Exam 2 Hematopoietic Function

What does a WBC left shift mean?

there is an increased number of immature neutrophils (especially bands) in the blood

When does a WBC shift occur?

• with acute bacterial infection or significant inflammation

• bone marrow releases neutrophils early to meet demand

What is Leukopenia?

an abnormally low WBC count

What is the concern with decreased platelet count?

• thrombocytopenia

• major concern is bleeding

What is an INR?

• International normalized ratio

• standardizes PT and used mainly to monitor warfarin therapy

• Higher INR=blood takes longer to clot

What is ITP (Immune thrombocytopenia purpura)

hypocoagulation due to autoimmune destruction of platelets

Who is ITP mainly seen in?

kids

What are the causes of ITP?

idiopathic causes and autoimmune diseases

What are the symptoms of ITP?

abnormal/GI bleeding

What is the treatment for ITP?

• glucocorticoid steroids

• immunoglobulin infusions

• blood transfusions

• rare: splenectomy

What is hemophilia A?

• inherited bleeding disorder that results in decreased coagulation

• deficiency of clotting factor 8

What are the manifestations of hemophilia A?

bleeding/signs of bleeding

What is the diagnosis for hemophilia A?

• bleeding studies

• serum levels of factor VIII or IX

• genetic testing

What is the treatment for hemophilia A?

• clotting factor transfusions

• advate

• desmopressin

• bleed precautions

What is multiple myeloma?

• cancer of the plasma cells

• relatively uncommon

Who does multiple myeloma primarily effect?

adults

What are the manifestations of multiple myeloma?

• persistent bone pain

• decreased bone density

• anemia

• thrombocytopenia

• renal impairment

What is the diagnosis of multiple myeloma?

• serum and urine protein

• renal function proteins

What is the treatment for multiple myeloma?

• treat the hypercalcemia (bone demineralization)

• treat the bone pain (related to demineralization)

Why does demineralization occur in multiple myeloma?

due to the production of more osteoclasts

How is the prognosis of multiple myeloma?

depends on the staging

Hodgkins Lymphoma

• contains reed-sternberg cells

• very curable with chemo and radiation, or surgical treatment (75%)

• large lymph nodes above the diagram (I-IV staging)

• affects primarily 20-30 year olds

Non Hodgkins Lymphoma

• more common

• poor prognosis

• kids are more likely to be affected

• resembles Hodgkin's in manifestations, staging, and treatment

• originates in T and B cells

• can spread anywhere (not just above diaphragm)

• 73% curable

Von Willebrand disease

decreased platelet adhesion and aggregation (most common hereditary bleeding disorder)

What is the cause of Von Willebrand disease?

• mutation on chromosome 12 causing deficits in the Von Willebrand factor

• platelets don’t adhere to cell walls

What are the manifestations of Von Willebrand disease?

• abnormal bleeding (nose bleeds, bruise)

• decreased platelet adhesion and aggregation

What is the diagnosis for Von Willebrand disease?

• bleeding studies

• factor VIII levels (1,2,5,7,10)

• CBC

• APPT (8,9,11,12)

• PT time

What is the treatment for Von Willebrand disease?

• intravenous/intranasal DDVAP

• intravenous recombinant Von Willebrand factor

• parenteral/oral antifibrinolytic medications

• birth control for heavy periods

What is sickle cell anemia?

inherited co-dominant disorder in which erythrocytes are crescent/sickle shape

What is the cause of sickle cell anemia?

hemoglobin S

What are the manifestations of sickle cell anemia?

• abdominal/bone pain

• dyspnea

• swelling of hands and feet

• fatigue

• jaundice

• acute chest pain

• fever

• tachycardia

• pallor

What is the diagnosis for sickle cell anemia?

• hemoglobin electrophoresis

• CBC

• bilirubin tests

What is the treatment for sickle cell anemia?

• medications

• avoiding triggers

• oxygen therapy

• blood transfusions

• genetic counseling

• pain/ infection control

Why does iron deficiency anemia happen?

supply of iron is inadequate to meet the demands of hemoglobin production

What type of cells are present in iron deficiency anemia?

microcytic RBCs

What is leukemia?

• cancer of the leukocytes

• second most common blood cancer after lymphomas

  
  

What are the risk factors of leukemia?

• mutagens

• viruses

• chemicals

• radiation

• smoking

• chemo

• other diseases/ immunodeficiencies

Who is most at risk of developing leukemia?

• kids

• white men

What are the manifestations of leukemia?

• leukopenia

• anemia

• thrombocytopenia

• lymphadenopathy

• joint swelling

• bone pain

• weight loss

What is the diagnosis of leukemia?

• blood smears

• CBC

• bone marrow biopsy

What is the treatment for leukemia?

• chemo (more effective in acute)

• bone marrow transplant

• drug therapy

• stem cell transplant

Mono (kissing disease)

• caused by Epstien-Barr virus (EBV) in the herpes family

• kills B cells or incorporates into their genome (heterophile antibodies)

What are the manifestations of mono?

• insidious onset (4-6 weeks)

• anorexia

• malaise

• chills

• leukocytosis

• acute phase = 2-3 weeks

• recovery = few months

What are the symptoms of mono?

• fever

• sore throat

• fatigue

What are the diagnostic tests for mono?

• viral capsid antigen

• early antigen

• EBV nuclear antigen

• monospot test

What is the treatment for mono?

• treatment is symptomatic and supportive

• analgesics

• antipyretics

• steroids

What is a complication of mono?

ruptured spleen or hepatitis