Blood & Circulatory Disorders

How is ABO type determined?

Presence of A/B ANTIGENS on cell membrane of erythrocytes

How does ABO type (antigens) relate to antibodies and blood donations?

Body can accept blood with same antigens (i.e. A) but cannot accept antigens it does not have due to antibodies (i.e. anti-B antibodies).

What determines Rh factor?

Inherited proteins on surface of RBCs

Can can Rh+ recieve? And Rh -?

Rh+ can get + or -, Rh- can only get - (anti-Rh antibodies)

What does a differential WBC count tell providers?

Proportions of leukocytes

What are Hgb levels important for?

Sufficiency of oxygen transport

What does HCT tell providers?

% Erythrocytes in specific volume of blood → indicates fluid volume or anemia

What test measures bone marrow function?

Reticulocyte count (shows immature nonnucleated RBCs)

What pathway does PT/INR measure? Tested with what therapy? Ideal range?

Extrinsic pathway, effectiveness of Warfarin therapy; 1.5-2.5 (2.0-3.0 on Warfarin)

What pathway does aPTT/PTT measure? What therapy does it monitor? Ideal range?

Intrinsic clotting pathway, effectiveness of Heparin therapy; 25-38s

What does an O2 deficit (anemia) lead to in the body? (3)

Decreased energy → decreased cell metabolism and production; tachycardia & peripheral vasoconstriction (compensation); angina (if severe)

Key s/s of Anemia (general)?

Tachycardia, dypsnea, pallor, decreased regen of epithelial cells → stomatitis, dry lips, dysphagia, inflammed/ulcerated GI

Define Iron Deficiency Anemia; is it common?

Lack iron → impaired Hgb formation → decreased O2 transport; yes (1 of every 5 women)

Potential underlying causes of Iron Deficiency Anemia?

Severe liver disease (→ impaired absorption & storage), malabsorption/insufficient intake, chronic blood loss

Iron rich foods? (Less common)

Tofu, legumes, fruits, pumpkin seeds, whole grains

Key s/s of Iron Deficiency Anemia?

Delayed healing, irritability (brain less O2), oral mucosa inflammation, brittle hair + spoon nails, tachycardia, dypsnea, cold intolerance

Key considerations for iron supplementation?

Take w/ food if GI upset, liquid forms → teeth staining (straw, rinse mouth), risk for constipation, dark stools

Define Pernicious Anemia (Vitamin B12 Deficiency)

Lack B12 absorption → megaloblastic (large, immature) erythrocytes that are destroyed prematurely

Pathophysiology of Pernicious Anemia?

Antibodies/chronic gastritis (AUD) destroy gastric mucosa → no intrinsic factor secretion → no B12 absorption in ileum → B12 excretion & deficit → production of megaloblastic erythrocytes

What groups are high risk for Pernicious Anemia?

vegeterians & vegans

What surgical interferences can contribute to Pernicious Anemia?

Gastrectomy, resection of the ileum

Key s/s of Pernicious Anemia?

Tongue enlarged/red/sore (beefy red), GI upset, paresthesias, ataxia

Tx for Pernicious Anemia? Administration consideration?

Cyanocobalamin (B12) IM injections → use z-track to avoid staining skin

Define Sickle Cell Anemia

Inherited disorder → gene mutation → abnormally shaped Hemoglobin (HgS)

Sickle Cell Anemia demographics?

Africa/Middle East background; 1 in 12 African Americans have trait, 1 in 500 have sickle cell anemia

Pathophysiology of Sickle Cell Anemia?

HgS deoxygenated → crescent/sickle shape → obstruction small vessels → thrombus & necrosis → high hemolysis rate → hyperbilirubinemia, jaundice, gallstones

Key s/s of Sickle Cell Anemia?

Appear around age 1, hyperbilirubinemia → jaundice/gallstones, splenomegaly → infections (cannot filter blood), vascular occlusions → PAINFUL crisis/organ dmg, CHF (constant high O2 demand)

Pharmacological Tx for Sickle Cell Anemia? MOA?

