Components of the Hematologic System

13 Pages·2013·1.03 MB·English

Bio217 Fall2013 Unit 6
Components of the
Bio217: Pathophysiology Class Notes
Hematologic System
Professor Linda Falkow

• Main functions

Unit VI: Blood and Cardiovascular System Disorders –Delivery of substances needed for cell metabolism
–Removal of wastes
Chapter 19: Structure & Function of the Hematologic System –Defense against microorganisms and injury
Chapter 20: Alterations of Hematologic Function –Maintain acid-base balance
Chapter 22: Structure & Function of CV & Lymphatic Systems
Chapter 23: Alterations of Cardiovascular Function

Components of the Hematologic System
Components of the Hematologic System
Composition of blood (~6 quarts) • Composition of blood
Plasma –Cellular components (~45%)
• ______________ of the blood volume •_______________ (red blood cells)
• Organic and inorganic elements –Carry O2 and remove CO2
______________ –120-day life cycle
•_______________ (white blood cells)
• Albumins
–Defend the body against infection and remove debris
- Function as carriers and control plasma oncotic press.
–Granulocytes (neutrophils, eosinophils, basophils)
• Globulins
–Agranulocytes (monocytes and lymphocytes)
- Carrier proteins and immunoglobulins (antibodies)
•______________ (platelets)
• Fibrinogen
–Disk-shaped cytoplasmic fragments
- Functions in blood clotting –Essential for blood clotting

Composition of Whole Blood
Blood Cells
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Evaluation of the
Leukocytes
Hematologic System
• Tests of bone marrow function
–Bone marrow aspiration
–Bone marrow biopsy
–Measurement of bone marrow iron stores
–Differential cell count
• Blood tests
–Large variety of tests
Concept Check
• 1. Which is not a component of plasma?
–A. Colloids C. Glucose • 4. About how many times more RBCs than WBCs
–B. Electrolytes D. Platelets are there in a mm3 of blood?
–A. 15 C. 100
• 2. Which is the most abundant protein in blood? –B. 90 D. 1000
–A. Fibrinogen C. Globulins

–B. Albumins D. Hormones
• 5. Which of the following are agranulocytes?
• 3. The purpose of EPO: –A. Mast cell
–A. Decrease maturation of RBCs –B. Lymphocyte
–B. Detect hypoxia –C. Monocyte
–C. Control RBC production – D. Reticulocyte
–D. Control platelet size
– E. B and C are correct

Alterations of Hematologic Function
Chapter 20 Anemia
• Anemia = reduced number of ________ or Hb • Physiologic manifestation
–Impaired erythrocyte production –Reduced oxygen-carrying capacity
–Acute or chronic blood loss

–Increased erythrocyte destruction
• Variable symptoms depending on
–Classifications
severity and body’s ability to
•__________
–Identified by terms that end in “-cytic” compensate
–Macrocytic, microcytic, normocytic • Classic anemia symptoms
•____________ content
–Identified by terms that end in “-chromic” –Fatigue, weakness, dyspnea, and pallor
–Normochromic and hypochromic

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Microcytic-Hypochromic Anemias
Macrocytic-Normochromic Anemias
• Iron deficiency anemia (IDA)
• Pernicious anemia (PA) –Most common type of anemia worldwide
–Due to:
–Caused by a lack of intrinsic factor (IF)
• Inadequate dietary intake of _________
( ________________ cells in stomach)
–Results in vitamin B deficiency •Pregnancy
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–Loss of appetite, abdominal pain, beefy red tongue •Blood loss (2-4ml/day- ulcer, hiatal hernia, colitis,
(atrophic glossitis), icterus, and splenic enlargement menorrhagia)
•Iron malabsorption (chronic diarrhea, celiac disease)
–PA associated with incr. alcohol intake, hot tea, smoking –Progression of iron deficiency causes:
–Treatment: Vit. B throughout life •Brittle, thin, coarsely ridged, and spoon-shaped nails (koilonychia)
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•Red, sore, and painful tongue (glossitis)
Microcytic-Hypochromic Anemias Alterations of Leukocyte Function
• Pathophysiology • Quantitative disorders
–Iron use in body for Hb and storage for future Hb –____________ or ___________ in cell numbers
–Iron is recycled and it is important to maintain a –Bone marrow disorders or premature destruction
balance. of cells
–Blood loss  disrupts the balance
–Response to infectious microorganism invasion
–Normal Hb = ~12-18g/dl

