NURS 8022 Advanced Pathophysiology (Hematology) /Nurs 8022 Exam 2 Study Guide

NURS 8022 Advanced Pathophysiology Exam 2 Study Guide
MODULE 3: Hematology
Readings: Ch. 27-29; article – interpretation of iron studies

Blood NOT ON STUDY GUIDE
 Volume: 6 quarts or 5.5 L
 Consists of fluid, cells, and protein
o Electrolytes and proteins maintain the osmolarity and acid-base balance of the blood
 Functions:
o Provide nutrition to cells; provide O2 for cellular metabolism; removes by-products of
cellular metabolism; carries cells that protect the body against infection and invading
organisms
 Plasma
o Solution of protein and inorganic materials
o 92% water, 8% dissolved solutes – 50-55% of blood volume
o Contains plasma proteins which are mainly synthesized in the liver – primary element of plasma
 Albumins: function as carriers; control plasma oncotic pressure in blood/capillaries; “protein
pressure”; regulate fluids and solutes through circulation; very large – not easily passed
through microvasculature which is how the maintain oncotic pressure
 Globulins will discuss in immunity lecture
 Clotting factors: mainly fibrinogen – precursor to fibrin clot
 Lipoproteins: triglycerides; cholesterol; and fatty acids
o Also contains several charged ions that regulate cell function, osmotic pressure, and blood pH
 Serum
o Plasma that has been allowed to clot in the lab in order to remove fibrinogen and other clotting factors
 May interfere with some diagnostic tests




Pluripotent cells NOT ON STUDY GUIDE
 “precursor cells” - in the bone marrow that differentiate into major blood cells
o Red cells: erythrocytes
o White cells: leukocytes
o Platelets: thrombocytes

,  Erythrocytes
o Most abundant cells of the blood
o Responsible for tissue oxygenation
o Contain hemoglobin; carry gases and electrolytes
o Have limited life span – 120-day life cycle
 No mitotic division
 Can be removed from circulation by spleen and replaced with new
o Biconcavity: function/efficient shape that allows gas diffusion and ability to change shape
o Reversible deformity: enables torpedo shape to squeeze through microcirculation & return to normal
 Leukocytes
o Defend the body against infection and remove debris (dead and damaged cells)
o Classified by structure and function
 Granulocytes and agranulocytes – will discuss in immune lecture
 Thrombocytes
o 150,000-400,000/mm3 = normal
o Irregularly shaped cytoplasmic fragments; formed by fragmentation of megakaryocytes
o Essential for blood coagulation and the control of bleeding
o Incapable of mitotic division – no nucleus or DNA; limited life span – 5-9 days & removed by spleen
o Granules are proinflammatory – released when there is vessel injury – ATP, ADP, calcium, serotonin,
histamine
o Produced in bone marrow – stored in spleen – slowly released
Lymphoid Organs NOT ON STUDY GUIDE

 Sites of residence, proliferation, differentiation, and function of lymphocytes and mononuclear phagocytes
 Link to hematologic and immune systems
 Primary lymphoid organs:
o Thymus, bone marrow
 Secondary lymphoid organs: spleen, lymph nodes, tonsils, peyer patches of the small intestine
 Spleen
o Largest secondary lymphoid organ
o Functions: fetal hematopoiesis, filters and cleanses the blood, mounts an immune response
to bloodborne microorganisms, serves as a blood reservoir
 Lymph nodes
o Site of the development or activity of lymphocytes, monocytes, and macrophages
o Structurally part of lymphatic system
o Functionally part of the immune and hematologic systems
Understand the basic physiology of hematopoiesis, erythropoiesis, and what erythropoietin is and what it does
 Hematopoiesis: process of blood cell production in adult bone marrow or the liver and/or spleen of the fetus
o Two stages
 Mitosis (proliferation)
 Maturation (differentiation)
o Act on pluripotent cells
o Bone marrow: “myeloid tissue” - primary site of hematopoietic stem cells
 Red marrow (produces RBCs) yellow marrow (does not produce RBCs)
 Active bone marrow sites: pelvic bones, vertebrae, cranium, mandible, sternum, ribs,
humerus, femur
o Process
 STEM CELL POOL contains: hematopoietic stem cell – progenitor cell
 BONE MARROW POOL contains: proliferating and maturing cells and storage for those cells
as they prepare for release

,  PERIPHERAL BLOOD: granulocytes 50% storage/50% functional – thrombocytes 30%
storage/70% functional – erythrocyte 0% storage/100% functional




o Factors that increase hematopoiesis
 Conversion of yellow bone marrow, which does not produce blood cells, to hematopoietic
red marrow by actions of erythropoietin
 Faster differentiation of progenitor cells
 Faster proliferation of stem cells into progenitor cells
 Erythropoiesis: development of RBCs
o Derived from erythroblasts
o Maturation stimulated by erythropoietin
 Stimulates stem cells to form proerythroblasts, which are committed into producing erythroid
cells – promotes release of reticulocytes
o Sequence
 In each step, the quantity of hemoglobin increases and the nucleus decreases in size




o Erythropoietin: hormone released from the kidney in response to low renal oxygenation
 NOT the # of RBCs but rather oxygen delivery
 Produced in the peritubular interstitial cells of the kidney - only 10% produced in the liver
 The RBC production increases within 24 hours; life span 4-12 hours; increased RBC # in 5 days
 EPO is always present in the plasma
 Give to dialysis and chemo patients
o Reticulocytes
 Last immature form of erythroblast
 Contains polyribosomes (globin synthesis) and mitochondria (heme synthesis)
 24-48 hours after leaving bone marrow for circulation, matures into erythrocyte
 Loses polyribosomes and mitochondria