N300 Hemolytic Disorders
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when entire CBC is suppressed, marked decrease in the number of RBCs, WBCs, and platelets
When is the Hemoglobin (Hb) value reduced?
in cases of anemia, hemorrhage, and states of hemodilution.
So, if Hb is increased, it can be found in polycythemia or in states of hemoconcentration-- which can be developed from volume depletion
What is the HCT?
- represents the percentage of RBCs compared with the total blood volume.
- Reductions adn elevations of hct are seen in teh same conditions that raise adn lower Hb. HCT= 3xHb
What does a WBC over 11,000 mean?
associated with indection, inflammation, tissue injury or death, and malignancies (leukemia or lymphoma). Doesn't tell degree of illness but can help with etilogy
What does a WBC of less than 4,000 mean?
- associated with bone marrow depression, severe of chronis illness, and some types of leukemia
What is the WBC differential count?
- measures the % of each type of leukocyte
- provides clues to determine the cause
What is a "shift to the left?"
- when infections are severe, the body releases more granulocytes from the bone marrow. To meet the increased demand, mant young, immature polymorphonuclear neutrophils are released into circulation.
- Since we write in lab notes the WBCs in order of maturity, with the immature ones on the left of the sheet. So.... the existence of many immature cells will be termed a "shift to the left".
- absolute neutrophil count is less than 1000 cells/mul
- severe is less than 500 cells
What is the normal platelet count?
150,000 to 400,000
What is thrombocytopenia?
neutrophil count of below 100,000
- bleed may occur.
- Spontaneous hemmorrhage occurs when it is below 20,000
What is Thrombocytosis and when does it occur?
- excessive platelets
- occurs with inflammation adn some malignant disorders
- Excessive clotting is a likely complication
What is anemia?
deficiency in the # of RBCs, the quality of Hg, and/or the volume of packed RBCs (HCT).
What is thalassemia?
a group of diseases that have an autosomal recessive genetic basis involving inadequate productino of normal hemoglobin
What is pernicious anemia?
a disease in which the astric mucosa is not secreting IF beacuse of antibodies being directed against the gastric parietal cells and/or If itself. Causes Megaloblastic anemia
What is megaloblastic anemia?
- group of disorders caused by impaired DNA synthesis. Characterized by the presence of large RBCs (megaloblasts)
- Majority result in teh deficiency of Cobalmin (vit B12) and folic acid
What does the lack of B12 do?
- Alters the structure and disrupts the function of the peripheral nerves, spinal cord and brain.
- Impairs cellular division and maturation esp in rapidly proliferating RBCs.
What is IF?
- Intrinsic factor
- Protein secreted by the patietal cells of teh gastric mucosa
- IF is required for colbalmin absorption in the small intestine
What happens when you have a folic acid deficiency?
You can get megaloblastic anemia. Folic acid is required for DNA synthesis-- RBC formatino and maturation
What is aplastic anemia?
- results from a decreased production of bone marrow elements.
- Hypocellular bone marrow
What is pancytopenia and what does it cause?
- decrease of all blood cell types-- RBCs, WBCs, and platelets.
- Causes Aplastic anemia
What is hypocellular bone marrow and what does it cause?
- marrow replaces with fat
- Causes Aplastic anemia
What is acute blood loss caused by?
- trauma, stroke, adn surgery-- a result of sudden hemorrhage
- Blood volume and RBCs usually diminished
Sources of chronic blood loss are.....
bleeding ulcer, hemorrhoids, menstrual and post menopausal blood loss
What is hemolytic anemia?
destruction or hemolysis of RBSs at a rate that exceeds production.
What is intrinsic hemolytic anemia?
- result from defects in the RBCs themselves caused by abnormal hemoglobin (e.g. sickle cells), enzyme deficienciesthat alter glycolysis, or RBC membrane abnormalities
- *usually hereditary
What is are extrinsic hemolytic anemias?
These are acquired. in this type, the patient's RBC's are normal, but damage is caused by external factors such as trapping of cells within the sinuses of the liver or spleen, antibody-mediated destruction, toxins, or mechanical injury
What is SCD?
- Sickle Cell Disease
- Group of inherited, autosomal recessive disorders.
- Chronic form of hemolytic anemia
What race is most likely to have SCD?
