Lecture 8: Alteration of Hematologic System

what is anemia? symptoms, manifestation of anemia, how body compensate during anemia

decrease in number of functional rbcs (either by number or functionality), symptoms vary based on severity but typically fatigue, weakness, dyspnea, pallor, manifestation is hypoxia, compensation is increased rate and depth of breathing, increased heart beat and other hematologic compensations

what stimulates erythropoiesis

erythropoietin

how could anemia be classified? explain

by etiology or morphology. morphology is divided further into size (macrocytic, microcytic, normocytic) and hb content/quality (hypo chromic, normochromic)

what are the major physiologic manifestations of anemia

hypoxia

explain the following terms: macrocytic, microcytic, normocytic, normocromic, and hypochromic

large rbcs, small rbcs, reg rbcs, reg hb content, low hb content

which anemia produces small, pale erythrocytes

hypo chromic (ex iron deficient)

a patient has a decreased number of leukocytes. what term would describe this finding?

leukopenia

after a patient has a subtotal gastrectomy, what type of anemia would result?

pernicious anemia

what is the most common cause of iron deficiency anemia?

chronic blood loss (nutritional iron deficiency)

a man has cheilosis, stomatitis, and painful ulceration of the buccal mucosa and mouth. he complains of dysphagia and watery diarrhea. these clinical manifestations are indicative of which type of anemia?

pernicious anemia

a 45 yr old male is diagnosed with macrocytic, normochromic anemia. what is the most likely cause of this condition

b12 deficiency

what causes the paresthesia that occurs in vitamin b12 deficiency anemia

nerve demyelination

a patient has fatigue, weakness, and dyspnea. his conjunctiva and palms are pale. his nails appear brittle, thin, and concave, and he has sores at the corners of his mouth. what type of anemia does he likely have?

iron deficient

a 62 yr old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. she also remarks that she has been unintentionally losing weight. physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. she should be screened for which cancers?

Hodgkins lymphoma

where is folic acid stored?

liver

what is the most common granulocyte cell

neutrophils

which vitamin deficiency will cause the patient to have decreased clotting capabilities and increased risk of bleeding

vitamin k

the underlying disorder of which anemia is defective secretion of instrisic factor?

pernicious

what lab report is typical of a patient experiencing thrombocythemia

high platelets

most individuals with a deficiency of which vitamin will experience easy bruising and excessive bleeding

k

a 21 yr old female was recently diagnosed with iron deficiency anemia. in addition to fatigue and weakness, which clinical signs and symptoms would she most likely exhibit

hair loss, brittle coarse nails, sores at corners of mouth

a patient is septic. which complication should the nurse monitor for in this patient

disseminated intravascular coagulation (dic)

what is the percentage of blood volume composed of rbcs called?

hematocrit

a low Hct is indicative of?

anemia

high mean corpuscular volume of rbcs is called?

macrocytic

what is anisocytosis? in this anemia erythrocytes are… its symptoms are…

variability of rbc size, classic symptoms

what is the schilling test and how is it done?

administration of radioactive cobalamin and measurement of its excrement in urine to test for b12 deficiency

what is the characteristic of microcytic hypo chromic anemia? give an example of this type of anemia. what are causes, symptoms etc

small, pale erythrocytes, ex. iron deficient anemia

where does folic acid absorption take place

upper small intestine

a 21 yr old woman was recently diagnosed with iron deficiency anemia. her Hct is 32%. what treatment is expected?

iron replacement

how does the body compensate for anemia?

increased rate and depth of breathing, increased heart beat

explain anemia associated with iron deficiency. what would be the anatomy/shape of erythrocytes in this type of anemia?

small pale (microcytic hypo chromic) bc iron is necessary for hemoglobin

what is macrocytic normochromic anemia? give an ex. causes, symptoms etc

large (often immature) rbcs with normal hb levels. pernicious and folate deficient, causes: folate/b12 deficiencies, symptoms: classic, beefy red tongue, abdominal pain, splenic enlargement, (b12) neurological manifestations (parethesia)

explain the role of folate and vitamin b12 in anemia

essential for nuclear maturation, dna synthesis. dna synthesis is slowed which allows other materials (rna) to build up as they produce at the regular rate causing macrocytic rbcs and immature ones (bc the dna synthesis was still impaired)

how would the fingernails of iron deficiency anemia appear

coarse, brittle

if a man has inherited the gene for sideroblastic anemia, he received the gene from which parent

mother

when does jaundice occur in hemolytic anemia?

excess hemoglobin from destroyed rbcs turns into bilirubin and it builds up faster than it can be removed

what is the pathophysiologic process of aplastic anemia?

cytotoxic T cells activate against hematopoiesis

in aplastic anemia, why does pancytopenia develop?

the autoimmunity is against the bone marrow that produces all so they are all reduced

a 2 yr old malnourished child has vitamin b12 and folate deficiencies. a blood smear suggests the deficiency is macrocytic and normochromic. what would the hemoglobin level be?

normal

what is the most likely cause of sideroblastic anemia

genetic mutation

why would a nurse check individuals with liver disease for clotting problems

the liver produces proteins involved in platelet function

a patients anemia is described as having erythrocytes that demonstrate anisocytosis. what would the erythrocytes look like?

