Download chapter 09 the blood and lymphatic systems

CHAPTER 9
Blood and
Lymphatic Systems
Blood System Overview
• Blood transports oxygen and nutrients to
body cells
• Blood removes carbon dioxide and other
waste products from body cells for
elimination
2
Composition of Blood
• Plasma
– 90 percent water = liquid portion of blood
• Transports cellular elements of blood throughout
circulatory system
– Remaining portion = solutes
• Electrolytes, proteins, fats, glucose, bilirubin, and
gases
• Most abundant solutes are plasma proteins:
albumins, globulins, and fibrinogen
3
Composition of Blood
• Solid components
– Formed elements = cells + cell fragments
• Erythrocytes, leukocytes, thrombocytes
4
Plasma Proteins
• Albumins
– Constitute about 60 percent of the plasma
proteins
– Help maintain normal blood volume and
blood pressure
– Help to maintain balance between fluid in
the blood and fluid in the interstitial tissues
5
Plasma Proteins
• Globulins
– Constitute approximately 36 percent of
plasma proteins
– Alpha and beta globulins transport lipids (fats)
and fat-soluble vitamins in blood
– Gamma globulins are antibodies and function
in immunity
6
Plasma Proteins
• Fibrinogen
– Constitutes approximately 4 percent of
plasma proteins
– Largest of plasma proteins
– Essential in process of blood clotting
7
Blood Cells
• Erythrocytes
– Known as red blood cells (RBC)
• Tiny biconcave-shaped disks
• Thinner in center than around edges
• No nucleus in mature red blood cell
– Average life span = approximately 120 days
– Main component = hemoglobin
– Primary function = transport oxygen to cells of
body
8
Blood Cells
• Leukocytes
– Known as white blood cells (WBC)
• Larger than erythrocytes, but fewer in number
• Mature WBC has a nucleus; does not have
hemoglobin
– Two categories = granulocytes +
agranulocytes
• Granulocytes have granules in their cytoplasm
• Agranulocytes have no granules in their cytoplasm
• Five different types of leukocytes within the
categories
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Blood Cells Granulocytes
• Neutrophils
– Constitute approximately 60-70 percent of all
WBCs
– Have multi-lobed nuclei
– Phagocytic in nature
– Do not absorb acid or base dye well
• Remain fairly neutral color
10
Granulocytes
• Eosinophils
– Constitute approximately 2-4 percent of all
WBCs
– Have a nucleus with two lobes
– Increase in number in response to allergic
reactions
– Stain a red, rosy color with an acid dye
11
Granulocytes
• Basophils
– Constitute less than 1 percent of all WBCs
– Have a nucleus with two lobes
– Secrete histamine during allergic reactions
– Secrete heparin – a natural anticoagulant
– Stain a dark blue with a base dye
12
Blood Cells Agranulocytes
• Monocytes
– Constitute approximately 3-8 percent of all
WBCs
– Largest of all white blood cells
– Have a kidney bean-shaped nucleus
– Phagocytic in nature
13
Agranulocytes
• Lymphocytes
– Constitute approximately 20-25 percent of all
WBCs
– Have a large spherical-shaped nucleus
– Play important role in immune process
– Some lymphocytes are phagocytic
– Other lymphocytes produce antibodies
14
Cell Fragments
• Thrombocytes
– Small, disc-shaped fragments of very large
cells called megakaryocytes
– Also known as platelets
– Contain no hemoglobin
– Essential for normal clotting of blood
15
Blood Types
• Blood Type A
– Has A-antigen present on RBC
– Has Anti-B antibody present in plasma
• Blood Type B
– Has B-antigen present on RBC
– Has Anti-A antibody present in plasma
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Blood Types
• Blood Type AB
– Has AB-antigens present on RBC
– Has no antibodies present in plasma
• Blood Type O
– Has no antigens present on RBC
– Has both anti-A and Anti-B antibodies present
in plasma
