N3366 Hematological systems: Leukocytes & Erythrocytes terms

Hypercalcemia S&S

Confusion, lethargy, weakness, kidney stones & failure

Leukemia

Cancer of the hematopoietic system -> uncontrolled proliferation of leukocytes -> overcrowding of bone marrow and decrease production of normal hematopoietic cells

Leukemia S&S

- Leukocytosis, WBC count >10,000, due to uncontrolled proliferation of leukocytes

- Thrombocytopenia (easy bleeding/ bruising), due to decreased production of hematopoetic cells (thrombocytes)

- Anemia-> Fatigue, SOB, due to decreased production of hematopoietic cells (RBC)

- Ease of infection b/c WBC function is impaired due to overcrowding of bone marrow

Multiple Myeloma

- Cancer w/ idiopathic etiology, plasma cells become malignant and begin overproducing immunoglobulins which infiltrate bones, causing multiple malignant tumors that increase osteoclast activity

Multiple Myeloma S&S

Osteoporosis (leads to pathological fractures) & Hypercalcemia (because excessive breakdown of bone)

Multiple Myeloma Tx

Chemotherapy, radiation, bone marrow transplantation

Osteoclasts

Hematopoietic cells that normally break down bone for calcium when needed

How do osteoclast behave in multiple myeloma?

they go into overdrive breaking down too much bone causing Hypercalcemia

Pathological fractures

Bone breakage that occurs w/ minimal stress

- Caused by osteoporosis

Anemia

RESULT OF A DISEASE PROCESS;

less than normal # of circulating erythrocytes and/ or decrease in the quality or quantity of HgB

anemia etiologies

Disorders that cause a decrease in erythropoiesis and/ or loss of RBC (via hemorrhage and/ or pathological hemolysis)

What would cause a decrease in erythropoiesis that results in anemia?

bone marrow disfunction, leukemias or hypersplenism

What would cause a loss of RC that resulted in anemia?

hemorrhage and/ or pathological hemolysis

Anemia CBC

-RBC count

-HgB

-Hct

-RBC count <4 million (4-6 million normal)

-Hemoglobin <14 (14-18 normal)

-Hematocrit <42% (42% to 52% normal)

Anemia S&S

- Fewer and/ or deranged RBC or Hgb = less O2 to tissues & organs = S&S related to Hypoxemia

- SOB, Weakness & Fatigue, muscle cramps CNS effects, pallor of skin (less pink)

Anemias

Disorders due to pathologically decreased number of RBC

Classifications of Anemias

Based on Size, Substance (reduced Hgb-> hypochromic (less color)), Shape (sickle cell anemia) of RBC

Complete Blood Count (CBC)

Blood test used to diagnose and class an Anemia

Erythropoietin

Growth hormone that stimulates bone marrow to make more RBCs, typically given for chronic diseases that cause anemia

What is erythropoietin usually given for?

Chronic diseases that cause a slow down of production in RBC -> Normocytic anemia

Glossitis

Inflammation of tongue; swollen, beefy red, smooth, painful tongue

(macrocytic anemia)

Hematocrit (Hct)

Percentage of RBC in the blood (42-52% normal)

Low Hct indicates

Anemia

<42%

High Hct indicates..

Polycethemia

>52%

Hypoxemia

Lack of Oxygen in the blood

Hypoxemia S&S

SOB, Weakness & Fatigue, muscle cramps CNS effects, pallor of skin (less pink)

CNS effects associated with Hypoxemia

Slowed mentation, dizziness, lethargy, syncope (fainting)

What is Intrinsic factor

Hormone made by parietal cells in stomach

-Responsible for absorption of V-B12

What does a lack of intrinsic factor cause?

V-B12 is not adequately absorbed from digested food -> DNA malfunctions & makes coding error in RBC creation -> too few RBCs made that are larger than normal

(MCV >95)

What is Macrocytic Anemia

CBC, RBC, MCV

-Anema is which Size (MCV) is larger than normal

-CBC shows

-RBC <4 million

-MCV >95

Macrocytic Anemia S&S

-Specific

-General

- *MCV >958

- Glossitis (inflammation of tongue)

- Neuropathies most often in legs (paresthesia) due to lack of B12

- RBC <4 million, fatigue, weakness, sometimes SOB, & dull mentation

Why does macrocytic Anemia result in neuropathies such as paresthesia?

Lack of b12 absorption

-B12 nerve modulator

Macrocytic Anemia patho

Certain disease processes cause faulty DNA coding of RBC size (RBC are larger & don't fxn right),

Example; Pernicious anemia

Whats the most common macrocytic Anemia

Pernicious anemia

-Diminished production of intrinsic factor = less b12 = DNA malfxn = coding error = larger RBC

Macrocytic Anemia Tx

Why?

Usually B12 injection

Due to decrease in production of Intrinsic factor -> less absorption of B12 so we must counteract

Mean Corpuscular Volume (MCV)

Range, micro, normo, macro

The size of each RBC,

-Normal Range 80 to 95;

-Microcytic <80,

-Normocytic 80-95

-Macrocytic >95

Microcytic Anemia Patho

Something causes body to slowly, chronically, lose RBCs (women w/ heavy menses, occult GI bleeding) -> begins to "run low" on material to make full sized RBC -> bone marrow tries to "catch up" by making RBC that are smaller

What are examples of causes of Microcytic anemia?

