MS1 - Blood disorders

Blood is a type of

specialized connective tissue (cells, fiber, matrix)

Blood have all of the following characteristics EXCEPT:

it is not liquid at room temperature.

Plasma is a components of blood that is approx 90% ______ 10% _______

H20; solutes

The solutes contained in plasma include

Proteins, Electrolytes, Nutrients, Hormones

What are the formed elements contained in blood?

Erythrocytes (RBC)

leukocytes (WBC)

platelets

Complete Blood Count (CBC) is a group of 4 specific tests that provide results regarding the concentration of

WBC, RBC, platelets, as well as hemoglobin and hematocrit

The CBC can provide information regarding

an indv’s overall health and is utilized in medical differential diagnosis

(e.g., anemia, infection, leukemia)

Monitor vital signs, use a symptom-based approach, and collaborate with the interprofessional team regarding

risk vs benefit of PT intervention w/ ABN findings in the context of a complex clinical condition

Plasma =

Whole blood minus formed elements

Serum =

Plasma minus fibrinogen

Hematocrit (HCT) =

% of RBCs in the total blood volume (10cc centrifuged whole blood)

→ Plasma/Buffy Coat/Packed RBCs

Normal Hematocrit =

Male 42-52%; Female 37-47%

Pregnant female Hematocrit =

> 33%

Hematocrit values may be slightly decreased in

elderly

Hematocrit trending upward

polycythemia

Hematocrit trending downward

anemia

hematocrit critical low

<15

hematocrit critical high

>60

Red Blood Cells trending upward

erythrocytosis

Red Blood Cells trending downward

anemia

KNOW → trending upward/trending downward/presentations/implications/critically low and critically high

Hemoglobin (Hgb) is the

pigment of red blood cells that binds oxygen and carries it thru the body

_______ is the oxygen-carrying pigment of red blood cells

(gives them their red color and serves to convey oxygen to the tissues).

hemoglobin (Hgb)

Hemoglobin (Hgb) occurs in reduced form (_________) in venous blood

and in combination with oxygen (________) in arterial blood.

deoxyhemoglobin: oxyhemoglobin

Normal hemoglobin =

Male 14-18 g/dL; Female 12-16 g/dL

Hemoglobin level for Pregnant female:

> 11 g/dL

Hemoglobin critical low

<5

Hemoglobini critical high

>20

Hemoglobin trending upwards

polcythemia

Hemoglobin trending downards

anemia

What lab values usually correlate?

HCT & Hgb

Certain diseases may allow normal numbers of ____, but reduced concentration of _______ w/in individual cells

RBCs(HCT); hemoglobin

such as iron deficiency

Other diseases affect the number of

RBCs, leading to decrease HCT and possibly Hgb

Hematopoiesis =

blood formation

blood formation for adults occur in the

bone marrow

bood formation for fetus occur in the

liver, spleen, and thymus

Anisocytosis =

varying sizes in a blood sample, indicating an underlying medical condition.

Poikilocytosis =

abnormal shapes of red blood cells in a sample, often signifying medical issues.

Polycythemia =

Increased red blood cells

affecting blood viscosity and oxygen delivery.

Leukocytosis =

increased number of white blood cells in the bloodstream, often indicating infection or other medical conditions.

Leukopenia =

reduced number of white blood cells, resulting in increased susceptibility to infections.

Lymphocytosis =

increased lymphocytes

associated with viral infections or certain cancers.

Lymphocytopenia =

decreased lymphocytes

may lead to an increased risk of infections

Thrombocytosis =

increased number of platelets in the blood, which can increase the risk of blood clots and may be associated with various disorders or conditions.

Thrombocytopenia =

decreased number of platelets in the blood, which increases the risk of bleeding and can be caused by a variety of conditions.

Anisocytosis

Poikilocytosis

Edema

Accumulation of excessive fluid in body Edema cavities or interstitial tissues

Congestion

Accumulation of excessive blood within Congestion the blood vessels of an organ or tissue

Infarction

Localized region of necrosis caused by reduced arterial perfusion

Thrombus

Solid mass of clotted blood within an Thrombus intact blood vessel or heart chamber

Embolus

Mass of solid, liquid, or gas that moves within a blood vessel to lodge at a distance site

Lymphedema

Chronic swelling of an area’s interstitial tissues due to inadequate lymphatic drainage

