Other Blood Cells diagnoses

Polycythemia

overproduction of red cells

relative polycythemia

Result of dehydration

Fluid loss results in relative increases of red cell counts and Hgb and Hct values

Absolute polycythemia

primary and secondary

secondary polycythemia

physiologic response resulting from erythropoietin secretion cause by hypoxia

what is the common caused of secondary polycythemia

living in high elevations

smokers with increased levels of carbon monoxide

COPH, CHF

abnormal types of Hb with have a greater affinity for oxygen

secretion of erythropoietin by tumors

primary polycythemia is also known as...

polycythemia vera

polycythemia vera

a myeloproliferative disorder where the pluripotent stem cell is abnormal and there is an abnormal regulation over the hematopoietic stem cells

how is polycythemia vera caused

is is a autosomal dominant (genetic form) that causes increased secretion of erythropoietin

is polycythemia vera cancerous?

no, it is non-malignant condition of abnormal proliferation of bone marrow stem cells with destruction of RBCs

how is polycythemia vera diagnosed?

diagnosed via lab results with the presence of the JAK2 mutation

what are the manifestations of polycythemia vera?

Increased blood vol/ increased blood viscosity

increased BP

plethoric complex - brick redness

headaches, dizziness, difficulty concentration, visual blurring, fatigue, itching after showering

what could polycythemia vera lead to?

myelofibrosis and the individual is prone to thrombosis and bleeding

what is most common... primary or secondary polycythemia?

secondary

hereditary hemochromatosis

autosomal recessive disorder of iron metabolism

what happens in hereditary hematochromatosis

increased GI iron absorption with abnormal iron accumulation

what is found in hereditary hemochromatosis (lab findings)

elevated blood iron levels, elevated ferritin (what stores iron in organs) levels and transferrin (blood protein that transport iron) saturation

where is iron stored and what is subsequent to tissue damage during hereditary hemochromatosis

liver, pancreas, heart, joints, endocrine glands

hereditary hemochromatosis treatment

phlebotomy

iron chelating agents (drugs that bind to excess iron to help body excrete it)

avoid iron supplements, vit. C, consuming raw shellfish

leukocytosis

increase in leukocytes

granulocytosis

increase granulocytes ~ neutrophilia

myeloproliferative disorders

disorders which a general increase in blood forming cells occur

band neutrophils

immature neutrophils that enter the circulation due to the increased demand of leukocytes (bc of acute inflammation or infection)

neutrophilia

granulocytes are mobilized from the marginated pool

what is the marginate pool?

pool of granulocytes that temporarily adhered to the endothelial cells of blood vessels, particularly in the small capillaries and veins ~ corticosteroids are thought to inhibit margination of granulocytes (more in blood stream)

granulocytopenia

deficiency of granulocytes

causes of granulocytopenia

Interference with hematopoiesis

Immune mechanisms

Chemotherapy destruction

Ionizing radiation

leukopenia

decreased number of leukocytes - low white count predisposes a patient to infections

What is eosinophilia?

Increase in circulating eosinophils

What triggers the release of eosinophilic chemotactic factor of anaphylaxis?

Hypersensitivity reactions

From which cells is eosinophilic chemotactic factor of anaphylaxis released?

Mast cells

what could caused eosinophilia

allergic reactions or parasitic infections

eosinopenia

decrease in circulation numbers of eosinophils

what can cause eosinopenia

migration of cells to inflammatory sites

surgery/ shock

trauma/burns

mental distress

infectious mononucleosis

acute, self-limiting infection of B lymphocytes transmitted by saliva through personal contact

what is the common cause of infectious mononucleosis

Epstein-Barr virus (85%)

how does the epstein-barr virus interact with b-cells

the b-cells have a EBV receptor site, which the virus attaches itself to... hijacks the cell then replicates the cell with the virus

what is sent to attack the hijack b-cells during mononucleosis

cytotoxic T cells

Symptoms of Infectious Mononucleosis

fever

sore throat

swollen cervical lymph nodes

increased lymphocyte count

atypical lymphocytes

what is the most common cause of death by infectious mononucleosis

spleen rupture (5% frequency)

treatment of mono

symptomatic

where are WBC formed and differentiate

bone marrow ~ neoplasm here cause leukemias

Where are WBC matured and develop

lymphoid organs ~ neoplasm here cause lymphomas

leukemia

malignant disorder of the blood and blood-forming organ ~ excessive accumulation of leukemic cells which can lead to pancytopenia if cells crowd bone marrow

acute leukemia

presence of undifferentiated or immature cells, usually blast cells ~ onset is abrupt and rapid which can be fatal in months if left untreated

chronic leukemia

predominant cells is mature but does not function normally ~ onset is gradual and prolonged clinical course results in longer survival time

