Cardiovascular and Hematologic system

When the blood is low in oxygen, the kidneys secrete \__________ which stimulate bone marrow to synthesize \_____________ to increase oxygen carriage in the blood

When the blood is low in oxygen, the kidneys secrete ERYTHROPOIETIN which stimulates bone marrow to synthesize ERYTHROCYTES to increase oxygen carriage in the blood

The spleen removes bad/old RBC after its \_________ day lifespan and then the \_______ gets recycled

The spleen removes bad/old RBC after its 120 day lifespan and then the IRON gets recycled

What are signs and symptoms of hematologic disorders?

-Edema
-Lymphedema
-Infarction
-Thrombus
-Embolus
-Splenomegaly
-Bleeding and bruising
-Hypotension and shock

ELITES Be Hematologic

What is excess interstitial fluid in tissue or body cavity?

Edema

What in infarction?

Local region of necrosis (tissue death) by decreased arterial perfusion

What is the difference between thrombus and embolus?

Thrombus is solid and stays in place, embolus moved within blood and can be solid, liq, or gas

-Thrombus: solid mass of clotted blood with intact vessels that slows blood flow
-Embolus: solid, liquid, or gas that moves within blood vessel and lodges at a distal site

What is chronic swelling of an area from accumulation of interstitial fluid?

Lymphedema

Give characteristics of healthy lymph nodes

Rubbery feel unattached to surrounding tissue and small

What is splenomegaly?

Enlargement of spleen

What is shock?

-When the circulatory system can't maintain adequate pressure to perfuse organs
-Hypoperfusion with hemodynamic abnormalities

What are common clinical signs of shock?

-Tachycardia
-Tachypnea
-Cool extremities
-Decreased pulses and urine output
-Altered mental state

What vitals may indicate hypovolemia?

Systolic drop \>10-20 mmHg with increase in HR 15-20bpm/min

We know that blood composition changes little with age, but what about hematopoietic (blood-forming) tissue?

The amount of hematopoietic tissue in marrow spaces declines progressively with age

Anemia is categorized as what lab values for males and females?

-Hgb

What are the pathophysiologic classifications of anemias?

1. Blood loss
2. Peripheral erythrocyte destruction
3. Decreased erythrocyte production

How is anemia classified?

-Cell morphology
-Size and Hb content of RBCs

What are general signs and symptoms common to all anemias?

-Excessive fatigue
-Weakness
-Dyspnea on exertion (DEO)
-Exercise intolerance
-Tachycardia, palpations, chest pain
-Dizziness, feeling faint

What are signs of nutritional anemia?

-Glossitis (swelling of tongue)
-Cheilitis (lip inflammation)
-Koilonychia (spooning fingernails)
-Pica (craving non-nutritional things)

What causes iron deficiency anemia?

-Shortage of iron (Fe) which causes bone marrow to not be able to make Hb

What is pernicious anemia?

-Aka macrolytic anemia
-Lack of intrinsic factor so body can't absorb vitamin B12 causing insufficient RBC creation
-Chronic H. pylori infection can cause this too

What is aplastic anemia?

Rare life-threatening anemia due to bone marrow disorder where body cant make enough RBCs

What can cause anemia of inflammation?

-Bone marrow disease like leukemia or myelofibrosis
-Cancer
-HIV/AIDS
-Kidney disease
-Crohn disease
-Hemolytic anemias

What is hemolytic anemia?

-RBC are destroyed faster than bone marrow can replace them
-inherited or developed later in life

What is a type of hemolytic anemia that is inherited and sometimes serious?

Sickle cell anemia

What causes sickle cell anemia?

Defective Hgb that is crescent shaped and die prematurely which causes a chronic shortage of RBCs

Ultimately leads to decreased oxygenation and vaso-occlusion due to shape

What is sickle cell crisis?

Actue episode when body experiences low oxygen (ex. exercise, going to higher elevations)

What are the three main groups of leukocytes?

-Granulocytes (contain proteins)
-Monocytes (largest circulating blood cells- immature til becoming macrophages)
-Lymphocytes (B&T cells)

In leukocytes
-cytosis means \_____ count
-Penia means \______ count

-Cytosis means high count
-Penia means low count

What is the clinical manifestation of leukocytosis\>

-Fever
-Headache
-SOB
-Symptoms of: infection, inflammation, tissue trauma

What can cause leukopenia?

Decrease in WBC from...
-HIV or other infection
-ETOH and nutritional deficiencies
-Infectious diseases
-Overwhelming infections
-Meds
-Bone marrow disorders

What is the clinical manifestation of leukopenia?

Asymptomatic or signs of....
-infection
-mucous membrane ulcers
-painful and frequent urination
-persistent infections

What is a condition associated with a reduction in circulating neutrophils?

Neutropenia

Aside from reduction of neutrophils what can cause neutropenia?

-Carcinoma
-Congenital causes

When does lymphocytosis occur?