Hydroxyurea (Chemo drug) → produce non-HgS Hgb → diluted HgS; Folic Acid Supplements (support RBC formation)

Acute crisis management for Sickle Cell Anemia?

PAIN MANAGEMENT, IV hydration, Oxygen

Define Hemophilia A + gene characteristics

Deficit/abnormality clotting factor VIII; x-linked recessive (women carry, men manifest)

Key s/s of Hemophilia A?

Spontaneous hemarthrosis (hemorrhage joints); prolonged hemorrhages/hematomas to minor injuries; hematuria/blood in feces

Hemophilia A Diagnostics?

Prolonged PTT/aPTT & coagulation time; low serum levels VIII

Tx for Hemophilia A? MOA?

Desmopression (synthetic ADH); stimulates blood vessel endothelial lining to release stored VIII

Define Von Willbrand Disease

Deficiency of Von Willebrand Factor (VWF, helps platelets clump & stick to injury walls)

Key s/s of Von Willebrand Disease?

Abnormal menstrual bleeding, nosebleeds/bleeding gums/bruising, rashes

Diagnostics for Von Willebrand Disease?

Bleeding time, platelet count + aggregation, VWF tests

Tx for Von Willebrand Disease?

Mild → Desmopressin → VWF & VIII into blood ; Severe → direct injection VWF into veins

Define Disseminated Intravascular Coagulation (DIC)

Excessive bleeding AND clotting ; hemostasis out of control

Pathophysiology of DIC?

Trigger event → massive activation coagulation cascade → tiny clots form everywhere → blockages → infarcts → all clotting factors consumed → hemorrhage → hypotension/shock

Possible triggers of DIC?

Major trauma, carcinomas, infections (gram -), obstetric complications

Key s/s of DIC?

Petechiae/ecchymoses, critical hemorrhage, thrombocytopenia, respiratory/renal impairments, LOC

Define Thrombophilia

Abnormal clots in veins/arteries due to group of inherited disorders (mutation of coagulation protein genes)

Tx for Thrombophilia?

Chronic anticoagulation (Warfarin)

Define Neoplastic

Abnormal tissue growth; cells divide more than they should or fail to die when they should; can be benign or malignant (not necessarily cancerous)

Pathophysiology of Primary Polycythemia (Polycythemia Vera)?

Increased blood cell production → increased BP/BV/viscosity → distended blood vessels & sluggish flow → frequent thromboses & infarctions (stasis → clotting)

Polycythemia Vera etiology?

Unknown origin, develops ~40-60 years

Key s/s of Polycythemia Vera?

Plethora, bounding pulse, swelling/splenomegaly, distended veins, HTN, headaches

Polycythemia Vera diagnostics?

Increased cell counts (increased Hgb & HCT), hyperuricemia (increased cell division rate)

Tx for Polycythemia Vera?

Phlebotomy (blood-letting), bone marrow suppression

Define Lukemias

Group of neoplastic disorders involving WBCs

Etiology of Leukemias?

Association w/ chromosomal abnormalities, acute → common in kids, chronic → common older adults

Lukemia pathophysiology?

Uncontrolled production immature WBCs → resistant infections, congestion/enlarged tissues, and crowding out other cell productions; → bone pain, anemia, thrombocytopenia/hemorrhage

Leukemia diagnostics?

Immature leukocytes & immature WBCs, decreased RBCs/platelets, bone marrow biopsy → confirm

Tx for Leukemia?

Chemotherapy, hydration + nutrition, bone marrow transplant

Define Peripheral Vascular Disease

Any abnormality in arteries or veins outside the heart

Arterial disorders? (3)

Arteriosclerosis, Atherosclerosis, Aortic Aneurism

Venous Disorders? (3)

Varicose Veins (Varicosities), Thrombophlebitis, Phlebothrombosis

Define Arteriosclerosis

Umbrella term for all arterial changes

Arteriosclerosis pathophysiology?

