Summary NUR 3129 Exam 2 Study Guide

Exam #2 – Material Review
 Composition of Blood – Granulocytes
o Granulocytes mature in the bone marrow
 Membrane-bound granules in their cytoplasm
 The granules contain enzymes capable of destroying
microorganisms
 Inflammatory and immune functions
 Capable of ameboid movement (diapedesis) – the migration
through vessel walls to the sites where their action is needed
 Natural Killer Cells (NK)
o kill some types of tumor cells and some virus-infected cells
 Regulation of Erythropoiesis
o Numbers of circulating red cells in healthy individuals remain constant
o The peritubular cells of the kidney produce erythropoietin
o Hypoxia stimulates the production and release of erythropoietin
 Control of Hemostatic Mechanisms – Pulmonary Embolism
o Clot retraction
 Fibrin strands shorten; become denser and stronger to approximate
the edges of the injured vessel and site of injury
 Facilitated by large numbers of platelets within the clot
o Lysis (breakdown) of blood clots carried out by:
 Fibrinolytic system
 Plasminogen converted to plasmin (an enzyme that
dissolves clots, a process called fibrinolysis)
 The dissolved products are termed fibrin degradation
products (FDP). The major FDP are D-dimers.
 Clinical note: measurement of the levels of circulating D-
dimer has been used for diagnosis of DVTs and PEs.
 Macrocytic-normochromic anemias
o Also termed megaloblastic anemias
o Characterized by unusually large stem cells
o Result of defective DNA synthesis
 Caused by deficiencies in vitamin B12 or folate
 Coenzymes for nuclear maturation and the DNA synthesis
pathway
o Pernicious anemia
 Caused by a lack of intrinsic factor from the gastric parietal cells
 Required for vitamin B12 absorption
 Results in vitamin B12 deficiency
o Pernicious anemia (Cont.)
 Early symptoms nonspecific and vague
 When hemoglobin at 7-8 g/dl:

,  Weakness
 Fatigue
 Paresthesia’s
 Difficulty walking
 Loss of appetite
 Abdominal pain
 Weight loss
o Neurologic manifestations – result from nerve demyelination that produce
neuronal death
o Treatment
 Parenteral (injections) or high oral doses of vitamin B12
 Lifelong
o Folate deficiency anemia
 Absorption of folate occurs in the upper small intestine
 Not dependent on any other factor
 Similar symptoms to pernicious anemia except neurologic
manifestations generally not seen
 Treatment requires daily oral administration of folate
 Types of Anemias – Normocytic-normochromic
o Reduction in the total number of erythrocytes in the circulating blood or in
the quality or quantity of hemoglobin
 Impaired erythrocyte production
 Acute or chronic blood loss
 Increased erythrocyte destruction
 Combination of the above
o Normocytic-normochromic
 Characterized by red cells that are relatively normal in size and
hemoglobin content but insufficient in number
 Aplastic - damage to bone marrow erythropoiesis
 Post hemorrhagic – acute blood loss
 Acquired hemolytic – immune destruction of erythrocytes
 Hereditary hemolytic – such as sickle cell disease
 Anemia of chronic inflammation – multiple causes
 Polycythemia vera
o Polycythemia vera (PV) – characterized by an abnormal uncontrolled
proliferation of RBCs
 JAK2 mutation
o Abnormal, uncontrolled proliferation of RBCs, WBCs, and platelets
o Manifestations due to increased red cell mass and hematocrit
 Increased blood viscosity
 Hyper coagulopathy
 Infectious mononucleosis

, o Acute, self-limiting infection of B lymphocytes transmitted by saliva
through personal contact
o Commonly caused by the Epstein-Barr virus (EBV)—85%
 B cells have an EBV receptor site
o Symptoms:
 Fever
 Sore throat
 Swollen cervical lymph nodes
 Increased lymphocyte count
 Atypical (activated) lymphocytes
o Serious complications are rare
 Splenic rupture is the most common cause of death
 Leukemia signs and symptoms
o Most common malignancy of childhood
o 80% to 85% are acute lymphoblastic leukemia (ALL); remainder acute
myelogenous leukemia (AML)
o Result of Eco genetics (genetic traits related to the response to
environmental substances)
o Manifestations of pallor, fatigue, purpura, and fever
o Blast cell is hallmark of acute leukemia
o 5-year survival rate is 80%
 Signs and symptoms
o Fatigue
o Bleeding
 Petechiae
 Ecchymosis
o Fever
o Weight loss
o Bone pain
o Elevated uric acid
o Liver, spleen, and lymph node enlargement
o Infections
o Neurologic manifestations
 Hodgkin lymphoma
o Characterized by the presence of Reed-Sternberg cells (B cells) in the
lymph nodes
 Reed-Sternberg cells are necessary for diagnosis, but they are not
specific to Hodgkin lymphoma. a large multinucleated or multilobed
cell surrounded by a halo of clear nucleoplasm
o Physical findings
 Adenopathy, mediastinal mass, splenomegaly, and abdominal mass