Chapter 7 - Hematology and Immunology (Blood and lymphatic system)

Hematology

Study of the blood

Immunology

Medical specialty of the lymphatic and immune system

Function of the blood

• continuously transport:

  • formed elements

  • plasma

  • nutrients

  • electrolytes

  • oxygen

  • carbon dioxide

  • clotting factors

  • waste products of cell metabolism

Lymphatic system consists of:

• Lymphatic vessels

• lymph fluid

• lumph nodes

• lymph organs

Lymphatic system functions

• provide an immune response that defends against:

  • bacteria

  • viruses

  • parasites

  • foreign cells

  • cancer cells

Components of blood

• Plasma

• formed elements

  • RBCs

  • WBCs

  • platelets

• when placed in a centrifuge, the formed elements settle to the bottom as they are heavier than the clear plasma on the top

Anatomy of blood

• Plasma

  • the liquid component of blood

  • makes up 55% of blood

  • thicker than water bc it contains substances like albumin and electrolytes

• Formed elements

  • suspended in the plasma

  • nutrients

  • metabolic wastes

Formed elements are created through ___

hematopoiesis

• occurs in the red marrow of long bones and flat bones

• Each type of cell or cell fragment begins in the marrow as a very immature stem cell

• all formed elements of blood begin in the red bone marrow as it produces stem cells that progress to mature cells, which then enter the blood

-poiesis

process of formation

Hemorrhage

loss of a large amount of blood due to a disease or injury; often arterial

septicemia

severe bacterial infection that spreads from tissue to blood and affects the entire body

• results in sepsis

• bacteria and endotoxins cause severe symptoms inflammation and blood clots

• often deadly

septic/o

infection

-emia

condition of the blood

anatomy of erythrocytes

AKA RBCs

• most numerous formed cell

• flat, red disks w/ no nucleus

  • cannot heal themselves since theres no nucleus

    • die in about 120 days

    • erythrocytes must constantly be replenished

• Hemoglobin (Hgb) in erythrocytes carries oxygen (and some CO2)

• when there are too few RBCs, erythropoietin (EPO) prompts their function

  • EPO is found in the kidneys

• Spleen removes old erythrocytes and recycles their iron and amino acis

Anemia

decrease in the number of erythrocytes

• several causes

  • low iron

  • red bone marrow damage from cancer, radiation therapy, or chemotherapy drugs

  • excessive blood loss due to hemorrhage, menstruation, or chronic bleeding

Iron-deficiency anemia

not enough iron, means hemoglobin is not made

• results in lower oxygen delivery to tissues

• fatigue

microcytic

pertaining to small cell (erythrocyte)

hypochromic

pertaining to loss of color (in an erythrocyte)

in adults, hematopoiesis occurs primarily in the____

axial skeleton and proximal ends of the humerus and femur

Pernicious anemia

Type of Erythrocyte disease

• Vitamin B12 deficiency caused by inability to absorb B12

  • usually results form lack of intrinsic factor

    • w/o intrinsic factor, B12 cannot be absorbed adequately in the small intestine

    • B 12 is essential for normal RBC production

Sickle Cell Anemia

Inherited blood disorder in which an abnormal form of hemoglobin causes RBCs to be sickle shaped

• Lower O2 leads to RBCs becoming sickle/crescent shaped

  • sickle cells are rigid and less flexible

  • can block small blood vessels, leading to pain and tissue damage

  • sickled cells also have a shorter lifespan (10-20 days)

Acute Hemolytic Transfusion Reaction

serious immune reaction that can occur when incompatible blood is tranfused

• incompatible blood leads to antibodies binding to donor RBCs, leading to hemolysis, leading to complications

chrom/o

color

hem/o

blood

-lysis

breakdown/destruction

fus/o

pouring

Leukocytes

AKA WBCs

• Five types determined by nuclear shape and cytoplasmic granules

  • two groups groups determined by cytoplasmic granules

    • ones with visible granules = granulocytes

      • Neutrophil

      • Eosinophil

      • Basophil

    • no obvious granules = agranulocytes

      • Lymphocyte

      • Monocyte

Primary cell involved in immune defense

Leukocytes

The immune system responds to….

