Hematology Function Flashcards
1
Q
What kind of tissue is blood?
A
Connective tissue
2
Q
Main function of blood has to deal with _____ and _____
A
connect and transport
3
Q
The whole system of blood is referred to as the
A
hematologic system
4
Q
If we produce more CO2, what does this mean?
A
blood pH will go down
5
Q
if CO2 goes up, then what is the response of the respiratory system ?
A
The breathing speeds up
6
Q
The hematologic system connects all parts of the organisms through ________ ________
A
chemical messengers, such as hormones
7
Q
The main buffer system in the blood is
A
the bicarbonate system
8
Q
Components of blood
A
92 % water and 8% solutes
9
Q
If you had a vial of blood, what would happen?
A
The plasma would rise to the top while the formed elements would fall to the bottom
10
Q
What is plasma ?
A
plasma is 50-55% of the blood volume it is the liquid portion that contains organic, inorganic elements and coagulation factors
11
Q
What is serum ?
A
This is plasma without the coagulation factors
12
Q
What is the most abundant plasma protein ?
A
Albumins
13
Q
What is the function of albumins?
A
Functions as a carrier of iron, hormones, calcium and many drugs controls the plasma oncotic pressure- influences the movement of water into the vessels
14
Q
Someone presents with liver failure - what would we expect to see ?
A
edema Since albumin plasma proteins are synthesized in the liver, there would be a lack, and hence this would then affect the ability of the blood to keep water within the vessels
15
Q
With edema, there is not enough ______ ______ to keep the fluid in the blood vessels
A
oncotic pressure
16
Q
Cellular components of blood
A
erythrocytes, leukocytes platelets
17
Q
What are erythrocytes ? what is unique about them ?
A
Red blood cells ; they lack a nucleus
18
Q
Red blood cells transport ……
A
oxygen and carbon dioxide
19
Q
What is the life cycle of red blood cells ?
A
120 days
20
Q
this is the most abundant cell in the body
A
red blood cells
21
Q
What are leukocytes ?
A
white blood cells - these defend the body against infection and disease
22
Q
__________ constitute 60-70% of all WBC
A
Granulocytes
23
Q
What are granulocytes ?
A
Membrane-bound granules in their cytoplasm The granules contain enzymes capable of destroying microorganisms Inflammatory and immune functions Capable of amoeboid movement (diapedesis)
24
Q
Granulocyte cells are
A
neutrophils basophils eosinophils
25
Agranulocytes are part of the _________ and __________ system
inflammatory and immune
26
3 types of cells in the blood
red blood cells white blood cells platelets
27
These types of WBC are agranulocytes , are part of the mononuclear phagocyte system, and are immature macrophages
monocytes
28
These two types of WBCs make up the _________________ system (MPS)
mononuclear phagocyte system
Monocytes and Macrophages
29
These cells are part of the coagulation process ?
Platelets
30
Do platelets have a nucleus ?
No nucleus
31
Normal values for hemoglobin, hematocrit, RBC count, WBC count and platelet count
make sure to know the normal values and to note the normal values pertaining to your clinical site
32
This is the process of blood cell production
Hematopoiesis
33
Hematopoiesis occurs where?
In the bone marrow
34
concerning the life span of hematological cells, is it long or short ?
Short, which means there is constant replacement
35
True or false ..... we cannot divide platelets or red blood cells into two daughter cells
True. They cannot divide. They form through maturation
36
How long does it take for a RBC to mature ?
34 days or so
37
This term refers to blood cell production in tissues other than bone marrow such as the spleen and liver and is usually a sign of disease
Extramedullary hematopoiesis
prior to birth, blood cell production does occur in the spleen and liver. but after birth, blood cell production only occurs in the bone marrow
38
If we have less RBC than usual, we can become
anemic
39
If we have more RBC than usual, there will be greater
viscosity of blood, which will affect blood pressure
40
The number of circulating red cells in healthy individuals should _______ \_\_\_\_\_\_\_\_
remain constant
41
This substance stimulates the red cell maturation in bone
Erythropoietin
42
These cells of the kidney produce erythropoietin
Peritubular cells
43
\_\_\_\_\_\_\_\_\_ stimulates the production and release of erythropoietin
Hypoxia
44
What is the name of the oxygen carrying protein of the erythrocyte?
