Hematopoietic Function

hematopoiesis

the process of forming blood

5L needed

plasma

liquid of dissolved protein

transport medium for proteins

maintains colloid osmotic pressure and electrolyte/fluid balance

leukocytes

white blood cells involved in the inflammatory response

erythrocytes

red blood cells carry oxygen and transport carbon dioxide out of tissues

contain HBG that bind to oxygen

hemoglobin

carries oxygen

hematocrit

how much blood volume consists of erythrocytes

thromboplastin

a substance released by damaged cells which signals HELP

create a sticky surface and stimulate coagulation

plasmin

dissolves clots once healing has occurred

thrombocytes

platelets

when does hemtopoiesis begin

during early embryonic development only to deliver oxygen to developing organs

where does hematopoiesis occur in adults

primarily in the bone marrow along with the spleen and liver

what does the lymph system do

produces lymphocytes

liver, spleen, lymph nodes, and thymus produce monocytes

what influences the rate of hematopoiesis

the body’s needs and demands to replace old blood cells

erythropoiesis

formation of RBCs in response to hypoxia or ischemia

what is used for erythropoiesis formation

precursor/stem cells, vitamin B12, folic acid, and iron (for heme)

hypoxia

oxygen is needed so the body will make erythrocytes to deliver more oxygen to organs

infection

inflammatory response activated

WBC are made to fight infection

homeostasis

stopping blood flow in case of injury or clotting disorders

3 steps to homeostasis

vasospasm/vasoconstriction - restricts blood flow to injury

formation of platelet plug - prevents blood from flowing out

coagulation/clotting (fibrin mesh) - liquid to mesh

coagulation cascade

a complex interaction involving 12+ clotting factors

initiated with 20s of injury, may take several minutes to complete

heparin

given to pt to prevent and thin clotting damage

thromboxanes

cause platelets to swell, grow filaments, and clump

VW Factor

secreted by vessels

sticky to promote coagulation & platelet aggregation

thymus

site of t cell maturation

bone marrow

site of hematopoiesis

spleen

filters the blood of damaged/aged RBC

leukocytes normal range

5,000 - 10,000 cells/mL of blood

leukocytosis

increased WBC levels

*active infection

leukocytopenia

decreased WBC

*immune deficiency

neutrophils

first leukocytes to arrive at an infection cite phagocytize microorganisms to prevent infection from spreading

*create pus

neutropenia

condition where the concentration of neutrophils reaches <1,500 cells/mL

causes of neutropenia

increased usage of neutrophils (active infection)

suppression, reduced production, or death of neutrophils

congenital conditions

neutropenia manifestations

infections & ulcerations

fever

infectious mononucleosis

Mono aka kissing disease

spread by oral transmission

most prevalent in adolescents & young adults

causes of mono

epstein-barr virus in herpes family

infects B cells by killing them or incorporating into its genome

mono manifestations

onset after 4-8 wk incubation

anorexia, malaise, and chills

can lead to leukocytosis,, fever, sore throat, lymphopathy

acute phase 2-3wks

make take 2-3 months to revover

lymphomas

cancers affecting the lymphatic system

hodginks lymphoma

less common = better prognosis

solid tumors containing reed-Sternberg cells often originating in lymph nodes and upper body

B cell only

hodgkins lymphoma treatment

most curable with chemo, radiation, surgery

hodgkins manifestations

painless enlarged node, night sweats, pruritis, splenomegaly

only a single group of lymph nodes

non-hodgkin lymphoma

the BAD one

more common 90% = poor prognosis

resembles hodgkins

NO reed sternberg cells

B or T cells

difference of non-hodgkins

metastasize in an unorganized manner

metastasis is often present at diagnosis

difficult to treat, poor prognosis

stage 1 lymphoma

found in lymph node group or only 1 part of a tissue or an organ

stage 2 lymphoma

cells are in at least 2 lymph groups on the same side of the diaphragm

OR are in one part of a tissue or organ on the lymph nodes near that organ, still on the same side of diaphragm

stage 3 lymphoma

cells are in the lymph nodes above and below the diaphragm

stage 4 lymphoma

cells are found in several parts of one or more organs and tissues and in distant lymph nodes

leukocytes normal count

4,000-11,000 cells/mL

leukemias

cancel of the leukocytes

2nd most common blood cancer

most common childhood cancer

leukemia pathology

they abnormally proliferate and crowd normal blood cells

risk facts of leukemia

mutagens

smoking

chemo

immunodeficiencies

men > women

white >

acute leukemia

less differentiated

good prognosis

chronic leukemia

more differentiated

okay prognosis

chronic leukemia

responds poorly to therapy

myeloid leukemia

improved prognosis by allogenic bone marrow transplant

manifestations of leukemias

leukopenia/anemia/thrombocytopenia

lymphadenpathy

joing swelling, bone pain, WL, anorexia

hepatomegaly, splenomegaly

CNS dysfunction

multiple myeloma

cancer of the plasma cells

3rd most common blood cancer in the US

non curable

excessive number of abnormal plasma cells in the bone marrow which cause Bence Jones protein excretion in uring

