Week 7: Blood, Circulatory, & Lymphatic Disorders Flashcards
Blood is a _________ that has fluid and cellular components
tissue
Cellular components of the blood are:
RBC - erythrocytes
WBC - leukocytes
platelets
________ is the fluid component of blood
plasma
RBC are important for
oxygen transport
WBC are critical for host _________
defense
Platelets function: critical for :
hemostasis- blood clotting
Albumins are
plasma proteins
Erythropoietin is a glycoprotein hormone, naturally produced by the kidney, that stimulates:
red blood cell production.
The circulatory system consists of:
cardiovascular system
lymphatic system
Arteries—arterioles
~Transport blood :
away from heart
Veins—venules
~Return blood:
back to the heart
Capillaries
~Microcirculation within:
tissues
Systemic circulation
~Exchange of _________________________ in tissues
gases, nutrients, and wastes
Pulmonary circulation
~ ______ exchange in ________
~Gas exchange in lungs
Histology of Arteries and Veins
Tunica ____________ —endothelium (simple
squamous epithelium)
Tunica _____________ —middle layer, mostly smooth muscle
Tunica _____________ (externa)—connective
tissue with fibrocytes, collagen (type I), and
elastic fibers
Tunica intima—endothelium (simple
squamous epithelium)
Tunica media—middle layer, mostly smooth muscle
Tunica adventitia (externa)—connective
tissue with fibrocytes, collagen (type I), and
elastic fibers
Composition of Blood
Plasma- Plasma proteins
Cellular component
-Erythrocytes
-Leukocytes
-Thrombocytes (platelets)
Erythrocytes (Red Blood Cells)
shape:
Biconcave flexible discs
~No nucleus in mature state
Erythrocytes (Red Blood Cells)
Contains hemoglobin:
~Globin portion
~Heme group
Erythrocytes (Red Blood Cells)
Life span—
120 days
Erythropoietin produced in the __________
stimulates : ?
kidney
erythrocyte production.
Blood Clotting—Hemostasis
Three steps:
1- _________________________ after injury
2- __________________________
3- __________________ mechanism
1- Vasoconstriction or vascular spasm after injury
2- Platelet clot
3- Coagulation mechanism
___________ will eventually break down the blood clot
Plasmin
Blood typing is based on __________ in the plasma
membrane of the erythrocytes.
antigens
Blood Typing
ABO system
-Based on the presence or absence of:
-___________ in the blood plasma
Rh system
-___________ in plasma membrane: Rh+
-Absence of ____________: Rh-
ABO system
-Based on the presence or absence of specific antigens
-Antibodies in the blood plasma
Rh system
-Antigen D in plasma membrane: Rh+
-Absence of antigen D: Rh-
Complete blood count (CBC)
-Includes total :
red blood cells (RBCs)
white blood cells (WBCs)
platelets
-Leukocytosis (increased WBCs)
* Associated with:
inflammation or infection
Leukopenia (decreased WBCs)
* Associated with some:
viral infections, radiation, chemotherapy
Leukocytosis is
increased WBC
Increased eosinophils
* Common in:
allergic responses
Leukopenia is
decreased WBC
Morphology
-Observed with ________1_______
-Shows size, shape, uniformity, maturity of cells
* Different types of ____2______ can be distinguished.
1- blood smears
2- anemia
Hematocrit- Percent by volume of
cellular elements in blood
Hemoglobin
-Amount of hemoglobin per unit volume of blood
-Mean corpuscular volume (MCV)
* Indicates the : ?
oxygen-carrying capacity of blood
Reticulocyte count: Assessment of __________________ function
bone marrow
Chemical analysis
-Determines __________ ________ of components, such as iron, vitamin B12, folic acid, cholesterol, urea, glucose
serum levels
Bleeding time- Measures __________ function
platelet
Prothrombin time (PT) and partial thromboplastin
time (PTT)
-Measure function of various factors in : _____________________
-International normalized ratio (INR) is a
standardized version.
coagulation process
Anemia causes a reduction in: ?
oxygen transport.
Basic problem of anemia is :
hemoglobin deficit
Oxygen deficit leads to:
-Less ____________1___________ in all cells
* Cell metabolism and reproduction diminished
-_______2_________ mechanisms
* Tachycardia and peripheral vasoconstriction
-General signs of _______3_____
* Fatigue, pallor (pale face), dyspnea, tachycardia
-Decreased regeneration of epithelial cells
* Digestive tract becomes inflamed and ulcerated, leading to stomatitis
* Inflamed and cracked lips * Dysphasia
* Hair & skin may show degenerative changes.
