Major function of blood
transport nutrients and aid in removal of wastes.
Elements of blood
55% plasma 45% RBC, WBC & platelets
Avg supply of blood in adult
5-6 liters or 1.5 gallons
pH of blood
Life span of RBC
Filters out worn RBCs
spleen & liver - also save iron for new RBCs
component of RBC transports O2
WBC > 11,000
sign of infection
Phases of blood coagulation
1. platelets & plasma protiens clump- thromboplastin formed
2. prothrombin converted to thrombin in presence of calcium
3. thrombin & fibrinogen form fibrin w/ calcium fibrin clot forms
4. clot is removed thru fibrinolysis
Type A blood
has A antigens and anti B antibodies
Type B blood
has B antigens and anti A antibodies
Type AB Blood
has A&B antigens and NO antibodies
Type O blood
has NO antigens but both A&B anti-bodies
Blood forming organs
lymph nodes, bone marrow, spleen & liver
Where is bone marrow?
center of long bones and in the spongy part of other bones
Where is the spleen?
ULQ of abd
What does the spleen do?
produces lymphocytes, plasma cells & antibodies, filters MO's and removes old blood cells from body
Where is the liver?
URQ of abd
What does liver do in regards to blood formation?
blood forming intrauterine, produces thrombin & fibrinogen for clotting.
decrease in red blood cells leads to anemia
low or decreased RBC volume; any decrease in O2 carrying ability of the RBC. 400 types. 3 common
low erythrocyte count, headace, fatigue, pallor & shortness of breath.
conditino of increased RBC's
high RBC count, reddened skin tones, bloodshot eyes, increased blood volume & pressure and an increase in workload of the heart.
decrease in WBC count
Neurtopenia & lymphonpenia
neurtophil & lumphocyte decreases. Can be associated with chronic infection.
increase in WBCs. Normal repsonse to acute infection.
"white blood" Leukoctyosis related to a tumor WBC count is EXTREME.
decrease in platelets leading to coagulation problem
small hemorrhages in the skin
large areas of bruising or hemorrhage
S/S of Thrombocytopenia
petechiae, ecchymosies, epitaxis, bleeding lesions in the mouth, gums & mucous membranes
increase in plateles. uncommon and usually no serious side effects
due to low number or RBCs or decrease in hemoglobin in RBCs.. Acute hemorrhage or chronic bleeding, diseases of blood forming organs, abnormal cell formation, dietary definciencies.
S/S of Anemia
Pallor, weakness, fatigue, dyspnea, tachycardia, tachypnea, headache, irritability & syncope
simple case: history, PE, hemoglobin levels, hematocrit, iron, folic acid & B12 levels. Examination of size & shape of RBC
healthy diet high in iron & Bcomplex vitamins. some are not preventable.
Iron Deficency Anemia
insufficient iron for body to produce hemoglobin w/in RBC
Iron Def Anemia ET
loss of iron, inadequate intake of iron, bleeding hemorrhoids, GI bleed & heavy &/or prolonged menses.
Iron Def Anemia Symptoms
pallor, weakness, fatigue, dyspnea, tachycardia, tachypnea
Iron Def Anemia Dx
History, P/E, blood tests shwoing low levels of hemoglobin, iron or both. Also may look for blood in urine & stool. Gastroscopy & colonoscopy.
Iron Def Anemia Tmt
reslove bleeding problem, increase dietary intake of iron - fruits, green veg, lean meat, whole grains
Iron Def Anemia Prev
eating healthy diet high in iron. Seek med help at first sign of excessive bleeding.
Folic Acid Anemia
Definicy in folic acid - beeded for maturation of RBC. Folic Acid is a B complex vitamin
Folic Acid Anemia ET
poor diet, overcooking veg, alcoholism during time of high need as in infancy & pregnancy
Folic Acid Anemia Symptoms
fatigue, weight loss, abd pain, black or bloody stools, chest pain.
Folic Acid Anemia Dx
blood tests. CBC show abnormally large RBC. Blood folate level is low. Bone marrow (rarely needed) biopsy will show large red cell size.
Folic Acid Anemia TMT
increase dietary intake of folic acid: green leafy veg, mushrooms, lima beans & kidney beans.
Folic Acid Anemaia Prev
diet high in folic acid
Vitamin B12 Deficiency Anemia AKA
AKA Pernicous Anemia
Pernicous Anemia Descrp
usually older folks. Autoimmune disease blocks production of intrinsic factor needed for B12 absorption.
Causes of inability to absorb B12
removal of small intestine, disease of small intestine (Crohn's), diet deficint in B12, loss or lack of intrinsic factor.
Pernicous Anemia S/S
pallor, fatigue, weakness, confusion, depression numbness in hands & feet.
Pernicous Anemia DX
Thorough history & physical, CBC, tesing for B12, gastroscopy.
