Module 5: Hematological Emergency Overview
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Questions and Answers

What event initiates the physiological response of hemostasis?

  • Blood vessel dilation
  • Vascular injury (correct)
  • Platelet activation
  • Blood coagulation

What is the duration of the vasoconstriction response following an injury?

  • Up to 10 minutes (correct)
  • 1 to 2 minutes
  • 15 to 20 minutes
  • Indefinite duration

Which of the following describes the formation of a platelet plug?

  • Activated platelets stimulate the release of anticoagulants
  • Platelets adhere to injured vessels and secrete activating chemicals (correct)
  • Blood coagulation occurs prior to platelet adhesion
  • Platelets become less sticky upon contact with collagen

What is the primary function of red blood cells (RBCs)?

<p>Facilitating tissue oxygenation (B)</p> Signup and view all the answers

What is the first step in the blood coagulation process upon vessel damage?

<p>Formation of prothrombin activator (A)</p> Signup and view all the answers

What role do calcium ions play in the coagulation process?

<p>They act as a co-factor for enzyme activity (B)</p> Signup and view all the answers

What happens to aging red blood cells in the body?

<p>They lose elasticity and get trapped in small blood vessels (B)</p> Signup and view all the answers

What does a hematocrit value of 45% indicate?

<p>45 mL of RBCs in 100 mL of blood (C)</p> Signup and view all the answers

How soon does blood coagulation begin after a vessel is severely ruptured?

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

What happens to a clot after its formation within the first half hour?

<p>It retracts and seals the vessel further (B)</p> Signup and view all the answers

What can a low reticulocyte count indicate?

<p>Bone marrow disease or anemia (B)</p> Signup and view all the answers

Which of the following conditions could lead to a high hematocrit value?

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

What is a critical function of the fibrous tissue that grows into the blood clot?

<p>It seals the injured vessel permanently (D)</p> Signup and view all the answers

What is the normal lifespan of a red blood cell?

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

How many oxygen molecules can each hemoglobin molecule carry?

<p>Four oxygen molecules (D)</p> Signup and view all the answers

What prompts an increase in white blood cell (WBC) production?

<p>Response to infections (B)</p> Signup and view all the answers

What percentage of total WBC count do neutrophils account for?

<p>65% (A)</p> Signup and view all the answers

Which of the following conditions is NOT associated with an increased WBC count?

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

What is the primary role of platelets in the circulatory system?

<p>Facilitate blood clotting (C)</p> Signup and view all the answers

What is the primary treatment approach for primary polycythemia?

<p>Phlebotomy and anticancer drug therapy (A)</p> Signup and view all the answers

Which of the following is NOT a common symptom of primary polycythemia?

<p>Loss of smell (C)</p> Signup and view all the answers

Which factors are specifically evaluated during a Prothrombin time test?

<p>V, VIIa, and X (A)</p> Signup and view all the answers

In which phase of disseminated intravascular coagulation (DIC) is bleeding most likely to occur?

<p>Second phase characterized by depletion of clotting factors (C)</p> Signup and view all the answers

What happens to platelets when a blood vessel is damaged?

<p>They swell and adhere to the vessel wall. (C)</p> Signup and view all the answers

What laboratory finding is indicative of disseminated intravascular coagulation?

<p>Decreased fibrinogen concentration (B)</p> Signup and view all the answers

Which process is activated when the damage to a vessel is severe?

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

What is the normal clotting time in healthy individuals?

<p>7 to 10 minutes (C)</p> Signup and view all the answers

How does disseminated intravascular coagulation (DIC) typically affect the body?

<p>It causes simultaneous clotting and bleeding due to misbalance. (A)</p> Signup and view all the answers

What is a major complication associated with primary polycythemia?

<p>Development of other bone marrow diseases (A)</p> Signup and view all the answers

Which type of WBC makes up approximately 5% of the total WBC count?

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

Which symptom is commonly linked to both primary polycythemia and disseminated intravascular coagulation?

