Cardiovascular 1 blood pathologies Flashcards
Anemia
(Umbrella term for multiple types of Erythrocyte Pathologies)
Reduced haemoglobin concentration
Signs and symptoms:
• Fatigue
• Shortness of breath on exertion
• Palpitations
• Irritability
• Feinting
• Tachycardia
• Thin, tready pulse
• Pale pallor (skin / conjunctiva)
Anaemia; Aplastic
(without formation/growth)
A rare and potentially life-threatening failure of haematopoiesis (blood cell production)
Pathophysiology:
• Pancytopenia (lack of all 3 blood cell types
• Hypocellular bone marrow (few or no cells)
Causes:
• Congenital (Fanconi’s anaemia)
• Idiopathic
• Can be secondary to drugs (naproxen, diclofenac etc.), chemicals, radiation, cancer, hepatitis, EBV
Signs and symptoms:
• General anaemia symptoms (low RBC count)
• Multiple infections (due to low WBC count)
. Easy bleeding (due to low thrombocyte count)
Allopathic treatment;
• Need conventional / urgent treatment
• Platelet transfusion
• Blood transfusion
• Bone marrow stem cell transplant
Anemias; Haemolytic
(Umbrella term for multiple types of blood destruction)
Anaemia resulting from excessive breakdown of erythrocytes, when bone marrow activity cannot compensate for the loss of RBCs
Pathophysiology:
• Erythrocyte lifespan can be as low as five days
Causes:
• Genetic e.g. sickle cell, thalassaemia
• Rhesus factor incompatibility
• Medications e.g. penicillin
• Autoimmune disorders
• Radiation
• Infections e.g. malaria, viral infections
Signs and symptoms:
• General signs of anaemia
• Jaundice (excess bilirubin production)
• Splenomegaly (excess haemolysis in spleen causes it to enlarge, leading to abdominal distension & feeling of full quickly whilst eating)
• Gallstones
• Vascular occlusions (blockages in blood vessels)
Anaemia; Iron-deficiency
A reduced concentration of haemoglobin in erythrocytes, when bone marrow activity cannot compensate for the loss of RBC’s
Pathophysiology:
• Iron deficiency leads to a reduced concentration of haemoglobin in erythrocytes causing them to appear pale & small (hypochromic microcytic anaemia = low colour small cell)
Causes:
• Deficient diet intake; low meat, dark leafy veg
• Malabsorption; low stomach acid, coeliac disease etc
• Blood loss; Mensus, GIT bleed, post-partum
• Excess requirements; pregnancy, rapid growth
Signs and symptoms:
• General signs & symptoms of anaemia +
• Spoon shaped nails (koilonychia)
• Angular stomatitis (sores in corners of mouth)
• Glossitis (red, inflamed tongue)
• Brittle hair
• Tachycardia
Diagnostic:
• Low RBC’s
• Low Haemoglobin (Hb)
• Low ferritin(correlates w/total body iron stores)
Notes:
• The most common cause of anaemia worldwide
Anaemia ; Megaloblastic
Megaloblastic anaemia is characterised by large, immature and dysfunctional red blood cells
(large immature cells)
Pathophysiology;
• Folate (folic acid) & B12 are required for DNA synthesis in all proliferating cells e.g. erythrocytes
• DNA replication is slowed down & cell growth continues without division & maturation resulting in large erythrocytes (may have a nucleus & shorter life span) – macrocytic cells
Causes:
• Deficient dietary intake of folate (folic acid) & / or Vitamin B12 - (rare, except in vegans)
• Lack of intrinsic factor due to autoimmune disease (pernicious anaemia), gastrectomy, chronic gastritis, stomach cancer
• Malabsorption in crohns disease, surgical excision, coeliac disease.
• Low HCL and pancreatic enzymes
• Drugs – methotrexate is a folate antagonist
Signs and symptoms:
• General anaemia signs & symptoms
• Megaloblast anaemia B12:
• Enlarged red sore shiny tongue
• Neurological symptoms; tingling, numbness, weakness, loss of coordination, burning sensations, tinnitus, depression
• Megaloblast anaemia Folate:
• Same as above for B12 but no neurological damage
Diagnostic:
• Diagnosis by blood test;
• MCV >97 Fl
Anaemia; Sickle Cell
(Haemolytic Anaemia)
Sickle cell anaemia/disease is associated with an abnormal beta-globin chain in haemoglobin, which distorts the shape of the cell
Causes:
• To be born with sickle cell anaemia, bith parents must have the gene for a sickle haemoglobin (HbS)
• People who inherit a gene for sickle haemoglobin (HbS) from one parent & a gene for normal haemoglobin (HbA) from the other have sickle cell traits
• Sickle cell disease occurs predominantly in people of Africa and Afro-Caribbean origin
Signs and symptoms:
• Usually begions age 3-6 months as HbF falls
• General signs and symptoms of anaemia
• Splenomegaly
• Jaundcie
• Can also occlude vessels. Pain and swelling in hands / feet, placental infarction, strokes, renal colic
Diagnostic:
• Blood test;
• Low FBC
• Low Haemoglobin (Hb is 6-8 g/dL)
• Blood film
Allopathic treatment;
• Analgesics (pain relief)
• Antibiotics (prophylacis)
• Fluid therapy
• Blood transfusion
• Bone marrow transplant
Haemolytic Disease of the Newborn
(Haemolytic Anaemia)
Occurs when the mother produces anti-rhesus antibodies that cross the placenta
Pathophysiology:
• The antibodies bind to the foetal rhesus antigens, causing agglutination and haemolysis
• Sensitisation occurs with the first baby producing maternal antibodies against rhesus
• The greatest possibility of sensitization occurs at delivery, so the first born child is normally unaffected
Allopathic treatment;
• Anti rhesus antibodies can be given during pregnancy to bind to rhesus antigens & block them
Haemophilia
A deficiency of clotting factors
(Tendency to bleed)
Pathophysiology:
• Haemophilia A; Deficiency in clotting factor 8
• Haemophilia B; Deficiency of clotting factor 9
(AKA Christmas factor/disease)
Causes:
• Genetic; X-linked recessive disorder (usually affects males. 1 in 5000 males. Females normally carriers.)