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Terms Related
to Blood Transfusions
• Donor
– Person who gives blood
• Recipient
– Person who receives blood
18
Terms Related
to Blood Transfusions
• Universal Donor Blood
– Type O
– No A antigens or B antigens present on its
RBCs
• Universal Recipient Blood
– Type AB
– No anti-A or Anti-B antigens present in its
plasma
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Rh Factor
• Rh Positive (Rh+)
– Rh antigen is present on the RBC
• Rh Negative (Rh-)
– Rh antigen not present on the RBC
• Concern: Rh- blood being exposed to Rh+ blood
via transfusion
• Concern: Rh- mother giving birth to Rh+ baby
and blood mixes during birth process
20
Blood Clotting
• Clotting of blood = coagulation
– Injury to blood vessel creates roughened area
in vessel
– Platelets come in contact with rough spot and
disintegrate
• Release substance called thromboplastin
– Thromboplastin converts prothrombin into
thrombin
• In presence of calcium ions and other clotting
factors
– Thrombin converts fibrinogen into fibrin
• Fibrin threads form a mesh that forms the clot
21
PATHOLOGICAL
CONDITIONS
The Blood
Anemia
• Pronounced
– (an-NEE-mee-ah)
• Defined
– Deficiency of oxygen being delivered to cells
due to decrease in quantity of hemoglobin or
red blood cells
23
Anemia
• Similarities in all types of anemia
– Fatigue
– Paleness of skin
– Headache
– Fainting
– Tingling sensations and numbness
– Loss of appetite
– Swelling in lower extremities
– Difficulty breathing
24
Aplastic Anemia
• Pronounced
– (ah-PLAST-ik an-NEE-mee-ah)
• Defined
– Form of anemia characterized by
pancytopenia, an inadequacy of all the formed
blood elements (RBCs, WBCs, platelets)
• Also known as “bone marrow depression anemia”
25
Hemolytic Anemia
• Pronounced
– (he-moh-LIT-ik an-NEE-mee-ah)
• Defined
– Form of anemia characterized by the extreme
reduction in circulating RBCs due to their
destruction
26
Iron Deficiency Anemia
• Pronounced
– (EYE-urn dee-FIH-shen-see an-NEE-meeah)
• Defined
– Anemia that is characterized by deficiency of
hemoglobin level due to a lack of iron in the
body
27
Pernicious Anemia
• Pronounced
– (per-NISH-us an-NEE-mee-ah)
• Defined
– Form of anemia resulting from a deficiency of
mature RBCs and the formation and
circulation of megaloblasts with marked
poikilocytosis, and anisocytosis
• Distorted RBCs due to lack of vitamin B12
absorption necessary for maturation of RBCs
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Sickle Cell Anemia
• Pronounced
– (SIKL-SELL an-NEE-mee-ah)
• Defined
– Chronic hereditary form of hemolytic anemia in
which RBCs become crescent-shaped in
presence of low oxygen concentration
• Crescent-shaped RBCs clump together forming
thromboses which occlude small blood vessels,
causing much pain for the individual
29
Granulocytosis
• Pronounced
– (gran-yew-loh-sigh-TOH-sis)
• Defined
– Abnormally elevated number of granulocytes
in the circulating blood as a reaction to any
variety of inflammation or infection
30
Hemochromatosis
• Pronounced
– (hee-moh-kroh-mah-TOH-sis)
• Defined
– Rare iron metabolism disease characterized
by iron deposits throughout the body
– Usually as a complication of one of the
hemolytic anemias
31
Hemophilia
• Pronounced
– (hee-moh-FILL-ee-ah)
• Defined
– Hereditary inadequacies of coagulation
factors resulting in prolonged bleeding times
32
Hemophilia
• Hemophilia A
– Also called classic hemophilia
– Result of a deficiency or absence of
antihemophilic factor VIII
• Deficiency results in traumatic or spontaneous
bleeding
– Characterized by bleeding in joints, gums, or
mouth
– Hematuria is a common characteristic
33
Hemophilia
• Hemophilia B
– Also called Christmas disease
– Result of deficiency of a coagulation factor
called factor IX
– Only distinguishable from Hemophilia through
