Lab 2: Blood Pathologies Heart Anatomy

Activity 1 Blood Pathologies Observe prepared slides of blood smears taken from patients with the following disorders: pernicious anemia iron deficiency anemia sickle cell anemia chronic lymphocytic leukemia eosinophilia Pathology = disorder or disease RBC disorders = pernicious anemia, iron deficiency anemia & sickle cell anemia WBC disorders = chronic lymphocytic leukemia, eosinophilia

Anemia refers to any condition in which there is a reduction in the number of RBCs or a reduction in the concentration of normal hemoglobin Anemia can be classified according to etiology (cause) or on the basis of morphology – For morphological classification, the following terms are used: RBC Size RBC Color Microcytic: small size Hypochromic: pale color Normocytic: normal size Normochromic: normal color Macrocytic: large size Hyperchromic: dark color Etiology = cause or origin of disease is known Idiopathic = do NOT know cause of disease Anemia = ability to carry oxygen 2 classifications: 1) cause 2)basis (RBC/WBC)

caused by vitamin B12 deficiency Pernicious Anemia: caused by vitamin B12 deficiency Larger RBC Hyper-segmented = >5 nuclei RBC resembles “Jelly donut” *RBC disorder that affects WBC, lack of intrinsic factor produced by parietal cells in stomach Most common in people over 60 because of vitamin B12 deficiency, Gastric mucosa does not secrete IF needed for B12 absorption (Symptoms are weakness shortness of breath and janudice. GI = diarrhea, nausea and vomiting, pain. Degeneration of the white matter in parts of the CNS leads to several neurological symptoms Can be either macrocytic, hyperchromic or macrocytic, normochromic Note the enlarged, dark red blood cells, and the hypersegmented neutrophil in this smear

Iron Deficiency Anemia caused by iron insufficiency leading to decreased hemoglobin synthesis Is an example of microcytic, hypochromic anemia Note the small erythrocytes of varying sizes and the large area of central pallor Small & pale Decreased hemoglobin synthesis due to insufficient iron. May be due to pregnancy, diet, or bleeding. Symptoms are fatigue, irritability, breathlessness, palpations, dizziness/headache Resemble a “cheerio”

Sickle Cell Anemia: caused by a single amino acid substitution in the β chain of hemoglobin (valine replaces glutamic acid) An inherited autonomic recessive gene – hemoglobin S When hemoglobin S is deoxygenated it crystallizes in the red blood cell. Leading to a distortion in shape of RBC, rapid setruction of RBC and reduced RBC cell number and anemia. Masses of sickled RBC may block the lumen of small blood vessels and cause infarcts (areas of cell death) in various tissues Sickle cell is painful – bone, joints and abdomen Reticulocyte & platelet count elevated. Moderate neutrophilia. Shape change affects reversible deformity, RBC do not travel easily and get “stuck” This is a normochromic, normocytic anemia Note the sickle shaped erythrocytes.

Disorders Related to Leukocytes: Chronic Lymphocytic Leukemia caused by malignant lymphocyte progenitor cells in bone marrow Cancer of bone marrow, too many lymphocytes that are generally small, mature cells that contain a nucleus with a small dent or cleft. Problem: WBC is deformed, not enough of other WBC (NLMEB) leaving body vulnerable to fighting infections Note the abundant small lymphocytes in this blood smear The lymphocyte nucleus may have a small indentation, or cleft

Eosinophilia many causes, including malignancy, connective tissue diseases, parasitic diseases, allergies; in some cases, no known cause More circulating eosinophils than normal (>450 per microliter of blood) Not sure of cause Lots of eosinophils can be seen when you would rarely find one (2-4% normally), look normal Note the two normal looking eosinophils in the field

Objective 2 Human Heart Anatomy The heart has an apex and a base: Base Apex Heart and Circulation Introduction/Overview of next three weeks: Video: http://www.mayoclinic.com/health/circulatory-system/MM00636 Base tilts toward right shoulder Apex tilts toward left hip

The heart is located in the mediastinum, surrounded by a pericardium: More of heart located on the left side than right Heart protected by boney ribs Pericardium – Why do you think it has two layers?

