Cardiovascular & Lymphatic Systems: Fluid Balance & Disorders

• Unit 6 is about blood and lymphatic disorders
• Blood and circulatory system disorders are discussed in chapter 10

Circulatory systems

• Includes the cardiovascular and lymphatic systems
• The covered topics include blood vessels, the blood, and associated disorders

Blood Vessels

• Arteries and arterioles transport blood away from the heart
• Veins and venules return blood to the heart
• Capillaries facilitate microcirculation within tissues
• Systemic circulation involves the exchange of gases, nutrients, and wastes in tissues
• Pulmonary circulation facilitates gas exchange in the lungs

Histology of Arteries and Veins

• Tunica intima is the endothelium composed of simple squamous epithelium
• Tunica media is the middle layer, consisting mostly of smooth muscle
• Tunica adventitia (externa) is the outer connective tissue with fibrocytes, collagen (type I), and elastic fibers

Blood

• Blood transports oxygen and nutrients to tissues
• It removes waste products of cellular metabolism
• Blood plays a crucial role in body defenses/immune system
• It helps in maintaining body homeostasis
• Plasma is a component of Blood, including plasma proteins
• The blood cellular component is composed of erythrocytes, leukocytes, and thrombocytes (platelets)
• Whole blood consists of 55% plasma and 45% formed elements (Leukocytes & Erythrocytes)
• Plasma consists of 91% of water, 7% Proteins, and 2% other solutes
• Plasma proteins consist of 57% Albumins, 30% Globulins, 4% Fibrinogen and 1% Prothrombin
• Formed elements consist of <1% Leukocytes and 60%-70% Neutrophils
• Formed elements consist of <1% Leukocytes and 20%-25% Lymphocytes
• Formed elements consist of <1% Leukocytes and 3%-8% Monocytes
• Formed elements consist of <1% Leukocytes and 2%-4% Eosinophils
• Formed elements consist of <1% Leukocytes and 0.5%-1% Basophils

Erythrocytes

• Are biconcave flexible discs without a nucleus when mature
• Erythrocytes contain hemoglobin, including globin and a heme group
• The life span of an erythrocyte is approximately 120 days
• Erythropoietin, produced in the kidney, stimulates erythrocyte production

Hemoglobin Breakdown

• Erythrocytes hemolysis happens in the speen and liver
• Hemoglobin breaks down to globin and heme
• Globin breaks down to amino acids that are recycled
• Heme breaks down to iron and bilirubin
• Iron goes to bone marrow, bilirubin goes to the liver
• In the liver bilirubin is transported bound to serum albumin
• In the liver unconjugated bilirubin is converted to conjugated bilirubin
• The conjudated bilirubin turns to bile

Blood Clotting - Hemostasis

• Vasoconstriction/vascular spasm occurs after injury
• This is followed by platelet plug formation
• Then a coagulation mechanism happens
• Plasmin will eventually break down the blood clot

Clot Formation

• Prothrombin factor production is triggered by tissue damage
• Prothrombin factor II is converted into thrombin
• Thrombin converts Fibrinogen (factor I) into fibrin threads
• A fibrin mesh then forms to trap cells
• Pulling the edges of damaged together and sealing is enabled by clot retraction/shrinking

Blood Typing

• Blood type is based on antigens in the plasma membrane of erythrocytes.
  • ABO System
    • The presense or absence of specific antigens are tested
    • Antibodies are tested in the blood plasma
  • Rh System
    • Antigen D in plasma membrane indicates Rh+
    • Absence of antigen D indicates Rh-
• Blood group O has Anti-A and anti-B in plasma
• Blood group A has RBC antigens A and anti-B in plasma
• Blood group B has RBC antigens B and anti-A in plasma
• Blood group AB has RBC antigens A&B and neither anti-A or anti-B in plasma
  • Group O can receive group O
  • Group A can receive group O or A
  • Group B can receive group O or B
  • Group AB can receive group O, A, B, or AB

Complete Blood Count (CBC)

• Includes total red blood cells (RBCs), white blood cells (WBCs), and platelets
  • Leukocytosis (increased WBCs), associated with inflammation or infection
  • Leukopenia (decreased WBCs)
  • Associated with some viral infections, radiation, chemotherapy
  • Increased eosinophils are common in allergic responses
• A differential count for WBCs measures different attributes of the blood

Morphology

• Morphology, observed with blood smears is the size, shape, uniformity, and maturity of cells
• Morphology can distinguish different types of anemia
• Hematocrit measures the percent by volume of cellular elements in blood
• Hemoglobin measures the amount of hemoglobin per unit volume of blood
  • Mean corpuscular volume (MCV) indicates the oxygen-carrying capacity of blood

Diagnostic Tests

• Reticulocyte count assesses bone marrow function
• Chemical analyisis determines serum levels of components
  • Iron, vitamin B12, folic acid, cholesterol, urea, glucose are tested
• Bleeding time measures platelet function
• Prothrombin time (PT) & partial thromboplastin time (PTT) measure function of coagulation process
• International normalized ratio (INR) is a standardized version of these tests

