Saturday, March 12, 2011

Hematologic and Immune System

  • Serum Magnesium if less than 1.5mEq/l confirms hypomagnesemia; if greater than 2.5 mEq/l confirms hypermagnesemia.
  • CD4=T cell count less than 200 cells/ul indicative of AIDS
  • Serum ionized calcium leve less than 4.5 mEq/L confirms hypocalcemia; if greater than 5.5 confirms hypercalcemia
  • Serum chloride level less than 98mEq/L confirms hypochloremia
    • supportive values with metabolic alkalosis include a serum pH greater than 7.45 and a serum carbon dioxide level greater than 32 mEq/L
  • Serum chloride level greater than 108 mEq/L confirms hyperchloremia
    • supportive values with metabolic acidosios include a serum pH less than 7.35 and a serum carbon dioxide level less than 22 mEq/L
  • Serum Phosphorus level less than 1.7 mEq/L (or 2.5 mg/dl) confirms hypophosphatemia, urine phosphorus level more than 1.3 g/24/hrs supports this
  • Serum Phosphorus level greater than 2.6 mEq/L (or 4.5 mg/dl) confirms hyperphosphatemia, urine phosphorus level less than 0.9 g/24/hrs supports this
  • Sodium - hyponatremia less than 135 mEq/;L hypernatremia greater than 145 mEq/L

  • Disseminated Intravascular Coagulation - PT greater than 15 seconds; PTT greater than 60 to 80 seconds; fibrinogen levels less than 150 mg/sl; platelets less than 100,000; fibrin degradation products typically greater than 100 mcg/ml; and a positive D-dimer test specific for DIC
  • Hemophilia Factor VIII assay reveals 0% to 25% of normal factor VIII (hemophilia A)
    • hemophilia B factor IX assay shows deficiency in addition to baseline coagulation results similar to that of A
  • Idiopathic Thrombocytopenic Purpura (ITP)  platelet count is less than 20,000/ul; prolonged bleeding time
  • Iron Deficiency Anemia decreased Hb, HCT, iron, ferritin, reticulocytes, red cell indices, transferring and saturation; absent hemosiderin, and increased iron biding capacity.
  • Aplastic Anemia - bone marrow biopsy shows fatty marrow with reduction of stem cells, Fecal occult blood test is positive, decreased granulocytes, thromobocytes, and RBCs, hematuria
  • Pernicious Anemia - from vitamin B mal-absorption
  • Polycythemia vera - chronic myeloproliferateve disorder characterized by increased RBC mass, leukocytosis, thrombocytosis and increased Hb, common with jewish males age 40 - 60
  • Rheumatoid Arthritis -  antibodies attack the synnovium of the joint , then the articular cartilage and surrounding tendons and ligaments. ANA positive, elevated ESR, WBC, platelets and anemia, Rheumatoid factor test is positive
  • Scleroderma - connective tissue disease, more women 30 -50 elevated ESR, positive rheumatoid factor 25% - 35% of the time, positive antinuclear antibody test. CXR - bilateral basilar pulmonary fibrosis, UA - proteinuria, microscopic hematuria, and casts
  • Sickle Cell Anemia - congenital hematologic disease, inherited
  • Systemic lupus erythematosus (SLE) - ANA test positive, decreased HB, HCT, WBC and platelets and an increased ESR, rheumatoid factor is positive, UA - proteinuria and heaturia. Lupus Erythematosus cell positive
  • Vasculitis - inflammation and necrosis of blood vessels
    • Wegener's Granulomatosis - affects medium to large vessels of upper and lower respiratory tract and kidney
      • positive leukocytosis, elevated ESR, IgA, IgG; low titer rheumatoid factor; tissue biopsy shows narcotizing vasculitis with granulomatous inflammation
    • Temporal arteritis - affects medium to large arteries, most connonly branches of th ecarotid artery
      • decreased Hb and elevated ESR, tissue biopsy shows panarteritis with infiltration of mononucliar cells, giant cells within vessel wall, fragmentation of internal elastic lamina and proliferation of intima
    • Takayasu's arteritis - AKA aortic arch syndrome 
      • decreased HB, leukocytosis, positive lupus erythematosus cell preparation and elevated ESR; Arteriography shows calcification and obstruction of affected vessels; tissue biopsy shows inflammation of adventita and intima of vessels and thickening of vessel wall
PLATE = key blood components:
Plasma - liquid portion - water, protein (albumin and globulin), glucose, and electrolytes
Leucocytes- white blood cells
AB antigens - blood type
Thrombocytes - platelets clotting - contributors
Erythocytes - red blood cells - oxygen carrier

T-Cells -
killer, helper or suppressor
B-Cells -
 responsible for humeral or immunoglobulin-mediated immunity
Immunoglobulin -
Immunoglobulin G (IgG) - major antibacterial and antiviral antibody
Immunoglobulin M (IgM) - first Immunoglobulin produced too large to cross membrane barriers, usually only in vascular system
Immunoglobulin  A (IgA) - mainly found in body secretions, defends against pathogens on body surfaces, especially respiratory and GI tract
Immunoglobulin D (IgD) - in plasma, dominant antibody on surface of B cells mainly an antigen receptor.
Immunoglobulin E (IgE) - antibody involved in immediate hypersensitivity or allergic reactions, stimulates the release of mast cell granules which contain histamine and heparin.

  • Lymphangiography - radiographic picture of lymphatic system -
    • note allergies to iodine, seafood and radiopaque dyes
    • possible throat irritation and flushing after dye
    • NPO
  • After procedure
    • monitor V/S
    • encourage fluids
    • may have blue discolored skin, stool, and urine for about 48 hours
Schilling Test - oral radioactive cyanocobalamin then 24 hour urine (all urine, room temp) for vitamin B 12

Hodgkin's progress - 4 stages
    • Stage I  - single lymph node region or single extralymphatic organ
    • Stage II  - two or more nodes on same side of diaphragm or in an extralymphatic organ
    • Stage III - spreads to both sides of the diaphragm or in an extralymphatic organ, the spleen or both
    • Stage IV -  disease disseminates
*all review material was taken from - NCLEX-RN Review made Incredibly Easy 5th Edition Lippincott, Williams & Wilkins

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