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Common Disorders and
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Conditions
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Phlebotomy
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OUTLINE
7
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OBJECTIVES
After studying this chapter, readers should be able to:
Introduction
1. Describe the condition known as angina pectoris.
Cardiovascular Disorders
2. Explain major factors that cause myocardial
Coronary Artery Disease
Angina Pectoris © Jones & Bartlett Learning, LLC infarction.
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3. Describe primary hypertension.
Myocardial Infarction
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4. Compare arteriosclerosis with atherosclerosis.
Cardiac Arrhythmias
5. Distinguish among endocarditis, myocarditis, and
Hypertension
pericarditis.
Cardiomyopathy
6. Explain the various types of anemias.
Carditis
7. Compare
polycythemia
and leukemias.
Failure
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8. Describe the various types of shock.
Cardiac Arrest
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9. Explain the possible consequences of emboli.
Pulmonary Edema
10. Describe disseminated intravascular coagulation.
Rheumatic Fever
Valvular Heart Disease
Mitral Valve Prolapse
KEY TERMS
Shock
Abruptio
complication of
pregnancy wherein the
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placental lining has separated from the uterus of the mother,
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Atherosclerosis
causing late pregnancy bleeding, fetal heart rate effects, and
Arteriosclerosis
potential fetal or maternal death.
Emboli
Angina pectoris: Sharp pain usually felt in the chest or arm
Aneurysms
that occurs when the heart does not receive enough oxygen
Phlebitis
to support its workload.
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Anoxia: Absence of oxygen supply to an organ or tissue.
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Arrhythmia: An irregular heartbeat,
which
can range
fromOR
mild DISTRIBUTION
Blood Disorders
to life-threatening; also called dysrhythmia.
Anemias
Arthralgia: Joint pain.
Polycythemia
Atherosclerosis: A form of arteriosclerosis characterized by
Hemochromatosis
deposits of cholesterol and other fats on the sides of the
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arteries. © Jones & Bartlett Learning, LLC
Lymphatic Diseases
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Celiac disease:
An FOR
autoimmune
disorder
the small intestine
Transfusion Incompatibility Reaction
that causes diarrhea, failure to thrive (in children), fatigue,
Clotting Disorders
and other effects upon multiple body systems; it is triggered
Summary
by a reaction to wheat gluten.
Critical Thinking
Dysrhythmia: Also called arrhythmia, meaning “irregular
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heartbeat.”
Review Questions
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68
CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy
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KEY TERMS continued
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Partial or complete removal of one or both
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Introduction
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NOTCardiovascular
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OR DISTRIBUTION
is the leading cause of death in the
breasts.
Eclampsia: An acute, life-threatening complication of
Megaloblastic
anemia: An anemia that results from
pregnancy wherein the mother may experience tonic-clonic
inhibition
of
DNA
synthesis in red blood cell production; it is
seizures and coma.
characterized
by
megaloblasts in the bone marrow.
Gastrectomy: Partial or complete surgical removal of the
Myocardial
infarction:
A heart attack; sudden death of cells
stomach.
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in
the
heart
muscle
caused
by an abrupt interruption of
Graves’ disease: An autoimmune
condition
caused
OR DISTRIBUTION
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SALE
ORbyDISTRIBUTION
blood flow (and lack of oxygen)NOT
to partFOR
of the SALE
heart.
overactive thyroid (hyperthyroidism), causing “bulging” eyes,
Myxedema: A type of cutaneous and dermal edema
bone damage, and central or peripheral nervous system
secondary to hypothyroidism and Graves’ disease.
symptoms.
NSAID:
Nonsteroidal anti-inflammatory drug; common
Hemarthrosis: Blood accumulation or hemorrhage in a joint.
examples
include aspirin and ibuprofen.
Hematopoietic
cells: Stem
cells that develop
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Pancytopenia:
A combination
of anemia, Learning,
leukopenia
the different types of blood cells.
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(decreased white blood cells), and thrombocytopenia
Hemochromatosis: Iron overload caused by either repeated
(decreased platelets).
transfusions or a genetic disorder.
Proliferation: Growth and reproduction of cells.
Hemoglobin S: An inherited type of abnormal adult
Reed-Sternberg cells: Cells usually derived from B
hemoglobin, which mostly affects African Americans,
lymphocytes that are much larger than surrounding cells and
causing sickle-cell anemia.
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are found
via light microscopy
in cases
of Hodgkin’s disease
A: The most common form of hemophilia; it is
and
certain
other
disorders.
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an inherited condition primarily affecting males wherein
Respiratory acidosis: A condition in which decreased
coagulation is much more prolonged than normal.
respiration increases blood carbon dioxide and decreases
Hypertrophied: Enlarged, due to an increase in cell size.
pH.
Hypoplasia: Lack of development of a tissue or organ.
Sepsis: The presence of pathogenic bacteria in tissue.
Hypoplastic anemia: Aplastic anemia; actually a variety of
Thalassemia: An inherited autosomal
recessive
disorder
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Learning, LLC
related anemias that ©
result
from destruction
of or Learning,
injury to
in
which
hemoglobin
chains
are
not
synthesized
normally,
stem cells in the bone
marrow
or itsSALE
matrix. OR DISTRIBUTION
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NOT
FOR
leading to anemia.
Ischemia: A temporary reduction of blood supply to an organ
Thrombus:
A blood clot that forms in the cardiovascular
or tissue due to obstruction of a blood vessel.
system.
