Hematologic and Immune Function Flashcards
(131 cards)
1
Q
What are the three primary cell types?
A
- Erythrocytes
- Thrombocytes
- Leukocytes
2
Q
What consists primarily of hemoglobin, contains and carries iron and carries oxygen to tissues, lives for 120 days?
A
Erythrocytes (RBC’s)
3
Q
What protein molecule in RBC’s carries oxygen to the tissues and returns CO2 back to the lungs for excretion (exhale)?
A
hemoglobin
4
Q
What is the percent of blood volume consisting erythrocytes called?
A
hematocrit
5
Q
What is the male and females percentages of hematocrit?
A
Male: 40 - 53%
Female: 37 - 47 %
6
Q
What fights infection, lives days to years, depending on the type?
A
Leukocytes (WBC’s)
7
Q
What is the process of replenishing the supply of cells called?
A
hematopoiesis
8
Q
What provides basis for coagulation to occur, maintains hemostasis, lives 7 - 10 days?
A
Thrombocytes (platelets)
9
Q
Balance of the body is called?
A
hemostasis
10
Q
Name the two stem cells.
A
Myeloid and Lymphoid
11
Q
What are primitive cells that have the ability to self-replicate, differentiation into either myeloid or lymphoid?
A
stem cells!
12
Q
which stem cell differentiates into either erythrocytes, leukocytes, or platelets?
A
Myeloid Stem Cells
13
Q
Which stem cell differentiates into either T lymphocytes (Thymus) or B lymphocytes (bone marrow)?
A
Lymphoid stem cells
14
Q
What attack foreign substances in the body?
A
antibodies
15
Q
What are toxin, foreign substances in the body?
A
antigens
16
Q
What generates antibodies to attack antigens and disable them.
A
B Lymphocytes (B cells)
17
Q
What moves from the bone marrow to the thymus, where they differentiate and mature to become helper T cells and cytotoxic T cells?
A
T Lymphocytes (T cells)
18
Q
What do you assess for in patients with a low hemoglobin and hematocrit?
A
- Fatigue
- Dyspnea
- Activity intolerance
- Difficulty concentrating
- Pallor
- Jaundice
- Tachycardia
19
Q
Conjunctival pallor =
A
anemia
20
Q
What are the hemoglobin values for a male and female?
A
Male: 14 - 18 g/dL
Female: 12 - 16 g/dL
21
Q
What are the hematocrit values for a male and female?
A
Male: 40 - 52%
Female: 37 - 47%
22
Q
What are normal platelet values?
A
140,000 - 400,000 mm
23
Q
What are normal RBC values?
A
4.0 - 5.5
24
Q
low hct/hgb may be asymptotic at first due to?
A
compensatory mechanisms.
25
S/S of decreased oxygenation to vital organs:
- fatigue
- dyspnea
- palpations
- poor activity tolerance
- headaches
- tinnitus
- anorexia
- indigestion
- irritability
- difficulty sleeping or concentrating
- abnormal menstruation
- impotence in males
- loss of libido
- chest pain
- SOB
- PALLOR**
- tachycardia
- flow murmurs
- jaundice, splenomegaly (hemolytic anemia)
26
Normal WBC:
5,000 - 10,000
27
Normal absolute neutrophil count:
>1,800/ul
28
What do you assess for in patient with a low white blood cell count?
- absolute neutrophil count (ANC)
- < 500/mm server neutropenia
- total WBC x (%segs+%bands) = ANC
- signs of infection
- FEVER: > 100.4 F
29
```
Normal values for-
Segments:
Bands:
Monocytes:
Basophils;
Eosinophils:
Lymphocytes:
```
- 38-71% of total WBC
- 0-10% of total
- 2-15% of total
- 0-1% of total
- 20-40% of total
30
What is the math for ANC:
Total WBC x (%seg +%bands) = ANC
31
Any ANC greater than 2,000mm is not an indictor of?
neutropenia
32
Any ANC <500/mm is severely?
low
33
Fever must be addressed?
immediately
34
True or false:
| Leukocytes protect the body against infection and tissue injury?
