1. Lab 2: Blood Pathologies
Heart Anatomy

2. 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

3. 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)

4. 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

5. 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”

6. 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.

7. 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

8. 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

9. 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:
Base tilts toward right shoulder
Apex tilts toward left hip

10. 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?

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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 #

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

18. 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

19. 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.

20. 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

21. 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

22. 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