Lymphatic system
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Questions and Answers

What is the primary function of albumin in blood plasma?

  • Maintaining blood volume and pressure (correct)
  • Transporting oxygen
  • Carrying fats
  • Fighting infections
  • Which of the following components of blood is responsible for transporting substances, regulating body temperature and pH, and transporting protective cells?

  • Plasma (correct)
  • Red blood cells
  • Platelets
  • White blood cells
  • Where does the maturation and differentiation of T-lymphocytes primarily take place?

  • Thymus (correct)
  • Lymph nodes
  • Spleen
  • Bone marrow
  • Which of the following blood components makes up approximately 45% of blood volume?

    <p>Formed elements (D)</p> Signup and view all the answers

    What is indicated by a decreased reticulocyte count?

    <p>RBC maturation defect (D)</p> Signup and view all the answers

    Which organ plays a key role in synthesizing plasma proteins, including clotting factors?

    <p>Liver (D)</p> Signup and view all the answers

    What are gamma globulins and what role do they serve?

    <p>Antibodies produced by lymphocytes (A)</p> Signup and view all the answers

    A patient presents with a hematocrit of 55%. What condition is this finding most likely associated with?

    <p>Dehydration (B)</p> Signup and view all the answers

    What occupational history is important to consider for potential hematologic disorders?

    <p>Working in a paint factory (B)</p> Signup and view all the answers

    Why is a family's health history significant in assessing hematologic disorders?

    <p>Some blood disorders are hereditary (A)</p> Signup and view all the answers

    Which symptom is commonly associated with anemia?

    <p>Fatigue (D)</p> Signup and view all the answers

    What are possible hematologic causes for cyanosis as noted in physical examination?

    <p>Poor oxygenation of red blood cells (B)</p> Signup and view all the answers

    Which of the following diagnostic tests is commonly used to assess coagulation issues?

    <p>Coagulation test (A)</p> Signup and view all the answers

    What is the role of an INR test in patients undergoing warfarin therapy?

    <p>To assess blood clotting times (A)</p> Signup and view all the answers

    What is a potential effect of alcohol on the hematologic system?

    <p>It can cause folic acid-deficiency anemia (C)</p> Signup and view all the answers

    Which finding in a physical exam may indicate a bleeding disorder?

    <p>Purpura, ecchymoses, petechiae (A)</p> Signup and view all the answers

    Which question should be asked to assess for possible dietary deficiencies?

    <p>What is your usual diet? (C)</p> Signup and view all the answers

    What signs may indicate poor immune function in the objective data collection?

    <p>Fever and inflammation (D)</p> Signup and view all the answers

    Which symptom might a patient with anemia experience related to the respiratory system?

    <p>Shortness of breath (B)</p> Signup and view all the answers

    Which laboratory study is routinely done for hematologic disorders?

    <p>Complete blood count (CBC) (C)</p> Signup and view all the answers

    Why is a social history critical in assessing hematologic disorders?

    <p>It may uncover potential exposures affecting health (A)</p> Signup and view all the answers

    What skin condition might indicate a liver involvement or hemolysis?

    <p>Jaundice (A)</p> Signup and view all the answers

    What stimulates the kidneys to secrete erythropoietin?

    <p>Hypoxia (A)</p> Signup and view all the answers

    Which of the following symptoms might suggest a problem with the lymphatic system?

    <p>Neck, axillary, or groin swelling (A)</p> Signup and view all the answers

    Which of the following is NOT a function of plasma?

    <p>Transporting oxygen (A)</p> Signup and view all the answers

    Which vitamin is necessary for DNA synthesis in red bone marrow stem cells?

    <p>Vitamin B12 (C)</p> Signup and view all the answers

    What is the approximate lifespan of a red blood cell?

    <p>120 days (B)</p> Signup and view all the answers

    What condition can cause an accelerated destruction of red blood cells (hemolysis)?

    <p>Malaria (B)</p> Signup and view all the answers

    What causes the yellowish orange hue of the skin and mucous membranes in jaundice?

    <p>Excess bilirubin (D)</p> Signup and view all the answers

    Which white blood cell type is most numerous?

    <p>Neutrophils (A)</p> Signup and view all the answers

    Which white blood cell combats the effects of histamine?

    <p>Eosinophils (B)</p> Signup and view all the answers

    What is the role of plasma cells?

    <p>Produce antibodies (D)</p> Signup and view all the answers

    What initiates the extrinsic pathway of coagulation?

    <p>Damage to a blood vessel or surrounding tissues outside the blood (A)</p> Signup and view all the answers

    Which of the following is NOT a function of the lymphatic system?

    <p>Producing red blood cells in adults (A)</p> Signup and view all the answers

    Where do T lymphocytes complete their development?

    <p>Thymus (B)</p> Signup and view all the answers

    What is the term for small purplish hemorrhagic spots under the skin?

    <p>Petechiae (B)</p> Signup and view all the answers

    What are platelets involved in?

    <p>Hemostasis (A)</p> Signup and view all the answers

    What is the normal range for platelets?

