blood pathophysiology

BLOOD PATHOPHYSIOLOG

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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

CHANGE IN BLOOD VOLUME

• Blood volume is the volume of blood (both  red blood cells and plasma) in the circulatory system of any individual.

Types :1. Hypovolemia2. Hypervolemia 3. Euvolemia

Change in blood volume

Normovolemia

HypovolemiaHypervolemia

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

hypovolemia

1.Cell number decreasing hypovolemia

2. Cell number increasing hypovolemia

3.Normal hypovolemia

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)

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

1.Cell number decreasing

hypervolemia-

• Renal disease

2.Cell number increasing

hypervolemia

• Lives in high altitude

• Heart disease

3.Normal hypervolemia-

• High temperature• exercising

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

• Erythrolysis• Anemia• Loss blood

1.Cell number decreasing

normovolemia

• Take blood2.Cell number

increasing normovolemia

LOSS OF OXYGENATION

Loss of oxygenation depends on number of RBC & quality of RBC.

What is loss of RBC? It is non balancing of Erythropoiesis & Eritrodierez

• Erythrocytosis•

• Erytropenia

Quality of RBC

• Anisocytosis • Poikilocytosis • Hb depends• Regeneration of RBC

Anisocytosis

• Makrocyte /7µ</

• Microcyte/7µ>/

• Megalocyte /12µ</

Poikilocytosis

• Changing shape of RBC Target Sickle Oval Round… etc

Hb depends

Hyperchromt Hypochromt Normochromt

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.

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

Anemia• There are 2 main types of anemia

Due to blood lossHemolytic anemia

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.

• Causes of blood loss include trauma and gastrointestinal bleeding among others

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

Genetic anemia

MembranopathyHemoglobinopathy Fermentopathy

Membranopathy

• Spherocyte• Elliptocyte

• Spherocyte is a common anemia. It’s heritable by autosomic dominant gene.

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

Anemias of DeficientRed Cell Production

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)

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

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

Mechanism

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.

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

Megaloblastic Anemias

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

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.

Vitamin B12–Deficiency Anemia

• Pernicious anemia • Cause:

– Low intake– Malabsorption– Pregnant

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.

• 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.

Myelophthisic Anemia

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

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

• 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

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

ERYTHROCYTOSIS

Physiological Causes

• Hypoxia or severe pulmonary or heart disease:

Increased erythropoietin Increased erythropoiesis Increased RBC

Pathological Causes

• Kidney diseases (hydronephrosis, tumor)

• Myeloproliferative disease (EPO level is low)–Polycythemia vera (common in older

men)

Symptoms

• Hypertension• Headache• Ishemia• Infarction• Enlarged spleen or liver

Leukopenia

• Neutropenia• Lymphocytopenia More

common

• Monocytopenia• Eosinopenia

Neutropenia

• Causes:- Decreased production in bone marrow- Increased destruction (drug, immune)

• Symptoms:Fever, mouth ulcer, sore throat, pain or swelling around a wound

• 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

Lymphocytopenia

• Causes- Common cold, infection, malnutrition, stress, exercise, chemotherapy

• Symptoms– Chronic fever– Lymphodenopathy (enlarged lymph nodes)

Leukocytosis

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

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)

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)

Right Shift

Left Shift

Leukemia

• Bone marrow malfunction• High numbers of WBC• Not fully developed blasts• Becomes cancerous cells• Caused by smoking, ionized

radiation, chemicals, Down syndrome

Classification

Leukemia

Acute

Lymphoblastic Myelogenous

Chronic

Lymphoblastic Myelogenous

Acute lymphoblastic leukemia

• Increase in lymphoblast• Common in children

Acute Myelogenous Leukemia

• Increase in myeloblast• Low number of mature neutrophils• Common in adults and men

Chronic Myelogenous Leukemia

• Low number of myeloblast• Enlarged spleen and liver

Chronic Lymphoblastic Leukemia

• High number of lymphocytes• Lymph nodes, spleen and liver expand

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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