patho exam 3 - hematology
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patho exam 3 - hematology
what is the normal range for hemaglobin (Hgb)?
what is the normal range for hematocrit (Hct)?
what is a reduction in number or circulating RBC's or a decrease in quality/quantity of Hgb?
why do women have lower RBC's and hematocrit?
what are some causes of anemia from chronic diseases?
AIDS, neoplasms (cancer), and chronic hepatitis
what are some symptoms of hemolytic anemia?
what is microcytic-hypochromic and what are 2 anemias classified under it?
small cell-low hemaglobin. iron-deficiency and siberoblastic
what causes folate (folic acid) anemia?
dietary deficiency of folic acid
how do you treat pernicious anemia?
give vitamin B
what are the symptoms for pernicious anemia?
typical symptoms (fatigue, weakness, dyspnea, and pallor), peripheral neuropathy, tingling, numbness, and loss of vibratory senses, glossitis
what are two causes of pernicious anemia?
chronic gastritis and they lack intrinsic factor in the stomach
what type of anemia is insufficient influence of vitamin B
on developing cells?
what does macrolytic-normochromic mean and name 2 anemias that are classifed under this type:
large RBC's-normal hemaglobin. pernicious anemia and folate deficiency (folic acid)
what does normochromic mean?
normal amounts of hemaglobin
what does hypochromic mean?
contains abnormally low concentration of Hgb because not enough iron and B
what does hyperchromic mean?
contains unusally high concentration of Hgb in cytoplasm because there's not enough RBC's
what does normolytic mean when referring to anemia?
cells of normal
what does microlytic mean when referring to anemia?
what does macrolytic mean when referring to anemia?
what dies "chromic" mean when referring to anemia?
what does "cytic" mean when referring to anemia?
what are the typical symptoms of anemia?
fatigue and weakness - O
is not getting to the brain and muscles, dyspnea - body is starving for O
and pallor - decreased RBC and Hct
what are the symptoms of aplastic anemia?
typical symptoms (fatigue, weakness, dyspnea, and pallor), petechiae, purpura, ecchymosis, bleeding, and infection
what causes aplastic anemia?
radiation, viruses, lesions in red bone marrow that depress its action - quit producing
what is aplastic anemia associated with?
what is normocytic-normochromic and what 4 anemias are are classified under it?
normal size-normal hemaglobin. aplastic anemia, posthemorrhagic anemia, hemolytic anemia, and anemia of chronic disease (ACD)
what are the symptoms of sideroblastic anemia?
typical symptoms (fatigue, weakness, dyspnea, and pallor), mild hepatomegaly, and splenomegaly
what type of anemia is characterized by decreased heme synthesis (genetic), acquired from lead, chloramphenicol (Chloromycetin), antitubercular drugs?
what are some social/physical risk factors for iron-deficiency anemia?
poverty, alcohol abuse, poor dentition, candle burning, GIT disease, and depression
what are some dietary risk factors for iron-deficiency anemia?
low-iron, low vitamin C, excess phytate, excess tea/coffee, fad diets
what are some demographic risk factors for iron-deficiency anemia?
elderly, teenager, female, immigrant, aborigine, and widower
what are the symptoms of iron-deficiency anemia?
the typical symptoms (fatigue, weakness, dyspnea, and pallor)
who are the most at risk for iron-deficiency anemia?
individuals of all ages with minor chronic blood loss
what is another name for absolute polycythemia and what can it cause?
polycythemia vera, causes leukemia
what causes primary absolute polycythemia?
results from abnormality of bone marrow stem cells (stem cells all want to be a RBC)
what causes relative polycythemia?
dehydration for any reason
what are the two forms of polycythemia?
relative and absolute
what is the blood like in someone with polycythemia?
thicker, increased BP and increased risk for clots
what is polycythemia?
what symptoms would someone have if they had decreased O
supple to the GI tract (hypoxia in the GI tract)?
abdominal pain, n/v, and anorexia
is the neurologic system affected in someone with a B
when you have tissue hypoxia and decreased blood flow, what happens in the kidneys?
the kidneys sense the decreased blood flow and activate the renin-angiotensin response
what happens to the character of someone's breathing when someone has tissue hypoxia?
rate and depth of breathing increases in attempt to make more O
available to remaining RBC's
what does tissue hypoxia cause?
inadequate cellular O
what is the end result of anemia?
in blood causes arterial dilation which results from what?
what is a diagnosis for infectious mononucleosis based on?
atypical lymphocytes and classic symptoms
what is an absolute rise in lymphocyte count and presence of atypical lymphocytes a result of?
proliferation of B and T cells
how does infectious mononucleosis begin?
begins with invasion of B lymphocytes that possess an EBV receptor site
with symptomatic infectious mononucleosis, what age group does it normally affect?
