Blood Disorder PDF

Blood Disorder By: Maria Lita L. Lopez, MD, FPPS, MHPEd HEMATOLOGY The hematologic or hematopoietic system includes the blood, blood vessels, and blood forming organs ( bone marrow, spleen, liver, lymph nodes, and thymus gland). Major function of blood is to carry necessary materials...

Blood Disorder By: Maria Lita L. Lopez, MD, FPPS, MHPEd HEMATOLOGY The hematologic or hematopoietic system includes the blood, blood vessels, and blood forming organs ( bone marrow, spleen, liver, lymph nodes, and thymus gland). Major function of blood is to carry necessary materials ( oxygen, nutrients ) to cells and to remove CO2 system and metabolic waste products. It also plays a role in hormone transport, inflammatory and immune responses, temperature regulation, fluid-electrolyte balance, and acid-base balance. Blood has three main functions: Transportation Blood carries oxygen, nutrients, hormones, and waste products throughout the body. Regulation Blood helps maintain homeostasis by regulating body temperature, pH, and water levels. Protection Blood protects the body from disease and foreign molecules and helps prevent excessive blood loss. Hematopoiesis (Blood Cell Formation) Occurs in the Red Bone Marrow, chiefly in flat bones like Skull, ribs, pelvis, sternum and proximal epiphyses of the humerus and femur Erythropoiesis – RBC production, is a very active process RBC are continuously being destroyed by the liver & spleen RBC’s have a lifespan of 120 days As RBC’s are destroyed, iron is recycled to the bone marrow for use in the formation of new RBC’s Erythropoietin – secreted by the kidneys & released when blood levels of Oxygen begins to decline for any reason; which stimulates the Red Bone Marrow to produce more RBC’s Hematopoiesis (Blood Cell Formation) ERYTHROPOIESIS- RBC production Requirements : a. Erythropoietin b. Iron c. Folic Acid d. Vitamin B6, Vitamin B12 e. Vitamin C Main components of blood: 1) Plasma The liquid part of blood that makes up about 55% of blood volume Plasma is mostly water, but also contains proteins, fats, vitamins, minerals, hormones, and glucose Plasma carries red and white blood cells and platelets throughout the body Main components of blood: 1) Plasma It is Straw colored, non-living part of the blood Blood plasma is a mixture of proteins, enzymes, nutrients, wastes, hormones and gases. It contains: 91% water and 9% solids That compromises: 1% inorganic molecules like: Na, Ca, Cl, HCO3, K, Mg Main components of blood: 1) Plasma Proteins: Normal Value: 6.4-8.3mg% Albumin: 55% (3-5gm%) It helps substance dissolve in the plasma by binding to them, hence playing an important role in plasma transport of substances such as drugs, hormones and fatty acids. Main components of blood: 1) Plasma Nutrients: These include glucose, amino acids, fats, cholesterol, phospholipids, vitamins and minerals. Gases: O2 and CO2 Electrolytes: Most abundant Sodium Amino Acids, nitrogenous waste, Urea, Uric Acid, Creatinine Main components of blood: 2) Red blood cells Also called erythrocytes, these cells carry oxygen from the lungs to the rest of the body Red blood cells are produced in the bone marrow Red blood cells give blood its red color Main components of blood: 2) Red blood cells Function primarily to ferry Oxygen in the blood to all cells in the body Also transports Carbon dioxide out of the body Lifespan of 120 days only Hemoglobin in the RBC binds with the Oxygen as it is transported in the blood Female : 12 – 16 g/100ml Male : 13 – 18 g/100ml Normal RBC count: about 4 – 6 million/mm³ Hematocrit (HCT) – percentage of RBC per given volume of blood and is an important indicator of the Oxygen-carrying capacity of the blood Female : 37 – 48% Male : 45 – 52% Main components of blood: 2) Red blood cells > destruction - mature cells removed chiefly by spleen & liver * BILIRUBIN = byproduct of Hgb released when RBC’s destroyed * IRON = freed from Hgb during bilirubin formation = transported to bone marrow via TRANSFERIN & reclaimed for new Hgb production `` Liver and Spleen- Graveyard of the RBC Main components of blood: 3) White blood cells Also called leukocytes, these cells help fight infections and disease Different types of white blood cells include lymphocytes, monocytes, eosinophils, basophils, and neutrophils Main components of blood: 3) White blood cells Average value : 4,000 – 11,000 / mm³ Protects the body against any damage Are able to slip in and out of the blood vessels by ameboid fashion – in a process called diapedesis When mobilized, the body speeds up production which usually indicates the presence of infection in the body Leukocytosis – total WBC count above 11,000 / mm³ Leukopenia – an abnormally low WBC count Main components of blood: 3) White blood cells Types: 1. Granulocytes – Neutrophils -Basophils – Eosinophils 2. Agranulocytes – Lymphocytes -Monocytes Cells of the Immune System Lymphocytes – Lymphocytes are created in the bone marrow and migrate to the Thymus where they mature – After becoming immunocompetent, the B & T cells transfer to the lymph nodes & spleen Main components of blood: 3) White blood cells Types 1. B lymphocytes or B cells – produces antibodies to incapacitate the antigen 2. T lymphocytes or T Cells – attacks antigens directly Macrophages Literally means “Big Eaters” Arise from monocytes