Advanced Pathophysiology Exam #2
Overview of the Blood - ANS-•Blood
•5000ml
•Plasma
•3000ml
Hematocrit defined - ANS-- % of RBCs
[higher value = higher viscosity = thicker blood)
- Example: Polycythemia may have Hct of 60-70%
Types of Blood Cells
- Erythrocytes [RBCs) - ANS-- Transport O2
- Small disc shape
- Lifespan = 120 days
- Carry Hgb [ferrous oxide, also an acid/base buffer)
- Made in the bone marrow - Iliac crest for sample in leukemia
[after age 20 in the vertebrae, sternum, ribs, iliac)
- Hgb Levels: 14-16g/dL in males / 12-14g/dl females
Cytic vs Chromic - ANS-Cytic = Size of RBCs
Chromic = Amount of Hgb
MCV and MCHC - ANS-MCV: Mean corpuscular volume - [average size rbc]
MCHC: normal Mean corpuscular Hgb concentration - [average amount of hemoglobin in the
RBCs compared to the average size of the RBCs. The amount of hemoglobin that was there
Morphology Size or Erythrocyte Volume Cytic Values - ANS-- Normocytic: Normal RBC size
[MCV = 83-99)
- Microcytic: Small RBC size
[MCV = 50-82)
- Macrocytic: Large RBC size
[MCV is > 100)
Chromic Values
[Hgb content) - ANS-- Normochromic: Normal amount of Hgb [MCHC -Average amount of
hemoglobin in the RBCs compared to the average size of the RBCs.
[MCHC = 32-36)
- Hypochromic: Low amount of Hgb
[MCHC is < 32)
- Hyperchromic: Increased amount of Hgb
[MCHC is > 36)
,Leukocytes
[WBCs) - ANS-- Defend the body against foreign proteins
- Made in the bone marrow
- 9,000/mm^3
- CBC w/ Diff shows: Leukocytes broken down into:
Neutrophils, Basophils, PMNs [polymorphonulcear), Bands
Bands - {Infective process - ANS--Immature Leukocytes
- Indicate an infective process
- Increase in bands = 12 to 20 or more = shift to the left indicating a bacterial infection
- If bands are not increased it is a shift to the right and a viral infection
Alterations of Leukocytes
Quantitative:
1. Bone marrow dysfunction
2. Premature destruction of cells
a. May originate in lymphoid organs secondary to infectious process - ANS-Leukocytosis
equals increase WBC's
Leukopenia Equals decreased wbc's
Types of Leukocytes:
- Granular - ANS-- Categorized according to the presence or absence of granules in the cell
cytoplasm
- *Granular Leukocytes*:
- PMNs - Polymorphonuclear leukocytes[2 or more lobes to the granular site)
- Neutrophils
- Eosinophils - Allergic reaction or parasites
- Basophils
Types of Leukocytes:
- Non-granular - ANS-*Non-granular* Leukocytes :
- Lymphocytes
- Monocytes
- platelets or thrombocytes
WBC Morphology/Fx
[Shape and function] - ANS-- Total WBC count increases with infection
- As % of 1 increases, the %s of the others will decrease
[shift in %) = Shift to the left or shift to the right
- Bands = immature neutrophils aka stabs
[German for rods due to shape)
,WBC Morphology/Fx - ANS-- Bands being immature with infection there is an increase in
production
= shift to the left
- Neutrophils = segs or polys = mature polymorphonuclearcytes and segmented
WBC's and bands - ANS-Should tell you right away that when you have an infection and the
WBCs are called on to replicate and attend to this infection, that the faster they do it the more
immature cells they have so the more bands produced.
How to tell if an infection is viral or bacterial?
- If there is a shift to the left [increase in bands) it is bacterial - ANS-- This is because of the way
the differential used to be displayed [Shift to the left then you would see the WBCs going up, the
bands going up, the neutrophils or segs rising as well and the other percentages going down
[lymphocytes and monocytes in particular]
Response to infections - ANS-- Neutrophils are released
- Many are immature or "bands"
- "Shift to the left" indicating more bands = acute bacterial infection
- "Shift to the right" indicates a more viral infection
Platelets - ANS-- Small, round, colorless cells
- Made in the bone marrow
- Lifespan: 5 - 8 days
- Normal level: 150k - 300k
- Key substance for blood clotting
Pathology of Platelets - ANS-- Thrombocytopenia Purpura
Caused by: Viruses, radiation, and drugs
- Example = HELLP Syndrome:
[Hemolysis. Elevate Liver enzymes. Low Platelets)
Due to Hypertension,spilling proteins
Pathology of Platelets and pregnancy - ANS-- Seen in pregnant women
- The liver doesn't make platelets
- Delivery of the baby is the treatment
- C-section is the best way, To prevent mother from deteriorating into a DIC - risky due to low
platelet count
Blood Proteins
- Albumin - ANS-- Normal range is 3-5
- Sponge Responsible for blood osmotic pressure
, aka oncotic [pulling) force - Albumin and its presence in the bloodstream and with it ,
hydrostatic pressure and oncotic pressure functions and blood returns to the vascular tree.