TRUE
35
What are the granulocytes?
- eosinophil
- basophil
- neutrophil
36
What granulocytes are involved in parasitic and allergic reactions?
** neutralizes histamine, digests foreign proteins.
eosinophil
37
What granulocytes are released in response to exposure to allergens?
basophil
38
What granulocytes prevent or limit bacterial infection viz phagocytosis?
Neutrophil
39
What are the agranulocytes?
- lymphocytes
| - monocyte
40
What are medications to consider when checking WBC?
- chemo
- radiation
- TB
- HIV
- leukemia
- lymphoma
- cancer
41
What do you assess for in pt's at risk for bleeding?
- platelet count (<100,000/mm is thrombocytopenia)
- platelet count (<50,000/mm is bleeding precautions)
- platelet count (<10,000/mm *high risk for spontaneous bleeding, intracranial hemorrhage)
- petechiae
- ecchymosis
- bleeding gums
- hypotension
- neurological changes
42
platelet count for thrombocytopenia?
< 100,000/mm
43
platelet count for bleeding precautions?
< 50,000/mm
44
platelet count that makes you HIGH RISK for spontaneous bleeding, intracranial hemorrhage!!
< 10,000/mm
45
hemoglobin levels:
male: 14-18g/dL
female: 12-16g/dl
46
hematocrit levels:
male: 40-52%
female: 37-47%
47
platelets levels:
140,000-400,000/mm
48
red blood cell levels:
4.0-5.5/mm
49
Petechiae are most often seen in _______, and are first seen on the _____ and then _______ ________.
- clusters
- extremities
- mucous membranes
50
With prolonged thrombocytopenia _______ are found on the truck and throughout the body.
petechiae
51
With severe thrombocytopenia monitor for?
- subtle changes in mental status.
| ex: irritability, restlessness, and headache
52
What do you assess for while caring for patient with immune disorders?
- health history: diseases/disorders, allergies, autoimmune disorders, diet, meds, travel
- common complaints: impaired wound healing, fatigue, recurrent infections, weight loss, lymphadenopathy
53
```
Specific complaints for:
Systemic lupus erythematosus:
Rheumatoid arthritis:
HIV:
Anaphylactic reaction:
```
- butterfly rash
- joint deformities
- thrush
- erythema, hoarseness, and dyspnea
54
Autoimmune disorders:
- SLE
- RA
- psoriasis
(on set, severity, remissions and exacerbations, limitations, and treatments.)
55
Neoplastic diseases:
- CA, any family hx of CA.
| type, onset, relationship of family member, treatment
56
CA-treatment can cause?
immunosuppression
57
What are the hematological cancers?
- leukemia
| - lymphoma
58
Leukemia and lymphoma are associated with altered production and function of?
WBC's and lymphocytes
59
Chronic illness:
- DM:
- Renal disease
- COPD
- Fibromyalgia
60
What increases incidence of infection, associated with neuropathy, microvascular disease, microvascular dysfunction?
DM (diabetes m)
61
Deficiency in circulating lymphocytes can cause:
renal failure (renal disease)
62
Recurrent respiratory tract infections, altered inspiratory and expiratory function and ineffective airway clearance can cause:
COPD
63
Check medication for which chronic illness?
fibromyalgia
64
What can impair skin integrity which in turn compromises the body's fist line of defense?
burns
65
What deficiencies can lead to immune function suppression?
- vitamins
| - minerals
66
Depletion of protein reserves results in?
- atrophy of lymphoid tissues
- depression of antibody response
- reduction in # of circulation T-cells
- impaired phagocytic function
67
How could altered nutrition lead to delayed post-op recovery?
- more serious infections
| - delayed wound healing
68
Antibiotics, corticosteroids, cytotoxic agents, salicylates, NSAIDs, anesthetics can cause?
