Exam 2: NU 606/ NU606 (Latest 2026/ 2027 Update) Advanced Pathophysiology | Questions & Answers | Grade A | 100% Correct (Verified Solutions)- Regis

GRADED A++ Exam 2: NU 606/ NU606 (Latest 2026/ 2027 Update) Advanced Pathophysiology | Questions & Answers | Grade A | 100% Correct (Verified Solutions)- Regis Q: What is neonatal polycythemia? Answer Excess RBCs in preterm infants. Q: Why do children have higher levels of blood cells? Answer Higher hematopoietic rate closer to birth. Q: What can cause neonatal polycythemia? Answer Placental issues or preeclampsia. Q: What happens to the excess RBCs in neonatal polycythemia? Answer GRADED A++ They are destroyed by the body after birth. Q: What can excess bilirubin from the destruction of RBCs lead to? Answer Jaundice. Q: Why do older adults have a lower BC count? Answer Erythrocytes replenish slower and become more fragile. Q: What can cause iron deficiency in older adults? Answer Lower hemoglobin levels. Q: What happens to T-cell function in older adults? Answer It declines with age. GRADED A++ Q: What can a diminished immune response in older adults lead to? Answer Increased vulnerability to infection. Q: What is platelet adherence? Answer Higher risk for arterial clotting. Q: What are the potential issues associated with platelet adherence? Answer Strokes or heart attacks. Q: What does anemia mean? Answer Lowered total mass of red blood cells or lowered quality/quantity of hemoglobin. Q: What does anemia lead to? Answer GRADED A++ Reduced oxygen-carrying capacity in the blood. Q: What are the symptoms of mild anemia? Answer Signs and symptoms upon exertion. Q: What can severe anemias affect? Answer Multiple body systems and lead to tissue hypoxia. Q: What is Hemoglobin (Hgb)? Answer Protein in RBCs that carries oxygen and CO2. Q: What is Hematocrit (Hct)? Answer Percentage of RBCs in the blood. GRADED A++ Q: What is Reticulocyte count? Answer Count of immature RBCs; indicates new RBC synthesis. Q: What is Mean corpuscular volume (MCV)? Answer Average size and volume of RBCs. Q: What is Plasma iron? Answer Iron in RBCs. Q: What is Total iron-binding capacity (TIBC)? Answer Availability of transferrin for iron binding. Q: What is Ferritin? Answer Iron storage protein. GRADED A++ Q: What is Serum B12? Answer Water-soluble vitamin necessary for erythropoiesis. Q: What is Folate? Answer Water-soluble vitamin necessary for erythropoiesis. Q: What is the function of Hemoglobin (Hgb)? Answer Carries oxygen to organs and tissues, and carries CO2 back to the lungs. Q: What is the function of Hematocrit (Hct)? Answer Indicates the percentage of RBCs in the blood. GRADED A++ Q: What does a low Hemoglobin (Hgb) level indicate? Answer Most anemias. What does a low Hematocrit (Hct) level indicate? Answer Most anemias. What does a low Reticulocyte count indicate? Answer Pernicious anemia, folate deficiency anemia, and iron deficiency anemia. What does a high Reticulocyte count indicate? Answer Hemolytic anemia, including sickle cell anemia, and posthemorrhagic anemia. What does a low Mean corpuscular volume (MCV) indicate? Answer Iron deficiency anemia and sideroblastic anemia. GRADED A++ What does a high Mean corpuscular volume (MCV) indicate? Pernicious anemia and folate deficiency anemia. What does a high Plasma iron level indicate? Pernicious anemia, folate deficiency anemia, sideroblastic anemia, and aplastic anemia. What does a low Plasma iron level indicate? Iron deficiency anemia. What does a high Total iron-binding capacity (TIBC) indicate? Iron deficiency anemia. What does a high Ferritin level indicate? Pernicious anemia, folate deficiency anemia, and sideroblastic anemia. What does a low Ferritin level indicate? Iron deficiency anemia. GRADED A++ What does a low Serum B12 level indicate? Pernicious anemia. What does a low Folate level indicate? Most anemias. What is necessary for DNA and RNA synthesis? Folate What is bilirubin? Yellow-to-green bile pigment in the liver What does high levels of bilirubin cause? Jaundice What is transferrin? Glycoprotein that transports and delivers iron to tissue GRADED A++ What is the cell type associated with microcytic anemias? Abnormally small RBCs What is the cell type associated with macrocytic anemias? Abnormally large RBCs What is the cell type associated with normocytic anemias? RBCs with a normal size What is the cell type associated with