Patho section 2

Anemias: Anemias reduce oxygen transport in the blood because of a decrease in hemoglobin content.

  • General signs: fatigue, pallor, dyspnea, and tachycardia. Severe anemia can lead to angina and CHF

Iron deficiency anemia: Insufficient iron impedes the synthesis of hemoglobin, thereby reducing the amount of oxygen transported in the blood. Leads to microcytic (small) and hypochromic (less color) cells. Common, especially in pregnant women 

Pernicious Anemia: characterized by very large, immature, nucleated erythrocytes.

This type of anemia usually results from a deficit of folic acid (vitamin B9) or vitamin B12 (cyanocobalamin). Caused by a lack of intrinsic factor 

Aplastic anemia: Aplastic anemia results from impairment or failure of bone marrow, leading to loss of stem cells and pancytopenia, which is decreased numbers of erythrocytes, leukocytes, and platelets in the blood. 

Sickle cell anemia: abnormal hemoglobin, Hemoglobin S, changes the shape of RBCs to a crescent (sickle) shape. The cell membrane is damaged and the cells have a shorter lifespan. It is caused by genetic factors. 

  • Type of Hemolytic anemia: excessive destruction of RBCs

Hemophilia: 

Hemophilia A, or classic hemophilia, is a deficit or abnormality of clotting factor VIII. most common inherited clotting disorder. Causes hemorrhage. No treatment just take precautions

Hemophilia B (Christmas disease) is similar and involves a deficit of factor IX; hemophilia C (Rosenthal hemophilia) is a milder form resulting from a decrease in factor XI. Some cases of hemophilia result from a spontaneous gene mutation in a person with no previous family history of the disease.

Disseminated Intravascular Coagulation: is a condition, often life-threatening, that involves both excessive bleeding and excessive clotting. Occurs as a compilation of numerous problems that activate the clotting process. Causes multiple thrombosis, infarctions, consumes the available clotting factors and platelets, and stimulates the fibrinolytic process. This combination leads to hemorrhage and hypotension or shock.



Signs of clotting disorders: nosebleeds, bleeding gums, anemia, rapid pulse. Can be caused by immunodeficiency, HIV, lack of platelets, vitamin K deficiency, etc.



Polycythemia: neoplastic disorder that is characterized by an increase in RBC production. Increased blood volume and blood viscosity. Elevated BP, spleen and liver congestion.



Leukemias: One or more of the leukocyte types are present as undifferentiated, immature, nonfunctional cells that multiply uncontrollably in the bone marrow, and large quantities are released into the general circulation. Infiltrate the lymph nodes, spleen, liver, brain, and other organs. High WBC numbers causes a decrease in RBCs and thrombocytes. Crowding in the bone marrow. Overwhelming infection and hemorrhage

  • ALL – acute lymphocytic leukemia

  • CLL – chronic lymphocytic leukemia

  • AML – acute myelogenous leukemia

  • CML – chronic myelogenous leukemia

Hodgkin Lymphoma: a type of lymphoma starring in lymphocytes, often in the upper part of the body. Primarily in adults 20-40.

  • Initially involves a single lymph node (usually in the neck) which later spreads to adjacent nodes and then organs via the lymphatics 

  • Reed- sternberg cell: an atypical giant cell present in the lymph node. Used to diagnose 

  • Often staged through the Ann Arbor staging system. Stage 1: 1 lymph node, 2: 2+, 3: nodes on both sides of the diaphragm, 4: diffuse extralymphatic involvement

  • Signs and symptoms: enlarged lymph node often cervical that is painless, splenomegaly, enlarged nodes in other places, general signs of cancer, pruritus, recurrent infection

  • Treatment: radiation, chemotherapy, and surgery

Non Hodgkins: similar, but often seen in HIV patients. Multiple scattered nodes; intestinal nodes and organs involved early

Multiple myeloma: An increased number of malignant plasma cells replace the bone marrow and erode the bone. Unknown cause 

  • The onset is usually insidious and the malignancy well-advanced before diagnosis.

  • Signs and symptoms: frequent infections related to impaired production of antibodies, pain in bone involvement, pathologic fractures due to weak bones, anemia, kidney function is impaired leading to proteinuria and kidney failure

  • Chemotherapy is used to encourage remission but median survival is 3 years 

Lymphedema: involves missing lymphatics or damage to the lymphatic system 

Shock: decreased blood volume, Decreased tissue perfusion, General hypoxia

  • Can be caused by blood volume, heart contraction, or peripheral resistance 

  • Compensation: SNS and adrenal medulla: increase HR and vasoconstriction, Renin is secreted, ADH is secreted, Glucocorticoids are secreted, Increased respirations

  • Issues: vasodilation and pooling creates less venous return, vasodilation (less flow to tissue), thrombi in microcirculation, fluid shifts into tissue, organ damage 

  • Decompensation: Acute renal failure, ARDS, Hepatic failure, Paralytic ileus, Septicemia, DIC, Cardiac function depressed

  • Vital signs: Inc. HR, dec. BP, inc respirations 

  • Types: Hypovolemic, Cardiogenic, Neurogenic or vasogenic, Septic, Anaphylactic

  • Signs & symptoms: thirst, agitation, oliguria, cool moist pale skin (septic- warm dry flushed), tachycardia, weakness, dizziness, respirations inc.