Chronic steady loss of RBC

-Women w/ heavy menses

-Occult GI bleeding

What is Microcytic Anemia

Anemia in whcih Size (MCV) is smaller than normal so...

-CBC shows RBCs of <4 million and MCV of <80

Microcytic Anemia S&S

-Low MCV (<80) & low Hgb (<14)-RBC <4 million, fatigue, weakness, sometimes SOB, & dull mentation

Microcytic Anemia Tx

- Stop blood loss if possible;

- Give iron supplements (due to decreased Hgb due to loss of RBC)

Why is Microcytic Anemia associated with "iron-deficiency anemia"?

Iron is a essential part of Hgb which is lost when the RBC are lost

What is Normocytic Anemia

Anemia in whch Size (MCV) is normal so....

-CBC shows RBC of <4 million

-MCV that is normal (b/n 80 & 95)

Normocytic Anemia Patho

-Something causes RAPID blood loss (traumatic hemorrhage) no time for compensatory smaller RBC

-Chronic disease causes slowdown in production of RBC (AIDs, Lupus, Chronic Renal Failure)

What chronic diseases would cause a slowdown of RBC production?

AIDs, Lupus, Chronic Renal Failure

Normocytic Anemia S&S

-Particular to its classification

-In general for all Anemias

-Normal MCV (80-95)

-RBC <4 million, fatigue, weakness, sometimes SOB, & dull mentation

Normocytic Anemia Tx

-For acute blood loss

-For chronic Disease

- For acute blood loss-> Stop blood loss & give units of blood to replace

-For chronic disease -> Erythropoietin (stimulate bone marrow to make more RBC)

Occult bleeding?

Hidden-> Occult GI bleeding causes Microcytic anemia

What type of anemia is Pernicious Anemia? Who is it seen in?

Macrocytic Anemia

-seen in elderly patients

-patients GI absorption disorders

-ppl w/ inadequate nutrition (alcoholics)

How does Pernicious Anemia occur?

Parietal cells don't make intrinsic factor so B12 can't be absorbed

How does Pernicious Anemia occur?

(Most common type of macrocytic anemia)

1) parietal cells diminished production of intrinsic factor

2) inadequate b12 absorption leads to DNA malfunctions & errors in coding -> 3) RBC malfunction, too few RBC that are larger than normal

Polycythemia

Disorder in which there are more than normal # of total circulating RBCs

Polycythemia forms

-Primary (Polycythemia Vera)

-Secondary (Compensatory Increase in response to hypoxic conditions)

Polycythemia CBC

-RBC

-Hct

RBC > 6million, hematocrit >52%

Polycythemia Vera tx

Removal of 300 to 500 ml of blood 3 to 4 times per month

What is Primary Polycythemia

Polycythemia Vera

(rare condition)

-slow development of hyper-proliferation of bone marrow stem cells

What are Qualitative problems w/ Erythrocyte fxn

defect in quality of function of the cell (genetic; i.e. Sickle cell)

Quantitative Erythrocyte disorders

Anemias (pathologically decreased # of RBC), Polycythemia (Pathologically increased # of RBC)

Quantitative problems w/ Erythrocyte fxn

Alterations in numbers, either insufficient or excess

-Too few (pathologically decreased number-> Anemia)

-Too many (pathologically increased number-> Polycythemia

Pathological decrease in # of RBC <4mil

Anemia

Pathological increase in # of RBC >6mil

Polycythemia

S&S of most types of Anemia

S&S onset can be slow (body can compensate) or immediate (severe),

- Related to Hypoxemia

(b/ fewer RBC (<4mil))

-or Hgb (<14) means less O2 circulating))

Secondary Polycythemia

Compensatory Mechanism in response to hypoxic conditions i.e.

-living at higher altitudes (>10,000 ft)

-smoking (increased level of CO2)

-chronic low- O2 conditions i.e. COPD

Secondary Polycythemia Mechanism of Compensation

Low O2 -> body increased Erythropoietin secretion -> more RBC made

Size classification of Anemia

- Microcytic (tiny cell)

- Normocytic

- Macrocytic (big cell) anemias

Step by step to understanding Anemias

1.) Look at number of RBCs, if <4 million = anemia

2.) Look at MCV which tells you size and type of anemia;

-Large (macrocytic >95),

-Normal (normocytic),

-Small (microcytic <80)

What does MCV in CBC tell you?

Size and type of anemia

Step by step to understand Polycythemias

1.) Look at the number of RBC, if >6 million = polycythemias

2.) The hematocrit, if >52% confirms polycythemias

Steps in classification of Anemias (RAW #'s & SIZE of cell)

1) Fist look at RBC count (anemia is <4 million)

2) NAME anemia w/ MCV (aka size)

--Microcytic Anemia, MCV <80

--Normocytic Anemia, MCV 80-95 (normal range)

--Macrocytic Anemia, MCV >95

Substance Classification of anemia

If there is reduced hemoglobin content, an anemia may be classified as hypochromic (less color)