Capillaries

Site of gas, nutrient, and waste exchange

Blood cells formed in RED bone marrow

Hemocytoblast (early stem cell), Proerythroblast (RBC), Myeloblast (Granulocytic WBC), Lymphoblast (lymphocytes/agranulocytes), Monoblast (monocytes/agranulocytes), Megakaryoblast (thrombocytes/platelets)

Erythrocyte characteristics

Biconcave flexible discs, no nucleus, glucose is the primary nutrient source, contains hemoglobin. Erythropoietin produced in the kidney stimulates erythrocyte production. Folic acid and Vitamin B12 are essential for RBC maturation.

Breakdown of hemoglobin

1. Hemolysis of erythrocyte->Hemoglobin->Heme and Globin. 2. Heme->Iron that is recycled to bone marrow or stored->Hematopoiesis. 3. Heme->Bilirubin/unconjugated (transported bound to serum albumin)->Blood->Liver (conjugated with glucuronic acid)->Bilirubin/conjugated-> Bile 4. Globin-> Amino acids recycled

Hemostasis steps

Vasoconstriction or vascular spasm after injury, platelet plug, coagulation fibrin mesh formation

The Common Pathway of Clot Formation and Anticoagulant Drugs

CBC test

Measures RBC, WBC, platelet counts hemoglobin and hematocrit.

Leukocytosis

Increased WBCs associated with inflammation or infection

Leukopenia

Decreased WBCs associated with some viral infections, radiation, chemotherapy

Increased eosinophils

Common in allergic responses

Types of diagnostic tests

Morphology (shows size, shape, uniformity, maturity of cells), 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

Indicates bone marrow production of RBCs

Chemical analysis

Determines serum levels of components such as iron, vitamin B12, folic acid, cholesterol, urea, glucose

Bleeding time

Measures platelet function

PT and PTT

Tests measuring blood clotting factor function

Whole blood, packed RBCs, packed platelets

For severe anemia or thrombocytopenia

Plasma or colloid volume-expanding solutions

To maintain blood volume. Crystalloids (intravenous saline; increase intravascular and interstitial volume) and Colloid (contain glucose or hydroxyethyl starch to increase intravascular volume)

Artificial blood products

O2 and CO2 transport. Compatible with all blood types. None of them can perform all the complex functions of normal whole blood

Epoetin Alpha

Artificial form of erythropoietin. Boost RBC production. Before certain surgical procedures, anemia related to cancer, chronic renal failure

Bone marrow or stem cell transplantation

Close tissue matches necessary. Treatment of some cancers, severe immunodeficiency, severe blood cell diseases

Drug treatment

Aids in the clotting process

Anemia general definition

Reduced oxygen transport due to low hemoglobin or RBCs

In anemia oxygen deficit leads to what?

Less energy production, Compensation mechanisms (Tachycardia and vasoconstriction=Increased HR and BP), General signs of anemia (fatigue, pallor, dyspnea/shortness of breath), Decreased regeneration of epithelial cells, Angina and Congestive Heart Failure

Iron deficiency anemia cause

Low iron from blood loss, poor intake, malabsorption, liver disease, which impairs hemoglobin synthesis.

Iron deficiency RBC type

Microcytic (small) hypochromic (reduced hemoglobin content) erythrocytes

Iron deficiency manifestations

Cold intolerance, irritability, fatigue, pallor, stomatitis/glossitis (inflammation of the mouth mucous membranes and tongue), tachycardia, syncope (fainting)

Iron deficiency treatment

Iron replacement and treatment of underlying cause

Pernicious anemia cause

Lack of intrinsic factor prevents vitamin B12 absorption possibly due to genetic factors and often accompanied by chronic gastritis

Pernicious anemia RBC type

Large immature megaloblastic erythrocytes that carry less hemoglobin and have a shorter life span

Pernicious anemia manifestations

Red enlarged sore smooth tongue, Paresthesia (tingling due to nerve damage), digestive discomfort (nausea and diarrhea)

Pernicious anemia diagnosis

Microscopic examination (erythrocytes), Bone marrow examination (hyperactive), Low serum B12, hypochlorhydria/achlorhydria (low levels of stomach acid), gastric atrophy (stomach cells atrophy)

Pernicious anemia treatment

Vitamin B12 replacement injections

Aplastic anemia definition

Bone marrow failure causing pancytopenia (low levels of RBCs, WBCs, and platelets.) Normal appearing RBCs.

