Hematologic and Lymph System Flashcards
1
Q
Hematopoietic System
A
- Bone marrow, blood, and blood components
- Transports O2, nutrients and cellular waste products
- Transport of cells to protect the body
2
Q
Hematopoietic System regulates:
A
- Body temperature
- pH
- Fluid balance
3
Q
Blood is produced in:
A
- Red bone marrow (RBM) tissue in flat bones
- Irregular bones
- Epiphysis of long bones
4
Q
Plasma contains:
A
90% water, 10% plasma
5
Q
Plasma transports:
A
Nutrients Wastes Hormones Enzymes Electrolytes Gases
6
Q
Plasma protects:
A
Clotting factors (liver) circulating until activated by clotting
7
Q
Albumin (liver) helps maintain:
A
Blood volume and pressure
8
Q
Globulins carry:
A
Fats
9
Q
Gamma globulins are the:
A
antibodies produced by the lymphocytes
10
Q
Reticulocytes:
A
Immature blood cells
1% of the RBCs in the human body
11
Q
Where do reticulocytes develop and mature?
A
In the RBM
12
Q
Reticulocytes circulate for how long before developing into a mature RBC?
A
1 day
13
Q
When reticulocyte mature, they eject their:
A
nuclei, giving the biconcave look
14
Q
What destroys old RBCs?
A
Liver and spleen
15
Q
Life span of RBCs
A
120 days
16
Q
RBCs carry O2 binded to the:
A
Iron in Hgb
17
Q
Erythropoisesis occurs from:
A
stem cells in the RBM and is influenced by O2 levels
18
Q
What determines the amount of O2 the blood can carry?
A
Amount of Hgb in the RBCs
Amount of iron in the Hgb
# of RBCs
19
Q
Malaria and Sickle Cell Anemia destroys:
A
RBCs
20
Q
Heme is converted to:
A
Bilirubin (blue pigment) and excreted in bowel
-Causes jaundice
21
Q
Bilirubin
A
- Orange-yellow pigment in the blood
- Natural byproduct from the normal breakdown of RBCs
-Pigment portion of bile
When RBCs are destroyed, pigment is excreted and the liver combines it into bile
22
Q
Bile
A
-Yellow-green fluid made by the liver, stored in gallbladder, passes through the common bile duct into the duodenum where it aids in digesting fat
23
Q
Principle Components of Bile
A
- Cholesterol
- Bile salts
- Pigment bilirubin (give bile its green color)
24
Q
RBC Normal Lab Value
A
MEN: 4.7-6.1 million/mm3
WOMEN: 4.2-5.4 million/mm3
25
Hct Normal Lab Value
MEN: 42% - 50%
WOMEN: 40-48%
26
Hgb Normal Lab Value
MEN: 13-18 g/dL
WOMEN: 12-16 g/dL
27
Hemoglobin Test
Determines amount of hemoglobin in 100 dL of blood
A deciliter is 1/10th of a Liter
28
Hemoglobin
Protein in RBCs that carries O2
| Also contains iron
29
Hemoglobin Test Measurements
MAN: 13-18 g/dL
WOMAN: 12-16 g/dL
CHILD: 11.12.5 g/dL
30
Hematocrit Test
Measures percentage or RATIO of RBCs per fluid volume of blood
31
Hematocrit Test Measurements
MAN: 42-50%
WOMAN: 40-48%
CHILD (3-12 years): 35-45%
32
Erythropoiesis
Process of RBC production
| Depends on healthy bone marrow
33
Dietary requirements of erhythropoiesis
```
Iron
Copper
Vitamin B 12
Folic Acid
Riboflavin (Vitamin B2)
Pyridoxine (Vitamin B6)
```
34
Erythropoietin is carried to the bone marrow where it initiates development of:
Mature RBCs
35
Leukocytes
```
WBCs
Indicate infection
Contain a nuclei
Colorless
Involved in body defenses
```
36
2 types of Leukocytes
Granular or Granulocytes
| Agranular or Nongranulocytes
37
Leukocytosis
WBCs elevated above normal
38
Leukopenia
WBCs lower than normal
"Peenie-Weenie"
39
Normal WBC Count
5,000 - 10,000/mm3
40
3 types of Granulocytes
Basophils
Eosinophils
Neutrophils
41
Granulocytes
Contain granules in their cytoplasm
42
Basophil
Release histamine (vasodilator)
Cytoplasm granules contains heparin, serotonin, and histamine
Released in an allergic response
43
Basophil Range
0.5-1%
44
Eosinophils
Plays role in allergic reaction and certain parasitic worms - EOs!!