  • Treatment: fix underlying problem, oxygen, epinephrine, dopamine/ dobutamine (inc heart function & dilate renal vessels), vasoconstrictors/dilators




Hypovolemic shock results from loss of blood or loss of plasma from the circulating blood.

Cardiogenic shock is associated with cardiac impairment, such as acute infarction of the left ventricle, or arrhythmias.

Neurogenic or vasogenic shock may develop from pain, fear, drugs, or loss of SNS stimuli with spinal cord injury.

Anaphylactic shock results from rapid general vasodilation caused by the release of large amounts of histamine in a severe allergic reaction 

Septic shock may develop in persons with severe infection, particularly infections with gram-negative endotoxins, 






Hypertension: 

  • Malignant: uncontrollable, diastolic is very high. renal failure, hemorrhagic stroke, vision loss, and CHF

  • Characterized by Increased arteriolar vasoconstriction, Decreased renal flow: renin secretion, Damage to arterial walls

  • Signs and symptoms: Fatigue, malaise, morning headache; elevated BP consistently

  • Treated by: lifestyle changes, diuretics (High Na), ACE inhibitors (renin), alpha blockers (vasodilator), calcium channel blockers, beta blockers (reduced heart action)

Arteriosclerosis: General term for all types of arterial changes

  • Degenerative changes in small arteries and arterioles, Loss of elasticity, Lumen gradually narrows and may become obstructed, Cause of increased BP

  • Often caused by aging

Atherosclerosis: Presence of atheromas in large arteries

  • Plaques consisting of lipids, calcium, possible clots. Cause: Diet, exercise, and stress

  • S/S: fatigue and weakness in the legs; intermittent claudication; sensory impairment; weak or absent distal pulses; skin changes

  • Diagnosed by doppler and arteriography

Angina pectoris: recurrent, intermittent brief episodes of substernal chest pain. triggered by physical or emotional stress. Occurs when there is a deficit of oxygen to meet myocardial needs

  • Relieved by rest and vasodilators 

  • Emergency treatment: Rest, Seat in an upright position, Administration of nitroglycerin, checking pulse and respiration, administer oxygen. Sometimes a second dose of nitroglycerin if theres a history of angina

Myocardial infarction: When the coronary artery is totally obstructed. Atherosclerosis is the most common cause. May also be caused by thrombus or vasoplasm. Damage varies.

  • Warning signs of a heart attack: pressure, heaviness, or burning in the chest, shortness of breath, weakness, fatigue, nausea, anxiety/fear, pain (substernal, crushing, radiating)

  • Complication: death, shock, CHF, rupture of necrotic heart tissue, thromboembolism causing stroke 

  • Treatment: reduced cardiac demand, oxygen, medication, Analgesics, Anticoagulants, Thrombolytics 

Cardiac dysrhythmias: Deviations from normal cardiac rate or rhythm. Reduces the efficiency of the hearts pumping cycle 

  • Caused by electrolyte abnormalities, fever, hypoxia, stress, infection, drug toxicity

  • Cause need to be determined and treated, antidysrhythmic drugs, pacemakers, defibrillator 

Cardiac arrest: no conduction or impulses 

  • Excessive vagal nerve stimulation, potassium imbalance, cardiogenic shock, drug toxicity, insufficient O2, respiratory arrest, blow to heart 

Congestive heart failure: Heart is unable to pump out sufficient blood to meet metabolic demands of the body

  • Can be a combination of factors and a complication of other conditions 

  • Cardiac output or stroke volume decreases: less blood reaches the various organs, decreased cell function, fatigue and lethargy

  • Backup and congestion develop as coronary demands for oxygen and glucose are not met. Output is less than inflow, congestion in venous circulation

  • signs/symptoms: decreased blood to tissues, fatigue, weakness, dyspnea, tachycardia, cutaneous and visceral vasodilation

  • Effects of left sided failure: dyspnea and orthopnea (fluid in lungs), cough

  • Effects of right sided failure: edema in feet/legs, hepatomegaly and splenomegaly, ascites,