Aplastic anemia causes

Often idiopathic but could be due to Myelotoxins (Radiation, chemicals, drugs), Viruses, Genetic disorders (Myelodysplastic syndrome and Fanconi's anemia)

Aplastic anemia treatment

Removal of any bone marrow suppressants and supportive care bone marrow transplant

Hemolytic anemia definition

Excessive destruction of red blood cells

Hemolytic anemia causes

Immune reactions, changes in blood chemistry, infections, toxins, incompatible transfusion, genetic defects

Sickle cell anemia cause

Genetic condition (Autosomal, incomplete dominance, homozygous recessive) Inherited abnormal hemoglobin HbS (Amino acid, Valine, is replacing glutamic acid on the Beta chain)

Sickle cell crisis trigger

Low oxygen causes RBC sickling and vessel obstruction because they are too large to pass through microcirculation.

Sickle cell complications

Infarctions (obstruction of blood flow), Hyperbilirubinemia, jaundice, gallstones (high rate of hemolysis)

Sickle cell manifestations

Vascular occlusion/infarctions (lungs: acute chest syndrome and smaller blood vessels: Hand-foot syndrome), necrosis, ischemia, severe pain, Hyperbilirubinemia (Jaundice), splenomegaly (enlarged spleen), Congestive heart failure

Sickle cell diagnosis

Hemoglobin electrophoresis, Blood test (abnormal RBC morphology), Prenatal DNA analysis

Sickle cell treatment

Hydroxyurea, folic acid, immunizations, bone marrow transplant

Thalassemia cause

Genetic defect (Autosomal dominant inheritance) reducing alpha or beta globin chains. Abnormal globin damages RBCs causing hemolysis (lower RBC numbers) and anemia

Thalassemia manifestations

Pallor, tachycardia, vasoconstriction, increased hemolysis, impaired growth, hyperactivity in the bone marrow, and heart failure.

Thalassemia diagnosis

Microcytic (small) hypochromic (reduced hemoglobin content) RBCs, increased erythropoietin, iron overload

Thalassemia treatment

Blood transfusions, iron chelation (removes excess iron), bone marrow transplant

Primary polycythemia

Neoplastic bone marrow disorder causing excessive RBC production with low erythropoietin

Secondary polycythemia

Increased RBC production from chronic hypoxia with high erythropoietin

Polycythemia manifestations

Thick sluggish blood, increased BP, thrombosis, hypertrophied heart, headaches, dyspnea (shortness of breath), splenomegaly, hepatomegaly, visual disturbances

Polycythemia diagnostic tests

Tests to determine increased cell counts, increased hemoglobin and hematocrit, hypercellular bone marrow, hyperuricemia (elevated uric acid levels)

Polycythemia treatment

Identify specific cause (Primary: low erythropoietin levels or secondary: elevated erythropoietin levels). Drugs or radiation, suppressions of bone marrow activity, periodic phlebotomy (bloodletting)

Indications of blood clotting disorders

Bleeding from gums, epistaxis (nosebleed), hemarthrosis (joints), hematuria (feces), Hemoptysis (cough), and Hematemesis (vomit). Petechiae, purpura, anemia, low BP and rapid pulse.

Hemophilia A cause

Inherited x-linked recessive trait (manifested in men and carried in woman) where there is a factor VIII deficiency.

Hemophilia A manifestations

Prolonged bleeding, hemarthrosis (bleeding into joints), hematuria (blood in feces)

Hemophilia A diagnostic tests

Normal PT and bleeding time, prolonged PTT, low serum levels of factor VIII

Hemophilia A treatment

Factor VIII replacement, desmopressin

Petechiae

Small pinpoint hemorrhages under skin

Purpura

Medium sized bleeding spots in skin

Ecchymosis

Large bruising from bleeding into tissue

Von Willebrand's Disease cause

Most common hereditary clotting disorder. Type 1: most common (85% of cases), mildest form, low levels of VWF and factor VIII. Type 2: normal amounts of VWF, but non-functional; 4 subtypes (A: wrong size, B: attaches at the wrong time, M: doesn't attach to platelets, N: cannot attach to factor VIII)

