Hematopoietic System - Module 3

Hematopoiesis

process of forming blood

plasma

liquid protein

most albumin - hold fluid within blood vessels

leukocytes

white blood cells

erythrocytes

red blood cells

hemoglobin

oxygen carrying component

(amount of O2 in red blood cells)

hematocrit

amount of blood volume occupied by erythrocytes (%)

thrombocytes

platelets

hemostasis

stoppage of blood flow

normal hemostasis

when it seals a blood vessel to prevent blood loss and hemorrhage

abnormal hemostasis

when it causes inappropriate clotting or when clotting is insufficient to stop blood flow

stages of hemostasis

vessel spasm

formation of platelet plug

coagulation cascade ends in fibrin clot

normal range of leukocytes

5,000 to 10,000 cells/mL3

leukocytopenia

decreased leukocyte levels

can be a manifestation for disorders

ceukocytosis

increased levels of leukocytes

neutrophils

type of leukocyte

usually the first to arrive at the site of infection

normal range of neutrophils

2-000 - 7,500 cells/mL

neutropenia

neutrophils < 1,500 cells/mL

causes of neutropenia

bone marrow disorders

bone marrow cancer

increased use of neutrophils

drug suppression

vitamin B12 and folate feciciency

manifestations of neutropenia

frequent infections

signs and symptoms of infections (fever, malaise, chills)

especially infections of the respiratory tract

mouth ulcerations

treatment of neutropenia

hematopoietic growth factors (filgastrim) (medication that works on bone marrow to make more neutrophils

reverse isolation - nurse covers to protect own germs from pt

infectious mononucleosis

kissing disease d/t oral transmission - saliva, cough, sneeze

most prevalent in adolescent and young adults

mono cause

epstein-barr virus (EBV) in the herpes family

epstein-barr virus

infect B cells to make heterophiles antibodies (weak antibodies)

once disease in eliminated, few B cells remain altered / asymptomatic infection

can be dormant

manifestations of mono

initially see anorexia, malaise, chills

intensify to: leukocytes, fever, headache, sore throat, and lymphopathy (swollen lymph nodes)

diagnosis of mono

monospot test (heterophile antibodies)

treatment of mono

symptomatic and supported

acute illness usually lasts 2-3 weeks; full recovery make take 2-3 months

how do lymphomas originate

in a single lymph node or chain (cervical)

what is lymphoma

abnormal proliferation of lymphocytes

what is the most common hematologic cancer in the US

lymphomas

what cells are in Hodgkin's lymphoma

Reed-Sternberg

where does hodgkins lymphoma originate

lymph nodes of upper body

how does hodgkins lymphoma metastisize

lymph node to lymph node in an organized progression

who is most susceptible to hodgkins lymphoma

M and female 20-40; M>50

where does non hodgkins lymphoma originate

any lymph node

how does non hodgkins lymphoma metastisize

in a scattered pattern

who is susceptible to non hodgkins lymphoma

any age

which lymphoma is more common

non-hodgkins

which lymphoma has a poorer prognosis

non hodgkins

manifestations of lymphoma

painless enlarges nodes

fever

malaise, fatigue, weakness

night sweats

pruritis

loss of appetite and weight loss

splenomegaly and hepatomegaly

pruritis

itchiness/hives

what is the second most common blood cancer

leukemia

is leukemia more common in males or females

males

what is leukemia

leukocytes abnormally proliferate to immature/useless cells

what do the immature cells of leukemia do

don't die when they should and crowd out normal blood cells

risk factors of leukemia

exposure to chemical, viral, and radiation mutagens; smoking; use of chemo; certain disease conditions (Down Syndrome)

manifestations of leukemia

leukopenia

anemia

thrombocytopenia

lymphadenopathy

joint swelling

bone pain

weight loss

anorexia

fatigue and weakness

leukopenia

decrease in mature WBCs

thrombocytopenia

low platelets

lymphadenopathy

swollen lymph nodes

multiple myeloma

plasma cell cancer

who does multiple myeloma mostly affect

> 50, males, African American 2x incidence/mortality

when does multiple myeloma typically get dx

when it is well advanced

it has insidious onset with vague symptoms

what happens in multiple myeloma

excessive numbers of abnormal plasma cells invade the bone marrow and crowd normal cells