    <p>150,000-450,000/mm3 (D)</p> Signup and view all the answers

    Where are lymph nodes concentrated?

    <p>Cervical, axillary, and inguinal regions (A)</p> Signup and view all the answers

    What is the primary function of lymph nodules?

    <p>Destroying microbes that penetrate the epithelium (B)</p> Signup and view all the answers

    What is thrombocytopenia?

    <p>Decreased platelets (D)</p> Signup and view all the answers

    Which organ stores up to one-third of the body's platelets?

    <p>Spleen (B)</p> Signup and view all the answers

    Which WBC type is increased in allergic responses?

    <p>Eosinophils (A)</p> Signup and view all the answers

    What does the thymus primarily produce?

    <p>T cells (B)</p> Signup and view all the answers

    What is intrinsic factor necessary for?

    <p>Vitamin B12 absorption (C)</p> Signup and view all the answers

    What substance inhibits the clotting mechanism?

    <p>Heparin (A)</p> Signup and view all the answers

    What is the role of antithrombin in the clotting process?

    <p>Inactivates excess thrombin (C)</p> Signup and view all the answers

    What role do valves play in lymph vessels?

    <p>Preventing backflow of lymph (D)</p> Signup and view all the answers

    Where is bilirubin sent after the spleen breaks down red blood cells?

    <p>Liver (B)</p> Signup and view all the answers

    Which blood type has both anti-A and anti-B antibodies?

    <p>Type O (C)</p> Signup and view all the answers

    Which vein does lymph from areas below the diaphragm enter?

    <p>Left subclavian vein (C)</p> Signup and view all the answers

    What is the term for the breakdown of red blood cells?

    <p>Hemolysis (A)</p> Signup and view all the answers

    What is a recommended practice to prevent energy expenditure by a patient with anemia?

    <p>Limiting visitors and unnecessary interruptions (A)</p> Signup and view all the answers

    Which of these is NOT mentioned as a symptom related to hematologic disorders?

    <p>Joint pain (A)</p> Signup and view all the answers

    Which nutrient is specifically recommended for patients with pernicious anemia?

    <p>Vitamin B12 injections (B)</p> Signup and view all the answers

    Why should iron supplements be taken with vitamin C-rich foods or fluids?

    <p>To enhance the absorption of iron (B)</p> Signup and view all the answers

    What is a proper method for administering oral iron supplements to avoid teeth staining?

    <p>Use a drinking straw (C)</p> Signup and view all the answers

    What should patients with folic acid deficiency include in their diet?

    <p>Foods from each food group (C)</p> Signup and view all the answers

    What should a patient do if they experience side effects from iron supplements?

    <p>Notify the healthcare provider (A)</p> Signup and view all the answers

    What is an oral care recommendation to maintain oral mucous membrane integrity for anemic patients?

    <p>Using a soft toothbrush (A)</p> Signup and view all the answers

    What is the purpose of administering intramuscular iron injections using the Z-track method?

    <p>To avoid staining of the injection site (D)</p> Signup and view all the answers

    How should oral iron supplements be timed around meals to enhance absorption?

    <p>1 hour before or 2 hours after meals (C)</p> Signup and view all the answers

    What dietary modification can aid anemic patients if they have a deficiency in their diet?

    <p>Consulting a dietitian for diet instruction (A)</p> Signup and view all the answers

    What does an increase in immature bands indicate in a WBC differential count?

    <p>A worsening of an infection (A)</p> Signup and view all the answers

    In which part of the body can a bone marrow biopsy be safely performed?

    <p>Sternum (B)</p> Signup and view all the answers

    What changes in lymphocytes are observed during a viral infection?

    <p>Increase in lymphocyte count (B)</p> Signup and view all the answers

    Which procedure involves injecting dye into a lymphatic vessel?

    <p>Lymphangiography (A)</p> Signup and view all the answers

    What implication does a high INR have for a patient on anticoagulant therapy?

    <p>Decreased dosage of anticoagulants is needed (A)</p> Signup and view all the answers

    Which of these WBC patterns indicates an acute bacterial infection?

    <p>Segs ↑ Bands ↑ Lymphocytes ↓ (C)</p> Signup and view all the answers

    Which factor is NOT evaluated by activated partial thromboplastin time (aPTT)?

    <p>Factor VII (B)</p> Signup and view all the answers

    What is a main role of segmented neutrophils in the body’s immune response?

    <p>Act as fully mature fighters against infection (C)</p> Signup and view all the answers

    What should be done to prevent infection during a bone marrow biopsy?

    <p>Create a small incision to avoid skin plug contamination (B)</p> Signup and view all the answers

    What does prolonged bleeding time indicate in coagulation studies?

    <p>Platelet disorder (A)</p> Signup and view all the answers

    Which site is NOT typically used for adult bone marrow biopsy?

    <p>Radius (C)</p> Signup and view all the answers

    Which factor may be affected by prothrombin time (PT) values?

    <p>Factor VII (D)</p> Signup and view all the answers

    When would lymph nodes be biopsied?

    <p>To evaluate enlarged lymph nodes for infection or malignancy (D)</p> Signup and view all the answers

    Which test measures capillary resistance against rupture?