laboratory differentiation of factor deficiencies
34
Leukemia
• Pronounced
– (loo-KEE-mee-ah)
• Defined
– Excessive uncontrolled increase of immature
WBCs in the blood eventually leading to
infection, anemia, and thrombocytopenia
• Course of leukemia is subclassified as acute or
chronic
35
Leukemia
• Acute leukemia
– Rapid onset
– Swiftly progresses to severe
thrombocytopenia, progressive anemia,
infective lesions in throat and mouth, high
fever, and severe infection
• Chronic leukemia
– Gradual onset
– Progression slower than with acute form
36
Leukemia
• Classifications of leukemia
– AML
• Acute Myelogenous Leukemia
– ALL
• Acute Lymphocytic Leukemia
– CML
• Chronic Myelogenous Leukemia
– CLL
• Chronic Lymphocytic Leukemia
37
Multiple Myeloma
(Plasma Cell Myeloma)
• Pronounced
– (MULL-tih-pl- my-eh-LOH-mah)
• Defined
– Malignant plasma cell neoplasm causing an
increase in the number of both mature and
immature plasma cells
• Often entirely replace the bone marrow and
destroy the skeletal structure
38
Polycythemia Vera
• Pronounced
– (pol-ee-sigh-THEE-mee-ah VAIR-ah)
• Defined
– Abnormal increase in the number of RBCs,
granulocytes, and thrombocytes leading to an
increase in blood volume and viscosity
39
Purpura
• Pronounced
– (PURR-pew-rah)
• Defined
– Collection of blood beneath the skin in the
form of pinpoint hemorrhages appearing as
red-purple skin discolorations
• Idiopathic thrombocytopenic purpura = antibodies
formed by the individual that destroys his/her own
platelets
40
Thalassemia
• Pronounced
– (thal-ah-SEE-mee-ah)
• Defined
– Hereditary form of hemolytic anemia in
which the production of hemoglobin is
deficient creating hypochromic microcytic
RBCs
• Alpha or beta hemoglobin chains are defective
41
DIAGNOSTIC
TECHNIQUES, TREATMENTS
AND PROCEDURES
The Blood
Diagnostic Techniques,
Treatments, and Procedures
• Direct Antiglobulin Test (Coomb’s Test)
– Blood test used to discover the presence of
antierythrocyte antibodies present in the blood
of an Rh negative woman
• Production of these antibodies is associated with
an Rh incompatibility between a pregnant Rh
negative woman and her Rh positive fetus
43
Diagnostic Techniques,
Treatments, and Procedures
• Bleeding time
– Measurement of the time required for
bleeding to stop
• Blood transfusion
– Administration of blood or a blood component
to an individual to replace blood lost through
surgery, trauma, or disease
44
Diagnostic Techniques,
Treatments, and Procedures
• Bone marrow biopsy
– Microscopic exam of bone marrow tissue,
which fully evaluates hematopoiesis by
revealing the number, shape, and size of the
RBCs, WBCs, and platelet precursors
• Bone samples are obtained through aspiration or
surgical removal
45
Diagnostic Techniques,
Treatments, and Procedures
• Bone marrow transplant
– Donor’s bone marrow cells are infused
intravenously into the recipient
• After recipient receives an infusion of aggressive
chemotherapy or total-body irradiation to destroy
all malignant cells and to inactivate the immune
system
46
Diagnostic Techniques,
Treatments, and Procedures
• Complete Blood Cell Count (CBC)
– Series of tests performed on peripheral
blood, that inexpensively screens for
problems in the hematologic system as well
as several other organ systems
– CBC includes
• RBC count, Hemoglobin, Hematocrit, RBC
indices, WBC count, WBC differential, Blood
smear, Platelet count
47
Diagnostic Techniques,
Treatments, and Procedures
• Erythrocyte Sedimentation Rate (ESR)
– Test performed on blood, that measures the
rate at which red blood cells settle out in a
tube of unclotted blood
• ESR is determined by measuring the settling
distance of RBCs in normal saline over one hour
48
Diagnostic Techniques,
Treatments, and Procedures
• Hematocrit