Blood therapies

• Whole blood products are packed red blood cells or platelets
  • It can assist in anemic or thrombocytopenic instances
• Plasma or Colloid Volume-expanding solutions
  • Help maitain blood volumne
• Artificial blood products
  • Compatible with all blood types BUT
  • None of them can perform all complex functions normal whole blood can

Artificial erythropoietin

• Epoietin Alpha - artificial form of erythropoietin
  • Given before certain procedures, anemia related to cancer, and in patients with chronic renal failure

Bone marrow or Stem Cell Transplantation

• Requires close tissue mass necessary
• Used to treat cancers, severe Immunodeficiency, and severe blood cell dieases

Drug treatment

• Aids drug usage in the clotting progresses

Anemia

• Is a reduction in oxygen transport
• The basic problem is hemoglobin deficit
• Oxygen deficit has many potential causes

Oxygen Deficit Symptoms

• There is less energy production in all cells
  • Cell metabolism and reproduction is diminished
• There are some compensation mechanisms
  • Tachycardia and peripheral vasoconstriction
• General signs of anemia are fatigue, pallor (Pale face), dyspnea, tachycardia
• Decreased epithelial cell regeneration leads to
  • Digestive tract becomes ulcerated and inflamed, leading to stomatitis
  • Dysphagia, inflamed and cracked lips
  • Degenerative changes take place in hair and skin
• The disease can also lead to angina or congestive heart failure (CHF)

Iron deficiency anemia

• Is when insufficient iron impairs hemoglobin synthesis, resulting in microcytic, hypochromic RBCs
  • Results from a low hemoglobin concentration in cells
• Iron deficiency anemia is common, with a varying range of severity
  • It is most common in women of childbearing age, with an estimated one in five women affected
  • Proportion increases for pregnant women
• Iron deficiency anemia is frequently a sign of an underlying problem

Iron Deficiency Anemia: Causes

• Dietary intake of iron below minimum requirement
• Chronic blood loss, such as bleeding, ulcer, hemorrhoids, cancer
• Impaired duodenal absorption of iron, due to malabsorption syndromes such as iron
• Impaired duodenal absorption of iron, due to severe liver disease
• May affect iron absorption as well as storage

Iron Deficiency Anemia: Signs and Symptoms

• Pallor of skin and mucous membranes
• Fatigue, lethargy, cold intolerance
• Irritability
• Digestive issues/degenerative changes
• Stomatitis and glossitis
• Menstrual irregularities
• Delayed healing
• Tachycardia, heart palpitations, dyspnea, syncope

Pernicious Anemia

• Is mainly characterized with a vitamin B12 deficiency
• It is a basic problem from the lack of absorption of vitamin B12 due to lack of intrinsic factor
  • The intrinsic factor is secreted by gastric mucosa and is
  • Needed for intestinal B12 absoprtion

Pernicious Anemia: Immature Erythrocytes

• Characterized by very large, immature, nucleated erythrocytes
• Immature Erythrocytes carry less hemoglobin
• Immature Erythrocytes have a shorter life span
• Dietary insufficiency is very rarely a cause Genetic factors have been implicated
  • Common in light skinned women of northern European ancenstry
• Often accompanies chronic astritis May also be an outcome of gastric surgery
• Vitamin B12 is needed for proper neuron function and maintenance.
  • Significant vitamin deficit will cause symptoms in peripheral nerves that can be reversible

Additional Manifestations of Vitamin B12 deficiency

• Tongue is typically enlarged, red, sore, and shiny
• There is digestive discomfort, often with nausea and diarrhea
• There is tingling, pins, and needles in limbs

Diagnostic Test for Pernicious Anemia

• Microscopic examination on (Erythrocytes)
• Bone marrow examination (hyperactive)
• Vitamin B12 deficiency
  • Serum levels are below normal
• There may be hypochlorhydria or achlorhydria
• There may presence of have gastric atrophy

Aplastic Anemia

• Is often caused by bone narrow failure or impairment
  • This is often temporary, but may be permanent
• Some potential causes inculde
  • Myelotoxins that affect industrial chemicals drugs
  • Viruses particularily hepititis c
  • Genetic Abnormalities
  • Myelodystplastic syndrome
  • Fanconi's anemia

Aplastic Anemia II

• Blood counts indicate pancytopenia
  • Anemia, Leukopenia, Thrombocytopenia
  • Bone marrow biopsy may be required
  • Erythrocytes tend to appear normal

Hemolytic Anemia

• Excessive RBC destruction
• Causes are
  • Genetic defects, immune reactions, changes in blood chemistry infection such as malaria
  • Toxins in the blood and atigen antiody reactions