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

What is a critical clinical consequence of the processes in disseminated intravascular coagulation?

<p>Multiple-system organ failure (C)</p> Signup and view all the answers

Which factor is NOT associated with the development of leukemia?

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

What primarily distinguishes acute leukemia from chronic leukemia?

<p>The maturity of the cancer cells (C)</p> Signup and view all the answers

Which of the following conditions is most closely associated with acute lymphocytic leukemia (ALL)?

<p>Children younger than 15 years (D)</p> Signup and view all the answers

Which symptom is NOT commonly associated with leukemia?

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

The diagnosis of leukemia is primarily confirmed by which procedure?

<p>Bone marrow biopsy (B)</p> Signup and view all the answers

What is a common result of the proliferation of leukemic cells in the body?

<p>Accumulation in vital organs (B)</p> Signup and view all the answers

Which type of leukemia primarily affects middle-aged adults?

<p>Acute myelogenous leukemia (AML) (B)</p> Signup and view all the answers

Which symptom may indicate severe spleen enlargement in leukemia patients?

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

What is a common cause associated with Burkitt’s lymphoma in Africa?

<p>Infection by Epstein-Barr virus (D)</p> Signup and view all the answers

Which factor is NOT linked to an increased risk of certain lymphomas?

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

How does secondary polycythemia typically develop in individuals at high altitudes?

<p>Reduced air pressure and low oxygen concentration (D)</p> Signup and view all the answers

What is the primary hormone responsible for stimulating red blood cell production in response to low oxygen levels?

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

Which of the following describes primary polycythemia?

<p>A bone marrow disorder leading to excessive RBC production (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with lymphomas?

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

What type of polycythemia results from known physiological responses, such as living at high altitudes?

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

Which characteristic is most closely associated with the condition known as polycythemia vera?

<p>Increased red blood cell mass independent of erythropoietin (D)</p> Signup and view all the answers

Flashcards

Monocytes

White blood cells that account for about 5% of the total WBC count. Their numbers increase during chronic infections.

Lymphocytes

White blood cells that account for about 27.5% of the total WBC count.

Neutrophils

White blood cells that account for about 65% of the total WBC count.

Eosinophils

White blood cells that, along with basophils, account for about 2.5% of the total WBC count.

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Basophils

White blood cells that, along with eosinophils, account for about 2.5% of the total WBC count.

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Platelets

Small, sticky cell fragments that play a critical role in blood clotting.

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Clotting Time

A test that measures the time it takes for blood to clot. It is typically 7 to 10 minutes.

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Prothrombin Time (PT)

A test that measures the clotting time of plasma and assesses the functionality of certain clotting factors.

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Hemostasis

The process of stopping bleeding from a wounded blood vessel.

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Vasoconstriction in Hemostasis

The first step of hemostasis is vasoconstriction, which involves the narrowing of blood vessels to slow blood loss.

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Platelet Plug Formation

Platelets are small cells that stick to the injured vessel wall and form a plug, initially stopping blood loss.

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Blood Clot Formation

A blood clot is a mesh of fibrin threads that traps red blood cells, platelets, and plasma to completely seal the injured vessel.

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Prothrombin Activator

Prothrombin activator, formed after vessel injury, is essential for the conversion of prothrombin to thrombin, a key enzyme in clot formation.

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Thrombin in Hemostasis

Thrombin converts fibrinogen into fibrin threads, forming the framework of the blood clot.

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PT and PTT Tests

The PT test measures the time it takes for blood to clot, while the PTT test measures the time it takes for plasma to clot, aiding in the diagnosis of clotting disorders.

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What are red blood cells and what is their main function?

Red blood cells (RBCs) are the most numerous cells in the body and their primary function is to deliver oxygen to the tissues.

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Describe the shape of a red blood cell and explain its significance.

Red blood cells have a unique shape resembling a flattened disk with a hollowed-out center. This shape increases the surface area of the cell, maximizing its oxygen-carrying capacity.

