Pathophysiology - Alt. of Hematologic Fxn
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What is hematocrit?
Percentage of whole blood that is made up of RBCs.
What is the definition of anemia and the 3 causes?
Conditions in which there is a decrease in the quality/quantity of hemoglobin.
Causes: Defective RBCs, blood loss, increased RBC destruction
What is polycythemia?
Conditions in which there is excessive RBC numbers or volume.
What are common causes of polycythemia?
- Blood doping
What is a decrease of RBCs or hemoglobin function?
What are some signs someone has anemia?
Increased respiratory rate/depth
How does the cardiovascular system compensate for anemia?
Increases heart rate and dilates capillaries.
How does the respiratory system compensate for anemia?
Increased respiratory rate and depth.
How does the renal system compensate for anemia?
Decreased blood flow to the kidneys triggers the rennin-angiontensin cycle, causing the kidneys to retain water.
How does the hematologic system compensate for anemia?
Bone marrow is stimulated to increase RBC production.
What is the reticulocyte count?
The number of immature RBCs.
What is regenerative anemia and what are 2 examples?
Anemia where the bone marrow is still working to produce RBCs.
Examples: Hemolytyic disorders, blood loss.
What is non-regenerative anemia?
Anemia caused by decreased erythropoiesis (formation of RBCs). Bone marrow is probably the cause of disease.
What happens to the RBC as it matures?
More hemoglobin is formed and the cells become redder and smaller.
What stage of immature RBC is forced into circulation during anemia?
What causes macrocytic-normochromic anemias?
Abnormal DNA synthesis causes cells to die prematurely.
What causes microcytic-hypochromic anemias?
Iron metabolism disorders
What causes normocytic-normochromic anemias?
Insufficient number of RBCs.
What are 2 forms of macrocytic-normochromic anemias?
- Pernicious anemia
- Folate deficiency anemias
What causes pernicious anemia?
Lack of gastric intrinsic factor.
What are folate deficiency anemias?
There is a lack of folic acid which is needed to make red blood cell DNA.
Humans are dependent on dietary intake of folate.
What are causes of iron-deficiency anemia?
Pregnancy and menorrhagia in women
Ulcers, ulcerative colitis, cancer
Insufficient iron intake
What are 5 examples of normocytic-normochromic anemias?
- Aplastic anemia
- Posthemorrhagic anemia
- Hemolytic anemia
- Anemia of chronic inflammatino (AIDS, SLE)
- Sickle cell anemia
What is sickle cell disease?
Inherited disease with a higher incidence in African-americans where abnormal hemoglobin is produced causing elongated RBCs that die easy.
What 2 disorders that alter leukocyte function?
- Quantitative disorders: decreased bone marrow activity and production
- Qualitative disorders: altered WBC function
What is leukocytosis?
An increased number of WBCs.
What is leukopenia?
Deficient numbers of WBCs which is never normal or beneficial.
What is neutophilia?
Increased number of neutrophils seen in early phases of infection.
The left shift is the premature relase of neutrophils (band cells) into circulation.
What is neutropenia?
Decreased number of neutophils seen with severe/prolonged infections and decreased bone marrow production.
What is agranulocytosis?
Drastically low numbers of neutrophils, eosinophils, and basophils.
What does neupogen stimulate?
Bone marrow production.
What is eosinophila?
Increased number of eosinophils seen with allergic and dermatologic disorders.
What is eosinopenia?
Decreased number of eosinophils seen in Cushing syndrome and stress responses.
What is a basophilia?
An increased number os basophils, rare, seen with heartworm disease.
What disorder is related to basopenia?
What is monocytosis?
An increased number of monocytes that correlates poorly with disease states.
What is monocytopenia?
A decreased number of monocytes, rare.
What is lymphocytosis?
An increased number of lymphocytes seen with viral infections and malignancies.
What is lymphopenia?
Decreased number of lymphocytes seen with AIDs and stress.
What are 6 common WBC disorders?
- Infectious mononucleiosis: Epstein-Barr virus, 30-50 day incubation period; fever, sore throat.
- Leukemia: malignant proliferation of WBCs, exact cause unknown.
- Multiple myeloma: M-Proteins in the blood, destructive bone lesions, and Bence Jones proteins in the urine.
- Lymphadenopathy: enlarged, tender lymph nodes.
