Blood pathophysiology

Blood pathology and physiology

1. BLOOD PATHOPHYSIOLOGY

2. Blood System Overview Blood transports oxygen and nutrients to body cells Blood removes carbon dioxide and other waste products from body cells for elimination

3. CHANGE IN BLOOD VOLUME Blood volume  is the volume of blood (both  red blood cells and  plasma) in the circulatory system of any individual .

4. Types : Hypovolemia Hypervolemia Euvolemia

5. HYPOVOLEMIA H ypovolemia   is a state of decreased blood volume 1.Cell number decreasing hypovolemia – due to number of erythrocytes decrease 2. Cell number increasing hypovolemia - due to volume of blood plasma decrease 3.Normal hypovolemia – eryhtrocytes and blood plasma both decrease

6. 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 )

7. Hypervolemia It is a state of blood volume decrease Types: 1. Cell number decreasing hypervolemia - due to blood plasma decrease 2. Cell number increasing hypervolemia - blood cell number increase 3.Normal hypervolemia- both of blood cell and plasma are increased, ratio of hematocrit unchanged

8. 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

9. LOSS OF OXYGENATION Loss of oxygenation depends on number of RBC & quality of RBC.

10. What is loss of RBC? It is non balancing of Erythropoiesis & Eritrodierez Erythrocytosis E r y tropenia

11. Quality of RBC Anisocytosis Poikilocytosis Hb depends Regeneration of RBC

12. Anisocytosis Makrocyte /7µ</ Microcyte /7µ>/ Megalocyte /12µ</

13. Poikilocytosis Changing shape of RBC Target Sickle Oval Round… etc

14. Hb depends Hyperchromt Hypochromt Normochromt

15. 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.

16. 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

17. Anemia There are 2 main types of anemia Due to blood loss Hemolytic anemia

18. 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 .

19. Causes of blood loss include trauma and gastrointestinal bleeding among others

20. 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 anemia Acquired anemia

21. Genetic anemia Membranopathy Hemoglobinopathy F ermentopathy

22. Membranopathy Spherocyte Elliptocyte Spherocyte is a common anemia. It’s heritable by autosomic dominant gene.

23. 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

24. Anemias of Deficient Red Cell Production

25. 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 )

26. 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

27. 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

28. Mechanism

29. 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.

30. 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

31. Megaloblastic Anemias Megaloblastic anemias are caused by impaired DNA synthesis, usually because of a deficiency in vitamin B12 or folic acid.

32. 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.

33. Vitamin B12–Deficiency Anemia Pernicious anemia Cause: Low intake Malabsorption Pregnant

34. Aplastic Anemia Aplastic anemia describes a disorder of pluripotential bone marrow stem cells that results in a reduction of all three hemato poietic cell lines—red blood cells, white blood cells, and platelets.

35. 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.

36. Myelophthisic Anemia Myelophthisic anemia is caused by extensive infiltration of the marrow by tumors or other lesions .

37. 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

38. 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

39. Abnormal red blood cell morphologies associated with various types of anemia.

40. ERYTHROCYTOSIS

41. Physiological Causes Hypoxia or severe pulmonary or heart disease: Increased erythropoietin  Increased erythropoiesis  Increased RBC

42. Pathological Causes Kidney diseases ( hydronephrosis , tumor) Myeloproliferative disease (EPO level is low) Polycythemia vera (common in older men)

43. Symptoms Hypertension Headache Ishemia Infarction Enlarged spleen or liver

44. Leukopenia Neutropenia Lymphocytopenia More common Monocytopenia Eosinopenia

45. Neutropenia Causes: - Decreased production in bone marrow - Increased destruction (drug, immune) Symptoms: Fever, mouth ulcer, sore throat, pain or swelling around a wound

46. L ess than 1000 cells per mm 3 - worrisome Less than 500 per mm 3 - serious treated with granulocyte colony-stimulating factor (G-CSF) , a growth factor that stimulates the production of granulocytes from marrow

47. Lymphocytopenia Causes - Common cold, infection, malnutrition, stress, exercise, chemotherapy Symptoms Chronic fever Lymphodenopathy (enlarged lymph nodes)

48. Leukocytosis

49. Causes of Leukocytosis Neutrophilic 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

50. 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)

51. 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 )

52. Right Shift

53. Left Shift

54. Leukemia Bone marrow malfunction High numbers of WBC Not fully developed blasts Becomes cancerous cells Caused by smoking, ionized radiation, chemicals, Down syndrome

55. Classification Myelogenous

56. Acute lymphoblastic leukemia Increase in lymphoblast Common in children

57. Acute Myelogenous Leukemia Increase in myeloblast Low number of mature neutrophils Common in adults and men

58. Chronic Myelogenous Leukemia Low number of myeloblast Enlarged spleen and liver

59. Chronic Lymphoblastic Leukemia High number of lymphocytes Lymph nodes, spleen and liver expand

60. 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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