young adults between 15-35
what is infectious mononucleosis?
acute infection of B lymphocytes
what disease is lymphocytopenia a major problem in?
what does lymphocytosis occur most often with?
viral infections such as Esptein-Barr virus (infectious mononucleosis)
what is monocytopenia?
hairy cell leukemia/prednisone therapy
what is monocytosis?
increase in monocytes and is most common in late stages of bacterial infections
what is eosinopenia?
decreased eosinophil count (1-5%) due to migration into inflammatory sites
what is eosinophilia associated with?
allergic disorders associated with asthma, hay fever, and parasitic invasions
what is eosinophilia?
absolute increase in total numbers of eosinophils in blood
what does a shift to the left mean?
when demand for neutrophils > circulatory supply. marrow releases immature WBC's into blood and blood smears look similar to leukemia
what is agranulocytosis?
neutrophils < 500... very serious
what is neutropenia?
low neutrophil count <2000 r/t decreased marrow production
what is granulocytosis or neutraphilia?
prevalent in early stages of infection or inflammation when stored neutrophils from venous sinuses released into circulating blood
what does increased WBC's 24 hours after surgery indicate versus 3 days after surgery?
24 hours - inflammation
3 days - infection
is leukopenia ever good?
no, put them on neutrapenic precautions
what is leukopenia?
lower than normal <5,000
what can cause leukocytosis?
invading microorganisms, allergic responses, inflammatory response after surgery, and anesthesia
what is leukocytosis?
higher than normal > 10,000
what may leukocytosis indicate?
what are some treatment options for absolute polycythemia?
minimize risk of thrombosis and prevent progression to acute leukemia
what causes secondary absolute polycythemia?
increase in erythropoietin in response to chronic hypoxia (high altitude, smokers, COPD) or erythropoietin tumors
is primary or secondary absolute polycythemia more common?
people affected with primary absolute polycythemia have a mutation in what gene? what does that gene do?
Janus kinase 2 (JAK2), it increases erythropoietin receptors in bone marrow regardless of the level of erythropoietin
what is thrombocythemia?
platelet count > 600,000
how do you treat immune thrombocytopenic purpura?
when is chronic immune thrombocytopenic purpura more common?
in females ages 20-40
what is immune thrombocytopenic purpura preceded by?
what age group is acute immune thrombocytopenic purpura common in?
children and young adults
can Immune thrombocytopenic purpura (IPT) be acute, chronic, or both?
what are some secondary causes to thrombocytopenia?
viral infections that destroy platelets, bacterial infections that consume platelets, IgG autoantibodies, or drug hypersensitivities (ex. heparin)
when can hemorrhage occur in thrombocytopenia?
from minor trauma and when platelet count is < 50,000
what is thrombocytopenia?
platelet count <100,000
what does Waldenstrom macroglobulinemia do?
produces IgM that leads to high blood viscosity that interferes with circulation to eyes, brain and kidneys
what type of bone tumor is Waldenstrom macroglobulinemia?
what are the most common initial symptoms for malignant myelomas?
bone pain in single or entire skeletal system, pathologic fractures (bones can break by just turning them in bed), renal failure, recurrent bacterial infections (most common cause of death)
in malignant myelomas, what abnormal antibody becomes protein and is at its highest level in the blood?
what causes malignant myelomas?
bone lesions and hypercalcemia
is lymphoblastic lymphoma common in males or females?
the majority of lymphoblastic lymphoma originates from what cell?
what age group and region is Non-Hodgkin Lymphoma most prevalent in?
children, East Africa and New Guinea
what is Burkitt Lymphoma?
B cell tumor involving jaw and facial bones
what symptoms are specific to Non-Hodgkin Lymphoma?
pleural effusion, abdominal pain, and splenomegaly
which cells are deviated in Non-Hodgkin Lymphoma?
B cells, T cells, and NK cells
what are some causes of Non-Hodgkin Lymphoma?
cancer causing viruses, immunodeficiency, H. pylori infection
are there Reed-Sternburg cells in non-Hodgkin lymphoma?
how do you confirm if someone has Hodgkins Lymphoma and why?
get a sample of lymph to verify because that's where Reed-Sternburg cells are
what are some symptoms for Hodgkins lymphoma?
night sweats, fever, weight loss, and weakness
in Hodgkins lymphoma, are lymph nodes painful or painless?
which lymph nodes are involved in Hodgkins lymphoma?
neck nodes; single or chain, cervical, inguinal, axillary, and retroperitoneal - abdominal pain
what happens to B cells in Hodgkins lymphoma?