hypochromic anemias? RBCs with low hemoglobin What are the categories of anemias based on morphology? Microcytic, macrocytic, normocytic What does the suffix '-cytic' indicate in anemia morphology? Size of the cells GRADED A++ What does the suffix '-chromic' indicate in anemia morphology? Hemoglobin content of the cells What are the two types of macrocytic anemias? B12 deficiency anemia, folate deficiency anemia What is the most common type of microcytic anemia? Iron deficiency anemia What is low in folate deficiency anemia? Folate What is normal in most anemias? Transferrin What is high in hemolytic anemias and sideroblastic anemias? Bilirubin GRADED A++ What is slightly high for pernicious, folate deficiency, and iron deficiency anemias? Bilirubin What is high in sideroblastic anemia? Transferrin What is low in iron deficiency anemia? Transferrin What is slightly low in anemia of chronic disease? Transferrin What are the characteristics of B12 deficiency anemia and folate deficiency anemia? Macrocytic-normochromic, large RBCs, normal Hgb. What are the characteristics of iron deficiency anemia? Microcytic, hypochromic, small RBCs, low Hgb. GRADED A++ What are the three etiological classifications of anemia based on underlying mechanism? Blood loss, increased erythrocyte destruction, deficient erythropoiesis. What are the causes of acute blood loss? Trauma. What are the causes of chronic blood loss? Illness. What are the causes of increased erythrocyte destruction? Anemias with abnormally sized or shaped cells, hemolysis, eryptosis. Can increased erythrocyte destruction be inherited? Yes. Can increased erythrocyte destruction be acquired? Yes. GRADED A++ What are the causes of deficient erythropoiesis? Anemias with bone marrow destruction. Can deficient erythropoiesis be inherited? Yes. Can deficient erythropoiesis be nutritional? Yes. What are the characteristics of acute blood loss? Caused by trauma, can lead to coagulopathy. What is coagulopathy? Impaired coagulation. What is the leading worldwide cause of preventable death after injury? Acute blood loss following trauma. GRADED A++ What percentage of individuals with bleeding trauma also suffer from coagulopathy? One-third. Can an individual recover from acute blood loss? Yes, as long as it is not severe. When is a blood transfusion necessary for acute blood loss? When the blood loss is severe and the bone marrow needs time to replenish the lost blood. What is the condition called when erythrocytes are destroyed more quickly than they can be replaced? Hemolytic anemia. What is B12 deficiency anemia? Anemia caused by a deficiency in vitamin B12. What are the causes of B12 deficiency anemia? Inadequate dietary intake or malabsorption of vitamin B12. GRADED A++ What are the symptoms of B12 deficiency anemia? Fatigue, weakness, shortness of breath, pale skin, and neurological symptoms. How does B12 deficiency lead to anemia? Vitamin B12 is necessary for the production of healthy red blood cells. What is megaloblastic anemia? Anemia characterized by the presence of large, immature red blood cells. How does B12 deficiency cause megaloblastic anemia? B12 deficiency affects DNA synthesis, leading to abnormal red blood cell production. What are the consequences of megaloblastic anemia? Decreased oxygen-carrying capacity and increased destruction of red blood cells. What are the neurological symptoms of B12 deficiency anemia? Numbness, tingling, and difficulty with balance and coordination. GRADED A++ How is B12 deficiency anemia diagnosed? Blood tests to measure B12 levels and evaluate red blood cell morphology. What is the treatment for B12 deficiency anemia? Supplementation with vitamin B12, either orally or by injection. What is folate deficiency anemia? Anemia caused by a deficiency in folic acid (vitamin B9). What are the causes of folate deficiency anemia? Inadequate dietary intake, malabsorption, or increased demand for folate. What are the symptoms of folate deficiency anemia? Similar to B12 deficiency anemia, including fatigue, weakness, and pale skin. How does folate deficiency lead to anemia? Folate is necessary for DNA synthesis and red blood cell production. GRADED A++ What is the difference between B12 deficiency anemia and folate deficiency anemia? B12 deficiency affects neurological function, while folate deficiency does not. How is folate deficiency anemia diagnosed? Blood