NUR 2063 Essentials of Pathophysiology - Cellular Function Ch 3

Disorders of the RBCs - -Erythropoiesis +Production of erythrocytes +Regulated by erythropoietin +Occurs in bone marrow -Disorders typically result from a deficit or defect in the erythrocytes Hematopoiesis - The process of forming blood -Plasma - liquid protein -Leukocytes - white blood cells -Erythrocytes - red blood cells -Thrombocytes - platelets Erythrocytes - -Hemoglobin: oxygen carrying component -Hematocrit: amount of blood volume occupied by erythrocytes Hemostasis - -Stoppage of blood flow -Normal when it seals a blood vessel to prevent blood loss and hemorrhage -Abnormal when it causes inappropriate clotting or when clotting is insufficient to stop blood flow. Stages of Hemostasis - 1. Vessel spasm 2. Formation of platelet plug 3. Blood coagulation 4. Clot retraction 5. Clot dissolution Disorders of the WBCs - -Leukocytes key players in the inflammatory response and fighting infections -Normal range = 5,000 to 10,000 mm3 -Leukopenia-decreased levels -Leukocytosis-increased levels Neutrophils - -One type of leukocytes -Usually the first to arrive at the site of infection -Normal range is 2,000-7,500 cells/μL Neutropenia - -Neutrophils < 1500 -Causes: +Increased usage +Drug suppression +Radiation therapy +Congenital conditions +Bone marrow cancers +Spleen destruction +Vitamin deficiency -Manifestations: +Depends on severity and cause +Infections and ulcerations especially of the respiratory tract, skin, vagina, and gastrointestinal tract +Signs and symptoms of infection (e.g., fever, malaise, and chills) -Diagnosis: neutrophil levels and bone marrow biopsy -Treatment: Antibiotic therapy and hematopoietic growth factors Infectious Mononucleosis - -"Kissing Disease"-oral transmission -Self-limiting -Most prevalent in adolescents and young adults -Caused by Epstein-Barr virus in the herpes family -EBV infects the B cells by killing the cell or being incorporated into its genome -Those B cells incorporated with EBV produce heterophile antibodies -Once the disease is eliminated, a few B cells remain altered, giving the individual an asymptomatic infection for life and occasional spreading the EBV to others -Manifestations +Insidious onset +Incubation = 4 to 8 weeks +Initially see anorexia, malaise, and chills +Manifestations intensify to include leukocytosis, fever, chills, sore throat, and lymphopathy +Acute illness usually last 2-3 weeks; may not fully recover for 2-3 months -Treatment: symptomatic and supportive Lymphomas - -Cancers affect lymphatic system -Most common hematologic cancer in the US -Two main types +Hodgkin's +Non-Hodgkin's Hodgkin's Lymphoma - -Least common lymphoma -Solid tumors with the presence of Reed-Strenberg cells -Typically originate in the lymph nodes of the upper body -Several subtypes -Very curable with treatment -Manifestations: painless enlarge nodes, weight loss, fever, night sweats, pruritis, coughing, difficulty breathing, chest pain, recurrent infections, and splenomegaly -Diagnosis: physical examination, presence of Reed-Sternberg cells in a lymph node biopsy, complete blood count, chest X-rays, computed tomography scan, magnetic resonance imaging, positron emission tomography scan, and bone marrow biopsy -Treatment: chemotherapy, radiation, and surgery Hodgkin's Lymphoma - Staging - -Stage I: The lymphoma cells are in one lymph node group or one part of a tissue or an organ. -Stage II: The lymphoma cells are in at least two lymph node groups on the same side of the diaphragm, or the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ. -Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma cells may be found in one part of a tissue or an organ near these lymph node groups. Cells may also be found in the spleen. -Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues, or the lymphoma cells are in an organ and in distant lymph nodes. -Recurrent: The disease returns after treatment. Non-Hodgkin's Lymphoma - -More common -Poor prognosis -Many different types -Similar to Hodgkin's manifestations, staging, and treatment -Different in the spread and diagnosis -Can originate in the T or B cells -No Reed-Sternberg cells Leukemia - -Cancer of the leukocytes -Leukemia cells abnormally proliferate, crowding normal blood cells -Manifestations: leukopenia, anemia, thrombocytopenia, lymphadenopathy, joint swelling, bone pain, weight loss, anorexiam hepatomegaly, splenomegaly, and central nervous system dysfunction -Diagnosis: a history, physical examination, peripheral blood smears, complete blood count, and bone marrow biopsy -Treatment: chemotherapy and bone marrow transplant Acute lymphoblastic leukemia - -Affects primarily children -Responds well to therapy -Good prognosis Acute myeloid leukemia - -Affects primarily adults -Responds fairly well to treatment -Prognosis somewhat worse than that of acute lymphoblastic leukemia Chronic lymphoid leukemia - -Affects primarily adults -Responds poorly to therapy, yet most patients live many years after diagnosis Chronic myeloid leukemia - -Affects primarily adults -Responds poorly to chemotherapy, but the prognosis is improved with allogenic bone marrow transplant Multiple Myeloma - -Plasma cell cancer