Chapter 7

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chapter 7
Blood and Blood-Forming Organs
Diseases and Disorders

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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

Blood Components

• Erythrocytes
– Normal count:
• 4.2 to 6.3 million
– Life span:
• 120 days
– Form in bone marrow and do not reproduce

• 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

• Leukocytes protect individual from infection
– Normal count:
• 4,500 to 11,000

• Platelets
– Also known as thrombocytes
– Important in blood clotting
– Normal count:
• 150,000 to 350,000

• Blood-forming organs:
– Lymph nodes
– Bone marrow
– Spleen
– Liver
• Lymph system protects against pathogens

• 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

Animation
Click Here to Play Blood Animation

Common Signs and Symptoms
• Erythrocytopenia
– Decrease in RBCs leading to anemia
– Symptoms:
• Fatigue
• Headache
• Low RBCs
• Pallor
• Shortness of breath

• Erythrocytosis
– Increased RBCs
– Symptoms:
• High RBCs
• Reddened skin tones
• Bloodshot eyes
• Increased blood volume and pressure
• Increased blood volume of heart

• Leukocytopenia
– Decreased white blood cells
– Weakens immune system
• Leukocytosis
– Increased white blood cells
– Normal response to acute infections

• Thrombocytopenia
– Decreased platelet count leading to coagulation problem
– Symptoms:
• Petechiae
– Small hemorrhages in skin
• Ecchymoses
– Large areas of bruising or hemorrhage

– Symptoms:
• Epistaxis
– Nosebleeds
• Bleeding in mouth, gums, and mucous membranes

• Thrombocytosis
– Increase in platelets
– Uncommon
– Usually no serious side effects

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

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

Diagnostic Tests
• Biopsy
– Bone marrow
– Lymph node

Disorders of Red Blood Cells
• Anemia
– Decrease in oxygen-carrying ability of RBC
– Symptoms:
• Pallor
• Fatigue
• Shortness of breath

• Anemia
– Symptoms:
• Tachycardia
• Headache
• Irritability
• Syncope

• Iron deficiency anemia
– Loss of iron or inadequate intake of iron
– Causes:
• Blood loss
• Low dietary intake
– Treatment:
• Increase dietary intake of iron

• 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

• Pernicious anemia
– Lack of intrinsic factor leading to inadequate absorption of
vitamin B12
– Treatment:
• Monthly injections of vitamin B12 for life

• 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

• 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

• Aplastic anemia
– Failure of bone marrow to produce blood components
– Causes:
• Chemotherapy
• Radiation
• Viruses
• Toxins

• Aplastic anemia
– Treatment:
• Avoid causative agent
• Bone marrow transplantation
• Transfusions

• Polycythemia
– Too many blood cells
– Symptoms:
• Enlarged spleen
• Reddened mucous membranes
• Bloodshot eyes
• Deep red color on palms

• Polycythemia
– Treatment:
• Donate blood at regular intervals to reduce blood volume

Disorders of White Blood Cells
• Mononucleosis
– Also known as kissing disease
– Symptoms:
• Fatigue
• Sore throat
• Swollen glands

• Mononucleosis
– Diagnosis by increased monocytes in white blood cells
(WBCs)
– Treatment:
• Rest
• Analgesics
• Throat gargles

• 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

• Leukemia
– Chronic forms affect older adults, are often asymptomatic,
and may not be fatal
– Classified as:
• Myelogenous
– Affecting bone marrow
• Lymphocytic
– Affecting lymph nodes

• Leukemia
– Diagnosis by bone marrow biopsy
– Symptoms:
• Fatigue
• Headache
• Sore throat

• 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

• Leukemia
– Treatment:
• Aggressive chemotherapy
• Once in remission, bone marrow transplant to replace neoplastic
tissue with normal tissue
• Remission at 50 percent

• 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

• 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

• 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

• 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

Multiple Myeloma

• 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

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

• Hemophilia
– Symptoms:
• Epistaxis
• Bruising
• Prolonged bleeding
– Diagnosis by blood test

• Hemophilia
– Treatment:
• Prevention of injury
• Treat symptoms
• Blood transfusions
• Concentrated form of clotting protein
– No cure

– 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

– Symptoms:
• Ecchymoses
• GI hemorrhages
• Epistaxis
• Hematuria

– Diagnosis by platelet count and bleeding time
– Treatment:
• Avoid tissue trauma to reduce bleeding
• Vitamin K
• Transfusions of platelets
• Splenectomy

• 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

• DIC
– Symptoms:
• Petechiae
• Ecchymosis
• Hematoma
• Hematuria
• GI bleeding

• DIC
– Symptoms:
• Hematemesis
• Blood in stool
– Treatment:
• Heparin
• Platelets

• Rare diseases
– Thalassemia
• Primarily affects people of Mediterranean descent
• Fragile, thin RBCs form defective hemoglobin

• Rare diseases
– von Willebrand’s disease
• Hereditary
• Congenital
• Deficiency in clotting factor and platelet function
• Also known as angiohemophilia
• Affects females and males

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

Chapter 7

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Chapter 7