Hemoglobin
45
When the RBC leave the lungs they are usually _________ saturated? Saturated with what ?
100% saturated with oxygen
46
Hemoglobin consists of
two pairs of polypeptide chains Globins-proteins Heme Iron atom
47
Without a sufficient amount of iron in your diet, you will have \_\_\_\_\_\_\_\_\_\_, which will lead to \_\_\_\_\_\_\_
hemoglobin deficiency, anemia
48
About what percentage of the body;s total iron composition is in hemoglobin and myoglobin ?
70%
49
Besides being stored in Hgb and myoglobin, the rest of iron is stored as .......
ferritin or hemosiderin
50
This is the major storage form of iron....
Ferritin
51
This hormone controls iron absorption and is produced in the liver
Hepcidin
Hepcidin is a key regulator of the entry of iron into the circulation
52
Red blood cell destruction happens where
THE SPLEEN! Aged red cells are sequestered and destroyed primarily in the spleen
53
if bilirubin goes above 2 or 2.5 , the patient looks
yellow- there is jaundice
54
Hemostasis is
the stopping of the flow of blood
55
Who are the main players required in hemostasis ?
Platelets
Clotting Factors
Vasculature
56
Phases of hemostasis
Subendothelial exposure
Adhesion
Activation
Aggregation
Platelet plug formation
Clot retraction and clot dissolution
57
Aspirin is an
anti aggregate drug
58
Heparin is an anti-
coagulant
59
what is the only substance in the body that breaks down the fibrin strands of a clot ?
Plasmin
60
Inactive plasminogen in the circulation is activated by what substance ?
t-PA
61
In Hypercoagulability disorders your blood _______ more than it should
clogs
62
What is this condition called ? And what are some risk factors ?
deep vein thrombosis
***•Risk factors for DVT:***
**•Stasis of blood -** Bed rest, CHF, obesity
**•Increased coagulability** - Stress, trauma, pregnancy, BCP, smoking
**•Vessel wall injury** - Trauma, surgery
63
What is DVT ?
The presence of a clot in a deep vein with the accompanying inflammatory response - common in the extremities
64
A patient with DVT is at risk for
Pulmonary embolism
65
Risk factors for DVT
Stasis of blood Bed rest, CHF, obesity Increased coagulability Stress, trauma, pregnancy, BCP, smoking Vessel wall injury Trauma, surgery
66
True or false..... DVT prevents blood from going back.
True
67
DVT causes a PE but not a heart attack or stroke. True or false.
True..... clot becomes lodged within the tiny capillaries of the lungs and cannot make its way any further
68
best treatment for DVT of course is P\_ven\_t\_\_n
prevention
early ambulation after surgery
* Leg exercises, support stockings, pneumatic compression devices improve venous flow
* Anticoagulation therapy for treatment and prevention
69
DVT S/S
Up to 50% asymptomatic Mostly affected calf and thigh veins Swelling in one or both legs Pain or tenderness in one or both legs, which may occur only while standing or walking Warmth in the skin of the affected leg Red or discolored skin in the affected leg Visible surface veins Leg fatigue Homan’s sign- calf pain with foot dorsiflexion
70
S/S of PE
SOB Tachycardia or irregular heart beat, (A.fib) Chest pain, which worsens with a deep breath or coughing Extreme anxiety Coughing up blood Very low BP, lightheadedness, or fainting Acute respiratory failure Shock
71
Blood clotting involves what two processes ....
aggregration: platelets coagulation: coagulation factors
72
Anticoagulants inhibit
fibrin formation
73
Antiaggregants inhibit
platelet aggregration
74
Therapeutic use of anticoagulants:
Prevention of deep vein thrombosis (DVT) Prophylaxis in post-surgical patients Patients with a history of DVT Anticoagulation in patients with a likelihood or history of thrombotic stroke Transient ischemic attack (stroke prodrome) Previous thrombotic stroke Patients who are likely to have clot formation in their left heart, (atrial fibrillation or patients with artificial heart valves) For patients with a hyper-coagulability syndromes
75
if you give more heparin than you should you can cause
bleeding
76
if you give less heparin than you should you can cause
clotting
77
heparin infusion is adjusted based on the \_\_\_\_\_\_\_\_\_-
activated Partial Thromboplastin Time (aPTT
78
what is aPTT
the clotting time from the activation of factor XII, through the formation of fibrin clot
79
can heparin be given during pregnancy and lactation ?