Combat effects of histamine
45
Eosinophils Normal Value
1-4%
46
Neutrophils
Responsible for phagocytosis
47
Who is 1st to arrive at infection site?
Neutrophils
48
Mature neutrophils are called what and why?
Segmental neutrophils or SEGs because the nucleus is segmented into 2-5 lobes connected by strands
49
Lysozymes are released by what and kill what?
Neutrophils
| Bacteria (stomach)
50
Lysozymes Normal Value
60-70%
51
Mature neutrophils life span
approx. 7 hours
52
What constantly works to produce neutrophils?
Bone marrow
Stores a 6 day supply
Overwhelming infection depletes the stores and immature "polys" are released
53
Polys are also called:
BANDs
54
When BAND count exceeds 8% of the total # of of polyps,
marrow has used up its reserve
55
Presence of excess bands in the peripheral blood is called:
A shift to the left
| Indicates severe infection
56
If segmented neutrophils are elevated, but bands are not:
A new infection
If bands are also elevated, infection is worsening
More elevated the bands, worse the infection
57
Normal segmented neutrophils
60-70%
58
Bands should be
< 8%
59
2 types of Agranulocytes
M - Monocytes
L - Lymphocytes
Mary Lou is not gritty
60
Monocytes
Similar function to neutrophils
Circulate and move into tissue where they engulf and destroy foreign antigens and cell debris
Remove dead bacteria in recovery phase
61
2nd type of WBC to arrive at scene of injury
Monocytes
62
Monocyte range
2-6%
63
Lymphocytes
Responsible for antibody formation (a protein)
| Set up the antigen-antibody formation
64
Lymphocytes Range
20-40%
65
Two groups of Lymphocytes
B cells and T cells
66
B cells
Bone cells
Hunt through blood for bacteria
Responsible for humoral immunity
67
Where are B cells produced?
Bone marrow
68
B cell produce:
Immunoglobulins
69
T cells
```
Thymus cells
Hunt through tissues for viruses
Hunt transplanted organs
75% of total lymphocytes
Responsible for cellular immunity
```
70
Where are T cells formed?
In marrow and develop in the thymus
71
T and B lymphocytes become activated, proliferate, and differentiate in the:
Lymph nodes, spleen, and lymphatic nodules
72
Indications of viral infection:
Lower segmented neutrophils and BANDs
| Elevated lymphocytes
73
Normal WBC count all adds to 100%
```
Neutrophils: 40-60%
Lymphocytes: 20-40%
Monocytes: 2-8%
Eosinophils: 1-4%
Basophils: 0.5-1%
BAND (young neutrophil): 0-3%
```
74
Platelets
Thrombocytes - smallest cells, circular cell fragments, no nuclei
75
Where are platelets produced?
RBM
76
Average life span of platelets
5-9 days
77
Platelets assist in:
Clotting formation and hemostasis
- Vascular spasms
- Platelet plugs
- Chemical clotting
78
Normal Platelet Count
150,000 - 400,000/mm3
79
Platelets activate:
Blood clotting system
80
Megakaryocyte
Large bone marrow cell
Regarded as the source of blood platelets
81
When a blood vessel is damaged:
Platelets release serotonin
Vasoconstriction
Clot adherence
82
Platelet factors
Produced by platelets
Chemicals released when blood comes in contact with a rough surface, such as broken or damaged vessel lining
83
You need Ca+ to clot!
Just a reminder : )
84
Ionized Calcium
Freely flowing calcium in your blood not attached to proteins
Also called "free calcium"
85
Normal Ionized Ca+ Range
4.5-5.5 mg/dL
86
Normal Calcium Range
9-11 mg/dL
87
Prothrombin converts to
Thrombin
88
Fibrinogen converts to
Fibrin (clot)
89
Normal Clot Lysis takes
7-10 days
90
Antithrombin (liver) inactivated excess thrombin to:
prevent the clotting mechanism from becoming a viscous cycle
91
Homeostasis
Control of bleeding and prevention of hemorrhage
92
3 actions of homeostasis
Vessel spasm - reduces amount of bleeding
Platelets adhere - to injured blood vessel, forming an unstable platelet plug
Clot formation forms a scab (coagulation cascade)
93
5 Lymphatic Tissues
```
Lymph nodes
Lymph
Tonsils
Spleen
Thymus
```
94
Function of Lymphatic System
Maintain fluid balance
Produce lymphocytes
Absorb and transport lipids from the intestine to the bloodstream
95
Lymph
Specialized fluid formed in tissue spaces
| Transported by way of lymphatic vessels and re-enters circulatory system
96
How many lymph nodes does the body have?
