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Blood and Lymph Disorders

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What composes hematocrit?
RBCs
platelets
monocytes
lymphocytes
what is the pH of blood?
7.35-7.45
how much blood is in the human body and in what percentages is it composed?
5 -6 liters
45% RBC
1% WBC/platelets
54% plasma
RBCs
4.8 to 5.4 million/cu mm
120 life span
biconcave disc (looks like a smartie)
contains hemoglobin
what is hemoglobin, how is it composed, and what does it do?
protein
carries oxygen and carbon dioxide
composed of 2 alpha globin + 2 beta globin binded to 4 iron heme group chains
thalassemia
anemia resultant from a variation in alpha/beta genes in the nucleus of the bone marrow stem cells
decreased alpha/beta synthesis
genetic
generally asymptomatic
severe cases = growth retardation/splenomegaly/jaundice/death before 30
treat severe cases with transfusion
erythropoeisis
RBC production
stimulated by erythropoietin released from the kidneys
occurs in the bone marrow of the axial skeleton
reticulocyte
newly formed RBC recently ejected from from the marrow
should be 1-2% of RBC count
unconjugated bilirubin
catabolized hemoglobin
conjugated bilirubin
formed in liver from unconjugated bilirubin
excreted in bile
excess causes jaundice
define hematocrit
the volume of packed RBCs per 100mL of blood
anemia
reduction of # of functioning RBCs circulating/cu mm
anemia causes
bone marrow dysfunction (primary/toxic)
nutritional deficiency (iron/folic acid/others)
infection
chronic renal failure
increased RBC destruction
blood loss
anemia signs/symptoms
fatigue/headache/exertional dyspnea
pallor/cheilosis/jaundice/beefing red tongue/koilonychia
polycythemia
excess of red blood cells
pica
craving to eat things that are not typically considered food
what are the percentages of hematocrit in the blood?
males 39-49%
females 35-45%
how much hemoglobin is in the blood?
males 14-17g/mL
females 12-16g/mL
mean corpuscular volume (MCV)
average of the measure of red blood cell size
low MCV = microcytic anemia
high MCV = macrocytic anemia
what is the average MCV
80-94 fL (fL femtolitre = one quadrillionth of a liter)
mean corpuscular hemoglobin MCH
average mass of hemoglobin per red blood cell
low MCH = hypochromic
high MCH = hyperchromic
what is the average MCH
27-32 pg (pg picogram = 10 to negative 12 grams)
iron deficiency
hypochromic microcytic anemia
most common worldwide
pica = hallmark symptom
elevated total iron-binding capacity (TIBC)
eat iron rich foods -or- 325mg bid w/ food
body only loses 1mg/day Fe; absorbed in illeum
Fe consumption causes: constipation/nausea/black stool/diarrhea
200-250 mg/kg Fe = lethal oral dose
copper deficiency
may cause hypochromic microcytic anemia
wilson's disease
normochromic normocytic anemias
caused by organ failure: kidney/pituitary/thyroid
caused by protein malnutrition/impaired marrow function from injury/infiltrative marrow disease (neoplasm/fibrosis)
associated with NORMAL SIZ*E
NORMAL SIZ*E
n - normal pregnacy
o - overhydration
r - chronic Renal failure
m - myelophthisic (tumor/fibrosis/leukemia)
a - acute blood loss
l - liver disease

si - systemic infection
z - zero production
e - endocrine disorders
folic acid deficiency
macrocytic anemia
alcoholism/drug abuse/increased demand(pregnancy/development)/impaired utilization(oral contraceptives/chemotherapeutics)
daily requirement 400mcg
sore throat/abd. pain/intermittent constipation/diarrhea
eat leafy green vegetables
r/o b12 deficiency
B12 deficiency
macrocytic anemia
sore throat/beefy red tongue/anorexia/nv/indigestion/abd pain/weight loss
may lead to irreversible neurological damage
clinical findings: stocking glove parasthesias/loss of fine touch and vibratory sensation/altered sphincter control/psychotic behavior/irritability/ataxia
aplastic anemia
bone marrow failure to produce RBC
pancytopenia: all blood cells are decreased
can be macrocytic/normocytic
avoid ASA
hemolytic anemia
accelerated RBC destruction
micro/macro/normocytic
acute/chronic/episodic
gallstones/back+abd. pain/chills/fever
elevated reticulocyte count/plasma hemoglobin
sickle cell anemia
hemolytic
RBCs sickle under increased altitude/trauma/physical exertion/cold temperature/dehydration/acidosis
painful/swollen joints/splenomegaly/seizures/stroke
avascular necrosis of femoral head
give pneumococcal vaccine
what is the order of clotting and what nutrients are necessary for it to take place?
order: vasoconstriction -> platelet aggregation -> fibrinogen converts to fibrin -> coagulation system begins
needs calcium ions + vitamin K
coagulation cascade
intrinsic pathway: factors VII, XI, IX, XII, Ca+
extrinsic pathway: factors III, VII, Ca+ tissue factors
common pathway: factors V, X, Ca+, platelet phospholipids
factor VIII is only factor not made entirely in liver
bleeding time
indicative of platelet function
should be 3 to 9.5 mins
thrombocytopenia
<100,000 circulating platelets
decreased production/increased destruction
autoimmune thrombocytopenic purpura (ATP)
acute idiopathic thrombocytopenic purpura (acute ITP)
abrupt petechiae and purpura on skin
usually spontaneously resolves
platelet count 10,000 to 20,000
may need corticosteroids/splenectomy
chronic idiopathic thrombocytopenic purpura (chronic ITP)
platelet count 25000 to 75,000
corticosteroids/immunosuppressive therapy/splenectomy
DIC (disseminated intravascular coagulation)
generalized hemorrhage in severe systemic illness
exhausted supply of platelets/clotting factor
one clot here, bleeding everywhere else
uremia
toxic metabolic byproduct build up due to renal failure
hemophilia A
factor VIII deficiency (von willebrand's)
woman are carriers and pass on
men are hemophiliacs
hemophilia B
factor IX deficiency (christmas disease)
k-dependent factor deficicency
liver failure/malnutrition/breast milk is low in vitamin K
decreased K + factors II, VII, IX, X
peyer's patches
gut associated lymph tissue
lymph organs
nodes
thymus
spleen
return/clean fluid from interstitial space to blood stream
lymphadenopathy
swelling of lymph
symptom of other systemic illness
suspect benign when: young adult/symptomatic/rapid change in size (days to weeks)/tenderness/soft consistency
suspect malignant when: elderly/asymptomatic/slow growth/firm/rubbery/systemic symptoms
armpit - think cat scratch
inguinal - think STD
splenomegaly
usually secondary disease (CHF/liver disease/vascular congestion/infection)
can mean sarcoidosis/lupus (but it's never lupus and sarcoidosis is just silly)