs

• destruction of RBCs

Diagnostic tests for anemia?

CBC, reticulocyte count, peripheral blood smear

Neurological symptoms of anemia?

• impaired thought process

• irritability

• depression

• headache

• vertigo

• lethargy

At what value does anemia become symptomatic?

Hgb <60 g/dL

Sensory symptoms of anemia?

• pruritus

• jaundice

• blurry vision

• retinal hemorrhage

• sensitivity to pain

• bone pain

GI symptoms of anemia?

• anorexia

• weight loss

Cardiovascular/Respiratory symptoms of anemia?

• tachycardia

• increased pulse pressure

• systolic murmur

• heart failure

• myocardial infarction

• palpations

• tachypnea

What can decreased erythrocyte production cause?

iron-deficiency anemia

Normal lifespan of an RBC?

120 days

What is iron-deficiency anemia caused by?

• GI surgery

• gastric bypass

• blood loss

• peptic ulcers

Iron is often inadequate for people who ________ or who become ________.

menstruate; pregnant

Symptoms of iron-deficiency anemia?

• often asymptomatic

• pallor

• glossitis

• chelitis

What is iron obtained from?

food or supplements

What are the treatment goals for iron-deficiency anemia?

treat the underlying cause

Where in the body is iron absorbed?

duodenum and proximal jejunum

Medications for iron-deficiency anemia?

oral iron + vitamin C

Why is oral iron taken with vitamin C?

to aid absorption

Potential side effects of oral iron?

• stains teeth

• constipation

How to avoid iron tooth staining?

use straw

Management of hemorrhage?

• replacing blood volume to prevent shock

• identify source of the bleed

• stop the bleed

• IV fluids

• blood transfusion

• supplemental iron

Causes of chronic blood loss?

• hemorrhoids

• menstruation

• postmenopausal blood loss

• ulcers

What does chronic blood loss lead to?

depleted iron stores => iron deficiency anemia

Management of chronic blood loss?

• stop bleed

• oral iron supplements

Name an example of anemia caused by increased erythrocyte destruction.

sickle cell disease

What is sickle cell disease?

group of inherited, autosomal recessive disorder with abnormal form of Hgb in RBCs

What is normal Hgb?

hemoglobin A

What is abnormal Hgb?

hemoglobin S

What does Hgb S cause?

Causes RBC to stiffen and elongate and take on a sickly cell shape

What are sickling episodes triggered by?

low oxygen in the blood => infection, high altitude, emotional/physical stress, surgery, blood loss

What do sickling episodes cause?

• severe pain

• vaso-occlusive crisis

• vasospasm + further restricting blood flow

• tissue ischemia, infarction, necrosis

• shock

Symptoms of sickle cell disease?

• mild-sever pain

• fever

• swelling

• tenderness

• tachypnea

• hypertension

• nausea/vomiting

Most affected areas in sickle cell disease?

back, chest, extremities, abdomen

Treatment for sickle cell disease?

• oxygen: hypoxia and sickling

• DVT prophylaxis: anticoagulants

• fluids/electrolytes: reduce blood viscosity and maintain kidney function

• pain management: NSAIDs, local nerve block, acupuncture, PCA

What 3 elements work together to maintain hemostasis?

• vascular endothelium

• platelets

• coagulation factors

Name the 3 main hemostatic disorders.

• thrombocytopenia

• hemophilia

• disseminated intravascular coagulation

It is considered thrombocytopenia once the platelet count is below __________.

150 × 10⁹ /L

At what platelet level do we become concerned about thrombocytopenia?

<50 × 10⁹ /L

Name 3 types of thrombocytopenia.

1. Immune Thrombocytopenia purpura

2. Thrombotic Thrombocytopenic purpura

3. Heparin induced Thrombocytopenia

Which thrombocytopenia is most common?

Immune Thrombocytopenia purpura

What is Immune Thrombocytopenia purpura?

autoimmune condition where the body produces antibodies against the platelets => abnormal destruction of platelets

What is Thrombotic Thrombocytopenic Purpura?

• agglutination of platelets which form microthrombi that can get stuck in the arterioles and capillaries

• uncommon and idiopathic

• results in blood clots throughout the body

What is Heparin Induced Thrombocytopenia?

• complication resulting from heparin

• 5-10 days after initiation

• can lead to venous and arterial thrombus

Clinical manifestations of thrombocytopenia?

• bleeding: mucosal or cutaneous

• petechiae

• hemorrhage

Diagnostic test for thrombocytopenia?

platelet test

When is a platelet transfusion given for thrombocytopenia?

when platelet count is < 10 × 10⁹ /L

Treatments for Immune Thrombocytopenic Purpura?

• steroids

• splenectomy

• IVIG

• WinRho

• TXA

• Platelet transfusion

Treatments for Thrombotic Thrombocytopenic Purpura?

• steroids

• immunosuppressants

• splenectomy

Treatments for Heparin-induced Thrombocytopenia?

• STOP heparin

• direct thrombin inhibitor: argatroban

• indirect thrombin inhibitor: fondaparinux

• plasmapheresis: plasma exchange

• warfarin