blood pathophysiology
TRANSCRIPT
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BLOOD PATHOPHYSIOLOG
Y
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Blood System Overview• Blood transports oxygen and
nutrients to body cells
• Blood removes carbon dioxide and other waste products from body cells for elimination
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CHANGE IN BLOOD VOLUME
• Blood volume is the volume of blood (both red blood cells and plasma) in the circulatory system of any individual.
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Types :1. Hypovolemia2. Hypervolemia 3. Euvolemia
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Change in blood volume
Normovolemia
HypovolemiaHypervolemia
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HYPOVOLEMIA
• Hypovolemia is a state of decreased blood volume
1.Cell number decreasing hypovolemia – due to number of erythrocytes decrease2. Cell number increasing hypovolemia- due to volume of blood plasma decrease3.Normal hypovolemia – eryhtrocytes and blood plasma both decrease
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hypovolemia
1.Cell number decreasing hypovolemia
2. Cell number increasing hypovolemia
3.Normal hypovolemia
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Causes
• Loss of blood ( bleeding or blood donation)• Loss of plasma (severe burns and lesions )• Loss of body sodium and consequent
intravascular water; e.g. diarrhea or vomiting• Vasodilation (involving widening of blood
vessels)
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Hypervolemia
• It is a state of blood volume decreaseTypes:1. Cell number decreasing hypervolemia - due to blood plasma decrease2. Cell number increasing hypervolemia - blood cell number increase3.Normal hypervolemia- both of blood cell and plasma are increased, ratio of hematocrit unchanged
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1.Cell number decreasing
hypervolemia-
• Renal disease
2.Cell number increasing
hypervolemia
• Lives in high altitude
• Heart disease
3.Normal hypervolemia-
• High temperature• exercising
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Normovolemia
• Total blood volume is not changed but ratio between blood cell and plasma is changed
• 1.Cell number decreasing normovolemia• 2.Cell number increasing normovolemia
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• Erythrolysis• Anemia• Loss blood
1.Cell number decreasing
normovolemia
• Take blood2.Cell number
increasing normovolemia
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LOSS OF OXYGENATION
Loss of oxygenation depends on number of RBC & quality of RBC.
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What is loss of RBC? It is non balancing of Erythropoiesis & Eritrodierez
• Erythrocytosis•
• Erytropenia
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Quality of RBC
• Anisocytosis • Poikilocytosis • Hb depends• Regeneration of RBC
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Anisocytosis
• Makrocyte /7µ</
• Microcyte/7µ>/
• Megalocyte /12µ</
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Poikilocytosis
• Changing shape of RBC Target Sickle Oval Round… etc
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Hb depends
Hyperchromt Hypochromt Normochromt
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Anemia• Anemia is a condition that develops when
your blood lacks enough healthy RBC or Hb.• If you have too few or abnormal red blood
cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen.
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Symptoms of anemia
• When anemia comes on slowly the symptoms are often: feeling tired, weakness, shortness of breath or a poor ability to exercise.
• Anemia that comes on quickly it may include: confusion, feeling like one is going to pass out, and an increased desire to drink fluids
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Anemia• There are 2 main types of anemia
Due to blood lossHemolytic anemia
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Due to blood loss anemia
• Blood loss is the most common cause of anemia, especially iron-deficiency anemia. Blood loss can be short term or persist over time.
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• Causes of blood loss include trauma and gastrointestinal bleeding among others
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Hemolytic anemia
• Causes of decreased production include iron deficiency, a lack of vitamin B12 and a number of neoplasm of the bone marrow among others.
• There are 2 main types of hemolytic anemia
Genetic anemiaAcquired anemia
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Genetic anemia
MembranopathyHemoglobinopathy Fermentopathy
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Membranopathy
• Spherocyte• Elliptocyte
• Spherocyte is a common anemia. It’s heritable by autosomic dominant gene.
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Hemoglobinopathy
• Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one of the globin chains of the hemoglobin molecule.
• Common hemoglobinopathy include sickle-cell disease & thalassemia
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Anemias of DeficientRed Cell Production
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Iron
• ~2.5 g of iron, with 2.0 - 2.5 g circulating as part of heme in hemoglobin
• ~0.3 g found in myoglobin, in heme in cytochromes, and in Fe-S complexes
• Iron stored in body primarily as protein complexes (ferritin and hemosiderin)
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Nutritional Iron Balance
• Intake– Dietary iron intake– Medicinal iron – Red cell transfusions – Injection of iron complexes
• Excretion– Gastrointestinal bleeding– Menses
• Losses can be as much as 4 - 37mg/menstrual cycle
– Other forms of bleeding– Loss of epidermal cells from the skin and gut
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Erythrocyte
– 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
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Mechanism
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Iron-Deficiency Anemia
• Iron deficiency anemia is a condition where a lack of iron in the body leads to a reduction in the number of red blood cells.