Yes because it does not cross placenta easily as it is such a big molecule
80
what is the antidote of heparin?
Protamine Sulfate
81
Therapeutic uses of heparin
Heparin can be administered to prevent DVT after surgery because of its rapid acting During open heart surgery or dialysis During an evolving MI
82
Side effects of heparin
Bleeding in 10% of cases. Maybe severe. Monitor pt. for low BP, tachycardia, oozing in puncture sites, bleeding gums, red or dark stools, hematuria, headache, syncope. Risk increases when given with antiaggregants Spinal/epidural hematoma. Stop heparin before epidural catheter placement or removal HIT-Immune reaction against PLT factor 4 and heparin
83
Low molecular weight heparin
: heparin molecules that have a lower molecular weight than “unfractionated” heparin Abdominal surgery, knee and hip replacement Treatment of DVT Post MI, Non Q-wave MI, unstable angina
84
benefits of molecular weight heparin
They don’t need monitoring with lab tests (aPTT) like IV unfractionated heparin They can be given by the patient or caregiver at home. These preparations are almost as effective as unfractionated heparin They inhibit the activation of factor X but not that of thrombin The have the same contraindications as heparin but they do cause less HIT
85
Can heparin and coumadin be given at the same time ?
Yes
86
Warfarin/Coumadin Therapeutic Uses
Prevention of venous thrombosis and PE Prevention of thromboembolism in pt. with prosthetic heart valves and A.fib
87
MOA for Warfarin/Coumadin
Inhibits the synthesis of vit. K dependent clotting factors: (II (prothrombin) VII, IX, and X) by inhibiting Vitamin K activation in liver Takes days for the full effect hence the pt. needing anticoagulation must remain on heparin until the full effect of Coumadin takes place Because its long half-life coagulation remains inhibited for 2-5 days after its discontinuation
88
Side effects of Warfarin/Coumadin
Bleeding
89
Antidote for Warfarin/Coumadin
Vitamin K through IV or PO
90
t-PA
tissue plasminogen activator
91
t-PA activates plasminogen to
plasmin
92
Nursing interventions for pt. taking anticoagulents
avoid IM injections use electric razors Use soft brushes Use paper tape Use stool softeners Implement protocols to prevent falls
93
A patient is taking anticoagulents and you are about to shave him and perform hygiene- you pick up a razor and shaving cream and are using a hard, old toothbrush you found in the supply room .... what are the issues here ?
Should not use razor due to risk of cutting and bleeding instead use electric razors use soft brushes to prevent bleeding in the gums as you brush teeth
94
What is thrombocytopenia?
A deficiency of platelets
95
Thrombocytopenia increases the risk for
bleeding
96
platelet count indicating thrombocytopenia
\<150,000/mm3
97
Thrombocytosis
excessive amount of platelets in the blood
98
platelet count indicating Thrombocytosis
\>400,000/mm3
99
What is heparin induced Thrombocytopenia ?