–When Hb levels drop to7-8g/dl patients seek
• Qualitative disorders
medical attention
• Treatment –Disruption of cellular function
–Determine source of blood loss
–Iron replacement therapy
Quantitative Alterations of Leukocytes
Granulocytosis (Neutrophilia)
• Leukocytosis
• Neutrophilia is evident in the first stages of
–Leukocytosis is a normal protective physiologic
an infection or inflammation
response to physiologic stressors

• If the need for neutrophils increases
• Leukopenia
beyond the supply, immature
–Leukopenia is not normal and not beneficial neutrophils (banded neutrophils) are
–A low white count predisposes a patient to released into the blood
infections
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Granulocytosis (Neutrophilia) Monocytes
• Monocytosis
• This premature release is detected in the
–Poor correlation with disease
manual WBC differential and is termed a
–Usually occurs with neutropenia in later stages of
shift to the left
infections
–Monocytes are needed to phagocytize organisms and
• When the population returns to normal, it is debris
termed a shift to the right
• Monocytopenia
–Very little known about this condition
Lymphocytes Infectious Mononucleosis
• Lymphocytosis
• Acute, self-limiting infection of B-
–Acute viral infections
lymphocytes transmitted by saliva
•Epstein-Barr virus
through personal contact
• Lymphocytopenia
–Immune deficiencies, drug destruction, viral • Commonly caused by the Epstein-Barr
destruction virus (EBV)—85%
–B cells have an EBV receptor site
–Others viral agents resembling IM
•Cytomegalovirus (CMV), hepatitis, influenza, HIV
Infectious Mononucleosis Infectious Mononucleosis
• Symptoms: fever, sore throat, swollen cervical
• >50% lymphocytes and at least 10% atypical
lymph nodes, increased lymphocyte count,
lymphocytes
and atypical (activated) lymphocytes
• Diagnostic test

–Monospot qualitative test for heterophilic
• Serious complications are infrequent (<5%)
antibodies
–Splenic rupture is the most common cause • Treatment: ____________
of death
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Leukemias
Leukemias
Acute lymphocytic leukemia (ALL)
80% of all childhood leukemias (~81% remission)
• Malignant disorder of the blood and blood- Acute myelogenous leukemia (AML)
forming organs One of most common leukemias in adults
• Excessive accumulation of leukemic cells 1 yr. survival after diagnosis w/ aggressive treatment
• Acute leukemia Chronic myelogenous leukemia (CML)
–Presence of undifferentiated or immature cells, Myeloproliferation in bone marrow, middle aged mostly
usually blast cells
Chronic lymphocytic leukemia (CLL)
• Chronic leukemia
Most benign and slow growing; affects elderly
–Predominant cell is mature but does not
function normally
• Lymphocytic leukemia Pathophysiology
• Myeloid leukemia Immature hematopoietic cells leukemic cells
Leukemic cells multiply  crowding other cell
 abnormal RBCs, WBCs, platelets and decreased numbers
Leukemias Disorders of Platelets
• Signs and symptoms of leukemia • _______________
–Anemia, bleeding, purpura, petechiae, –Platelet count <150,000/mm3
ecchymosis, thrombosis, hemorrhage, •<50,000/mm3—hemorrhage from minor trauma
DIC, infection, weight loss, bone pain, •<15,000/mm3—spontaneous bleeding
elevated uric acid, and liver, spleen and •<10,000/mm3—severe bleeding
lymph node enlargement
Disorders of Platelets
Disorders of Platelets
• Thrombocytopenia
–Causes
•Hypersplenism, autoimmune disease, hypothermia, and viral Immune thrombocytopenic purpura (ITP)
or bacterial infections that cause disseminated intravascular
coagulation (DIC), HIT –IgG antibody that targets platelet glycoproteins
• ITP (Idiopathic thrombocytopenia) –Antibody-coated platelets are sequestered and removed
–I- immune system makes antibodies against platelets from the circulation
–T- trapped platelets appear in spleen and liver –Acute form of ITP that often develops after a viral
–P- phagocytosis causes thrombocytopenia infection is one of most common childhood bleeding
disorders
Symptoms:
–Manifestations: Petechiae and purpura, progressing
• Nosebleed, oral bleeding
to major hemorrhage
• Purpura
• Petechiae

