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Chapter 1-7 Lecture Review: Blood and Cell Biology

Blood and Blood Factors

  • Components of Blood:

    • Red Blood Cells (RBCs)

    • White Blood Cells (WBCs)

    • Platelets

  • Function: Essential for maintaining life and homeostasis (the body's ability to maintain internal equilibrium).

  • Blood Volume: The human body contains approximately 5 liters of blood.

  • Systemic Interaction: Blood works in conjunction with the lymphatic system to transport nutrients throughout the body.

Red Blood Cells (RBCs) / Erythrocytes

  • Definition: Mature red blood cells, also known as erythrocytes.

  • Main Function: Transport oxygen throughout the body.

  • Measurement:

    • Hemoglobin (Hgb/Hg): Measures the amount of oxygen carried by red blood cells in the bloodstream. Each hemoglobin molecule carries 4 oxygen molecules.

    • Hematocrit: Measures the total amount of red blood cells in the blood.

  • Oxygenation Indicator: Brighter red blood indicates higher oxygen content.

  • Production (Erythropoiesis):

    • Location: Produced in the bones.

    • Regulation: Regulated by the body's oxygen needs, primarily determined by the kidneys (and slightly by the liver).

    • Mechanism: When oxygen is low, the kidneys produce erythropoietin, which stimulates bone marrow to produce more red blood cells.

Anemia (General)

  • Definition: A decrease in circulating red blood cells (not enough RBCs).

  • Causes: Blood loss or early destruction of red blood cells.

  • Symptoms: Lethargy, easy fatigue, easy bruising, easy bleeding.

Specific Anemias and Blood Disorders

  • Sickle Cell Anemia (Group 1)

    • Problem: Red blood cells take on a sickle or crescent shape instead of a normal circular shape.

    • Consequence: Sickled cells get stuck in the bloodstream, leading to swelling and severe pain.

    • Demographic Focus: Pain management and oxygen therapy are crucial.

    • Cure: No cure.

    • Treatment: Aims to manage symptoms (e.g., pain medication, oxygen therapy).

  • Iron Deficiency Anemia (Group 2)

    • Problem: Decrease in healthy red blood cells due to insufficient iron in the body.

    • Presentation: Weakness, shortness of breath (SOB), tiredness, increased bleeding and bruising.

    • Diagnosis: Lab work (hemoglobin and hematocrit levels).

    • Treatment: Oral iron supplements, intravenous iron therapy, or blood transfusions.

    • Nursing Implications: Monitor labs, signs and symptoms, and intervene as needed.

  • Pernicious Anemia (Group 3)

    • Problem: Decrease in red blood cells because the body cannot absorb Vitamin B\text{12}. Vitamin B\text{12} is vital for metabolism.

    • Presentation: Neurological signs and symptoms.

    • Diagnosis: Labs.

    • Cure: No cure.

    • Treatment/Management: Vitamin B\text{12} injections initially, followed by oral supplementation if effective.

    • Nursing Implications: Extensive patient education on the chronic disease, signs/symptoms, when to seek help, correct B\text{12} administration, and administering B\text{12} shots.

  • Polycythemia Vera (Group 4)

    • Problem: Chronic myeloproliferative neoplasm (a rare, slow-growing blood cancer) caused by a JAK\text{2} gene mutation, leading to the bone marrow producing too many red blood cells.

    • Presentation: Fatigue, weakness, night sweats, weight loss, extreme risk of bleeding and blood clots (stroke, heart attack, embolism).

    • Diagnosis: Complete blood count (CBC), genetic testing for JAK\text{2} mutation, bone marrow biopsy.

    • Treatment: Low-dose aspirin, phlebotomy, JAK\text{2}} inhibitors, cancer treatments.

    • Nursing Implications: Regular monitoring of vital signs, phlebotomy care, patient education, medication management, lifelong monitoring for thrombosis risk, encourage mobility and hydration to prevent clots.

  • Thalassemia (Group 5)

    • Problem: Inherited disorder causing a decrease in hemoglobin (the oxygen-carrying protein).

    • Presentation: Pale or yellow skin, shortness of breath, dizziness, irregular/fast heartbeat, abdominal swelling, dark urine.

    • Diagnosis: Blood work (complete blood count).

    • Treatment: Mild forms may not need treatment. Severe forms require blood transplants or stem cell transplants.

    • Nursing Implications: Manage iron overload, transfusion management, pain management, educate families and patients.

  • Aplastic Anemia (Group 6)

    • Problem: The body stops making new blood cells (red, white, and platelets).

    • Presentation: A wide array of symptoms due to the lack of all blood cell types:

      • Anemia symptoms: Fatigue, easy bruising, easy bleeding (similar to iron deficiency anemia).

      • Neutropenia (low WBCs): Infections, fever.

      • Thrombocytopenia (low platelets): Prolonged bleeding, nosebleeds, bruising.

    • Diagnosis: Blood tests (blood cell counts), bone marrow biopsy, medical history (e.g., exposure to radiation), checking for bleeding.