The wall of the heart consists of three tissue layers: 1. Epicardium (visceral pericardium) 2. Myocardium 3. Endocardium Myocardium is largest section, made up of muscle, because the heart is a pump that needs a lot of muscle

Structures Visible On the Anterior Surface/Associated Vessels: Brachiocephalic Left Common Left Subclavian Artery Carotid Artery Artery Superior Vena Cava Right Pulmonary Veins Right Auricle Pulmonary Trunk Inferior Vena Cava Aortic Arch Left Pulmonary Veins Left Auricle Anterior Interventricular Sulcus Anterior Surface Features “ABC’s” of of aorta to remember arteries = Aorta, Brachiocephalic, left Common carotid, left Subclavian (under clavicle) Atrium (chamber) refers to an entrance/start Outside flap on top of atrium is an auricle – little ear Vein = TO heart (usually blue and De-oxygenated) Artery = AWAY from heart (usually red and Oxygenated) NOTICE: L/R pulmonary veins are RED… WHY? (going away from heart to the lungs for gas exchange, return to heart via veins with oxygenated blood)

Structures Visible on The Posterior Surface: Aorta Pulmonary Veins Coronary Sinus Superior Vena Cava Pulmonary Arteries Inferior Vena Cava Posterior Interventricular Sulcus Posterior Surface Features Better view of inferior vena cava entrance to right atrium Coronary sinus

Atria Ventricles The Heart Has Four Chambers: Right chambers Left chambers Atria Ventricles Interatrial Septum: lies between the atria Interventricular Septum: lies between the ventricles

Internal Structures of the Heart Pectinate muscle is inside both atria Trabeculae carneae muscle inside both ventricles Tricuspid valves held closed by chordae tendineae cords that connect to papillary muscle. ‘Tri’ before you ‘bi’ *layers of heart can be seen in this slide

Ligamentum Arteriosum These two Structures of the Adult Heart Are Remnants of Fetal Circulation: Ligamentum Arteriosum Fossa Ovalis Babies in utero obtain oxygen from mom’s placenta Fetal shunts are “short cuts” that by-pass the babies lungs Ligamentum ateriosum Is remnant of ductus arteriosum = and bypasses Fossa Ovalis is remnant of foramen ovale = and bypasses Textbook Page #

The heart receives its own branch of systemic circulation – there vessels collectively are called coronary circulation Heart has its own special blood supply *anastomosis

A Sectioned Preserved Human Heart: Interatrial septum Right atrium Left atrium Interventricular septum’ Right ventricle Left ventricle 9. Pulmonary trunk Frontal/Coronal cut showing anterior view of posterior half (cut in half from top to bottom and top section removed) NOTICE: right ventricle myocardium is smaller than left ventricle myocardium. WHY? Where do each pump to? Think pressure and job… Pulmonary circulation requires less force because it has to overcome a lower pressure in lungs whereas systemic circuldation requires more force due to overcoming higher pressure of the body and delivering blood to all parts of body. Frontal Section: anterior view of posterior section

Sheep’s Heart Dissection: note the thickness of the right ventricular and left ventricular walls Sheep’s Heart has a very obvious structure in right ventricle called a Moderator Band that is involved in the intrinsic conduction system (found in all grazing animals). Rare, but also found in humans.

Cardiac Muscle in found in the myocardium: NOTICE: branching, light striateions, intercalated disks separating each cell (location of desmosomes/gap junctions), 1-2 nuclei in cells are centrally placed Desmosomes = hold cells tightly together Gap Junctions = allow electrical signals to travel from cell to cell

Muscle Tissue Location Structure Function Cardiac Muscle Location Structure Function heart wall cells (myocytes) are faintly provide pressure striated and branching for the circulation with one (or two) of blood centrally placed nuclei cells are connected by intercalated discs (gap junctions/desmosomes) Intercalated Disc Nuclei

Location Structure Function Skeletal Muscle Location Structure Function Attached to the long, thin cells (fibers) are posture, movement skeleton striated and multinucleated, stabilizes joints nuclei are in the periphery of the cell                                        This slide is for comparison of skeletal muscle and cardiac muscle. NOTICE: location of numerous nuclei in periphery, distinct striations, no branching, no intercalated disks, neatly arranged cells nucleus