tests to measure folate levels and evaluate red blood cell morphology. What is the treatment for folate deficiency anemia? Supplementation with folic acid, either orally or by injection. What is iron deficiency anemia? Anemia caused by a deficiency in iron, resulting in low levels of hemoglobin. What are the causes of iron deficiency anemia? Inadequate dietary intake, poor absorption, or increased demand for iron. What is B12 deficiency anemia? Macrocytic, normochromic anemia caused by insufficient vitamin B12 absorption. GRADED A++ What are the key lab values for B12 deficiency anemia? Low hemoglobin, low hematocrit, high plasma iron, low serum B12, normal folate. What is one cause of B12 deficiency anemia? Dietary insufficiency of B12, especially in vegans and vegetarians. What can reduce the production of intrinsic factor (IF) necessary for B12 absorption? Gastric disorders and impairments. What is the most common cause of B12 deficiency anemia? Reduced production of intrinsic factor (IF). What are the risk factors for B12 deficiency anemia? Autoimmune gastritis, diet low in B12, gastric disorder, gastric impairment, medications that trigger gastric issues. What is pernicious anemia? B12 deficiency anemia caused by the inability to produce intrinsic factor. GRADED A++ What are the risk factors for pernicious anemia? Age of 30 or older, autoimmune gastritis, family history of pernicious anemia, gastric disorder, gastric impairment, medications that trigger gastric issues. What is Northern European ancestry? Ancestry originating from Northern Europe. What is the pathophysiology of pernicious anemia? B12 insufficiency leads to autoreactive T cells causing mucosal injury and synthesis of autoantibodies. What is the role of intrinsic factor (IF) in pernicious anemia? IF is produced by gastric parietal cells and is necessary for the transport of B12 across the intestinal mucosa. What is the manifestation of B12 deficiency anemia? Typical signs and symptoms of anemia, with paresthesia (tingling of feet and fingers) as a distinguishing feature. GRADED A++ What are the classic signs and symptoms of anemia? Tachycardia, tachypnea, mucosal pallor, glossitis, hepatomegaly, anorexia, weight loss, nausea, splenomegaly, jaundice, fatigue, weakness, unsteady gait, delirium or dementia, dizziness, paresthesia, loss of proprioception. What is folate deficiency anemia? A macrocytic (megaloblastic), normochromic anemia caused by insufficient folic acid. What are some key lab values for folate deficiency anemia? Low hemoglobin. What is hematocrit? The percentage of red blood cells in the blood. What does a low hematocrit indicate? Anemia or blood loss. What is plasma iron? The amount of iron in the liquid part of the blood. GRADED A++ What does a high plasma iron indicate? Iron overload or hemochromatosis. What is serum B12? The level of vitamin B12 in the blood. What does a normal serum B12 indicate? No deficiency or excess of vitamin B12. What is folate? A vitamin important for DNA and RNA synthesis. What does a low folate indicate? Folate deficiency. What are the risk factors for folate deficiency anemia? Alcoholism, anorexia, chronic malnourishment, diets low in folic acid foods, diets of only cooked food, and pregnancy. GRADED A++ How is folate absorbed? In the upper small intestine, without requiring intrinsic factor. Where is folate stored? In the liver. What can impede folate metabolism? Alcohol. What is the role of folate in DNA synthesis? It is a coenzyme important for the production of thymine, adenine, and guanine. What happens during folate deficiency? Improper DNA synthesis during erythropoiesis, leading to macrocytic (megaloblastic), normochromic RBCs with clumped nuclear chromatin. How does folate deficiency differ from B12 deficiency? Folate deficiency leads to clumped nuclear chromatin, while B12 deficiency leads to dispersed nuclear chromatin. GRADED A++ What are the signs and symptoms of folate deficiency anemia? Cheilosis (severe), stomatitis, ulcers on mucosa and tongue. How is folate deficiency anemia treated? With oral supplementation of folate until blood levels return to normal and symptoms resolve. What is the key distinguishing sign between folate deficiency anemia and B12 deficiency anemia? B12 deficiency anemia causes paresthesia, while folate deficiency anemia does not. What is iron deficiency anemia? Microcytic and