    <p>Capillary fragility test (C)</p> Signup and view all the answers

    What role does the nurse play in a bone marrow biopsy?

    <p>Coordinate between lab and healthcare provider (D)</p> Signup and view all the answers

    What is the primary reason for using washed or leukocyte-depleted blood in transfusions?

    <p>To minimize the risk of antigen sensitization and certain viral transmissions (A)</p> Signup and view all the answers

    What is the main goal of using filters in blood administration tubing?

    <p>To prevent potentially harmful particles from entering the patient (D)</p> Signup and view all the answers

    Which blood product is specifically used for severe anemia?

    <p>Packed red blood cells (RBCs) (B)</p> Signup and view all the answers

    Which reaction is most common during blood transfusions?

    <p>Febrile reaction (D)</p> Signup and view all the answers

    What type of solution should be used to flush IV lines before and after transfusions?

    <p>Normal saline solution (B)</p> Signup and view all the answers

    Which procedure helps reduce the risk of complications by allowing patients to receive their own blood?

    <p>Autologous transfusion (D)</p> Signup and view all the answers

    How long should a unit of packed cells be transfused to prevent deterioration and bacterial growth?

    <p>No longer than 4 hours (B)</p> Signup and view all the answers

    Which blood product is used to provide clotting factors for bleeding disorders?

    <p>Fresh frozen plasma (D)</p> Signup and view all the answers

    What symptom is a cardinal sign of an urticarial (hive) reaction?

    <p>Hive-like rash (D)</p> Signup and view all the answers

    Why might a blood warmer be used during rapid transfusions?

    <p>To prevent hypothermia and heart arrhythmias (C)</p> Signup and view all the answers

    What should be done if a febrile reaction is suspected during a blood transfusion?

    <p>Stop the transfusion and notify the Healthcare Provider (C)</p> Signup and view all the answers

    What is the role of albumin in transfusions?

    <p>To treat hypovolemia caused by hypoalbuminemia (C)</p> Signup and view all the answers

    Why is monitoring vital signs crucial during a blood transfusion?

    <p>To prevent and quickly respond to potential complications (C)</p> Signup and view all the answers

    Which component is necessary with blood transfusion tubing to ensure safety during administration?

    <p>Filter for harmful particles (D)</p> Signup and view all the answers

    Which statement about storing autologous blood for transfusion is correct?

    <p>It can be stored for up to 42 days (A)</p> Signup and view all the answers

    Which foods are rich in vitamin C?

    <p>Citrus, strawberries, and broccoli (C)</p> Signup and view all the answers

    What is the primary cause of macrocytic anemia?

    <p>Vitamin B12 and folate deficiency (D)</p> Signup and view all the answers

    What role does vitamin B12 play in the body?

    <p>Assists in DNA, RBC synthesis, and neurological function (B)</p> Signup and view all the answers

    Which medication can interfere with B12 absorption?

    <p>Metformin (B)</p> Signup and view all the answers

    Folate is primarily necessary for:

    <p>Formation of DNA and heme (D)</p> Signup and view all the answers

    What symptom is associated specifically with pernicious anemia?

    <p>Numbness of the hands or feet (C)</p> Signup and view all the answers

    Which test is performed to assess if anemia is due to iron deficiency?

    <p>Serum iron, ferritin, and TIBC measurements (B)</p> Signup and view all the answers

    A deficiency of which nutrient can lead to neural tube defects?

    <p>Folate (C)</p> Signup and view all the answers

    What is recommended for women of childbearing age to prevent neural tube defects?

    <p>Consuming 400 mcg of folate daily (B)</p> Signup and view all the answers

    What simple nursing intervention can help manage decreased activity tolerance in anemic patients?

    <p>Plan care to conserve energy after activity (B)</p> Signup and view all the answers

    What does a peripheral blood smear reveal in a patient with macrocytic anemia?

    <p>Large RBCs (C)</p> Signup and view all the answers

    What is an early sign of iron deficiency anemia?

    <p>Spoon-shaped nails (A)</p> Signup and view all the answers

    Which food source is NOT rich in folate?

    <p>Chicken (C)</p> Signup and view all the answers

    Which condition can lead to vitamin B12 deficiency?

    <p>Weight-loss surgery (B)</p> Signup and view all the answers

    Why should iron supplements be taken with vitamin C-rich foods?

    <p>To enhance iron absorption (D)</p> Signup and view all the answers

    What is the first step you should take when you suspect an acute hemolytic reaction during a blood transfusion?

    <p>Stop the transfusion immediately (D)</p> Signup and view all the answers

    Which symptom is NOT typically associated with an anaphylactic reaction from a blood transfusion?

    <p>Oliguria (C)</p> Signup and view all the answers

    Which condition increases the risk of TRALI in patients receiving blood transfusions?

    <p>Mechanical ventilation (B)</p> Signup and view all the answers

    What is one of the main differences in symptoms between TRALI and TACO during a transfusion?

