Exam 3 patho - Hematology

What is the hematologic system responsible for?

producing, circulating, and maintaining blood, which transports oxygen, nutrients, hormones, and immune cells throughout the body

encompasses blood components vital for homeostasis and systemic functionality

Red blood cells (RBCs)

carry oxygen via hemoglobin

White blood cells (WBCs)

fight infection and support immunity.

Platelets (thrombocytes)

help with clotting

Plasma

the liquid portion that carries cells, nutrients, and waste

What happens when any component is deficient or malfunctioning

systemic complications like hypoxia, bleeding, or infection can occur

Anemia

Low RBC count or hemoglobin → decreased oxygen delivery

Polycythemia

Increased RBC count and hemoglobin → higher blood viscosity, sluggish flow, and risk of thrombosis

Leukopenia

Low WBC count → increased infection risk.

Leukocytosis

Elevated WBC count → infection, inflammation, or leukemia

Thrombocytopenia

Low platelet count → bleeding risk

Thrombocytosis

High platelet count → clotting risk.

Hematocrit (Hct)

% of blood composed of RBCs.

Hemoglobin

Oxygen-carrying protein in RBCs.

Pancytopenia

Decrease in all blood cell types (RBCs, WBCs, platelets).

Iron Deficiency Anemia

“Low Iron, Low Oxygen”

“Iron makes it bright — without it, cells stay light.”

Iron deficiency anemia cause

Blood loss, poor dietary intake, pregnancy, chronic bleeding

Iron deficiency anemia pathophysiology

Low iron → less hemoglobin production → impaired oxygen transport.

Iron deficiency anemia S/S

Fatigue, pallor, dyspnea, tachycardia, brittle nails, pica, SOB, palpitations, dizziness, angular cheilitis, glossitis, VS changes

Iron deficiency anemia diagnosis

↓ Hgb, ↓ Hct, ↓ serum ferritin, low microcytic hypochromic RBCs

Iron deficiency anemia treatment

Iron supplements, treat underlying cause, dietary changes

Iron deficiency anemia pediatric note

Common in infants with cow’s milk overuse

Iron deficiency anemia geriatric note

Often due to GI bleeding or poor nutrition

Pernicious anemia (B12 deficiency) 

“No B12, No Mature RBCs”

“B12 builds big blood cells.”

Pernicious anemia cause

Autoimmune destruction of gastric parietal cells → loss of intrinsic factor → impaired vitamin B12 absorption and neurologic symptoms from demyelination also caused by nutritional deficiency, deals with GI 

Pernicious anemia pathophysiology

B12 required for DNA synthesis → without it, RBCs enlarge but don’t divide.

Pernicious anemia S/S

Glossitis, fatigue, numbness/tingling, ataxia, cognitive changes. Neurologic symptoms due to demyelination: neuropathy, memory problems, impaired coordination and balance

Pernicious anemia diagnosis

↑ MCV (macrocytic anemia), ↓ B12 levels, Schilling test.

Pernicious anemia treatment

Lifelong B12 injections

Pernicious anemia geriatric note

Often due to decreased gastric acid production.

anemia

means that a person has fewer red blood cells or less hemoglobin than normal.

Sickle cell disease

“Sickled Cells Stick”

“Sickled cells can’t slip—they stick and block.”

Sickle cell disease cause

Genetic mutation → abnormal hemoglobin S. - autosomal recessive

Sickle cell disease pathophysiology

Deoxygenation → RBCs sickle → block vessels → ischemia.

Sickle cell disease S/S

Pain crises, anemia, splenomegaly, delayed growth, infections, fatigue, pallor, jaundice, chronic pain, increased risk of infection, organ damage

Sickle cell disease triggers

Hypoxia, dehydration, cold, stress, infection

Sickle cell disease complications 

Stroke, organ damage, acute chest syndrome

Sickle cell disease treatment 

Hydration, oxygen, pain control, hydroxyurea, blood transfusions, supportive care

Think: hydrate, oxygen, pain control first

Sickle cell disease pediatric note

Symptoms appear ~6 months after birth

Polycythemia Vera

“Too Many Cells, Too Thick Blood”

“Too many cells make blood move slow.”

Polycythemia Vera cause

Bone marrow overproduction of RBCs (primary) or chronic hypoxia (secondary)

Polycythemia Vera pathophysiology

Increased RBC mass → thick blood → clot risk. Despite high RBC count, oxygen delivery is impaired due to sluggish flow

Polycythemia Vera S/S

Headache, dizziness, ruddy skin, pruritus, splenomegaly, hypertension.

Polycythemia Vera complications

Thrombosis, stroke, MI

Polycythemia Vera treatment

Phlebotomy, hydration, myelosuppressive therapy.

What are the common hematologic disorders

• iron deficiency anemia 

• pernicious anemia 

• aplastic anemia

• sickle cell disease

• polycythemia vera 

what are the coagulation disorders

• hemophilia 

• disseminated intravascular coagulation (DIC)

Iron deficiency

→ most common anemia globally — assess for GI bleeding in older adults.

Why is maintaining healthy blood crucial

for preventing disorders linked to oxygen deficiencies & immune dysfunctions.