-Acute viral infections (esp EBV)
-can be acquired or congenital

What is leukemia?

Malignant neoplasms of blood forming cells that replace normal bone marrow with malignant clone of lymphocytic or myelogenous cells

What does each suffix or prefix mean in terms of the location of leukemia?

lympho-
myelo-
-blastic
-cytic

Lympho- lymph
Myelo- bone marrow cells
-blastic ig immature functionless cells
-cytic mature smaller cells

What is acute leukemia?

Too many immature stem cells (blasts) with more rapid onset of symptoms

What are signs and symptoms of acute leukemia?

-abnormal bleeding
-easy bruising
-hematuria (blood urine)
-epistaxis (bloody nose)
-rectal bleeding
-Infections in blood and bone marrow cells

What are signs and symptoms of chronic leukemia?

-fatigue
-dyspenia
-weight loss
-decrease appetite
-fever/sweats
-left abdominal pain (spleen)
-occult bleeding and bruising (less common that acute)

What type of leukemia develops in partially mature cells and goes unnoticed for years with a poorer prognosis

Chronic leukemia

What is the main difference between hodgkins and non-hodgkin lymphoma?

-Type of lymphocyte infected
-Hodgkin has enlarged lymph nodes in upper body areas, neck, chest, underarm, groin
-Non-hodgkins has englarged lymph nodes anywhere in body

What is multiple myeloma?

-Plasma cell neoplasms
-lytic bone lesions initially in vertebrae, ribs, skll, pelvis, femur

What are symptoms of multiple myeloma?

-bone pain
-recurrent bacterial infections
-spontaneous fx
-anemia
-increase urination
-loss of appetite
-vomiting
-carpal tunnel syndrome

What are pt implications for multiple myeloma?

-Fatigue
-Muscle wasting
-Pain
-Watch for hypercalcemia and spinal cord compression/instability Or wbing precautions

What gene mutation causes polycythemia vera?

-Polycythemia vera
-JAK2 gene mutation

What are the two types of myeloproliterative neoplasms we need to know?

-Polycythemia vera (uncontrolled RBC production)
-Essential thrombocythemia (increase platelet count w/o secondary cause)

What is the clinical manifestation of myeloproliferative disorders- polythemia vera?

-Insidious onset
-Malaise
-Fatigure
-headache
-GI disturbances
-HTN
-gout
-pruitis esp after warm bath
-stroke or thrombosis

How is myeloprliferative neoplasms- polythemia vera detected?

Hgb lab values (Hgb \>16.5 men, \>16 women)

How is myeloproliferative neoplasms- polythemia vera treated?

Repeated phlebotomy, low dose ASA or other meds

What is Budd- chiari syndrome?

-hepaic veins are blocked by a clot causing abdominal pain, ascites, excess bruising, bloody noses

-can be caused by myeloproliferative neoplasm so need to watch for this

What is the clinical manifestation of myeloproliferative neoplasms- essential thrombocythemia?

-increase platelet ocunt
- 50% have splemomegaly
-distal ischemia from bleeding/thrombis
-visual disturbances
-headache, erythromelalgia
-livedo reticularis (pic)

What is hemostasis?

When bleeding stops after blood vessel injury

What is primary and secondary hemostasis?

-Primary: formation of platelet plug at site of vascular injury
-Secondary: triggered when vascular damage exposes tissue factor

What is von willebrand disease (VWD)?

-Common inherited bleeding disorder, 1% pop
-Missing, low or malfunctioning clotting portein VWF and factor 8 so can't make platelet plug

What is the clinical manisfestation of Von willebrand disease?

-excessive bleeding with minor trauma
-epistaxis
-easily bruising
-heavy menstruation

What is hemophilia?

-Relatively rare, inherited x linked autosomal recessive trait bleeding disorder

What are the two types of hemophilia?

-A: Lack of clotting factor VIII (more common)
-B: deficiency of factor IX

What is the clinical manifestation of hemophilia?

-Joint and deep muscle bleeding
-Excessive/delayed bleeding after surgery/trauma
-hematoma
-bruising
-hemarthrosis
-muscle hemorrhages

What is thrombocytopenia?

-Decrease in platelet blood count below 15,000/mL of blood from:
-Inadequate platelet production from the bone marrow, increase platelet destruction outside bone marrow or splenic sequestration

What is the main symptom of thrombocytopenia?

Mucosal bleeding

A single dose of asprin can suppress normal platelet aggregation for \______ hours or longer

48

What is disseminated intravascular coagulation (DIC) aka consumption coagulopathy?

Uncontrolled activation of both coagulation and fibrinolysis causing clotting and hemorrhage simultaneously

Acute vs chronic disseminated intravascular coagulation?

-acute:uncompensated and life threatening
-chronic: compensated and subclinical

What are some etiologic factors associated with disseminated intravascular coagulation?