    <p>TACO is characterized by frothy sputum; TRALI is not (A)</p> Signup and view all the answers

    In the context of blood transfusions, what is the primary physiological cause of a hemolytic reaction?

    <p>Transfusion of incompatible blood (C)</p> Signup and view all the answers

    Why might a patient who has experienced an anaphylactic reaction need future transfusions from frozen, deglycerolized blood cells?

    <p>To prevent reactions to donor immunoglobulins (A)</p> Signup and view all the answers

    Within what timeframe is TRALI most likely to develop after a blood transfusion?

    <p>12 to 72 hours post-transfusion (D)</p> Signup and view all the answers

    Which laboratory finding can indicate TRALI?

    <p>Bilateral pulmonary infiltrates (C)</p> Signup and view all the answers

    What is a common intervention if a patient exhibits TACO symptoms during a transfusion?

    <p>Give diuretics to reduce fluid overload (A)</p> Signup and view all the answers

    In older adults receiving blood transfusions, which sign should be reported immediately?

    <p>Dyspnea (C)</p> Signup and view all the answers

    How should the vein be managed after stopping a blood transfusion due to an acute hemolytic reaction?

    <p>Keep open with normal saline using a new tubing set (D)</p> Signup and view all the answers

    What preventive measure is suggested for avoiding TRALI with blood transfusions?

    <p>Screen donor plasma for anti-leukocyte antibodies (D)</p> Signup and view all the answers

    Which symptom is a late sign of an acute hemolytic reaction?

    <p>Disseminated intravascular coagulation (B)</p> Signup and view all the answers

    Which of the following symptoms might suggest a patient is experiencing a blood transfusion-related anaphylactic reaction?

    <p>Severe gastrointestinal cramping (A)</p> Signup and view all the answers

    What is a common vital sign abnormality seen in TRALI that requires immediate attention?

    <p>Hypotension with fever above 100.4°F (B)</p> Signup and view all the answers

    For which patient population is the risk of transfusion-associated circulatory overload (TACO) particularly high?

    <p>Older and debilitated patients (C)</p> Signup and view all the answers

    What primary function does the spleen serve in the lymphatic system?

    <p>It conducts immune responses through B cells and T cells. (B)</p> Signup and view all the answers

    Which pathway is initiated when a blood vessel or surrounding tissues are damaged?

    <p>Extrinsic pathway (C)</p> Signup and view all the answers

    What is a common symptom for patients with disorders affecting red blood cells?

    <p>Poor oxygenation symptoms (D)</p> Signup and view all the answers

    Which factor is necessary for the absorption of vitamin B12?

    <p>Intrinsic factor (A)</p> Signup and view all the answers

    What role do lymph nodes play in the lymphatic system?

    <p>They house lymphocytes and macrophages for immune responses. (C)</p> Signup and view all the answers

    What is a hallmark feature of G6PD deficiency in Mediterranean populations?

    <p>Hemolytic crisis when consuming fava beans or certain drugs (A)</p> Signup and view all the answers

    What essential nutrients are required for healthy RBC production?

    <p>Iron, vitamin B12, and folate (B)</p> Signup and view all the answers

    In which area is the thymus located?

    <p>In the mediastinum, anterior to the trachea (B)</p> Signup and view all the answers

    Which of the following could be a symptom of anemia?

    <p>Shortness of breath (A)</p> Signup and view all the answers

    What is the primary role of platelets in the blood?

    <p>Involved in hemostasis mechanisms like clotting (B)</p> Signup and view all the answers

    Which condition results from chronic or massive blood loss leading to fewer RBCs?

    <p>Aplastic anemia (B)</p> Signup and view all the answers

    Which of the following describes the condition of anemia on a cellular level?

    <p>Blood is deficient in RBCs or hemoglobin (D)</p> Signup and view all the answers

    What action should be taken during the first 15 minutes of a blood transfusion?

    <p>Monitor for any immediate reactions (A)</p> Signup and view all the answers

    How do lymphatic vessels prevent backflow?

    <p>Using one-way valves (D)</p> Signup and view all the answers

    Flashcards

    Hematologic System

    The network that includes bone marrow, blood, and its components.

    Functions of Blood

    Transport of substances, regulation of temperature, pH, fluid balance, and immune cell transport.

    Plasma Composition

    Plasma is about 91% water and contains proteins like albumin and globulins for transport and clotting.

    Red Blood Cells (RBCs)

    Cells that carry oxygen; increased levels indicate polycythemia, decreased indicate anemia.

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    Hematocrit (Hct)

    The percentage of blood volume made up by red blood cells; increased in dehydration.

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    Hemoglobin (Hgb)

    The protein in red blood cells that carries oxygen; abnormal levels indicate possible anemia.

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    White Blood Cells (WBCs)

    Cells involved in immune response; increased levels indicate leukocytosis, decreased indicate leukopenia.

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    Plasma Proteins

    Proteins in plasma like clotting factors, albumin, and globulins; synthesized by the liver.

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    WBC normal count

    Normal white blood cell count is between 4,500–11,000/mm3.

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    Neutrophils function

    Neutrophils fight bacterial infections and inflammation.

