Week 6: Chapters 23 and 26 - Hematologic Function, and Cardiovascular Function - NRSE 2112 Hopgood/Harper

What are arteries?

Blood vessels that carry blood away from the heart

What are veins?

Blood vessels that carry blood back to the heart

What is the structural comparison of arteries to veins?

Arteries have thick, muscular, and elastic walls to withstand high blood pressure, while veins have thinner, less elastic walls and larger lumens to accommodate lower-pressure blood and hold larger volumes. Both vessels are composed of three layers—tunica intima, tunica media, and tunica adventitia—but arteries have a proportionally thicker tunica media, whereas veins often have valves to prevent backflow, which arteries lack.

What are the components of blood?

plasma, red blood cells, white blood cells, platelets

What is hematopoiesis?

blood cell formation

What does the suffix "-cythemia" mean?

Over-proliferation of cells in the blood, typically RBCs

What does the suffix "-cytosis" mean?

High number of blood components- Leukocytosis, thrombocytosis, erythrocytosis

What does the suffix "-cytopenia" mean?

Deficiency of a cell in the blood- Erythropenia, leukopenia, thrombocytopenia

What is blood typing?

Determining what blood type you are based on the proteins located on your red blood cells.

What does a CBC test for?

1. Red Blood Cells (RBCs)

2. White Blood Cells (WBCs)

3. Platelets

What does a CMP test for?

It is a comprehensive metabolic panel, 14 blood tests to check the function of the kidney, liver, diabetes, parathyroid status, and electrolytes.

What is the H&H test?

Hemoglobin and Hematocrit

What is iron deficiency anemia?

Not enough iron means poor HEME of the hemoglobin molecule -> not enough O2 binding capacity.

How does iron-deficiency anemia clinically manifest?

- Pallor of the skin and mucous membranes related to cutaneous vasoconstriction

- Fatigue, lethargy, and cold intolerance as cell metabolism decreases

- Irritability, a central nervous system response to hypoxia

- Degenerative changes, such as brittle hair and spoon-shaped (concave) and ridged nails

- Stomatitis and glossitis, inflammation in the oral mucosa and tongue, respectively

- Menstrual irregularities

- Delayed healing

- Tachycardia, heart palpitations, dyspnea, and perhaps syncope (fainting) as the anemia becomes more severe

What is the basic problem in Vitamin B₁₂ deficiency?

Lack of absorption of Vitamin B₁₂ due to lack of intrinsic factor.

How are red blood cells characterized in Vitamin B₁₂ deficiency?

They are very large, immature, and nucleated.

What are some etiologies of Vitamin B₁₂ deficiency?

Malabsorption (no intrinsic factor production)

Chronic gastritis secondary to alcoholism (ETOHism)

Rarely dietary insufficiency

Genetic factors

Often accompanies chronic gastritis

May occur after gastric surgery

Why does malabsorption of Vitamin B₁₂ occur?

Because of no production of intrinsic factor.

What happens when intrinsic factor is missing?

Inadequate uptake of Vitamin B₁₂ in the ileum.

What can cause lack of intrinsic factor?

Atrophy or absence of gastric glands.

What results from atrophy of parietal cells?

Less HCl → reduced protein digestion → worsened iron deficiency.

What happens when DNA synthesis is poor due to Vitamin B₁₂ deficiency?

Poor erythrocyte formation → destruction of erythrocytes.

How does Vitamin B₁₂ deficiency affect hemoglobin levels and RBC count?

No issue with hemoglobin, but RBC number decreases.

Which white blood cells become hypersegmented in Vitamin B₁₂ deficiency?

Neutrophils and other granulocytes.

How does Vitamin B₁₂ deficiency affect the nervous system?

Causes degeneration of peripheral nerves and spinal cord (first sensory, then motor).

What happens to the tongue in Vitamin B₁₂ deficiency anemia?

It becomes enlarged, red, sore, and shiny.

How does decreased gastric acid affect digestion in Vitamin B₁₂ deficiency?

It causes digestive discomfort with nausea and diarrhea.

What neurologic effect is commonly seen in Vitamin B₁₂ deficiency?

Paresthesias—tingling or burning sensations in the extremities.

Why are neurologic symptoms in Vitamin B₁₂ deficiency often symmetrical?