    • Cure: No cure.

    • Management: Stem cell transplants (from a healthy match) to rebuild bone marrow, medications, blood transfusions to control bleeding and relieve symptoms.

    • Nursing Implications: Help patients manage symptoms, monitor for signs of infection (fever), fatigue, bruising, pallor, collaborate with the healthcare team, patient education.

Platelets and Coagulation

  • Function: Vital components of coagulation (blood clotting).

  • Mechanism: Respond to any cell injury to stop bleeding.

Abnormal Platelet Conditions

  • Thrombocytosis (Increased Platelets):

    • Problem: Too many clotting factors.

    • Risk: Increased risk for blood clots.

    • Complications: Blood clots can travel to the heart (heart attack), lungs (embolism), or brain (stroke).

    • Nursing Interventions: Encourage ambulation and movement, ensure hydration, monitor vital signs.

  • Thrombocytopenia (Decreased Platelets):

    • Problem: Too few clotting factors.

    • Risk: Major risk of bleeding (even minor cuts can lead to continuous bleeding).

    • Nursing Interventions: Avoid bleeding triggers, ensure patients are careful (e.g., using soft-bristle toothbrushes to prevent gum cuts).

Diseases Caused by Abnormal Platelets

  • Hemophilia (Groups 1 & 2)

    • Problem: Blood does not clot properly (genetic, most common in males).

    • Types:

      • Type A: Issue with Factor VIII (Factor 8).

      • Type B: Issue with Factor IX (Factor 9).

    • Main Goal: Replace clotting factors.

    • Treatment: Vitamin K can be given to provide clotting factors.

  • Disseminated Intravascular Coagulation (DIC) (Groups 5 & 6)

    • Problem: The body's blood clotting system becomes overactive and then ability to clot suddenly stops, leading to constant bleeding.

    • Common Cause: Sepsis (a bloodstream infection).

    • Symptoms: Bruising, organ failure, pain, swelling of limbs, fever, low blood pressure, seizures, bleeding from every orifice (e.g., IV sites, eyes, ears).

    • Diagnosis: CBC, CT scan, biopsies, lab testing.

    • Treatment: Blood transfusions, in mild cases, heparin can be given.

    • Nursing Implications: Administer clotting factors and anticoagulants, implement bed rest and activity restrictions. Survival rates are low due to widespread, uncontrolled bleeding.

  • **Von Willebrand Disease (Groups 3 & 4) - *QUIZ TOPIC*

    • Problem: Inherited bleeding disorder affecting the blood's ability to clot properly due to a deficiency or defect in the von Willebrand factor (a blood clotting protein).

    • Mechanism: Von Willebrand factor is directly involved in platelet adhesion (attaching to a surface) and aggregation (binding platelets together). Without it, clots cannot form.

    • Presentation: Bleeding from mucous membranes (nosebleeds, gum bleeding), easy bruising, heavy menstrual bleeding.

    • Diagnosis: Clinical evaluation, family history, lab work (including test for von Willebrand factor antigen).

    • Treatment: Hormone therapy, splenectomy, blood transfusions.

    • Nursing Implications: Anticipatory care, frequent patient assessments for bleeding, symptom recognition, communication with patients regarding issues.

Mini Review: Cell Biology and Related Concepts (from previous lectures)

  • Hypertrophy: Enlargement of a cell due to increased stress.

  • Atrophy: Shrinking/wasting of a cell.

    • Analogy: Working out causes muscle hypertrophy; not working out leads to muscle atrophy.

  • Powerhouse of the Cell: Mitochondria (responsible for energy production).

  • Structure Dictating Cell Activities: Nucleus.

  • Cell Membrane: (Function not specified in transcription, but noted as a key concept).

  • Gene Expression: Dominant genes are more likely to be expressed than recessive genes.

    • Tool: Punnett Square (used to determine gene expression probability).

  • Tumors:

    • Benign Tumor: Non-cancerous, does not spread, regular borders.

    • Malignant Tumor: Cancerous, spreads, irregular borders.

  • Genetic Syndromes:

    • Fragile X Syndrome: A complete mutation (specific details not elaborated in this recap).

    • Trisomy 21: Results in Down Syndrome.

  • Histamine: High levels of histamine cause vasodilation (dilation of blood vessels).

  • Stress Response (Fight or Flight - Sympathetic Nervous System):

    • Vitals: Increased heart rate, increased blood pressure, increased breathing rate, increased temperature.

    • Metabolism: Increased blood glucose (sugar).

    • Other Systems: Decreased need to urinate, decreased hunger (body prioritizes survival over non-essential functions).

  • Rest and Digest (Parasympathetic Nervous System):

    • Vitals: Lower heart rate, lower blood pressure, lower breathing rate.

    • Focus: Sleep and digestion.

Note for Exam Preparation: Focus on these review topics. The tutor (Katie Sykes) has specific review points for the quiz, and attending her session is highly recommended.