Lymph: Part of the interstitial fluid, which is referred to as
Ventricular asystole: The absence of contraction of the
lymph when it enters a lymph capillary; it picks up and
ventricles.
carries
bacteria
the lymph nodes
to be destroyed.
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Ventricular fibrillation: Abnormal discharge of electrical
Lymphoblasts:
Immature
cells
that
form
lymphocytes;
in
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nerve impulses
causeSALE
the heartOR
to stop
beating.
acute lymphoblastic leukemia, lymphoblasts proliferate
uncontrollably and are found in large numbers in the
peripheral blood.
United States.
Common disorders and conditions that are related to phlebotomy include cardiovascular disorders such as coronary
Coronary Artery Disease
artery disease, myocardial infarction, and hypertension as
Coronary artery disease is an abnormal condition that may
well as blood vessel disorders
and&blood
disorders.
Heart
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affect the arteries of the heart and produce varying pathologic
attack (myocardial infarction) is the leading cause of death in
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OR
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ORofDISTRIBUTION
effects, primarily reduced flow of
oxygen
and nutrients
the DISTRIBUTION
the United States. Hypertension
is aSALE
major cause
cardiac
Atherosclerosis
is
the
most
common
type
of
myocardium.
disease, renal failure, and stroke. Atherosclerosis (hardening
coronary
artery
disease
(see
Figure
7–1).
Angina
pectoris
of the arteries) causes most myocardial and cerebral infarcis the classic symptom of coronary artery disease; it results
tions. Anemias are defined as conditions of reduced blood
from myocardial ischemia.
cells or hemoglobin as well as the reduced ability to carry
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oxygen to the cells. Leukemias are malignant neoplasms of
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Angina Pectoris
the bone marrow, spleen, and lymph nodes. Diseases of the
lymphatic system include lymphedema, lymphangitis, and
Angina pectoris is a sudden outburst of chest pain frequently
various lymphomas.
caused by myocardial anoxia as a result of atherosclerosis or
coronary artery spasm.
Angina pectoris attacks are often related to emotional
Disorders
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stress, &
eating,
exertion,
and exposure
to intense cold. ComCardiovascular
disease is described as any abnormal conNOT FOR SALE
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NOTplications
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of angina pectoris include arrhythmias, myocardial
dition characterized by heart or blood vessel dysfunction.
infarction, and ischemic cardiomyopathy.
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Cardiovascular Disorders
69
by abnormal electrical conduction or automaticity. Normally,
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the sinoatrial (SA) node generates heart rhythms that travel
NOTthrough
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the heart’s
conduction
system. This causes the atrial
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and ventricular myocardium to contract and relax at a regular
rate. This rate maintains circulation during various levels of
Damaged
physical activity. Arrhythmias range from mild and asympendothelium
tomatic such as sinus arrhythmia to catastrophic ventricular
Normal smooth
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fibrillation (which requires immediate
resuscitation).
muscle cell
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Common causes of arrhythmias include the
following:
Fatty deposits accumulate in muscle cell
■■ Congenital defects
■■ Drug toxicity
Fatty
streak
■■ Electrolyte imbalances
■■ Myocardial infarction or ischemia
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© heart
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■■ Organic
disease
■
■
Degeneration
of
the
conductive
tissue
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Fibers Fibrous
■■ Connective tissue disorders
Fats plaque
■■ Cellular hypoxia
■■ Hypertrophy of the heart muscle
■■ Acid–base imbalances
■■ Emotional
stress
Large
plaque
obstructing
artery
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Figure 7–1 Development of a deposition of fat-containing
substances that form plaque and lead to arterial occlusion
NOTHypertension
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Hypertension is an elevation in either systolic or diastolic
blood pressure. It occurs as either essential (primary) hypertension or secondary hypertension. Primary hypertension is
the most common type and is of unknown cause. Secondary
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hypertension results from renal disease or other identifiable
Myocardial Infarction
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causes. Malignant hypertensionNOT
is a severe
form
of hypertenWhen coronary blood flow is interrupted for extended perision that may be either primary or secondary. Hypertension
ods, necrosis (tissue death) of part of the cardiac muscle
is a major cause of cardiac disease, renal failure, and stroke.
occurs. Necrosis results in myocardial
infarction (see Figure 7–2). When the
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coronary
arteries
obstructed,
this
mayNOT
result FOR
in atherosclerosis,
a spasm,
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or a thrombus. Myocardial infarction
(MI) is also called heart attack.
Heart attack is the leading cause
of death in the United States. When
mortality
is high.
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dial infarction deaths occur before the
patient can be hospitalized, usually
within 1 h of the onset of symptoms.
Risk factors for myocardial infarction
include the following:
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■■ Family history of MI
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■■ Aging
■■ Gender
■■ Hypertension
Clot
■■ Elevated total cholesterol
■■ Obesity
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■■ Smoking
Damaged
■■ Stress or type A personality
heart muscle
■■ Drug use (especially cocaine
and amphetamines)
Arrhythmias
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A dysrhythmia
(an arrhythmia) is a
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disturbance of heart rhythm caused
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Figure 7–2 Damage caused by myocardial infarction.