Von Willebrand's Disease manifestations

Skin rashes, frequent nosebleeds, easy bruising, bleeding of gums, abnormal menstrual bleeding, longer than normal bleeding

Von Willebrand's Disease Treatment

Desmopressin Acetate (mild forms/type 1) and Factor replacement therapy (more serious forms/type 2&3)

Disseminated intravascular coagulation definition

Excessive bleeding and clotting and consume clotting factors causing both thrombosis and severe bleeding

DIC causes

Septicemia, childbirth complications, severe burns, trauma

DIC manifestations

Ischemia, infarctions, excessive bleeding and hemorrhage, organ failure

DIC treatment

Treat underlying cause replace clotting factors supportive care

Thrombophilia

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.

Leukemia definition

Malignant proliferation of abnormal white blood cells in bone marrow

Leukemia pathophysiology

Immature nonfunctional leukocytes crowd out normal blood cell production

Acute leukemia characteristics

Rapid onset many immature blast cells severe symptoms common in children

Chronic leukemia characteristics

Slow onset more mature cells milder symptoms common in older adults

Leukemia manifestations

Frequent infections, anemia, bleeding, bone pain, enlarged spleen liver lymph nodes

Leukemia complications

Opportunistic infections, sepsis, congestive heart failure, hemorrhage, liver and renal failure, CNS depression and coma

Leukemia diagnosis

Blood smear abnormal leukocytes bone marrow biopsy confirmation

Leukemia treatment

Chemotherapy, biological therapy, stem cell transplant

Arteriosclerosis

General term for arterial thickening loss of elasticity, lumen narrowing, and increased BP

Atherosclerosis

Plaque formation of lipids calcium and clots in large arteries. Related to diet, exercise, and stress

LDL role in atherosclerosis

Transports cholesterol to tissues promotes plaque formation

HDL role in atherosclerosis

Removes cholesterol from tissues and carries it to liver where it is catabolized and excreted

Nonmodifiable atherosclerosis risks

Age, sex, genetic factors

Modifiable atherosclerosis risks

Smoking, obesity, sedentary lifestyle, diabetes, hypertension

Atherosclerosis treatment (no cure)

Weight loss, exercise, diet, reduce Na+ intake, control hypertension, stop smoking, antilipidemic drugs (lowers LDL levels), surgical intervention

Peripheral arterial disease definition

Atherosclerosis in arteries outside the heart causing reduced blood flow

Peripheral arterial disease symptom

Intermittent claudication (leg pain) during exercise due to ischemia

Peripheral arterial disease signs

Weak pulses, numbness, pale, or cyanotic skin, dry, hairless skin

Peripheral arterial disease treatment

Smoking cessation, exercise, control diabetes, reduce cholesterol, anticoagulants

Aneurysm definition

Localized dilation and weakening of arterial wall

Aneurysm types

Saccular (bulging wall on the side), fusiform (Circumferential dilation along a section of artery), and dissecting (develops when there is a tear in the intima of the wall and blood continues to dissect or separate tissues)

Aneurysm cause

Atherosclerosis, trauma, syphilis, congenital (present from birth) defects

Aneurysm manifestations

Murmurs may be heard on auscultation, pulse felt on palpation of abdomen, frequently asymptomatic until it ruptures

Aneurysm diagnosis

Ultrasound, CT, MRI, radiography

Aneurysm treatment

Blood pressure control, surgical repair, avoid strain

Varicose veins

Dilated tortuous superficial veins from valve weakness and venous pressure

Varicose vein treatment

Elevation compression stockings avoid prolonged standing

Thrombophlebitis

Thrombus formation in inflamed vein (IV site)

Phlebothrombosis

Thrombus formation without prior inflammation loosely attached

Venous thrombosis manifestations

Often unnoticed, Aching, burning, tenderness, fever, malaise, leukocytosis (high WBC count)

Major complication venous thrombosis

Pulmonary embolism

Venous thrombosis treatment

Anticoagulants, exercise, leg elevation, surgery if needed