hemorrhagic disorders and alterations & septic/toxic shock

plasma makes up what % of blood volume

55%

blood cells make up what % of blood volume

45%

red blood cells are called what

erythrocytes

what are erythrocytes responsible for

oxygen transport

white blood cells are called

leukocytes

% of blood leukocytes make up

less than 1%

what are leukocytes responsible for

immune system and inflammatory response

function of platelets thrombocytes

function in blood clotting and hemostasis - make up less than 1% of blood volume

the arrest of bleeding or hemostasis depends on:

adequate number of platelets, normal levels of coagulation factors, absence of defects in vessel walls

abnormal levels of coagulation factors can lead to

defective hemostasis or spontaneous and unnecessary clotting

diminished hemostasis results in

either internal or external hemorrhage, defined as copious or heavy discharge of blood from blood vessels

purpuric disorders

red or purple discoloured spots on the skin

why do purpuric spots occur

deficiency of normal platelets needed to plug the damaged vessels or prevent leakage from tiny tears in blood vessels, leading to bleeding into the skin

thrombocytopenia

decreased number of platelets in the blood

petechiae

small, pinpoint red or purple spots on the skin caused by bleeding from capillaries.

purpura

a condition characterized by the appearance of purple or red spots on the skin due to bleeding underneath the skin, often resulting from platelet deficiency or vascular fragility.

ecchymosis

larger bruises on the skin resulting from bleeding underneath due to trauma or other causes.

hematochezia

the passage of fresh blood through the anus, often indicating lower gastrointestinal bleeding.

melena

the passage of dark, tarry stools due to upper gastrointestinal bleeding.

quantitative abnormalities of platelets

thrombocytopenia, thrombocythemia

thrombocytopenia

a decrease in the number of circulating platelets`

thrombocythemia

an increase in the number of platelets

qualitative disorders of platelets affect:

the structure or function of individuals platelets can coexist with quantitative disorders,and lead to impaired platelet function.

quantitative meaning

measurable/countable

qualitative meaning

interpretation / descriptive

hemophilia

rare disorder in which the blood does not clot due to decrease in clotting factors

what does hemophilia result in and is most concerning for

bleeding in deep tissues including bleeding in the joints and within the muscles, damaging organs and can be life-threatening

what is hemophilia almost always

inherited as an X-linked recessive disorder and is more common in male patients

what is tx for hemophilia

replacement of clotting factor

Von willebrand disease - VWD

caused by deficiency or defect of von willebrand factor - this function is binding to other proteins and involves the lining of nose, intestines, uterus and vagina

what is vitamin K

fat-soluble vitamin that is required for the synthesis and regulation of prothrombin, procoagulant factors (V11,IX,X), anticoagulant factors within the liver

most common cause of vitamin K deficiency

parenteral nutrition in combination with antibiotics that destroy normal gut flora

what can bulimia do to vitamin k

can suppress vitamin K dependent activity

hemostatic derangements with defects in the clotting or fibrinolytic systems and platelet function result in:

liver disease (e.g., acute or chronic hepatocellular diseases, cirrhosis), vitamin K deficiency, liver surgery

hepatic parenchyma cells produce:

most of the factors involved in hemostasis and blood coagulation.

what is the first to decline after liver damage

level of factor V11 because of its rapid turnover

anemia meaning

decrease in the amount of circulating red blood cells or hemoglobin

what is hemoglobin

oxygen transporting molecule in RBC

types of anemia

dietary iron deficiency, blood loss from chronic bleeding such as hemorrhoids, cancer or ulcers (decreased iron recycling), impaired iron absorption, liver disease affecting iron absorption and storage, pernicious anemia

pernicious anemia

megaloblastic anemia caused by lack of vitamin b12 or folic acid

impaired absorption of B12 may be caused by

lack of intrinsic factor (IF) in the gastric mucosa due to autoimmune disorder, or chronic gastritis (commonly alcoholics)

can B12 be absorbed in the ileum without intrinsic factor binding

No, intrinsic factor is essential for B12 absorption in the ileum.