Less elastic, hard vessel walls → narrowed lumen → obstructions → ischemia & necrosis

Define Atherosclerosis

Plaques (atheromas) form inside of large arteries; composed of lipids, cells, fibrin, cell debris

Atherosclerosis pathophysiology?

Plaque weakens wall → aneurism → rupture/hemorrhage; causes strokes, MI, ulcers, etc.,

Define LDL + MOA

The "bad” cholesterol; moves cholesterol from liver → cells → plaque formation

Define HDL + MOA

The “good” cholesterol; moves cholesterol away from cells for excretion

Key s/s of Atherosclerosis?

Intermittent Claudication → leg pain w/ exercise due to ischemia (pain decreases w/ rest); cold legs + feet; elevated legs → pallor, dangling → rubor; hairless skin, weak peripheral pulses

Atherosclerosis diagnostics?

Doppler study (ultrasound), arterio/angiogram w/ x-ray & contrast dye

Tx for Atherosclerosis?

Cessation nicotine use, statins, platelet inhibitors/anticoagulants, peripheral vasodilators (CCBs), surgery, amputation

Surgical procedures for Atherosclerosis? (3)

Bypass graft (go around blocked vessel → collateral circulation), angioplasty (balloon to open walls → stent), endarterectomy (clean out plaque)

Key patient teaching for Atherosclerosis?

Check feet regularly → Decreased sensation to feet, may not notice injuries/infections

Define Aortic Aneurism (+ AAA)

Localized dilation & weakening of arterial wall; AAA = Abdominal Aortic Aneurism

Etiology of Aortic Aneurism?

HTN present in 50% of cases, syphilis/infections, MVAs, atherosclerosis, etc.,

s/s of Aortic Aneurism?

Asymptomatic until large or rupture occurs (may be pulsating & hear bruit w/ auscultation); generally found on accident!

Diagnostics for Aortic Aneurism?

Imaging, x-ray, CT, MRI, ultrasound

Tx for Aortic Aneurism?

BP regulation, avoid exertion, surgery

Define Varicosities

Irregular dilated & tortuous superficial/deep veins due to deficit in vein walls/valves

Why are superficial veins more affected by Varicosities? Why is there increased thrombus risk?

Lack of muscle support to promote circulation of blood back to the heart as compared to deep veins; blood stasis → thrombus risk!

Common sites for Varicosities + names?

Legs, esophagus = esophageal varices (AUD!), rectum = hemorrhoidss

What postures/habits can increase risk for Varicosities?

Standing for long periods, consistently wearing tight clothing, crossing legs (closes off veins), pregnancy → increased FV/BV

Tx for Varicosities?

Elevate legs, support stockings (mimic muscle), sclerosing agents → vein obliteration, surgical vein stripping

Define Thrombophlebitis (+ other name)

Inflammation w/n vein → thrombus/clot (AKA Thromboembolic Disease)

Define Phlebothrombosis

Thrombus forms spontaneously in vein w/o prior inflammation

Risk factors for Thromboembolic Disease?

Immobility, endothelial injury, increased coagulation (cancer/pregnancy/dehydration)

When can Thromboembolic Disease become a critical issue?

If it leads to a Pulmonary Embolism (Respiratory & CV complications)

Key s/s of Thromboembolic Disease?

Enlarged calf, edema/rubor/tenderness in area, Homan’s Sign (no longer best practice!)

s/s of Pulmonary Embolism?

Asymptomatic until chest pain/shock/code blue/”impending doom”/dyspnea

Tx for Thromboembolic Disease

Prevention → exercise, elevate legs; compression + anticoagulants (BEST!); surgery

HMG-COA reductase inhibitor (statins) use?

For intermittent claudication & to decrease cholesterol (plaques)

Antiplatelets to know? (2)

Clopidogrel & Aspirin

Basic anticoagulants to know? (3)

Heparin, Warfarin, Enoxaparin Sodium/Lovenox (Low-Molecular Weight Heparin)

Factor Xa inhibitors to know? (3)

Fondaparinux, Rivaroxaban, Apixaban

Direct-Acting Thombin Inhibitor to know?

Argatroban