- 8% of African americans are heterozygous (carriers),
- 1% are homozygous (have the disease)
What is Hydroxyurea
- An anti-sickling agent
- Erythropoietin in pt unresponsive to this
What is are the 3 causes of acquired hemolytic anemia?
- 1. physical factors
- 2. immune reactions
- 3. infectious agents and toxins
What is hemochromatosis?
autosomal recessive disease characterized by increased intestional iron absorption and, as a result, increased tissue iron depostition. The most common genetic disorder among whites
What is polycythemia?
Increase in teh number of circulating RBCs and concentration of Hgb
What is primary polycythemia?
neoplastic stem cells disorder increase production of RBCs, granulocytes, and platelets
What is secondary polycythemia?
most common out of the two, abnormal increase in erythropoietin causeing excessive RBC production
What is Erthromyalgia?
Burning sensation of the fingers and toes
What kind of polycythemia can occur with hypoxia?
What is Thrombocytopenia?
- a decrease in the # of circulating plateles
- Lecture= <100,000
- Book= <150,000
What is the circulating life of platelets?
What are the 3 causes of Thrombocytopenia?
- 1. Dec. production (inherited or acquired)
- 2. Inc. destruction (immune system defect called ITP or caused by infection or drug induced) acute form found in children. Chronic form found in women 20-50
- 3. Inc. Consumption
What is hemophilia?
group of hereditary sex-linked clotting factor disorders characterized by prolonged coagulation times resulting in excessive bleeding
What is Hemophilia A?
- deficiency in factor VII (necessary for stabilization of fibrin clots)
- Most common form (80% of all cases)
What is hemophilia B?
deficiency in factor IX (vitamin dependent beta globulin essential in stage one of intrinsic coagulation system as an influence on teh amount of thromboplatin available)
What is Von Wilebrand's disease?
deficiency of von Willebrand factor which is necessary for factor VII activity and platelet adhesion.
What is DIC?
disseminated intravascular coagulation
- abnormal initiation and acceleration of clotting adn simultaneous hemorrhage
- Paradoxical bleeding occurs as a result of consumption of clotting factors and platelets
What is the cause of DIC
Always an underlying condition
What is Leukopenia?
a decrease in the total WBC count (granulocytes, monocytes, and lymphocytes)
What is Granulocytopenia?
a deficiency of granulocytes (neutrophils, eosinophils, and basophils)
What is neutropenia?
- reduction in neutrophils-- some use this interchangeably with granulocytopenia.
- Neutrophils are monitored closely becuase they play a major role in phagocytizing pathogenic microbes-- indicates a patients risk for infection.
What is the normal range for neutrophils?
What is the level for neutropenia?
What is Leukemia?
- •Malignant disorder of blood forming tissues of the bone marrow, spleen, and lymph system
- characterized by unregulated proliferation of WBCs and their precursors.
What is ALL
–Acute lymphocytic leukemia (ALL)
•Peak ages 2-4
- •Immature granulcytes
- proliferate and accumulate in marrow
What is CLL?
- •More common in men peaks between
- ages 50-70
- •Abnormal and incompetent
- lymphocytes proliferate and accumulate in lymph nodes and spleen
What is AML?
- •Al age groups but peak is around
- age 60
- •Uncontrolled proliferation of myeloblasts
- which are precursors to granulocytes and accumulate in bone marrow
What is CML?
•Uncommon under age 20
- •Uncontrolled proliferation of
- granulocytes resulting in increased circulating blast cells
- •Marrow expands into long bones,
- and spleen
What are Malignant Lymphomas?
- Lymphomas are a group of
- malignant neoplasms that affect the lymphatic system resulting in the proliferation of lymphocytes
Hodgkin's and Non-Hodgkins
What are characteristic's of Hodgkin's lymphoma?
•More common in men and Whites
- •Peaks 15-35 years of age &
- 55-70 years of age
- •Possible causes (Epstein Barr
- virus/familial pattern, exposure to toxins)
- •Originates in lymph node and
- infiltrates the spleen, lung and liver
•Reed-Sternberg cell present
What are characteristics of Non-Hodgkin's lymphoma?
•Most common form of lymphoma
•Affects adults 50-70 years old
•More common in men and whites
- •Link to viral infections, immune
- disorders, genetic abnormalities, exposure to chemicals, infection with
•Reed-Sternberg cells are absent
- •Lymphoma originates outside lymph
- and infiltrates the lymph nodes
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