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Hematology Flashcards

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0
Q

roles of blood

A 
transport of oxygen, carbon dioxide, other waste products
transport of hormones
acid base balance
key role in body defence
body temperature regulation
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1
Q

how do kidneys aid in blood production?

A

sensitivity to oxygen levels
low oxygen levels stimulate the release of kidney hormone ethytropoeitin which stimulates red blood cell production in bone marrow

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2
Q

composition of plasma

A

90% water
contains electrolytes, nutrients, wastes, gases, hormones, plasma proteins (large molecules, albumin which helps maintain oncotic pressure, globulins immunology, fibrinogen involved in coagulation cascade)
purpose: medium for transport

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3
Q

composition of leukcytes

A

white blood cells
large cells involved in immune system
life span variable

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4
Q

life span of erthythrocytes

A

120 days

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5
Q

platelets

A

smallest elements of blood (megacaryocytes break up into 1000 platelets)
initiate coagulation at the site of damaged blood vessel walls
lifespan about 10 days
because they’re the lightest component, they float near the edges of the vessel
reservoir in the spleen

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6
Q

What are the four phases of hemostasis?

A

primary
seconday
finbrinolysis
restoration of normal blood flow

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7
Q

primary hemostasis

A

constricts to slow bloodflow
platelets contact collagen layer and release adhesive proteins, coagulation and growth factors
platelets change shape and becomes sticky, adhering to one another
platelet plug is formed

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8
Q

secondary hemostasis

A

intrinsic and extrinsic coagulation cascades are activated

formation of fibrin clot to stabilize the platelet plug

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9
Q

compare intrinsic and extrinsic clotting pathways

A

intrinsic - slow, takes 2-6 minutes to begin, inside the vessel, damaged endothelium, contact with plaque
extrinsic - rapid, begins in 15 seconds, outside vessel, tissue damage

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10
Q

which electrolytes are required and where are they stored?

A

calcium and vitamin k

fibrinogen, prothrombin, factor 4,5,6,7 found in the liver

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11
Q

describe the clotting cascade

A

factor ten, common pathway, prothrombin, thrombin, fibrinogen, fibrin, clot formation

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12
Q

what happens at the activation of factor ten?

A

platelets continue to aggregate
thrombin and fibrin are created
fibrin stabilizing factor is activated
clot is stabilized

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13
Q

fibrinolysis process

A

the process in dissolving the clot
to restore blood flow through the healed vessel, the fibrin clot must be lysed
endothelial cells secrete tissue plasminogen activators
leukocytes begin to clean up debris

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14
Q

hematocrit

A

measurement of volume of RBCs in 100ml of blood - comparing percentage of rbcs to plasma
looks at hydration status - elevated level indicative of decreased fluid volume
normal 0.36-0.46

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15
Q

prothrombin time

A

evaluates the extrinsic pathway and common clotting pathway
normal 8-13 seconds
if clotting factors are deficient, PT will be prolonged
used to evaluate therapeutic range for warfarin

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16
Q

INR

A

international normalized ratio

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17
Q

ptt

A

partial thromboplastin time
evaluates intrinsic system and common pathway
if clotting factors deficient it will be elevated
normal <40 seconds
used to evaluate heparin anticoagulation therapy

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18
Q

fibrinogen

A

an essential plasma protein synthesized by liver
ordered to further investigate abnormal bleeding
decreased level - liver disease, disseminated intravascular coagulation, leukemia, anemia,
increased level - acute infections, collagen diseases, inflammatory disorders

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19
Q

d-dimer

A

a protein fragment produced and usually only detectable during clot degredation
used to diagnose conditions related to thrombosis such as pulmonary embolism, DIC, DVT

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20
Q

reticulocyte count

A

yields information on bone marrow function
reticulocytes are immature cells released by bone marrow that become rbcs
useful in determining cause of anemia

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21
Q

esr

A

erythrocyte sedimentary rate

can be elevated in inflammatory states

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22
Q

c reactive protein

A

levels increase more rapidly than esr during acute inflammation

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23
Q

peripheral smear

A

most informative of all blood tests
time consuming
a person takes the time to look and count and differentiate

