ALU201_Ch12.pdf

HEMATOLOGICAL DISORDERS Introduction plasma maintain hemostasis. Plasma and cellular components exchanging elements result in a dynamic equilibrium. producing sixteen mature red blood cells (erythrocytes). As the cell nears maturity, it extrudes its nucleus, and it is released into the peripheral ci...

HEMATOLOGICAL DISORDERS Introduction plasma maintain hemostasis. Plasma and cellular components exchanging elements result in a dynamic equilibrium. producing sixteen mature red blood cells (erythrocytes). As the cell nears maturity, it extrudes its nucleus, and it is released into the peripheral circulation. The newly released cell is called a Page 361 ALU 201: Intermediate Medical Life Insurance Writing reticulocyte. A normal mature red blood cell is a biconcave disk saturated with hemoglobin. This organ systems without damage to the cell. erythropoietin, which is produced in the kidney. When oxygen transport to the tissues is impaired, erythropoietin activity is increased. This causes stem cells to commit to the red blood cell line as has the capacity to adjust its red blood cell production to ten or more times the normal rate. and carbon dioxide reversibly. In the lung, where oxygen tension is high, hemoglobin is 95% saturated with oxygen. In the tissues, where oxygen tension is low, the oxygen dissociates readily. by the spleen. Following phagocytosis, the hemoglobin molecule is broken down into iron, to treatment, prognosis, and recovery. The CBC is used as a diagnostic tool in the emergency prognosis can be directly related to the corresponding blood counts. The CBC is also used as a CBC, it is not necessarily to diagnose anemia. Page 362 1. white blood cell count (WBC) 2. 3. 4. 5. 6. 1. 2. red blood cell morphology. White Blood Cell Count 1. 2. physical stimuli such as heat, cold, pain, surgery, malignancies, and drug reactions 3. emotional stimuli such as stress. 1. a decrease in red blood cell production or reduction in hemoglobin level 2. an increase in red blood cell destruction 3. 4. actual blood loss. Increased red blood cell counts are seen in polycythemia. Anemia and polycythemia will be covered in more detail later in this chapter. Page 363 ALU 201: Intermediate Medical Life Insurance Writing hyperthyroidism, liver cirrhosis, severe hemorrhage, hemolytic reactions, and cancer. Increased are again seen in anemia. Increased values, as with red blood cell counts and hemoglobin, are seen content (i.e., normochromic, hypochromic). Traditionally, these quantities have been used as a subjective impressions with objective quantitative standards. macrocytes in a blood sample with a normal MCV. This occurs because the MCV is a calculated hemoglobin concentration can indicate spherocytosis, in which the red cell is shaped like a sphere rather than the normal biconcave disk. Page 364 Platelet Count later in this chapter. WBC MCV lymphocytes, monocytes, eosinophils, basophils) and any abnormal cells is noted as a percentage. or conditions. White blood cell disorders will be covered later in this chapter. Page 365 ALU 201: Intermediate Medical Life Insurance Writing been obtainable with a complete hematological examination. larger than eight microns are macrocytes. Anisocytosis is the term used to describe an abnormal moderate, or marked. Interpreting the CBC 1. 2. 3. been resolved. 4. whether a diagnosis has been made – medical records should be checked. 5. whether there is a pattern to the results over time – All CBC results should be organized be getting lower with each test. Using the CBC with Anemias With an anemia, the CBC numbers should be analyzed using only the hemoglobin, MCV, and hypochromic. Page 366 1. 2. 3. Elevated MCV can also be due to excess alcohol intake. diagnosis and correct underwriting action. 1. 2. 3. 4. 5. 6. age sex racial and geographic derivation occupations aspiration and examination. Page 367 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. 3. 1. 2. 3. anemia due to increased destruction (hemolytic anemia, sickle cell, thalassemia). Anemia due to blood loss is a common clinical experience. Blood loss anemia can be due to acute blood loss or chronic blood loss, and the blood loss can be internal or external. Acute blood loss integrity. Severe blood loss due to hemorrhage will acutely decrease total blood volume to the normocytic, normochromic anemia. ruptured aortic aneurysm, trauma resulting in spleen rupture, and bleeding associated with hemophilia. process, the individual can recover by increased red blood cell production in the bone marrow mortality risk. When blood loss is due to a disease process, the underwriter must assess based on the appropriate cause. Page 368 blood loss due to ulcer, esophageal varices, carcinoma, menstrual bleeding, hemorrhoids, or 1. Storage iron is decreased or absent while serum iron levels and hemoglobin and hematocrit levels are normal. This is called iron depletion. 2. 