Chapter 23: Alterations Hematologic Function

Question 1

anemia

Answer 1

reduced total erythrocytes in circulating blood or decrease in quality/quantity of hgb

Question 2

anisocytosis

Answer 2

RBC assuming various sizes; seen in some anemias
having red blood cells (RBCs) that are unequal in size.

Question 3

poikilocytosis

Answer 3

RBC assuming various shapes; seen in some anemias

Question 4

patho of anemia

Answer 4

reduced O2 carrying capacity= tissue hypoxia
reduced consistency/volume blood
compensation for cell loss is movement of interstitial fluid into blood, increase plasma volume= adequate volume but viscosity decreases
thinner blood=faster= hyperdynamic= increase HR & SV= cardiac dilation, heart valve insufficiency if not corrected

Question 5

S/S anemia

Answer 5

increase rate/depth breathing
SOB (dyspnea)
rapid/pounding heartbeat
dizziness
fatigue
mild chronic= maybe only present during physical activity when need O2
pale or jaundiced skin/mm/nails/conjunctiva
impaired healing
loss skin elasticity
thinking/graying hair

Question 6

leading cause preventable death in injured

Answer 6

uncontrolled posttraumatic bleeding

Question 7

Labs acute blood loss

Answer 7

low hematocrit
elevated neutrophils & platelets
low iron

Question 8

Macrocytic (megaloblastic) anemias

Answer 8

diminished RBC production d/t ineffective erythrocyte DNA synthesis d/t nutritional deficiencies of B12 (cobalamin) or folate (folic acid)

unusually large stem cells (megaloblasts) in marrow mature into erythrocytes large in size (macrocytic), thickness, volume
megaloblastic erythrocytes DIE prematurely

Pernicious anemia is a type of megaloblastic anemia in which the body isn’t able to absorb vitamin B12 due to a lack of intrinsic factor in stomach secretions.

Question 9

Pernicious anemia

Answer 9

type of megaloblastic anemia d/t B12 deficiency
autoimmune gastritis ****impedes production of IF (instrinsic factor) ** which is required for b12 uptake from gut

Question 10

diseases and risk factors associated w/ pernicious anemia

Answer 10

DM 1
autoimmune thyroiditis
surgical removal stomach
resection ileum
tapeworm
H.Pylori
ETOH, hot tea, smoking d/t risk gastritis
increased b12 demand: pregnancy, hyperthyroid, chronic infection, cancer

Question 11

s/s pernicious anemia

Answer 11

slowly over 20-30 years
initially vague sx: infections, mood swings, GI/cardiac/kidney ailments

Hgb 7-8: weakness, fatigue, paresthesias feet/fingers, difficulty walking, loss appetite, abd. pain, weight loss, sore tongue smooth/beefy red
“lemon yellow” (sallow) skin (pallor+jaundice)
hepatomegaly (right HF)
splenomegaly
neuro (d/t nerve demylenation)= loss of position/vibration sense, ataxia, spasticity

Question 12

folate deficiency anemia

Answer 12

megaloblastic anemia; folate essential for RNA/DNA synthesis w/ maturing erythrocyte

Question 13

common people w/ folate anemia

Answer 13

alcoholics
chronic malnourishment

Question 14

s/s folate anemia

Answer 14

cheilosis (scales/fissures in mouth)
stomatitis (inflam. mouth)
painful ulcerations buccal mucosa and tongue characteristic burning mouth syndrome
dysphagia
flatulence
watery diarrhea
neuro sometimes d/t thiamine deficiency

*disappear 1-2 week after tx

Question 15

microcytic-hypochromatic anemias

Answer 15

abnormally small erythrocytes contain reduced hgb.
impairs the normal transport of iron in cells
**iron deficiency anemia most common nutritional disorder

Question 16

iron deficiency anemia

Answer 16

most common nutritional disorder worldwide
NO intrinsic dysfunction

Question 17

cause iron deficiency anemia

Answer 17

1. dietary deficiency
2. impaired absorption
3. increased req.
4. chronic blood loss
5. chronic diarrhea
6. meds cause bleed (NSAIDs)
7. surgery
8. ED
9. parasite
10. H Pylori

Question 18

iron deficiency anemia population

Answer 18

toddlers
adolescent girls
women childbearing age
poverty
infant consume cow milk
older adult restricted diet
teenagers poor diet

Question 19

early s/s iron deficiency anemia

Answer 19

gradual; seek help level 7-8
fatigue
weak
SOB
pale earlobes palms conjunctivae

Question 20

progressive s/s iron deficiency anemia

Answer 20

low h/h
koilonychia (spoon-shaped fingernails, brittle, thin, ridged)
cheilosis (inflammatory condition that causes cracking, crusting, and scaling of the corners of the mouth)
stomatitis (inflammation of the oral mucosa, which presents with ulcers)
painful ulcer mouth
dysphagia
hyposalivation
gastritis
neuromuscular changes
HA
irritable
tingle/numb
vasomotor disturb
children= cognition

Question 21

anemia chronic disease

Answer 21

mild-mod from decreased erythropoeisis & impaired iron utilization d/t chronic systemic disease/inflam.

