in neutrophils < 1500 cells/uL agranulocytosis-severe- <200 cells/uL “shift to the left”-immature neutrophils o thrombocytopenia- in platelets normal=150,000-450,000 neutropenia o in neutrophils o occurs rapidly-neutrophil lives only 1 day o Pathophysiology use of neutrophils-inflam and infection rx induced wipes out bone marrow production of stem cells dose of rx-thorazine (tranquilizer), sulfonamides, dilantin (long term seizure tx) neoplasms-cause CA cells to replace bone marrow stem cells, leukemias and lymphomas o S&S Malaise Chills and fever Weakness to extreme fatigue Ulcerations of mouth, skin, vagina, GI tract o Dx Leucopenia- WBCs- <1000/uL, severe-200-300/uL Neutropenia o Complications Infections (neutrophils important in inflam response) Pt susceptible to “common” organisms on skin, GI tract Resp tract is target area Septicemia-can be fatal o Tx Antibiotics Hematopoietic growth factors Purpose to stimulate growth of stem cells to mature
CSF-colony stimulating factors-interleukin and interferon Leukemias o Pathophysiology Malignant CA cells take over in cell division and differentiation of the stem cell in bone marrow-production of abnormal cells Abnormal cell production effects lymphocytes and myelocytes Abnormal cells have life span and proliferation o Acute leukemias ALL-acute lymphocytic leukemia AML-acute myelocytic leukemia o Chronic leukemias CLL=chronic lymphocytic leukemia CML-chronic myelocytic leukemia o Causes Unknown Genetics Identical twins-show rate of leukemia Fraternal twins-show rate Environment Ionizing radiation-sun, nuclear exposure o S&S Pallor Malaise to fatigue Fever Bleeding-petechiae, ecchymosis, gingival bleeding, epitaxis Weight loss Lymphadenopathy-nodes, spleen, liver (abnormal) CNS, HA, N&V, seizures, coma o Dx HgB, Hct, WBCs PT (prothrombin time) and PTT (partial thromboplastin time)-measures clotting speed uric acid (hyperuricemia)-due to cell breakdown and chemo Bone biopsy-from hip, breast bone-cells are absent-bone is like a honey comb Hematologic Hemoglobin o O2 binds with and releases to cells o Picks up CO2 and H+ and releases in lungs
RBCs o Deficiency=anemia o Factors leading to anemia Drugs, toxins Congenital or acquired defects that cause bone marrow to stop producing RBCs o Vit or min deficiencies B12-pernicious anemia Iron, folic acid o Excessive or chronic blood loss o Chronic illness (renal dz, CA, chronic infections) o Plasma volume-excess RBCs-polycythemia Leukocytosis o in WBCs Leukopenia o Deficiency of WBCs o Causes HIV, infection, stress, chemo, leukemia Thrombocytosis o Excess of circulating platelets (>400,000) o Both hemorrhage and thrombosis may occur o Paradox occurs because accelerated clotting results in generalized activation of prothrombin
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- Fall '08
- l. vent