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24
what are some causes of anemia in the adult icu patient?
``` decreased rate of erythropoeisis acute kidney injury chronic renal failure heorrhage hemolysis inflammation liver disease excessive phlebotomy ```
25
anemia treatment
``` medications (b12, erythropoeitin, folate, iron) crrt blood transfusion blood conversion nutritional consult ```
26
diagnosis and treatment of dvt
venous ultrasound blood work prevention if on bedrest, elevate injured leg analgesic anticoagualtion
27
what are some risk factors for development of dvt?
``` immobility surgery invasive procedues spinal cordi njury obesity age sepsis trauma ```
28
pulmonary embolus patho and management
a clot that travels through right side of the heart and gets lodged in pulmonary vasculature dvt common cause can be blood, fat, tumor tissue treatment anticoagulation therapy, inferior venacava filter, surgical removal chest pain, rapid onset sob, increased oxygen demands, radiating pain to neck, jaw, worsens with inspiration
29
what are some examples of coagulation disorders
thrombotic thrombocytopenic purpura hellp hit - heparin induced thrombocytopenia dic
30
ttp patho, presentation
thrombotic thrombocytopenia purpura usually caused by under regulation coagulation component von Willebrand factor, red blood cell damage spontaneous platelet aggregation presents with fever, renal injury, micro hemolytic anemia, neurologic abnormalities
31
hellp
hemolytic elevated liver enzyme low platelet count happens with pre-eclampsia can lead to stroke
32
hit
sudden onset with drop in platelets when patient on heparin 50% drop in platelet count usually occurs about 4 days of receiving heparin, has occurred up to 3 weeks after heparin discontinued type 1 - benign, moderate but transient decrease in the platelet count type 2 - severe, immune mediated formation of heparin-antibody complexes, greater risk for thrombosis than bleeding, thrombin released and platelet clumps are formed, complexes adhere to platelets and endothelium
33
what are some triggers of DIC?
sepsis severe trauma obstetrical events such as placental abruption severe inflammation
34
Describe the hemorrhagic signs for various systems
``` integ- oozing, bleeding from access sites, surgical sites and mucous membranes, purpura, ecchymosis, cyanosis neuro- altered loc pulm- hemoptysis gi- gi bleed, abdominal distension renal- hematuria ```
35
Describe the micro-emboli signs for various systems
``` integ- patchy cyanosis neuro- altered loc, cva pulm- pe, ards gi - bowel infarct renal- hematuria, oliguria, renal failure ```
36
how does lab work change in dic
``` ptt elevated pt/inr elevated d-dimer elevated platelets low fibrinogen low ```
37
what is treatment of hemorrhage aimed to prevent
decreased oxygen carrying capacity decreased waste removal tissue and organ ischemia circulatory collapse
38
what are some of the risk associated with blood and blood product transfusion?
acute transfusion reaction allergic reaction (anaphylaxis) TRALI not related to volume overload (transfusion related acute lung injury) hypothermia (blood products stored in fridge) metabolic alkalosis (sodium citrate in blood products to prevent clotting, which breaks down into water and bicarb) volume overload
39
ffp
each unit has 650mg of fibrinogen | indicated to reverse bleeding, reverse coagulopathy prior to surgery,
40
cryopreciptate
the precipitate of ffp ffp without the extra fluid contains fibrinogen, factors 8 and 13 and von willebrand factor indicated in hemophilia, bleeding from excessive anticoagulation, hemorrhage, dic
41
important thing to remember about platelet infusions
never via pressure bag or with warming
42
prothrobin complex concentrates
``` derived from pooled plasma contains multiple clotting factors protein stored at room temp vitamin k administered with initial dose indicated in reversal of warfarin, vitamin k deficiency with life threatening emergency ```
43
transexamic acid
synthetic inhibits fibrinolysis indicated in polytrauma, hemorrhage, risk of bleeding
44
organs of immunology
lymphatics- bacteria, virus, and debris are removed by wbcs mucous membranes and skin - immuno globulin a gastric fluid thymus - t lymphocyte maturation tonsils and adenoids - exchange lymphocytes with lymph, produce antibodies and sensitized t cells, remove microbes spleen - exchanges lymphocytes with blood, produced antibodies an d sensitized t cells, removes microbes, stores rbcs bone marrow- origin of all blood cells, b lymphocyte maturation appendix - rich in lymphoid cells, manufactures hormones in fetal development
