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Blood and Circulatory System Disorders

front 1

Blood

back 1

  • 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

front 2

Two Separate Circulations

back 2

  1. The pulmonary circulation
  2. The systemic circulation

front 3

The Pulmonary Circulation

back 3

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

front 4

The Systemic Circulation

back 4

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

front 5

Arteries

back 5

  • Transports Blood away from the heart

front 6

Arterioles

back 6

  • 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

front 7

Capillaries

back 7

  • 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

front 8

Precapillary Sphincters

back 8

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

front 9

Small Venules

back 9

  • conduct blood from the capillary beds toward the heart

front 10

Veins

back 10

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

front 11

Capacitance Vessels

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

front 12

Walls of arteries and veins

back 12

  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

front 13

autoregulation

back 13

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

front 14

Causes of local vasodilation

back 14

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

front 15

composition of blood

back 15

  • 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

front 16

Hematocrit

back 16

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

front 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

front 18

serum

back 18

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

front 19

Examples of plasma proteins

back 19

  • Albumin
  • Globulins/Anti-bodies
  • fibrinogen

front 20

albumin

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  • Maintains osmotic pressure in the blood

front 21

Fibrinogen

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  • essential for the formation of blood clots

front 22

Red bone marrow

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

front 23

Erythrocytes or red blood cells

back 23

  • 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

front 24

Erythropoietin

back 24

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

front 25

Hemoglobin

back 25

  • 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

front 26

Oxyhemoglobin

back 26

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

front 27

deoxyhemoglobin

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  • Dark bluish red in color and font and venous blood

front 28

Leukopoiesis

back 28

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

front 29

leukocytes

back 29

  • 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

front 30

Lymphocytes

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

front 31

neutrophils

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  • 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

front 32

Basophils

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

front 33

Eosinophils

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

front 34

monocytes

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  • can enter the tissue to become macrophages

front 35

differential count

back 35

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

front 36

Thrombocytes

back 36

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

front 37

Hemostasis (3 steps)

back 37

  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

front 38

Heparin

back 38

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

front 39

Blood type

back 39

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

front 40

ABO groups

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

front 41

type O blood

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  • Lack A and B antigens
  • are considered universal donors

front 42

type A and B blood

back 42

  • Are universal recipients

front 43

RH system

back 43

  • 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

front 44

Complete blood count (CBC)

diagnostic test for blood

back 44

  • 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

front 45

Leukocytosis

back 45

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

front 46

leukopenia

back 46

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

front 47

increase in eosinophils

back 47

  • Common with allergic responses and parasitic infections

front 48

morphology

back 48

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

front 49

Hemoglobin (diagnostic test)

back 49

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

front 50

Reticulocyte Count

back 50

  • Assessment of bone marrow function

front 51

Chemical analysis of the blood

back 51

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

front 52

Bleeding time (diagnostic test)

back 52

  • Measures platelet function

front 53

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

back 53

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

front 54

partial thromboplastin time

back 54

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

front 55

prothrombin time

back 55

  • measures the extrinsic pathway

front 56

anemia

back 56

  • 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

front 57

Iron deficiency anemia

back 57

  • 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

front 58

Etiology of iron deficiency anemia

back 58

  • 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

front 59

Manifestations of iron deficiency anemia

back 59

  • 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

front 60

Diagnostic tests for Iron deficiency anemia

back 60

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

front 61

Treatment for iron deficiency anemia

back 61

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

front 62

pernicious anemia: vitamin B12 deficiency (megaloblastic anemia)

back 62

  • 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

front 63

Vitamin B12 and nerve cells

back 63

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

front 64

Manifestations of pernicious anemia

back 64

  • 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

front 65

Diagnostic tests for pernicious anemia

back 65

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

front 66

Treatment for Pernicious Anemia

back 66

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

front 67

Aplastic anemia

back 67

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

front 68

Pancytopenia

back 68

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

front 69

Hemolytic Anemia

back 69

  • 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

front 70

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

  • Leucopenia
  • Neutropenia
  • Pancytopenia
  • Erythrocytosis

back 70

  • PANCYTOPENIA

front 71

Capillary walls consist of:

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

back 71

  • a single endothelial layer

front 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.

back 72

  • lacks A and B antigens.

front 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

back 73

  • Vitamin B12 deficit causing peripheral nerve demyelination

front 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

back 74

  • Deficit of oxygen for epithelial cell mitosis and metabolism

front 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.

back 75

  • The ingested vitamin would not be absorbed into the blood.

front 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

back 76

  • Erythrocytes change to sickle shape when hypoxia occurs

front 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.

back 77

  • increased blood volume.

front 78

In individuals with pernicious anemia, antibodies form to:

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

back 78

  • intrinsic factor or parietal cells.

front 79

Petechiae and purpura are common signs of:

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

back 79

  • increased bleeding.

front 80

Which of the following substances acts as an anticoagulant?

  • Prothrombin
  • Heparin
  • Fibrinogen
  • Vitamin K

back 80

  • Heparin

front 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

back 81

  • Decreased platelets

front 82

Multiple myeloma is a malignant tumor involving:

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

back 82

  • plasma cells.

front 83

The Reed-Sternberg cell is diagnostic for:

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

back 83

  • Hodgkin’s lymphoma.

front 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.

back 84

  • Chronic leukemias are more common in older people.

front 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.

back 85

  • acute myelogenous leukemia (AML).

front 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.

back 86

  • It stimulates production of red blood cells.

front 87

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

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

back 87

  • iron deficiency anemia.