symptoms CRAB

hypercalcemia

renal dysfunction

anemia

bone pain

RBC normal cound

4.2-5.9 million cells/mcL

anemia

RBC disease

decreased number of RBC, reduction of HBG, or abnormal HBG

decreases oxygen-carrying capacity creating hypoxia

anemia manifestations

weakness, fatigue, pallor, syncope, dyspnea, tachycardia

iron-deficiency anemia

most widespread most commonly seen in women of childbearing age

iron manifestations

cyanotic sclera

brittle nails

decreased appetite

headache

irritability

stomatitis

pica

delayed healing

pernicious anemia

vitamin B12 deficiency usually caused by a lack of intrinsic factor

leads to decreased maturation, cell division, & protential neruologic complications

pernicious anemia manifestations

bleeding gums, diarrhea, impaired smell, loss of deep tendon reflexes, anorexia, personality or memory changes, positive Babinski’s sign, stomatitis, paresthesia, unsteady gait

pernicious anemia treatment

B12 injections, not PO bc body cant absorb

aplastic anemia

bone marrow fails to make enough RBC

potentially insidious, sudden, & severe onset

causes of aplastic anemia

idiopathic, autoimmune, medical, viral, or genetic

aplastic anemia manifestations

anemia, leukocytopenia, thrombocytopenia symptoms

hemolytic anemia

results from excessive RBC destruction (hemolysis)

causes of hemolytic anemia

idiopathic, autoimmune, genetic, infections, blood transfussion reactions, blood incompatibility

types of hemolytic anemia

sickle cell, thalassemia, erythroblastosis fetalis

sickle cell anemia

a codominant disorder

hemoglobin S causes RBC to carry less oxygen and clog vessels leading to hypoxia & tissue ischemia

heterozygous sickle cell

less than half of RBC are sickled

homozygous for sickle cell

almost all erythrocytes are sickled

manifestations of sickle cells

around 4months

Sickle cell crisis: painful episodes of ischemia & necrosis

sickle cell triggers

dehydrations, stress, high altitudes, fever, extreme temperatures

thalassemia

autosomal dominant inheritance

abnormal HBG due to lack of either alpha or beta globin (make up HBG)

most common in mediterranean/asian/indian/african

major issues with thalassemia

hypercoagulability

ineffective erythropoiesis

hemolysis

thalassemia manifestations

abortion, growth and developmental delays, fatigues, dyspnea, heart failure, hepatomegaly, splenomegaly, bone deformity, jaundice

polycythemia vera

abnormally high RBC and BV and viscocity leading to ischemia and necrosis

complications of polycythemia vera

thrombosis, hypertension, heart failure, hemorrhage, splenomegaly, hepatomegaly, acute myeloblastic leukemia

clinical manifestations of polycythemia vera

cyanotic/plethoric skin, hypertension, tachycardia, dyspnea, headaches, vision impairment

normal platelet count

150,000 - 350,000 cells/mL

thrombocytosis

increased platelet level

increases risk of thrombus formation

thrombocytopenia

decreased platelet levels

increased risk of bleeding & infection

hemophilia A

X-linked recessive bleeding disorder caused by deficiency or abnormality of clotting factor VIII

von willebrand disease

most common herditary bleeding disorder

decreased platelet adhession and aggregation

VWD manifestations

bleeding

indications of bleeding

most common in women due to menstruation and childbirth

disseminated intravascular coagulation (DIC)

life threatening complication that occurs from many conditions springing from and inappropriate immune response

DIC manifestations

tissue ischemia

abnormal and massive bleeding

complications of DIC

shock

multisystem organ failure

immune thrombocytopenic purpura (ITP)

hypocoagulation due to autoimmune destruction of platelets

causes of ITP

idiopathic, autoimmune disease, live vaccine immunization, immunodeficiency disorders, viral infections

manifestations of ITP

bleeding

indications of bleeding

treatment of ITP

glucocorticoid steroids, immunoglobulins, plasmapheresis, platelet pheresis

thrombotic thrombocytopenic purpura (TTP)

caused by a deficiency in the enzyme that cleaves VWF leading to hypercoagulation that depleted platelet levels

causes of TTO

idiopathic, hereditary, bone marrow transplant, cancer, medication, pregnancy, HIV

manifestations of TTP

purpura, consciousness changes, confusion, fatigue, fever, headache, tachycardia, pallor, dyspnea with exertion, speech changes, weakness, and jaundice