B cells are deviated
what causes Hodgkins Lymphoma?
caused by Reed-Sternburg cells that are malignant tissue macrophages that are scattered among normal cells
how does malignant lymphomas develop?
proliferation of malignant lymphocytes in lymphoid system, classified by cell type
is chronic myelogenous leukemia generic?
what is a common complication in chronic myelogenous leukemia?
hyperuricemia which produces gouty arthritis
what chromosomes are affected in chronic myelogenous leukemia and in how many cases?
9 and 22 (Philadelphia chromosome) in >95% of cases
how does someone get chronic myelogenous leukemia?
clonal and believed to arise from hematopoietic stem cell
in chronic lymphocytic leukemia, what does hypogammaglobulinemia affect the body? what is someone more at risk for?
is affects humoral immunity, and someone is at higher risk for infection with encapsulated bacteria
why does someone get chronic lymphocytic leukemia?
B cells fail to mature into plasma cells that synthesize immunoglobulin
what are the symptoms for acute myelogenous leukemia?
fatigue, fever, night sweats, petechial hemorrhages, weight loss, uricemia, pallor r/t bone marrow depression
why does someone get pancytopenia with acute myelogenous leukemia?
bone marrow involvement, bleeding, anemia, and infection
is acute myelogenous leukemia more common in adults or children?
what happens to the liver, spleen and lymph nodes in acute lymphocytic leukemia?
is it harder to get adults or children into remission in acute lymphocytic leukemia and why?
adults, dealing with B AND T cells
where does acute lymphocytic leukemia originate from?
transformed precursor B cells in children and from precursor B and T cells in adults
how do you define acute lymphocytic leukemia as far as lymphoblast count?
> 30% lymphoblasts in marrow or blood
is acute lymphocytic leukemia more common in adults or children?
what is acute lymphocytic leukemia?
which drug can predispose someone to getting leukemia and why?
the antibiotic chloramphenicol, causes bone marrow depression
the most common genetic abnormality is on which chromosomes?
9 and 22 (the Philadelphia chromosomes)
is leukemia usually familial?
what are the 4 types of leukemia?
AML - acute myeloid leukemia
ALL - acute lymphoid leukemia
CML - chronic myeloid leukemia
CLL - chronic lymphoid leukemia
how is leukemia classified?
1) predominant cell of origin
: myeloid (from bone marrow) and lymphoid (from lymph)
2) rate of progression (acute or chronic)
what does uncontrolled proliferation of dysfunctional WBC's in leukemia result in?
pancytopenia or reduction in all blood cells
what is leukemia?
malignant disorder of the blood and blood forming organs
why does someone have coagulation disorders?
usually caused by defects/deficiencies of one or more of clotting factors (genetic)
where does DIC happen, in the intrinsic or extrinsic pathway?
when is the only time a clot should form?
when something is wrong, not for no reason
when does thrombocythemia clot?
when nothing is wrong
what does it mean if a PT test is decreased?
doesn't take as long to clot
in someone with thrombocytopenia, is a PT increased or decreased and what does that indicate?
increased, takes longer to clot
in a simplified version, what is going in with someone who has DIC?
they bleed then clot, bleed then clot. clotting and hemorrhaging are simultaneously occuring
in DIC, what does plasmin do?
it degrades fibrin before stable clot can develop and pieces of it are released
what can cause DIC?
gram-negative sepsis, septic chock, hypoxia can damage endothelium and precipitate DIC by activating clotting pathway
what are the 3 pathologic processes in DIC?
-exposure to tissue factor (TF) which complexes with Factor VII. Excess TF activates clotting pathway
-direct activation of factor x
how does someone get disseminated intravascular coagulation (DIC)?
acquired with variety of predisposing conditions
what happened to the clotting cascade in liver disease?
clotting cascade takes longer or has no cascade at all which impacts platelet function, and fibrinolytic systems
Why are the containers that TPN come in a risk factor for vitamin K deficiency?
the containers are sterile which inhibit E. coli in the GI tract which is needed to produce vitamin K
what is the most common cause of a deficiency in vitamin K?
parenteral nutrition combined with broad-spectrum antibiotic that destroy normal gut flora
what is the Triad of Virchow?
-loss of vessel wall integrity from injury (tissue factor released)
-blood flow abnormalities such as obstruction
-blood constituent alterations such as polycythemia
what is secondary hypercoagulability?
conditions that promote venous stasis (immobility, DVT)
what does hypercoagulability result from?
deficiency of anticoagulation proteins (too much ability to clot)
what is thromboembolic disease?
occur from a fixed clot (thrombus) or moving clot (embolus) that obstructs blood flow
is a d-dimer test increased or decreased in someone with DIC?
what is the max range for d-dimer test in adults?
0.5 is max
what is a D-dimer?
neoantigen produced by plasmin lysis of fibrin clots
what is the most reliable and specific test for diagnosing DIC?