Download Hematology Test Guide: Comprehensive Review of Blood Cells, Hemostasis, and Hematopoiesis and more Exams Nursing in PDF only on Docsity!
NRS 525 - Hematology Test Guide
With Complete Solution
What are Erythrocytes? - ANSWER Red blood cells. The most abundant cells in the blood, responsible for oxygenation of the tissues.
What is Hemoglobin? - ANSWER A protein in red blood cells that carries oxygen.
Special features of RBCs? - ANSWER Their size and shape. Bioncavity and reversible deformity.
How long of a life cycle do RBCs have? - ANSWER 120 days
What are leukocytes? - ANSWER white blood cells
What do Leukocytes do? - ANSWER Defend the body against infection and remove debris.
What is the normal level of leukocytes? - ANSWER 5000-10,000 cells
Plasma proteins: Albumins - ANSWER Function as carriers, control plasma oncotic pressure.
Plasma proteins: Globulins - ANSWER Carrier proteins and immunoglobulins (antibodies)
Plasma proteins: Clotting factors - ANSWER mainly fibrinogen
What are the cellular components of platelets? - ANSWER Thrombocytes
What are the types of Leukocytes? - ANSWER Granulocytes, agranulocytes
What are granulocytes? - ANSWER A type of leukocyte. Membrane bound granules are in their cytoplasm. Contain enzymes capable of destroying microorganisms, catabolism debris injested during phagocytosis.
Granulocytes: Neutrophils - ANSWER Most numerous. Defend against infection. Serve as phagocytes in early inflammation, ingest and destroy microorganisms and debris and then die in 1-2 days.
Granulocytes: Eosinophils - ANSWER Phagocytic; release toxics (cytokines); increase and attack parasitic infections
Granulocytes: Basophils - ANSWER release histamine; work in allergic responses
Agranulocytes - ANSWER A group of leukocytes without granules in their cytoplasm. Monocytes, lymphocytes, and natural killer cells.
Agranulocytes: Monocytes and Macrophages - ANSWER Make up the mononuclear phagocyte system. Found in tissue and lymphoid organs, provide the main line of defense against bacteria in the bloodstream. Cleanse the blood by removing old, injured, or dead blood cells.
Agranulocytes: Monocytes - ANSWER mature into macrophages in tissues where they are phagocytic
Agranulocytes: Macrophages - ANSWER Clean up crew, initiate wound healing and tissue remodeling.
Agranulocytes: Lymphocytes - ANSWER Major cells of the immune system; are mature T, B, and plasma cells; life span varies
Agranulocytes: Natural Killer Cells - ANSWER Found mainly in the peripheral blood and spleen, kill tumor cells and virally infected cells, produce cytokines
What is Hematopoiesis? - ANSWER blood cell formation in adult bone marrow or in the liver/spleen of the fetus.
Goes through two stages: mitosis and maturation.
Continues throughout life to replace blood cells that die off
Hematopoiesis: Bone Marrow - ANSWER Primary site of residence of hematopoietic stem cells. Also called myeloid tissue. Confined to the cavity of the bones.
Factors that increase Hematopoiesis: - ANSWER Conversion of yellow bone marrow (which does not produce blood cells) to hematopoietic red marrow by actions of erythropoietin (hormone that stimulates erythrocyte production)
Which physiologic process occurs in Hematopoiesis? - ANSWER Niches control the differentiation of hematopoietic progenitor cells.
What is Erythropoiesis? - ANSWER production of red blood cells. Erythrocytes are derived from erythroblasts. The maturation is stimulated by erythropoietin.
Regulation of Erythropoiesis - ANSWER - Volume of circulating RBCs in healthy individuals remains constant
- Peritubular cells of the kidney produce erythropoietin.
- Hypoxia stimulates the production and release of erythropoietin.
- Erythropoietin causes an increase in RBC production and release from the bone marrow.
Nutritional requirements for Erythropoiesis - ANSWER Proteins (amino acids)
for structural support and synthesis of hemoglobin
Vitamins (B12, B6 and E, Folic acid)
What does folic acid do for erythropoiesis? - ANSWER Synthesis of DNA and RNA; maturation of erythrocytes
A person has an inadequate intake of folic acid (folate). What will happen to this person's RBCs? - ANSWER Impaired DNA synthesis.
Development of Leukocytes - ANSWER arise from stem cells in bone marrow. Increase in response to infection, presence of steroids, and reduction or depletion of reserves in the marrow.
Development of Platelets - ANSWER Endomitosis is the dna breaking up into fragments, and thrombopoietin maintain levels.
