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Advanced Pathophysiology: Blood Composition and Anemia Overview, Exams of Nursing

University College of London (UCL)Nursing

A detailed overview of blood composition, blood cells, and various types of anemia. It covers topics such as hematocrit, types of blood cells (erythrocytes, leukocytes, platelets), and their functions. The document also discusses the morphology of blood cells, including cytic and chromic values, and alterations in leukocytes. It further explains the different classifications of anemias based on etiology, such as altered hemoglobin synthesis, deficient nutrients, stem cell dysfunction, bone marrow infiltration, and rbc destruction. Specific anemias like iron deficiency anemia, thalassemia, and pernicious anemia are also discussed, along with their causes and diagnostic approaches. Useful for medical students and healthcare professionals seeking a comprehensive understanding of blood and anemia. (449 characters)

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Advanced Pathophysiology Exam 2025 2

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Overview of the Blood - Correct answer•Blood

•5000ml

•Plasma

•3000ml

Hematocrit defined - Correct answer- % of RBCs

[higher value = higher viscosity = thicker blood)

- Example: Polycythemia may have Hct of 60-70%

Types of Blood Cells

- Erythrocytes [RBCs) - Correct answer- 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 - Correct answerCytic = Size of RBCs

Chromic = Amount of Hgb

MCV and MCHC - Correct answerMCV: 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 - Correct answer-

Normocytic: Normal RBC size

[MCV = 83-99)

- Microcytic: Small RBC size

[MCV = 50-82)

- Macrocytic: Large RBC size

[MCV is > 100)

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Advanced Pathophysiology Exam 2025 2

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Overview of the Blood - Correct answer •Blood •5000ml •Plasma •3000ml Hematocrit defined - Correct answer - % of RBCs [higher value = higher viscosity = thicker blood)

Example: Polycythemia may have Hct of 60-70% Types of Blood Cells
Erythrocytes [RBCs) - Correct answer - Transport O
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 - Correct answer Cytic = Size of RBCs Chromic = Amount of Hgb MCV and MCHC - Correct answer 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 - Correct answer - 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) - Correct answer - 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) - Correct answer - Defend the body against foreign proteins
Made in the bone marrow
9,000/mm^
CBC w/ Diff shows: Leukocytes broken down into: Neutrophils, Basophils, PMNs [polymorphonulcear), Bands Bands - {Infective process - Correct answer -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:

Bone marrow dysfunction
Premature destruction of cells a. May originate in lymphoid organs secondary to infectious process - Correct answer Leukocytosis equals increase WBC's Leukopenia Equals decreased wbc's Types of Leukocytes:

Granular - Correct answer - 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

"Shift to the left" indicating more bands = acute bacterial infection
"Shift to the right" indicates a more viral infection Platelets - Correct answer - 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 - Correct answer - 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 - Correct answer - 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 - Correct answer - Normal range is 3-
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 - Correct answer - 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 - Correct answer - 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 - Correct answer - 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 - Correct answer - Alpha
Beta
Gamma [Part of the inflammatory / immune process)
May be used to transport molecules Anemias - Correct answer - Not a disease
Reduced number of RBCs or quality/quantity Hgb
O2 carrying capacity of Hgb is reduced S/S of Anemias - Correct answer - Hypoxia
Night cramps
Angina
Fatigue
Weakness S/S of Anemias continued - Correct answer - 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 O What is the #1 Diff Dx for pt's c/o fatigue? - Correct answer ANEMIA Anemia Patho - Correct answer - 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 due to CA, drugs, radiation, chemo)
Disorders of hemostasis
Disorders of Leukocytes

Blood Loss Anemia - Correct answer - Acute hypovolemia and shock usually

Cells are normcytic and normochromic
Low H&H
Hypoxia causes and increase in RBC production [compensatory mechanism - takes a while)
H&H should return to normal in 3-4 weeks Blood Loss Anemia - Causes: - Correct answer - L&D [iron supps and prenatal vits help prevent this - In one month back to normal)
Trauma
Insidious loss due to ulcers or lesions *According to Reavis, all pts of age or that are insidiously bleeding With a drop in hemoglobin are to have a colonoscopy to help prevent colon CA Microcytic Anemia - small cell - Correct answer MCV 52-82, MCHC 24-32 - Do not hold as much hemoglobin = low MCHC Microcytic Anemias: Seen in : - Correct answer - IDA = Iron deficiency anemia
Thalassemia Microcytic Anemias:
Thalassemia - Correct answer - Genetic disorder passed on to children
Recessive trait
Minor: 2/4 alpha forming genes are defective [both parents pass on to minor, child would present with major]
Major: incompatible with life - all 4 alpha forming genes are defective - O cannot be released to the tissues Causes of Microcytic Anemias - Correct answer - Chronic Diseases:
CRF [Chronic Renal Failure)
DM
RA Diagnosis for Microcytic [Small RBCs) - Correct answer - Iron deficiency anemia
Anemia of chronic disease
Labs to help differentiate:

-a. Transferrin

b. Serum Fe
c. Ferritin
d. TIBC Pathology when the pt is Normocytic and Normochromic - Cell size normal / MCHC is normal - Correct answer MCV 82-92, MCHC 32-
Hemorrhage - acute blood loss
Hemolysis
Chronic diseases [ draw TIBC [total iron binding capacity] low and ferritin rises = anemia of chronic disease that is early on Anemia [aplastic and early iron deficiency] - Correct answer - EARLY iron deficiency [transferrin rises [when iron stores in body are low] and ferritin falls[blood cell contains iron] =Iron deficiency anemia
Aplastic Anemia - Cancer hypoplastic cell invading the bone marrow where red blood cells are made Macrocytic Values - Correct answer - Big RBCs MCV > 100 MCHC > 36 3 Types of Macrocytic Anemias
B12 deficiency
Folic acid deficiency
Antimetabolites - Correct answer - Low B12: normal folate
Must be used with Intrinsic factor which is missing from the stomach
Low B12 and normal Folate
Tx: B12 injections
Folic acid deficiencies:
Low folate
Causes neural tube deficits
Tx: Oral folic acid Macrocytic Anemias - Antimetabolites - Correct answer - Antimetabolites:
Pernicious [destruction of parietal cells /Gastric mucosa = no production of intrinsic factor which absorbs B12)
Tx: B

-b. Psychosis Folate Deficiency - Correct answer - Etiology: Dietary deficits

S/S: Similar to B12 but WITHOUT NEURO SYMPTOMS
- So fatigue
Tx: PO Folic Acid
Dietary counseling with foods high in folic acid Foods high in Folic Acid - Correct answer - Liver
Wheat Bran
Leafy Green Veggies
Beans
Grain Diagnosis Folate Deficiency - Correct answer •First draw a CBC with differential, peripheral smear •Group according to red cell indices and blood smear results •Macrocytic? •Approach differentials B12? -Shilling test [confirms low level is result of intestinal malabsorption due to intrinsic factor deficiency) Diagnosis Folate Deficiency - Correct answer •Folate Deficiency •Microcytic •Differentiate IDA and Chronic Disease •Transferrin, Serum FE, Ferritin, TIBC Folate Normal Levels - Correct answer - Adults: 2-20 ng/mL OR 4.5-45.3 nmol/L. Hereditary Hemachromatosis (HH)
Etiology [cause] - Correct answer - Hereditary: autosomal RECESSIVE
- In general population: 0.3% - 0.5%, but 11% are carriers
Most common hematologic genetic disorder [in US)
- 1/10 Caucasians are carriers Body absorbs to much iron Hereditary Hemachromatosis (HH) -
Etiology continued - Correct answer - Males affected 5-10 times more than females

[iron loss during menses prevents it from showing up)

First s/s usually appear after age 40
Environmental factors may accelerate the process due to: a. Iron rich diet, High intake of Vit C, Alcohol abuse Reavis story about Hereditary Hemachromatosis [HH) - Correct answer - Male pt in for annual check up
Is a recovering alcoholic in rehab and takes megavitamins
CBC showed an elevated Hgb
Skin was sallow and yellow in appearance Hereditary Hemachromatosis [HH) Patho - Correct answer - Disorder of iron metabolism [IRON OVERLOAD)
Increased intestinal iron absorption
Deposited ino the liver, pancreas, heart, joints, pituitary gland and endocrine glands
This causes progressive tissue damage and functional impairment Hereditary Hemachromatosis (HH) Patho continued Not on lecture - Correct answer - Normally crypt cells have HFE protein that facilitates transferrin receptor dependent iron uptake
Disorder in crypt cells of the duodenum
HFE protein malfunctions cause relative iron deficiency = an increase in DMT- [Divalent metal iron transporter 1) -Equals increase in intestinal absorption S/S of Hereditary Hemachromatosis [HH) - Correct answer - Fatigue
Abdominal pain
Arthralgia
Weight loss
Change in skin color [marked)
- Decreased libido
Palpitations
Menstrual changes
Impotence [of both sexes according to Reavis)
Cirrhosis
Diabetes

