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C hapter © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Common Disorders and © Jones & Bartlett Learning, Conditions Related to LLC NOT FOR SALE OR DISTRIBUTION Phlebotomy © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION OUTLINE 7 © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 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. © Jones & Bartlett Learning, LLC 3. Describe primary hypertension. Myocardial Infarction NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 ©Heart Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 8. Describe the various types of shock. Cardiac Arrest NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Blood Bartlett © Jones & placentae: Bartlett ALearning, LLC VesselLearning, Disorders LLC placental lining has separated from the uterus of the mother, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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. © Jones & Bartlett Learning, LLC Thrombophlebitis© Jones & Bartlett Learning, LLC Anoxia: Absence of oxygen supply to an organ or tissue. Varicose Veins NOT FOR SALE OR DISTRIBUTION NOT FOR SALE 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 ©Leukemias Jones & Bartlett Learning, LLC arteries. © Jones & Bartlett Learning, LLC Lymphatic Diseases NOT FOR SALE OR DISTRIBUTION NOT SALE ORofDISTRIBUTION 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 © Jones & Websites Bartlett Learning, LLC © Jones & Bartlett Learning, LLC heartbeat.” Review Questions NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 67 2/6/12 1:32:40 PM 68 CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy © Jones & Bartlett Learning, LLC KEY TERMS continued NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC Partial or complete removal of one or both NOTMastectomy: FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Introduction © Jones & Bartlett Learning, LLC NOTCardiovascular FOR SALEdisease 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. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC in the heart muscle caused by an abrupt interruption of Graves’ disease: An autoimmune condition caused OR DISTRIBUTION NOT FOR 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 © Jones stem & Bartlett Learning, LLCinto all © Jones & Bartlett LLC Pancytopenia: A combination of anemia, Learning, leukopenia the different types of blood cells. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (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. © Jones & Hemophilia Bartlett Learning, LLC © Jones & Bartlett Learning, LLC are found via light microscopy in cases of Hodgkin’s disease A: The most common form of hemophilia; it is and certain other disorders. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 Jones & Bartlett LLC © Jones & blood Bartlett 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 NOT FOR SALE OR DISTRIBUTION 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. © Jones &toBartlett Learning, LLC © Jones & Bartlett Learning, LLC Ventricular fibrillation: Abnormal discharge of electrical Lymphoblasts: Immature cells that form lymphocytes; in NOT FOR SALE OR DISTRIBUTION NOTthatFOR DISTRIBUTION 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 © Jones Bartlett Learning, LLC © Jones & Bartlett Learning, LLC affect the arteries of the heart and produce varying pathologic attack (myocardial infarction) is the leading cause of death in NOT FOR SALE to OR NOT FOR 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC oxygen to the cells. Leukemias are malignant neoplasms of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Cardiovascular Bartlett Learning, LLC © Jones Bartlett Learning, LLC stress, & eating, exertion, and exposure to intense cold. ComCardiovascular disease is described as any abnormal conNOT FOR SALE OR DISTRIBUTION NOTplications FOR SALE OR DISTRIBUTION of angina pectoris include arrhythmias, myocardial dition characterized by heart or blood vessel dysfunction. infarction, and ischemic cardiomyopathy. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 68 2/6/12 1:32:40 PM Cardiovascular Disorders 69 by abnormal electrical conduction or automaticity. Normally, © Jones & Bartlett Learning, LLC the sinoatrial (SA) node generates heart rhythms that travel NOTthrough FOR SALE OR DISTRIBUTION the heart’s conduction system. This causes the atrial © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC fibrillation (which requires immediate resuscitation). muscle cell NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © heart Jones & Bartlett Learning, LLC ■■ Organic disease ■ ■ Degeneration of the conductive tissue NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Fibers Fibrous ■■ Connective tissue disorders Fats plaque ■■ Cellular hypoxia ■■ Hypertrophy of the heart muscle ■■ Acid–base imbalances ■■ Emotional stress Large plaque obstructing artery Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones & NOT FOR SALE