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Intro to Hematology
Clinical Medicine II Spring 2012
| Question | Answer |
|---|---|
| The study and tx of diseases of blood and blood forming organs | hematology |
| Malignant hematology | leukemia, lymphoma, myeloma |
| Benign blood dzs | anemias, genetic blood dzs: thalassemia, sickle cell, enzyme defects, bleeding and clotting d/o, immune deficiencies |
| What are the formed elements of blood | RBC, WBC, platelets |
| What are the plasma elements | water, dissolved ions, proteins |
| Where is blood made, and 3 compartments | bone marrow, circulation, peripheral tissues |
| What are leukocytes and thrombocytes | l: WBCs T: platelets |
| Main component of plasma | water |
| Where are proteins in the blood? 3 types? | plasma, carrier proteins, immunoproteins, coagulation proteins |
| What are carrier proteins | albumin, lipoproteins, transferrin |
| What are immunoproteins | IgG, IgA, IgM, IgD, IgE complement proteins |
| Hematopoiesis | making or production of blood |
| When is blood begin to develop in gestation | 4-5 weeks |
| When do blood cells migrate to be produced during gestation | liver 5 weeks, bone marrow and thymus 8 weeks, spleen 12 weeks |
| Why do we look for enlarged liver and spleen during blood diseases | liver and spleen help take over RBC production hence enlargement |
| What does the thymus do | maturation of WBC shriveled in adulthood, lg and soft in newborns |
| At birth what is the primary hematopoietic | bone marrow |
| What happens to bone marrow tissue as we age | we don’t need it all, usually at about 20% of what we had in 1st decade of life |
| Why do medications affect blood counts so much more as we age compared to when we’re young | ↓bone marrow tissue |
| Sinuses lined w/ endothelial cells and fibroblasts support the devellpment of blood cells | stroma |
| What plays and important supportive role in the stroma of bone marrow | osteoblasts |
| What are hematopoietic cells | stem cells → mature blood cells |
| What is the 1st type of cells that many other arise from | pluripotent hematopoietic stem cell |
| Two types of 2nd stem cells | myeloid:RBC, platelets, leukocytes or lymphoid stem cells(go into thymus to mature to B and T lymphocytes) |
| Requirements for hematopoiesis | healthy bone marrow, hormones, and nutritional factors |
| Two most important hormones in hematopoiesis and where are they made | erythropoietin: kidney, thrombopoietin: liver |
| What happens w/ kidney and liver dz | k: anemia L: thrombocytopenia |
| What 3 nutriitional factors are needed for hematopoiesis | iron, folate, vit B12 |
| MC anemia deficiency ever | iron deficiency anemia |
| Why are blood dz’s so common | manyyyy systemic disease affects the parts of blood production |
| Process to make RBC | erythropoiesis |
| Where do RBC originate from | common myeloid stem cell |
| What happens to the RBC prior to release from the marrow | nucleus is ejected from the cell |
| What happens to the RBC development w/ folate and VIt B12 def | the nuclease doesn’t condense, and looks like an early stage |
| Why is folate and Vit B12 so important | need them for DNA synthesis |
| 5 types WBC | neutropohils, eosinophils, basophils, monocytes and lymphocytes (lymphoid path) |
| Why do we call T and B lymphocytes that? | T: mature in thymus B: mature in bone marrow |
| What is a platelet | chunk of cytoplasms from a megakaryocyte |
| What type of cell has more than one nucleus | megakaryocyte, cytoplasms divides, but cell does not, eventually chunks break out→platelets |
| What are 6 big things can cause anemia | 1: nutritional def, 2: marrow toxins, 3: infxs, 4: marrow replacement, 5: autoimmune dzs 6: primary bone marrow dzs |
| What are examples of marrow replacements | infections: fungal, TB, sarcoids, leukemia, lymphoma, myeloma, carcinoma |
| Three critical ways to evaluate blood and bone marrow | CBC, peripheral blood smear, bone marrow |
| Where do we get a bone marrow biopsy from | post, superior, iliac spine, bc no major structures here, lots of bone marrow |
| Two types of bone marrow biopsies | core sample, and aspirate: need two holes in bones |
| Size and shape of RBC | biconcave disk (once they lose their nucleus) , 7mM diameter |
| What are the 4 compoenets of a RBC | membrane, Hb, enzymes, electolytes |
| What are the enzymes in a RBC doing | protecting the Hb from getting oxidized |
| Fxns of a RBC | transports O2 and CO2 to and from tissues |
| Why do we need to know about enzyme difiencies | some like g6phosphate dehydrogenase: can’t use sulfa drugs |
| Why is iron important w/ RBCs | in the center structure of heme w/o iron, no Hb, no RBC no O2 transport |
| If creatnine is nl, how can there still be anemia | need to check EPO level, can be making urine, and not EPO |
| Three nutrients to make RBC | iron, folate, B12 |
| If there is anemia, what should we immediately check | reticulocyte count, immature RBCs showing that the bone marrow is making new RBCs, more anemia→↑the retic count |
| Ave life span of RBC, removed how | 120 days, phagocytized by macrophages in spleen, liver, bone marrow d/t different proteins on cell surface |
| RBC count | number per uL blood |
| Three ways and MC way to measure anemia | RBC count, Hct % and Hgb: MC thing to look at |
| 3 types of anemia | micrcytic, normocytic, macrocytic |
| Types of erythrocytosis | polycythemia ver, 2nd: hypoxia, abnl EPO production, abnl Hgb w/ ↑O2 affinity: smokers |
| 3 tyeps of hemoglobinopathies | abnl hb structures, thalassemia, sickle cell |
| What is microcytic hypochromic anemia | iron deficiency anemia |
| What should nl RBC be shaped like | central pallor 1/3 of the cell, cell size should be the size of a sm. Lymphocyte |
| With severe iron deficiency, what is the retic count and EPO level | low retic count d/t no iron to make RBC and sky high EPO level d/t need for more RBCs |
| When do you see target cells on the differential | thalassemia and liver dz |
| What do symptoms of anemia depend on | rate of blood loss |
| Sxs of anemia | fatigue, dyspnea, palpiations, tachy, dizzy, lightheadness, faintness, HA, angina, claudication |
| PE of anemia | pallor, jaundice, tachy, tachypnea, edema, lymphadenopathy, hepatosplenomegly, ecchymosis, petchiae, stool occult blood |
| Anemia algorhytima | check retic count: nl or low then can’t MAKE it d/t deficiencies 2: Check MCV |
| Microcytic anemia causes | iron deficiency, anemia of chronic dz, thalassemia |
| Normocytic anemia | anemia of chronic dz, renal failure, early/mild iron def, 1 bone marrow failure (aplastic anemia) |
| Macrocytic anemia | B12/folate def, liver dz, hypothyroidism, drugs, myelodysplastic syndrome |
| What are common drugs causeing macrocytic anemia | Mess w/ DNA synthesis MTX, sulfa, trimeterine, phenytoin, chemo, antivirals |
| 4 MC causes of anemia | Iron def, renal failure, B12/folate def, liver dz |
Created by:
becker15
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