Question 22

s/s anemia of chronic disease (ACD)

Answer 22

decreased erythropoiesis or iron utilization from chronic inflamm. disease
older adult
similar COPD, critical illness after acute event (surgery), trauma, MI, sepsis, elderly, cancers
significant drop hgb= sx
low iron, low transferrin
***very high total body iron storage
low/normal TIBC
norm/high ferritin

Question 23

why elderly predisposed to anemia chronic disease

Answer 23

age-associated hematopoetic changes w/ increased inflam. cytokines

Question 24

aplastic and hemolytic anemia

Answer 24

aplastic=
Cardiac/respiratory sx, infection
hematopoietic fail/bone marrow aplasia w/ reduction in effective production of mature cells by marrow causing peripheral panacytopenia (reduction all 3 blood cells: RBC, neutrophils, thrombocytes)

hemolytic=
splenomegaly, jaundice, bone disease/fx, cardiac/resp. if severe
premature accelerated destruction of erythrocytes

Question 25

*polycythemia vera

Answer 25

aka primary polycythemia a type of chronic myeloproliferative disorder (Type of chronic leukemia) slowly growing blood cancer in which bone marrow makes too MANY RBC increase blood volume & viscosity > blot clots! JAK2 gene 60-80 y/o males

Question 26

labs in polycythemia vera

Answer 26

elevated WBC, RBC, platelets increased hematocrit

Question 27

*s/s polycythemia vera

Answer 27

increased blood viscosity= hypercoagulable= clogging/occlusion of vessels ischemia/infarction plethora (ruddy, red color of face, hands, feet, ears, mm) engorgement retinal & cerebral veins *intense, painful itching intensified by heat or water HTN angina neuro: HA, drowsy, delirium, mania, psychotic depression, chorea, visual disturb elevated WBC, RBC, platelets splenomegaly w/ abdominal pain

Question 28

why itching in polycythemia vera

Answer 28

exacerbated by heat and water concentration of mast cells in skin; not responsive to antihistamines or topicals

Question 29

*leukemia/lymphoid neoplasm

Answer 29

clonal malignant disorder bone marrow, usually not always, of blood uncontrolled proliferation of malignant leukocytes causing overcrowding of bone marrow and decreased production & function normal hematopoietic cells

Question 30

acute leukemias

Answer 30

aggressive, rapid ALL in kids AML in adults

Question 31

s/s acute leukemia

Answer 31

abrupt stormy onset, esp. ALL anemia bleeding (purpura, petechiae, ecchymosis, hemorrhage; gums, heavy menses) infection (oral, throat, colon, urinary, lungs, skin) weight loss bone pain liver, spleen, lymph enlargement diminished sensitivity sour/sweet neuro: HA, vomit, meningeal irritation elevated uric acid

Question 32

chronic leukemia: CML & CLL

Answer 32

CLL most common in western world; slow-growing, too many immature lymphocytes bone & bone marrow

Question 33

s/s chronic leukemia

Answer 33

slow, insidious *lymphadenopathy infection w/ encapsulated bacteria

Question 34

*Hodgkin lymphoma

Answer 34

malignant lymphoma progresses from one group of lymph nodes to another and includes development of systemic sx and presence of B cells called Reed-Sternberg (RS) cells

Question 35

risk for hodgkin lymphoma

Answer 35

males whites early in life (20/30) then later in life (60/70) EBV in 70% cases

Question 36

s/s Hodgkin lymphoma

Answer 36

*enlarged painLESS lymph nose in neck lymphadenopathy intermittent fever w/o other signs infection drenching night sweats itchy skin fatigue weight loss anemia high sed. rate

Question 37

*multiple myeloma

Answer 37

clonal plasma cell cancer characterized by slow proliferation of tumor cell masses in bone marrow masses associated w/ lytic bone lesions (round, punched out regions of bone) Multiple myeloma cells found in BONE MARROW not peripheral blood

Question 38

s/s multiple myeloma

Answer 38

elevated serum Ca renal fail anemia bone lesions pain pathologic fx amyloidosis (antibody proteins stick in peripheral nerves & organs) proteinuria hyperviscosity neuro= confusion, HA, blurred vision repeated infection (PNA) *overwhelming infection leading cause of death

Question 39

Immune thrombocytopenia purpura (ITP)

Answer 39

most common thrombocytopenia (platelets < 150,000 to MD significant if < 100,000) secondary to increased platelet destruction acute (infection or allergy) or chronic (autoantibodies against platelet antigens)

Question 40

clinical manifestations ITP immune thrombocytopenic purpura

Answer 40

minor bleeding: petechiae & purpura hemorrhage from mucosal sites (epitaxis, hematuria, menorrhagia, bleeding gums) pregnancy= infant w/ thrombocytopenia bleeding & associated sx (weight loss, fever, HA) chronic= remissions & exacerbations