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    Eosinophils role

    Eosinophils increase during allergic reactions and certain leukemias.

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    Basophils purpose

    Basophils release heparin and histamine during allergic reactions.

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    Lymphocytes

    Lymphocytes are increased in viral infections and some leukemias.

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    Monocytes function

    Monocytes increase in chronic inflammation and eventually become macrophages.

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    Platelet ranges

    Normal platelet count ranges from 150,000–450,000/mm3.

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    Thrombocytosis

    Increased platelet count is known as thrombocytosis.

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    Thrombocytopenia

    Decreased platelet count is known as thrombocytopenia.

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    Hemoglobin

    Hemoglobin binds oxygen in RBCs and gives blood its color.

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    Erythropoietin

    Erythropoietin stimulates RBC production in response to low oxygen levels.

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    Intrinsic factor

    Intrinsic factor helps absorb vitamin B12 in the intestine.

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    Blood types

    Blood types are determined by antigens on RBCs and include ABO and Rh factor.

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    Jaundice

    Jaundice is a yellowing of the skin due to high bilirubin levels.

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    WHAT’S UP? Format

    A method for collecting symptom data from patients.

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    Family History

    Review of health conditions in blood relatives.

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    Diet History

    Assessment of a patient's usual diet.

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    Alcohol Intake

    Amount of alcohol consumed by a patient.

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    Occupational History

    Review of a patient's work history.

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    Fatigue

    A common symptom associated with anemia and cancers.

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    Bleeding Tendency

    Symptoms indicating potential clotting disorders.

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    Shortness of Breath

    Dyspnea due to reduced red blood cell count.

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    Lymphadenopathy

    Swollen lymph nodes indicating potential disorders.

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    Vital Signs

    Measurements that can indicate hematologic issues.

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    Coagulation Tests

    Tests assessing blood clotting function.

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    International Normalized Ratio (INR)

    A measure of blood coagulation effectiveness.

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    Neutrophils

    White blood cells that fight infections.

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    Signs of Hematologic Disorders

    Can involve vague signs like dyspnea or fatigue.

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    Objective Data Collection

    Collection of measurable data during examination.

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    Extrinsic Pathway

    The pathway triggered by damage to blood vessels or surrounding tissues, initiating coagulation.

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    Intrinsic Pathway

    The pathway initiated when platelets adhere to damaged endothelium and release clotting factors.

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    Fibrin Clot

    A stable blood clot formed through a cascade of reactions in either intrinsic or extrinsic pathways.

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    Role of Endothelium

    The smooth lining of blood vessels that helps repel platelets to prevent excessive clotting.

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    Heparin

    A substance produced by mast cells that inhibits the clotting mechanism.

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    Antithrombin

    A protein that inactivates excess thrombin to prevent an overactive clotting cycle.

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    Lymph

    Tissue fluid that enters lymph capillaries and is returned to the bloodstream.

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    Thoracic Duct

    A major lymphatic vessel that returns lymph from most of the body to the bloodstream.

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    Lymph Nodes

    Structures that contain lymphatic tissue, activated lymphocytes, and macrophages for immune response.

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    Spleen Functions

    Organ that filters blood, stores platelets, and produces immune responses using B and T cells.

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    Thymus

    Organ where T lymphocytes mature; its function decreases with age.

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    Aging Effects

    Changes in hematologic and lymphatic systems associated with aging.

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    Hemolysis

    The breakdown of red blood cells, releasing heme into circulation.

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    Lymphatic Nodules

    Small masses of lymphatic tissue found beneath mucosal surfaces, involved in immune response.

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    Bilirubin

    A substance formed from the breakdown of hemoglobin, excreted through the liver.

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    Blood Administration

    The process of delivering blood products to patients by qualified nurses.

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    Autologous Transfusion

    A procedure where individuals donate their own blood for future use.

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    Blood Component Storage

    Blood can be stored for 42 days or frozen for longer shelf-life.

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    Transfusion Consent Form

    A specific form that must be signed before blood transfusions can occur.

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    Normal Saline Compatibility

    Only normal saline should be used to dilute blood; others may be harmful.

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    Transfusion Timing

    Blood must be started within 30 minutes and transfused within 4 hours to prevent risks.

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    Blood Filtering

    Filters are used during transfusions to prevent harmful particles from entering.

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    Washed Red Blood Cells

    Packed RBCs that have been washed to remove plasma, reducing reactions.

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    Warmed Blood Transfusion

    Blood warmed to body temperature during rapid transfusions prevents hypothermia.

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    Monitoring During Transfusion

    Vital signs must be monitored before, during, and after blood transfusions.

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    Febrile Reaction

    Common transfusion reaction with symptoms of fever and chills, often post-transfusion.

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    Urticarial Reaction

    Minor allergic reaction during transfusion characterized by hives and possible fever.

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    Volume Replacement

    Fresh frozen plasma is used to provide clotting factors and replace volume in bleeding disorders.

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    Packed Red Blood Cells

    Used for severe anemia or blood loss, concentrated form of RBCs.

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    Monitoring Complications

    Regular checks are essential to detect any transfusion complications early.

