Blood and Circulatory System Disorders

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1

Blood

  • Transports essential oxygen to tissues along with nutrients required for cellular metabolism
  • provides for the necessary removal of many cell wastes
  • plays a critical role in the body's defenses/immune system
  • serves in maintaining body homeostasis
  • Provides a mechanism for controlling body temperature by distributing Core heat throughout the peripheral tissues
2

Two Separate Circulations

  1. The pulmonary circulation
  2. The systemic circulation
3

The Pulmonary Circulation

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  • allows The exchange of oxygen and carbon dioxide in the lungs
4

The Systemic Circulation

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  • Provides for the exchange of nutrients and wastes between the blood and the cells throughout the body
5

Arteries

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  • Transports Blood away from the heart
6

Arterioles

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  • The smaller branches of arteries
  • Controls the amount of blood flowing into the capillaries in specific areas through the degree of contraction of smooth muscle in the vessel wall
7

Capillaries

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  • Very small vessels
  • Forms the microcirculation
  • Blood flow very slowly through capillaries
  • precapillary sphincters
  • Single endothelial layer
    • Facilitates the exchange of fluid, oxygen, carbon dioxide, electrolytes glucose, and other nutrients and waste between the blood and interstitial fluid
8

Precapillary Sphincters

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  • Determines the amount of blood flowing from the arterioles into the individual capillaries
  • depends on the metabolic needs of the tissues
9

Small Venules

  • conduct blood from the capillary beds toward the heart
10

Veins

  • returns blood back to the heart
  • Have thinner walls than arteries and less smooth muscles
11

Capacitance Vessels

  • the blood vessels that hold the major portion of theintravascular blood volume
  • veins
12

Walls of arteries and veins

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  1. Tunica Intima
    • the inner layer
    • endothelium (simple squamous)
    • flat so fluid can be exchanged back-and-forth
  2. Tunica Media
    • The middle layer
    • Layer of smooth muscle
    • Controls the diameter and lumen size
  3. Tunica Adventitia
    • outer connective tissue layer
    • Contains elastic and collagen fibers
13

autoregulation

  • A reflex adjustment in a small area of a tissue
  • varies depending on the needs of the cells in the area
14

Causes of local vasodilation

  • decrease in pH
  • increase in carbon dioxide
  • decrease in oxygen
15

composition of blood

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  • Water and its dissolve solutes (plasma) = 55% of the whole blood volume
  • remaining 45% is composed of the cells or formed elements erythrocytes, leukocytes, and thrombocytes
16

Hematocrit

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  • Refers to The proportion of cells in blood
  • Indicates the viscosity of the blood
17

plasma

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  • The clear yellowish fluid remaining after the cells have been removed
  • contains:
    • water 92%
    • plasma proteins 7%
    • other solutes 1%
      • Amino acids
      • Carbohydrates
      • Lipids
      • Vitamins
      • Hormones
      • Enzymes
      • Electrolytes
      • Wastes
18

serum

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  • Refers to the fluid and solutes remaining after the cells and fibrinogen has been removed
19

Examples of plasma proteins

  • Albumin
  • Globulins/Anti-bodies
  • fibrinogen
20

albumin

  • Maintains osmotic pressure in the blood
21

Fibrinogen

  • essential for the formation of blood clots
22

Red bone marrow

  • Origination of all blood cells
  • found in the flat and irregular bones, ribs, vertebrae, sternum, and pelvis
23

Erythrocytes or red blood cells

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  • Biconcave flexible discs
  • non-nucleated when mature state
  • Contain hemoglobin
  • Size and structure are essential for easy passage to small capillaries
  • life span = 120 days b/c no nucleus
24

Erythropoietin

  • Originates in the kidney
  • Hormone that stimulates erythrocyte production in the red bone marrow
25

Hemoglobin

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  • Consists of:
    • the globlin portion
      • two pairs of amino acid chains
    • four heme groups
      • each containing a ferrous iron atom, to which oxygen molecule can attach
26

