Patho: Hematology Study Guide

What are the chief functions of the Hematologic System?

• Delivery of substances needed for cellular metabolism

• Removal of metabolic wastes

• Defense against microorganisms and injury

• Maintenance of acid-base balance

• Maintenance of body temperature

• Defense against bleeding

Cellular Components of Blood:

WBC = 5,000-10,000 microliter

Hemoglobin

• Male: 14-18 g/dL

• Women: 12-16 g/dL

Hematocrit

• Male: 10-52%

• Female: 37-47%

Red blood cells (RBCs)

• Male: 4.5-5.5 × 106/mm3

• Female: 3.8-5.2 × 106/mm3

Platelets: 150-100,000/mm3

What do erythrocytes do?

• Responsible for tissue oxygenation

• Transport O2 and CO2

What do leukocytes do?

Protect body against infections, cancers

What kind of leukocytes are there?

• Granulocytes

• Agranulocytes

What are the types of Granulocytes?

• Neutrophils — PMN

• Eosinophils

• Basophils

What are the types of Agranulocytes?

• Monocytes

• Lymphocytes

• NK cells

What are thrombocytes?

Disk-shaped cytoplasmic fragments of megakaryocytes

Where are platelets produced?

In the bone marrow

What are the plasma proteins?

• Albumins

• Globulins-carrier proteins

• Clotting factors

  • Mainly fibrinogen

What does Albumin do?

• Function as carrier: Iron, hormones, calcium, many drugs

• Control the plasma oncotic pressure

What do the Globulin-carrier proteins do?

• α - transports bilirubin and steroids

• β-globulins - Iron, copper

What are some clotting studies?

• Activated Partial Thromboplastin Time (aPTT)

• Prothrombin Time (PT)

• International Normalized Ration (INR)

• D-Dimer

Activated Partial Thromboplastin Time (aPTT)

Assessment of intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII longer in patients using heparin

Prothrombin Time (PT)

Assessment of extrinsic coagulation by measurement of factors I, II, V, VII, X

International Normalized Ration (INR)

Standardized system of reporting PT based on a reference calibration made and calculated by comparing patient’s PT with a control value

D-Dimer

Assay to measure a fragment of fibrin that is formed as a result of degradation and clot lysis

What are specific labs with focus on hematologic problems?

• Reticulocyte count — Measurement of immature RBCs, a reflection of bone marrow activity in producing RBCs

• Cobalamin (Vitamin. B12) — Deficiency

• Folic acid — Deficiency

• Ferritin, Iron, TIBC & Transferrin-Iron studies

What are some diagnostic procedures?

• Bone Marrow

• Lymph Node Biopsy

Assessment questions: Health Management

• Do you have any difficulty performing daily activities because of a lack of energy?

• Have you ever received a blood transfusion?

• Is there any family history of anemia, cancer, bleeding, or clotting problems?

Assessment questions: Nutritional-Metabolic

• Have you had any mouth sores, sore tongue, swollen or sore gums, excessive oral bleeding?

• What kind of diet do you follow? If a vegetarian, do you eat eggs, milk products, fish?

• Do you take any vitamins, nutritional supplements, or iron?

• Have you ever experienced any unusual bleeding or bruising?

• Have you noticed any swelling in your armpits, neck, or groin?

Assessment questions: Elimination

• Have you had black or tarry stools?

• Have you noticed any blood or dark “tea color” in your urine?

Assessment questions: Activity-Exercise

• Do you have any shortness of breath at rest? With activity?

• After activity, do you ever notice bleeding or bruising

Assessment questions: Sleep-Rest

• Have you experienced excessive fatigue recently?

• Are you more fatigued than usual?

• Do you feel rested on awakening? If no, explain.

Assessment questions: Cognitive-Perceptual

• Have you had any problems with your vision, hearing, or taste?

• Have you experienced any numbness or tingling?

Assessment questions: Sexuality-Reproductive

• Women: When was your last menses? Do you consider you cycle normal? How long does you bleed usually last? Have you had any increase in cramping or clotting? Have there been any changes in the amount of flow?

Assessment questions: Value-Belief

• Do you have any personal or religious objection to receiving blood or blood products?

Blood Tests

HCT is a ratio-plasma over RBC

What happens when there’s a decrease in RBCs in the HCT test?

Plasma volume increased

What happens when there’s an increase in RBCs in the HCT test?

Plasma volume decreased