without b12 erythrocyte maturation in the bone marrow is:

impaired due to interference with DNA synthesis

pernicious means

harmful in a gradual or subtle way

hemolytic anemia

a condition where red blood cells are destroyed faster than they can be made, leading to anemia.

causes of hemolytic anemias include:

genetic of hemolytic accelerating RBC destruction, sickle cell anemia, autoimmune reactions, leukemia, toxins in the blood, infections - malaria

polycythemia

increase in red blood cell mass in the body

causes of polycythemia

increased release of erythropoietin (glycoprotein hormone produced by peritubular cells of the kidney, that stimulates RBC production

functions of the inflammatory response are

destroy and remove unwanted substances, wall off infected and inflamed area, stimulate the immune response, promote healing

4 phases of inflammation

acute inflammation, chronic inflammation, granuloma formation, healing

mast cells

located around blood vessels, activate the inflammatory response by degranulation and synthesis

degranulation

the process where mast cells rapidly release/empty the granules within them

histamine

vasoactive amine which increases blood flow to the injury site and increases permeability of vessel walls

chemotaxis

the movement of cells towards a chemical stimulus, often involved in immune responses

leukotrienes

are signaling molecules produced by leukocytes that promote inflammation and contribute to bronchoconstriction in asthma.

prostaglandins

are lipids that have various roles in inflammation, pain, and fever regulation. They are derived from fatty acids and are involved in glandular signaling.

the complement system

part of innate immunity, a cascade of plasma protein activation that ultimately leads to destruction of offending substances/organisms by phagocytosis

the coagulation system

blood clotting cascade which leads to the formation of a protein called fibrin to wall off/trap infectious organisms, stop bleeding, and begin the healing process

the kinin system

a system that produces bradykinin; a substance that works with prostaglandins to cause pain and also has similar functions as histamine, though it acts more slowly and is more important in later stages

phagocytosis

the destruction and removal of micro-organisms by macrophages

local effects of inflammation include

redness and warmth, swelling/edema, pain, collection of interstitial fluid in inflamed area called exudate

serous exudate

watery exudate consisting of fluid with small amounts of protein and white blood cells

fibrinous exudate

thick, sticky exudate with high cell and fibrin content, increased risk of scar tissue

purulent (pus) exudate

thick, yellow-green in colour, contains more leukocytes, cell debris and microbes as seen in bacterial infection

abscess exudate

localized pocket of purulent exudate in a solid tissue

hemorrhagic exudate

may be present if blood vessels have been damaged and includes red blood cells, indicating potential bleeding or injury to the tissue

most infections are

in the lungs, brain, urinary tract skin or abdominal organs

key role in development of severe sepsis is completed by

an immune and coagulation response to an infection

clinical manifestations of sepsis

change in mental status, fast shallow breathing, sweating for no clear reason, feeling lightheaded, shivering, symptoms specific to the type of infection

SIRS: systemic inflammatory response syndrome

clinical response arising from a non specific insult with >/= 2 of the following:

Temp >38 degrees celsius or <36 degrees C

HR >90 beats/min

RR >20 /min

severe sepsis

sepsis with organ failure: vascular collapse, renal, hemostasis, lung

sbp <90 mmHg

spo2 <90%

septic shock

refractory hypotension, hypotension persisting after fluid bolus

septic shock is the result of

a systemic infection that has spread to the bloodstream and resulted in widespread vasodilation of the venules, arteries, and capillaries, leading to hypotension

causes of toxic shock

wound (staph) infection, post surgery, tampons - staph infections - 30% of all cases of toxic shock

result of septic and toxic shock

widespread loss of volume from the vascular space to the interstitial space, leading to hypotension and shock

signs of circulatory collapse

tachycardia, tachypnea, pale cool diaphoretic, hypotension