Download Blood Disorders

HEMATOLOGY
The study of the physiology of the blood
BLOOD COMPONENTS
• Erythrocytes (Red Blood Cells-RBC)
• Leukocytes (White Blood Cells-WBC)
• Platelets
• Plasma-Blood cells are suspended in this
liquid (55% of blood volume)
• Gases: O2, Co2, Nitrogen
STEM CELLS MATURE INTO 3 MAIN
TYPES OF BLOOD CELLS
RBC’s
WBC’s
Platelets
Hemoglobin = Protein
inside RBC that carries
oxygen to the body
tissues
Trigger immune
responses caused by
allergens,
inflammation,
infection, and disease
Bind to the site of a
damaged vessel &
cause a clot
Hematocrit = % of
RBC’s in the blood
150,000- 450,000 per
microliter of blood
WBC’S (LEUKOCYTES)
• 3 Types of WBC”s:
• Lymphocytes• orchestrate the immune system’s
response to infection
• 2 Types: B cells-make antibodies
T cells-Destroy infected cells
• Monocytes• make macrophages that destroy
bacteria
• Granulocytes• Destroy bacteria
• 3 Types of Granulocytes:
• Neutrophils• First responders to site of
infection
• Eosinophils• Parasitic infections
• Basophils• Allergic & Inflammatory
reactions
RBC’S (ERYTHROCYTES)
• Produced in the Bone marrow
• Destroyed in the Spleen & Liver
• Life Cycle is approximately 4 months
• Made from: Iron, Vitamin B-12 and Vitamin B-9
(Folate)
• (Synthetic form is Folic Acid)
BLOOD COUNTS MATTER
RBC’s
WBC’s
Platelets
Too many:
Too many:
Too many:
Polycythemia = Heart
attack or Stroke
Leukemia
Not enough:
Anemia = Fatigue,
Vertigo, Syncope
Not enough:
Leukopenia=
infection
Thrombocytosis =
Heart attack or Stroke
Not enough:
Thrombocytopenia=
Easy bruising or
internal bleeding
WHAT BLOOD DISORDER
WAS ONE OF THE CAUSES
OF IMA PASHUNT’S
SYNCOPE?
ELDERLY PEOPLE
•With anemia have twice the risk of
experiencing physical declines that
can end up robbing them of their
independence.
• National Institute on Aging
STATS
• 13% of people over age 70 are Anemic.
• If not treated it can force the heart to
work harder, leading to more serious
consequences.
3 CAUSES OF ANEMIA
WHICH TYPE DID IMA PASHUNT HAVE?
Quantity made
Rate of Loss
Decreased
production of
RBC’s
Loss of RBC’s
more quickly
than they can
be replaced
Lysis or breakdown of
the cell (RBC)
Destruction of
RBC’s
EXAMPLES OF ANEMIA TYPES
Decreased
production
Loss of RBC’s
Iron Deficiency
Pernicious
GI Bleed
Hemorrhage
(Vitamin B
deficiency)
Aplastic
(Chemo)
Destruction
of RBC’s
Hemolytic
Intrinsic
Hyperslenism
Extrinsic
Heart Valve
SYMPTOMS
DID IMA HAVE ANY OF THESE?
• Fatigue/Weakness
• Pallor
• Tachycardia (Increased heart rate)
• Arrythmia (Irregular heart beat)
• Dyspnea (Shortness of Breath)
• Hypoxemia (Sp02 < 90)
• Cyanosis
• Vertigo (Dizziness)
LABORATORY TESTING
• *Complete Blood Count (CBC): RBC’s, Hemoglobin (protein on the
RBC that carries O2), Hematocrit (% of RBC’s compared to the total
blood volume)
• *Serum iron-can be normal even if amount of iron in the body is low,
therefore other tests:
• *Ferritin is a protein that binds to iron & can determine if it is an iron
deficiency anemia
• *Transferrin is a protein that carries iron in the blood. Iron deficiency
anemia will result in a high level of transferrin that has no iron
• *Reticulocyte count shows whether bone marrow is making RBC’s at
the correct rate
OTHER TESTS
• Physical Assessment: Pallor, Dyspnea, Tachycardia,
Arrythmia, Cold extremities, Cyanosis
• Determine source of bleeding if indicated
(hemoccult stools, endoscopy, colonoscopy)
• RBC Size & Color can help determine cause –Blood
Smear
SIZE AND COLOR
• Microcytic: iron deficiency anemia, RBC’s will be small
and pale under microscope
• Normocytic: aplastic anemia which results in failure of the
bone marrow to produce RBC’s
• Macrocytic: Pernicious anemia-body lacks intrinsic factor
required to absorb vitamin B-12 from food
TREATMENT
• Treatment:
•
Locate and stop source of bleeding if indicated (may involve surgery)
•
Iron rich diet + iron supplements
•
Folic acid supplements & vitamin B-12 injections if digestive system is
unable to absorb vit. B-12
•
Vitamin C can help increase iron absorption
•
Stimulate RBC production with injections of synthetic erythropoietin
(produced in the kidneys)
•
Blood transfusion to boost RBC levels
•
Bone marrow transplant &/or chemotherapy if bone marrow is diseased
and cannot make healthy RBC’s
•
Oxygen
BLOOD TRANSFUSIONS
T2S
• ALL (Acute Lymphocytic)-
LEUKEMIA
4 Main Types
children
• AML (Acute Myeloid)older adults
• CLL (Chronc Lymphocytic)older adults
• CML (Chronic Myeloid)
ACUTE VS. CHRONIC
•Acute
•Chronic
• Progresses quickly if not
treated
• Slow growing
• Asymptomatic in early
stages
LYMPHOCYTIC VS. MYELOID
•Lymphocytic
•Myeloid
• Cancer of the stem cells that
produce lymphocytes that
replicate quickly producing
too many immature
lymphocytes called BLASTS.
• Cancer of the bone marrow
produces Myelocytes that do
not develop into mature
healthy Granulocytes =
Myeloblasts or BLASTS
• Therefore crowding out space
for other healthy blood cells
• Therefore crowding out space
for other healthy blood cells
• Therefore, not as capable of
defending against infections
• Therefore, not as capable of
defending against infections
CROWDING OUT =
PANCYTOPENIA
• All 3 blood components are low
• RBC’s
• WBC’s
• Platelets
If a patient has pancytopenia, are they anemic?
What symptoms might you see?
Did Ima have any of these symptoms?
ALL VIDEO (1:54)
• http://www.cancercenter.com/leukemia/types/tab/acute-lymphocyticleukemia/
CML VIDEO (2:13)
• http://www.cancercenter.com/leukemia/types/tab/chronic-myeloidleukemia/
STANDARD TREATMENT OPTIONS
ALL
CLL
AML
CML
Chemo
Chemo
Chemo
Chemo
Radiation
Radiation
Stem Cell transplant
Targeted Therapy
Targeted Therapy
Targeted Therapy
Stem cell after chemo
Surgery
TREATMENT
• Targeted Therapy• Biologic Drug
Gleevec (imatinib)
• Not all Cancer types
• Attack specific cancer cells with less harm to normal
cells
• CML Example: Gleevec Binds specifically with the
Super Villain (BCR-ABL) that causes CML growth
DIFFERENTIAL DIAGNOSIS
• Susan Forrest
and
Ima Pashunt
• How would their labs differ?
• How would their treatment differ?