Oxyhemoglobin

  • A bright red color that distinguishes arterial blood from venous blood
27

deoxyhemoglobin

  • Dark bluish red in color and font and venous blood
28

Leukopoiesis

  • Production of white blood cells
  • Stimulated by colony stimulating factors that are produced by cells such as macrophages and T lymphocytes
29

leukocytes

  • Makes up only about 1% of blood volume
  • Subdivided into two categories:
    1. Granulocytes
    2. Agranulocytes
  • All types develop in differentiate from the original stem cell in bone marrow
  • There are five types of leukocytes
    1. Lymphocytes
    2. Neutrophils
    3. Basophils
    4. Eosinophils
    5. Monocytes
30

Lymphocytes

  • Makes up 30 to 40% of the white blood cells
31

neutrophils

  • The most common leukocyte
  • Makes up 50 to 60% of White blood cells
  • Survive only four days
  • The first to respond to any tissue damage And phagocytosis
  • Increase in numbers by bacterial affection
32

Basophils

  • Can release histamine and heparin
  • Maybe fixed in tissues or wandering
33

Eosinophils

  • Combat the effects of histamine
  • Increase by allergic rea ctions and parasitic infections
34

monocytes

  • can enter the tissue to become macrophages
35

differential count

  • Indicates the proportion the specific types of white blood cells in the blood
  • Assist in making a diagnosis
36

Thrombocytes

  • Essential part of the blood clotting process
  • Not cells
  • Non-nucleated
37

Hemostasis (3 steps)

  1. An immediate response of a blood vessel to injury is vasoconstriction of vascular spasm
  2. Form a platelet plug in the vessel
  3. Coagulation mechanism
38

Heparin

  • an anticoagulant
  • Released from basophils or mast cells in the tissues
  • Blocks thrombin
  • Does not dissolve clots but prevents further growth of the thrombus
39

Blood type

  • Determined by the presence of specific antigens on the cell membranes of erythrocytes
40

ABO groups

  • An inherited characteristic
  • Depends on the presence of type A or B antigens
41

type O blood

  • Lack A and B antigens
  • are considered universal donors
42

type A and B blood

  • Are universal recipients
43

RH system

  • May cause blood and incompatibility if the mother is Rh negative and the fetus is Rh positive
  • Antigen D in plasma membrane = RH positive
  • Absence of antigen D = RH negative
44

Complete blood count (CBC)

diagnostic test for blood

  • Includes total red blood cells, white blood cells, platelet count, and morphology (size and shape), a differential count for white blood cells, hemoglobin, and hematocrit values
45

Leukocytosis

  • An increase in white blood cells
  • Often associated with inflammation or infection
46

leukopenia

  • Decrease in leukocytes
  • Occurs with some viral infections as well as with radiation and chemo therapy
47

increase in eosinophils

  • Common with allergic responses and parasitic infections
48

morphology

  • Observe with blood sMears
  • Shows size, shape, uniformity, and maturity of cells
    • Helps to distinguish different types of anemia
49

Hemoglobin (diagnostic test)

  • Amount of hemoglobin per unit volume of blood
  • Mean corpuscular volume
    • Indicates the oxygen-carrying capacity of blood
  • Mean corpuscular hemoglobin
50

Reticulocyte Count

  • Assessment of bone marrow function
51

Chemical analysis of the blood

  • Determine serum levels of components such as iron, vitamin B12, folic acid, cholesterol, urea, and glucose
52

Bleeding time (diagnostic test)

  • Measures platelet function
53

prothrombin time (PT) and partial thromboplastin time (PTT)

  • Measures function of various factors in coagulation process
  • interNational normalized ratio is a standardized version
54

partial thromboplastin time

  • Measures the intrinsic pathway
  • PTT... the 2 t's are in(trinsic) a relationship
55

prothrombin time

  • measures the extrinsic pathway
56

anemia

  • A reduction in oxygen transport in the blood due to a decrease in hemoglobin content
  • May result from the declining production of the protein, a decrease in the number of erythrocytes, or a combination of these factors
  • May be classified by typical cell morphology
  • oxygen deficiency leads to:
    • Less energy production and all cells
      • Cell metabolism and reproduction diminished
    • Compensation mechanism to improve the oxygen supply
      • ex:
        • Tachycardia
        • peripheral vasoconstriction
    • General signs of anemia
      • Fatigue, Pallor, dyspnea, and tachycardia
    • Decrease regeneration of epithelial cells
57

