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Gould's Pathophysiology Ch. 10: Blood and Circulatory System Disorders

Terms in this set (100)

Achlorhydria
Lack of hydrochloric acid in the gastric secretions
Agglutination
Clumping together of cells or particles
Autoregulation
Automatic regulation or reflex control of blood flow in an area depending on the local needs
Bilirubin
A product from the breakdown of hemoglobin, transported in blood to liver and excreted in bile; the balance of the heme component
Cyanosis
Bluish color of skin and mucosa that occurs when a large proportion of hemoglobin is unoxygenated
Demyelination
Loss of the myelin sheath from a nerve surface, interfering with conduction
Deoxyhemoglobin
The reduced form of hemoglobin, resulting when oxyhemoglobin loses its oxygen
Diapedesis
The passage of leukocytes through intact capillary walls to a site of inflammation
Dyscrasia
Abnormality of the blood or bone marrow; abnormal cell characteristics or numbers; a pathological condition of the blood that usually refers to disorders involving cellular componemnts of the blood
Dyspnea
Difficulty breathing
Ecchymoses
Reddish blue discoloration of skin mucosa because of bleeding
Erythropoietin
A glycoprotein hormone secreted by the kidney in the adult and by the liver in the fetus, which acts on stem cells of the bone marrow to stimulate red blood cell production in response to tissue hypoxia
Ferritin
A storage form of iron; can be stored in the liver, blood and other body tissues
Gastrectomy
The surgical removal of all or part of the stomach.
Glossitis
Inflammation of the tongue
Hemarthrosis
Bleeding into a joint cavity
Hematocrit
Percentage of erythrocytes in a blood sample
Hematopoiesis
The growth and maturation of the blood cells and other formed blood elements in the bone marrow
Hemolysis
Destruction of erythrocytes with release of hemoglobin
Hemoptysis
Frothy sputum containing streaks of blood, usually bright red; spitting up blood
Hemosiderin
it is an insoluble form of storage iron that can be stored in the liver, blood, and other body tissues; a pigment that is a product of hemolysis (golden-yellow or yellow-brown)
Hemostasis
-Blood clotting or controlling bleeding

-Consists of 3 Steps:

1. Immediate response of blood vessel injury: vasoconstriction or vasospasm. (In small blood vessels this decreases blood flow and allows platelet plug to form)

2. Thrombocytes tend to adhere to underlying tissue at site of injury and if blood vessels are small, they form a platelet plug.