Shock

Inability of circulatory system to maintain adequate pressure and perfuse organs

Shock may be classified as all of the following EXCEPT

Hypervolemic

Hypovolemic =

Hemorrhage, vomiting, diarrhea, dehydration, burns, pancreatitis, peritonitis

Cardiogenic =

Arrhythmias, acute valve dysfunction, acute MI, severe CHF, cardiomyopathy

Obstructive =

Massive pulmonary embolism, pulmonary HTN, pneumothorax, aortic or mitral valve stenosis, cardiac tumor

Neurogenic =

SCI, pain, vasodilator drugs, trauma

s/s of shock include all of the following EXCEPT

warm, red, dry skin

s/s of cardiovascular collapse include all of the following EXCEPT:

edema

For cardiovascular collapse, death can occur in

<30 mins

(med ER)

Clinical Response for cardiovascular collapse includes all of the following EXCEPT:

maintain pt’s emotional safety

Medical management of blood Disorders include all of the following EXCEPT

Short-Term Treatment

Transfusions can be ______ or ______

whole blood; components

Autologous transfusions are blood transfusions where the patient receives

their own blood

collected before a medical procedure

Reduces the risk of transfusion reactions and disease transmission.

Recombinant Human Erythopoietin (rHuEpo or EPO) stimulates

erythropoiesis to increase RBCs and decrease need for transfusion(s)

Long term treatment can include all of the following EXCEPT

Bone Plasma (BMT)

Blood Transfusion Complications includes

Post-transfusion reaction, Disease transmission, Iron overload. Air embolism, Circulatory overload

The following below are s/s of ______ Blood Transfusion Reaction

 Local burning sensation at transfusion site

 Facial flushing

 Nausea & vomiting

 Chills & fever

 Flank & abdominal pain; low back pain

 Headache

 Dyspnea

 Hypotension

 Tachycardia

 Red urine

 Allergic reaction: hives, wheezing, anaphylaxis

ACUTE

The following below are s/s of ______ Blood Transfusion Reaction

 Dyspnea

 Anemia (drop in Hgb)

 Jaundice

 Hives/Rash

DELAYED

With DELAYED blood transfusion, a reaction generally occurs

5-10 days after

PT more likely to encounter/identify

What effect does exercise have on blood?

INC blood vol

plasma vol (immediate); erythrocyte vol (over time)

Exercise increasing blood volume is associated with improved

Healing, quality of life, and exercise capabilities/activity tolerance

Sport “Blood Doping” =

Exogenous erythropoietin (one form)

What is used to measure sport ‘blood doping’?

urine test but debated validity

Mainly rely on Athlete Biological Passport (ABP), which

tracks an athlete's blood values over time for unusual fluctuations

Sport “Blood Doping” risks =

INC blood viscosity and thrombosis

Anemia is reduced oxygen-carrying capacity of the blood due to

abnormal quantity / quality of erythrocytes

Anemia is a

SYMPTOM

Hemorrhagic Anemia

Acute or chronic blood loss

Hemolytic Anemia

Congenital hemoglobin defects

Decreased Erythrocyte Production disorders include

Nutritional anemia

Poison exposure

Bone marrow disease

Most common anemic presentations include all of the the EXCEPT

acute disease / anti-inflammatory processes (RA, SLE)

Iron deficiency associated with

chronic GI blood loss secondary to NSAID use (geriatric)

Nutritional conditions

vitamin B12, iron, or folate deficiency

Exercise Guidelines for Anemia If hospitalized

may find institutionally estab. guidelines / physician may define

Or medical staff may look to YOU to establish for a specific patient!

Expect VO2 max during exercise for patients with anemia to be

significantly decreased

Consider workload intensity distribution for patients with anemia to

paced, short multiple sessions

For patients with anemia there should be careful monitoring for warnings signs of

cardiovascular compromise

The following are precautions for _____

 Tachycardia & palpitations

 Fatigue (new or significantly pronounced)

 Generalized weakness (new or significantly pronounced)

 Exertional dyspnea greater than anticipated

 Decreased diastolic BP during activity

anemia

White Blood Cells critical low

<2500

White Blood Cells critical high

>30000

White blood cells trending upwards

leukocytosis

White blood cells trending downward

leukopenia

Generally speaking, high WBC is a

normal response to infection or other challenge (clinical judgment needed)

Generally speaking, low WBC is

never good (no or low intensity exercise)

Platelets critical low

<50,000

Platelets critical high

>1 mil

A patient with resting SBP >200 / resting DBP > 100 is permitted to start exercise

no they are not