Because both sides of the peripheral nerves are equally affected.

What is ataxia, and how is it related to Vitamin B₁₂ deficiency?

Ataxia is the loss of muscle control or coordination, resulting from nerve damage caused by B₁₂ deficiency.

What is the main problem in aplastic anemia?

Impairment or failure of bone marrow.

What are some possible causes of bone marrow failure in aplastic anemia?

Idiopathic, myelotoxins, Hepatitis C, SLE, and MDS.

Is aplastic anemia temporary or permanent?

It may be either temporary or permanent.

What are some possible causes of idiopathic aplastic anemia?

Myelotoxins, viruses, and genetic abnormalities.

What do blood counts indicate in aplastic anemia?

Pancytopenia (deficiency of all blood cell types).

What does erythropenia cause in aplastic anemia?

Low oxygen-carrying capacity leading to pallor, weakness, and dyspnea.

What does leukopenia cause in aplastic anemia?

Reduced infection-fighting capacity and repeat infections.

What does thrombocytopenia cause in aplastic anemia?

Increased risk of bleeding, petechiae (macular microhemorrhages), and purpura.

What happens if aplastic anemia is not treated?

Major bleeding and infection can occur.

What is essential for bone marrow recovery in aplastic anemia?

Identifying the cause and providing prompt treatment.

What is the main cause of hemolytic anemia?

Excessive destruction of red blood cells (RBCs).

What is hemolysis?

The breakdown or destruction of red blood cells.

What are the possible causes of hemolytic anemia?

Defects in RBCs that trigger breakdown

Genetic defects affecting RBC structure

Immune reactions

Changes in blood chemistry

Toxins in the blood

Infections such as malaria

Transfusion reactions

Erythroblastosis fetalis

What is erythroblastosis fetalis?

A hemolytic disease of the newborn caused by Rh incompatibility between mother and fetus.

What type of genetic condition is sickle cell anemia?

Autosomal with incomplete dominance.

In which genotype does anemia occur for sickle cell disease?

Homozygous recessive.

In which ancestry is sickle cell anemia more common?

Individuals of African ancestry.

What causes the abnormal shape of RBCs in sickle cell anemia?

Hemoglobin S gene codes for abnormal hemoglobin that polymerizes under low oxygen, changing RBCs to a rigid, sickle shape.

What happens to sickled cells as they pass through capillaries?

They stick together and obstruct circulation, causing hypoxia and more sickling.

What happens to RBCs during hemolysis in sickle cell anemia?

They are destroyed, reducing RBC count and increasing bilirubin.

What are some causes of sickling crises?

Dehydration, lung infection, or any condition causing poor oxygen delivery.

Which organs and vessels are most affected during a sickling crisis?

Brain, bones, kidneys, and coronary arteries.

What are common manifestations of sickle cell anemia?

Anemia

Hyperbilirubinemia

Splenomegaly

Vascular occlusion and infarction

Pulmonary issues (acute chest syndrome)

Pain and swelling in extremities (especially in kids)

Delayed growth and intellectual impairment

Congestive heart failure

Recurrent infections

What is hydroxyurea used for in sickle cell treatment?

To increase fetal hemoglobin and reduce sickling episodes.

What are other treatments for sickle cell anemia?

Transfusion, phlebotomy, folic acid, and bone marrow transplant (BMT).

How can sickle cell crises be prevented?

Avoid overexertion or high altitudes

Avoid temperature extremes

Stay well-hydrated

Get vaccinations (pneumonia, influenza, meningitis)

What is Hemophilia A?

- A disorder in which blood does not clot normally

- Most common inherited clotting disorder

- Has varying degrees of severity

What is DIC?

disseminated intravascular coagulation

What is the etiology of DIC?

Triggered by endothelial cell injury or release of tissue factors that activate the coagulation cascade. Can also be caused by:

Obstetric complications (amniotic fluid embolism, retained dead fetus, abruption placentae), Transfusion reactions, Malignancy (pancreatic carcinoma, adenocarcinoma, acute promyelocytic leukemia), Trauma (brain injury, crush injury, burns), Infection or sepsis (gram negative bacteria), Acute pancreatitis, ARDS

What is the prognosis of DIC?