500-600
97
Lymph Nodes (shape, where they're found, what they house)
Small, bean-shaped
Found beneath epithelium
House lymphocytes and monocytes
98
MALT
Mucosa-associated lymphatic tissue
99
2 functions of lymph nodes
Defense
| WBC Production
100
Tonsils
Masses of lymphoid tissue
Protect body against invasion of foreign substances by producing lymphocytes and antibodies
Trap bacteria and may become enlarged
Atrophy after age 7
101
How large is the spleen?
5-6" long x 2-3" wide
102
Spleen contains:
Lymphatic nodules
103
Spleen stores:
1 pint of blood that can be released in 60 seconds
104
Functions of the spleen:
- Reservoir of blood
- Forms lymphocytes, monocytes, and plasma cells
- Destroys RBCs
- Stores up to 1/3 of the body's platelets
105
Thymus
- Functions in utero and 1st few months after birth to develop immune system
- Development of T Cells before they migrate to lymph nodes and spleen
- Replaced at puberty with fat and connective tissue
106
Peripheral Smear
Examines size, shape, and structure of RBCs and platelets
- Helps differentiate types of anemias and blood dyscrasias
- RBCs and WBCs can be examined
107
Schilling Test
Diagnostic test for Pernicious Anemia
-Measures radioactive Vitamin B12 before and after injection of intrinsic factor by examining urine excretion in a 24 hr urine
108
Megaloblastic Anemia Profile
Replaces Schilling test
Measures Vitamin B 12, methylmalonic acid and homocystine levels for diagnosis of Pernicious Anemia
109
Tourniquet Test
Test of capillary fragility or thrombocytopenia
BP cuff applied for 5 minutes (1/2way between diastolic and systolic BP)
of petechiae within a circumscribed area is counted (0-+4 petechiae)
110
Bone Marrow Aspiration
Evaluation of the cells, types, and maturation
Risks: Pain, penetration of the bone, infection leading to osteomyelitis
111
Bleeding Time Test
Measures duration of bleeding after standardized skin incision
Used for pre-op screening
Normal: 2-9 minutes
112
PT
Monitors effectiveness of Coumadin therapy
| Detects coagulation disorders
113
PT Values
Normal: 9-13 seconds
Therapy: 1.5-2.5 x normal
Critical: >20
114
INR
Used to have uniform PT results in different countries
| INR results are independent of the reagents or methods used
115
INR Value
Therapeutic: 2-3
Critical: >5.5
116
aPTT
Monitors effectiveness of heparin therapy
| Detects coagulation disorders
117
aPTT values
25-35 seconds
Critical: >70 seconds
118
Sedimentation Rate (ESR)
Speed RBCs settle out in a tube of unclotted blood in one hour
Indicated inflammation
Increase in tissue destruction
Stable indicator of course of disease, especially inflammatory auto-immune disorders
119
Sedimentation Rate (ESR) values
Men: 0-15 mm/h
Women: 0-20 mm/h
120
D-Dimer
```
Assess thrombin and plasmin activity
Fibrin degradation fragment
Confirmatory test for DIC
High levels in:
-PE
-Sickle cell anemia
-Thrombosis of malignancy
-Screen for DVT
```
121
D-Dimer Value
< 250-600 mcg/L
122
Rh Factor
D antigen is present
- Rh antibodies located on surface of RBC
- Rh (+) antibodies present
- Rh (-) antibodies not present
123
9 Types of Blood Replacement Products
- Packed RBCs
- Clotting Factors
- Fresh frozen plasma
- Antibodies
- White cells
- Albumin
- Cryoprecipitate
- Platelets
- Blood substitutes
124
Packed RBCs
Restore blood's O2 carrying capacity
-RBCs separated from plasma
Can be refrigerated up to 42 days
-Rare blood types can be frozen up to 10 years
125
When would you want to use whole blood?