OR DISTRIBUTION Figure 7–1 Development of a deposition of fat-containing substances that form plaque and lead to arterial occlusion NOTHypertension FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC hypertension results from renal disease or other identifiable Myocardial Infarction FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones &are Bartlett Learning, LLC © Jones & Bartlett Learning, LLC coronary arteries obstructed, this mayNOT result FOR in atherosclerosis, a spasm, SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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. © Jones & treatment Bartlettis delayed, Learning, LLC © Jones & Bartlett Learning, LLC Nearly one-half of sudden myocarNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■■ Family history of MI NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Aging ■■ Gender ■■ Hypertension Clot ■■ Elevated total cholesterol ■■ Obesity © © Jones & Bartlett Learning, LLC ■■ Jones Lifestyle & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Smoking Damaged ■■ Stress or type A personality heart muscle ■■ Drug use (especially cocaine and amphetamines) Arrhythmias © Jones & Cardiac Bartlett Learning, LLC A dysrhythmia (an arrhythmia) is a NOT FOR SALE OR DISTRIBUTION disturbance of heart rhythm caused © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Figure 7–2 Damage caused by myocardial infarction. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 69 2/6/12 1:32:43 PM 70 CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy Pulmonary Edema Risks for hypertension increase with age. Hypertension © Jones & Bartlett Learning, LLC © Jones &isBartlett Learning, LLC more prevalent in the black population than in the white Pulmonary edema involves fluid that shifts into the extravasNOTcular FOR SALE OR DISTRIBUTION NOT FOR SALE 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC following: a patient goes to bed. Pulmonary edema is caused by leftSALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ 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 ©■ Sleep Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC ■ 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 © Jones & Bartlett Learning, LLC © Jones Bartlett Learning, LLC include carditis, knees, & ankles, and fingers. Other symptoms Cardiomyopathy cardiomegaly, and congestive heart failure. NOT FOR SALE OR DISTRIBUTION 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 Learning, LLC © Jones Learning, LLC an inflammatory reaction, which migrates & to Bartlett the endocardiomyopathy. Other risk factors include coronary artery disdium and heart valves. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC 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, Bartlettand Learning, © other causes.LLC © Jones NOT FOR SALE OR DISTRIBUTION Heart Failure acquired or congenital. If insufficient, the valves do not close completely, and blood is forced back intoLearning, the previous cham© Jones & Bartlett LLC ber as the heart contracts. This 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 & Bartlett Learning, LLC phylactic antibiotics. NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC mon cause of heart failure. However, the right ventricle may patients being asymptomatic. When symptoms do exist, they NOTdizziness, FOR SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION 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. © Jones Cardiac Arrest& Bartlett Learning, LLC NOTarrest FORis SALE DISTRIBUTION Cardiac a suddenOR cessation of cardiac output and Shock © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 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 © Jones & bolic Bartlett LLC © Jones Bartlett Learning, LLC 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. NOT FOR SALE DISTRIBUTION NOTrapid FOR SALEasOR Cardiac arrest is also called cardiopulmonary arrest. Drops in blood pressure may cause anxiety, irritability, and © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 70 2/6/12 1:32:43 PM 71 Blood Vessel Disorders Arteriosclerosis restlessness. Other symptoms include dizziness, extreme © Jones & Bartlett Learning, LLC © Jones &thirst, Bartlett Learning, LLC profuse sweating, and then dilation of the pupils, shakArteriosclerosis is actually a group of diseases characterized FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones &orBartlett Learning, LLC © Jones & Bartlett Learning, LLC ents to sustain life. Rapid blood loss fluid loss, with hypocontractility occurs. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © ume; Jones Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 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 FOR SALE OR DISTRIBUTION NOT fainting, FOR SALE 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 © Jones & Bartlett Learning, LLCor sympathetic understimu© Jones Bartlett Learning, LLCin a narrow vessel, is caused by spinal cord or medulla trauma, as aSALE vessel inOR the lungs. Thrombi can form in the heart NOT FOR SALElation; OR itDISTRIBUTION NOTsuch FOR 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC untreated Aneurysms are defined as abnormal dilations of blood vessels NOT FOR7–3). SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ 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. © Jones & Bartlett Learning, LLC Blood Disorders NOTVessel FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC 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. © Jones & appropriate Bartlett organs Learning, LLC The arteries carry oxygen© Jones & can Bartlett LLC Although the ated blood away from the heart, and in general, the veins carry exact cause is unknown, it is possible that venous stasis, blood NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 & Bartlett Learning, LLC Atherosclerosis © Jones & Bartlett Learning, LLC forming on the vessel wall. It interferes with blood flow NOT FOR warmth SALE inOR NOT SALE OR DISTRIBUTION Atherosclerosis is defined as aFOR form of arteriosclerosis charand causes edema, pain, swelling, heaviness, the DISTRIBUTION 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 Bartlett Learning, LLC diabetes © Jones & Bartlett Learning, LLC and©cholesterol, cigarettes, hypertension, be gross edema in one leg, with tenderness to the touch. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mellitus, and obesity. Infarction becomes more likely as 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 © Jones & Drug Bartlett Learning, LLC including hyperlipidemic © Jones & that Bartlett Learning, LLC therapies are quite varied, vessel so collateral circulation can develop. Prevention agents and that inhibit cholesterol absorption in the deep vein thrombosis during immobilization or reduced NOT FOR SALE ORthose DISTRIBUTION NOTofFOR SALE OR DISTRIBUTION intestine. physical activity is essential. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 71 2/6/12 1:32:43 PM 72 CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Anemias © Jones & Bartlett Learning, LLC Anemias are defined as conditions of reduced red blood cells NOTorFOR SALE OR DISTRIBUTION hemoglobin as well as the reduced ability to carry oxygen to the cells. Types of anemias include iron deficiency, folic acid deficiency, pernicious, aplastic, sickle cell, hemorrhagic, and hemolytic. Most anemic patients are pale and fatigued. Progressive symptoms include dyspnea, tachycardia, and the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC pounding of the heart, which a physician should promptly NOT FORheavy SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones Treatment & Bartlett Learning, LLC globin, and hematocrit. is based on the etiology NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of the anemia. Iron Deficiency Anemia Iron deficiency anemia is a disorder of oxygen transport. Hemoglobin synthesis is deficient in this disease, which © Jones & Bartlett Learning, LLC © Jones Bartlett Learning, affects& between 10 and 30% of adultsLLC in the United States. It NOT FOR SALE OR DISTRIBUTION NOTisFOR SALE OR DISTRIBUTION the most common type of anemia, and IT occurs in all ages. Replacement therapy usually reverses the condition. Possible causes of iron deficiency anemia include the following: ■■ 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 ■■ Iron malabsorption (from chronic diarrhea, gastrecNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tomy, celiac disease, etc.) ■■ Various types of hemoglobinuria (the presence of free hemoglobin in the urine) ■■ Pregnancy (wherein iron is carried from the mother to the© fetus) © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC ■■ Mechanical red blood cell trauma (due to prosthetic NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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, © Jones & Varicose BartlettVeins Learning, LLC © Jones & Bartlett Learning, LLC usually occurring in infants, adolescents, pregnant or lactating women, NOT FOR SALE NOTalcoholics, FOR SALE OR DISTRIBUTION VaricoseOR veins DISTRIBUTION 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 Jones absent & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the cause is not clearly©identified, or defective valves ■■ Impaired absorption due to intestinal dysfunction or NOT FOR SALE OR DISTRIBUTION NOTWhen FORthe SALE DISTRIBUTION 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) Jones & Bartlett Learning, LLC involves © Jones & Bartlett Learning, LLC the© affected vessels to become brownish. Treatment ■■ Increased need for folic acid (during pregnancy, frequent withSALE the legsOR raised, exercise, submergence in NOTrest FOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 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 NOT FOR SALE OR DISTRIBUTION NOTBFOR SALE OR DISTRIBUTION 12 clotting disorders. 