-Severe anemia may lead to angina or congestive
heart failure (CHF).
1- energy production
2- Compensation
3- anemia
Iron Deficiency Anemia
Insufficient iron impairs :
Microcytic, hypochromic RBCs
* Result of low hemoglobin concentration in cells
hemoglobin synthesis.
Iron Deficiency Anemia
Very common
-Ranges from mild to severe
-Occurs in all age groups, but more common in
women of childbearing age
-Estimated that ________ women is affected
* Proportion increases for pregnant women
one in five
Iron Deficiency Anemia is Frequently a sign of :
an underlying problem
Iron Deficiency Anemia: Causes
-Dietary intake of iron below min. requirement
- ________1____________ [from bleeding, ulcer, hemorrhoids, cancer]
-Impaired __________2____________ of iron
-In many disorders, ______3_________ syndromes
-Severe ____4____ disease
-May affect iron absorption as well as storage
1- Chronic blood loss
2- duodenal absorption
3- malabsorption
4- liver
Iron Deficiency Anemia: Signs
and Symptoms
-Pallor of skin and mucous membranes
-Fatigue, lethargy, cold intolerance
-Irritability
-Degenerative changes
-Stomatitis and glossitis
-Menstrual irregularities
-Delayed healing
-Tachycardia, heart palpitations, dyspnea, syncope
-Intrinsic factor secreted by gastric mucosa
-Required for intestinal absorption of: ?
vitamin B12
Pernicious Anemia: Vitamin B12 Deficiency
Basic problem is lack of absorption of vitamin B12 because of :
lack of intrinsic factor
Pernicious Anemia: Vitamin B12 Deficiency
Characterized by ____________________________________ erythrocytes
-Carry less ?
- _______ life span
Characterized by very large, immature, nucleated erythrocytes
-Carry less hemoglobin
-Shorter life span
Pernicious Anemia: ______________ Deficiency
Vitamin B12
Pernicious Anemia: Vitamin B12 Deficiency
Causes
Dietary insufficiency is very rarely a cause.
- _________ factors have been implicated.
-Often accompanies ?
-May also be an outcome of _______ surgery
Dietary insufficiency is very rarely a cause.
-Genetic factors have been implicated.
-More common in light-skinned women of northern European ancestry
-Often accompanies chronic gastritis
-May also be an outcome of gastric surgery
Vitamin B12 is needed for the function and maintenance of :
neurons.
A significant deficit of vitamin B12 will cause
symptoms in the _____________________
-These may be reversible.
peripheral nerves.
Pernicious Anemia: Vitamin B12 Deficiency
Manifestations in addition to those typical for anemias
-Tongue is :
-Digestive :
-Feeling of :
-Tongue is typically enlarged, red, sore, and shiny.
-Digestive discomfort, often w/ nausea & diarrhea
-Feeling of pins and needles, tingling in limbs
Pernicious Anemia: Vitamin B12 Deficiency
Diagnostic tests
- Microscopic examination (erythrocytes)
- Bone marrow examination (hyperactive)
- Vitamin B12 serum levels below normal
- Presence of hypochlorhydria or achlorhydria
- Presence of gastric atrophy
Aplastic Anemia
-Impairment or failure of ________________
~May be temporary or permanent
bone marrow
Aplastic Anemia is often idiopathic but possible causes include:
Myelotoxins
Viruses
Genetic abnormalities
examples?
Myelotoxins
* Radiation, industrial chemicals, drugs
Viruses
* Particularly hepatitis C
Genetic abnormalities
* Myelodysplastic syndrome
* Fanconi’s anemia
Aplastic Anemia
Blood counts indicate _____________
-Anemia, leukopenia, thrombocytopenia
-Bone marrow biopsy may be required.
-Erythrocytes often appear normal.
pancytopenia.
Aplastic Anemia
Identification of cause and prompt treatment
needed for : _________________________
-Removal of any bone marrow suppressants
-Failure to identify cause and treat effectively is
life-threatening!
bone marrow recovery
Hemolytic Anemia results from excessive:
destruction of RBCs
Hemolytic Anemia
Causes
-Genetic defects
-Immune reactions
- Changes in blood chemistry
-Infections such as malaria
- Toxins in the blood
- Antigen-antibody reactions
* Incompatible blood transfusion
* Erythroblastosis fetalis
Sickle Cell Anemia is a
Genetic condition
Sickle Cell Anemia
-Autosomal
- _____________ dominance
-Anemia occurs in ____________ recessive.
