Pathophys- Hematologic system

Anemia

lack of mature red blood cells to produce hemoglobin

low levels of oxygen to tissues

Causes of anemia

impaired erythrocyte production

acute or chronic blood loss

increased erythrocyte destruction

combination of all

Symptoms of anemia

fatigue, weakness, dyspnea, pallor

Classification of anemia

Size describes it ending with -cytic and hemoglobin content which ends with -chromic

Microcytic

small size caused by a lack of iron in hemoglobin (hypochromic) or lack of hemoglobin production (normochromic)

Thalassemia

issue with hemoglobin production

Normocytic

caused by hemolytic or non-hemolytic

increased reticulocyte count with normocytic

means there was a hemorrhage or there is hemolytic anemia

Normal or decrease reticulocyte count in normocytic

due to a cancer, inflammation, or other chronic diseases

Macrocytic

caused by reticulocytes being large because they do not function properly by developing into red blood cells and making hemoglobin

Megaloblastic macrocytic

large sized caused by defects in DNA synthesis in RBCs

Non-megaloblastic macrocytic

large size caused by RBC developmental issues

Acute blood loss

equal loss of blood and plasma cells and hematocrit stays the same

chronic blood loss

slow loss of blood that occurs at a rate that RBC can not be replaced sufficiently enough

Can cause iron deficiency anemia

aplastic anemia

when the body is not making enough RBC (bone marrow issue)

causes of aplastic anemia

hematopoietic failure or bone marrow aplasia

reduced production of mature cells

pancytopenia- reduction in RBC, WBC, platelets

hemolytic anemia

premature accelerated destruction of erythrocytes

Causes of hemolytic anemia

autommune disorders with IgG attacking the blood cells (Lupus, CLL) or IgM

Polycythemia

overproduction of red blood cells

Dehydration causing polycythemia

plasma levels are lower increasing hematocrit

What causes polycythemia

increased erythropoietin, cancer, tumors in cell lines, tumor that produces erythropoietin, dehyrdation

Hereditary hemochromatosis

iron overload disorder

autosomal recessive disorder iron metabolism

Symptoms of hereditary hemochromatosis

fatigue, damage to vital organs, absorption of iron increases and abdominal pain

Quantitative (amount) disorders of leukocyte function

increases or decreases in cell numbers

bone marrow disorders or premature destruction of cells

response to infectious microorganisms invasion

Qualitative disorders of leukocyte function

disruptions of leukocyte function

phagocytes or lymphocytes lose ability

usually caused by genetic mutations

Leukocytosis

to many WBCs could be a normal response to an infection

Leukopenia

to few leukocytes can be from infection but is not normal and not beneficial is a cause for concern

Granulocytosis

to many granulocytosis, usually a normal response to early infection

If neutrophils exceed the amount that bone marrow can produce

they shift left to an immature shape because of a production of immature neutrophils can be described as severe or mild-moderate.

Neutropenia

reduction in circulating neutrophils

Causes of neutropenia

prolonged infection, decreased production, reduced survival, abnormal neutrophil distribution and sequestration, chemotherapy, and agranulocytosis

Eosinophilia

increased in circulating eosinophilsc

causes of eosinophilia

hypersensitivity reaction, allergic disorders, and parasitic infections

eosinopenia

decrease in the circulating numbers of eosinophils

Causes of eosinopenia

migration of cells to inflammatory sites, cushing’s syndrome

Basophilia

increased circulating basophils

causes of basophilia

response to inflammatory and hypersensitivity reactions

seen in myeloproliferative disorders

Basopenia

decrease in circulating basophils

causes of basopenia

acute infections, hyperthyroidism, ovulation and pregnancy, and long-term steroid therapy

Monocytosis

increased circulating monocytes

causes of monocytosis

occurs with neutropenia in later stages of infections when monocytes are needed to phagocytize organisms and debris

Monocytopenia

not very common decrease in monocytes

Lymphocytosis

increase number of lymphocytesc

causes of lymphocytosis

acute viral infection, Epstein barr virus

lymphocytopenia

to few lymphocytes

causes of lymphocytopenia

abnormal production due to immune deficiencies, destruction by drugs viruses or radiation

Lymphadenopathy

enlarges lymph nodes that become palpable and tender

Localized lymphadenopathy

drainage of an inflammatory lesion located near the enlarged node

Generalized lymphadenopathy

occurs in the presences of infections, autoimmune diseases, or disseminated malignancy

Multiple myeloma

malignant proliferation of plasma cells B-cell elevation and produce an abundance of antibodies

Manifestations of multiple myeloma

hypercalcemia, renal failure, anemia and immune abnormalities

Splenomegaly

enlargement of the spleen

Congestive splenomegaly

red pulp effected

Infiltrative and infectious splenomegaly

white pulp effected

Hypersplenism

overactivity of the spleen and causes anemia

Clotting proccess

1. vascular injury-vasoconstriction

2. platelet plug (primary hemostasis)

3. Coagulation cascade thrombin→fibrinogen→fibrin

4. Blood clot

5. Plasmin

6. Fibrinolysis and clot degradation

Throbocytopenia

decrease in circulating platelets

thrombocythemia

increase in the number of circulating platelets

Impaired hemostasis

inability of coagulation and stable fibrin clot

Vitamin K deficiency

is necessary for synthesis and regulation of prothrombin

liver disease

hepatic cells produce most factors involved in hemostasis

damage causes production of fewer clotting factors

Thrombus

stationary clot attached to vessel wall

Virchow triad (causes of thrombus)

injury to vessel

abnormal blood flow

hypercoagulopathy

Embolus

unattached mass circulating within the bloodstream

Iron deficiency anemia

most common nutritional disorder of infancy and childhood

Causes of iron deficiency anemia

lack of iron intake

problems with iron absorption

blood loss and increased iron requirements

Hemolytic disease of the newborn

maternal antibody directed against fetal antigens

mom is Rh- baby is Rh+ (first birth it does not occur)

Can also be a ABO incompatibility

manifestations of hemolytic disease of fetus and newborn

anemia, hyperbilirubinemia, neonatal jaundice, bilirubin encephalopathy

Sickle cells disease

disorders characterized by the presence of hemoglobin S

Hemophilias

serious bleeding disorders that involve mutations in coagulation factors cannot form a fibrin clot but everything else will occur as far as blood clotting

Primary immune thrombocytopenia

most common platelet consumption disorder

platelet destruction rate exceeds production

usually occurs after viral attack in children

typical onset 1-6 years old

Leukemia

most common cancer in children

cancer of blood-forming tissue

most common types are acute lymphoblastic leukemia

acute myelogenous

Acute myelogenous leukemia

leukemia of the granulocytes- basophils, eosinophils, neutrophils, mast cells common in children

Acute lymphoblastic leukemia

cancer of the t-cells, b-cells and NK-cells common in children

infectious mononucleosis

caused by epstein barr virus

symptoms include: enlargement of the spleen, fatigue, fever, sore throat and lymph-nodes increasing in size

Non-hodgkin’s Lymphoma

mutations in proto oncogenes that cause tumors to form from T/NK cells and B cells

Hodgkin lymphoma

Reed-sternberg cells coming from the germinal center of B cells are mutated releasing cytokines that provide tumor supportive environments attractive immunes cells which causes lymph node enlargement

Thrombocytopenia

Blood disorder causing reduction in platelet count

Two types one caused by immune response or clots that use up platelets that causes damage