Iron deficiency anemia

  • Insufficient iron impairs hemoglobin synthesis
    • Which reduces the amount of oxygen transported in the blood
  • Red blood cells are microcytic and hypochromic
  • Very common
  • Ranges from mild to severe
  • Occurs in all age groups
  • One in five women is affected
    • Proportion increases for pregnant women
  • Frequently a sign of an underlying problem
58

Etiology of iron deficiency anemia

  • Dietary intake of iron may be below the minimum requirement
  • Chronic blood loss
  • duodenal absorption of iron may be impaired
  • Severe liver disease may affect both iron absorption and iron storage
59

Manifestations of iron deficiency anemia

  • pallor of the skin and mucous membranes
  • Due to vasoconstriction
  • Fatigue,lethargy, and cold intolerance
    • b/c cell metabolism decreased
  • Irritability
    • A central nervous system response to hypoxia
  • Degenerative changes
    • such as brittle hair, spoon shaped and rigid nails
  • Inflammation of oral mucosa and tongue
  • Menstrual irregularities
  • Delayed healing
  • Tachycardia, heart palpitations, dyspnea, syncope

* People who have iron deficiency anemia may have unusual craving for nonfood items such as ice, paint, or starch. This craving is called pica

60

Diagnostic tests for Iron deficiency anemia

  • Laboratory test demonstrate low values of hemoglobin, hematocrit, mean corpuscular volume and mean corpuscular hemoglobin, serum ferritin and serum iron, and transferrin saturation
61

Treatment for iron deficiency anemia

  • Identified underlying cause and resolves if possible
  • Consume Iron rich foods or iron supplements
62

pernicious anemia: vitamin B12 deficiency (megaloblastic anemia)

  • The common form of megaloblastic anemia
  • Caused by the malabsorption of the vitamin B12
  • Iron deficiency may be present as well
  • Red blood cells are very large and contain nuclei
  • Dietary and sufficiency is a very rare cause
  • May be an outcome of surgeries in which the parietal cells are removed or resection of the ileum which is a sight of absorption
63

Vitamin B12 and nerve cells

  • Vitamin B12 is needed for the function and maintenance of neurons
  • Deficiency can result in neuropsychiatric symptoms
64

Manifestations of pernicious anemia

  • Tongue is typically in large, red, sore, and shiny
  • Decrease in gastric acid leads to digestive discomfort such as nausea and diarrhea
  • Tingling or burning sensations in the extremities or loss of coordination and ataxia
65

Diagnostic tests for pernicious anemia

  • Microscopic examination (erythrocytes)
  • Bone marrow examination (hyperactive)
  • Vitamin B12 serum levels below normal
66

Treatment for Pernicious Anemia

  • Oral supplements are recommended
  • Vitamin B12 is administered by injection
67

Aplastic anemia

  • Results from impairment or failure of bone marrow leading to loss of stem cells and pancytopenia
  • may be temporary or permanent
  • often idiopathic
68

Pancytopenia

  • decreased numbers of erythrocytes, leukocytes, and thrombocytes in the blood.
69

Hemolytic Anemia

  • results from excessive destruction of RBCs
  • leads to a low erythrocyte count and low hemoglobin
  • causes:
    • genetic defects
    • immune reactions
    • Changes in blood chemistry
    • Presence of toxins in the blood
    • Infections such as malaria
    • Antigen-antibody reaction
      • Incompatible blood transfusion
70

What term is used to describe a deficit of all types of blood cells?

  • Leucopenia
  • Neutropenia
  • Pancytopenia
  • Erythrocytosis
  • PANCYTOPENIA
71

Capillary walls consist of:

  • multiple endothelial layers.
  • a thick layer of smooth muscle.
  • two or three epithelial layers.
  • a single endothelial layer
  • a single endothelial layer
72

Individuals with type O blood are considered to be universal donors because their blood:

  • contains A and B antibodies.
  • contains A and B antigens.
  • lacks A and B antibodies.
  • lacks A and B antigens.
  • lacks A and B antigens.
73

What causes numbness and tingling in the fingers of individuals with untreated pernicious anemia?