- Hodgkin disease: malignant lymphoma, spreads through lymph nodes.
- Non-Hodgkin lymphoma: wide spectrum of malignancies of the lymphoid system, rarely localized, responds poorly to chemo.
What are 3 causes of hemorrhage?
Neoplastic erosion of vessel walls
What kind of flow results from arterial hemorrhage?
Spurting and pulsating.
What kind of flow results from venous hemorrhage?
What are the 3 different capillary hemorrhages?
- Petechia: minute
- Purpura: slightly larger
- Ecchymoses: large (1-2 cm)
What is hematoma?
Accumulation of blood enclosed in tissue.
What is it called to have blood in the thorax, peritoneum, and pericardium?
- Hemopericardium or cardiac tamponade
What is hemoptysis?
Coughing up blood.
WHat is hemetemesis?
What is hemarthrosis?
Blood in a joint capsule.
What is hematochezia?
What is melena?
Passage of discolored blood in the stool.
What is hematuria?
Blood in the urine.
What is menorrhagia?
Menstrual bleeding (known to attract bears)
What are the 10 steps of thrombogenesis?
1) Tissue damage of endothelial cells of vessel wall
2) Vasoconstriction slows flow
3) Platelets rapidly adhere to the walls
4) Clotting cascade
5) Thrombin converts fibrin to fibrinogen
6) Fishnet meshwork starts to form clot
7) Meshwork traps RBCs and adheres to vessel wall
8) Anticoagulants (Plasmin) control clotting
9) Fibrin retracts the wound
10) Fibrinolytics dissolve clotted blood
(Damaged/Intact) endothelial cells (stimulate/inhibit) thrombogenesis?
Damaged endotehlial cells stimulate thrombogenesis (clotting).
Intact endothelial cells inhibit clotting.
What is a thrombus?
An abnormal mass of clotted blood attached to the wall of a blood vessel.
What is an embolus?
An abnormal mass of clotted blood or foreign matter moving freely in ciculation.
What are the 5 types of thrombi based on location?
- Intramural: endocardium, usually overlying MI
- Valvular: heart valves
- Arterial: seen with atherosclerotic diseas
- Venous: seen with varicose veins
- Microvascular: small vessels
What happens to most small thrombi?
They are lysed (plasmin) without consequences.
What is recanalization?
When blood again flows through a previously obstructed lumen.
What are 5 possible outcomes of larger thrombi?
- Remain attached and degrade into collagenous fibrous tissue.
- May break off into emboli
- Narrow the lumen of a blood vessel causing ischemia
- Occlude the lumen of ablood vessel causing hypoxia or MI
What are the 4 types of embolism?
- Thromboemboli: frags of thrombi, most common
- Liquid emboli: fat, amniotic fluid
- Gaseous emboli: the bends
- Solid particle emboli: tumor cells, foriegn bodies
Where do venous emboli typically lodge?
In the pulmonary arteries and lungs.
Where do arterial emboli originate?
The l. heart or arterial system.
What do arterial emboli frequently cause?
Ischemia in various organs.
Stroke if they lodge in cerebral circulation. Heart attack in coronary circulation.
Where do pulmonary emboli originate and what do the result in?
The originate in the veins of the legs and travel to the heart and pulmonary arteries when could be fatal if they lodge there.
How do arterial emboli become fragmented?
Due to the disruption of fast arterial flow.
What is infarction?
An acute onset of insufficient blood supply due to thrombi/emboli.
What happen when blood from collateral circulation reaches an infarcted area w/i a few days?
What is a white infarct?
Typical of arterial occlusion in solid organ.
What is a red infarct?
Infarction typical of venous obstruction.
How do infarcts affect port-mitotic cells?
Damaged cells are replaced by fibrous tissue.
- Heart: myocardial fibrosis (scarring)
- Brain: liquefactive necrosis
How do infarcts affect mitotic cells?
Heal with relatively few residual effects like with the liver or spleen.
What are septic infarcts?
Caused by infected thrombi/emboli, may transform into a shitty abscess.
What are the 3 mechanisms of shock?
What is cardiogenic shock?
Shock caused by heart pump failure.
What causes hypovolemic shock?
Massive hemorhage, water loss, vomiting, diarrhea
What is hypotonic shock?
Shock due to loss of vascular tone causing blood to pool in blood vessel periphery.
What type of shock is anaphylactic shock?
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