- immune suppression
69
There is a small risk for blood transfusion r/t?
HIV
70
What do you assess the skin/mucous membranes for in patients with immune disorders?
- lesions
- dermatitis
- purpura (subcutaneous bleeding)
- urticarial
- inflammation
- discharge
71
What do you assess for signs of infection in patients with immune disorders?
- temperature
- chills
- seating
- fever
72
What do you assess the lymph nodes for in patients with immune disorders?
- palpate for enlargement (lymphadenopathy apathy)
73
Lymphadenopathy indicated?
- immune system activation against pathogens
74
What do you assess the joints for in patients with immune disorders?
- tenderness
- swelling
- increased warmth
- limited range of motion
75
In patients with immune disorders limited range of motion can mean?
- infiltration by leukocytes, including macrophages and cytokines
76
What labs do you assess for patient with immune disorders?
- CBC with diff
- peripheral blood smear
- bone marrow aspiration and biopsy
- skin testing
77
What lab do you look are to assess for presence of infection?
WBC's they are elevated.
78
What lab is usually normal with allergic reactions?
WBC's
79
```
Eosinophils:
normal:
mild:
moderate:
severe:
```
- 1-3% of WBCs
- 5-25%
- 15-40%
- 50-90%
80
A mild amount of eosinophils suggests?
allergic reaction
81
A moderate amount of eosinophils is seen in?
- allergic disorders
- malignancy
- immunodeficiencies
- parasitic infection
- congenital heart disease
- peritoneal dialysis
82
A severe amount of eosinophils is called?
- hypereosinophilic syndrome
83
What checks the shape and size of the erythrocytes and platelets, and the appearance of leukocytes?
- peripheral blood smear
84
What allows you to assess how blood cells are being formed and quantity and quality of each type of cell produce, and infection or tumor within marrow?
- bone marrow aspiration and biopsy
85
Bone marrow aspiration and biopsy is usually aspiration from the ______ ___ ____, aspiration can cause a sudden and sharp, brief pain, resulting from suction exerted as the marrow is aspirated into the syringe, relaxation/deep breaths helpful.
- posterior iliac crest
86
Skin testing assess for specific?
allergan
87
Types of skin tests:
- prick skin tests
- scratch tests
- intradermal skin tests
88
Positive skin tests:
- wheal: raised, round reddened area.
| - localized erythema
89
What are the classifications of anemia?
- normocytic
- microcytic
- macrocytic
90
Anemia is usually classified by the shape of?
- the RBC
91
Normocytic anemia is?
- normal or average size
92
Microcytic anemia is?
- smaller than normal cell size with reduced amounts of hgb.
93
Macrocytic anemia is?
- larger than normal cell size, large in size, thickness, and volume.
94
Anemia can also be described by color what are the three colors:
- normochromic: normal in color
- hyperchromic: darker cellular contents
- hypochromic: pale or lighter cellular contents
95
What are the normocytic anemias?
- aplastic anemia
- acute blood loss
- hemolytic anemia
96
What are the microcytic anemias?
- iron deficiency anemia
97
What are the macrocytic anemias?
- folic acid deficiency
| - vitamin B12 deficiency
98
Expected lab values for normocytic anemia?
- normal: MCV, MCHC
| - decreased: Hgb, Hct
99
Expected lab values for microcytic anemia?
- decreased MCV, MCHC
| - decreased Hgb, Hct
100
Expected lab values for macrocytic anemia?
- elevated MCV
- normal MCHC
- decreased Hgb, Hct
101
MCV means?
mean corpuscular volume (average volume of red cells)
102
MCHC means?
mean corpuscular hemoglobin concentration (measures the average concentration of hemoglobin inside a single red blood cell)
103
What type of anemia has a decrease in or damage to marrow stem cells that causes cell death and bone marrow failure?