- Assists with wound healing
Problems with low albumin levels - ANS-- Low albumin = low oncotic pressure = leakage of
fluids into the interstitial space = ascites and edema of dependent extremities
- Albumin Usually <2 is incompatible with life although Reavis has seen people come back
low albumin levels - ANS-- Decreased albumin is usually from decreased liver fx
- Reavis says that giving albumin IV does nothing because it doesn't stay in the vessels, it leaks
out.
Reavis surgeon story about Albumin - ANS-- Liver CA pt had 19L of paracentesis fluid removed
- MD filtered it and put it back into the pt IV which caused a spike in albumin resulting in a spike
in oncotic pressure resulting in a crisis and increased CVP
Blood Proteins
- Globulins - ANS-- Alpha
- Beta
- Gamma
[Part of the inflammatory / immune process)
- May be used to transport molecules
Anemias - ANS-- Not a disease
- Reduced number of RBCs or quality/quantity Hgb
- O2 carrying capacity of Hgb is reduced
S/S of Anemias - ANS-- Hypoxia
- Night cramps
- Angina
- Fatigue
- Weakness
S/S of Anemias continued - ANS-- Dyspnea with pallor
- Tachycardia, palpitations, systolic murmur, hypertrophy, HF
- Increased Epogen = bone pain and sternal tenderness
- Increased 2, 3, DPG = reduction in Hgb affinity for O2
What is the #1 Diff Dx for pt's c/o fatigue? - ANS-ANEMIA
Anemia Patho - ANS-- Defined as a Hgb less than 10
- Pernicious Anemia: = Lack of B12 and/or intrinsic factor)
- Hypoxia [rate of RBC production is increased by erythropoietin in response to this
- Bone Marrow suppression
Overview of the Blood - ANS-•Blood
•5000ml
•Plasma
•3000ml
Hematocrit defined - ANS-- % of RBCs
[higher value = higher viscosity = thicker blood)
- Example: Polycythemia may have Hct of 60-70%
Types of Blood Cells
- Erythrocytes [RBCs) - ANS-- Transport O2
- Small disc shape
- Lifespan = 120 days
- Carry Hgb [ferrous oxide, also an acid/base buffer)
- Made in the bone marrow - Iliac crest for sample in leukemia
[after age 20 in the vertebrae, sternum, ribs, iliac)
- Hgb Levels: 14-16g/dL in males / 12-14g/dl females
Cytic vs Chromic - ANS-Cytic = Size of RBCs
Chromic = Amount of Hgb
MCV and MCHC - ANS-MCV: Mean corpuscular volume - [average size rbc]
MCHC: normal Mean corpuscular Hgb concentration - [average amount of hemoglobin in the
RBCs compared to the average size of the RBCs. The amount of hemoglobin that was there
Morphology Size or Erythrocyte Volume Cytic Values - ANS-- Normocytic: Normal RBC size
[MCV = 83-99)
- Microcytic: Small RBC size
[MCV = 50-82)
- Macrocytic: Large RBC size
[MCV is > 100)
Chromic Values
[Hgb content) - ANS-- Normochromic: Normal amount of Hgb [MCHC -Average amount of
hemoglobin in the RBCs compared to the average size of the RBCs.