Pathogens, foreign subtances, abnormal cells

path/o

disease

-gen

producing or causing

Neutrophils

“Eat”/Phagocytose bacteria

small phagocytosis image

most abundant WBC

Eosinophils

attack parasites

parasite image

parasite defense

Basophils

release histamines to attack pathogens

histamine/inflammation image

inflammation

phagocytes

process of a cell engulfing and digesting material

Antibodies

produced by B cells

• antibodies coat the surface of an invading cell

  • the coating attracts leukocytes to the cell and marks it for destruction

Acquired Immunodeficiency Syndrome (AIDS)

Advanced stage of HIV infection characterized by severe immune deficiency

• Human immunodeficiency virus (HIV) infects and destroys CD4+ helper T-cells

• AS CD4 T-cell numbers decline the immune system becomes less able to coordinate an effective immune response

• severe immune deficiency increases the risk of opportunistic infections and certain cancers

Leukemia

Cancer of the lymphocytes w/ excessive number of immature leukocytes in red marrow

• leads to anemia

• leads to hemorrhage

• leads to susceptibility to infection

• leads to bruising and fever

• named according to the prevalent type of lymphocyte and acute or chronic onset

• can occure in adults or children

Mononucleosis

AKA Mono

Infectious disease caused by Epstein-Barr Virus (EBV) that causes lymph node enlargement, fever, and fatigue

• named after the increase in the number of WBCs monocytes in the blood of infected individuals

mon/o

one

nucle/o

nucelus

Thrombocyte formation

AKA Platlet

stem cells in red bone marow develop into large cells called megakaryocytes

• megakaryocytes shed fragments of their cytoplasm

• cell fragments become thrombocytes aka platelets

thromb/o

blood clot

Process of bloodclotting

• injured blood vessels constrict to decrease blood flow

• thrmbocytes form clumps (aggregation)

• clotting factors are released

• Fibrin strands form, trapping erythrocytes and creating a clot (coagulation)

• Bleeding ceases (homeostasis)

DVT

Deep Vein Thrombosis

• blood clotting that forms in a dep vein, usually in the leg

  • risk increases w surgery, bedrest, or prolonged immobility

  • clot may break freee and travel through the bloodstream

  • if it lodges in a pulmonary artery is causes a pulmonary embolism

Hemophilia

inherited disorder caused by a deficiency of a blood clotting factor

• leads to prlonged bleeding

thrombocytopenia

low thrombocyte (platelet) count caused by damage to the bone marrow from radiation chmicals or certain drugs

petechiae

small pinpoint hemorrhages

echhymoses

larger hemorrhages under the skin

-penia

condiion of deficiency

ecchym/o

pouring out

anatomy of the lymphatic system

Tissues:

• tonsils

• adenoids

• peyer patched

• appendix

Organs:

• Thymus

• spleen

• lymph nodes

  • filter the fluid to remove miccroorganisms and cells

• pieces of encapsulated lymphoid tissure

• 
  

GVHD

graft-versus-host disease

• donor immune cells attack the transplant recipients tissues

• usually associated w bone marrow/stem cell transplantation

• may caus rash diarrhea and liver problems

• severe GVHD can be life threatening

Lymphadenopathy

enlarged lymph nodes, often felt in the neck, armpits, or groin

common causes:

• lymph nodes responding to infection

• occur w cancer or other disease

• cancer cells can spread through the blood or lymphatic system to other parts of the body

• spread of cancer (metastasis)

lymph/o

lymph

aden/o

gland

Lymphedema

generalized swelling in a limb

• occurs after surgery when a chain of lymph nodes are removed

  • tissue fluid in that area cannot drain like normal

    • removal or enlargemnt og lymph nodes most common cause in US

    • obstruction (eg parasite) more common in developing countries

elephantiasis

caused by a parasite (commonly a nemotode)