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Disseminated Intravascular
Coagulation (DIC)
• Complex, acquired disorder in which clotting and
hemorrhage simultaneously occur Structure and Function of the Cardiovascular
• DIC is result of increased protease activity in blood and Lymphatic Systems
caused by unregulated release of thrombin w/
subsequent fibrin formation and accelerated
Chapter 22
fibrinolysis
• Endothelial damage is primary initiator of DIC

Circulatory System
The Heart Wall

Pulmonary circuit Systemic circuit
(right heart) (left heart)

The Chambers of the Heart The Valves of the Heart

LA

RA LV

RV
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Blood Flow Blood Flow and Cardiac Cycle
• Cardiac cycle
• Diastole
• Systole
• Phases of the cardiac cycle
The Coronary Vessels
Blood Flow and Cardiac Cycle
Conduction System of the Heart Cardiac Output
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Systemic Circulation Structure of Blood Vessels
• Arteries • Lumen
• Arterioles • Tunica intima
• Capillaries • Tunica media
• Venules • Tunica externa (adventitia)
• Veins
Endothelium Structure of Blood Vessels
Structure of Blood Vessels Concept Check
• 1. Oxygenated blood flows through:
A. SVC
B. Pulmonary veins
C. Pulmonary arteries
D. Coronary veins
2. In the normal cardiac cycle which of the
following occurs? (more than one is correct)
A. RA and RV contract together
B. The 2 atria contract together, while the 2 ventricles relax
C. The 2 ventricle contract together , while the 2 atria relax.
D. Both the ventricles and the atria contract simultaneously to increase
cardiac output.
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• 3. The normal heartbeat is initiated by:
– A. Coronary sinus C. SA node
– B. AV bundle D. AV node

• 4. Which does not significantly affect HR: Alterations of CV Function
– A. SNS nerves C. AV valves
B. PSN nerves D. ACh
• Chapter 23
5. Which is the correct sequence of the pulmonary circuit?
a. Pulm. Veins
b. Pulm. Arteries
c. Lungs
d. RV
e. LA
Diseases of the Veins Diseases of Veins
Deep venous thrombosis (DVT)
◦ Obstruction of venous flow leading to increased venous press.
◦ Factors
Poor circulation Venous stasis (immobile, age, CHF)
Venous endothelial damage (drugs, trauma)
Hypercoagulable states (inherited states, _______)
Venous stasis ulcer
Venous thrombi are more common than arterial due to low
pressure in veins
Venous thrombi
Understanding HT
Diseases of the Arteries and Veins
• Hypertension (HT) • 1. Kidneys  renin into blood
– consistent elevation of BP • 2. Renin converts angiotensin to angiotensin I (in liver)
– Systolic > 140 mmHg; Diastolic > 90 mmHg • 3. Angiotensin I  Angiotensin II (in lungs)
–Angiotensin II - potent VC
• 4. Angiotensin II  constriction in arterioles and
–Primary HT
secretion of aldosterone
•aka essential or idiopathic HT
• 5. Aldosterone  Na+ and H 0 retention
•Genetic and environmental factors 2
• 6. Retained Na+ and H O  incr. blood vol.
•Affects 92% to 95% of individuals with HT 2
• 7. VC  increased PR
–Secondary HT
•Caused by a systemic disease that raises PR or CO • 8. Incr. blood vol. and PR  HT
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HT Diseases of the Arteries and Veins
• Complications • Arteriosclerosis
–- can occur late in the disease
–Chronic disease of the arterial system
–- can attack any organ
–- CAD, angina, MI, arrhythmias, sudden death •Abnormal ____________and _________
of vessel walls
Location, location, location

Symptoms depend on location of vessel damage
– brain – ___________, _________ •________________ and collagen fibers
– retina - _____________ migrate to the tunica intima
– heart – _________
– kidneys – proteinuria, edema  ___________ •Results in narrowing of lumen
Arteriosclerosis Diseases of the Arteries and Veins
• Atherosclerosis
–Most common form of arteriosclerosis

–Thickening and hardening is caused by
accumulation of lipid-laden macrophages in
the arterial wall

–____________ development
Diseases of the Arteries and Veins Atherosclerosis
• Atherosclerosis
–Progression
•Damaged endothelium
•Cellular proliferation & macrophage migration
•Macrophages  foam cells that accumulate fat
•Fatty streak (lesion)
•Fibrous plaque due to SMC proliferation

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