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2013-02-20 15:26:28
Anemia Blood disorders

Chapter 20
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  1. What is anemia?
    The reduction in the numbers of RBCs or decrease in quality or quantity of hemoglobin
  2. What are causes of Anemia?
    • ◦Altered production of RBCs
    • ◦Blood loss
    • ◦Increased RBC destruction
    • ◦Combination of all three
  3. Anemia Classification? Morphology
    Size: -cytic ( Macrocytic, Microcytic, Normocytic)

    Hemoglobin content: -chromic (Normochromic, Hypochromic)
  4. What is the Physiologic Manifestation of Anemia?
    Reduced-oxygen carrying capacity of the blood causing tissue hypoxia.
  5. What ae symptoms of Anemia?
    • Extreme Fatigue
    • Cold Hands and feet
    • Shortness of breath
    • headache
    • Dizziness
    • Weakness
    • Pale Skins
  6. What is Normocytic-normochromic anemia?
    Aplastic (Rare) and Posthemorrhagic
    A blood disorder characterized by normal amounts of haemoglobin within normal-sized red blood cells. However, the number of red blood cells is low.
  7. What is Macrocytic-Normochromic Anemia? (Megaloblastic)
    Unusually large stem cells in the marrow that mature into erythrocytes that are unusually large in size, thickness, and volume
  8. What is Pernicious Anemia?
    Lack of intrinsic factor which is used for gastric absorption of Vitamin B12.
  9. What is the treatment for Prenicious anemia?
    B12 injections until deficiency is corrected and then monthly for life.
  10. What are Prenicious anemia symptoms?
    • Typical Anemia symptoms
    • Loss of appetite
    • Abdominal pain
    • Jaundice
    • Splenomegaly
    • Beefy red tongue
    • Difficulty walking
    • Weight loss
  11. What is Folate Deficiency anemia?
    Essential vitamin for DNA and RNA synthesis. Absorption occurs in upper small intestine
  12. Symptoms of Folate deficiency are?
    Similar to pernicious anemia but can also have: Inflammation of the mouth

    • Painful ulcerations of buccal mucosa
    • Dysphagia
    • Flatulence
    • Watery Diarrhea
  13. What are treatments for Folate deficiency anema?
    Daily oral administration of folate?
  14. What is Iron deficiency anemia. (Microcytic-hyponormic)?
    Most common type of anemia worldwide.

    Without enough iron your body cannot produce enough hemoglobin.
  15. Causes of Iron deficiency?
    • Pregnancy
    • Continuous loss of blood
    • Nutritional iron deficiency
  16. What is the treatment and prevention for Iron deficiency?
    • Elimate sources of blood loos
    • Iron supplements
    • Avoid Milk and Antacids
    • Eat foods rich in iron (Egg yold, fish, legumes, livers, poultry, WHole grain bread)
  17. Normocytic -Normochromic (Hemolytic Anemia)?
    • Premature destruction of RBCs. (intrinsic or extrinsic)
    • -In: Abornomalities in RBC membrane of cytoplasmic content.)

    -Ex: Liver or kidney disease, side effects of meds, infections, abnormal immune response.
  18. Sickle Cell disease And Sickle cell trait

    What causes abnormal shape?
    Child inherits 1 HbS foreach parent (Ressive Dominant)

    Child inherits HbS from 1 parent and HbA from another.

    Deoxygenation and dehydration
  19. What are alterations of Leukocyte Functions Quantitative?
    • –Increases or decreases in cell numbers
    • •Bone marrow disorders or premature destruction of cells
    • •Response to infectious microorganism invasion
  20. What are alteration of Leukocyte Funtion Qualitative?
    •Disruption of cellular function

    •Ex. leukemias – disorder that suppresses marrow function
  21. Leukocytosis?
    Increase WBC (Normal response)

    Excercise, pregnancy, surgery
  22. Leukopenia
    Decrease in WBC

    –Never normal and not beneficial 

    –A low white count predisposes a patient to infections
  23. Granulocytosis and Neutropenia?
    - Increase of neutrophils

    -reduction of circulating neutrophils <2,000mm.

    • (Prolonged severe infection
    • decreased production
    • reduced survival)
  24. What is Infectious Mononucleosis?
    Acute, self limiting infection of B-Lymphocytes transmitted by personal contact.

    Caused by Epstein Barr Virus- 85%
  25. What are symptoms and treatment of Mono?
    • Fever
    • Sore throat
    • Swollen cervical lymph nodes
    • increased lymphocyte count

    Severe: Spleen rupture

    Treatment: Rest and alleviate symptoms
  26. What is Leukemia? Which ones are the most common in children and adults?
    Malignant disorder of the blood and blood forming organs.

    Excessive accumulation of leukemic cells.