Sickle Cell Anemia

• It is a genetic condition of incomplete dominance that is passed down by an autosomal process
• Anemia occurs in individuals who are homozygous recessive
• Diagnostic testing is available
• Is more common in indivduals of african descent
  • The heterozygous condition makes them protective against the effects of malaria

Abnormal Hemoglobin & Sickle cells

• The disease is cause by abnormal hemoglobin (HbS)
• Episodes of sickle cell crisis occur whenever oxygen level are lowered
  • It results in lowered stability of hemoglobin in hypoxic states

Problems due to the Sickle cell shape

• The unusual elongated shape hinders the ability of the sickle cells to navigate the microcirculatory environment – Obstruction leads to multiple tissue infarct and areas of necrosis

Sickle Cell Anemia: Effects

• Multiple infarctions affect brain, bones, organs
• hyperbilirubinemia, jaundice, gallstones
  • Caused by a high rate of hemolysis
• Clinical signs
  • Do not usually appear until the child is about 12 months old
• Can cause
• Multi infarction of major organ
• Hemolytic anemia
• Increased hemolisis in the spleen and tissue damage

Signs and Symptoms of Sickle Cell Anemia

• Severe pain caused by restricted blood flow from affected tissue.
• Pallor of skin w/ weakness w/ tachycardia
• Splenomegaly
• Hyperbilirubinemia-jaundice Vascular restriction due to small micro infarct
• hand and for syndrome
• Acute chest sydrome due to infarction
• Delayed growth and development
• Congestive Heart failure

Diagnosis & Treatment

• Abnormality may determine w/ blood work
• Hemoglobin and prenatal dna analyisis
• To lower crises
• Hydroxy urea (increase red production)
• Dietary suppliment w/ Folic acid
• Bone marrow transplant
• Vaccinations in children
• Pneumonia, Flu & meningitis

Thalassemia

• This genetic defect causes one or more of the genes for hemoglobin to be missing or affected
• Moderate to severe conditions result when two genes are invovled

Thalassemia effects

• Inadequate globulin chain formation
• reduced hemoglobin
• reduced output of red blood cells

Thalassemia Symptoms

• Typical anemia, increased hemolysis Hypoxia may hinder growth and development
• Direct impairments is common due to hyperactivity
• Hyperactiviity results from invasive skeletal development

Indications of blood clotting disorders

• Gums that constantly bleed and persistent nosebleeds.
• flat red dots, frequent eecymosis of skin areas.
• Elevated injury-trauma Bleeding
• Swollen and Pain joint, with frequent hemopptisis

Hemophelia

• A classis form which stems from abnormal facotr VIII
• Common genetic disorder from X linked recessive
• It varies in various degrees

Von Willebrand's Disease

• Genetic clotting disorder that has major types
• Includes frequent skin rashes and bleeds

DIC

• Intavascualr disorder caused by the over clotting of blood
• the clotting factors are reduced to dangerous levels

Thrombophilia

• Inherited disorders cause risk of abnormal clots

Myelodysplastic Syndrome

• Where bone marrow inadequality produces cells

Polycythemia

• Erythrocytes production increase other activity in bone cells

Lymphatic structures

• Vessels, noduels and tissue areas

Primary Polycethemia Indicators

• High blood flow and pressure.
• Large liver size.
• Short of breadth and headaches.
• Blood clots from infarctions

Lympathic System Functions

It re-cycles ISF and absorbs lipids

• Filters for foreign material, starting immune repose
• Ducts flow into subclavis veins
• Isototonic bodily
• Vessels resemble more like a less protein blood system
• Flow from cappilarries to lymphatic ducts.

Lymphatic Circulation

• Largets vessles are interupted periodically by small noded areas
• Drains from subcalvian lymph nods and right subclavia veins.

Lymoh Disorders

• Node of infections - swelling inflammation
• Cancer infection also swelling Lymphadenopathy: May find related to other disease such as aids In swollen and self resolving conditions are present. Diagnosis testing is pet scans and treatment depends type.

Lymphomas

• Maligent Neoplasms with lymphocyte orliferation
• Higher infection or causes. (radiation treatment)
• Main Types
• hodgekinds lumphoma v Non hodgkins. Non Hodgkin are not really localized as much
• Hodgkins-Intailized for a single lyph nodes
• Cancer Spreads from adjacent nodes
• Hodgkins symtoms
• Pailess lymph node enlargment (first idicator)
• later Spheomeglay and enlargemed lymph nodes

Hodgekin Treatment

• Therapy with radiation and surgery (if need)

Non hodgekins

• Symptoms are similar, but not localized
• Cancerous enlarged painless lump

Multi Mylemmae -

• When blood cell productions cells increase with tumors. (blood disroder)
• This causes a decrease in bone cell/Bone production.
• Treatment does not have good result rate

Lypedema

• Most common in congenital formations.
• Where lymphatic vessles are not in shape creating swelling.

Treatment

• Medication regulation and killing of paracite