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Chapter 7
Blood and Blood-Forming Organs Diseases and Disorders
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Anatomy and Physiology
• Hematologic system
• Major functions of blood:– Transport nutrients to cells
– Aid removal of wastes
• Average adult has 5 to 6 liters of circulating blood
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Blood Components
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Anatomy and Physiology
• Erythrocytes– Normal count:
• 4.2 to 6.3 million
– Life span:• 120 days
– Form in bone marrow and do not reproduce
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Anatomy and Physiology
• Hemoglobin important in oxygen transport
• Normal hemoglobin:– Male
• 13.5 to 18 hemoglobin in grams (gm)/100 milliliter (ml)
– Female• 12 to 16 gm/100ml
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Anatomy and Physiology
• Leukocytes protect individual from infection– Normal count:
• 4,500 to 11,000
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Anatomy and Physiology
• Platelets– Also known as thrombocytes
– Important in blood clotting
– Normal count:• 150,000 to 350,000
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Anatomy and Physiology
• Blood-forming organs:– Lymph nodes
– Bone marrow
– Spleen
– Liver
• Lymph system protects against pathogens
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Anatomy and Physiology
• Bone marrow– Major blood cell producer
• Spleen produces lymphocytes, plasma cells, and antibodies to filter microorganisms from blood
• Liver produces prothrombin and fibrinogen for blood clotting
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Animation
Click Here to Play Blood Animation
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Common Signs and Symptoms
• Erythrocytopenia– Decrease in RBCs leading to anemia
– Symptoms:• Fatigue
• Headache
• Low RBCs
• Pallor
• Shortness of breath
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Common Signs and Symptoms
• Erythrocytosis– Increased RBCs
– Symptoms:• High RBCs
• Reddened skin tones
• Bloodshot eyes
• Increased blood volume and pressure
• Increased blood volume of heart
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Common Signs and Symptoms
• Leukocytopenia– Decreased white blood cells
– Weakens immune system
• Leukocytosis– Increased white blood cells
– Normal response to acute infections
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Common Signs and Symptoms
• Thrombocytopenia– Decreased platelet count leading to coagulation problem
– Symptoms:• Petechiae
– Small hemorrhages in skin
• Ecchymoses– Large areas of bruising or hemorrhage
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Common Signs and Symptoms
• Thrombocytopenia– Symptoms:
• Epistaxis– Nosebleeds
• Bleeding in mouth, gums, and mucous membranes
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Common Signs and Symptoms
• Thrombocytosis– Increase in platelets
– Uncommon
– Usually no serious side effects
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Diagnostic Tests
• Complete blood count with differential and indices
• Biopsy of blood-forming organs
• Hematocrit (Hct) reflects amount of red cell mass as proportion of whole blood
• Hemoglobin (Hgb) reflects blood’s oxygen-carrying potential
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Diagnostic Tests
• Bleeding time determines platelet disorders– E.g., hemophilia, thrombocytopenia, disseminated
intravascular coagulation
• Prothrombin time (PT) and partial prothrombin time (PTT) measure blood’s ability to clot
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Diagnostic Tests
• Biopsy– Bone marrow
– Lymph node
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Disorders of Red Blood Cells
• Anemia– Decrease in oxygen-carrying ability of RBC
– Symptoms:• Pallor
• Fatigue
• Shortness of breath
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Disorders of Red Blood Cells
• Anemia– Symptoms:
• Tachycardia
• Headache
• Irritability
• Syncope
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Disorders of Red Blood Cells
• Iron deficiency anemia– Loss of iron or inadequate intake of iron
– Causes:• Blood loss
• Low dietary intake
– Treatment:• Increase dietary intake of iron
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Disorders of Red Blood Cells
• Folic acid deficiency anemia– Folic acid needed for maturation of RBCs
– Causes:• Poor diet
• Overcooking of vegetables
• Over consumption of alcohol
– Treatment:• Increase folic acid intake by eating green and yellow vegetables
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Disorders of Red Blood Cells
• Pernicious anemia– Lack of intrinsic factor leading to inadequate absorption of
vitamin B12
– Treatment:• Monthly injections of vitamin B12 for life
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Disorders of Red Blood Cells
• Hemolytic anemia– Destruction of RBCs related to antibody-antigen reaction
– Disorder of immune system leading to destruction of erythrocytes
– Treatment:• Exchange transfusion and/or splenectomy
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Disorders of Red Blood Cells
• Sickle cell anemia– Hereditary
– Found in African American race
– Abnormal sickle shape of erythrocyte• Does not allow cell to travel smoothly through vessels
– Symptomatic treatment
– No cure
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Disorders of Red Blood Cells
• Aplastic anemia– Failure of bone marrow to produce blood components
– Causes:• Chemotherapy
• Radiation
• Viruses
• Toxins
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Disorders of Red Blood Cells
• Aplastic anemia– Treatment:
• Avoid causative agent
• Bone marrow transplantation
• Transfusions
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Disorders of Red Blood Cells
• Polycythemia– Too many blood cells
– Symptoms:• Enlarged spleen
• Reddened mucous membranes
• Bloodshot eyes
• Deep red color on palms