-Diagnostic testing is available.
-More common in individuals of _________ ancestry
* Heterozygous condition is somewhat protective against __________.
* 1/10 African Americans heterozygous for trait.
-Autosomal
-Incomplete dominance
-Anemia occurs in homozygous recessive.
-Diagnostic testing is available.
-More common in individuals of African ancestry
* Heterozygous condition is somewhat protective against malaria.
* One in ten African Americans is heterozygous for the trait.
Sickle cell crisis occurs whenever oxygen
levels are:
lowered
Sickle Cell Anemia
-Abnormal hemoglobin (HbS)
-Altered hemoglobin is unstable and changes shape in hypoxemia.
-Sickle-shaped cells are too _________ to pass through the microcirculation.
-Obstruction leads to ____________________________________________________________
-Abnormal hemoglobin (HbS)
-Altered hemoglobin is unstable and changes shape in hypoxemia.
-Sickle-shaped cells are too large to pass through the microcirculation.
-Obstruction leads to multiple infarctions and areas of necrosis
Sickle Cell Anemia
Multiple infarctions affect :
brain, bones, organs
Clinical signs of Sickle Cell Anemia do not usually appear until the child is:
about 1 year old
Sickle Cell Anemia: Signs and
Symptoms
-Severe pain due to ischemia of tissues & infarction
-Pallor, weakness, tachycardia, dyspnea
-Hyperbilirubinemia—jaundice
-Splenomegaly
-Vascular occlusions and infarctions
»>In lungs
* Acute chest syndrome
»>Smaller blood vessels
* Hand-foot syndrome
-Delay of growth and development
- Congestive heart failure
Sickle Cell Anemia
Diagnostic tests
- Blood test
- Hemoglobin electrophoresis
- Prenatal DNA analysis
Sickle Cell Anemia Treatment
-Hydroxyurea reduced the frequency of this crisis.
- Dietary supplementation with folic acid
- Bone marrow transplantation
- Immunization in children
* Against pneumonia, influenza, meningitis
Primary polycythemia—polycythemia vera
-Increased production of __________ and other
cells in the bone marrow
- ___________ disorder
- Serum erythropoietin levels are low.
-Increased production of erythrocytes and other
cells in the bone marrow
- Neoplastic disorder
- Serum erythropoietin levels are low.
Secondary polycythemia—erythrocytosis
- Increased _____ in response to prolonged hypoxia
- Increased erythropoietin secretion
- Compensation mechanism to provide increased
___________________
- Increased RBCs in response to prolonged hypoxia
- Increased erythropoietin secretion
- Compensation mechanism to provide increased
oxygen transport
Polycythemia: Signs and Symptoms
-Distended blood vessels, sluggish blood flow
-Increased blood pressure
-Hypertrophied heart
-Hepatomegaly
- Splenomegaly
- Dyspnea
- Headaches
- Visual disturbances
- Thromboses and infarctions
Polycythemia Diagnostic tests show
Increased_____ counts
Increased ____________________________________________ values
Hypercellular _________________
Hyperuricemia
- Increased cell counts
- Increased hemoglobin and hematocrit values
- Hypercellular bone marrow
- Hyperuricemia
Polycythemia Treatment
- Identify cause
- Drugs or radiation
- Suppression of bone marrow activity
- Periodic phlebotomy
Indications of Blood-Clotting Disorders
-Persistent bleeding from gums
-Repeated epistaxis
-Petechiae
-Pinpoint, flat, red spots on skin & mucous membrane
-Frequent purpura and ecchymosis
-More than normal bleeding in trauma
-Bleeding into joint—hemarthroses
-Swollen, red, painful
-Hemoptysis
Hemophilia A
Classic hemophilia- Deficit or abnormality of ______________
Classic hemophilia
~Deficit or abnormality of factor VIII
Hemophilia A
trait?
Manifested in?
Carried by?