    • –AML most common adult leukemia
    • •Most common malignancy of childhood–80% to 85% are acute lymphocytic leukemias (ALL); remainder acute myelogenous leukemia (AML)
  27. What is acute Leukemia?
    •Presence of undifferentiated or immature cells, usually blast cells

    •Fast growth
  28. What is Chronic Leukemia?
    •Predominant cell is mature but does not function normally

    •Slower growth
  29. What is the common Pathologic feature of all leukemias?
    • –uncontrolled proliferation of malignant leukocytes leading to overcrowding of bone marrow
    • –decreased production/function of normal hemotopoietic cells
  30. Acute Myelogenous Leukemia?
    Fast growing, deals with RBC, some WBC and Platelet production in bone Marrow.
  31. Chronic Lymphocytic leukemia?
    Slow growing takes place in the bone marrow that grows B-lymphocytes.
  32. Signs and symptoms of Leukemia
    • •anemia
    • –bleeding purpura
    • –petechiae
    • –ecchymosis
    • –thrombosis
    • –hemorrhage
    • –DIC
    • –infection
    • –weight loss
    • –bone pain
    • –liver, spleen,
    • and lymph node enlargement
  33. Manifestation of Leuk?
    •Manifestations of pallor, fatigue, purpura, bleeding, and fever

    Decrease in RBCs, platelets, and changes in WBCs
  34. Hodgkin Lymphoma?
    Characterized by its progression from one group of lymph nodes to another, development of systemic symptoms, and the presence of Reed-Sternberg cells in the lymph nodes.

    Rare in childhood
  35. Hodgkins? Physical findings and symptoms
    • •Physical findings–Adenopathy (painless lymph node enlargement), mediastinal mass, splenomegaly, and abdominal mass
    • •Adenopathy in the neck is often the first sign of HL

    •Symptoms–Fever, weight loss, night sweats, pruritus, fatigue
  36. Evaulation and treatment of Hodgkins?
    CXR and radiation/chemo
  37. Non Hodgkins
    • •Generic term for a diverse group of lymphomas:
    • –B-cell neoplasms
    • –T-cell neoplasms
    • –NK-cell neoplasms

    Defferiented from HL by LACK of RS cell
  38. What are risk factors of Non- Hodgkins Lymp.
    •Risk factors include exposure to variety of mutagenic chemicals, irradiation, infection with certain cancer related viruses, immune suppression, and genetics
  39. Manifestation of NON HL?
    –Manifestations start out as localized or generalized lymphadenopathy similar to HL (cervical, inguinal, axillary, femoral most common sites); others include retroperitoneal and abdominal masses that cause fullness, back pain, ascites, and leg swelling
  40. Multiple Myeloma?
    •Cancer of the plasma cells in bone marrow(Plasma cells normally produce antibodies fight infections)

    •Infiltrate bone marrow and aggregate into tumor masses in skeletal system
  41. Symptoms of Multiple Myeloma?
    Hypercalcemia (what range?),Pain, renal failure, anemia,bone lesions
  42. Manifestation of Multiple Myeloma?
    –Infiltration of bone by malignant plasma cells à stimulation of osteoclasts to reabsorb bone à pain & release of calcium
  43. Multiple Myeloma Evaluation and treatment?
    –Diagnosis made by symptoms; radiographic and laboratory studies, and bone marrow biopsy

    –Chemotherapy, radiation, and bone marrow transplantation

    •Prognosis remains poor even with treatment
  44. What causes thrombocytopenia?
    Normal Lab values: 150-400

    Less than 150000 Platelets

    • Cause}Hypersplenism
    • Autoimmune diseases
    • Viral or bacterial infections that cause disseminated intravascular coagulation (DIC)
    • Heparin Induced Thromboyctopenia (HIT)
  45. What is Immune thromcytopenic Purpura and treatment?
    Bleeding disorder in whic the immune system destroys platelets by producing antibodies against them:

    Treatment: Pallative (Steroids, splenectomy, more aggressive immunosuppressives)
  46. Essential (Primary) Thrombocythemia?
    •A disorder in which platelet production increases, resulting in platelet counts greater than 600,000/mm3

    •This condition slowly gets worse over time

    •A result of defects in thrombopoietin receptor–Receptor cannot bind and adequately remove the hormone so levels remain high
  47. Thrombocythemia manifestations?
    –Large vessel arterial or venous thrombosis and ischemia in fingers, toes, or cerebrovascular regions
  48. Thrombocythemia Treatment?
    –Anagrelide, a drug that interferes with platelet maturation rather than production

    •doesn’t interfere with RBC and WBC growth and development
  49. What is Disseminated Intravascular Coagulation?
    •Complex, acquired disorder in which widespread clotting and hemorrhage occur simultaneously

    •Infectious disease, particularly sepsis, is most commonly associated with DIC

    •DIC leads to the formation of small blood clots inside the blood vessels throughout the body.

    Can lead to organ failure.
  50. DIC Cinical signs and symptoms?
    • –Bleeding at 3 or more unrelated sites
    • –Shock – may be preceded by bleeding into closed compartments
    • –Purpura, petechiae, and hematomas
    • –Symmetric cyanosis of the fingers and toes–Change in LOC, behavior, and confusion
  51. Treatment of DIC?
    –Eliminating underlying pathology first then controlling ongoing thrombosis and maintaining organ function