Cardiac dysfunction improves
Diabetes may NOT improve, but disease progression may SLOW
Arthralgia, impotence, menstrual problems may NOT improve Increased Epogen = - Correct answer - Increased bone pain
Sternal tenderness Causes of Leukocytosis - increased WBC's - Correct answer - Infectious organisms
Exercise
Emotional changes
Temp changes
Anesthesia, surgery
Pregnancy
Drugs
Hormones
Toxins Alterations of Leukocytes - can be quantitative - Correct answer Quantitative

Bone marrow dysfunction 2.Premature destruction of cells a. May originate in lymphoid organs secondary to infectious process Leukocytosis is a defense mechanism... - Correct answer - Absolute Leukocyte count that is HIGHER than normal

Absolute neutrophil count is greater than 7500 - Neutrophils become so few that they cannot defend your body Leukopenia - Correct answer - Never normal or beneficial
Defined as as an absolute blood cell count less than 4000 cells/mm Pathologic Leukocytosis - Correct answer - From Malignancies
Hematologic disorders such as Myelotic leukemia having an absolute neutrophil count greater 100,000/microliters which
- Increases the viscosity of the blood and the risk of thrombus formation Neutropenia - Correct answer - Defined as neutrophil count 200/microliter Low count of Neutrophils which destroy bacteria.

Causes of Neutropenia - Correct answer - Severe prolonged infection

Aplastic anemia
leukemia
Drug or Toxin induced
Starvation / anorexia nervosa Neutropenia is a classic s/s of what? - Correct answer Anorexia nervosa Severe Neutropenia [Granulocytopenia or Agranulocytosis] - Correct answer Called [Granulocytopenia or Agranulocytosis] which causes:
Interference with hematopoiesis
- Increased cell destruction in circulation from: a.Chemotherapeutic agents b.Drugs: NSAIDS and anti-thyroid drugs Agranulocytosis can be a complication of what? - Correct answer Anti- thyroid medications S/S of Severe Neutropenia - Correct answer - Malaise
Septicemia
Fever
Tachycardia
Ulcerations in the mouth/colon
Death if untreated Eosinophilia - Correct answer - Greater than 450/microliter
Caused by:
- Allergic disorders
- Atopic dermatitis
- Eczema
- Pemphigus
- Scleroderma
- Parasitic infestation 1st thing to think about when you have a pt with watery diarrhea and Eosinophilia? - Correct answer - Gastroenteritis from a parasitic infection Basophilia - Correct answer - Too many Basophils
Response to inflammation/hypersensitivity
Contain histamines

(AML): Acute Myelogenous
(CLL): Chronic Lymphocytic
(CML): Chronic Myelogenous Classes of Leukemias - Correct answer 1. Acute or chronic comes as Undifferentiated or immature [blast) cells

*Myeloid or Lymphoid Leukemia arise from:

80% are from B cells
15% - 20% are from T cells Acute Leukemias - Correct answer - Usually seen in the neonate period
Onset is abrupt
Survival is short Most common genetic error resulting in Leukemia - Correct answer - Reciprocal translocation between chromosomes 9 and 22 (Philadelphia chromosome) Chronic Leukemias - Correct answer - Have mature cells, but they don't function normally
Onset is gradual
Survival is longer ALL is most commonly seen in... - Correct answer Kids Clinical Manifestations of ALL - acute lymphocytic leukemia - Correct answer Anemia Bleeding DIC Infection Weight loss Bone pain -Elevated uric acid [by product of protein catabolism, urate concentration secondary to dehydration caused by anorixa or fever and drug TX]
TX: Chemotherapy, supportive TX, allopurinol for gout, bone marrow transplants CML [Chronic Myelogenous Leukemia) - Correct answer - Clonal, neoplastic expansion of multipotent myeloid stem cell [myeloproliferative disease) -NEB cells