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Hemophilia and Clotting Disorders

Hemophilia and other hereditary clotting disorders are often detected using the PT and PTT tests.

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What is hemoglobin and what is its role in oxygen transport?

Hemoglobin is a protein found within red blood cells that gives them their characteristic red color. It binds to oxygen molecules in the lungs and carries them throughout the body to be delivered to the tissues.

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Where are red blood cells produced and what happens to them as they age?

Red blood cells are constantly being produced in the bone marrow to replace old and dying cells.

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What is the lifespan of a red blood cell and how are they destroyed?

The lifespan of a red blood cell is approximately 120 days. As they age, they lose their elasticity and become trapped in small blood vessels, eventually being destroyed by specialized white blood cells called macrophages.

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What happens to hemoglobin when red blood cells are destroyed and what is the resulting product?

Hemoglobin, when broken down, forms the waste product bilirubin, which is responsible for the yellowish color of urine and feces.

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What does a hematocrit test measure?

A hematocrit test measures the percentage of red blood cells in a sample of blood.

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What does a low hematocrit value often indicate and what are some possible causes?

A low hematocrit reading can indicate anemia, a condition characterized by a deficiency in red blood cells or hemoglobin. Anemia can be caused by various factors such as: trauma, surgery, internal bleeding, nutritional deficiencies, bone marrow diseases, or sickle cell disease.

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Leukemia

A type of cancer characterized by the uncontrolled production of white blood cells (WBCs) in the bone marrow.

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Acute Leukemia

A form of leukemia where immature WBCs rapidly multiply, leading to a buildup of abnormal cells in the blood and organs.

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Chronic Leukemia

A form of leukemia where more mature WBCs proliferate abnormally, but the development is slower.

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Acute Lymphocytic Leukemia (ALL)

A type of acute leukemia affecting mainly children under 15, characterized by uncontrolled proliferation of immature lymphocytes.

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Acute Myelogenous Leukemia (AML)

A type of acute leukemia affecting mostly adults, characterized by abnormal proliferation of immature myeloid cells.

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Immune Deficiency in Leukemia

One of the serious consequences of Leukemia, where the abnormal WBCs crowd out healthy cells, making patients susceptible to infections.

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Bone Pain in Leukemia

A common symptom of leukemia, caused by the abnormal WBCs crowding the bone marrow, leading to pain and tenderness.

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Bone Marrow Biopsy for Leukemia

A diagnostic procedure where a sample of bone marrow is extracted and examined under a microscope to confirm the presence of leukemia.

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Lymphoma

A type of cancer that affects the lymphatic system. Often characterized by painless swelling in lymph nodes, enlarged liver and spleen, potential fever, abdominal pain, and gastrointestinal bleeding.

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Burkitt's Lymphoma

A specific type of lymphoma commonly seen in children, particularly in Africa, with strong association to Epstein-Barr virus infection.

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Polycythemia Vera

A condition where the body produces an abnormally high number of red blood cells, leading to thicker blood.

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Secondary Polycythemia

Polycythemia caused by factors outside the bone marrow, often due to chronic hypoxia (reduced oxygen supply).

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Erythropoietin

The hormone produced by the kidneys that stimulates red blood cell production in the bone marrow. It plays a vital role in adapting to low oxygen conditions.

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Apparent Polycythemia

An apparent increase in red blood cell count due to dehydration, not actual overproduction of the cells.

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Altitude-Related Polycythemia

An elevation in red blood cells due to living in high altitudes where oxygen levels are low.

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Bone Marrow Transplantation

The process of replacing bone marrow with healthy cells from a donor, used to treat conditions affecting the bone marrow, including certain types of lymphoma.

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What is Polycythemia?

A condition where the bone marrow makes too many red blood cells, leading to thicker blood that can cause various health problems.

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What are the symptoms of Polycythemia?

Blurred vision, dizziness, itching, headache, hypertension, red hands and feet, red-purple complexion, and enlargement of the spleen.

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What is Disseminated Intravascular Coagulation (DIC)?