99069_ch07_6101.indd 72 and incidence increases with age. It is a fatal condition if not © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 2/6/12 1:32:45 PM 73 Blood Disorders anemia occurs when the bone marrow cannot produce more treated. When treated properly, its signs and symptoms sub© Jones & Bartlett Learning, LLC © Jones &side, Bartlett Learning, LLC red blood cells than are being destroyed. Hemolytic anemias although certain neurologic deficits may be permanent. NOTare FOR SALE ORsuch DISTRIBUTION NOT FOR SALE seen in disorders as malaria and thalassemia. These Possible OR causesDISTRIBUTION of pernicious anemia include the following: ■■ ■■ ■■ ■■ Genetic predisposition Thyroiditis, myxedema, or Graves’ disease Partial gastrectomy Lack of adequate dietary consumption of vitamin B12 © Jones & Bartlett Learning, (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 © Jones & Bartlett Learning, LLC rocytes in the blood. It may be primary or secondary to pulNOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION monary disease, heart disease, or prolonged exposure to highDISTRIBUTION 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 blood tests, spleen enlargement, and total RBC mass evalu& Bartlett Learning, © phlebotomy Jones & isBartlett Learning, LLC pancytopenia cells©inJones the bone marrow or its matrix. It causesLLC ation. Periodic used to reduce blood volume, hypoplasia . Pancytopenia actually results andNOT bone marrow FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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: © Jones & include Bartlett Learning, LLC © Jones & Bartlett Learning, LLC When related to heredity, the disorder causes the small intes■■ Drugs (antibiotics, anticonvulsants) or toxic agents NOT FOR SALE OR DISTRIBUTION NOTtine FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jonesusually & Bartlett Learning, LLC may result in liver carcinoma. Symptoms develop in ■■ Congenital (idiopathic) causes the fifth or sixth decade of life, with clinical being OR moreDISTRIBUTION NOT FORsigns SALE NOT FOR SALE OR DISTRIBUTION 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 Bartlett SLearning, LLCis initially asymptomatic. However, about 50% of patients die by their NOT FOR OR DISTRIBUTION early twenties fromSALE this condition. Very few will live to middle age. Sickle-cell anemia mainly affects people of African or 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, © Jones Bartlett LLC spleen, and lymph nodes.& They produceLearning, an abnormal proliferation of certain or myeloid cells, causing reduced NOTlymphoid FOR SALE OR DISTRIBUTION 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 lymphocytic LLC leukemia, acute myelogJones & Bartlett Learning, enous leukemia, and chronic myelogenous leukemia. © Jones & Hemorrhagic Bartlett Learning, LLC © Anemia NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC massive hemorrhage. Most commonly, hemorrhagic anemia bone pain, sore throat, fatigue, night sweats, weakness, and NOT FOR SALE OR DISTRIBUTION NOTmajor FORsurgery, SALEgunshot OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC OR DISTRIBUTION © Jonesleukemia & Bartlett Learning, LLC Chronic lymphocytic is a neoplasm that usually NOT FOR SALE OR DISTRIBUTION 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 Learning, LLC © Jones &ofBartlett Learning, 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 NOT FOR SALE OR DISTRIBUTION NOTbyFOR SALEis OR DISTRIBUTION lymphocytic leukemia: red blood cell disorders, or neoplastic diseases. Hemolytic Hemolytic Anemia NOT FOR SALE © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 73 2/6/12 1:32:45 PM 74 CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy ■■ Stage 0—low risk—lymphocytosis exists © Jones & Bartlett Learning, LLC ■■ Stage I—intermediate risk—lymphocytosis NOT FOR SALE OR DISTRIBUTION enlarged lymph nodes the extremities. It is characterized by fine red streaks that © Jones & Bartlett Learning, LLC extend from the infected area to the axilla or groin. Other NOTsymptoms FOR SALE DISTRIBUTION 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. Jones & Bartlett LLC © Jones & Bartlett Learning, LLC ■■ Stage IV—high© risk—lymphocytosis plusLearning, thromboLymphomas NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 Jones &inBartlett Learning, LLC Jones & Bartlett Learning, 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 loss. The may spread NOT FOR SALE OR DISTRIBUTION NOT and FOR SALE ORdisease DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chronic Myelogenous Leukemia to confirm diagnosis of this disease (see Figure 7–4). The NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC leukemia accounts for 15 to 20% of adult leukemias. Nearly fused be compatible with the individual receiving the transNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC als must be carefully monitored for a transfusion reaction. Lymphatic Diseases NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR from DISTRIBUTION 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 © Jones & Lymphedema Bartlett Learning, LLC © Jones & Bartlett Learning, 