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Causes of Iron Deficiency• Increased demand for iron and/or hematopoiesis
– Rapid growth in infancy or adolescence– Pregnancy
• Increased iron loss– Chronic blood loss– Menses– Acute blood loss– Blood donation
• Decreased iron intake or absorption– Inadequate diet– Malabsorption from disease (sprue, Crohn's disease)– Malabsorption from surgery (post-gastrectomy)– Acute or chronic inflammation
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Megaloblastic Anemias
• Megaloblastic anemias are caused by impaired DNA synthesis, usually because of a deficiency in vitamin B12 or folic acid.
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Folic Acid–Deficiency Anemia.
• Folic acid deficiency anemia is caused by having too little vitamin B9 (folate) in your blood.
• Unlike in vitamin B12 deficiency, neurologic abnormalities do not occur.
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Vitamin B12–Deficiency Anemia
• Pernicious anemia • Cause:
– Low intake– Malabsorption– Pregnant
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Aplastic Anemia
• Aplastic anemia describes a disorder of pluripotential bone marrow stem cells that results in a reduction of all three hematopoietic cell lines—red blood cells, white blood cells, and platelets.
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• There are two main mechanisms of stem cell injury.
– Predictable, dose-dependent, toxic injury, typified by exposure to certain chemotherapeutic drugs, chemicals and ionizing radiation.
– Idiosyncratic, dose-independent, immunologic injury, as seen in idiopathic cases or after certain drug exposures or viral infections.
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Myelophthisic Anemia
• Myelophthisic anemia is caused by extensive infiltration of the marrow by tumors or other lesions.
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Polycythemia
• Polycythemia, or erythrocytosis, denotes an increase in red cells per unit volume of peripheral blood, usually in association with an increase in hemoglobin concentration.
• Polycythemia may be – absolute (defined as an increase in total red cell
mass) – relative
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• Relative• Reduced plasma volume (hemoconcentration)
• Absolute• Primary
– Abnormal proliferation of myeloid stem cells, normal or low– erythropoietin levels ; inherited activating mutations in the
erythropoietin receptor (rare)
• Secondary– Increased erythropoietin levels
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Abnormal red blood cell morphologies associated with various types of anemia.
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ERYTHROCYTOSIS
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Physiological Causes
• Hypoxia or severe pulmonary or heart disease:
Increased erythropoietin Increased erythropoiesis Increased RBC
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Pathological Causes
• Kidney diseases (hydronephrosis, tumor)
• Myeloproliferative disease (EPO level is low)–Polycythemia vera (common in older
men)
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Symptoms
• Hypertension• Headache• Ishemia• Infarction• Enlarged spleen or liver
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Leukopenia
• Neutropenia• Lymphocytopenia More
common
• Monocytopenia• Eosinopenia
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Neutropenia
• Causes:- Decreased production in bone marrow- Increased destruction (drug, immune)
• Symptoms:Fever, mouth ulcer, sore throat, pain or swelling around a wound
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• Less than 1000 cells per mm3 - worrisome• Less than 500 per mm3 - serious• treated with granulocyte colony-stimulating
factor (G-CSF), a growth factor that stimulates the production of granulocytes from marrow
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Lymphocytopenia
• Causes- Common cold, infection, malnutrition, stress, exercise, chemotherapy
• Symptoms– Chronic fever– Lymphodenopathy (enlarged lymph nodes)
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Leukocytosis
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Causes of LeukocytosisNeutrophilic leukocytosis
Acute bacterial infections, inflammation (myocardial infarction, burns)
Eosinophilic leukocytosis (eosinophilia)
Allergic disorders such as asthma, allergic skin diseases; parasitic infestations; drug reactions; Hodgkin’s disease; collagen vascular disorders
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Basophilic leukocytosis (basophilia)
Rare, often indicative of a myeloproliferative disease
Monocytosis Chronic infections (e.g., tuberculosis), malaria and inflammatory bowel diseases
Lymphocytosis Associated with chronic immunologic stimulation (e.g., tuberculosis); viral infections (e.g., hepatitis)
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Neutrophil Shift
• Determines affinity of leukopoiesis by
studying neutrophil’s nucleus
– Left shift – high number of immature
cells (infection, necrosis, inflammation)
– Right shift – low number of immature
cells (hypersegmentation)
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Right Shift
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Left Shift
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Leukemia
• Bone marrow malfunction• High numbers of WBC• Not fully developed blasts• Becomes cancerous cells• Caused by smoking, ionized
radiation, chemicals, Down syndrome
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Classification
Leukemia
Acute
Lymphoblastic Myelogenous
Chronic
Lymphoblastic Myelogenous
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Acute lymphoblastic leukemia
• Increase in lymphoblast• Common in children
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Acute Myelogenous Leukemia
• Increase in myeloblast• Low number of mature neutrophils• Common in adults and men
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Chronic Myelogenous Leukemia
• Low number of myeloblast• Enlarged spleen and liver
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Chronic Lymphoblastic Leukemia
• High number of lymphocytes• Lymph nodes, spleen and liver expand
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Lymphoma
• Tumor of lymphoid tissue• Factors: virus, infection, pesticide• Symptoms: weight loss, fever, sweating• Types
– Hodgkins Lymphoma (Reed-Sternberg cells)– Non-Hodgkins Lymphoma (No RS cells)
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