Class 9 - Alterations in Cardiovascular Function Flashcards
Red Blood Cells
Purpose: To carry oxygen and CO2
Building Blocks: Iron B12, folic acid, others
Lab Values
- Hemoglobin: 120-180 g/L
- Hematocrit: % of blood that is RBC’s
- If saline is given hematocrit decreases
Anemia
- Reduction in the number of RBC’s in the blood or a decrease in the level of hemoglobin
- Less RBC = lower oxygen carrying capacity
- Manifestations - Tiredness
Etiology: Impaired production of
- Iron, B12, folate, causes chronic disease
- Blood loss or destruction (hemolysis) of RBC’s
- Or a combination of both
Size
- Identified by terms that end in cytic “microcytic, macrocytic, normocytic,
Colour
- Hemoglobin content
- Identified by terms that end in cytic
- Hypochromic (paler), normochromic
Iron Deficiency Anemia
- Cells will be smaller than normal (microcytic)
- Cells will be paler, hypochromic
- Related to nutritional iron intake, increased need (from pregnancy), or continuous blood loss
Clinical Manifestations
- Fatigue, weakness, dyspnea, pallor
- Spoon-shaped nails
- Glossitis (red, sore, painful tongue)
Treatment
- Treat the cause
- Iron supplements
Pernicious Anemia
Caused by an inability to absorb vitamin B12
- Malabsorption
- Lack of intrinsic factor from the gastric parietal cells. Required for vitamin B12
- Cells are large, macrocytic
Clinical Manifestations
- Fatigue, weakness, dyspnea, pallor
- Nerve demyelination: paresthesia of feet (numbness, burning, tingling), loss of position sense, dementia
Treatment
- Lifelong B12 supplementation
Folate Deficiency Anemia
- Folate deficiency: green leafy vegetables, fruits, cereals, meats
- Poor absorption of folate
- Increased requirements of folate (pregnancy)
Similar to pernicious anemia
- Macrocytic cells
- So large they have trouble getting out of the bone marrow, and spleen gets rid of abnormal blood cells
Clinical Manifestations
- Fatigue, weakness, dyspnea, pallor
- Lack of folate is also linked to cardiovascular disease and neural tube defects in children
Treatments
- Dietary adjustments
- Supplemens
Linked to Spina Bifida
Anemia due to Chronic Disease
Pathologic mechanisms
- Inadequate production of erythropoietin
- Ineffective bone marrow response to erythropoietin
- Decreased erythrocyte life span
- Depletion of iron stores
Associated with systemic lupus erythematous (SLE), rheumatoid arthritis, and chronic renal failure
Blood Loss Anemia
- Can be acute or chronic
- Acute symptoms are usually related to blood loss (tachycardia, hypotension)
- Chronic use of iron stores
Hemolytic Anemia
- Premature destruction
- Hemolytic disease of the newborn
- Sickle Cell disease
- Venoms, infections, snake bites, E Coli, malaria
- Transfusion reaction
- Mechanical heart valve
Sickle Cell Anemia
- Abnormal production hemoglobin
- An autosomal recessive disorder
- More common in those living near the equator, increased malaria resistance
- Triggered by dehydration and hypoxemia
- HbS can revert back to normal, or can become irreversibly sickled
Major consequences
- Chronic hemolytic anemia
- Premature destruction by spleen - Blood vessel occlusion
- Hypoxia
- Pain
- Organ failure
Leukocytosis
Increased white blood cells
May be normal protective physiologic response physiologic stressors
- Neutrophils
Leukopenia
Decreased white blood cells
- Never normal
- Radiation, chemotherapy, immune deficiencies
- Predisposes a patient to infection
Neoplasia
- Both leukaemia and lymphoma are caused by malignancies of blast cells
- Leukaemia starts in the bone marrow
- Lymphoma starts in the lymph nodes
Leukemia
Malignancy of precursors to WBC, immature white blood cells (leukaemia blasts)
Types:
- Acute lymphocytic leukemia - Children
- Acute myelogenous leukemia - Worst
- Chronic lymphocytic leukemia - Best
- Chronic myelogenous luekemia
Incidence
- Rates are rising
- Leading cause of death in young children
- Most common in caucasian children
Risk Factors
- Genetics: down syndrome for acute leukemia, Philadelphia chromosome (CML)
- Ionizing radiation
- Chemotherapy
- Chemical exposure
- Smoking
- Leukemia blasts crowd out bone marrow and causes pancytopenia (decreased cellular proliferation of all types of blood cells)
- Infiltrate spleen, liver etc
Manifestations
- Pancytopenia (decreased cellular proliferation)
- Infiltration into the liver, spleen, lymph
- Fatigue, weakness, dyspnea, pallor
- Bone pain
- Hepatomegaly
- Splenomegaly
- Weight loss and night sweats
Diagnosis
- Blood and bone marrow studies
Treatment
- Chemotherapy
- Bone marrow or stem cell transplant
Lymphatic System
Links immune and hematological systems
- Site where various WBC;s mature and function
Primary structures
- Thymus
- Spleen
Secondary Structures
- Lymph nodes
Lymphadenopathy
Enlarged lymph nodes that become palpable and tender
Local: can be normal (strep throat)
Generalized: related to some type of cancer