-sepsis
-ob/gyn complications
-cancer
-massive trauma
-ABO incompatible blood transfusion

What are clinical manifestations of disseminated intravascular coagulation?

-Clotting and bleeding
-dyspnea
-severe pain in back, muscles, chest

What are the two types of hypercoagulation clotting disorders?

-thrombocytosis
-disseminated intravascular coagulation

What is the difference between functional PVD and organic PVD?

-Functional: doesn't involve defects in blood vessel structure
-Organic: involved structural blood vessel changes

What is an example of a vasomotor peripheral vascular disease?

Raynauds disease

What is an example of a venous peripheral vascular disease?

Chronic venous insufficiency

What causes raynauds phenomenon disease?

Vasospasm in arterioles of hands and feet thought to be form exaggerated SNS response leading to vasoconstriction

Someone with raynauds has low levels of \_____ and high levels of \______

-Low NO
-High endothelin

What is hardening and narrowing of arteries?

Arteriosclerosis

What is atherosclerosis?

Plaque build up on arterial wall

What is an aneurysm?

Dilation of vessel wall to \>50% diameter more than normal because of weakened arterial or venous wall

What is the type of aneurysm that is a separation of blood vessel layers so blood flow gets between?

Dissection aneurysm

What is the symptom onset for an aortic dissection?

-usually sudden hearing of ripping or tearing sound
-palor
-tachycardia

What are signs of aortic dissection?

-Bounding pulse
-wide oulse pressure
-diastolic murmur
-signs of heart failure

Cardiac tamponade can occur with aortic dissenction what is this?

Blood pools in pericardium causing extra pressure so the heart can't pump well

What is the most common type of arterial aneurysm?

Abdominal aortic aneurysms

What condition should make you avoid abd maneuvers with pts?

-Aortic aneurysm

What are some risk factors for an aortic aneyrysm?

-advancing age \>50yrs
-family hx
-male

What are risk factors for a rupture of an aortic aneurysm?

\-Artherosclerosis -smoking -HTN

If a cerebral aneurysm ruptures what would it cause?

Subarachnoid hemorrhage

What are treatments for an aortic aneurysm?

-Antihypertensive treatment/BP reg
-smoking cessation
-surveillance
-surgical/endovascular intervention

What is an arteriovenous malformation (AVM)?

Loss of normal capillary network between higher pressure arterial to venous

What are the most common sites for an arteriovenous malformation (AVM)?

-Brain
-GI
-skin

Ho would paitents with an arteriovenous malformation (AVM) present?

-hemorrhage
-aneurysm
-cerebral ischemia
-seizures
-migrane type HA
-Neuro deficits

What is peripheral arterial disease and where is the most common site?

-arteriosclerosis and artherosclerosis outside coronary arteries
-most common at femoral artery above knee

What is the primary sign of peripheral arterial disease?

-intermittent claudication (but only 10% ppl get this)- pain with exertion relieved by rest

What are traditional risk factors for peripheral arterial disease?

-advanced age
-smoking (increases risk 4x)
-diabetes
-hyperlipidemia
-hypertension

What are some non-traditional risk factors for peripheral arterial disease?

-chronic renal disease
-genetics
-hypercoaguable states
-abnormal waist to hip ratio
-sedentary lifestyle

What is the single most important modifiable risk factor for peripehral artery disease?

Smoking (there is a dose response relationship between pack/day per year history and PAD risk)

How do you assess for peripheral artery disease?

-sings of arteriosclerosis/artherosclerosis (htn, hyperlipidemia, diabetes, CAD, MI)
-assessment of symptoms with exercise
-examine for diminished or absent pulses

What is the ankle-brachial index (ABI)?

-Compared upper and lower extremity BP in patients who you suspect might have peripheral arterial disease
-Normal is 1 or slightly greater
-less than 1 indicated PAD

What are symptoms of lower extremity PAD?

-claudication: dull cramping of LE when walking, climbing stairs or exercising thats relieved by rest (most common manifestation)
-fatigue in legs which may require pt to stop and rest while walking
-slow or antalgic gait

What is a differential diagnosis to intermittent claudication caused by lumbar canal stenosis?

pseudoclaudication

Pseudoclaudication causes leg pain with walking or prolonged standing and has relief of symptoms when sitting for at least \________

20 min

What is rest pain?

-Cramping pain triggered without activity that is constant and may be worse at night
-pain relieved with dangling leg over EOB

Very serious refer to vascular surgeon

What are the 6 P'sfor PAD?

-Pulselessness
-Pain
-Pallor
-Poikilothermy (cold)
-paresthesia (represents severe and potentially irreversible ischemia)
-Paralysis (represents severe and potentially irreversible ischemia)

What are skin signs of PAD?

-muscle wasting
-thin, atrophic skin
-hair loss
-poor toenail growth
-hypertrophic nails
-gangrene

these are independent predictors of cardiovascular complications and death