A disorder where blood clots form inappropriately throughout the body, leading to bleeding and tissue damage.

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How does DIC progress?

DIC occurs in two stages: the first involves excessive blood clotting due to thrombin and fibrin deposits, and the second is characterized by bleeding caused by depletion of clotting factors.

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What are the symptoms of DIC?

Shortness of breath, bleeding, hypotension (low blood pressure), and poor tissue oxygenation.

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What are platelet complications associated with Polycythemia?

Problems with platelet function, leading to either excessive bleeding or clot formation.

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What is Phlebotomy?

The removal of blood from the body, often used to treat Polycythemia and reduce blood thickness.

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What are anticancer drugs used for in Polycythemia?

Drugs used to treat cancer, sometimes used to control the overproduction of red blood cells in Polycythemia.

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Study Notes

Module 5: Emergencies of Hematological Disorders

  • Module covers emergencies related to blood disorders
  • Objectives include describing blood physiology and components, discussing the pathophysiology and signs/symptoms of specific hematological disorders, outlining general assessment and management of patients with hematological disorders.

Blood and Blood Components

  • Blood consists of cells and formed elements suspended in plasma
  • 95% of formed elements are red blood cells (RBCs/erythrocytes)
  • Remaining 5% consists of white blood cells (WBCs/leukocytes) and cell fragments (platelets)
  • Blood movement keeps formed elements dispersed throughout plasma, allowing various functions
  • Chief functions include: delivery of substances needed for cellular metabolism, defense against invading microorganisms and injury, and acid/base balance.
  • 55% of blood is plasma, 1% is buffy coat, 45% is red blood cells

Cellular Components of Blood

  • Erythrocytes (RBCs)—non-nucleated, contain hemoglobin, responsible for oxygen transport, lifespan 80-120 days.
  • Leukocytes (WBCs)—nucleated, various types, crucial for immune defense, lifespan varies by type.
    • Lymphocytes
    • Monocytes
    • Macrophages
    • Eosinophils
    • Neutrophils
    • Basophils
  • Platelets (thrombocytes): Irregularly shaped cell fragments, involved in hemostasis, lifespan 8-11 days
  • Blood cells are formed within red bone marrow and other blood-forming organs.

Laboratory Tests

  • Hematocrit: Percentage of red blood cells in total blood volume.
    • Normal values vary by sex.
  • Hemoglobin: Measures the amount of hemoglobin in the blood.
    • Normal values vary by sex.
  • Reticulocyte count: Measures the rate of RBC production.
    • Low count suggests decreased production, high count increased production

White Blood Cells

  • WBCs arise from bone marrow and lymph glands, destroy foreign substances and debris
  • Healthy persons have 5,000-10,000 WBCs/mm³.

Platelets

  • Platelets are small sticky cell fragments
  • Important in blood clotting following blood vessel injury
  • Form a platelet plug to stop bleeding

Clotting Measurements

  • Clotting time is typically 7-10 minutes
  • Prothrombin time (PT) measures plasma clotting time.
  • Used to monitor patients on anticoagulants (eg, warfarin), screen for clotting disorders, liver failure.
  • Prolonged PT indicates problems with clotting factors

Hemostasis

  • Initial physiologic response to wounding to stop bleeding
  • Involves vasoconstriction, platelet plug formation, coagulation, and the growth of fibrous tissue into the clot

Specific Hematologic Disorders

  • Anemia, leukemia, leukopenia, lymphomas, polycythemia, disseminated intravascular coagulopathy (DIC), hemophilia, sickle cell disease, and multiple myeloma
  • These disorders are often grouped by the affected cell type(s)
    • RBC disorders
    • WBC disorders
    • Hemostasis disorders

Anemia

  • Condition where hemoglobin or erythrocyte concentration is below normal.
  • Not a disease, but a symptom of underlying conditions.
  • Causes: blood loss, decreased production, and increased destruction of RBCs
  • Example types: iron-deficiency, pernicious, hemolytic