Most common inherited clotting disorder
- X-linked recessive trait
- Manifested in men, carried by women
Hemophilia A
- Prolonged bleeding after ___________________
- Spontaneous bleeding into _______
- Possible hematuria or ________________
- Prolonged bleeding after minor tissue trauma
- Spontaneous bleeding into joints
- Possible hematuria or blood in feces
Hemophilia A Diagnostic tests
-Bleeding time and PT normal
-PTT, activated PTT (aPTT), coagulation time prolonged
-Serum levels of factor VIII are low
Hemophilia A Treatment
Desmopressin (DDAVP)
Replacement therapy for factor VIII
Von Willebrand’s Disease is the most common __________ _____________ disorder
hereditary clotting
Von Willebrand’s Disease has ____ major types
3
Von Willebrand’s Disease
Signs and symptoms include:
- Skin rashes
- Frequent nosebleeds
- Easy bruising
- Bleeding of gums
- Abnormal menstrual bleeding
Disseminated Intravascular Coagulation involves both :
excessive bleeding and clotting
Disseminated Intravascular Coagulation
Excessive ___________________
- Thrombi and infarcts occur.
clotting in circulation
Disseminated Intravascular Coagulation
Clotting factors are : ____________________________
reduced to a dangerous level.
Disseminated Intravascular Coagulation
leads to:
Widespread, uncontrollable hemorrhage results.
Very poor prognosis, with high fatality rate
Complication of many primary problems
-Obstetrical complications, such as abruptio placentae
-Infections, Carcinomas, Major trauma
Thrombophilia
- Group of inherited or acquired disorders
- Risk of _________________ in veins or arteries
- Blood testing for _________________ levels and
abnormal antibody levels - Causative condition should be treated.
- Group of inherited or acquired disorders
- Risk of abnormal clots in veins or arteries
- Blood testing for clotting factor levels and
abnormal antibody levels - Causative condition should be treated.
Myelodysplastic Syndromes
Diseases that involve inadequate production of cells by:
the bone marrow
Myelodysplastic Syndromes
Signs and symptoms include anemia;
dependent on type of ____________ that occur
May be idiopathic or occur after
chemotherapy or radiation treatment
deficiencies
The Leukemias
Group of neoplastic disorders involving:
white blood cells
Myelodysplastic Syndromes
Treatment measures depend on deficiency
type;
Treatment measures depend on deficiency
type.
- Transfusion replacement
- Chelation therapy to reduce iron overload
- Bone marrow transplantation
Leukemias
Uncontrolled WBC production in :
bone or lymph nodes
The Leukemias
- One or more types of leukocytes are
_______________________________________ - Large numbers released into ____________________
- Infiltrate lymph nodes, spleen, liver, brain, other
organs
- One or more types of leukocytes are
undifferentiated, immature, and nonfunctional. - Large numbers released into general circulation
- Infiltrate lymph nodes, spleen, liver, brain, other
organs
Acute leukemias (ALL and AML)
- High proportion of immature _______________ cells in bone marrow and peripheral circulation
- Onset usually __________, marked signs of complications
- Occurs primarily in :
- High proportion of immature nonfunctional cells in bone marrow and peripheral circulation
- Onset usually abrupt , marked signs of complications
- Occurs primarily in children and younger adults
Chronic leukemias (CLL and CML)
- Higher proportion of ________ cells
- Insidious onset
- Mild signs and better prognosis
- Common in :
- Higher proportion of mature cells
- Insidious onset
- Mild signs and better prognosis
- Common in older adults
Signs and Symptoms of Acute Leukemia
Usual signs at onset
-Frequent or uncontrolled infections
-Petechiae and purpura
-Signs of anemia
Severe and steady bone pain
Weight loss, fatigue, possible fever
Enlarged lymph nodes, spleen, liver
Headache, visual disturbances, drowsiness,
vomiting
The Leukemias Diagnostic tests
Peripheral blood smears
* Immature leukocytes and altered numbers of WBCs
* Numbers of RBCs and platelets decreased
* Bone marrow biopsy for confirmation
The Leukemias Treatment
-Chemotherapy
-ALL in young children responds well to drugs
-Biological therapy (interferon)
* May be used to stimulate the immune system
Complications of Leukemia
-Opportunistic infections, including ________________
-Sepsis
-Congestive _______ failure
-Hemorrhage
-_______ failure
-_______ failure
-CNS depression and coma
-Opportunistic infections, including pneumonia
-Sepsis
-Congestive heart failure
-Hemorrhage
-Liver failure
-Renal failure
-CNS depression and coma