hypochromic anemia caused by lack of iron. What are the key lab values for iron deficiency anemia? Low hemoglobin, low hematocrit, low plasma iron, high TIBC, low ferritin. What are the risk factors for iron deficiency anemia? GRADED A++ AFAB adolescents, AFAB individuals of childbearing age, individuals living in poverty, infants on cow's milk, older individuals on restricted diets, teenagers with high-fat, -sugar, and -salt content diets, toddlers. What is the pathophysiology of iron deficiency anemia? Disruption of iron cycle in the body due to dietary deficiency or deficiency in RBCs. What are the stages of iron deficiency anemia? Depletion of iron stores, diminished iron transport to bone marrow, iron-deficient erythropoiesis. What is iron-deficient erythropoiesis? Generation of small, hemoglobin-deficient erythrocytes. What are the characteristics of iron-deficient erythrocytes? Microcytic and hypochromic. At what stage is iron deficiency anemia (IDA) detectable? Stage 3. GRADED A++ What are the early signs and symptoms of IDA? Fatigue, paleness of earlobes, palms, and conjunctivae, shortness of breath, weakness. What are the signs and symptoms of more severe IDA? Brittle, concave fingernails, burning mouth syndrome, difficulty swallowing, gastritis, glossitis, headache. What signs and symptoms may elderly individuals with IDA experience? Disorientation, memory loss, mental confusion. How is IDA treated? Oral iron replacement therapy. When is parenteral iron therapy used for IDA treatment? Poor iron absorption, uncontrolled blood loss, intolerance to oral iron, nonadherence to oral iron regimen. What must be addressed for iron replacement therapy to be effective in IDA caused by blood loss? GRADED A++ The cause of the blood loss. What is the most likely diagnosis for the 49-year-old male patient with fatigue, pallor, and shortness of breath? Iron deficiency anemia secondary to damaged gastric mucosa. What is the other possible diagnosis for the 49-year-old male patient with fatigue, pallor, and shortness of breath? B12 deficiency anemia secondary to chronic blood loss. What is the patient's history that may contribute to the diagnosis? Recent gastric ulcer diagnosis with episodes of melena. What dietary changes has the patient made? Eliminated irritating fried and spicy foods, increasing intake of fruits and vegetables. What additional symptoms does the patient now have? Numbness and tingling in hands and feet. GRADED A++ What laboratory findings support the diagnosis of iron deficiency anemia? Decreased hemoglobin, decreased hematocrit, increased mean corpuscular volume (MCV). What laboratory finding supports the diagnosis of B12 deficiency anemia? Decreased B12 levels. What should be investigated in elderly patients showing signs and symptoms of anemia? The possibility of anemia, not assuming it's a consequence of normal aging. What is the treatment for IDA if oral iron is not suitable? Parenteral iron replacement therapy. What is the importance of investigating anemia in elderly patients? To determine the cause of signs and symptoms, not assuming it's due to normal aging. What is folate deficiency anemia? Anemia caused by a lack of folate in the diet. GRADED A++ What is pernicious anemia? Anemia caused by a loss of intrinsic factor, which is needed for vitamin B12 absorption. What is the rationale behind pernicious anemia? Damage to the gastric mucosa affects the production of intrinsic factor, leading to vitamin B12 deficiency and resulting in macrocytic, normochromic anemia with paresthesia. What is sideroblastic anemia? Anemia caused by a defect in heme synthesis, characterized by ringed sideroblasts and normal to high iron levels. How can sideroblastic anemia be identified? Ringed sideroblasts can be seen under the microscope using Prussian Blue staining of the bone marrow smear. What are normocytic-normochromic anemias? Anemias characterized by normal-sized RBCs with normal hemoglobin content but insufficient oxygen-carrying capacity. What causes acquired hemolytic anemias? GRADED A++ Autoimmune destruction of normal cells. What is aplastic anemia? Anemia caused by bone marrow failure, leading to reduced production of cells in the bone marrow and potentially pancytopenia. What is Fanconi anemia? An aplastic disorder characterized by pancytopenia and malfunctioning DNA repair. What are hereditary hemolytic anemias? Anemias