Immune reaction against heparin and Plt Factor 4
100
Hemophilias are serious ___________ disorders
bleeding
101
DIC
Disseminated Intravascular Coagulation A complication of other conditions like sepsis, trauma, cancers, obstetric disorders Inflammation or immune mediated with release of cytokines, IL-1, TNF Massive thrombin and fibrin formation-excessive clotting Micro thrombi, vessel occlusion, tissue ischemia, organ failure All coagulation proteins and platelets are consumed and massive hemorrhage ensues
102
What is the hematocrit (HCT)
A ration between the cells and the plasma
103
Hematocrit is increased with
increase of RBC decreased plasma volume
104
Hematocrit is decreased with
decreased RBC increased plasma volume
105
cytic
size
106
MCV
mean corpuscular volume - this is a measurement of the size of the RBC
107
small MCV is called
microcytic anemia
108
large MCG
macrocytic anemia
109
normal MCV
normocytic anemia
110
if you don't have iron, you don't form a lot of
hemoglobin
111
different types of anemia
iron deficiency anemia megaloblastic anemia sickle cell disease
112
Two groups of disorders for RBC
Anemia Polycythemia
113
Anemia is a reduced
oxygen carrying capacity of the blood, resulting in tissue hypoxia
114
Physiologic manifestation of anemia
Hypoxemia
115
Anemia can be the result of
Abnormally low # RBC, Hg, or both
116
What is polycythemia ?
Excessive number of RBC with hct greater than 50%
117
Classic anemia symptoms
Fatigue Weakness Dyspnea Pallor
118
Several of the clotting factors need which vitamin for synthesis ?
Vitamin K
119
•Antiplatelets/Antiaggregants : Aspirin
•blocks irreversibly the formation of TxA2
120
the medications Plavix and Ticlid block the ADP receptor, thus preventing what during the clotting process
Aggregation
121
•ReoPro and Integriline inhibit GpIIb /IIIa receptor- this is the receptor for
fibrinogen
122
Clotting Cascade Picture
123
Warfarin inhibits what in the clotting cascade process
•Warfarin inhibits vit. K dependent factors , II, VII, IX, X
124
What process of the clotting cascade suffers if there is a low platelet number ?
Clot retraction - this is when the clot retracts to brings the edges of the wound closer together. This is facilitated by large numbers of platelets within the clot
•Fibrin strands shorten; become denser and stronger to approximate the edges of the injured vessel and site of injury
125
What happens in the clot retraction phase of the clotting cascade process ?
The clot retracts to brings the wound edges closer together
## Footnote
•Fibrin strands shorten; become denser and stronger to approximate the edges of the injured vessel and site of injury
126
What does plasmin digest ?
Fibronogen, fibrin strands, factor V and factor VIII
127
What is a D-Dimer ?
D-dimer (D dimer, DDimer) is a specific fibrin degradation product (or FDP), a small protein fragment present in the blood, generated after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrin protein
128
Xarelto is a medication that inhibits
factor X
129
•Pradaxa, Eliquis are both
direct Thrombin inhibitors
130
In what instances is there an accelerated activity of coagulation ?
* Pregnancy
* Oral birth control
* Postoperative
* Immobility
* CHF
* Malignant dx
131
There is increased platelet function in what conditions ?
* Atherosclerosis
* Diabetes Mellitus
* Smoking
* Lipids/ Cholesterol
* Platelets
132
DVT causes a ________ but not a heart attack or stroke....
pulmonary embolism. This can happen without any signs/symptoms of DVT
one or more arteries in the lungs becomes blocked by a blood clot
- leads to sudden shortness of breath and chest pain
133
To help prevent DVT, in post surgery patients we should especially encourage
ambulation
134
What can we do to prevent DVT ?
* Early ambulation after surgery
* Leg exercises, support stockings, pneumatic compression devices improve venous flow
* Anticoagulation therapy for treatment and prevention
135
Anticoagulents help to
prevent clots by reducing fibrin formation
136
Heparin infusion is adjusted based on the aPTT? What is the aPTT time?
•activated Partial Thromboplastin Time (aPTT)
aPTT is the clotting time from the activation of factor XII, through the formation of fibrin clot
137
Heparin is administed through what routes .....
When does it take effect ?
What is the goal with heparin therapy?