Multiple Myeloma
Neoplastic disease that involves increased
production of ______________ in bone marrow
plasma cells
Multiple Myeloma
-_________ cause
-Occurs in:
-Production of other blood cells is impaired
- Multiple tumors in _____
-Loss of bone
-Severe bone pain
-Prognosis poor, with short life expectancy
-Unknown cause
-Occurs in older adults
-Production of other blood cells is impaired
- Multiple tumors in bone
-Loss of bone
-Severe bone pain
-Prognosis poor, with short life expectancy
Lymphatic Structures
Lymphatic vessels
Lymphoid tissue
Lymphatic nodules
Tonsils
Lymph nodes
Spleen
Thymus gland
Red bone marrow
Function of lymphatic system
Return of excess interstitial fluid to:
Filter and destroy foreign material > Initiate the immune response
Absorb lipids from:
Return of excess interstitial fluid to the
cardiovascular system
Filter and destroy foreign material > Initiate the immune response
Absorb lipids from the GI tract
Lymphatic Vessels Originate as __________ in contact with blood capillary bed in tissues
capillaries
Lymphatic trunks empty into:
Ducts empty into the :
ducts
subclavian veins
Lymph
-Clear, watery, ____________________
-Circulates in lymphatic vessels
-Resembles _______________, with a lower protein content
-Returned to:
-Clear, watery, isotonic fluid
-Circulates in lymphatic vessels
-Resembles blood plasma, with a lower protein content
-Returned to the cardiovascular system
Lymphomas
Malignant neoplasms involving lymphocyte
proliferation in _______________
lymph nodes
Lymphomas
Specific causes not identified
-Higher risk in adults who received __________ during childhood
radiation
Lymphomas
Two main disorders
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
* Distinguished by multiple node involvement
* Nonorganized, with widespread metastases
Hodgkin’s Lymphoma
Initially involves a single __________________
lymph node
Hodgkin’s Lymphoma
Cancer spreads to _________________
- To organs via lymphatics
- T lymphocytes seem to be defective; lymphocyte
count decreased
- Presence of Reed-Sternberg cells
* _____________ present in lymph node
- Four subtypes
* Based on cell found at biopsy
Cancer spreads to adjacent nodes
- To organs via lymphatics
- T lymphocytes seem to be defective; lymphocyte
count decreased
- Presence of Reed-Sternberg cells
* Giant cells present in lymph node
- Four subtypes
* Based on cell found at biopsy
Hodgkin’s Lymphoma Symptoms
First-
Later-
General-
-First indicator—usually a painless enlarged lymph
node
-Later—splenomegaly and enlarged lymph nodes
- General signs of cancer
- Weight loss, anemia, low-grade fever, night sweats; fatigue may develop.
Hodgkin’s Lymphoma Treatment
Radiation, chemotherapy, surgery
Hodgkin’s Lymphoma
Staging and prognosis dependent on:
Number of nodes involved
Location of nodes involved
Non-Hodgkin’s Lymphoma
Increasing in incidence
- Partially caused by HIV infection
- Similar to Hodgkin’s lymphoma
- Clinical signs and symptoms are similar.
- More difficult to treat when tumors are not
localized - Initial manifestation—enlarged, painless
lymph node
Signs and Symptoms of Multiple Myeloma
Pain caused by ______________________
Anemia and___________________________
Impaired __________ function; eventually failure
Chemotherapy to encourage remission
Median survival, ___ years
- Pain caused by bone involvement
- Anemia and bleeding tendency
- Impaired kidney function; eventually failure
- Chemotherapy to encourage remission
- Median survival, 3 years
Lymphedema
- Obstruction of _______________________
- Most common form is ________
- Extremities swell because of lymph accumulation
- Obstruction of lymphatic vessels
- Most common form is congenital
- Extremities swell because of lymph accumulation
Lymphedema
Treatment:
- Diuretics
- Bed rest
- Massage of affected area
- Elevation of affected extremity
Elephantiasis
- Lymphedema caused by blockage because of parasitic infection
- Significant swelling of affected extremity
–Extreme swelling of legs, breast, and/or genitalia
–Thickening of subcutaneous tissue
–Frequent infections
–Skin ulcerations
–Fever
Treatment of Elephantiasis
medication regimen to kill parasite
Castleman’s Disease is a Rare illness that Involves overgrowth of:
lymphoid tissue
Castleman’s Disease
Two types:
- ____________ form
* Affects a single lymph node - _____________ form
* Affects multiple lymph nodes and tissue—may have severe effects on the immune system
- Unicentric form
* Affects a single lymph node - Multicentric form
* Affects multiple lymph nodes and tissue—may have severe effects on the immune system