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CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy
Pulmonary Edema
Risks for hypertension increase with age. Hypertension
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Learning, LLC
more prevalent in the black population than in the white
Pulmonary edema involves fluid that shifts into the extravasNOTcular
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ORIt isDISTRIBUTION
population.
also more prevalent in people with less eduspaces of the lungs. Pulmonary circulation becomes
cation and lower income. During young and middle adultoverloaded with excessive blood volume. It causes dyspnea;
hood, men have a higher incidence of hypertension, but
coughing; orthopnea; raised cardiac and respiratory rates; and
thereafter, women have a higher incidence.
bloody, frothy sputum. Blood pressure may be reduced, and
Risk factors for essential hypertension include the
the skin feels cold and clammy. Symptoms often occur after
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following:
a patient goes to bed. Pulmonary edema is caused by leftSALE
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■■ The aging process
sided heart failure, mitral valveNOT
disease,FOR
pulmonary
embolus,
■■ Family history
arrhythmias, renal failure, or systemic hypertension. Other
■■ Obesity
causes include drug overdose, exposure to high altitudes,
■■ High intake of sodium
and head trauma.
■■ High intake of saturated fat
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■
apnea
Rheumatic©
Fever
■
■ Stress
NOT
FOR SALE OR DISTRIBUTION
NOT
FOR
ORcardiac
DISTRIBUTION
Rheumatic fever affects
theSALE
joints and
tissue, and it
■■ Excessive alcohol consumption
is a systemic inflammatory and autoimmune disease. It fol■■ Sedentary lifestyle
lows a sore throat that is caused by group-A beta-hemolytic
■■ Diabetes mellitus
streptococcus. This usually occurs in children, resulting in
■■ Tobacco use
fever and polyarthritis. The joints most affected include the
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Bartlett
Learning,
LLC include carditis,
knees, &
ankles,
and fingers.
Other symptoms
Cardiomyopathy
cardiomegaly,
and congestive heart failure.
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NOTcardiac
FORmurmurs,
SALE OR
DISTRIBUTION
Cardiomyopathy is a term that generally applies to a disease
Symptoms occur within 5 weeks after the upper respiratory
of the heart muscle fibers. It is the second most common
tract infection. Prompt assessment is required. Rheumatic
direct cause of sudden death (after coronary artery disease).
fever develops as antibodies against the bacteria cross-react
The most common type of cardiomyopathy is the dilated
with normal tissues. The body attacks its own cells to initiate
form. Men and blacks©have
the greatest
risk for dilated
carJones
& Bartlett
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an inflammatory reaction, which
migrates &
to Bartlett
the endocardiomyopathy. Other risk factors include coronary artery disdium and heart valves.
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ease, hypertension, pregnancy, viral infections, and the use
of alcohol or illegal drugs. Hypertrophic cardiomyopathy is
Valvular Heart Disease
different in that it is caused by a genetic abnormality.
Valvular heart disease can affect all heart valves, and it may be
Carditis
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Carditis is defined as inflammation of the heart and its surNOT FOR SALE OR DISTRIBUTION
rounding structures. The several types of carditis include
pericarditis, myocarditis, and endocarditis. Common causes
of the various forms of carditis include viral infections, bacterial infections, fungal infections, immune conditions, myocardial infarction, trauma, uremia, cancers, certain medications,
& radiation,
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Heart Failure
acquired or congenital. If insufficient, the valves do not close
completely, and
blood is forced
back intoLearning,
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ber as the heart
contracts.
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increases
the heart’s workNOT FOR SALE OR DISTRIBUTION
load. Stenosis occurs when the cusps of the valves harden,
preventing complete opening. Diagnosis of valvular heart
disease requires electrocardiogram, echocardiogram, cardiac
catheterization, and radiographic chest studies. Treatment
involves digitalis or quinidine, to treat arrhythmias, and proJones
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phylactic antibiotics.
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Mitral Valve Prolapse
Heart failure is the inability of the heart muscle to contract
Mitral valve prolapse is defined as one or both cusps of the
with enough force to properly circulate the blood throughout
mitral valve protruding back into the left atrium when the
the body. Dysfunction of the left ventricle is the most comventricles contract. It is usually a benign condition, with
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mon cause of heart failure. However, the right ventricle may
patients being asymptomatic. When symptoms do exist, they
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also be dysfunctional, NOT
especially
in pulmonary
disease
(right
include dyspnea, chest pain, fatigue,
and syncope.
ventricular failure). The most common form of heart failure
It affects all age groups and often results in severe anxiety.
is congestive heart failure. It is called this because of the colMitral valve prolapse is usually diagnosed during a routine
lection of fluid (congestion) in the lungs and extremities.
physical examination, although a physician should evaluate
any reports of chest pain promptly.
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NOTarrest
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Cardiac
a suddenOR
cessation
of cardiac output and
Shock
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Shock is defined as cardiovascular system collapse. It includes
effective circulation. It is usually precipitated by ventricular fibrillation or ventricular asystole. When cardiac arrest
fluid shifts and vasodilation along with inefficient cardiac
occurs, the delivery of oxygen and removal of carbon dioxide
output. The organs and tissues experience inadequate percease. Tissue cell metabolism becomes anaerobic, and metafusion, and the patient appears pale, cold, and clammy. The
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acidosis occur. Immediate iniacidosisLearning,
and respiratory
pulse is&rapid
(tachycardia),
weak, and
thready, and there is
tiation ofOR
cardiopulmonary
resuscitation (CPR) is required.
breathing
wellDISTRIBUTION
as an altered level of consciousness.
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NOTrapid
FOR
SALEasOR
Cardiac arrest is also called cardiopulmonary arrest.