Pernicous Anemia TMT
Absorption & diet def: oral vitamins or injectable B12 or diet high in B12. No intrinsic factor: B12 injections for life
Pernicous Anemia Prev
diet high in vit B12, otherwise not preventable.
Anemia characterized by increased RBC destruction
Hemolytic Anemia ET
Anemia related to antigen-antibody reaction, auto immune leading to destruction of one's own RBC, exposure to benzene, asprin, penicilin & bacterial toxins
pallor, weakness, fatigue, tachycardia (can lead to heart failure)
Hemolytic Anemia DX
History, P/E, blood tests. CBC will reveal anemia. Blood smear will show increase # of immature & fragmented RBC.
Hemolytic Anemia TMT
total exchange of blood; steroids & splenectomy
Hemolytic Anemia Prev
genetic = not preventable. Acquired can be avoided by proper blood screening for transfusions.
Sickle Cell Anemia
Hereditary in African Americans & Mediteraninans.Carried by mother, both sexes can get it, predominatly males
Sickle Cell Anemia S/S
Swelling joints, pain etc
Sickle Cell Anemia TMT
No tmt or cure. Symptoms & complicatins can be prevented or delayed with tmt.
2ndary Polycythemia (Erythrocytosis)
differs from primary in that only RBCs increase
2ndary Polycythemia ET
protective mech of body for increased O2 requirements. Highly trained athletes, high altitude living, smoking.
2ndary Polycythemia S/S
heaches, weakness, fatigue, lightheadedness, shortness of breath. If due to disease of lungs, reddened face & blue during exercise or exertion.
2ndary Polycythemia DX
History, P/E, blood testing. ABG (arterial blood gasses) test can show low O2 levels as well as normal or low ertythropoietin levels. Xray & CT rule out liver, kidney & spleen issues or tumors.
Secondary Polycythemia TMT
Address causes. Lungs: stop smoking.
Secondary Polycythemia Prev
some cases can be prevented by stopping causative factor or by not doing things that deprive the body of O2. Living at high altitude or smoking can be avoided.
Common symptom of WBC disorders
Compromised immune response
Infections aka "kissing disease" or "mono". Affects children & young adults. Somewhat contagious & illness can lasts for several weeks.
Caused by EBV (Epstein Barr virus). Many people are carriers or exposed and never develop disease. spread by direct contact with saliva, sharing utensils, drinking straws, kissing.
Begin 4-7 days after infection. Fatigue, sore throat, fever, swollen lymph glands & splenomegaly.
hstory, P/E & WBC count showing marked elevation in monocytes.
symptomatic only. rest, analgesics, throat gargles w/out complications symptoms are resolved in 3-4 weeks. No sports activities for 1 month following to avoid spleen injury.
Frequent hand washing, covering mouth and nose when sneezing or coughing, not sharing drinks or eating utensils.
Malignant neoplasm of teh blood forming organs. Abnormally high production of immature leukocytes that function abnormally and cause decrease in prod. of RBC and platelets.
commonly affects children, progresses rapidly and can be fatal.
occurs more often in older adults, often asymptomatic & may not cause death.
Leukemia affecting the bone marrow
Leukemia affecting the lymph nodes
cause is unknown
Fatigue, headache, sore throat, dyspnea, bleeding of mucus membranes of the mouth & GI sys, bone & joint pain. Enlargement of lymph nodes, liver & spleen. Bleeding disorders & anemia common due to erythrocytopenia & thrombocytopenia.
clinical history & blood studies. Bone marrow biopsy most definitive to confirm Dx
aggressive chemo. When in remission, bone marrow transplant. Pain for megaly of spleen, lymph nodes & liver treated w/ analgesics. Complete remission abt 50%.
No known way to prevent, although avoiding toxic chems, smoking & radiation may prevent some forms.
aka thrombocytopenia purpura. Decrease in platelets leading to inability to clot normally.
inadequate or abnormal platelet production or destruction. In destruction, platlet life may be only hours instead of days.
Abnormal bleeding in the skin, mucous membranes & internal organs. Petechiae & ecchymoses. GI hemorrhages, frequent epitaxis & hematuria
clinical history, platlet count & bleeding time.
Avoiding tissue trauma, admin of vitamin K to improve clotting, transfussion of platelets. Persistant leads to splenectomy.
Most cases not preventable. Certain ones are: avoid meds that decrease platelet stickiness (asprin & ibuprophen). Avoid heavy drinking (slows platelet production)
Hereditary hemolytic anemia primarly of Mediterranean folks. RBCs are fragile, thin & form defective hemoglobin. RBCs do not functino normally & lead to sys of anemia.
Thalassemia Major. Most severe form of disease and presents in childhood
Von Willebrand's Disease
Hereditary, congenital bleeding disorder caused by deficiency in clotting factor and platelet function. Males & females.
Von willebrand's Disease