[MCHC = 32-36)
- Hypochromic: Low amount of Hgb
[MCHC is < 32)
- Hyperchromic: Increased amount of Hgb
[MCHC is > 36)
,Leukocytes
[WBCs) - ANS-- Defend the body against foreign proteins
- Made in the bone marrow
- 9,000/mm^3
- CBC w/ Diff shows: Leukocytes broken down into:
Neutrophils, Basophils, PMNs [polymorphonulcear), Bands
Bands - {Infective process - ANS--Immature Leukocytes
- Indicate an infective process
- Increase in bands = 12 to 20 or more = shift to the left indicating a bacterial infection
- If bands are not increased it is a shift to the right and a viral infection
Alterations of Leukocytes
Quantitative:
1. Bone marrow dysfunction
2. Premature destruction of cells
a. May originate in lymphoid organs secondary to infectious process - ANS-Leukocytosis
equals increase WBC's
Leukopenia Equals decreased wbc's
Types of Leukocytes:
- Granular - ANS-- Categorized according to the presence or absence of granules in the cell
cytoplasm
- *Granular Leukocytes*:
- PMNs - Polymorphonuclear leukocytes[2 or more lobes to the granular site)
- Neutrophils
- Eosinophils - Allergic reaction or parasites
- Basophils
Types of Leukocytes:
- Non-granular - ANS-*Non-granular* Leukocytes :
- Lymphocytes
- Monocytes
- platelets or thrombocytes
WBC Morphology/Fx
[Shape and function] - ANS-- Total WBC count increases with infection
- As % of 1 increases, the %s of the others will decrease
[shift in %) = Shift to the left or shift to the right
- Bands = immature neutrophils aka stabs
[German for rods due to shape)
,WBC Morphology/Fx - ANS-- Bands being immature with infection there is an increase in
production
= shift to the left
- Neutrophils = segs or polys = mature polymorphonuclearcytes and segmented
WBC's and bands - ANS-Should tell you right away that when you have an infection and the
WBCs are called on to replicate and attend to this infection, that the faster they do it the more
immature cells they have so the more bands produced.
How to tell if an infection is viral or bacterial?
- If there is a shift to the left [increase in bands) it is bacterial - ANS-- This is because of the way
the differential used to be displayed [Shift to the left then you would see the WBCs going up, the
bands going up, the neutrophils or segs rising as well and the other percentages going down
[lymphocytes and monocytes in particular]
Response to infections - ANS-- Neutrophils are released
- Many are immature or "bands"
- "Shift to the left" indicating more bands = acute bacterial infection
- "Shift to the right" indicates a more viral infection
Platelets - ANS-- Small, round, colorless cells
- Made in the bone marrow
- Lifespan: 5 - 8 days
- Normal level: 150k - 300k
- Key substance for blood clotting
Pathology of Platelets - ANS-- Thrombocytopenia Purpura
Caused by: Viruses, radiation, and drugs
- Example = HELLP Syndrome:
[Hemolysis. Elevate Liver enzymes. Low Platelets)
Due to Hypertension,spilling proteins
Pathology of Platelets and pregnancy - ANS-- Seen in pregnant women
- The liver doesn't make platelets
- Delivery of the baby is the treatment
- C-section is the best way, To prevent mother from deteriorating into a DIC - risky due to low
platelet count
Blood Proteins
- Albumin - ANS-- Normal range is 3-5
- Sponge Responsible for blood osmotic pressure
, aka oncotic [pulling) force - Albumin and its presence in the bloodstream and with it ,
hydrostatic pressure and oncotic pressure functions and blood returns to the vascular tree.
- Assists with wound healing
Problems with low albumin levels - ANS-- Low albumin = low oncotic pressure = leakage of
fluids into the interstitial space = ascites and edema of dependent extremities
- Albumin Usually <2 is incompatible with life although Reavis has seen people come back
low albumin levels - ANS-- Decreased albumin is usually from decreased liver fx
- Reavis says that giving albumin IV does nothing because it doesn't stay in the vessels, it leaks
out.
Reavis surgeon story about Albumin - ANS-- Liver CA pt had 19L of paracentesis fluid removed
- MD filtered it and put it back into the pt IV which caused a spike in albumin resulting in a spike
in oncotic pressure resulting in a crisis and increased CVP
Blood Proteins
- Globulins - ANS-- Alpha
- Beta
- Gamma
[Part of the inflammatory / immune process)
- May be used to transport molecules
Anemias - ANS-- Not a disease
- Reduced number of RBCs or quality/quantity Hgb
- O2 carrying capacity of Hgb is reduced
S/S of Anemias - ANS-- Hypoxia
- Night cramps
- Angina
- Fatigue
- Weakness
S/S of Anemias continued - ANS-- Dyspnea with pallor
- Tachycardia, palpitations, systolic murmur, hypertrophy, HF
- Increased Epogen = bone pain and sternal tenderness
- Increased 2, 3, DPG = reduction in Hgb affinity for O2
What is the #1 Diff Dx for pt's c/o fatigue? - ANS-ANEMIA
Anemia Patho - ANS-- Defined as a Hgb less than 10
- Pernicious Anemia: = Lack of B12 and/or intrinsic factor)
- Hypoxia [rate of RBC production is increased by erythropoietin in response to this
- Bone Marrow suppression