Bence Jones proteins

secreted by plasma cells in multiple myeloma - causes kidney damage/death

what happens to bone as it gets invaded by plasma cells of multiple myeloma

causes destruction

leads to hypercalcemia and pathologic fractures

manifestations of multiple myeloma

anemia

thrombocytopenia

leukopenia

decreased bone density

bone pain

hypercalcemia

renal impairment

(CRAB)

CRAB

(hyper) calcium, renal failure (from bence jones), anemia (RBCs crowded out), bone damage

what is the normal range of erythrocytes

4-6 million cells / ml3

what gives blood red color

hemoglobin as it binds to oxygen

(brighter the red, more oxygen)

erythropoiesis

production of erythrocytes

what regulates erythropoiesis

erythropoietin (hormone)

what secretes erythropoietin

kidneys

what does erythropoiesis need to occur

iron

anemia

too little RBCs

polycethemia

too many RBCs

what does anemia result in

decreased oxygen delivery to the body's cells

causes of anemia

blood loss

nutritional deficiencies

destruction of RBCs

abnormal bone marrow function

decreased erythropoietin

inadequate mutation of RBCs

general manifestations of anemia

weakness

fatigue

decreased activity tolerance

pallor

shortness of breath and dyspnea

decreased O2 sat

tachycardia, murmur

ortho hypotension

syncope

why does anemia cause weakness, fatigue, and decreased activity tolerance

less oxygen to brain and muscles

pallor

pale skin

what causes pallor

blood less red/less blood

dyspnea

difficulty breathing

what is the most common anemia

iron-deficiency anemia

who is most susceptible to deficiency anemia

infants, older adults, young adult women (pregnancy and menses)

RBCs are what during iron-deficiency anemia

microcytic hypochromic

define microcytic hypochromic

small cells with lighter color

causes of iron-deficiency anemia

decreased iron consumption

decreased iron absorption

chronic blood loss

iron-deficiency anemia additional manifestations

cyanosis to sclera (eyes), decreased appetite, pica

iron-deficiency anemia tx

identify and treat cause

increase dietary intake

administer iron supplements

pernicious anemia

vitamin b12 deficiency

why is vitamin B12 important

it is required for DNA synthesis, keep nerve and blood cells healthy

what are the RBCs like in pernicious anemia

macrocytic immature (megaloblastic)

causes of pernicious anemia

vitamin B12 deficiency and/or lack of intrinsic factor

atrophy of gastric mucosa

total gastrectomy

malnutrition

vegan

intrinsic factor

found in stomach, aids vitamin B12 absorption

pernicious anemia additional manifestations

hypoxemia, paresthesia, unsteady gait, memory changes

hypoxemia

low O2 in blood

paresthesia

numbness and tingling

pernicious anemia tx

injectable b12 once a month

what is folic acid

b9

required for DNA synthesis, keep blood cells healthy

what are the RBCs like in folic acid deficiency anemia

macrocytic immature (megaloblastic)

folic acid deficiency anemia causes

folic acid deficiency

poor nutrition

chronic alchoholism

malabsorption d/t Chron's

folic acid deficiency additional manifestations

symptoms similar to all anemias + pernicious, without nervous system abnomralities

folic acid deficiency anemia tx

folic acid replacement

aplastic anemia

bone marrow suppression of all new stem cells causing deficiency in all blood cells

causes of aplastic anemia

idiopathic

autoimmune

medications

medical treatments

viruses

genetic abnormalities

aplastic anemia additional manifestations

pancytopenia

pancytopenia definition

all blood cells low

aplastic anemia tx

identify and manage underlying cause

oxygen therapy

infections tx

bleeding percautions

stem cell transplant

hemolytic anemia

excessive erythrocyte destruction

what happens in hemolytic anemia

bone marrow cannot increase production to make up for destruction