chapter 10 and 11

blood

Review of Blood
Blood provides the major transport system of the body for essentials such as oxygen, glucose and other nutrients, hormones, electrolytes, and cell wastes. It serves as a critical part of the body’s defense, carrying antibodies and white blood cells for the rapid removal of any foreign material.

Thrombocytes-

also called platelets, are an essential part of the blood-clotting process or hemostasis. Thrombocytes are not cells!

 Thrombocytopenia-

refers to a decreased number of circulating platelets
 Associated with:
 Decreased bone marrow production
 Increased pooling in the spleen
 Decreased of blood vessel integrity result from
structurally weak vessels or vessel damage due to
inflammation and immune mechanisms.

Manifestations of Thrombocytopenia:
 Rapid drop in platelet count several days after resuming drug
 Hemorrhagic diathesis( unusual susceptibility or predisposition)
 Splenomegaly
 Diagnosis
 History of taking drug before
 Platelet count
 S/S

Treatment of Thrombocytopenia:
 Discontinue Drug
 Splenectomy

Idiopathic Thrombocytopenic Purpura-

an auto immune disorder, results in platelet
antibody formation and excess destruction of
platelets.

Manifestations of Idiopathic
Thrombocytopenic:
 Sudden onset of petechiae and purpura- acute
condition
 Bruising, bleeding from gums, epistaxis and
abnormal menses
 Splenomegaly

Diagnosis: Platelet counts < 20,000/ml
 Treatment: corticosteroid drugs, Splenectomy
and immunosuppressive agents

Coagulation Defects-

deficiencies of one or more of the known clotting factors
 Defective synthesis
 Inherited disease
 Increased consumption of the clotting factors
 Manifestations:
 Bleeding typically occurs after injury or trauma
 Large bruises, hematomas, or prolonged bleeding into GI or urinary tract or joints

Agglutination-

(clumping) antigen-antibody
reaction would occur with, for example, an
incompatible blood transfusion
 Primary coagulation defects- Hemophilias
 Types:
 Hemophilia A
 Hemophilia B
 Hemophilia C

Secondary:
 Clotting factors deficiencies or enhanced
consumption or breakdown of factors
 Prothrombin deficiency and or deficiency of
other Vitamin K clotting factors
 Drug induces- oral anticoagulants or heparin
 Liver disease
 Anemia

Diagnosis-
 CBC, Clotting tests
 PTT (partial thromboplastin time) measures
the presence of plasma factors that act in a
portion of the coagulation pathway
 PT (prothrombin time) Test the ability of blood
to clot (used to monitor patients take
coumadin)

Blood Therapies

 Whole blood, packed red blood cells, or
packed platelets
 Bone Marrow or stem cell transplants are
used to treat some cancers severe immune
deficiency or severe blood cell diseases

Anemia-

not a disease but an indication of a disease process or alteration in body function.
(Blood dyscrasia- disease)
 Categories of Anemias:
 1. Impaired oxygen transport
 2. Changes in red cell structure
 3. Signs and Symptoms of pathological process causing anemia

Anemia
 Signs and Symptoms:
 1. pallor
 2. Angina
 3. Fatigue
 4. dyspnea
 5. Tachycardia
 6. Jaundice
 7. Purpura, petechia

1. Acute hypovolemic shock

 Caused by hemorrhage
 Dx: H&H(hemoglobin and hematocrit)
 Trx: blood replacement (transfusion), treat
underlying problem(cause)

Chronic-

loss of blood leads to iron
deficiency creating microcytic, hypochromic
anemia
 Dx: H&H, CBC, blood smear
 Trx: iron replacement, ferrous sulfate,
Imferon, blood replacement, treat underlying
problem

Hemolytic Anemias

 Premature destruction of RBCs short life span of RBC with hemolysis
 S&S: jaundice, hemoglobinemia, hemglobinuria, and general symptoms
 Causes: Primary or Intrinsic- genetic,
hemoglobinopathy, defect in cell membrane
 Causes: Acquired or extrinsic- drugs, bacteria, trauma
 Dx: CBC, H&H, bilirubin, blood smears, urine bilirubin
 Trx: Splenectomy- reduces RBC destruction and removal

Hemoglobinopathies
 Sickle Cell Anemia

genetic defect in the
hemoglobin causes shape of the cell to change
 Cells cause obstruction in the vascular structures
(spleen, bone) and causes small infarcts, cells
rupture
 Dx: CBC, blood smear, genetic studies
 Trx: blood transfusions, palliative, pain meds,
bone marrow transplant, counseling

Thalassemia (Cooley’s Anemia)-

absence of defective synthesis of hemoglobins,
hereditary (found in the Mediterranean
population)
 S&S: splenomegaly, hepatomegaly
 Dx: CBC, blood smear
 Trx: Blood replacement

Iron Deficiency Anemias

 Associated with inadequate dietary iron,
chronic blood loss
 More common in women
 Leads to decreased hemoglobin synthesis,
RBCs
 S&S:
 Fatigue dysphagia Brittle hair and
nails
 Angina SOB pallor

Cause: blood loss, decreased dietary intake
of iron
 Dx: CBC, blood smear
 Trx: ferrous sulfate, Imferon

Vitamin B-12 Deficiency Anemia
(pernicious)

 Lack of mature erythrocytes
 Caused: lack of intestinal absorption of B-12.
B-12 cannot be absorbed into the
bloodstream without the aid of a special
substance intrinsic factor that normally found
in gastric juice
 Dx: CBC, blood smear, serum B12
 Trx: Vitamin B-12 injections, treat underlying
intestinal disorder if present

Folic Acid Deficiency Anemia

 Caused by malnutrition, found in alcoholics
and debilitated patients
 Dx: CBC
 Trx: Folic Acid 1-5mg/day

Aplastic Anemia

 Failure of blood cell production due to aplasia
(absence of development, formation) of bone
marrow cells
 Cause- unknown in 66% of cases, drugs,
radiation, chemicals
 Dx: CBC, blood smear, bone marrow
aspiration
 Trx: Blood Transfusions, bone marrow
transplant

Polycythemia Vera

 An increase in RBCs from over production in
the bone marrow
 Dx: CBC, bone marrow, aspiration
 S&S: headache, hypertension, weight loss,
 Trx: phlebotomy, chemotherapy

Myelodysplastic Syndrome

 MDS- involve inadequate production of cells
by the bone marrow
 Cause: idiopathic or following chemotherapy
or radiation treatment
 Dx: Blood test, Bone Marrow Biopsy
 Trx: transfusion replacements, bone marrow
transplants
 It can progress into chronic or acute leukemia

Leukemia’s

 A malignant neoplasm of hematopoietic stem cells
causes replacement of bone marrow with
immature neoplastic cells in large numbers
 Classifications:
 Lymphocytic:
 Acute lymphocytic leukemia (ALL) kids ages 2-4
 Chronic lymphocytic leukemia (AML) adults over the
age of 50

Myelocytic:

 Acute myelocytic leukemia (AML) ages 13-39
 Chronic myelocytic leukemia (CML) ages 30-
50
 Dx: Blood smear and bone marrow
aspiration(bx)
 Trx: Chemotherapy and supportive trx, bone
marrow transplant

Leukemia’s

 Sample Chemo Protocol for ALL:
 Cytoxan
 Prednisone
 Vincristine
 Asparaginase