Drops in blood pressure may cause anxiety, irritability, and
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Blood Vessel Disorders
Arteriosclerosis
restlessness. Other symptoms include dizziness, extreme
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Learning, LLC
profuse sweating, and then dilation of the pupils, shakArteriosclerosis is actually a group of diseases characterized
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ing, and trembling.
Shock is a true medical emergency. NOTby
the hardening of the arteries. The most common form
Shock may be caused by anaphylaxis, hemorrhage, respiof arteriosclerosis is atherosclerosis. Some types of arterioratory distress, sepsis , heart failure, neurologic failure,
sclerosis involve the destruction of muscle and elastic fibers
emotional catastrophe, or severe metabolic insult. The vital
as well as deposits of calcium. Arteriosclerosis occurs when
organs eventually do not receive enough oxygen and nutrithe walls of the arterioles thicken, and a loss of elasticity and
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ents to sustain life. Rapid
blood loss
fluid loss, with
hypocontractility occurs.
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OR
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volemia, precipitates shock. Another cause of shock is failure
Emboli
of the heart to pump adequately.
Types of shock include the following:
Emboli are (usually) blood clots that lodge in blood vessels to
■■ Cardiogenic—decreased cardiac output with tissue
inhibit blood flow. Symptoms vary, but usually include severe
hypoxia in the presence of adequate intravascular volpain in the area of the embolus. If an embolus lodges in an
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it is &
caused
by heart
failure (usually
after myoextremity, paleness,
numbness,
or coldness
may develop.
If
cardial
infarction)
nausea, vomiting,
or shockOR
occurs,
the patient is
NOT
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NOT fainting,
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DISTRIBUTION
■■ Hypovolemic—develops when intravascular volume
in an emergency state. Emboli may also be composed of air
has decreased by approximately 15%; it is caused by
bubbles, clumps of bacteria, globules of fat, or pieces of tishemorrhage, burns, or loss of interstitial fluid
sue. Venous thrombosis in the deep veins of the legs is most
■■ Neurogenic—widespread vasodilation due to parasymcommon. When a portion of a thrombus breaks loose, it
pathetic
overstimulation
travels&
through
the veins
until it lodges
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LLCor sympathetic understimu© Jones
Bartlett
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LLCin a narrow vessel,
is caused by spinal cord or medulla trauma,
as aSALE
vessel inOR
the lungs.
Thrombi can form in the heart
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OR itDISTRIBUTION
NOTsuch
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DISTRIBUTION
depressants, anesthetics, pain, or severe emotional
because of cardiac arrhythmias. This can result in a myostress
cardial infarction, or the thrombus can travel to the brain,
■■ Anaphylactic—results from a widespread hypersenwhich results in a stroke.
sitivity reaction (anaphylaxis); often caused by allerAneurysms
gies and poisons—it may lead to death quickly if
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untreated
Aneurysms are defined as abnormal dilations of blood vessels
NOT
FOR7–3).
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■■ Septic—part of the systemic inflammatory response
located in distinctly limited areas
(see Figure
Symptoms
syndrome; it begins with an infection that progresses
vary with location, and abdominal aortic aneurysm is the most
to bacteremia and sepsis, resulting in multiple organ
common type. Aneurysms are often caused by a buildup of
dysfunction syndrome
atherosclerotic plaque that weakens vessel walls. If the aneurysm is abdominal, a “bruit” sound is heard on auscultation.
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Blood
Disorders
NOTVessel
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Phlebitis NOT FOR SALE OR DISTRIBUTION
The vascular system contains the arteries, arterioles, capillarPhlebitis is defined as inflammation of a vein. It occurs usually
ies, venules, and veins. These vessels supply the tissues with
in the lower legs, but it can affect any veins in the body. Pain
oxygen and nutrients, which are carried in the blood. This
and tenderness in the affected area develop first, followed
system also moves carbon dioxide and waste products to the
by intensifying discomfort, swelling, redness, and warmth.
for excretion.
Phlebitis
developLearning,
into thrombophlebitis.
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Bartlett organs
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Bartlett
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ated blood away from the heart, and in general, the veins carry
exact
cause
is
unknown,
it
is
possible
that venous stasis, blood
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deoxygenated
blood back to the heart. The capillaries are the
disorders, obesity, injury to a vein during phlebotomy, and
point of exchange at the cellular level. Blood vessel disorders
surgery may be related.
include atherosclerosis, arteriosclerosis, emboli, aneurysms,
Thrombophlebitis
phlebitis, thrombophlebitis, and varicose veins.
Thrombophlebitis results from©phlebitis,
a thrombus
Joneswith
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Atherosclerosis © Jones & Bartlett Learning, LLC
forming on the vessel wall. It interferes with blood flow
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acterized by deposits of cholesterol and other fats on the
affected area, and chills and fever. It is also influenced by
sides of blood arteries (see Figure 7–1). Atherosclerosis
venous stasis, blood disorders that cause hypercoagulacauses most myocardial and cerebral infarctions. Risk facbility, and injury to the venous wall. The tunica intima is
tors include heredity, a sedentary lifestyle, a diet high in fats
affected, allowing the formation of clots. Often, there will
Jones &smoking
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Thrombophlebitis is confirmed with radiographic venograplaque forms and thickens the arterial walls. Blood tests will
phy and ultrasonography. It requires immediate treatment,
indicate elevated cholesterol, triglyceride, and lipid levels,
with immobilization of the affected part. Heparin is given to
and hypertension is usually noted. Treatment consists of
prevent enlargement of the clot, and antibiotics are used to
changes in diet and exercise as well as stopping smoking.
prevent infection. Surgery may be used to ligate the affected
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therapies
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vessel so
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agents and
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thrombosis
during immobilization or reduced
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intestine.