Administered IV by a continuous infusion or SQ injection
it takes effect promptly (within 20-0 minutes)
* Infusion is adjusted based on the activated Partial Thromboplastin Time (aPTT)
* The goal is usually to achieve an aPTT that is 1.5 to 2 times the normal value (~35 seconds)
* The aPTT should be drawn 6 hours after a change in the rate of infusion and daily if the infusion rate is stable
138
HIT
Heparin induced cytopenia
•HIT-Immune reaction against PLT factor 4 and heparin
139
Low molecular weight hepain causes less
HIT
140
Increased Platelet Function occurs
atherosclerosis
diabetes mellitus
smoking
high lipids/cholesterol
high platelets
141
Accelerated Activity of Coagulation occurs
pregnancy
oral birth control
postoperative
immobility
CHF
malignant dx
142
Rivaroxaban (Xarelto) inhibits what clotting factor ?
binds to factor X and inhibits the formation of thrombin
143
Xarelto is an alternative for
indications
Warfarin
* Prevention of DVT after knee or hip replacement surgery
* Prevention of stroke in pt. with atrial fibrillation
144
Dabigatran (Pradaxa), Apixaban (Eliquis) both inhibit
it is only approved for patients with
thrombin and its ability to convert fibrinogen into fibrin
•Only approved for patients with atrial fibrillation to prevent stroke
145
Alteplase (Activase) and related drugs Tenecteplase (TNKase) and Reteplase (Retavase)
are all
when should they be given for most effect ?
Indications ?
t-PA activators
They must be given shortly after the onset of symptoms to be most effective. This is a major constraint to their use
* Indications
* Ischemic stroke
* Acute MI
* PE
146
•Can t-PA therapy be given intra-arterially into a clotted blood vessel (coronary artery, pulmonary artery, carotid artery) or IV ?
Yes it can
•If given directly into a clotted area, the dose is much lower and therefore safer
147
what kind of heparin causes less HIT ?
Low molecular weight heparin
148
ITP - what is it ?
Immune Thrombocytopenic Purpura (ITP)
•Autoimmune disorder -Antiplatelet antibody formation and excess destruction of plts
•
* Antibodies against IIb / IIIa receptor
* Half cases occur as acute primary disorder in children (5yrs) following viral infection – lasts about 1-2 months with petechiae & purpura -\> self-limiting
* Primary ITP -\> chronic disorder in adults (no Hx of infection); onset 18-40 years of age, 3:1 female to males
* Insidious onset of bruising, bleeding gums, epistaxis, melena. Later, splenomegaly, internal hemorrhage
* Rx: depends on severity, steroids, IgG, splenectomy
149
Von Willebrand Disease
* Autosomal dominant -\> deficiency or defect in vWF à affects plt function & coagulation pathway
* Spontaneous bleeding with normal plt count
* Bleeding usually mild
* TX: Avoid ASA; DDAVP with surgical & dental procedures to stimulate endothelial cells to release stored vWF
150
Macrocytic-Normochromic Anemias is also termed
•megaloblastic anemias
characterized by unusually large stem cells, a result of defective DNA synthesis
* Caused by deficiencies in vitamin B12 or folate
* Coenzymes for nuclear maturation and the DNA synthesis pathway
151
most common type of megaloblastic anemia
vitamin B12 deficiency - can be caused by Pernicious anemia (intrinsic factor is missing)
152
normal hemoglobin count
For men, 13.5 to 17.5 grams per deciliter.
For women, 12.0 to 15.5 grams per deciliter.
153
manifestations of megalblastic anemia
* When hemoglobin at 7-8 g/dl:
* Weakness
* Fatigue
* Loss of appetite
* Abdominal pain
* Weight loss
* Sore tongue
MCV increased while
MCHC is normal
* Neurologic manifestations
* Deranged myelin formation
* Paresthesia
Difficulty walking
154
Folate deficiency anemia - this is similiar to pernicious anemia except that what manifestations are not seen
also where is folate absorbed? Is it dependent on anything for absorption?
* neurologic manifestations generally not seen
* Absorption of folate occurs in the upper small intestine
* Not dependent on any other factor
155
Folic acid and pregnancy - is there an increased need? what are deficiencies associated with ?
recommended daily amounts for women of CB age and those pregnant
* Increased need for folic acid 5-10x
* Result of poor dietary habits, anorexia, nausea
* Folate deficiency associated with neural tube defects
* All women of CB age should take 400mcg daily; pregnant women 600 mcg daily
156
