Hemotalogy Blood Cell Alterations

What is the most common RBC disorder?

Anemia

Anemia

 A deficiency in Number of erythrocytes (RBC’s)

What are the causes of Anemia?

◦Blood loss because of injury or chronic bleeding in GI system

◦Decrease production of RBC’s in bone marrow

◦Not enough nutrients for production

◦Decrease in erythropoetin (needed to stimulate RBC production)

◦Hereditary chromosome abnormalities

◦Destruction of RBC’s (Hemolytic anemia)

Signs and Symptoms of Anemia

◦Shortness of breath

◦Weakness, fatigue

◦Increased HR and RR

◦Pale skin, gums, and nail beds

◦Dizziness and confusion

Normocytic Anemia

Normal size red blood cells

Macrocytic Anemia

Large red blood cells

Microcytic Anemia

Small red blood cells

Anemia in Chronic Kidney Disease

When body low on RBC from normal RBC death, kidneys produce & release hormone erythropoietin (EPO). EPO stimulates the bone marrow to produce more RBC to replenish body.

Kidney failure = decreased EPO=decreased RBC production= anemia

Normocytic Morphology Anemia

 Anemia from loss of blood or hemolysis(break up)of RBC’s

◦Acute – hemorrhage from traumatic injury, surgery, bleeding (burst) aneurysm

Hemolysis of RBC’s from blood transfusion reaction, reaction to a toxin or defect in RBC membrane

 Iron Deficiency Anemia

 Most common anemia.

 Not enough iron for the body to make the correct amount

 of hemoglobin, therefore not enough RBC’s

What causes Iron Deficiency Anemia?

◦Insufficient iron in diet

◦Loss of iron by chronic blood loss (usually ulcer or intestinal bleed)

◦Malabsorption

◦Stomach/colon cancer, bariatric surgery

◦Decreased absorption b/c insufficient absorption of stomach/colon

Early Clinical Manifestations of Iron Deficiency Anemia

Fatigue

Weakness

Shortness of breath

Pale gums palms and conjunctivae

Later (severe) Clinical Manifestations of Iron Deficiency Anemia

Spoon-shaped fingernails (koilonychia)

Scales and fissures in mouth (cheilosis)

Ulcerations of mouth and tongue

Headache

Cognitive impairment

What are the most coomon Macrocytic Anemias?

B₁₂ (cobalamin) Deficiency

Folic Acid Deficiency

B₁₂ (cobalamin) Deficiency

1.Not enough B₁₂ for the body to make the correct amount & correct shape of RBC’s. Abnormal RBC’s die prematurely

◦Usually called Pernicious anemia

◦Disease autoimmune gastritis causes very low intrinsic factor (IF) secretion

of gastric membranes. Intrinsic factor needed for absorption of B_{12 .}  

Folic Acid Deficiency

◦Poor nutrition- lack of green, leafy veggies

◦some meds decrease absorption (methotrexate, anti-seizure)

◦Alcohol abuse

◦Hemodialysis patients

Sickle Cell Anemia

 Caused by abnormal form of hemoglobin in the erythrocyte, hemoglobin S (HbS)

[Normal -hemoglobin A (HbA)]

Aplastic Anemia

◦Pancytopenia (Decrease of all blood cell types, RBC’s, WBC’s, and platelets)

◦Bone marrow is suppressed fails to produce mature cells

What are some causes of Aplastic Anemia?

 Most common cause: immune system attacking the stem cells the bone marrow

 

 Other possible causes:

 Some medications

Radiation and chemotherapy treatments

Viral infection

Exposure to toxic chemicals 

Inherited genes

Polycythemia Vera

 Increased numbers of all blood cells, especially RBCs

◦Slowly growing blood cancer

◦Overproduction (proliferation) of RBC’s, hyperplasia of the bone marrow

◦Blood becomes very “thick”

Caused from chromosomal mutation

Usually >60 years of age when diagnosed

Usually in males

Clinical Manifestations of Polycythemia Vera

Hypertension

Headache

Dizziness

Tinnitus

Heart failure

Thrombophlebitis

Shortness of breath

Enlarged spleen and liver

Lymphomas

WBC disorder;  Neoplasms (tumors) developing from the proliferation of malignant lymphocytes in the lymph system

What are the two major types of Lymphomas?

◦Hodgkin Lymphoma

◦Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma

◦Malignant lymphocytes are B cells (not Reed-Sternberg) and T cells

◦Usually seen in males over the age of 55

Symptoms:

◦Can begin in lymph nodes anywhere in the body

◦Night sweats

◦Fever

◦Unexplained weight loss

Hodgkin Lymphoma

◦Associated with malignant lymphocyte called Reed-Sternberg B cells

◦Usually seen in males less than 40 years

Symptoms:

◦Begins with enlarged lymph nodes of neck that do not diminish

◦Night sweats

◦Fever

◦Unexplained weight loss

Multiple Myeloma

Cancer of the plasma cells (type of B cell)of the bone marrow

• Tumors form in the bone marrow, cause “punched out” areas called lytic lesions.

• Breakdown of bone releases calcium into the blood.

• Many tumor cells means overcrowding of normal cells, fewer RBCs, WBCs, and platelets are produced

Clinical Manifestations of Multiple Myeloma

Bone pain

Fractures

Fatigue

High calcium level/mental confusion                                                                                              

Depressed immune system

Frequent infections

Thromnocytopenia

Decreased production in bone marrow or body destroying platelets

Clincial Manifestations of Thrombocytopenia

◦Bruising under skin (purpura)

◦Excessive Nosebleeds (epistaxis)

◦Gum bleeds

◦Blood in vomit or stool

◦Petechiae- tiny purple, red, or brown spots on the skin

◦Intracranial bleeding                                         

What causes of Thrombocytopenia?

◦Chemotherapy drugs and radiation therapy

◦    Aplastic anemia

◦    Leukemia and other cancers

◦    Viral infections, such as hepatitis C or HIV

◦    Heavy alcohol consumption

Immune Thrombocytopenia Purpura

 Also called idiopathic thrombocytopenia purpura

• Immune system is stimulated to attack and destroy body's own platelets

What stimulates Immune Thrombocytopenia Purpura to happen?

◦Bacteria in the blood

◦Pregnancy

◦Immune disorders (rheumatoid arthritis and lupus)

◦Medications (heparin, quinine, sulfa-containing antibiotics and anticonvulsants)

◦Sometimes the cause is not known