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72
CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy
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Anemias are defined as conditions of reduced red blood cells
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acid deficiency, pernicious, aplastic, sickle cell, hemorrhagic,
and hemolytic. Most anemic patients are pale and fatigued.
Progressive symptoms include dyspnea, tachycardia, and the
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assess. Various causes include hemorrhage,
menstrual
flow, the insufficient intake of iron, the insufficient intake of
folic acid, oversized immature RBCs, autoimmune conditions, damaged stem cells, and exposure to certain cytotoxic
agents. Diagnosis shows reduced numbers of RBCs, hemo© Jones & Bartlett Learning, LLC
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of the anemia.
Iron Deficiency Anemia
Iron deficiency anemia is a disorder of oxygen transport.
Hemoglobin synthesis is deficient in this disease, which
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affects&
between
10 and
30% of adultsLLC
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the most common type of anemia, and IT occurs in all ages.
Replacement therapy usually reverses the condition. Possible
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■■ Inadequate dietary intake of iron
■■ Blood loss (due to drugs, heavy menses, hemorrhag© Jones & Bartlett Learning, LLC ing, peptic ulcers, etc.) © Jones & Bartlett Learning, LLC
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■■ Various types of hemoglobinuria (the presence of free
hemoglobin in the urine)
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Figure 7–3 Large arteriosclerotic aneurysm extending from renal
heart valves or vena cava filters)
arteries (above) to iliac arteries (below)
Folic Acid Deficiency Anemia
Folic acid deficiency anemia is a slowly progressing form of
megaloblastic
anemia
. It is very common,
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usually occur in the lower legs and appear swolelderly people, and patients with malignancies or
len, tortuous, and knotted. They usually develop gradually,
intestinal diseases. It is caused by the following:
causing leg fatigue and then a continuous dull ache. Eventu■■ Alcohol abuse, which suppresses the metabolic effects
ally, the veins become harder and thicker, with pain worsenof folate
ing. They are easily diagnosed by their appearance. Although
■■ Poor diet
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the cause is not clearly©identified,
or defective
valves
■■ Impaired absorption due to intestinal dysfunction or
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in the veins are suspected.
patientOR
has adequate
diseases
exercise, the blood in the legs moves normally. When the
■■ Overcooking of food, destroying much of the conpatient is standing or sitting for extended periods, gravity
tained folic acid
causes the blood to be pushed downward, causing pressure
■■ Prolonged drug therapy (including anticonvulsants
on the valves. When advanced, varicosities cause skin around
and estrogens)
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the©
affected
vessels
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■■ Increased
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increased periods of growth throughout life, and in
warm water, and wearing support stockings. Surgery may be
patients with skin diseases or neoplastic diseases)
indicated if these treatments are not adequate.
Pernicious Anemia
Blood Disorders
Pernicious anemia is the most common form of megaloblas© Jones & The
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tic anemia.
It is mainly
caused by malabsorption
of vitamin
common
blood disorders
include anemias, leukemias,
.
It
usually
affects
people
between
the
ages
of
50
and 60,
lymphatic
diseases,
transfusion incompatibility reaction, and
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12
clotting disorders.
99069_ch07_6101.indd 72
and incidence increases with age. It is a fatal condition if not
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Blood Disorders
anemia occurs when the bone marrow cannot produce more
treated. When treated properly, its signs and symptoms sub© Jones
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red blood cells than are being destroyed. Hemolytic anemias
although certain neurologic deficits may be permanent.
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seen in
disorders
as malaria and thalassemia. These
Possible OR
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of pernicious anemia include the following:
■■
■■
■■
■■
Genetic predisposition
Thyroiditis, myxedema, or Graves’ disease
Partial gastrectomy
Lack of adequate dietary consumption of vitamin B12
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(usually in the elderly)
Aplastic Anemia
may be due to protein abnormalities or differences.
Polycythemia
Polycythemia is an abnormal increase
in the number
of erythLLC
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altitudes. It may also be idiopathic. Symptoms include headAplastic anemia is also called hypoplastic anemia. These
aches, dyspnea, irritability, mental sluggishness, dizziness,
terms actually describe a variety of related anemias. Aplassyncope, night sweats, and weight loss. Diagnosis is made via
tic anemia results from the destruction of or injury to stem
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© phlebotomy
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pancytopenia
cells©inJones
the bone marrow
or its matrix.
It causesLLC
ation. Periodic
used to reduce
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as are myelosuppressive drugs and radiation.
from the decreased functioning of hypoplastic fatty bone
marrow. Aplastic anemia usually results in fatal bleeding or
Hemochromatosis
infection, with the death rate for severe cases being between
Hemochromatosis is defined as an iron overload that may be
80 and 90% of patients. Possible causes of aplastic anemia
caused by either repeated transfusions or a genetic condition.
the following:
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When related
to heredity,
the disorder
causes the small intes■■ Drugs (antibiotics, anticonvulsants) or toxic agents
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to absorb excessive iron. Symptoms include arthralgia,
■■ Radiation (nearly one-half of all cases are related to
decreased libido, and fatigue, followed by cirrhosis of the
radiation exposure)
liver, diabetes, excessive melanin-related skin pigmentation,
■■ Severe disease (especially hepatitis)
and heart failure. The excess iron is stored in muscles and
■■ Preleukemic and neoplastic infiltration of bone marorgans such as the liver, pancreas, and heart. Liver damage
row
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may result in liver carcinoma. Symptoms
develop in
■■ Congenital (idiopathic) causes
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moreDISTRIBUTION
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prevalent in males.