3. hematocrit occurs. hematocrit readings may be reduced, but not necessarily to an anemic level. Without serial testing smear and the red blood indices would mimic an acute blood loss with a normocytic, normochromic picture. ulcerative colitis or esophageal varices, which can arise at any age, have the potential to cause blood loss that could cause anemia. Page 369 ALU 201: Intermediate Medical Life Insurance Writing can be monitored with the reticulocyte count. A lack of vitamin B12 or bowel disorders such as Crohn’s disease. Pernicious anemia is an autoimmune disorder that A disorders. Aplastic anemia Page 370 can be due to diet, malabsorption, or inadequate utilization due to aplastic anemia include arsenic, DDT, and anticonvulsive drugs. Aplastic anemia presents with pancytopenia, a hypocellular bone marrow, and no abnormal cells in the peripheral blood. Pure red cell aplasia is a similar disorder except that only the red blood cell precursors are syndrome. Pure red cell aplasia can be caused by the same or similar toxic substances as those causing aplastic anemia. It can also be seen with lupus erythematosus, chronic lymphocytic possible bone marrow transplantation. occur extravascularly in the spleen, liver, or bone marrow, or intravascularly in the circulatory system. can be present due to excess red blood cell destruction. Splenectomy is the most common treatment Page 371 ALU 201: Intermediate Medical Life Insurance Writing apparent in young children. Children who have had a splenectomy present a higher mortality risk Sickle Cell Disease population. Individuals are in reasonably good health until a crisis occurs. When oxygen is reduced, sickle shape that is unable to pass through the capillary system. This results in blood vessels trauma and are readily destroyed in the spleen. present extra risk provided they have not experienced any crises. This diagnosis can be determined adults present the greatest risk due to numerous complications and a high mortality rate. Mortality both parents have the trait. Page 372 Thalassemia called thalassemia major thalassemia minor. with sickle cell anemia where the homozygous disorder is severe, and the heterozygous disorder is chains. Beta thalassemia major hemolytic anemia, jaundice, and splenomegaly that become evident in childhood. Conditions can Beta thalassemia minor, Polycythemia Vera acute granulocytic leukemia. There is an absolute increase in the peripheral red blood cell count, the hemoglobin, and the hematocrit, as well as an increase in red blood mass and the viscosity (i.e., phlebotomy). Page 373 ALU 201: Intermediate Medical Life Insurance Writing Secondary Polycythemia in the lung increases erythropoietin production and subsequent red blood cell production. This hypoxia can be caused by respiratory disorders such as emphysema or chronic bronchitis, or by high altitude. Decreased alveolar oxygen tension results in incomplete arterial oxygen saturation. disorder, certain renal and neoplastic disorders, and testosterone administration can also cause secondary polycythemia. Testosterone replacement therapy creates a polycythemia response in This can be seen with excessive vomiting, diarrhea, severe burns, stress, or exercise. The increased Drug reactions can increase or decrease the erythrocyte count. Smokers can also exhibit an elevated White Blood Cell Disorders substances. neutrophils, and segs. As the neutrophil precursors mature, the nucleus undergoes several changes cell gives rise to the name segmented neutrophils. The phase just prior to segmentation is called a Page 374 Eosinophils edema, and urticaria will precipitate an eosinophilic response. An eosinophilic response pushes the Basophils circulating leukocytes. The basophil contains heparin and histamine and appears in allergic states, Most circulating lymphocytes are either T lymphocytes or B lymphocytes. They cannot be antibodies. In other words, the lymphocyte count is increased due to a decrease in neutrophils. This is termed relative lymphocytosis. Absolute lymphocytosis is present with certain bacterial Page 375 ALU 201: Intermediate Medical Life Insurance Writing their own. Monocytes lymphoma, and monocytic or granulocytic leukemia. blood cell production results in anemia, reduced platelet production will lead to bleeding disorders, to other organs including the brain, spinal cord, lungs, heart, liver, spleen, and kidneys. 1. acute lymphocytic leukemia – Acute lymphocytic leukemia is most common in children and is the most curable. 2. tissues. This leukemia has a middle age to elderly onset with males twice as likely to be Page 376 3. acute myelogenous leukemia – Acute myelocytic (myelogenous) leukemia is characterized complete remission with remission being inversely related to age. 4. a gradual onset at older ages and is not curable with conventional chemotherapy. Platelets and Blood Coagulation Platelet Disorders numerous clinical situations. Cancer, chronic myelogenous leukemia, polycythemia vera, acute Decreased platelet counts (thrombocytopenia) are seen in idiopathic thrombocytopenic purpura ) and heparin. Alcohol ® antiplatelet agent to prevent thrombosis in heart patients. Page 377 ALU 201: Intermediate Medical Life Insurance Writing time, small pinpoint bruises on the skin (petechiae), or larger bruises (ecchymoses). Individuals hematuria, vaginal bleeding, nosebleeds, and bleeding gums. There are several common laboratory tests that can be used to monitor anticoagulant therapy used medically include heparin and Coumadin®. Coumadin® ® ® and Eliquis® Coagulation Disorders 1. 2. 3. the disease process develops predominantly in males. Page 378 therapy Von Willebrand’s Disease transmitted as an autosomal trait and characterized by a prolonged bleeding time. Von Willebrand’s postpartum bleeding being the most common symptoms. emboli, and spontaneous abortions. in the legs. These conditions are treated with aspirin or an anticoagulant such as Coumadin®, ® , or Eliquis® to eliminate recurrent deep vein thrombosis. Seen in viral response Page 379 ALU 201: Intermediate Medical Life Insurance Writing Increased levels = Polycythemia Polycythemia vera Secondary polycythemia From dehydration or smokers Decreased levels = Anemia Thalassemia Cancer, leukemia Dietary Decreased levels with MCV elevated Pernicious anemia Alcoholism Decreased levels with MCV decreased Decreased levels with MCV normal Acute blood loss Aplastic anemia Chronic disease Increased levels = Thrombocytosis Cancer, leukemia Polycythemia vera Following splenectomy Strenuous physical activity Decreased levels = Thrombocytopenia Anemias Cancer therapy or drug toxicity Page 380