caused by genetic factors, such as sickle cell anemia, where abnormal hemoglobin changes the shape of erythrocytes and leads to hemolysis. What is posthemorrhagic anemia? Anemia caused by acute blood loss, resulting in a normocytic-normochromic anemia with reduced blood volume. What is anemia of chronic disease? Anemia caused by chronic diseases, such as infections, inflammation, or malignancies, leading to decreased production of red blood cells or increased destruction. GRADED A++ What is Anemia of Chronic Disease (ACD)? Mild to moderate anemia in individuals with chronic conditions. What is another name for Anemia of Chronic Disease? Anemia of Inflammation (AI). How does ACD present initially? Normocytic-normochromic, but can become hypochromic-microcytic. Why is it important for clinicians to monitor patients for ACD? It often presents asymptomatically. What are the signs and symptoms of ACD if hemoglobin levels drop sufficiently? Signs and symptoms of iron deficiency anemia (IDA). What is the most common type of anemia? Iron Deficiency Anemia (IDA). GRADED A++ Who is at higher risk for ACD? Individuals over 65, especially those in nursing homes. What is primary defective iron utilization syndrome? ACD-like anemia in elderly individuals without an underlying condition. What are some risk factors for ACD? Autoimmune diseases, cancer, chronic kidney disease, infection, rejected organ transplant. How does ACD diminish erythropoiesis? By increasing erythrocyte destruction, reducing erythropoietin production, weakening bone marrow response to erythropoietin, and impeding iron metabolism. What is acute on chronic anemia? An acute episode of anemia superimposed on a chronic anemia. What findings on the blood smear would confirm the diagnosis of iron deficiency anemia? Microcytic and hypochromic red blood cells GRADED A++ How would you explain the mechanism of iron deficiency anemia to the patient? The chronic blood loss prevented her body from having aged red blood cells to break down and recycle the iron to make hemoglobin for new red blood cells. What is the effect of chronic blood loss on iron absorption? Chronic blood loss prevents the release of iron stores for absorption. What is the consequence of chronic blood loss on red blood cell production? Chronic blood loss impairs the production of new red blood cells. What is leukopenia? Leukopenia is a condition where the body fails to produce enough leukocytes for a proper immune response. What are some causes of leukopenia? Causes of leukopenia include radiation, anaphylactic shock, autoimmune disease, immune deficiencies, and drug exposure to chemotherapeutic agents. GRADED A++ What is the risk associated with leukopenia? Leukopenia compromises the structure of the immune system, leaving a risk for infection. What is leukocytosis? Leukocytosis is a condition characterized by excessive leukocyte production. What are some causes of leukocytosis? Causes of leukocytosis include infection, stress, trauma, and certain types of leukocytes indicating specific causes. What does an increase in immature neutrophils or bands indicate? An increase in immature neutrophils or bands may indicate an active bacterial infection. What is the significance of the left shift in leukocytosis? An increase in bands, also known as a left shift, can indicate a normal protective response to stressors or pathologic conditions. What are some normal protective responses that can cause leukocytosis? GRADED A++ Normal protective responses that can cause leukocytosis include infection, strenuous exercise, emotional changes, temperature changes, anesthesia, surgery, pregnancy, drugs, hormones, and toxins. What are some pathologic conditions that can cause leukocytosis? Pathologic conditions such as malignancies and hematologic disorders can cause leukocytosis. What is hematologic malignancy? Hematologic malignancy occurs when blood-forming tissues over-produce cells throughout the body, resulting in hematologic cancers such as leukemia, lymphoma, and multiple myeloma. What is leukemia? Uncontrolled division of abnormal leukocytes. What causes uncontrolled cell division in leukemia? Mutation in normal cells. What are the types of leukemia? Acute lymphocytic leukemia (ALL), Acute myelogenous leukemia (AML), Chronic lymphocytic leukemia (CLL), Chronic myelogenous leukemia (CML). GRADED A++ What is the difference