Sickle-Cell Anemia
Sickle-cell anemia is a congenital condition caused by defective hemoglobin molecules. The sickle-cell trait results from
gene. The disease
mutations
of the&hemoglobin
© Jones
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asymptomatic. However, about 50% of patients die by their
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early
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Very few will live to middle
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Mediterranean descent. It is also commonly seen in Puerto
Rico, India, the Middle East, and Turkey.
Leukemias
Leukemias are malignant neoplasms of the bone marrow,
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spleen, and lymph
nodes.&
They
produceLearning,
an abnormal proliferation of certain
or myeloid
cells,
causing reduced
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production and function of normal blood cells. They are
classified by the proliferating cell type and degree of differentiation of the neoplastic cells. Leukemias may be acute or
chronic. Common types of leukemias include acute lymphocytic leukemia,
chronic
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leukemia, acute myelogJones
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Anemia
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A hemorrhage
is a loss of a large amount of blood in a short
period, either externally or internally. Hemorrhaging may
Acute Lymphocytic Leukemia
occur in arteries, veins, or capillaries. An untreated hemorAcute lymphocytic leukemia causes an overproduction of
rhage may result in anemia. This is referred to as hemorrhagic
immature lymphoid cells (lymphoblasts) in the lymph nodes
anemia. Hemoglobin levels are lowered severely due to rapid,
and bone marrow. Common signs and symptoms include
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massive hemorrhage. Most
commonly,
hemorrhagic
anemia
bone pain, sore throat, fatigue, night sweats, weakness, and
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is seen after car accidents,
or stab
weight loss. Prompt assessment
by a physician
is required.
wounds, and other severe forms of tissue damage. Surgery to
This type of leukemia usually affects children and people over
repair the bleeding tissues or organs is usually indicated, as
age 65. It is the most common childhood leukemia.
are blood transfusions. If prompt treatment is not given, the
patient goes into shock, which leads to coma and death.
Chronic Lymphocytic Leukemia
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Chronic lymphocytic
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that usually
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affects the B lymphocytes. It progresses slowly, resulting in
mature-appearing but hypofunctional lymphocytes. There
Hemolytic anemia is a disorder characterized by the chronic
are often no symptoms prior to the disease being revealed in
premature destruction of red blood cells. Anemia may be mina complete blood count. When symptoms develop, they usuimal or absent and may reflect the ability of bone marrow to
ally include fever, night sweats, extreme fatigue, a noticeable
increase red blood cell production. The process of the destruc© Jones & tion
Bartlett
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LLC
© Jones
&ofBartlett
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LLCPrompt assessment
swelling
lymph nodes,
and weight loss.
of red blood
cells is called
hemolysis. The condition may
a physician
required.
There are five stages of chronic
be associated
with an infectious disease, certain inherited
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lymphocytic leukemia:
red blood cell disorders, or neoplastic diseases. Hemolytic
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CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy
■■
Stage 0—low risk—lymphocytosis exists
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■■ Stage I—intermediate risk—lymphocytosis
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enlarged
lymph nodes
the extremities. It is characterized by fine red streaks that
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extend from the infected area to the axilla or groin. Other
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includeOR
chills,
fever, headache, and myalgia. Risk
plus
Stage II—intermediate risk—lymphocytosis plus an
factors include chronic steroid use, diabetes mellitus, longenlarged liver or spleen, with or without lymphadeterm placement of a peripheral venous catheter, immunonopathy
compromise, bites (from insects, animals, or humans), and
■■ Stage III—high risk—lymphocytosis plus anemia
any skin trauma.
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risk—lymphocytosis
plusLearning,
thromboLymphomas
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cytopenia
Lymphomas are neoplasms of the lymphatic tissue that origiAcute Myelogenous Leukemia
nate in the lymphatic system. They are usually malignant, but
Acute myelogenous leukemia is a rapidly progressive neoin rare cases may be benign. A lymphoma normally appears
plasm of myeloid-related cells. In this condition, leukemic
initially as a single, painless, enlarged lymph node, usually
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Jones
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cells©accumulate
the bone marrow,
peripheral
blood, and
in the neck. ©
Signs
and symptoms
progress
to include LLC
fever,
other
tissues.