Etiology - Philadelphia chromosome - reciprocal translocation of long arms of 9 & 22 Etiology of Leukemias - Causes: - Correct answer 1. Causal risk factors a. Progression of chronic myelocytic leukemia b. Polycythemia vera c. Hodgkin disease d. Chronic lymphocytic leukemia e. Myelofibrosis, f. Sideroblastic anemia g. Ionizing radiation

Genetic predisposition [actual gene not known)
- Abnormal chromosomes CLL [Chronic Lymphocytic Leukemia) - Correct answer - Neoplastic transformation of lymphoid cells/B cells

Both are well differentiated
Etiology: malignant TRANSFORMATION of predominantly B-cells CML [Chronic Myelogenous Leukemia) S/S - Correct answer Splenomegaly Extreme fatigue Weight loss Night sweats Low-grade fever Hyperuricemia with Gouty arthritis What is the cardinal sign of CML? - Correct answer Lymphadenopathy Clinical Manifestations of CLL - Correct answer Increased infection rate Development of autoimmune diseases Anemia Thrombocytopenia Neutropenia [TINA] Lymphoma [Hodgkins] - Correct answer - Proliferation of lymphocytes and histocytes

Findings of Non-Hodgkin's Lymphoma - Correct answer *Molecular rearrangements of oncogenes and immunoglobulin genes

Chromosomal mutations transform or lose critical oncogenes and tumor- suppressor genes environmental agents
Inherited genetic abnormalities NHL [Non-Hodgkin's Lymphoma) Evaluation and Management - Correct answer 1. Staging
Biopsy of nodes and bone marrow
Treatment Depends on stage, symptoms, age, co-morbidities A. Radiation, chemotherapy, bone marrow or stem cell transplant, monoclonal antibodies Differences between Hodgkin's and Non-Hodgkin's (Page 1028, Table 29-7)

Spread - Correct answer - Hodgkin's:
Orderly spread by continguity
Non-Hodgkin's:
Non-continguous spread - not orderly spread Differences between Hodgkin's and Non-Hodgkin's (Page 1028, Table 29-7)
B Symptoms [fever, Weight loss, Night sweats) - Correct answer - Hodgkin's:
Common - to have B Symptoms [fever, Weight loss, Night sweats)
Non-Hodgkin's:
Uncommon Differences between Hodgkin's and Non-Hodgkin's (Page 1028, Table 29-7)
Extranodal Involvement - Correct answer - Hodgkin's:
Rare Extranodal Involvement
Non-Hodgkin's:
Common Extranodal Involvement Differences between Hodgkin's and Non-Hodgkin's (Page 1028, Table 29-7)
Extent of disease - Correct answer - Hodgkin's:
Often LOCALIZED disease

Non-Hodgkin's:
- Rarely localized, normally WIDESPREAD disease Differences between Hodgkin's and Non-Hodgkin's (Page 1028, Table 29-7)
Nodal Involvement - Correct answer - Hodgkin's:
- Localized to single axial group of nodes
- Mesenteric nodes and Waldeyer ring RARELY involved
Non-Hodgkin's:
- Multiple peripheral nodes
- Mesenteric nodes and Waldeyer ring COMMONLY involved Reavis story about pt with abd. mass r/t lymphoma - Correct answer - Pt c/o abd. mass, exploratory surgery was done, when pt opened up, their entire mesenteric nodes were one giant lymphoma. No resection was done, pt was closed up and send to oncologist. S/S of bleeding from the thrombocytopenia - Correct answer - Petechiae
Ecchymosis
Hematuria
Gingiva
Mid-cycle heavy menses Process of Hemostasis - Correct answer 1) Blood vessels constrict

Platelet plug forms temporary seal
Platelet + collagen = platelet adhesion
Blood coagulates Which factor deficiencies require Vit K? - Correct answer 7, 9, 10 Reversal of Hemostasis - Correct answer 1) Activation of intrinsic or extrinsic pathway
Conversion of fibrinogen to fibrin
Clot retraction
Clot dissolution [fibrinolysis) Coagulation Defects - Correct answer Factors synthesized in the liver:

5, 7, 8, 9, 10, 11, 12, prothrombin and fibrinogen

Advanced Pathophysiology: Blood Composition and Anemia Overview, Exams of Nursing

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Download Advanced Pathophysiology: Blood Composition and Anemia Overview and more Exams Nursing in PDF only on Docsity!

Advanced Pathophysiology Exam 2025 2

Study Material