3. In larger blood vessels, the blood-clotting or coagulation mechanism is required: circulating clotting factors in the blood are activated
Hepatomegaly
Enlarged liver
Hypochromic
A descriptive term applied to a red blood cell with a decreased concentration of hemoglobin leading to less color of the cell
Interleukin
Protein (cytokine) primarily produced by T cells, active in inflammatory and immune responses and leukocyte communication
Leukocytosis
An above-normal number of leukocytes (WBCs) in the blood; occurs with bacterial infection or inflammation
Leukopenia
A decreased number of leukocytes in the blood; occurs with some viral infections, radiation, and chemotherapy
Leukopoiesis
The production of leukocytes
Macrocyte
An abnormally large erythrocyte
Macrophage
Performs phagocytosis; processes and presents antigens to lymphocytes for the immune response
Malabsorption
Impaired absorption of nutrients from the intestines
Megaloblasts
Abnormally large, nucleated, immature erythrocytes
Microcytic
A descriptive term for a small red blood cell
Morphology
The physical size, form, structure, and shape of cells or organs
Myelotoxin
Toxin that destroys marrow cells
Myelodysplastic
The abnormal proliferation of bone marrow cells that are precursors to blood cells
Neutropenia
A deficit of neutrophils in the blood
Oxyhemoglobin
A bright-red chemical complex of hemoglobin and oxygen that transports oxygen to the tissues
Pallor
Extreme or unnatural paleness
Pancytopenia
Decrease in all blood cells, erythrocytes
Petechiae
Flat, red, tiny, pinpoint hemorrhages under the skin
Phlebotomy
Incision into a vein and collecting of blood
Plasma
The liquid proportion of blood, after cells are removed; the clear yellowish fluid remaining after the cells have been removed
Plethoric
Turgid; overinflated
Reticulocyte
An immature red blood cell (in mammals) that lacks a nucleus but contains a network of filaments consisting of residual RNA and organelles; a count of these can assess bone marrow function
Serum
The liquid portion of blood, lacking cells and clotting factors; the fluid and solutes remaining agter the cells and fibrinogen have been removed
Splenomegaly
Enlarged spleen
Stomatitis
Inflammation and ulceration of the mouth
Syncope
Fainting, temporary loss of consciousness
Tachycardia
Excessively rapid heartbeat
Thrombocytopenia
Abnormally low number of thrombocytes or platelets
Tunica intima
Endothelial layer of arteries and veins
Tunica media
A layer of smooth muscle that controls the diameter and lumen size of the blood vessel
Tunica adventitia
The outer connective tissue layer of arteries and veins that contains elastic and collagen fibers
Erythrocyte
Biconcave, flexible discs that are non-nucleated when mature and contain hemoglobin
Hypoxia
Insufficient oxygen available to cells, organs or tissues
Vasa Vasorum
consists of tiny blood vessels that supply blood to the tissues of artery and vein walls themselves
Vasoconstriction
effect of norepinephrine and epinephrine (stimulate alpha-adrenergic receptors), and angiotensin on arteriolar walls
1. biconcave
2. non-nucleated
3. hemoglobin
Erythrocytes (RBCs) are (1) discs that are (2) when mature and contain (3)
1. globin
2. amino acid chains
3. heme groups
Hemoglobin consists of the (1) portion, two pairs of (2), and four (3), each containing a ferrous iron atom, to which oxygen molecule can attach
Heme
Provides the red color associated with hemoglobin
Carbon Monoxide
Can easily displace oxygen from hemoglobin; binds tightly to iron, thus causing fatal hypoxia
1. carbon dioxide
2. bicarbonate ion
1. Only a small proportion in the blood is carried by hemoglobin (attached to nitrogen in an amino acid group at a different site than that for oxygen)

2. Most is transported in the blood as this
120 days
Normal lifespan for a red blood cell
spleen or liver
where red blood cells are broken down into globin and heme (2 organs)
1. globin
2. iron
(1) is broken down into amino acids, which can be recycled in the amino acid pool

(2) can be returned to the bone marrow and liver and be reused in the synthesis of more hemoglobin
hemochromatosis
a genetic disorder also known as iron overload, resulting from large amounts of hemosiderin accumulating in the heart, and other organs, causing serious organ damage
Colony-Stimulating Factors
Produced by macrophages and T lymphocytes, stimulates leukopoiesis
Band Neutrophils
Increase in number with a "shift to the left"; immature
Differential Count
Indicated the proportions of specific types of WBCs in the blood and frequently assists in a diagnosis (e.g. neutrophil increase = bacterial infection or inflammatory condition; eosinophil increase = allergic reaction or parasitic infections)
Thrombocytes
-Very small, irregular shaped, non-nucleated fragments from large megakaryocytes

-Essential in blood clotting process; stick to damaged tissue as well as to each other to form a platelet plug that seals small breaks in blood vessels, or they can adhere to rough surfaces and foreign material

-Can initiate the coagulation process

-Aspirin reduces their adhesion
Coagulation
-Clot formation:

1. Damaged tissue and platelets release factors that stimulate a series of reactions involving numerous clotting factors, finally producing PROTHROMBIN ACTIVATOR (PTA)

2. PROTHROMBIN or Factor II (inactive in plasma) is converted INto THROMBIN

3. FIBRINOGEN (Factor I) is converted into fibrin threads

4. A FIBRIN MESH forms to trap cells, making up a THROMBUS (a solid clot), stopping the flow of blood

5. The clot gradually retracts (shrinks), pulling the edges of damaged tissue closer together and sealing the site
1. Liver
2. Vitamin K
3. Calcium
1. Where circulating clotting factors are primarily produced

2. A fat-soluble vitamin required for the synthesis of most clotting factors

3. Ion essential for many steps in the clotting process
Fibrinolytic Process
-Can break down newly formed clots

1. Circulating inactive plasminogen is converted into plasmin by plasminogen activator (tPA) and streptokinase

2. Plasmin breaks down fibrin and fibrinogen

-This is a localized event only because plasmin is quickly inhibited by plasmin inhibitor
Hematocrit
Diagnostic test of blood that may be an indicator of anemias
Chemical Analysis
Diagnostic test of blood that may be an indicator of metabolic disorders and disorders within various body systems
Blood-clotting disorders
Can be differentiated by diagnostic tests such as:

-Bleeding time: measures platelet function-time to plug a small puncture

-Prothrombin time or INR International Normalized Ratio: measures extrinsic pathway

-Partial Thromboplastin Time (PTT): measures intrinsic pathway and the function of factors of the coagulation process
Albumin
Plasma protein primarily responsible for the osmotic pressure of the blood
Globulins
Plasma protein that acts as antibodies
Fibrinogen
Plasma protein that is a clotting factor
Iron Deficiency Anemia
Type of anemia:

-Low iron: low synthesis of hemoglobin resulting in lower amounts of oxygen transported in blood, this results in microcytic and hypochromic red blood cells.

-Etiology: varies; diet, blood loss, duodenal absorption issue, cancer, infection

-Signs/symptoms: can be asymptomatic, fatigue, lethargy, cold intolerance, irritability, brittle hair, concave nail, stomatitis, glossitis, tachycardia, dyspnea, syncope (fainting), and pallor of skin.

-Testing: Lab tests including blood work, values for hemoglobin, hematocrit, MCV, MCH, etc.

Treatment - Iron supplements, increase of iron-rich foods
Megaloblastic Anemia
Type of anemia:

-Pernicious Anemia: Vitamin B12 Deficiency

-Large, immature red blood cells or erythrocytes which are destroyed prematurely

-Deficit of folic acid (vitamin B9) or vitamin B12 because of intrinsic factor deficiency (needed for B12 absorption)

-Etiology: most often malabsorption (which can result from autoimmune reaction, chronic gastritis, gastric atrophy, and inflammatory conditions affecting digestive system)

-Signs/symptoms - enlarged red, sore, and shiny tongue, digestive discomfort, paresthesia (from demyelation), ataxia

Tests - Schilling's test (ingestion of radioactive vitamin B12 to measure absorption), blood work

Treatment - Supplements, oral or by injection
Aplastic Anemia
Type of Anemia:

-Results from impairment of bone marrow leading to pancytopenia

-Etiology: idiopathic, due to myelotoxins, viruses, autoimmune disease, or genetic abnormality

-Signs/symptoms: anemia, leukopenia, thrombocytopenia

-Tests: blood work, bone marrow biopsy

-Treatment: focus on underlying cause, blood transfusion, bone marrow transplant
Sickle Cell Anemia
Type of hemolytic anemia:

-Etiology: recessive gene, severity varies greatly; inherited characteristic leads to the formation of abnormal hemoglobin, hemoglobin S (HbS: one amino acid in the pair of beta-globin chains has been changed (valine replaces glutamine). When hemoglobin becomes deoxygenated it crystallizes and changes the shape of the RBC)

-Signs/symptoms: severe cases -tachycardia, jaundice (hyperbilirubinemia), splenomegaly, vascular occlusions and infarctions, tissue damage (ulcers on hands and feet, areas of necrosis in the bones or kidneys, or seizures or hemiplegia from cerebral infarctions (stroke)), delayed growth and development, death from respiratory occlusions

-Tests: Carriers - simple blood test

-Treatments: Hydroxyurea, dietary supplementation, avoidance of high altitudes
Thalassemia Anemia
Type of hemolytic anemia:

-Results from a genetic defect. Interferes with the production of the globin chains and the amount of hemoglobin synthesized and the number of red blood cells is impacted

-Etiology: genetic disorder, two types alpha and beta (apha is the most common genetic disorder in the world)

-Signs/symptoms: usual signs of anemia, impaired growth in children, can lead to heart failure, iron overload

-Tests: RBCs are microcytic and hypochromic, increase in erythropoietin levels, blood work
Hemophilia A
Blood-Clotting Disorder:

-Deficit or abnormality of clotting factor VIII

-Signs/symptoms: prolonged or severe hemorrhage from minor trauma, hemarthrosis, hematuria, or blood in feces

-Tests: PTT, APTT and coagulation time (all 3 are prolonged), bleeding time and PT are normal, blood work