It is also
known
as acute
myeloid, granulocytic,
weakness, anemia,
weight
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may spread
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or myelocytic leukemia. Rapidly accumulating myeloblasts
to the liver, bones, spleen, and gastrointestinal tract. Lympholead to pancytopenia and anemia. This type of leukemia is
mas are usually categorized as Hodgkin’s or non-Hodgkin’s
the most common adult leukemia and represents about 20%
lymphoma. Hodgkin disease is caused by clonal proliferation
of transformed B lymphocytes. The presence of Reed-Sternof childhood leukemias.
on a pathologic
examination
is all that is needed
berg cells
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Chronic Myelogenous Leukemia
to
confirm
diagnosis
of
this
disease
(see
Figure 7–4). The
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Chronic myelogenous leukemia is a slowly progressing neodisease spreads first to continuous lymphoid tissue and then
plasm arising in early progenitor cells or hematopoietic stem
to nonlymphoid tissue.
cells. It results in excessive mature-appearing but hypofuncTransfusion Incompatibility Reaction
tional neutrophils. Most cases are genetic in origin, identified because of the Philadelphia chromosome. This type of
It is extremely important that blood
components
to be trans© Jones & Bartlett Learning, LLC
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leukemia accounts for 15 to 20% of adult leukemias. Nearly
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one-half of patients are asymptomatic at diagnosis. It is usufusion. The correct individual must be identified prior to
ally diagnosed because of leukocytosis or thrombocytosis
the transfusion process. Transfusion incompatibility reacfound during routine blood tests. The disease usually occurs
tion occurs when a transfused blood product has antibodies
in adults over the age of 40. The only chance for a complete
to the recipient’s red blood cells, or when the recipient has
cure is bone marrow transplantation.
antibodies to the donated blood’s red blood cells. Individu© Jones & Bartlett Learning, LLC
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als must be carefully monitored for a transfusion reaction.
Lymphatic
Diseases
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The hypersensitivity
reaction
can range
mild to fatal.
Diseases of the lymphatic system include lymphedema, lympTherefore, vital signs should be checked every 5 min during
hangitis, and various lymphomas.
the procedure, and signs and symptoms such as chills, fever,
facial flushing, tachycardia, cold or clammy skin, and itching
Lymphedema
should also be checked. More intensive symptoms may lead to
is an abnormal
collection of lymph (usually
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© Jones
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LLCproduces hemolysis
circulatory
collapse. This
type of reaction
in
the
extremities)
that
results
in
a
painless
swelling.
It
is
or
agglutination
of
blood
cells.
Any
further
transfusion must
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usually due to an obstruction, but may also be caused by
be quickly stopped, and antihistamines are indicated.
inflammation or the removal of lymph channels. Congenital lymphedema (Milroy’s disease) is a hereditary condition
Clotting Disorders
characterized by chronic lymphatic obstruction. SecondClotting disorders include hemophilia and disseminated intraary lymphedema may©
follow
the surgical
removalLearning,
of lymph
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vascular coagulation. Hemophilia
from
deficiency of
channels in mastectomy, the obstruction of lymph drainage
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caused by malignant tumors, or adult filarial parasite infestation of lymph vessels. Lymphedema is most common in the
lower limbs. It can also occur in the arms, face, trunk, and
external genitalia. Lymphedema may be primary or secondary. There is no cure for lymphedema, but lymph drainage
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hypertrophied lymph channels and disfiguring tissue.
■■
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Bartlett Learning, LLC
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Lymphangitis
is an inflammation of the lymph vessels that
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may be caused by an acute streptococcal infection in one of
Figure 7–4 Reed-Sternberg cells
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Summary
clotting factors, and it is a hereditarily linked disorder. It affects
obstructed, this may result in atherosclerosis, a spasm, or a
© Jones
& Bartlett Learning, LLC
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Bartlett
Learning, LLC
thrombus. A dysrhythmia (arrhythmia) is a disturbance of
children and is signified by prolonged bleeding after
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rhythm
caused
abnormal electrical conduction or
injury, easy
bruising,
hematomas, and excessive nosebleeds.NOTheart
automaticity. Cardiac arrest is a sudden cessation of cardiac
output and effective circulation, which is usually precipitated
by ventricular fibrillation or ventricular asystole. Common
Hemophilia is a group of hereditary bleeding disorders charvascular disorders include phlebitis, thrombophlebitis, and
acterized by a deficiency of one of the factors necessary
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varicose veins.
for blood coagulation. The two most common forms of the
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Shock may be caused by anaphylaxis,
hemorrhage,
disorder are hemophilia A and hemophilia B. Hemophilia
ratory
distress,
sepsis,
heart
failure,
neurologic
failure,
emoA is also known as classic hemophilia. It is the result of a
tional
catastrophe,
or
severe
metabolic
insult.
There
are
many
deficiency or absence of antihemophilic factor VIII. Hemotypes of anemia, some of which have high fatality rates. Aplasphilia B (Christmas disease) represents a deficiency of plasma
tic anemia usually results in fatal bleeding or infection, with
thromboplastin component. The greater the deficiency, the
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the death rate
severe cases
being between
80 and 90%
of
more severe the disorder will manifest. Patients with hemopatients. Acute
myelogenous
leukemia
most common
philia
experience
greater than
loss of blood during
NOT
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OR normal
DISTRIBUTION
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ORis the
DISTRIBUTION
adult leukemia, while acute lymphocytic leukemia is the most
dental procedures, epistaxis, hematoma, and hemarthrosis.
common childhood leukemia.
Severe nonsurgical internal hemorrhage and hematuria are
less common.
The primary treatment for hemophilia is the replaceCRITICAL THINKING
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of deficient
factors with
recombinant factor products
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of weakness,
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ing episodes. Acetaminophen or codeine is used to control
Her physician orders blood tests to see if she has any type of
pain. Both aspirin and NSAID use, as well as intramuscular
anemia. The results confirm this.
injections, should be avoided because they may precipitate
1. What is the most common type of anemia during pregbleeding. When hemophiliacs need surgery or dental work,
nancy once iron deficiency anemia is ruled out?
extreme care must be©exercised.