S/S of leukemia

fatigue

bleeding

fever/weight loss/ bone pain

elevated uric acid

liver,spleen, and lymph node enlargement

etc.

what are the four types of leukemia

Acute lymphocytic (ALL)

acute myelogenous (AML)

chronic lymphocytic (CLL)

chronic myelogenous (CML)

what is the most common leukemia in children?

acute lymphocytic leukemia (ALL)

What does acute lymphocytic leukemia (ALL) affect

affect B and T cells ~ affecting circulating cell sof lymphoid origin

what is the most common leukemia in adults

Acute myelogenous leukemia (AML)

Acute myelogenous leukemia (AML)

affects myeloid (bone marrow) tissue and therefore many different cells/cell lines

clinical finding of AML

infections, spontaneous bleeding

low platelet count

bone pain (enlarged leukemic bone marrow), fatigue, anemia

what remains the leading cause of death for those with acute leukemia

infections

what plays a role in acute leukemia

genetics and environmental

lymphocytic leukemias

mutations of lymphoid cell line ~ which leads to overproduction of abnormal immune cells

myelogenous leukemias

mutation of myeloid cell line

myeloid stem cell

becomes erythrocytes, platelets, granular leukocyte, or monocytes

lymphoid stem cell

becomes b cells, t cells, and natural killer cells

Chronic Lymphoid Leukemia (CLL)

involves primarily transformation of B cells and they fail to develop into anti-body producing plasma cells and fail to respond to helper T cells

common S/S with chronic leukemias

splenomegaly

hyperuricemia ~ gouty arthritis

infections, fever, weight loss

lymphadenopathy are...

enlarged lymph nodes that are palpable, often tender or painful to the touch

local lymphadenopathy

drainage of an inflammatory lesion located near the enlarged node

general lymphadenopathy usually...

occurs in the presence of malignant or nonmalignant disease

malignant lymphomas

malignant transformation of lymphocyte and proliferation of lymphocytes, histiocytes, their precursors, and derivatives in lymphoid tissue

What are the two major categories of malignant lymphomas?

hodgkin lymphoma and non-hodgkin lymphoma

hodgkin lymphoma is a...

cancer that develop in the lymphatic system

Common causes of hodgkins lymphoma

malignant B cell invade lymphoid organs and orderly spread

what is commonly found with those with hodgkins lymphomas

Reed-Sternberg cells - malignant transformation of lymph cells

non-hodgkins lymphoma

the term used to describe all lymphomas other than Hodgkin's lymphoma

rick factors of non-hodgkins lymphoma

family history, exposure to mutagenic chemical, irradiation, infection

multiple myeloma is a...

B cell cancer characterized by multiple malignant tumor masses of plasma cells

in general, how does multiple myeloma act

produce abnormal antibodies and proliferation of osteoclasts

malignant plasma cells arise from...

one clone of B cells that produce abnormally large amounts of one class of immunoglobulins (usually IgG)

myeloma cells produce

cytokines (IL-6) which acts as an osteoclast activating factor ~ lead to hypercalcemia

what becomes the most prominent plasma protein in the blood with multiple myeloma

the abnormal antibody called M protein ~ increased protein blood viscosity

thrombocytopenia

low platelet count

thrombocythemia

overproduction of platelets, leading to thrombosis or bleeding disorders due to platelet malformations

platelet

granular, disk-shaped non-nucleated cell fragemtns from pluripotent stem cells

thrombocytopenia are usually secondary to

chemotherapy or radiation therapy

Immune Thrombocytopenic Purpura (ITP)

IgG antibody that target platelets glycoproteins and antibody-coated platelets are sequestered and removed from circulation

the acute form of immune thrombocytopenic purpura develops after...

a viral infection and is one of the most common childhood bleeding disorders

thrombotic thrombocytopenic purpura

a thrombotic microangiopathy where platelets aggregate, form microthrombi, and cause occlusion of arterioles and capillaries

what are alteration of coagulations

vitamin K deficiency and liver disease

disseminated intravascular coagulation

complex, acquired disorder in which clotting, and hemorrhage simultaneously occur

what is the possible cause of disseminated intravascular coagulation

increased protease activity in the blood caused by unregulated release of thrombin with subsequent fibrin formation and accelerated fibrinolysis

what is the primary initiator of disseminated intravascular coagulation

endothelial damage/tissue factor

what is the most common condition associated with disseminated intravascular coagulation

sepsis

sepsis

Dangerous infection of the blood

clinical S/S of disseminated intravascular coagulation

bleeding from venipuncture sites

bleeding from arterial lines

purpura, petechiae, and hematomas

symmetric cyanosis of the fingers and toes