-Treatment: Desmopression (DDVAP-stimulates blood vessel endothelium to release stored clotting factor VIII), IV administration of clotting factor, Advate, and/or Nplate (stimulates platelet production in bone marrow)

-Also termed classic hemophilia, Deficiency of clotting factor VIII

-Other types are Hemophilia B (Christmas disease, clotting factor IX), Hemophilia C (Rosenthal's hemophilia, clotting factor XI)
von Willebrand Disease
Blood-Clotting Disorder:

-Deficiency of the von Willebrand factor, a clotting factor that helps platelets clump and stick to the walls of blood vessels when they are injured

-Signs/symptoms: skin rashes, nosebleeds, easy bruising, gum bleeding, and abnormal menstrual bleeding

-Tests: blood work, bleeding time, blood typing, VIII Levels, etc.

-Treatment: manmade hormone desmopression, antifibrinoloytic drugs, birth control pills
Disseminated Intravascular Coagulation
Blood-Clotting Disorder:

-Excessive bleeding and excessive clotting (can be life-threatening)

-Etiology: varied, typically excessive body trauma or infection

-Signs/symptoms: depend on underlying cause, increased bleeding, and multiple bleeding sites

-Treatment: focus on underlying cause, difficult to treat successfully
Thromboplastin
-Clotting factor III

-Important in the formation of extrinsic prothrombin
Thrombophilia
Blood-Clotting Disorder:

-Group of inherited or acquired disorders that risk of development of abnormal clots in veins or arteries

-Signs/symptoms: abnormal clotting event(s)

-Test: blood testing for clotting factor levels and antibody levels

-Treatment: underlying cause if present, anticoagulant therapy (Coumadin)
excessive bleeding
May be caused by a vitamin K deficit, which impairs production of clotting factors, liver damage, thrombocytopenia resulting from ITP (idiopathic thrombocytopenic purpura), and certain toxins, infections, and drugs
Myelodysplastic Syndrome
-Disease that involves inadequate production of cells by bone marrow

-May be idiopathic or due to chemotherapy or radiation treatments

-Can progress to chronic or acute leukemia in some cases
Polycythemia
Neoplastic Blood Disorder:

-Primary (vera): increased production of red blood cells and other cells in bone marrow (hypercellular), serum erythropoietin levels are low; blood vessels distended and blood flow is sluggish; increased blood viscosity

-Etiology: primary polycythemia has unknown etiology

-Secondary (erythrocytosis): can be due to chronic lung or heart disease; chronic hypoxia and increased erythropoietin

-Signs/symptoms: plethoric, cyanotic, hepatomegaly, pruritus, increased blood pressure, increased pulse, dyspnea, headaches, visual disturbances, thrombosis, CHF, and high levels of uric acid (hyperuricemia, from cell destruction) resulting in joint pain

-Tests: blood work, bone marrow testing

-Treatment: pharmacology therapy, radiation
Leukemia
-Etiology: varies, chronic cases are more common in older adults, acute cases occur more often in children

-Some are associated with chromosomal abnormalities

-Signs/symptoms: infection, excessive bleeding, bone pain, weight loss, fatigue, fever, enlarged lymph nodes, spleen, liver, headaches, visual disturbances, and weakness

-Tests: blood smears, bone marrow biopsy

-Treatment: Chemotherapy, other drug therapy, interferon, nutrition and hydration, bone marrow transplant.
Acute Lymphocytic Leukemia (ALL)
Type of leukemia:

Malignant Cell: B-lymphocytes
Primary Age: Young Children
Acute Myelogenous Leukemia (AML)
Type of leukemia:

Malignant Cell: Granulocytic stem cells
Primary Age: Adults
Chronic Lymphocytic Leukemia
Type of leukemia:

Malignant Cell: B-lymphocytes
Primary Age: Adults greater than 50 years of age
Chronic Myelogenous Leukemia (CML)
Type of leukemia:

Malignant Cell: Granulocytic stem cells
Primary Age: Adults 30-50
Acute Monocytic Leukemia
Type of leukemia:

Malignant Cell: Monocytes
Primary Age: Adults
Hairy Cell Leukemia
Type of leukemia:

Malignant Cell: B-lymphocytes
Primary Age: Males greater than 50 years of age
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