In Hypovolemia
126
Clotting Factors
- Found in plasma
| - Proteins that work with platelets to help clot blood
127
Fresh Frozen Plasma
Contain proteins and clotting factors
Is frozen soon as separated from the cells of the donor blood
Can be stored up to 1 year
128
Antibodies
Disease fighting components of the blood
Provide temporary immunity
Antibodies are produced from treated plasma donations
129
White Cells
- Transfused in life-threatening infections to clients with greatly reduced WBCs or malfunctioning WBCs
- Rare
130
Albumin
-Plasma volume expander made from pooled human venous plasma
- Hypovolemic shock
- Burns
131
Cryoprecipitate
```
-From the plasma
Contains:
-Fibrinogen (for clotting)
-Von Willebrand factor
-Factor VIII and XIII
-Fibronectin
```
132
Immune-Mediated Thrombocytopenia Purpura (IMTP)
- Immune system mistakes platelets as invaders
- Antibodies coat the platelets
- Spleen phagocytes remove them 10x faster than normal
- Platelets live for minutes or hours - not days
133
Blood Substitutes
- Contains chemicals or specially treated solutions of Hgb
- Stored at room temperature
- More research needed
- Risky
134
Autologus Transfusions
- Pre-op donation collected 4-6 weeks before surgery
- Iron supplements may be ordered
- Prevention of infection
- Used for people with rare blood types
135
Contraindications for Autologus Transfusions
- Acute infections
- Chronic disease
- Hgb <11 g/L
- Cerebrovascular disease
- CVD
136
Symptoms of Allergic Reaction
```
Hypersensitivity to antibodies
-Urticaria
-Itching
-Flushing
-Hypotension
-Dyspnea
-Decreased O2 sats
Occurs immediately within 24 hours
```
137
Nursing Considerations of Allergic Reactions
```
Pre-medicate with antihistamines
STOP the blood
Restart NS
Notify MD
O2
Steroids
```
138
Acute Hemolytic Reaction Cause and Symptoms
```
Incompatible blood
Occurs within minutes to 24 hours
-N/V
-Lower back pain
-Hypotension
-Tachycardia
-Hematuria
```
139
Nursing Considerations of Acute Hemolytic Reactions
STOP the blood
O2
Antihistamines
Airway management
140
Febrile Reaction Symptoms
```
Most common
Antibodies to donor platelets or leukocytes
Occurs in minutes to hours
-Fever
-Chills
-Nausea
-HA
-Flushing
-Tachycardia
```
141
Nursing Considerations of Febrile Reactions
STOP the blood
Supportive care
ASA
Seen in clients with multiple transfusions
142
Cause and Symptoms of Bacterial Infections
```
Contaminated blood
Occurs within minutes to 24 hours
Symptoms:
-Tachycardia
-Hypotension
-Fever
-Chills
-Shock
```
143
Nursing Considerations of Bacterial Infections
```
STOP the blood
Obtain blood culture
Antibiotics
IV Fluids
Vasopressors
Steroids
```
144
Circulatory Overload Cause and Symptoms
```
Large volume over short time
Occurs within minutes to hours
Symptoms:
-Dyspnea
-Crackles
-Tachypnea
-Tachycardia
```
145
Nursing Considerations of Circulatory Overload
Monitor high risk patients
- Elderly
- Heart disease
- Slow or discontinue transfusion
146
Transfusion-Related Acute Lung Injury TRALI Cause and Symptoms
```
Presents like ARDS
"Shock lung"
Onset within 6 hours of transfusion
Symptoms:
-Fever
-Dyspnea
-Hypotension
-Non-cardiogenic pulmonary edema
```
147
TRALI Nursing Considerations
Notify MD
Probable transfer to ICU
Ventilator support
148
Monitoring Blood Transfusions
- Stay with pt for 15-30 minutes
- Recheck VS Q15 minutes after start of infusion x institution's policy
- Take hourly per institution's policy
- If reaction suspected, STOP THE BLOOD
149
Issues with Multiple Transfusions
- Transmitting infectious diseases or bacterial infections
- K+ disturbances
- Ca+ disturbances from Citrate
- Hypothermia carries risk of cardiac arrhythmia or cardiac arrest
- Volume overload
150
Hemostasis
Body process that arrests the flow of blood and prevents hemorrhage
151
Homeostasis
Body's internal environment is relatively stable
152
Clotting Cascade (1-6)
1. Injury occurs
2. Bleeding or hemorrhage occurs
3. Sticky platelets move to the site
4. Clotting factors released from the blood vessels and the platelets
5. Thromboplastin is released
6. Interacts with protein and Ca+ to form prothrombin activator
153
Clotting Cascade (7-11)
7. Prothrombin activator reacts with Ca+ to convert prothrombin to thrombin
8. Thrombin converts fibrinogen to fibrin
9. Threads of fibrin form a net, traps RBCs and platelets
10. Forms a clot - acts like a plug in a hole, draws the injured edges together
11. Clot shrinks