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    Bands

    Immature white blood cells that increase during severe infections.

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    Segmented Neutrophils

    Mature white blood cells ready to fight infections; also called 'segs'.

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    WBC Differential Count

    A test that measures types of white blood cells to assess infections.

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    Acute Bacterial Infection Pattern

    Segs increase, bands increase, lymphocytes decrease during a bacterial infection.

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    Viral Infection Pattern

    Segs decrease, bands decrease, lymphocytes increase during a viral infection.

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    Bone Marrow Biopsy

    A procedure to obtain bone marrow for diagnosing disorders.

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    Coagulation Studies

    Tests to evaluate clotting ability in blood.

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    Prothrombin Time (PT)

    Measures time for blood to clot, indicating liver function and bleeding risks.

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    Activated Partial Thromboplastin Time (aPTT)

    Measures time for blood clot formation; used for heparin therapy.

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    Bleeding Time

    Measures time to stop bleeding after a puncture; prolonged times indicate disorders.

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    Capillary Fragility Test

    Tests capillaries' ability to withstand pressure; relates to petechiae appearance.

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    Lymphangiography

    Imaging procedure to evaluate lymphatic issues using dye and X-ray.

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    Lymph Node Biopsy

    Procedure to determine causes of lymph node enlargement.

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    Formed Elements

    Components of blood including RBCs, WBCs, and platelets.

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    Anemia

    Condition with a deficiency of RBCs, hemoglobin, or both.

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    Microcytic Anemia

    Anemia characterized by smaller than normal RBCs.

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    G6PD Deficiency

    Genetic enzyme deficiency causing hemolytic anemia under certain conditions.

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    Pernicious Anemia

    Anemia caused by lack of intrinsic factor affecting vitamin B12 absorption.

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    Iron Deficiency

    A common cause of anemia due to inadequate iron intake.

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    Symptoms of Anemia

    Common symptoms include fatigue, weakness, and shortness of breath.

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    Clotting Factors

    Proteins in blood that help in the processes of hemostasis.

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    Pathophysiology of Anemia

    Anemia's causes include impaired RBC production, destruction, or blood loss.

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    Hemolytic Reaction

    A severe reaction from transfusion of incompatible blood causing RBC destruction.

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    Signs of Hemolytic Reaction

    Back pain, chest pain, chills, fever, and shortness of breath that occur rapidly.

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    Immediate Action for Hemolytic Reaction

    Stop the transfusion and notify the healthcare provider immediately.

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    Anaphylactic Reaction

    A rare, severe allergic reaction to components in transfused blood.

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    Symptoms of Anaphylactic Reaction

    Respiratory collapse, gastrointestinal cramping, or uncontrollable diarrhea.

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    TRALI

    Transfusion-related acute lung injury, causing respiratory distress post-transfusion.

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    Signs of TRALI

    Acute respiratory distress, low SpO2, crackles, and fever with hypotension.

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    Transfusion-Associated Circulatory Overload (TACO)

    A reaction occurring from too rapid transfusion, especially in elderly patients.

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    Signs of TACO

    Chest pain, cough, frothy sputum, and distended neck veins.

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    Emergency Procedures for Transfusion Reactions

    Immediately stop the transfusion and instigate emergency protocols.

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    Role of Antihistamines in Reactions

    Antihistamines like diphenhydramine may be given for allergic reactions.

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    Management of Shock in Reactions

    High fluid volumes and diuretics may be needed to manage shock.

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    Special Precautions for Older Adults

    Older patients are at higher risk for fluid overload and require careful monitoring.

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    Post-Transfusion Monitoring

    Patients need observation for potential complications for 48 to 96 hours after transfusion.

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    Energy Conservation

    Balancing activities and rest to save energy.

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    ADLs

    Activities of daily living that require assistance.

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    Dyspnea Relief

    Administer oxygen to ease difficulty in breathing.

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    Iron Deficiency Management

    Instruct patients on high-iron foods and supplements.

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    Vitamin B12 Administration

    Pernicious anemia requires lifetime vitamin B12 injections.

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    High-Iron Food Examples

    Foods like red meat and beans that are rich in iron.

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    Folic Acid Deficiency

    Include various food groups to ensure a balanced diet.

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    Signs of Anemia

    Symptoms vary from mild fatigue to severe weakness.

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    Glossitis

    Inflammation of the tongue often linked to nutritional deficiencies.

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    Oral Hygiene Importance

    Good oral care helps maintain oral mucous membrane health.

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    Vitamin C Sources

    Citrus, strawberries, kiwis, mangoes, tomatoes, broccoli, peppers, and cabbage are rich in vitamin C.

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    Iron Supplements Timing

    Iron supplements should be provided between meals with water or vitamin C-rich food to enhance absorption.

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    Intrinsic Factor Function

    Intrinsic factor is a protein that allows for the absorption of vitamin B12 in the intestine.

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    Vitamin B12 Sources

    Vitamin B12 is found in animal products like meats, eggs, and fortified foods such as soy milk and cereals.