varied sizes

what is the pathophysiologic process of aplastic anemia

cytotoxic T cells are activated against hematopoiesis

for a patient experiencing hypersplenism, what would the erythrocytes be expected to look like?

macrocytic

what is the life span of an rbc

120 days

what are examples of granulocytes

neutrophils basophils eosinophils

folic acid is essential for synthesis of which erythrocytic molecule

dna

what is a low hb concentration called (the erythrocytes)

hypochromic

what is pernicious anemia? what is the treatment? what are the main causes?

low b12, macrocytic normochromic, parenteral cyanocobalamin or oral b12, defective secretion of intrinsic factor by gastric parietal cells

why do vitamin b12 and folate deficiencies cause anemia

dna synthesis issues

give ex of normocytic normochromic anemias

post hemorrhagic, sickle cell, aplastic

explain anemia caused due to chronic inflammation

chronic inflammation increases macrophage activity which increase hemolysis and activates cytokines which decreases hematopoiesis

what is aplastic anemia? what is pancytopenia? what is the relationship btwn the two?

aplastic anemia is caused by the bone marrows inability to produce sufficient blood cells (usually bc of autoimmune disorder), pancytopenia is decreased levels of all blood cells types.

how does atrophy of gastric mucosal cells result in anemia? which type of anemia?

thats where b12 is absorbed so can result in pernicious anemia

how is the effectiveness of vitamin b12 therapy measured?

looking at erythrocytes

what are the major alteration/disorders of leukocyte function

leukemia, abnormal numbers, production or destruction disorders, inappropriate responses

name and explain some leukocyte disorders associated with changes in the quantities of leukocytes

leukocytosis (high, normal in response to physiologic stressors), leukopenia (low, not normal, predisposes to infection, more severe infection) ex. neutropenia

an iv drug user was diagnosed with hep c 5 yrs ago. he is now experiencing impaired blood clotting. which vitamin is expected to be decreased?

vitamin k, associated with clotting, liver disease predisposes to clotting issues

what are the classic clinical manifestations of infectious mononucleosis (im)?

lymph node enlargement, fever, sore throat, increased lymphocyte count, atypical activated lymphocyte

a 35 yr old male with with hyperthyroidism begins treatment to decrease thyroid activity. which conditions can result secondary to the treatment

aplastic anemia or thrombocytopenia

a 20 yr old female undergoes lab testing for anemia. results show high iron, bilirubin, and tranferrin, and low hemoglobin and hematocrit. what is the most likely diagnosis?

hemolytic anemia, high iron and bilirubin is from breakdown of rbcs

defective secretion of intrinsic factor is the underlying cause of which anemia?

pernicious anemia

a woman complains of chronic gastritis, fatigue, weight loss, and tingling in her fingers. lab findings show low hemoglobin and hematocrit levels and a high mean corpuscular volume. what is the most likely diagnosis

pernicious anemia

is thrombocytopenia congenital, acquired, or both?

both

why is pernicious anemia treated with cyanocobalamin by intramuscular injection

cyanocobalamin is a form of b12 and its intramuscular bc the issue is usually the absorption in the intestines so this bypasses the intestine absorption step

why is untreated pernicious anemia fatal?

heart failure

for which anemia is the preferred and successful method of treatment an allogenic bone marrow transplantation?

aplastic anemia

a newborn is diagnosed with congenital intrinsic factor deficiency. what type of anemia is likely to present?

pernicious anemia

what is the most likely cause of infectious mononucleosis

Epstein barr virus

a 35 yr old female is diagnosed with lymphadenopathy. which physical assessment finding will help confirm this diagnosis?

enlarged lymph nodes

a 5 yr old female is diagnosed w acute leukemia. what is the most likely treatment?

chemo

which hormone is released from kidneys and stimulates the marrow to produce and release rbcs

erythropoietin

what are the changes seen in leukocytes during an allergic disorder

eosinophilia

what is basophilia and basopenia

basophilia is high basophil count, usually in response to inflammation and hypersensitivity reactions, basopenia is low basophil count, usually in acute infections, hyperthyroidism, and long term steroid therapy

what is infectious mononucleosis? what are the common causes?

acute self limiting infection of b lymphocytes transmitted by saliva through personal contact commonly caused by Epstein Barr virus

which anemia is characterized by unusually large stem cells in the bone marrow that mature into erythrocytes that are unusually large in size, thickness, and volume

macrocytic anemia

a patient w bleeding disorder has a red purplish discoloration caused by diffuse hemorrhage into skin tissues. what is this discoloration called?

purpura

explain the clinical manifestation of infectious mononucleosis

enlarged lymph nodes

what is the mono spot test for infectious mononucleosis

tests for heterophillic antibodies (picks up on Igm)

what is leukemia

malignant disorder of the blood and blood organs

a 65 yr old male experienced loss of appetite, weight loss, lemon yellow skin, liver enlargement, and a beefy red tongue shortly before his death. what is the most likely cause of death?

heart failure from pernicious anemia

which electrolyte imbalance accompanies multiple myeloma?

calcium

a female is diagnosed w primary thrombocythemia. what will a blood smear reveal about the platelets

excess platelets

what are the early symptoms of leukemia?

bruising, fatigue, bone pain, anorexia

multiple myeloma can be defined as a neoplasm of which cells?

plasma cells