1. Blood and Lymphatic Diseases

2. Overview Blood Lymphatic Disorders The leukemias Diagnostic Test
Blood Therapies
Blood Dyscrasias
The anemias
Iron deficiency anemia
Hemolytic anemia
Sickle cell anemia
Blood clotting disorders
The leukemias
Lymphatic Disorders
Lymphomas
Hodgkin’s lymphoma
Non-Hodgkin lymphoma

3. Blood Diagnostic Tests
CBC (Complete blood count)
Characterization of blood cells important
Hematocrit
Hb measured
Bone marrow function
Blood clotting disorders differentiated by test

4. Blood Therapies Administration of whole blood, packed RBC/platelets
Plasma or colloidal volume-expanding solutions
Artificial blood products

5. Blood Dyscrasias—The Anemias
Cause decrease in oxygen transport
Oxygen deficit results in:
Decreased energy produced by cells
Tachycardia (irregular heartbeat)
Decreased regeneration of epithelial cells
Severe anemia

6. Iron Deficiency Anemia—Pathophysiology
Common among all ages
Typically there is an underlying problem
Decreased iron impedes synthesis of Hemoglobin (Hb)

7. Anemic RBCs vs Normal

8. Iron Deficiency Anemia
Low dietary intake of iron (Fe)
Chronic blood loss
Impaired absorption in duodenum
Severe liver disease
Infection, cancer

9. Iron Deficiency Anemia—Signs and Symptoms
Pallor of skin and mucous membranes
Fatigue, lethargy, cold intolerance
Irritability
Menstrual irregularities
Delayed healing
Severe
Tachycardia, heart palpitations, dyspnea, syncope

10. Iron Deficiency Anemia--Treatment
Underlying cause determined and treated
Depends on cause
Fe rich foods and supplements

11. Hemolytic Anemias—Sickle Cell Anemia—Pathophysiology
Abnormal Hb (called HbS)
Due to amino acid switch
HbS deoxygenated results in crystallization
Changes shape to crescent shape
Cell membrane damaged
Hemolysis, shorter life span
Transports oxygen normally
But low erythrocyte count
Therefore low Hb level
Sickeling is major problem
Shape obstructs small vessels
Thrombus formation, tissue necrosis, infarctions

12. Sickle Cell vs. Normal RBC

13. Sickle Cell Anemia—Etiology
Inherited; recessive gene
Homozygotes
Mostly HbS
Clinical signs
Heterozygotes
Half HbS
Only possess trait
Common in the black population
Africans w/ SCA resistant to malaria

14. Sickle Cell Anemia—Treatment
Search continues for more effective drugs
Avoid strenuous activity, high altitude, infection
Most do not survive past 20 years old

15. Blood Clotting Disorders
Indicated by spontaneous bleeding or excessive bleeding after minor injury
Warning signs
Persistent bleeding in gums, nose bleeds
Petechiae
Purpura and ecchymoses
Hemarthroses
Hemophysis
Hematemesis
Blood in feces
Anemia
Feeling faint, anxious, low bp, rapid pulse

16. Petechiae

17. Ecchymoses

18. Blood Clotting Disorders—Causes of Excessive Bleeding
Defective platelet function
Vitamin K deficiency
Liver disease
Inherited defects
Hemorrhagic fever viruses (Ebola)
Long-term anticoagulant drug treatment

19. The Leukemias—Pathophysiology
Neoplastic disorders involving WBC
1 or more leukocyte types present as:
Undifferentiated, immature, nonfunctional cells
Multiply uncontrollably
Lg quantities released into general circulation

20. Acute Lymphocytic Leukemia

21. Acute vs. Chronic Leukemia
High proportion of very immature, nonfunctional cells in bone marrow and periph circ
Abrupt onset
Marked signs, complications
Higher proportion of mature cells
Insidious onset
Mild signs
Better prognosis

22. Types of Leukemia Type Malignant Cells
Acute lymphocytic leukemia (ALL)
Lymphocytes
Acute myelocytic leukemia (AML)
Granulocytes (neutrophils, eosinophils, basophils)
Chronic lymphocytic leukemia (CLL)
B lymphocytes
Chronic myelocytic leukemia (CML)
Granulocytes

23. The Leukemias—Pathophysiology
Cell growth in bone marrow suppresses production of normal cells
Leads to:
Anemia, lack of normal functioning leukocytes
Bone marrow presses on nerves = pain
As disease progresses, increase # leukemic cells cause:
Congestion and enlargement of lymphoid tissue

24. The Leukemias—Etiology
Chronic
More common in older people
Acute
Primarily in kids, young adults
ALL
2-6 years old
Cause unknown
Leukemias in adults associated with exposure to chemicals, radiation, viruses
Some causes related to chromosomal abnormalities

25. The Leukemias—Signs and Symptoms: Acute
Onset marked by infection that is unresponsive to treatment or excessive bleeding
Multiple infections (b/c nonfunc. WBC)
Severe hemorrhage
Anemia
Severe and steady bone pain
Weight loss and fatigue
Fever
Enlarged lymph nodes, spleen, liver
Chronic: onset milder, insidious

26. The Leukemias— Diagnostic Tests
Peripheral blood smears
Show immature leukocytes
Altered # WBCs
# RBC, platelets low

27. The Leukemias—Treatment
Prognosis related to:
WBC count
Proportion of immature cells at time of count
Individuals with chronic may live 10 yrs. with treatment
Chemo
Less effective in adults with AML
May have to be discontinued if blood cell count drops too low
Thrombocytopenia, neutropenia
Transfusion of platelets might be req
Bone marrow transplant
If chemo ineffective
Must find suitable donor
Drugs
Only some respond
ALL does well

28. Lymphatic Disorders—Lymphoma
Malignant neoplasms involving lymphocyte proliferation in lymph nodes
Hodgkin’s and non-Hodgkin’s differentiated by lymph node biopsy

29. Hodgkin’s Lymphoma—Pathophysiology
Occurs primarily in adults yrs. old
Initially involves one lymph node
Spreads to adjacent nodes then organs
Via lymph vessels
T lymphocytes appear defective, low lymphocyte count

30. Hodgkin’s Lymphoma— Signs and Symptoms
1st indicator is large, painless, nontender lymph node
Later enlarged lymph nodes
Pressure effects
General signs of cancer
Recurrent infection

31. Hodgkin’s Lymphoma—Treatment
Radiation, chemo, surgery
Prognosis in early stages excellent
Most effective drug combo is ABVD
Remission common in advanced stages

32. Non-Hodgkin’s Lymphoma
Increase in incidence
Similarities to Hodgkin’s:
Initial manifestation
Clinical signs, staging, treatment
Differences:
Multiple node involvement scattered throughout body
Pattern of widespread metastasis, often at diagnosis
Much more difficult to treat