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    Folate's Role

    Folate is essential for DNA formation and is important for rapidly growing cells, including those in blood and fetal tissue.

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    Folate Sources

    Folate can be found in vegetables, fruits, nuts, legumes, animal products, and fortified grains.

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    Pernicious Anemia Symptoms

    Pernicious anemia, caused by B12 deficiency, may include numbness, weakness, memory problems, and a beefy red tongue.

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    Complete Blood Count (CBC)

    CBC measures red and white blood cell counts, helping diagnose anemia and other blood disorders.

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    Treating Anemia

    Treatment involves correcting underlying causes, enhancing nutrient intake through diet or supplements, and possibly blood transfusions for acute cases.

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    Iron Deficiency Symptoms

    Iron deficiency symptoms can include glossitis, fissures at the mouth's corners, and spoon-shaped nails.

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    Vitamin B12 Deficiency Risks

    Risk factors for B12 deficiency include strict vegetarian diets, weight-loss surgery, and medications like Metformin.

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    Daily Folate Requirement

    Women of childbearing age should consume 400 mcg of folate daily to prevent fetal neural tube defects.

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    Monitoring Anemia

    Monitor hemoglobin and hematocrit levels to assess response to anemia therapy and overall patient status.

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    Study Notes

    Hematologic and Lymphatic Systems

    • The hematologic system includes bone marrow, blood, and blood components.
    • The lymphatic system includes lymph nodes, lymphatic nodules (filtering pathogens), and lymph vessels (returning lymph to blood).

    Blood

    • Blood volume: 4-6 liters
    • Formed elements (RBCs, WBCs, platelets): ~45% of blood volume
    • Plasma (~91% water): transports substances, regulates temperature, pH, and fluid balance, and transports protective cells.
    • Formed elements are produced from stem cells in red bone marrow (hematopoietic tissue) of flat, irregular, and long bones.
    • T-lymphocyte maturation/differentiation happens in the thymus.

    Plasma

    • Primarily water (~91%)
    • Plasma proteins (synthesized in liver):
      • Clotting factors (prothrombin, fibrinogen): activate for clotting
      • Albumin: maintains blood volume/pressure by pulling tissue fluid into capillaries
      • Globulins (alpha/beta): carriers for substances like fats
      • Globulins (gamma): antibodies produced by lymphocytes.

    Blood Cell Counts (Table 27.1)

    • Red Blood Cells (RBCs):
      • Increased (polycythemia): seen in chronic hypoxia
      • Decreased (anemia): seen in anemia or blood loss
      • Normal values differ by sex
    • Hematocrit (Hct):
      • Increased: dehydration or chronic hypoxia
      • Decreased: anemia or blood loss
      • Normal values differ by sex
    • Hemoglobin (Hgb):
      • Increased: chronic hypoxia
      • Decreased: blood loss or anemia
      • Normal values differ by sex
    • Reticulocytes:
      • Increased: hypoxia or anemia
      • Decreased: RBC maturation defect
    • White Blood Cells (WBCs):
      • Increased (leukocytosis): infection
      • Decreased (leukopenia): possible infection
      • Normal values range (count): 4,500-11,000/mm3
      • Specific WBC types (neutrophils, eosinophils, basophils, lymphocytes, monocytes) and counts are detailed in Table 27.1. Specific increases/decreases indicate a potential cause, i.e. infection.
    • Platelets:
      • Increased (thrombocytosis): trauma
      • Decreased (thrombocytopenia): blood disorders

    Blood pH

    • Normal range: 7.35-7.45
    • Buffer systems maintain homeostasis.

    Red Blood Cells (RBCs)

    • Biconcave disks, no nuclei
    • Carry oxygen bound to iron in hemoglobin.
    • Oxyhemoglobin forms in pulmonary capillaries with oxygen binding.
    • Reduced hemoglobin results when oxygen is released.
    • Factors determining oxygen-carrying capacity: Hgb amount, iron content, and # of RBCs.
    • Decreased capacity (anemia): shortness of breath, fatigue.
    • Hypoxia stimulates kidneys to produce erythropoietin, increasing RBC production.
    • Immature reticulocytes mature by ejecting nuclei, forming biconcave disc.
    • Presence of many reticulocytes signifies the body needs more mature RBCs.
    • Dietary protein and iron are needed for Hgb synthesis.
    • Folic acid and vitamin B12 needed for DNA synthesis in red marrow stem cells (mitosis).
    • Vitamin B12 (extrinsic factor) comes from diet.
    • Intrinsic factor produced by stomach lining helps absorb B12 in small intestine.
    • RBC lifespan: ~120 days
    • Phagocytized by macrophages in liver, spleen, and red bone marrow.
    • Conditions (malaria, sickle cell) cause accelerated RBC destruction (hemolysis), potentially causing jaundice (bilirubin buildup).

    Blood Types

    • Determined by antigens on RBCs.
    • ABO group and Rh factor are critical.
    • ABO type indicates antigens present.
    • Plasma contains antibodies for missing antigens.
    • Rh-positive has D antigen, Rh-negative does not.
    • Rh-negative people can produce antibodies to Rh-positive blood upon exposure.