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Disorders of Red Blood Cells
• Polycythemia– Treatment:
• Donate blood at regular intervals to reduce blood volume
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Disorders of White Blood Cells
• Mononucleosis– Also known as kissing disease
– Symptoms:• Fatigue
• Sore throat
• Swollen glands
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Disorders of White Blood Cells
• Mononucleosis– Diagnosis by increased monocytes in white blood cells
(WBCs)
– Treatment:• Rest
• Analgesics
• Throat gargles
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Disorders of White Blood Cells
• Leukemia– Malignant neoplasm of blood-forming organs
– Abnormal production of immature leukocytes
– May be acute or chronic
– Acute forms affect children, progress rapidly, and may be fatal
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Disorders of White Blood Cells
• Leukemia– Chronic forms affect older adults, are often asymptomatic,
and may not be fatal
– Classified as:• Myelogenous
– Affecting bone marrow
• Lymphocytic– Affecting lymph nodes
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Disorders of White Blood Cells
• Leukemia– Diagnosis by bone marrow biopsy
– Symptoms:• Fatigue
• Headache
• Sore throat
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Disorders of White Blood Cells
• Leukemia– Symptoms:
• Dyspnea bleeding of mucous membranes of mouth and gastrointestinal (GI) system
• Bone and joint pain
• Enlargement of lymph nodes, liver, and spleen
– Infections common
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Disorders of White Blood Cells
• Leukemia– Treatment:
• Aggressive chemotherapy
• Once in remission, bone marrow transplant to replace neoplastic tissue with normal tissue
• Remission at 50 percent
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Disorders of White Blood Cells
• Hodgkin’s disease– Most common lymphoma
– Symptoms:• Painless enlargement of lymph nodes in neck
• Weight loss
• Fever
– Primarily affects young adults• Average age of 35
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Disorders of White Blood Cells
• Hodgkin’s disease– Cause thought to be viral
– Diagnosis by presence of Reed-Sternberg cell in lymphatic tissue
– Treatment:• Radiation
• Chemotherapy
– If in remission for five years or more, complete cure possible
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Disorders of White Blood Cells
• Non-Hodgkin’s lymphoma (NHL)– Lymphomas lacking Reed-Sternberg cell
– Symptoms:• Painless enlargement of lymph nodes of neck, axilla, and inguinal
areas
• Fever
• Night sweats
• Weight loss
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Disorders of White Blood Cells
• Multiple myeloma– Malignant neoplasm of plasma cells or B-lymphocytes
– Increases with age• Peaks in 70s
– Plasma cells multiply abnormally in bone marrow• Causes weakness
• Leads to fractures and bone pain
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Multiple Myeloma
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Disorders of White Blood Cells
• Multiple myeloma– Diagnosis by honeycombed bone pattern, hypercalcemia,
Bence-Jones protein found in blood and urine, and bone marrow biopsy
– Treatment:• Chemotherapy
• Radiation
• Not effective– Poor prognosis
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Disorders of Platelets
• Hemophilia– X-linked hereditary bleeding disorder
– Several types• Type A
– Most common
– Male children from asymptomatic mothers
– Lack protein necessary for clot formation
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Disorders of Platelets
• Hemophilia– Symptoms:
• Epistaxis
• Bruising
• Prolonged bleeding
– Diagnosis by blood test
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Disorders of Platelets
• Hemophilia– Treatment:
• Prevention of injury
• Treat symptoms
• Blood transfusions
• Concentrated form of clotting protein
– No cure
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Disorders of Platelets
• Thrombocytopenia– Also known as thrombocytopenia purpura
– Decrease in platelets leading to inability to normally clot blood
– Symptoms:• Abnormal bleeding in skin, mucous membranes, and internal
organs
• Petechiae
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Disorders of Platelets
• Thrombocytopenia– Symptoms:
• Ecchymoses
• GI hemorrhages
• Epistaxis
• Hematuria
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Disorders of Platelets
• Thrombocytopenia– Diagnosis by platelet count and bleeding time
– Treatment:• Avoid tissue trauma to reduce bleeding
• Vitamin K
• Transfusions of platelets
• Splenectomy
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Disorders of Platelets
• Disseminated intravascular coagulation (DIC)– Abnormal clotting followed by abnormal bleeding
– Usually follows major trauma• E.g., complicated childbirth, surgery, tissue destruction,
septicemia, snakebite, shock
– Multiple clots in capillaries
– Life-threatening
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Disorders of Platelets
• DIC– Symptoms:
• Petechiae
• Ecchymosis
• Hematoma
• Hematuria
• GI bleeding
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Disorders of Platelets
• DIC– Symptoms:
• Hematemesis
• Blood in stool
– Treatment:• Heparin
• Platelets
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Disorders of Platelets
• Rare diseases– Thalassemia
• Primarily affects people of Mediterranean descent
• Fragile, thin RBCs form defective hemoglobin
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Disorders of Platelets
• Rare diseases– von Willebrand’s disease
• Hereditary
• Congenital
• Deficiency in clotting factor and platelet function
• Also known as angiohemophilia
• Affects females and males
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Effects of Aging
• Age-related changes in other systems (e.g., immune, digestive) leave older adults more susceptible to infections and nutritionally related blood disorders
• Decreased iron
• Poor nutrition