Pathology - Hematologic System

What percent of a blood sample should be red blood cells?

45% erythrocytes

1% buffy coat

55% plasma

What causes the erythrocytes to be 45-55% instead of the expected?

decreased anemia and increased polycythemia

What is it called when the red blood cell count or the concentration of hemoglobin within red blood cells is lower than normal?

Anemia

What is it called when there is too many red blood cells in the blood?

Polycythemia

What plugs holes and has no nucleus?

Platelet cells

What are the 3 functions of the hematologic system?

- metabolism

- acid-base balance

- defence

What is the normal white blood cell distribution? %

neutrophils - 40-60%

lymphocytes - 20-40%

monocytes - 2-8%

eosinophils - 1-4%

basophils - 0.5-1%

What does a CBC test tell you?

How many blood cells are in the blood

What is defined as an increase in white blood cells?

Leukocytosis

What are 3 big causes of leukocytosis?

infection, trauma, inflammation (inflammation causes inflammation)

What condition usually cause elevations in basophilia?

alergic conditions

What condition usually cause elevations in eosinophilia?

parasitic infections

What condition usually cause elevations in lymphocytosis?

leukemia and hypersensitivity reactions

What condition usually cause elevations in monocytosis?

autoimmune diseases and infections

What condition usually cause elevations in neutrophilia?

chronic inflammation

What is the most common type of leukemia?

Acute Myelogenous Leukemia (AML)

80% cases in adults - stem cells do not mature

(acute lymphocytic leukemia (ALL) is the most common in children)

What are the symptoms of AML? and what labs are done?

weakness, fever, headache/dizziness, nose bleed, pale skin, easy bruising

complete blood count, bone marrow biopsies, imaging CT

How do we treat AML?

chemotherapy, radiation - hallmark

other options - stem cell transplant, biologics

PT - muscle mass and function, joint pain

What is a reduction in WBC called?

Leukopenia

What is a reduction in neutrophils called?

Neutropenia

What are the 5 causes of leukopenia and give 1 example for each?

infections - HIV

medications - Antibiotics

immune mediated - Rheumatoid arthritis or systemic lupus

bone marrow disorder - leukemia

idiopathic - unknown

Describe normal erythropoiesis?

process of RBC formation

- low RBC sensed by kidney causes release of (EPO) erythropoietin to go to the bone marrow and spleen. This causes more RBC to form

What are the 5 stimuli that can cause the process of erythropoiesis?

O2, Iron, B12, Folate (B9), T3/T4

Describe how B12 and Folate (B9) plays a role in erythropoiesis?

It is needed to form a mature RBC, it acts between phase 1 and phase 2 just after the early erythroblast step. Without it the RBC cannot get past this point

What is it called when the body created too many RBC and the blood becomes thick?

Polycythemia

What all can cause a decrease in O2 which can cause erythropoiesis (increase in EPO)?

High altitude, Obstructive sleep apnea, COPD, Heart disease

What all can cause an increase in EPO without O2?

Renal artery stenosis, CO poisoning, tumors

What is 1 other common cause of elevated EPO that is exogenous?

Testosterone therapy

What is an ancient practice that is still used today for erythroiesis?

phlebotomy (blood letting)

What is the threshold for anemia? include critical threshold?

women - 13

men - 15

without symptoms - <7-8 g/dL

critical threshold - <6.5 g/dL

What are some causes of low hemoglobin?

blood loss, destruction of RBC, decreased production of RBC

Describe the terms for classification of anemia?

Normocytic - normal size

Macrocytic - abnormally large

Microcytic - abnormally small

Normochromic - normal amountss

Hyperchromic - high concentration

Hypochromic - low concentration

Anisocytosis - various types

Poikilocytosis - various shapes

Describe how sickle cell anemia relates to anemia disorders?

cell shape is crescent moon like

decreases O2 carrying, RBC lifespan, increases pain from hypoxia and lack of blood flow

What is Mean corpuscular volume (MCV)?

(Hct x 10) / (RBC count) = MCV (aka mean cell volume)

microcytic = <80 fL

normocytic = 80-100 fL

macrocytic = >100 fL

What is described as the reduction in teh carrying capacity of O2?

Anemia

Describe the common causes for normocytic anemias?

blood loss (menstrual cycle), early iron deficiency, renal disease

What are the symptoms of normocytic anemia?

exactly what you would think for low blood,

malaise, muscle cramping, tachypnea, angina, hypotension

How do diagnose normocytic anemia?

symptom related, if chronic more can be done

ID underlying cause, alter physical activity (the more active they are the more RBC get destroyed and there RBC are already low!)

endoscopy - scope through mouth

colonoscopy - scope through butt

Pharm of course - EPO, vitamin C and iron absorption

What happens in Macrocytic anemias? and what are some common causes?

total RBC count good but there too big!

megaloblastic - folate deficiency, decreased B12,

nonmegaloblastic - liver disease, alcoholism, drugs

Describe what a deficiency in B12 is called?

Pernicious Anemia

Genetic cause (but literally everything is so duh)

low intrinsic factor so unable to absorb B12

B12 injections should do the trick

What are microcytic anemias? and common causes?

Too few RBCs

Iron deficiency is about all we talked about

Describe the process of iron absorption and how it causes microcytic anemia? super simple more later

normal to lose 1-2mg/day from GI shedding, however we then need to take in an equal amount through our diet

Where is the majority of our Iron stored and in what form?

Liver as ferroportin

What the heck does the spleen do in this process?

recycles iron from old RBCs to balance amount gains and lost!

What is an iron overload called?

hemochromatosis - can lead to accumulation/damage in multi-organ

How much iron is in the liver, plasma and bone marrow?

plasma - 2/3 mg

bone marrow - 20-25 mg/d

liver - 1000 mg

In what form in iron transfered?

transferrin - ferroportin is the transporter

What are some symptoms of iron deficiency?

Pica - craving/chewing without nutrient value

List come chronic complications for iron deficiency?

decrease T3/T4, fat accumulation, renal damage, decrease immune, heart failure

What is the primary coagulation disorder?

hemophilia - disruption of tissue causing decreased coagulation