    White Blood Cells (WBCs)

    • Larger than RBCs, have nuclei
    • Granular (neutrophils, eosinophils, basophils) and agranular (lymphocytes, monocytes)
    • Produced in red bone marrow; T lymphocytes mature in thymus
    • Activated/differentiated in lymph nodes, spleen, and lymphatic nodules
    • All involved in immune/inflammatory response to injury
    • Varying lifespans; most circulate a few days, some live years.

    Monocytes/Macrophages

    • Become macrophages in tissues.
    • Phagocytize pathogens and infected cells.

    Neutrophils

    • Numerous; phagocytize foreign matter.

    Eosinophils

    • Combat histamine effects. Detoxify foreign proteins. Respond to parasitic infections.

    Basophils

    • Release heparin and histamine during inflammatory reactions.

    Lymphocytes

    • Two groups: T cells and B cells
    • T cells (helper, suppressor, killer, memory).
    • B cells (memory cells and plasma cells): produce antibodies against foreign antigens.

    Platelets

    • Fragments of megakaryocytes produced in red marrow.
    • Involved in hemostasis (vascular spasm, platelet plugs, chemical clotting).
    • Lifespan: ~10 days.
    • Coagulation:
      • Extrinsic pathway: Initiated by damaged blood vessels/surrounding tissues.
      • Intrinsic pathway: Initiated when platelets adhere to damaged endothelium and release clotting factors.
      • Both pathways lead to a fibrin clot.
    • Prevention of excessive clotting:
      • Smooth endothelial lining repels platelets.
      • Heparin inhibits clotting.
      • Antithrombin inactivates excess thrombin.

    Lymphatic System

    • Consists of lymph, lymph vessels, lymph nodes/nodules, spleen, red bone marrow, and thymus.
    • Function: returns tissue fluid, defends against pathogens.
    • Lymph capillaries collect tissue fluid (lymph) returning it to blood.
    • Lymph nodes house lymphocytes and macrophages.
    • Lymph nodes concentrated in cervical, axillary, and inguinal regions.
    • Lymphatic nodules are found in mucous membranes; phagocytize pathogens.
    • Tonsils are examples of lymphatic nodules.
    • Spleen in abdominal cavity;
      • Functions: immunity (B cells & T cells), phagocytosis of pathogens/damaged cells, stores platelets.
      • Not vital; other organs compensate for spleen removal.
    • Thymus: location in mediastinum; T lymphocytes mature here; atrophies in adults.

    Aging and the Hematologic/Lymphatic Systems

    • Changes occur in older adults (detailed in 27.6).

    Patient Data Collection (Hematologic/Lymphatic)

    • Health History (Table 27.3): collects info on bleeding, fatigue, etc.
    • Family History: identifies hereditary predisposition to disorders.
    • Diet History: detects nutrient deficiencies.
    • Medical/Supplement History: screens for potential interactions with blood or immune function.
    • Environmental Exposure History: identifies substances linked to bone marrow or blood cancer.

    Physical Examination (Hematologic/Lymphatic)

    • Examination of various body systems (detailed in 27.4) for signs of anemia, bleeding, etc, is fundamental.

    Diagnostic Tests

    • Blood tests (CBC, Hgb, Hct, platelets)
    • Coagulation studies (PT, INR, aPTT, bleeding time, capillary fragility test)
    • Bone marrow biopsy
    • Lymphangiography
    • Lymph node biopsy

    Blood Administration

    • Safety measures:
      • Proper identification.
      • Transfusion consent form.
      • Fluid compatibility (using normal saline).
      • Timing (start within 30 minutes, infuse over 2 hours).
      • Filtering (using filters appropriate for blood type).
      • Washed/leukocyte-reduced blood (for reduced risk of febrile reactions).
      • Warming blood (for severe bleeding/multiple transfusions, to prevent hypothermia).
    • Monitoring: vital signs (especially temperature) before and throughout transfusion.

    Complications (Blood Transfusions)

    • Febrile reaction: common, fever, chills
    • Urticarial (hive) reaction: mild allergic reaction, rash
    • Hemolytic reaction: incompatible blood, hemolysis of RBCs, dangerous
    • Anaphylactic reaction: rare, life-threatening allergic reaction.
    • Transfusion-related acute lung injury (TRALI): serious
    • Transfusion-associated circulatory overload (TACO): fluid overload risk from rapid transfusion.

    Anemia

    • Condition of low RBCs, Hgb, or both.
    • Reduced oxygen delivery to tissues.
    • Symptoms: lightheadedness, weakness, shortness of breath.
    • Causes:
      • Impaired production (aplastic anemia, nutritional deficiencies)
      • Increased destruction (hemolytic anemia, sickle cell)
      • Blood loss
    • Types:
      • Microcytic anemia: smaller RBCs (often iron deficiency)
      • Macrocytic anemia: larger RBCs (often vitamin B12 or folate deficiency)
    • Cultural considerations: G6PD deficiency linked to certain cultural heritage and foods causing crisis.
    • Dietary considerations for treatment

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