– Assessment of RBC percentage in total blood
volume
• Hemoglobin test
– Concentration measurement of hemoglobin in
peripheral blood
49
Diagnostic Techniques,
Treatments, and Procedures
• Lipid profile
– Measurement of the lipids in the blood
• Partial thromboplastin time (PTT)
– Blood test used to evaluate the common
pathway and system of clot formation within
the blood
50
Diagnostic Techniques,
Treatments, and Procedures
• Platelet count
– Blood test that provides the count of
platelets per cubic millimeter of blood
• Prothrombin time (PT)
– Blood test used to evaluate common
pathway and extrinsic system of clot
formation
51
Diagnostic Techniques,
Treatments, and Procedures
• Red Blood Cell Count (RBC)
– Measurement of the circulating number of
RBCs in one millimeter of peripheral blood
• Red blood cell morphology
– Examination of the RBC on a stained blood
smear that enables the examiner to identify
the form and shape of the RBCs
52
Diagnostic Techniques,
Treatments, and Procedures
• Reticulocyte count
– Measurement of the number of circulating
reticulocytes, immature erythrocytes, in a
blood specimen
• Rouleaux
– Aggregation of RBCs viewed through the
microscope that may be an artifact, or may
occur with persons with multiple myeloma as
a result of abnormal proteins
53
Diagnostic Techniques,
Treatments, and Procedures
• Schilling test
– Diagnostic analysis for pernicious anemia
• White Blood Cell Count (WBC)
– Measurement of the circulating number of
WBCs in one cubic millimeter of peripheral
blood
54
Diagnostic Techniques,
Treatments, and Procedures
• White blood cell differential
– Measurement of the percentage of each
specific type of circulating WBCs present in
one cubic millimeter of peripheral blood
drawn for the WBC count
55
Lymphatic System Overview
• Lymphatic system functions to produce
antibodies and lymphocytes important to
immunity
• Lymphatic system also functions to
maintain a balance of fluid in the internal
environment
56
Lymphatic System Overview
• Lymphatic system
– Lymph fluid
• Stems from the blood and tissue fluid
– Lymph vessels
• Similar to blood vessels – designed to return
tissue fluid to bloodstream
– Lymph nodes
• Located along path of collecting vessels
– Lymphatic organs
• Thymus, spleen, and tonsils
57
Lymphatic System Overview
• How lymph vessels differ from blood
vessels
– Lymph vessels do not form a closed circuit as
does the cardiovascular system
– Lymph vessels originate in intercellular
spaces of soft tissues of the body
58
Lymphatic System Overview
• Lymphatic system is an important part of
the immune system
– Immune system consists of:
•
•
•
•
•
•
Bone marrow
Thymus
Lymphoid tissues
Lymph nodes
Spleen
Lymphatic vessels
59
Lymph Vessels
• Lymph capillaries
– Smallest lymphatic vessels
– Originate in tissue spaces as blind-ended
sacs
– Capillaries pick up accumulated interstitial
fluid and return it to the blood
– Fluid inside the lymphatic vessels is known
as lymph
60
Lymph Vessels
• Lymph vessels
– Larger than capillaries
– Receive lymph from lymphatic capillaries
– Valves prevent backward flow of fluid
– Transport fluid in only one direction
• Away from the tissues toward the thoracic cavity
61
Lymph Vessels
• Lymphatic ducts
– Only points of entry of lymph into blood
vessels of body
– Right lymphatic duct
• Receives lymph drainage from right side of head
and neck
• Also receives lymph drainage from right upper
extremity, and right side of chest
• Empties into right subclavian vein
62
Lymph Vessels
• Lymphatic ducts
– Thoracic duct
• Receives lymph drainage from remaining regions
of the body
• Empties into left subclavian vein
63
Lymph Nodes
• Collections of lymphatic tissue
• Also called lymph glands
• Located at intervals along course of
lymphatic system vessels
• Lymph passes through stationary lymph