** hereditary or acquired.
- aplastic anemia
104
What type of anemia is inherited or acquired, has RBC membrane damage, ineffective RBC production, and hemolysis?
- hemolytic anemia (also known as sickle cell)
105
Hemolytic anemia causes fewer erythrocytes resulting in decreased _______, causing _______, which stimulates an increases in erythropoietin release from the kidneys, which causes bone marrow to release erythrocytes prematurely as ________.
- oxygen
- hypoxia
- reticulocytes
106
What type of anemia is a result of chronic blood loss or demands for iron exceeding iron intake?
- iron deficiency
107
Decreased iron results in?
- use and depletion of iron stores, thus causing decreased Hgb production.
108
Risk for iron deficiency anemia?
- chronic blood loss
- premenopausal women
- pregnancy
- chronic alcoholism
109
causes of chronic blood loss?
- ulcers
- gastritis
- inflammatory bowel disease
- GI tumors
110
What are the causes of folic acid deficiency?
- inadequate intake
| - impaired absorption (ETOH)
111
What is folate found in?
- green vegetables
| - liver
112
What are the causes for B12 deficiency?
- decreased/absence of intrinsic factor
| - malabsorption
113
What is B12 found in?
- meats
- liver
- organ meats
- clams
- sardines
- beef
- tuna
- fortified cereals
114
The patient comes in with:
- symptoms gradual
- normal MCV
- decreased reticulocytes
- decreased WBC, Hgb, Hct, Platelets
What type of anemia is this?
- aplastic anemia (normocytic)
115
The patient comes in with:
- jaundice
- normal MCV
- elevated bilirubin
- elevated reticulocytes
What type of anemia is this?
- hemolytic anemia (sickle cell)
116
The patient comes in with:
- pica
- smooth, red tongue
- decreased MCV
- decreased iron, ferritin, and iron saturation
What type of anemia is this?
- iron deficiency anemia (microcytic)
117
The patient comes in with:
- beefy, fiery red and fore tongue
- increased MCV
- decreased folate
What type of anemia is this?
- folic acid deficiency (macrocytic)
118
The patient comes in with:
- neuro changes: neuropathy, paresthesia, changes in coordination
- lack of intrinsic factor
- increased MCV
- decreased B12 levels
- B12 deficiency (macrocytic)
119
Things that put you at risk for lack of intrinsic factor causing B12 deficiency?
** can take as much as you want but not be able to utilize it.
- faulty absorption in GI tract
- Crohn's disease
- ill resection
- gastrectomy
- absence of intrinsic factor
120
B12/Folic acid deficiency gradually progresses until severe you may see _____ _____ and patchy loss of ______ _________.
- premature graying
| - skin pigmentation
121
*Vitamin B12 keeps ____ and ____ ____ healthy, you may see s/s of _____ damage, such as _______.
- nerves
- blood cells
- nerve
- neuropathy
122
MVC if low (microcytic anemia) this is a shortage of?
hgb, not being formed properly
123
MVC if high (macrocytic anemia) this is shortage of?
DNA precursors
124
How would you manage aplastic anemia?
- bone marrow transplant/peripheral blood stem transplant
- steroids/immunosuppressants
- assess: neutropenia and thrombocytopenia
125
How would you manage hemolytic anemia?
- immunosuppressive therapy
| - my need a splenectomy
126
How would you manage iron deficiency anemia?
- prevention
- iron rich foods
- vitamin C
- education
- anticipate iron replacement (ferrous sulfate)
127
How would you manage folic acid deficiency?
- education
- folate enriched foods
- meds
- mouth care
128
How would you manage B12 deficiency?
- education
- diet
- B12 injections if lack of intrinsic factor
129
pernicious anemia is more common in? why?
- the elderly
| - the stomach wall atrophies and fails to secrete intrinsic factor.
130
The elderly is at risk for leukopenia which increases?
the risk for infection.
131
The elderly has a decrease response to?
antigens