  • Persistent hyperbilirubinemia
  • Increasing acidosis affecting metabolism
  • Vitamin B12 deficit causing peripheral nerve demyelination
  • Multiple small vascular occlusions affecting peripheral nerves
  • Vitamin B12 deficit causing peripheral nerve demyelination
74

What is the cause of oral ulcerations and delayed healing occurring with any severe anemia?

  • Lack of folic acid for DNA synthesis
  • Frequent microinfarcts in the tissues
  • Deficit of oxygen for epithelial cell mitosis and metabolism
  • Elevated bilirubin levels in blood and body fluids
  • Deficit of oxygen for epithelial cell mitosis and metabolism
75

Why is pernicious anemia treated with injections of vitamin B12?

  • An immune reaction in the stomach would destroy the vitamin.
  • Digestive enzymes would destroy the vitamin.
  • The vitamin irritates the gastric mucosa.
  • The ingested vitamin would not be absorbed into the blood.
  • The ingested vitamin would not be absorbed into the blood.
76

Why do vascular occlusions and infarcts occur frequently with sickle cell anemia?

  • The red blood cells are abnormally large.
  • Increased hemolysis of erythrocytes occurs.
  • Erythrocytes change to sickle shape when hypoxia occurs
  • HbS is unable to transport oxygen
  • Erythrocytes change to sickle shape when hypoxia occurs
77

In cases of polycythemia vera, blood pressure is elevated as a result of:

  • increased blood volume.
  • frequent infarcts in the coronary circulation.
  • congested spleen and bone marrow.
  • increased renin and aldosterone secretions.
  • increased blood volume.
78

In individuals with pernicious anemia, antibodies form to:

  • vitamin B12 .
  • intrinsic factor or parietal cells.
  • mucus-producing glands.
  • hydrochloric acid.
  • intrinsic factor or parietal cells.
79

Petechiae and purpura are common signs of:

  • excessive hemolysis.
  • leucopenia.
  • increased bleeding.
  • hemoglobin deficit.
  • increased bleeding.
80

Which of the following substances acts as an anticoagulant?

  • Prothrombin
  • Heparin
  • Fibrinogen
  • Vitamin K
  • Heparin
81

Why is excessive bleeding a common occurrence with acute leukemia?

  • Deficit of calcium ions
  • Impaired production of prothrombin and fibrinogen
  • Decreased platelets
  • Dysfunctional thrombocytes
  • Decreased platelets
82

Multiple myeloma is a malignant tumor involving:

  • plasma cells.
  • granulocytes
  • bone cells.
  • lymph nodes.
  • plasma cells.
83

The Reed-Sternberg cell is diagnostic for:

  • chronic myeloblastic leukemia.
  • Hodgkin’s lymphoma.
  • multiple myeloma.
  • non-Hodgkin’s lymphoma.
  • Hodgkin’s lymphoma.
84

Which of the following applies to the leukemias?

  • Chronic leukemias are more common in older people.
  • AML is the most common childhood leukemia.
  • Exposure to chemicals is not considered a predisposing factor.
  • Lymphoid tissue produces abnormal leukocytes.
  • Chronic leukemias are more common in older people.
85

A high percentage of blast cells in the leukocyte population indicates a poor prognosis for an individual with:

  • thalassemia
  • acute myelogenous leukemia (AML).
  • myelodysplastic syndrome.
  • multiple myeloma.
  • acute myelogenous leukemia (AML).
86

Which of the following applies to erythropoietin?

  • It is produced by the liver.
  • It increases iron absorption for heme production.
  • It stimulates production of red blood cells.
  • Hypoxia stimulates the red bone marrow to produce erythropoietin.
  • It stimulates production of red blood cells.
87

Microcytic and hypochromic erythrocytes are commonly found as a result of:

  • iron deficiency anemia.
  • polycythemia
  • disseminated intravascular coagulation.
  • hemophilia A
  • iron deficiency anemia.