nodes
– Old, dead cells and bacteria present in
lymph are filtered out
– Macrophages engulf and destroy any
bacteria present
64
Thymus
• Located in mediastinum
• Secretes thymosin – stimulates red bone
marrow to produce T lymphocytes
– T- cells important in immune response
– T-cells mature in the thymus
65
Spleen
• Located in upper left quadrant of
abdomen: just below diaphragm, behind
stomach
• Largest lymphatic organ in the body
• Plays an important role in the immune
response
– Filters blood
– Macrophages of spleen remove pathogens
from circulating blood
– Macrophages also remove old red blood
cells from circulation
66
Tonsils
• Masses of lymphatic tissue
• Located in protective ring, just under the
mucous membrane
• Surround the mouth and back of the throat
• Serve as first line of defense from the
external environment
67
Tonsils
• Three groups
– Pharyngeal tonsils or adenoids
• Located near opening of the nasal cavity into
pharynx (throat)
– Palatine tonsils
• Located on each side of the throat, near opening
or oral cavity into pharynx
• Commonly known as ‘the tonsils’
– Lingual tonsils
• Located near the base of the tongue
68
Immunity
• Natural
– Immunity with which we are born; genetic
• Acquired
– Body has developed ability to defend itself
against a specific agent
• Can occur as result of having had the particular
disease
• Can be result of having received immunizations
against a disease
• Can be passive acquired immunity or active
acquired immunity
69
Immunity
• Passive Acquired Immunity
– Acquired artificially by injecting antibodies into
a person’s body
– Protects person from a specific disease
– Short-lived immunity – lasts only a few weeks
– Example: gamma globulin
• Given to individuals exposed to viruses such as
measles and infectious hepatitis
70
Immunity
• Active Acquired Immunity
– Acquired naturally as result of having had a
disease
– Acquired artificially by being inoculated with a
vaccine, antigen, or toxoid
• Immunization = process of creating immunity to a
specific disease
71
Immune Reaction
• Immune reaction = Immune response
– Defense mechanism of the body
• Produces antibodies to destroy invading antigens
and malignancies
• Humoral immune response
– B lymphocytes come in contact with specific
invading antigens
• Produce antibodies known as immunoglobulins
72
Immune Reaction
• Cell-mediated immune response
– T lymphocytes come in contact with specific
invading antigens
– T lymphocytes multiply rapidly and engulf and
digest the antigen
• Multiplication of cells produces memory cells
• Memory cells provide the body with resistance
73
Hypersensitivity
• Abnormal condition characterized by an
excessive reaction to a particular stimulus
• Body’s immune system fails to protect
itself against foreign material
• Allergic reaction is triggered by an allergen
– Examples of allergens:
• Ingested foods, penicillin and other antibiotics,
grass, ragweed pollen and bee or wasp stings
74
Hypersensitivity
• Hypersensitive reactions
– Local reaction
• Occurs at the site where treatment or medication
was administered
– Systemic reaction
• Evidenced by generalized body symptoms such
as runny nose, itchy eyes, hives, and rashes
75
Hypersensitivity
• Hypersensitive reactions
– Anaphylactic shock
• Also known as anaphylaxis
• Antigen-antibody reaction stimulates a massive
secretion of histamine
• Example causes: insect stings, contrast media
containing iodide, aspirin, antitoxins prepared with
animal serum, allergens used in testing
76
PATHOLOGICAL CONDITIONS
Lymphatic System
Acquired Immunodeficiency
Syndrome (AIDS)
• Pronounced
– ( acquired ih-mew-noh-dee-FIH-shen-see
SIN-drom)
• Defined
– Clinical conditions that destroy the body’s
immune system in the last or final phase of a
human immunodeficiency virus (HIV)
