blood and lymph disorders, cancer, death and grief

what are the components of blood?

-RBCs

-WBCs

-throbocytes

-plasma

RBC lab value

4-6 million

Hgb and Hct lab values

hgb males = 14-18

hgb females = 12-16

hct = x3

wbc lab value

4,500-11,000

platelet lab value

150,000-450,000

what drugs can effect blood?

blood thinners

erythrocyte formation is dependent on what?

-healthy bone marrow

-iron and copper

-essential amino acids

-certain vitamins, esp b12, folic acid, riboflavin/b2, pyridoxine/b6

Hgb carries _____ to the cells from the lungs, and _______ ________ away from the cells to the lungs

oxygen; carbon dioxide

what are the different WBCs

-neutrophil

-basophil

-eosinophil

-monocyte

-lymphocyte

elevated levels of neutrophils may indicate what?

-bacterial infections

-stress

elevated levels of lymphocytes may indicate what?

-mononucleosis

-whooping cough

-viral infections

elevated levels of monocytes may indicate what?

-malaria

-TB

-fungal infections

elevated levels of eosinophils may indicate what?

-allergic reaction

-autoimmune disease

-parasitic worms

elevated levels of basophils may indicate what?

-cancers

-chickenpox

-hypothyroidism

WBC bands

immature wbc's (neutrophils) that can be an early indicator of infection or inflammation

who is the universal blood donor?

o-

who is the universal blood receiver?

ab+

hypovolemic anemia

-due to acute or chronic blood loss

-s/sx = restlessness, subtle rise in RR, rapid thready pulse, weakness, stupor, irritability, pale, cool, moist skin

-monitor blood count during and after suspected bleed

-tx = stop bleeding and replace fluid

pernicious anemia

-lack of healthy RBCs caused by vit b12 deficiency due to lack of intrinsic factor

-s/sx = pale skin and mucous membranes, weakness, fatigue, nausea, vomiting, glossitis, loss of appetite, tingling and numbness in hands and feet

-tx = vit b12 injections (cyanocobalamin)

-can be considered an autoimmune disease

aplastic anemia

-rare disorder where the bone marrow does not produce enough new blood cells

-s/sx = fatigue, pallor, headache, angina, dyspnea on exertion

-at an increased risk for infection

-tx = immunosuppressive therapy, blood transfusions, bone marrow transplant

iron deficiency anemia

-most common form of anemia caused by iron deficiency

-s/sx = pallor, fatigue, lack of energy, SOB, weakness, headache

-tx = increase iron in diet, iron supplements

sickle cell disease

-genetic disorder, caused by a mutation to chromosome 11

-abnormal RBCs (crescent shaped), sticky and can get stuck in small blood vessels and block flow of blood to parts of the body, they break apart easily and cause anemia

-s/sx = pain crises due to ischemia, fatigue, swelling in hands and feet, frequent infections, vision problems, delayed growth

-tx = pain meds, blood transfusions, bone marrow transplant, folic acid

sickle cell disease vs sickle cell trait

trait = typically no health consequences or sx

disease = significant impact on person's health and causes many sx

polycythemia

-overproduction of RBC

-primary = unregulated cell division

-secondary = result of underlying condition: tissue hypoxia, kidney diseases, hormone related meds

-s/sx = fatigue, headache, dizziness, episodes of blurred vision, peripheral tingling/burning/itching, hypertension, mucosal cyanosis, bruising, petechiae, enlarged spleen or liver

-tx = phlebotomy, increase fluid intake, aspirin, myelosuppressive agents

agranulocytosis

-condition in which the body has very low levels of granulocytes esp neutrophils caused by production failure, irradiation, exposure to chemicals, drugs

-causes very weak immune system

-s/sx = sudden fever, chills, sore throat, mouth ulcers, weakness, signs of infection that do not improve

-tx = if caused by medication d/c that med, antibiotics, G-CSF helps the bone marrow make WBCs, protective isolation

-avoid fresh flowers, raw foods and crowds

-strict infection control

-monitor temp frequently

-protective isolation

acute lymphoblastic leukemia

-found in lymphoid cells

-grows fast

-common in children

acute myelogenous leukemia

-found in myeloid cells

-grows quickly

-common in adults and children

chronic lymphoblastic leukemia

-found in lymphoid cells

-grows slowly

-common in older adults 55+

chronic myelogenous leukemia

-found in myeloid cells

-grows quickly

-common in adults

leukemia

-cancer of the bone marrow that spreads to bloodstream

-s/sx = fatigue, loss of appetite, weight loss, fever, frequent infections, SOB, swelling of lymph nodes, weakness, spleen enlargement, bone/joint pain and tenderness, liver enlargement, night sweats, easy bleeding and bruising, purplish patches and spots

-tx = stem cell transplant, chemo, immunotherapy, radiation, targeted treatment

thrombocytopenia

-low platelet count, below 150,000

-causes higher risk of bruising, excessive bleeding, interna bleeding

-caused by decreased production due to bone marrow problem (leukemia, aplastic anemia, chemo), increased destruction due to autoimmune diseases (lupus, ITP) or medications (heparin induced thrombocytopenia, antibiotics), or platelets trapped in spleen

-s/sx = easy bruising, petechiae, nose bleeds or bleeding gums, heavy menstrual bleeding, blood in stool/urine, prolonged bleeding

-tx = treat the cause, platelet transfusion, steroids, IVIG, splenectomy

-avoid aspirin and NSAIDs, IM injections, use electric razors,

hemophilia

-A = deficiency of clotting factor VIII

-B = deficiency of clotting factor IX

-primary sx = uncontrolled spontaneous bleeding

-other sx = bruising, nose bleeds, bleeding into joints, prolonged bleeding, bleeding in mouth/gums, blood in urine or stool

-tx = replace the deficiency factors

Disseminated Intravascular Coagulation DIC

complex disorder in which clotting and hemorrhage simultaneously occur because the body uses up

all the platelets and clotting factors

-s/sx = early: cool cyanotic extremities, decreased pulses, organ dysfunction, confusion, alt mental status, chest pain, SOB. Later: bruises easily, petechiae, bleeding from gums/nose/IV site, hematuria, bloody stools, coughing up blood (hemoptysis), shock signs low BP, high HR, pale

-increased PT/PTT, D-dimer

-decreased platelets, fibrinogen

-tx = treat the cause, prepare for transfusions (platelets, fresh frozen plasma)

multiple myeloma

-type of cancer that affects plasma cells, they grow uncontrollably and crowd out healthy cells

-s/sx = confusion, drowsiness, recurrent infections, kidney problems, bone and back pain, bone fractures, unexplained breathlessness, fatigue, general feeling of being unwell, weight loss, spinal cord compression, nausea and loss of appetite

lymphangitis

infection/inflammation of lymph vessels

-s/sx = red streaks at the infected area with swelling and tenderness along the streaks, fever, chills, swollen lymph nodes

-tx = antibiotics, pain relief meds, anti-inflammatories, elevate the affected limb, warm compresses

lymphedema

-accumulation of lymph fluid in the tissues, due to lymph system being blocked or damaged

-typically in arms or legs

hodgkin lymphoma

-cancer of lymphatic system with reed-sternberg cells

-fever, night sweats, weight loss

-typically involves neck, chest, armpits

-often curable and good prognosis

-tx = chemo, radiation, stem cell transplant

-can only come from B cells

-dx in young and old

non-hodgkin lymphoma

-cancer of lymphatic system, NO reed-sternberg cells

-more common and more severe

-can come from B or T cells

-only dx in older adults