formed in the bone marrow Major role : to engulf foreign particles Main components of blood: 3) White blood cells Cellular (Cell-Mediated) Immune Response T – Cells Responds directly to antigens Will destroy target cells thru secretions of Lymphokines and Perforin ( “Kiss of Death”) which is inserted to the cell membrane, shortly after that, the target cell ruptures They have a: License to KILL License to HELP License to Suppress Main components of blood: 3) White blood cells Three types : Killer T Cells – binds to the surface of invading cells, disrupt the cell membrane & destroy it by altering it’s environment Helper T cells – helps to stimulate the B Cells to mature into Plasma Cells which synthetize & secrete immunoglobulins (Antibodies) Suppressor T Cells – Reduces the Humoral response Main components of blood: 3) White blood cells Main components of blood: 3) White blood cells Humoral (Antibody-Mediated) Immune Response B Cells – Matures into Plasma Cells responsible for Antibody production – 5 Classes of Immunoglobulins (MADGE) : – Immunoglobulin M (IgM) 1st immunoglobulin produced in an immune responsepresent in plasma, too big to cross membrane barriers – Immunoglobulin A (IgA) Sound in body secretions like saliva, tears, mucus, bile, milk & colostrum – Immunoglobulin D (IgD) Present only in the plasma & is always attached to the B Cel - - Immunoglobilin G (IgG) 80% of circulating antibodies Can cross the placenta and provide passive immunity Present in all body fluids - Immunoglobulin E (IgE) Responsible for Allergic & hypersensitivity reactions Stimulates Mast cells & Basophils to release Histamine which mediates inflammation & the allergic response Main components of blood: 4) Platelets Also called thrombocytes, these small, colourless cell fragments help stop bleeding by sticking to blood vessel walls Platelets are produced in the bone marrow Average value : 250,000 – 450,000 / mm³ Lives for about 5 – 10 days Important in blood clotting Main components of blood: 4) Platelets Hemostasis (Blood Clotting) -Three Major Phases 1. Platelet Plug Formation – Platelets adhere and stick to vessel lining that are damaged forming a Platelet Plug or White Thrombus – Platelets release chemicals to attract more platelets to the injured site 2. Vascular Spasms – Platelets release Serotonin causing spasms of the blood vessel, constricting it & decreasing blood flow 3. Coagulation or Blood Clotting – Thromboplastin is released by damaged cells – plasma Clotting Factors form an activator that triggers the Clotting Cascade – a Blood Clot is formed – Serum is squeezed out within the hour pulling the ruptured edges together Plasma Clotting Factors I Fibrinogen II Prothrombin III Tissue Thromboplastin IV Calcium V Proacelerin VII Proconvertin VIII Antihemophilic Factor IX Christmas Factor X Stuart – Prower Factor XI Plasma Thromboplastin Antecedent XII Hageman Factor XIII Fibrin Stabilizing Factor ANEMIA Conditions in which the number of RBC’s or amount of hemoglobin is lower than normal leads to hypoxia and ischemia Classifications of Anemia According to Etiology Iron Deficiency Anemia most common type of anemia Iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in RBC’s Commonly results from blood loss, increased metabolic demands, syndromes of gastrointestinal malabsorption, and dietary inadequacy cause : inadequate absorption or excessive loss of iron Bleeding – principal cause in adults Vegetarian diets Vitamin C – increases iron absorption Anemia can be classified by the morphology of red blood cells (RBCs), which is based on their size and hemoglobin content. Size Microcytic: RBCs are smaller than normal Normocytic: RBCs are normal in size Macrocytic: RBCs are larger than normal Hemoglobin content Normochromic: RBCs have normal hemoglobin content Hypochromic: RBCs have low hemoglobin content Hyperchromic: RBCs have high hemoglobin content TYPES OF ANEMIA  A blood transfusion is usually considered when a person's hemoglobin level is less than 7 to 8 grams per deciliter (g/dL) Low hgb levels – physician consultation prior to surgery If Hgb is less than 8gm/dL, general anesthesia should be avoided Narcotic use should be limited Increase risk for ischemic heart disease The main types of thalassemia are alpha thalassemia and beta thalassemia. Each type can be mild, moderate, or severe. Alpha thalassemia Alpha thalassemia silent carrier: A person has one damaged or missing alpha-globin gene, but the other three are normal. This means they don't have symptoms, but they can pass the damaged gene on to their child. Alpha thalassemia major: A person has one or more missing or damaged alpha-globin genes. Beta thalassemia Beta thalassemia intermedia A type of beta thalassemia that may require intermittent blood transfusions Beta thalassemia major Also known as Cooley's Anemia, this is the most severe type of beta thalassemia. It requires regular blood transfusions throughout a person's life. Other types of thalassemia Hemoglobin H disease. Symptoms Jaundice Pale skin Drowsiness and fatigue Chest pain Shortness of breath Rapid heartbeat Delayed growth Dizziness and faintness Greater susceptibility to infection Treatment Blood transfusions, Medicine to help with complications from blood transfusions, and Chelation therapy to treat iron overload.  THANK YOU FOR LISTENING