45
goals of the immune system
defence against invading organisms removal of worn out cells and tissue debris homeostasis surveillance with recognition and removal of mutant/abnormal foreign cells
46
what are the components of the general immune response?
inflammatory humoral (antibody) slower to response, b cells cellular immune response t cells
47
inflammatory response
release of phagocytes, wbcs secretion of inflammatory mediators immediate and nonspecific
48
inflammatory mediators
molecules released by immune cells against invaders initiate, augment, and terminate aspects of the inflammatory response MAST CELLS is one of the key activators in the inflammatory response hitamine, bradykinin, prostaglandins
49
what are some local and systemic symptoms of inflammatory response?
inflamatory mediators being released from cells local vasodilation and increased capillary permeability increased blood delivery to tissue and local accumulation of fluid redness, heat, swelling and pain
50
innate immunity
skin, chemicals in blood, phagocytes, | first line of defence
51
adaptive immunity
recognition and processing of specific antigen creation of special antibodies to attack a specific antigen slower response to invader
52
adaptive immunity
recognition and processing of specific antigen vaccines exposure related immunity creation of special cells and antibodies to attack a specific antigen slower response to invader slower to invader
53
b cell lymphocytes
``` mature in bone marrow storedi n lymph nodes some circulatei n blood responsable for production of antibodies or immunoglobulins inactive circulating antigens ```
54
what are the five classes of immunoglobulins?
IgG- responsible for the majority of antibody basedi mmunity, only antibody crosses placenta to fetus IgM- first on the scene, largest, starts working to eliminate pathogens before there is enough IgG IgA prevents colonization of pathogens, found on the skin IgD- activates basophils and mast cells IgE involved in allergic response and against parasites
55
how does the complement system amplify the immune response?
``` help phagocytes engulf the pathogen attract more phagocytes to site (chemotaxis) create pores in bacterial membranes increase vascular permeability neutralize some viruses ```
56
t cell lymphoctyes
mature in thymus function in the peripheral tissues acquire the ability to distinguish self and non self 60-70% lymphocytes provides protection against viruses, intracellular bacteria and cancer cells three types: cytotoxic ( killer, release lymphotoxins causing cell lysis)' helper (immune managers, secrete lymphokines that stimulate ta nd b cells, attract neutrophils and enhance macrophages ability)' suppressor (inhibit t cell production when no longer needed)
57
natural killer cells
less than 2% of circulating volume from innate immunity system seek and destroy
58
neutorphils
``` most abundant first responder to inflammation very involved in bacterial infection segmented mature banded immature increased bands indicates an accelerated production or release of neutrophils ```
59
basophils
less than 1% of wbc | secrete inflammatory mediators that attract leukocytes to injury site
60
eospinophils
less than 6% of wbcs | levels may increase with parasitic infection and allergic response
61
gram positive
staphylococcus streptococcus c-diff
62
gram negative
``` e coli salmonella pseudomonas enterobacter legionella klebsiella ```
63
bone marrow aspirate
reveals number, size, shape of cells throughout all stages of development diagnosis and staging of hematologic disease, or to confirm a diagnosis
64
define infection
the invasion and multiplication of microorganisms in body tissue, making you unwell may be clinically unapparent may result in localized cellular injury may extend to a systemic infection
65
define colonization
microorganisms live on or in a host but do not invade or cause cellular damage once colonization invades or begins to cause localized cell injury, it becomes an infection
66
hypersensitivity
allergic reaction anaphylaxis four varieties based on mediators
67
autoimmune disease
inappropriate immune response of the body against substances and tissue normally present in the body may be systemic or against a specific organ the immune system mistakes some part of the body as a pathogen and attacks its own cells

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