- Very poor prognosis, with high fatality rate

- Complication of many primary problems

What does DIC do?

reduces perfusion and gas exchange, decreasing oxygen saturation, causing widespread hypoxia and ischemia

What is primary polycythemia?

Increased production of erythrocytes and other cells in the bone marrow

What is secondary polycythemia?

Increase in RBCs in response to prolonged hypoxia

What are some clinical manifestations of polycythemia?

- Engorged blood vessels with high viscosity blood

- Plethoric

- Cyanotic

- Hepatomegaly

- Splenomegaly

- Itching

- Hypertensive

- Bounding pulse

- CHF

- Hyperuricemia secondary to high cell breakdown level

- Clots and infarcts in extremities as well as vital organs

What is Hematologic Neoplasms?

A group of malignant diseases that affect the blood and blood-forming organs, such as the bone marrow and lymphatic system.

What are the general characteristics of hematologic neoplasms similar to other cancers?

Cellular mutation

Growth control is changed

Differentiation is impaired

What type of viruses can cause hematologic neoplasms?

Retroviruses and Herpesviruses

How do retroviruses contribute to hematologic neoplasms?

They insert their DNA into the host cell's DNA.

Which specific virus is associated with Human T-Cell Leukemia?

Human T-Cell Leukemia Virus (HTLV)

Which virus is linked to B-cell lymphomas in HIV patients?

HIV

Which virus is associated with Hodgkin and Burkitt's lymphoma?

Epstein-Barr Virus (EBV)

What chemical exposure is a known cause of hematologic neoplasms?

Tobacco

What causes myeloid neoplasms?

Transformation and proliferation of a precursor stem cell in the bone marrow.

Where do abnormal stem cell clones accumulate in myeloid neoplasms?

They build up in the bone marrow and are released into circulation.

What type of stem cell is abnormal in myeloid neoplasms?

A multipotent stem cell.

What does a multipotent abnormal stem cell cause?

Overproduction of more than one cell type.

Are myeloid neoplasms associated with unlimited types of cells?

No, the overproduction is still limited to a few cell types.

What are the common myeloproliferative diseases?

Chronic Myeloid Leukemia (CML)

Polycythemia Vera (PV)

Essential Thrombocythemia (ET)

In Chronic Myeloid Leukemia (CML), which cell type is overproduced?

Granulocytes

In Polycythemia Vera (PV), which cell type is overproduced?

Red blood cells

In Essential Thrombocythemia (ET), which cell type is overproduced?

Platelets

What cells are involved in lymphoid neoplasms?

B cells, T cells, and NK (natural killer) cells.

When are lymphoid neoplasms classified as leukemia?

When malignant cells are present in the blood or bone marrow.

When are lymphoid neoplasms classified as lymphoma?

When the malignancy is localized in lymphoid tissues.

What determines the location of lymphoid neoplasms?

The disease stage.

What system does the WHO use to classify lymphoid neoplasms?

The WHO classification uses cell type, not disease staging.

What is another name for Acute Myelocytic Leukemia?

Acute Granulocytic Leukemia

Which age group is most commonly affected by Acute Myelocytic Leukemia (AML)?

Adults

What is the survival rate for adults with AML?

About 25%

What are the main clinical manifestations of AML?

Bone pain

Anemia

Thrombocytopenia

Increased susceptibility to infection

What are common infection sites in patients with AML?

Skin

Gastrointestinal (GI) tract

Genitourinary (GU) tract

Respiratory tract

What percentage of all leukemias in the U.S. does Chronic Lymphoid Leukemia (CLL) account for?

30%

What is the typical course of CLL?

It follows an indolent (slow-progressing) course and is often asymptomatic.

How is CLL usually discovered?

By accident during routine blood examinations.

What are common symptoms of symptomatic CLL?

Fatigue

Weight loss

Anorexia

Increased susceptibility to infections

How does bone marrow infiltration affect patients with CLL?

It reduces production of red blood cells and platelets.

What type of cells are predominant in CLL?

Lymphoid cells.

What is unique about CLL cells compared to normal cells?

They have defective apoptosis and a longer life span.

What factors determine the prognosis and treatment of CLL?

Prognosis and treatment depend on disease stage, genetic mutations, and response to therapy.

What are the three main types of lymph disorders?

Lymphomas (Hodgkin's and Non-Hodgkin's)

Lymphedema