Gene
transfer Learning,
therapy is
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2. Under what form of anemia
is this type
being experimented with to develop methods of replacing
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the absent gene.
Hemophilia
WEBSITES
Disseminated Intravascular Coagulation
http://digestive.niddk.nih.gov/ddiseases/pubs​
Disseminated intravascular coagulation occurs as a complica/hemochromatosis
tion©ofJones
diseases and
conditions
that
accelerate
clotting.
When
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http://www.americanheart.org/presenter​
.jhtml​
clotting accelerates, it causes occlusion of small blood vessels
?identifier=4440
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and organ necrosis. Clotting in the microcirculation usually
http://www.heartfailure.org/eng_site/hf.asp
affects the lungs, kidneys, extremities, and brain. Dissemihttp://www.labtestsonline.org/understanding/conditions​
nated intravascular coagulation is caused by the following:
■■ Infection (gram-negative septicemia, gram-positive
/anemia.html
septicemia, or from viruses, fungi, rickettsiae, or prohttp://www.mayoclinic.com/health/high-blood-pressure​
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tozoans)
/DS00100
■■ Neoplastic
disease (including acute leukemia, aplastic
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anemia, and metastatic carcinoma)
http://www.merckmanuals.com/professional/sec07.html
■■ Necrotic disorders (including brain tissue destruction, extensive trauma or burns, hepatic necrosis, and
http://www.nlm.nih.gov/medlineplus​
transplant rejection)
/bloodandblooddisorders.html
■■ Obstetric complications
abruptio Learning,
placentae,
(including
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http://www.nlm.nih.gov/medlineplus/ency/article/001124
eclampamniotic fluid embolism,
retained
dead
fetus,
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.htm
sia, and septic abortion)
http://www.oncologychannel.com/leukemias/index.shtml
■■ Other conditions (including heatstroke, poisonhttp://www.wrongdiagnosis.com/medical/blood_vessel
ous snakebite, cirrhosis, fat embolism, incompatible
_disorder.htm
blood transfusion, cardiac arrest, shock, severe venous
thrombosis,
and
surgery
requiring
cardiopulmonary
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REVIEW QUESTIONS
bypass)
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Summary
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Multiple Choice
Common disorders related to phlebotomy include those
1. An area of dead cells due to lack of oxygen is called
A. ischemia
that affect the cardiovascular system, including the blood
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Bartlett
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LLC is the most common type
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& Bartlett
infarction Learning, LLC
blood vessels.
Atherosclerosis
atresia OR DISTRIBUTION
of coronary
disease. Necrosis of heart tissue results
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ORartery
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D. gangrene
in myocardial infarction. When the coronary arteries are
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76
CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy
2. The most common type of anemia in the United States
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is
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A.OR
sickle
cell
various cardiac arrhythmias
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D. complication of syphilis
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FORThe
SALE
OR
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presence
of Reed-Sternberg
cells can confirm diag-
B. pernicious
nosis of
C. folic acid deficiency
A. chronic lymphocytic leukemia
D. iron deficiency
B. acute myelogenous leukemia
3. Thrombophlebitis occurs most commonly in the
C. Hodgkin’s disease
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A. lower legs © Jones & Bartlett Learning, LLC D. hemophilia
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B. lower arms
11. Which of the following isNOT
a major
causeSALE
of cardiac
dis-DISTRIBUTION
C. lower abdomen
ease, renal failure, and stroke?
D. lungs
A. emphysema
4. When the heart is pumping inadequately to meet the
B. heart failure
needs of the body, the condition is called
C. hypertension
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D. asthma
cor pulmonale
B. heart
12. WhichNOT
of theFOR
following
does OR
not cause
disseminated
NOT
FORfailure
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DISTRIBUTION
C. arrhythmia
intravascular coagulation?
D. myocardial infarction
A. neoplastic diseases such as acute leukemia and
5. Which of the following is a sign of shock?
metastatic carcinoma
A. bradycardia
B. abruptio placentae and septic abortion
B. tachycardia
severe dehydration
and low
potassium in the
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LLC
C. bradypnea
blood
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D. hypertension
D. brain tissue destruction and hepatic necrosis
6. In which of the following types of anemia may you find
13. Which of the following cardiovascular disorders is the
hemoglobin S?
leading cause of death in the United States?
A. hemolytic
A. myocardial infarction
B. aplastic
© Jones & Bartlett Learning, LLC B. hypertension
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C. sickle cell
C. stroke
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D. megaloblastic
D. angina pectoris
7. Stasis of blood flow from immobility, injury to a ves14. Thrombophlebitis results from
sel, or predisposition to clot formation increases the
A. inflammation of veins
B. inflammation of the sac enclosing the heart
risk of
A. pulmonary embolism
C. hypertension
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B. emphysema
D. myocardial
infarction
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C. pneumothorax
15. The diagnosis
of anemia
indicates
that the patient is
D. chronic obstructive pulmonary disease
experiencing a reduction in
8. What is the most common type of coronary artery
A. platelets
disease?
B. leukocytes
A. dysrhythmia
C. antibodies or albumin
B. atherosclerosis
red blood cells
or hemoglobin
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LLC
C.
anoxia
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D. pancytopenia
9. Aneurysms are often caused by
A. buildup of atherosclerotic plaque that weakens
vessel walls
B. an inflammation
of a vein
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& Bartlett Learning, LLC
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