What is Hemostasis? - ANSWER stoppage of bleeding
Mechanisms of Hemostasis - ANSWER vascular spasm, platelet plug formation, blood clotting
Sequence of Hemostasis - ANSWER Vascular injury leads to vasoconstriction
Formation of a Hemostatic plug
Tissue factor activates coagulation cascade
Secondary hemostasis
Clot retraction and clot dissolution (fibrinolysis)
Function of Platelets - ANSWER Helps regulate blood flow into a damaged site by inducing vasoconstriction, initiating platelet-to-platelet interactions
clot after bleeding has ceased and repair has begun.
Clinical evaluation of the Hematologic System: Bone Marrow Function - ANSWER Can determine differential cell count
Clinical evaluation of the Hematologic System: Blood tests - ANSWER Provides information about the number of blood cells and their structural and functional characteristics.
Pediatrics and the Hematologic System: - ANSWER - blood cell counts increase above adult levels at birth and they decline during childhood.
- Children have more atypical lymphocytes as a result of frequent viral infections
Which information is correct regarding an infant or child's hematologic system? - ANSWER Polycythemia of the newborn occurs from the hypoxic intrauterine environment
Aging and the Hematologic System - ANSWER -Erythrocyte life span is normal but erythrocytes are replaced more slowly
--Possible causes
---Iron depletion
---Decreased total serum iron, iron-binding capacity, and intestinal iron absorption
-Lymphocyte function decreases with age
-The humoral immune system is less responsive
What is Anemia? - ANSWER A reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin.
What are possible causes of anemia? - ANSWER Impaired erythrocyte production, acute or chronic blood loss, increased erythrocyte destruction, or a combination of
How is Anemia classified? - ANSWER Etiology and size
Anemia: Size classification - ANSWER Identified by terms that end in '-cytic'
Anemia: Hemoglobin content classification - ANSWER Identified by terms that end in '-chromic'
Anemia: Microcytic hypochromic classification - ANSWER Disorders of hemoglobin synthesis (iron deficiency)
Macrocytic-Normochromic anemia: Pernicious Anemia - ANSWER The most common macrocytic anemia, caused by vitamin B12 deficiency, lacks intrinsic factor from gastric parietal cells, may be congenital or autoimmune disorder.
Increased risk: past infection withHeliobacter pylori, gastrectomy, proton-pump inhibitor
Clinical Manifestations of Pernicious Anemia - ANSWER Weakness, fatigue, loss of appetite, parasthesias of feet and fingers and difficulty walking, sore tongue that is smooth and beefy red, lemon yellow (sallow) skin, neurological symptoms. Often unrecognizable in older adults because of slow onset
Evaluation and Treatment for Pernicious Anemia - ANSWER Blood tests, gastric biopsy.
Weekly/monthly injections or high oral doses of Vitamin B12. If left untreated,death
Macrocytic-Normochromic Anemia: Folate (folic acid) Deficiency anemia - ANSWER Folate is an essential vitamin for rna and dna synthesis, common in alcoholics and individuals with chronic malnourishment, associated with neural tube defects of the fetus
Clinical Manifestations: Folate Deficiency Anemia - ANSWER Severe cheilosis: scales and fissures of the lips and corners of the mouth
Stomatitis: mouth inflammation
Painful ulcerations of the buccal mucosa and tongue, burning mouth syndrome
Dysphasia (difficulty swallowing)
Folate Deficiency Anemia: Treatment - ANSWER daily oral administration of folate until normal blood levels are obtained
A person with a gastrectomy is seen in the clinic for generalized weakness, fatigue, difficulty walking, and abdominal pain. The nurse suspects this individual has: - ANSWER Pernicious anemia
Microcytic-Hypochromic Anemia - ANSWER RBCs that are abnormally small and contain reduced amounts of hemoglobin. Causes are disorders of iron metabolism, porphyrin and heme synthesis, and globin synthesis
Microcytic-Hypochromic: Iron Deficiency Anemia - ANSWER Most common type of anemia worldwide. Highest at risk is toddlers, adolescent girls, women of childbearing age, persons living in poverty, infants consuming cows milk, older adults. Associated with cognitive impairment in children
Normocytic-Normochromic Anemia: Aplastic Anemia - ANSWER Most are autoimmune disorders, some are due to chemical exposure. Three types
Aplastic Anemia: Pancytopenia - ANSWER Reduction of absence of all 3 types of blood cells
Aplastic Anemia: Pure RBC aplasia - ANSWER Only RBCs are affected
Aplastic Anemia: Fanconi anemia - ANSWER Rare genetic anemia from defects in dna repair
Aplastic Anemia: Pathology and Clinical manifestations - ANSWER Patho: Hypo-cellular bone marrow that has been replaced with fat
Manifestations: Hypoxemia, palllor (brownish pigment), weakness along with fever and dyspnea.