Red blood cell disorders 

◦ Nutritional deficiency anemias
◦ Hemolytic anemias
◦ Polycythemia

Platelet disorders

◦ Thrombocytopenia
◦ Thrombocytosis

White blood cell disorders

◦ Acute or chronic
◦ Lymphocytic or myelogenous

CBC measures

◦ RBC
◦ Hgb & HCT
◦ WBC
◦ Differential (% types of WBCs)
◦ Platelets

Overview of anemias

Basic problem: hemoglobin deficit
Causes decreased oxygen-carrying capability
◦ Less energy production
◦ Compensatory mechanism
◦ Tachycardia and peripheral vasoconstriction

Iron deficiency complications

Any complications associated with chronic hypoxia, including
Ischemia, Infarction, Death

B12 deficiency - complications

Elevated homocysteine
Permanent neuropathy
Ataxia
Dementia
Depression
CV disease
Infertility and pregnancy complications
Folate deficiency anemia

Overview of hemolytic anemias 

Premature destruction of RBCs
Causes
◦ Intrinsic - defects within RBCs
◦ Extrinsic – external factors that damage RBCs
Location
◦ Intravascular hemolysis
◦ Extravascular hemolysis
Breakdown of RBCs
◦ Increased bilirubin
◦ Increased erythropoiesis

Sickle cell crisis

is a painful episode that happens in people with sickle cell disease

Manifestations - sickle cell crisis

Sudden, severe pain in various locations
Shortness of breath or chest pain
Fever or signs of infection
Severe fatigue or weakness
Enlarged spleen
Jaundice

Complications - sickle cell disease/ crisis

Severe anemiax
Stroke
MI
Acute chest syndrome & respiratory failure
Functional asplenia & infections
Pulmonary hypertension
Organ damage
Ulcers
Avascular necrosis

Polycythemia increased blood viscosity means

◦ Increases risk of clots
◦ Decreases blood flow

Primary polycythemia - Myeloproliferative disease

◦ Usually associated with a genetic mutation
◦ A type of “blood cancer”
◦ Bone marrow is too active

Secondary polycythemia - related to low oxygen levels

◦ Chronic lung disease
◦ Low oxygen stimulates kidneys to produce erythropoietin
◦ Erythropoietin stimulates RBC production

Problem with polycythemia

Increased blood viscosity
Reduced oxygen delivery
Increased workload of the heart
Sluggish blood flow

Complications with polycythemia 

Thrombosis
Hemorrhage
Gout
Myelofibrosis
Leukemia

What are leukemias ?

A group of neoplastic (cancerous) disorders involving white blood cells.

What happens to white blood cell production in leukemia?

There is uncontrollable production of abnormal white blood cells in the bone marrow or lymph nodes

How does leukemia affect other blood cell types?

The production of other hemopoietic (blood-forming) tissues is reduced, leading to anemia, thrombocytopenia, and risk of infection

What is the state of leukocytes in leukemia?

One or more types of leukocytes are undifferentiated, immature, and nonfunctional.

What happens to these abnormal white blood cells?

Large numbers are released into the general circulation, where they crowd out normal cells

Where can leukemic cells spread or infiltrate?

They can infiltrate lymph nodes, spleen, liver, brain, and other organs.

Acute leukemias - lymphocytic and myelogenous

Immature WBCs proliferate uncontrollably, crowding bone marrow and reducing normal blood cell production

High proportion immature, nonfunctional WBCs
◦ Abrupt onset
◦ Usually occurs in children or young adults
◦ Many complications

Chronic leukemias

Abnormal mature WBCs accumulate gradually, replacing normal cells over time

• Higher proportion of mature, functional dcells
  ◦ Insidious onset
  ◦ Mild signs & better prognosis
  ◦ Usually occurs in older adults

Acute leukemia pathophysiology

Immature WBCs proliferate uncontrollably, crowding bone marrow and reducing normal blood cell production

Chronic leukemia pathophysiology 

Abnormal mature WBCs accumulate gradually, replacing normal cells over time

Risk factors acute leukemia 

Genetic disorders (e.g., Down syndrome), radiation exposure, previous chemotherapy, family history, certain chemicals (e.g., benzene)

Risks factors chronic leukemia

Older age, exposure to radiation or chemicals, family history, certain genetic mutations (e.g., BCR-ABL in CML)

Acute leukemia manifestations

Fatigue, fever, bruising, infections, rapid weight loss, bleeding, bone pain. Symptoms develop quickly

Chronic leukemia manifestations

Often asymptomatic initially; later, fatigue, weight loss, swollen lymph nodes, night
sweats. Symptoms develop slowly over time

Acute leukemia complications 

Life-threatening if untreated, severe anemia, infections, bleeding, organ damage, rapid death without treatment.

Chronic leukemia complications

Increased risk of infections, anemia, excessive bleeding, or blood clot formation. Some forms may transform into acute leukemia (blast crisis)

Hodgkin lymphoma

A malignant disorder of lymph nodes marked by the presence of Reed–Sternberg cells

Painless, firm lymph node enlargement (usually in the neck), night sweats, fever,
weight loss, fatigue, anemia

Non-Hodgkin lymphoma

A diverse group of lymphoid cancers without Reed– Sternberg cells

more likely to involve multiple peripheral nodes, extranodal sites (GI tract, skin),
and hepatosplenomegaly

What is folate deficiency?

A lack of folate (vitamin B9) that causes problems making healthy red blood cells

What type of anemia does folate deficiency cause?

Megaloblastic (macrocytic) anemia — large, immature red blood cells

Main causes of folate deficiency

Poor diet, alcohol use, malabsorption, pregnancy, and some medications

Common symptoms of folate deficiency?

Fatigue, weakness, pale skin, sore tongue, and shortness of breath