infection, which primarily damages helper T
cell lymphocytes with CD4 receptors
78
Cytomegalovirus
• Pronounced
– (sigh-toh-meg-ah-loh VY-rus)
• Defined
– Large species-specific, herpes-type virus with
a wide variety of disease effects
– causes serious illness in persons with AIDS, in
newborns, and in individuals who are being
treated with immunosuppressive drugs
79
Hypersensitivity
• Pronounced
– (high-per-sens-sih-TIV-ih-tee)
• Defined
– Tissue damage resulting from exaggerated
immune responses
• IgE-mediated-Type I hypersensitivity response
• Cytoxic-Type II hypersensitivity reaction
• Immune complex-mediated-Type III sensitivity
response
• Delayed-Type IV hypersensitivity responses
80
Hypersplenism
• Pronounced
– (high-per-SPLEN-izm)
• Defined
– Syndrome involving a deficiency of one or
more types of blood cells and an enlarged
spleen
81
Kaposi’s Sarcoma
• Pronounced
– (KAP-oh-seez sar-KOH-mah)
• Defined
– Locally destructive malignant neoplasm of the
blood vessels associated with AIDS typically
forming lesions on the skin, visceral organs,
or mucous membranes
• Lesions appear initially as tiny red to purple
macules and evolve into sizable nodules or
plaques
82
Lymphoma
• Pronounced
– (LIM-foh-mah)
• Define
– A lymphoid tissue neoplasm that is typically
malignant, beginning with a painless
enlarged lymph node(s) and progressing to
anemia, weakness, fever, and weight loss
83
Lymphoma
• Burkitt’s lymphoma
– Malignant neoplasm in the jaw or abdomen
and seen chiefly in Central Africa
• Hodgkin’s disease
– Characterized by progressive, painless
enlargement of a malignant tumor of the
lymph tissue in the lymph nodes and spleen
typically noted first in the cervical region
84
Lymphoma
• Non-Hodgkin’s lymphoma
– Classification for any kind of malignant
lymphoma besides Hodgkin’s disease
– Includes histiocyte lymphoma and
lymphocytic lymphoma
85
Mononucleosis
• Pronounced
– (mon-oh-noo-klee-OH-sis)
• Defined
– A benign, self-limiting acute infection of the B
lumphocytes
– Usually caused by the Epstein-Barr virus
(EBV)
86
Myasthenia Gravis
• Pronounced
– (my-ass-THEE-nee-ah GRAV-is)
• Defined
– An autoimmune disease in which antibodies
block or destroy some acetylcholine receptor
sites
– Results in muscle weakness
87
Pneumocystis Carinii Pneumonia
(PCP)
• Pronounced
– (noo-moh-SIS-tis kah-rye-nee-eye nooMOH-nee-ah)
• Defined
– Pneumonia caused by a common worldwide
parasite, Pneumocystis carinii, for which
people have immunity if they are not severely
immunocompromised
88
Sarcoidosis
Pronounced
– (sar-koyd-OH-sis)
• Defined
– Systemic inflammatory disease resulting in
the formation of multiple small, rounded
lesions (granulomas) in the lungs, lymph
nodes, eyes, liver, and other organs
89
Systemic Lupus Erythematosus (SLE)
• Pronounced
– (sis-TEM-ik LOO-pus er-ih-them-ah-TOHsus)
• Defined
– Inflammatory connective tissue disease,
chronic in nature, in which immune complexes
are formed from the reaction of SLE
autoantibodies and their corresponding
antigens
• These immune complexes are deposited in the
connective tissues of lymphatic vessels, blood
vessels, and other tissues
90
DIAGNOSTIC
TECHNIQUES, TREATMENTS
AND PROCEDURES
Lymphatic System
Diagnostic Techniques,
Treatments, and Procedures
• Enzyme-Linked Immunosorbent Assay
(ELISA)
– Blood test used for screening for an antibody
to the AIDS virus
• Western Blot
– Blood test to detect the presence of the
antibodies to HIV, the virus that causes AIDS
92
Diagnostic Techniques,
Treatments, and Procedures
• CT (CAT) scan
– Collection of x-ray images taken from various
angles following an injection of a contrast
medium
• Lymphangiogram
– X-ray assessment of the lymphatic system
following injection of a contrast medium into
the lymph vessels in the hand or foot
93