• blocks lymph nodes and collecting vessels

lymphoma

cancerous tumor of lymph cells, nodes, or tissues

splenomegaly

enlargment of the spleen that is felt on palpation

DM Type 1

Diabetes Mellitus Type 1

• affects the pancreas

Graves disease

affects the thyroid

Hashimoto thyroiditis

affects the thyroid

• body makes antibodies that attack the cells in your thyroid

Gluten sensitivity enteropathy

affects the intestines

inflammatory bowel

affects the intestines

MS

Multiple Sclerosis

• Affects the nerves

Myasthenia gravis

affects the muscles

psoriasis

affects the skin

scelroderma

affects skin an blood vessels

RA

rheumatoid arthritis

• affects joints

SLE

Systemic Lupus Erythematosus

• affects the connective tissue, skin, kidneys, lungs

Blood Smear

smeared on glass slide

• hematoxylin and eosin are applied

• characteristics of blood observed when under microscope

• used as a followup to abnormal CBC

type and crossmatch

determines ABO blood type and Rh factor of recipient and blood donor

• recipients antibodies mixed w donor cells

• if antibodies and cells agglutinate, bloods are NOT COMPATIBLE

agglutin/o

clumping, sticking

Blood type anatomy

• erythrocytes contain genetic material that determines blood type

• each type named for the antigen of the RBC

• ABO Groups:

  • Group A (Antigen A, Antibody B (fights type B blood))

  • Group B (Antigen B, Antibody A)

  • Group AB (Antigen A and Antigen B, NO ANTIBODIES, universal receiver)

  • Group O (Antibody A and Antibody B, NO ANTIGENS, universal donor if negative blood type)

CBC

Complete Blood Count

• a group of blood test performed together to determine number, type, and characteristics of formed elements

• also measures hematocrit (HCT)

  • this is the percentage of RBCs in the blood

Coagulation Time Tests

Measures length of time it takes for blood to clot

• all test results are reported as an International Normalized Ration (INR), no matter test type

INR

International Normalized Ratio

• measures blood clotting speed by adding thromboplastin and calcium to a plasma sample to initiate clotting, calculating the ratio of the patients time to a standard mean

Blood Chemistries

Measures the levels of substances in the blood:

• electrolytes

• albumin

• total protein

• ALT, AST, BUN

• creatine

• bilirubin

• glucose

• LDH

• cholesterol

• uric acid

Ferritin

Indirectly measures the amount of iron stored in the body

• measures the amount of present blood, detecting iron deficiency and anemia

Blood donation

procedure in which a unit of whole blood is collected from a donor

blood tranfusion

procedure in which donor blood is given to a recipient

• whole blood corrects blood loss

• packed red cells avoid fluid overload

• platelets are given for thrombocytopenia or cancer

• plasma is given to patients with hemophilia

phlebotomy

procedure to make a small hole in the vein and collect a blood sample with a vacuum tube

phleb/o

vein

-tomy

process of cutting or making an incision

plasmapheresis

procedure that separates a unit of donated blood into red cells and plasma

• donor supplies a unit of blood which gets centrifuged

• blood cells and plasma seperate

• blood cells are given back to the donor

• plasma is pooled with other donors’ to make fresh plasma, albumin, or clotting factors

plasm/o

plasma

apher/o

withdrawal

Vaccination

injection of a dead or weakend pathogen into the body

• enables the body to create antibodies and memory cells to protect against later exposure

• important in protecting against diseases that cause serious disability

  • polio

  • diatheria

  • tetanus

• Vacca means cow in latin

  • refers to the historical practice of using cowpox virus (Vaccinia) to protect against small pox

Anticoagulants

prevents blood clots

• forms inhibiting clotting factors or reduces effects of vitamin K, which is essential for producing clotting factors

corticosteroids

suppresses immune response

• decreases inflammation and organ rejection during transplants

Erythropoietin drugs

stimulate red bone marrow to make eyrthrocytes

-poiesis

to make

Immunosuppressant drugs

suppresses the immune system to prevent organ rejection

NRITs

Nucleoside reverse transcriptase inhibitor drugs

• retroviral drug for HIV treatment

  • inhibits the enzyme reverse transcriptase, which is essential for replication of the HIV virus

Bone Marrow Aspiration

aspiration and removal of red bone marrow from the hip bone

• done o diagnose and monitor leukemia

• done to harvest donor bone marrow

Lymph Node Biopsy

removal of tissue from the lymph node

• uses fine needle

• tests for cancer cells in the node

Stem Cell transplantation

transplantation of bone marrow (aka stem cells) from a matched donor’s red marrow to a recipient

• donor and recipient are matched

• marrow is harvested from donor

• recipient recieves treatment to kill cancer cells and bone marrow cells

• marrow is transplanted by intravenous (IV) and migrates to the bone

lymph node dissection

separation of lymph nodes from surrounding tissue and removal of nodes form a chain

• done to look for cancer metastasis (growth)