between chronic and acute leukemia? Chronic leukemia involves accumulation of mature leukocytes, while acute leukemia involves accumulation of immature leukocytes. What are the characteristics of leukemia? Bleeding risk, anemia, and pancytopenia. What is pancytopenia? Deficiency of red blood cells, white blood cells, and platelets. Which type of leukemia is most common in children? Acute lymphocytic leukemia (ALL). Which type of leukemia is most common among adults? Acute myelogenous leukemia (AML). What is the impact of leukemia on the immune system? Leukemia weakens the immune system, making patients vulnerable to infections. GRADED A++ What is the impact of leukemia on the lymphatic system? Leukemia affects the lymphatic system, leading to a proliferation of T and B cells. What is the impact of leukemia on the myeloid stem cell? Leukemia affects the myeloid stem cell, leading to a predominance of neutrophils. What is the incidence of leukemia in children? Leukemia accounts for about 29% of all childhood cancers. Which population has a higher incidence of leukemia? People with Down syndrome. What are the symptoms of leukemia? Bleeding risk, anemia, and pancytopenia. What is the impact of leukemia on bone marrow? Leukemia uses all resources in bone marrow, resulting in pancytopenia. GRADED A++ What is the impact of leukemia on white blood cells? Leukemia produces incompetent white blood cells. What is the impact of leukemia on red blood cells? Leukemia results in a deficiency of red blood cells. What is the impact of leukemia on platelets? Leukemia results in a deficiency of platelets. What is the impact of leukemia on the immune system? Leukemia weakens the immune system, making patients vulnerable to infections. What is the impact of leukemia on the lymphatic system? Leukemia affects the lymphatic system, leading to a proliferation of T and B cells. What is the most common genetic abnormality in CML? Reciprocal translocation between chromosomes 9 and 22 (Philadelphia chromosome) GRADED A++ What percentage of people with CML have the Philadelphia chromosome? 95% Which age group is CML found mostly in? Adults What are the two types of malignant lymphomas? Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) What is Hodgkin lymphoma characterized by? Progression from one group of lymph nodes to another, presence of Reed-Sternberg (RS) cells, and development of systemic symptoms What is the median age of diagnosis for Hodgkin lymphoma? Around 64 years of age At what stages of life does Hodgkin lymphoma peak? Early in life (20's and 30's) and later in life (60's and 70's) GRADED A++ How does non-Hodgkin lymphoma differ from Hodgkin lymphoma? Non-Hodgkin lymphoma has less localization and non-contiguous node involvement, absence of Reed-Sternberg (RS) cells, and can develop from B-cells, T-cells, and NK-cell neoplasms How is non-Hodgkin lymphoma classified? Low, intermediate, or high-grade What is high-grade non-Hodgkin lymphoma associated with? Viral infections and HIV What do AML mutations cause? Disruption in effective production of cells across the myeloid progenitor line What does NHL develop from? B-cells, T-cells, and NK-cell neoplasms How can NHL be classified? Low, intermediate, or high-grade GRADED A++ What does acute lymphocytic leukemia (ALL) affect? The lymphatic system by proliferating immature T and B cells Match the cell, mutation type, or description with the disease: Philadelphia chromosome Chronic myelogenous leukemia Match the cell, mutation type, or description with the disease: Reed Sternberg cells Hodgkin lymphoma Match the cell, mutation type, or description with the disease: Most common leukemia in children Acute lymphocytic leukemia What is Thrombotic Thrombocytopenic Purpura (TTP)? Small clot formation leading to platelet consumption. What causes TTP? Low supply of adamTS13. GRADED A++ What is the role of adamTS13 in normal physiology? Prevents platelets from over-populating. What happens in TTP? Platelets aggregate, causing occlusion of arteries and capillaries. What organs can be affected by TTP? Brain, heart, kidneys, and other organs throughout the vascular system. How common is TTP? Roughly 5 per 1 million people per year. What are the two types of TTP? Familial and acquired idiopathic. What is the difference between familial and acquired TTP? Familial TTP is rarer, seen in children, and has predictable, recurring