Iron-Deficiency Anemia

  • Caused by inadequate iron intake or loss
  • RBCs produced are small and pale, have reduced oxygen-carrying capacity
  • Common cause is blood loss (menstruation, GI bleeding)

Pernicious Anemia

  • Caused by deficiency of vitamin B12 (needed for RBC production)
  • Lack of intrinsic factor (stomach protein necessary for vitamin B12 absorption)
  • Results in large, immature RBCs
  • Causes neurological complications

Hemolytic Anemia

  • Characterized by prematurely destroyed RBCs
  • Can be inherited (e.g., sickle cell anemia, thalassemia) or acquired (drug-induced)

Acquired Disorders

  • Resulting from mechanical forces, autoimmune disorders, or infections.

Signs and Symptoms of Anemia

  • Common symptoms: Fatigue, headaches, sore mouth/tongue, brittle nails, breathlessness, chest pain.
  • Additional symptoms related to low WBCs (leukopenia) or low platelets (thrombocytopenia) such as bleeding and other symptoms

Diagnosis and Treatment

  • Patient history, blood tests, bone marrow biopsy determine diagnosis
  • Treatment varies dependent upon the underlying cause and severity of condition

Leukemia

  • Cancer characterized by abnormal proliferation of WBCs (leukocytes)
  • Acute leukemia results from immature cells, chronic from more mature cells.
  • Causes: Genetic predisposition, exposure to radiation, certain viruses.
  • Symptoms: Abnormal blood cell counts, organ enlargement (spleen and liver), fatigue, frequent infections

Leukopenia

  • Decrease in the number of WBCs
  • Risk of developing infections
  • Causes: Chemotherapy, radiation therapy, post-transplant medications, leukemia, certain anemias, and other diseases

Lymphomas

  • General term for neoplastic disorders of lymphoid tissue.
  • Hodgkin lymphoma : Specific, curable form of lymphoma
  • Non-Hodgkin lymphoma: Unpredictable forms of lymphoma that have a high malignancy grade leading to more rapid progression compared to Hodgkin lymphoma.
  • Symptoms: Swelling of lymph nodes, fatigue, chills, night sweats, itching, cough, weight loss, shortness of breath and chest discomfort
  • Diagnosis and treatment vary dependent on the type of lymphoma

Polycythemia

  • Increase in RBC mass.
  • Primary polycythemia: No clear cause.
  • Secondary polycythemia: natural response to chronic hypoxia (e.g., high altitude)
  • Often associated with dehydration.
  • Symptoms: Blurred vision, dizziness, generalized itching, headache

Disseminated Intravascular Coagulation (DIC)

  • A complication of severe injury, trauma, or illness.
  • Characterized by abnormal clotting and bleeding simultaneously.
  • Often associated with hypotension, hypoperfusion, and organ ischemia.

Hemophilia

  • Inherited bleeding disorder caused by deficiency in clotting factors.
  • Typically, factor VIII (hemophilia A) or factor IX (hemophilia B) are deficient.
  • Symptoms: Uncontrolled bleeding, easy bruising, prolonged bleeding time.
  • Treatment involves factor infusions

Thrombocytopenia

  • Low platelet count
  • Causes: Reduced platelet production, increased platelet destruction, or splenic sequestration.
  • Symptoms: Small red or purple spots on skin, easy bruising, prolonged bleeding, nosebleeds, heavy menstrual bleeding.
  • Treatment: Careful monitoring, corticosteroids, platelet transfusions.

General Assessment and Management of Patients With Hematologic Disorders

  • Thorough assessment and detailed history, vital signs, focused physical examination.
  • Patient should be evaluated for specific conditions like bruising, jaundice, and edema.
  • Determining the urgency of emergency transport.

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Description

This quiz covers the key concepts of emergencies related to hematological disorders. It includes essential information about blood physiology, components, and the assessment and management of patients suffering from these conditions. Test your knowledge on the pathophysiology and signs/symptoms of various blood disorders.

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