Signs and symptoms:
• Severe disease; excessive and easy bleeding
• GIT/ mucosal haemorrhage
• Haematuria (blood in urine)
• Haemarthrosis (blood in joints)
• Inflammation and pain
• Moderate disease; easy bleeding
• Mild disease; bleeding after major trauma
Allopathic treatment;
• Replacemnet of clotting factors
• Blood transfusion
• Avoid contact sports
Other:
Haemophilla A and B are very similar. A is more prevalent and severe.
Leukaemia
(Bone marrow cancer)
Leukaemia describes a group pf bone marrow cancers, characterized by an abnormal over production of leukocytes
Pathophysiology;
• Uncontrolled proliferation of leukocytes results in suppressed erythrocyte production (anaemia) & thrombocytes (thrombocytopenia)
• Divided into 2 types:
• Acute leukaemias; rapid onset, more aggressive course, immature cells (>20% - blast cells in bone marrow)
• Chronic leukaemia; insidious onset & more differentiated / mature cells
Signs and symptoms:
• General anaemia symptoms
• Malaise
• Frequent infections
• Easy bleeding / bruising
• Fever
• Weight loss
• Splenomegaly (abdominal swelling / enlargement)
• Lymph node enlargement
Diagnostic:
• FBC; Anaemia, low thrombocytes, variable leukocyte count
• Blood film
• Bone marrow biopsy (gold standard)
Allopathic treatment;
• Chemotherapy
• Bone marrow transplant
• Radiotherapy
Other:
Four types of leukaemia:
1. Acute myelogenous leukaemia (AML)
2. Acute lymphocytic leukaemia (ALL) (most common known paediatric cancer)
3. Chronic myeloid leukaemia (CML)
4. Chronic lymphocytic leukaemia (CLL)
• Lymphoid cell line involves lymphocytes (T and B cells and NK cells)
• Myeloid cell line involves every other cell in immune system
• Relapse in common
Leukocytosis
Leukocytosis = marked increase in the number of all leukocytes
(Increase in WBC’s)
Causes:
• Response to infections (physiological)
• Leukaemia (uncontrolled production of leukocytes in bone marrow due to cancer)
• Physical stress e.g. injury, surgery)
Leukopenia
(Leukocyte pathologies)
Leukopenia = marked reduction in the number of leukocytes (Lack of WBC’s)
Causes:
• Viral infections e.g. glandular fever, hepatitis, HIV
• Drug toxicity e.g. chemotherapy, radiation
• Bone marrow disease
• Nutriitional deficiencies e.g. folate, B12
Signs and symptoms:
• Often asymptomatic until you get an infection
• Severe illness;
• Nausea
• Fatigue
• Cough
• Shortness of breath
• Fever Malaise
• Severe infections and sepsis can be fatal
Other:
• A common subgroup of leukopenia is neutropenia (the most abundant leukocyte)
• Normal neutrophil count is 2.5 – 7.5 x 10 9/L
Polycythaemia
(AKA Erythrocytosis)
Polycythaemia describes an excessive production of erythrocytes resulting in increased blood viscosity, reduced blood flow & an increased risk of thrombosis (many blood cells)
Causes:
• High altitude
• Genetic / Unknown
Signs and symptoms:
• Mild cases may cause no symptoms
• Arterial thrombosis; Myocardial infarction (heart attack), pulmonary embolism, stroke
• Venous thrombosis; Deep vein thrombosis (DVT)
• Hypertension
• Red skin
• Headaches
• Dizziness
• Pruritis
Thalassaemia (Haemolytic Anaemia)
Thalassaemia describes a defect in synthesis of either the alpha or beta Hb chains
Causes:
• Inherited disease (genetic fault)
Signs and symptoms:
• A-Thalassaemia (can be lethal in utero in severe cases ‘major’);
• General signs of anemia
• Jaundice
• Splenomegaly
• Hepatomegaly
• To compensate haemolysis, bone marrow proliferation (mostly skull / ribs)
• B-Thalassaemia (starts when HbA production begins / gamma chain ceases (usually later part of 1st year)
• Failure to thrive & anaemia
Notes;
HbA (2-alpha and 2-beta) - adult
HbF (2-alpha and 2-gamma) - foetal
Thrombocytopenia
Reduction in the thrombocyte count (Low platelets)
Causes:
• Leukaemia
• Congenital (e.g. Fanconi’s anaemia)
• Radiation
• Drugs
• Chemotherapy
• Viral infections (EBV, hepatitis, HIV, MMR)
• Autoimmune destruction
Signs and symptoms:
• Excessive bleeding and bruising
• Prolongued bleeding times (spontaneous bleeding occurs when count is less than 30)
• Petechia (micro haemorrhages in the skin)
• Haematuria (blood in urine)
• Vomiting blood
• Bleeding gums
• Post-partum haemorrhage
Other:
Normal levels; 150-400
Below 150 = thrombocytopenia