episodes of bleeding. Acquired TTP is more common, acute, severe, and primarily affects adults. GRADED A++ What is the essential treatment for TTP? Plasma exchange (plasmapheresis). What is Immune Thrombocytopenia Purpura (ITP)? Immune system attacks platelets, leading to bruising and bleeding. What often causes ITP? Viral infection. When does ITP resolve? Once the source of the antigen is resolved. What are the symptoms of ITP? Bleeding gums, nose bleeds (mucocutaneous bleeding), and bleeding under the skin (petechiae, purpura). Is ITP an acquired or inherited disorder? Acquired hematologic disorder. GRADED A++ What are the two types of ITP? Acute and chronic. Who is mostly affected by acute ITP? Children. How long does acute ITP last? About 1 to 2 months with complete remission. What are the characteristics of acute ITP? Destruction of platelets in the spleen, presence of immune complexes bound to Fc receptors on platelets, and presence of antigens from immune complexes with circulating antibodies. What causes acute ITP? Viral infections or other conditions that overpopulate antigens within the blood. What is the variability of chronic ITP? Variable. GRADED A++ What is Heparin-Induced Thrombocytopenia? Adverse reaction to heparin causing low platelet counts. What are the characteristics of HIT Type 1? Platelet levels decrease temporarily, no complications, not life-threatening. What are the characteristics of HIT Type 2? Immune and antibody-mediated, can cause serious reactions, thrombocytopenia and thrombosis. When does HIT Type 1 occur? Within 1 to 2 days after heparin administration. When does HIT Type 2 occur? Within 5 to 14 days after heparin administration. Is HIT Type 1 immune mediated? No, it can develop before the formation of antibodies. GRADED A++ Is HIT Type 2 immune mediated? Yes, it develops after the formation of antibodies. What happens in HIT Type 2? The immune system attacks the heparin-PF4 complex, causing platelet activation. How long can antibodies remain in the system for HIT Type 2? Upwards of 100 days. What complications can occur in HIT Type 2? Deep vein thrombosis, pulmonary embolism, heart attack, stroke. What is another name for HIT Type 2? Heparin-induced thrombocytopenia and thrombosis (HITT). What can happen if a patient with HIT Type 2 is readministered heparin? Thrombocytopenia and thrombosis can occur immediately. GRADED A++ What are the symptoms of HIT Type 2? Heparin-induced skin necrosis, bleeding gums, nose bleeds, bleeding under the skin. What is the gender distribution of TP? More common in women. What happens in pregnant patients with TP? Antiplatelet antibody, IgG, can cross the placenta, causing thrombocytopenia in the infant. What can IT bleeding progress to? Major hemorrhages from mucosal sites. What is the treatment for spontaneous bleeding? Emergency medical treatment. What should be monitored in patients who have received heparin? Low platelet counts. GRADED A++ What are the categories of HIT? Type 1 and Type 2. What is HIT Type 2? An adverse reaction to heparin with platelet activation. What percentage of people treated with heparin are affected by HIT Type 2? 5%. What is the mortality rate of HIT Type 2? 30%. Why is early identification and intervention important for HIT Type 2? Because it is life-threatening. What is the first step in treating HIT Type 2? Stopping the use of heparin immediately. GRADED A++ What can be used as a treatment for HIT Type 2? Non-heparin anticoagulants. How long can non-heparin anticoagulants be used as a treatment for HIT Type 2? 1 to 4 months, depending on the presence of thrombosis. What is the patient's past medical history? Hypertension, type ll diabetes, hypercholesterolemia, and extensive coronary artery disease. What surgery did the patient undergo? Complicated, emergent, open abdominal aortic aneurysm repair. What is the patient currently taking for VT prophylaxis? Enoxaparin. What were the patient's vital signs this morning? BP 126/72, HR 96, R 20, 02 saturation 96% on 4 LPM via nasal cannula, and temperature 36.5° Celsius. GRADED A++ What was the condition of the patient's abdominal incision? Clean, dry, and intact. What were the results of the patient's morning routine labs? Slightly decreased hemoglobin and hematocrit, stable and decreased platelet count that is steadily trending down. What symptoms did the nurse notice during