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 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 Jones & Bartlett LLC © results Jones &aBartlett Learning, LLC vascular coagulation. Hemophilia from deficiency of channels in mastectomy, the obstruction of lymph drainage NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC from the extremities can be improved if the patient sleeps NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION with the foot of his or her bed elevated 4 to 8 in. Other helpful measures include the wearing of elastic stockings and regular moderate exercise. Surgery may be performed to remove hypertrophied lymph channels and disfiguring tissue. ■■ © Jones & Lymphangitis Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Lymphangitis is an inflammation of the lymph vessels that NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION may be caused by an acute streptococcal infection in one of Figure 7–4 Reed-Sternberg cells © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 74 2/6/12 1:32:46 PM 75 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 © Jones &male Bartlett Learning, LLC thrombus. A dysrhythmia (arrhythmia) is a disturbance of children and is signified by prolonged bleeding after FOR SALE ORbyDISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC varicose veins. for blood coagulation. The two most common forms of the NOT FOR SALE respiOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC ©for Jones & Bartlett Learning, LLC 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 FOR aSALE OR normal DISTRIBUTION NOT FOR SALE 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 © Jones & ment Bartlett Learning, LLC © Jones & Bartlett Learning, LLC of deficient factors with recombinant factor products A woman who has been pregnant for 32 weeks has been or plasma. Treatment may be prophylactic, or to stop bleedNOT FOR SALE OR DISTRIBUTION NOTcomplaining FOR SALE OR DISTRIBUTION of weakness, tiredness, and lack of appetite. 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 Jones & Bartlett LLC © Jones & classified? Bartlett Learning, LLC 2. Under what form of anemia is this type being experimented with to develop methods of replacing NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC http://www.americanheart.org/presenter .jhtml clotting accelerates, it causes occlusion of small blood vessels ?identifier=4440 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tozoans) /DS00100 ■■ Neoplastic disease (including acute leukemia, aplastic NOT FOR SALE OR DISTRIBUTION NOThttp://www.medicinenet.com/heart_attack/article.htm FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett LLC © Jones & Bartlett Learning, LLC http://www.nlm.nih.gov/medlineplus/ency/article/001124 eclampamniotic fluid embolism, retained dead fetus, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION .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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC REVIEW QUESTIONS bypass) NOT FOR SALE OR DISTRIBUTION Summary NOT FOR SALE OR DISTRIBUTION 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 © Jones & and Bartlett Learning, LLC is the most common type © Jones B. & Bartlett infarction Learning, LLC blood vessels. Atherosclerosis atresia OR DISTRIBUTION of coronary disease. Necrosis of heart tissue results NOT FOR SALE ORartery DISTRIBUTION NOT FORC.SALE D. gangrene in myocardial infarction. When the coronary arteries are © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 75 2/6/12 1:32:47 PM 76 CHAPTER 7 Common Disorders and Conditions Related to Phlebotomy 2. The most common type of anemia in the United States © Jones & Bartlett Learning, LLC is NOT FOR SALE DISTRIBUTION A.OR sickle cell various cardiac arrhythmias © Jones C. & Bartlett Learning, LLC D. complication of syphilis NOT 10. FORThe SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC A. lower legs © Jones & Bartlett Learning, LLC D. hemophilia FOR OR NOT FOR SALE OR DISTRIBUTION 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 © A. Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC D. asthma cor pulmonale B. heart 12. WhichNOT of theFOR following does OR not cause disseminated NOT FORfailure SALE OR DISTRIBUTION SALE 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 © Jones & Bartlett Learning, LLC © Jones C. & Bartlett Learning, LLC C. bradypnea blood NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC C. sickle cell C. stroke NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC B. emphysema D. myocardial infarction NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 © Jones & Bartlett Learning, LLC © Jones D. & Bartlett Learning, LLC C. anoxia NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION D. pancytopenia 9. Aneurysms are often caused by A. buildup of atherosclerotic plaque that weakens vessel walls B. an inflammation of a vein © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION 99069_ch07_6101.indd 76 2/6/12 1:32:47 PM