Aplastic Anemia: Evaluation and Treatment - ANSWER Evaluation: bone marrow biopsy, blood tests
Treatment: Bone marrow transplantation, peripheral blood stem cell translation, immunosuppressive, identification of high-risk individuals. If not treated, death
A person is admitted with an autoimmune disease directed against the hematopoietic stem cells. The nurse knows this will produce: - ANSWER Aplastic anemia
Hemolytic Anemia - ANSWER anemia caused by the destruction of red blood cells
Drug-Induced Hemolytic Anemia - ANSWER Form of immune hemolytic anemia that is usually the result of an allergic reaction against foreign antigens. Called the Hapten model. Penicillin, cephalosporins, hydrocortisone
Anemia of Chronic Disease - ANSWER Mild to moderate anemia from decreased erythropoiesis
AIDS, malaria, RA, lupus, hepatitis, renal failure, and cancer
Anemia of Chronic Disease: Pathological Mechanisms - ANSWER Decreased erythrocyte lifespan, suppressed production of erythropoietin, ineffective bone marrow response to erythropoietin, altered iron metabolism
Anemia of Chronic Disease: Clinical Man., Evaluation, Treatment - ANSWER Clinical: same as iron-deficiency anemia
Leukocytosis - ANSWER increase in the number of white blood cells. Normal response to stressors or invasion of the microorganism but can be pathological
Leukopenia - ANSWER Abnormally low white blood cell count. Predisposes a person to infection
An individual has Leukocytosis. What would the nurse expect to find while taking the individual's history? - ANSWER A stressful work environment.
An increase in leukocytes is a normal protective response to physiologic stressors
Granulocytosis (Neutrophilia) - ANSWER Evident in the first stages of infection or inflammation. If the need for neutrophils increases beyond the supply, then immature neutrophils are released into the blood.
Shift to the left - ANSWER Premature release of immature leukocytes is termed this.
Neutropenia - ANSWER deficiency of neutrophils.
Causes are prolonged severe infection, decrease in production and/or survival of neutrophils, abnormalities
Primary cause of neutropenia - ANSWER Congenital and acquired (anemia, leukemia, lymphomas)
Secondary cause of Neutropenia - ANSWER To medications, chemo, radiation
Infectious Mononucleosis - ANSWER Acute, self limiting viral infection of the B lymphocytes. Commonly caused by EBV. Transmission is usually through saliva
Mono: Symptoms and Treatment - ANSWER Fever, pharyngitis, lymphadenopathy. Treatment is supportive care and no aspirin
Leukemias - ANSWER Uncontrolled proliferation of malignant leukocytes.
Bone marrow overcrowding —> decreased normal Hematopoiesis
Leukemia Classifications - ANSWER Predominant cell of origin: myeloid or lymphoid
Rate of progression: acute or chronic
Acute Leukemia - ANSWER presence of undifferentiated or immature cells,
transcription factors. Mutations in FLT3.
Risk factors: exposure to radiation,benzene and chemotherapy, hereditary conditions (Down syndrome)
AML Clinical manifestations - ANSWER Fatigue caused by anemia, bleeding resulting from thrombocytopenia (reduced numbers of circulating platelets), fever caused by infection, anorexia, weight loss, CNS involvement
AML Treatment - ANSWER Chemotherapy, bone marrow transplant, stem cell transplantation, supportive measures like bone transfusions, antibiotics, anti fungal, antivirals
A nurse recalls that acute lymphocytic leukemia (ALL): - ANSWER Is defined as greater than 30% lymphoblasts in blood or bone marrow
Lymphadenopathy - ANSWER Enlarged lymph nodes that become palpable and tender.
Local - drainage of inflammatory lesion located near the enlarged node
General - occurs in the presence of malignant or nonmalignant disease
Malignant Lymphomas - ANSWER Diverse group of neoplasms that develop from the proliferation of malignant lymphocytes in the lymphoid system.
Two major categories: Hodgkin and non-hodgkin
Hodgkin Lymphoma - ANSWER Reed Sternberg cells required for diagnosis. B cell in the germinal center has unsuccessful immunoglobulin gene rearrangement; should undergo apoptosis but survives.
Hodgkin Lymphoma Clinical Manifestations - ANSWER Enlarged painless neck lymph nodes
Lymphadenopathy, causing pressure or obstruction
Mediastinal mass
Fever, weight loss, night sweats, pruritus, fatigue
Hodgkin Lymphoma: Treatment - ANSWER Cure rate is 75%. Dual chemo-radiation treatment. High dose chemotherapy with bone marrow or stem cell transplantation. Monoclonal antibodies
Non-Hodgkin Lymphoma - ANSWER B Cell Neoplasms, includes T Cell and NK neoplasms. Linked to chromosome translocations. Clonal expansion of B cells, T cells, and NK cells.
Non-Hodgkin Lymphoma Clinical Manifestations - ANSWER -Localized or generalized painless lymphadenopathy