the assessment? New left-sided weakness, facial drooping, and slurred speech. What did the brain CT reveal? An occlusive ischemic stroke. What is the most probable cause for the patient's stroke? Thrombus formation from platelet activation secondary to heparin exposure. What is the rationale for the most probable cause of the patient's stroke? GRADED A++ The patient is at risk for developing heparin-induced thrombocytopenia (HIT) after receiving anticoagulation perioperatively. What is the highest priority treatment for this patient based on your suspected diagnosis? Discontinue all heparin and initiate alternate anticoagulation therapy. Which of the following lab values would confirm your suspected diagnosis? Elevated serum heparin-PF4 antibodies. Based on the patient presentation and lab results, the healthcare team determines that this is a type 2 reaction. What is the rationale for that diagnosis? Type 2 is immune-mediated whereas type 1 is not immune-mediated. Type 1 has a more rapid onset than type 2 with initial heparin exposure. What is Disseminated Intravascular Coagulation? Thrombohemorrhagic syndrome with clotting and bleeding throughout the body. How does DIC manifest? Formation of fibrin clots in medium and small blood vessels. GRADED A++ What are the consequences of clotting in DIC? Organ damage or failure due to blocked blood flow. What can happen due to the overactivation of coagulation in DIC? Severe bleeding due to depletion of clotting factors and platelets. What are the risk factors for DIC? Sepsis, metastatic cancer, acute leukemia, blood transfusions, pregnancy complications, and trauma. What is the most common cause of DIC? Sepsis, with up to 50% of individuals with gram-negative sepsis experiencing DIC. What percentage of individuals with metastatic cancer or acute leukemia develop DIC? 10 to 20%. What is the pathophysiology of DIC? Abnormal, systemic clotting throughout the body instead of localized clotting to specific areas of vascular damage. GRADED A++ What causes DIC? Damage or disorder (e.g., cancer, trauma, sepsis, or injury) to endothelial tissue or activation of the inflammatory cascade. What does tissue factor (TF) do in DIC? TF activates the clotting cascade by binding to clotting factor VII, leading to the conversion of prothrombin to thrombin. What happens to the clotting system in DIC? The clotting system becomes overactive. What happens to platelets and clotting factors in DIC? They are consumed. What happens to blood vessels in DIC? They experience vasodilation. What happens to the levels of anticoagulants in DIC? GRADED A++ They are lowered and cannot regulate the thrombin produced. What happens to fibrinolysis in DIC? It is lowered and cannot regulate the amount of fibrin in use. What are the clinical manifestations of acute DIC? Sudden hemorrhage, bleeding from eyes, mouth, nose, surgical wounds, venipuncture sites, and arterial lines. What are the clinical manifestations of chronic DIC? Subacute bleeding and diffuse thrombosis. How is DIC diagnosed? Combination of clinical presentation consistent with DIC and multiple lab value readings. What lab tests indicate DIC? Procoagulant activation, fibrin degradation, coagulation inhibitor consumption, and organ damage or failure. GRADED A++ What is the platelet count in DIC? Low. What is the fibrinogen level in DIC? Low. What is the PT/INR level in DIC? High. What is the PTT level in DIC? High. What is the D-Dimer level in DIC? High. What can be observed in a peripheral smear in DIC? Schistocytes and helmet cells. GRADED A++ What is the treatment for DIC? Depends on the underlying cause, may include supportive care, blood transfusions, anticoagulants, and treatment of the underlying condition. What is the underlying pathology of DIC? Decreased production of clotting factors from the liver How is thrombosis treated in DIC? Administration of anticoagulant in certain types of DIC What is the goal of treating organ function in DIC? Restore blood volume and organ and tissue perfusion What is DIC? Disseminated intravascular coagulation What are the two options that explain the presentation of a patient with DIC? Consumption of platelets and clotting factors to form microthrombi, Formation of numerous microthrombi causing microvascular occlusion GRADED A++ Why do wounds hemorrhage in DIC? Large thrombi cannot be formed in response to endothelial damage