Alterations In Blood Formation

Front 1

Anemia

Back 1

Abnormally low oxygen carrying capacity due to:

- Reduction in the number or volume of circulating RBCs
or
- Decrease in hemoglobin

Front 2

Common Causes

Back 2

1) impaired erythrocyte production
2) blood loss (acute/chronic)
3) Increased erythrocyte destruction
4) COMBO

Front 3

Classification of Anemia

Back 3

1) Erythrocyte size or concentration of hemoglobin
2) Their cause

Cytic - size
Chromic - Hb content

Front 4

Clinical Manifestations of Anemia

Back 4

Decreased oxygen delivery to tissues causes:
- pallor
- fatigue
- dyspnea
- syncope (fainting) and dizziness
- angina
- compensatory tachycardia
- organ dysfunction

Front 5

Cellular Patho that generates Anemia

Back 5

1) Hypoxia

2) Reduced blood volume causes fluids to move from interstitium into intravascular space, expanding plasma volume.

3) Increasing VR, preload, SV, viscosity (thickness) decreases causing blood to become diluted. This flows faster and more turbulent than normal blood

4) Hypoxemia - reduced O2 levels in blood. Systemic arterial dilation leading to decreased vascular resistance, reduces afterload. SNS activated causing HR to increase.

5) INC preload, HR, SV, reduced afterload. INC CO

6) Tissue Hypoxia - rate and depth of breathing INC

7) Peripheral blood vessels constrict, diverting blood flow to vital organs.

8) DEC blood flow detected by kidneys activates renin-angiotensin. Vasoconstriction and INC salt and water retention to INC blood volume and improve Kidney perfusion

Front 6

Macrocytic-Normochromic

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Deficiency of Vitamin B12 (Pernicious Anemia) or Folate Deficiency Anemia

Larger than normal RBCs

Normal levels of Hemoglobin

Front 7

PA Clinical Manifestations and Patho

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PATHO:

1) Inadequate B12 absorption because of autoantibodies against Intrinsic Factor (small intestine)

2) Antibodies against H/K ATPase causing achlorhydria

3) Chronic Gastritis - H. pylori

CM:
1) Slow onset of symptoms

2) Infections, mood swings, GI, cardiac, kidney ailments

3) Symptoms - weakness, fatigue, feet/finger tingling, difficulty walking, loss of appetite, abdominal pains, weight loss, glossitis, lemon yellow skin (pallor and icterus), hepatomegaly, splenomegaly, nerve demyelination.

Front 8

Folate Deficiency Anemia CM and PATHO

Back 8

PATHO:
1) Impaired DNA synthesis - clumped nuclear chromatin
2) Apoptosis of erythroblasts
3) INC risk for CAD and colorectal cancer

CM
1) Malnourished appearance

2) Symptoms - cheilosis, stomatitis, painful ulceration of buccal mucosa and tongue, GI issues (dysphagia, flatulence, watery diarrhea).

Front 9

Microcytic-Hypo-chromic Origin

Back 9

Disorders of:
1) Iron Metabolism
2) Porphyrin and Heme synthesis
3) globin synthesis

Small erythrocytes containing abnormally reduced hemoglobin

Front 10

Iron Deficiency CM and PATHO

Back 10

PATHO:
1) Inadequate dietary intake

2) Excessive Blood Loss

3) Both deplete iron stores and caused by reduced Hb synthesis

4) Metabolic or functional iron deficiency - Insufficient iron delivery to bone marrow/impaired iron use within marrow

5) Demand for iron exceeds supply : body's iron stores are depleted, erythropoiesis proceeds normally, iron transportation to bone marrow is diminished causing iron deficiency erythropoiesis, small Hb deficient cells enter circulation in sufficient numbers to replace the normal mature erythrocytes that have been removed from circulation. Iron stores are depleted and diminished Hb production.

CM:
1) Symptoms: fatigue, weakness, SOB, pale earlobes, palms, conjunctivae. Nails brittle, thin, coarse, spoon shaped or concave. Tongue is red, sore, painful. Dryness and soreness in corners of mouth (angular stomatitis), difficulty swallowing.

2) Gastritis, neuromuscular alterations, irritability, headache, numbness, tingling, vasomotor disturbances.

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Normocytic-Normochromic Anemias

Back 11

RBCs are normal in size and Hb content

Insufficient numbers of normal erythrocytes

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Aplastic Anemia, Posthemorrhagic Anemia, Hemolytic Anemia, Sickle Cell Anemia, ACD

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AA - insufficient erythropoiesis and depressed stem cell proliferation resulting in bone marrow aplasia

PHA - blood loss (acute/chronic) that stimulates increased erythropoiesis, depletes body iron.

Hemolytic anemia - premature destruction (lysis) of mature erythrocytes in the circulation and increased fragility of erythrocytes

SCA - abnormal Hb synthesis, abnormal cell shape with susceptibility to damage, lysis, and phagocytosis, and congenital dysfunction of Hb synthesis

ACD - abnormal increase demand for new erythrocytes and chronic infection or inflammation; malignancy

Front 13

Aplastic Anemia

Back 13

- Critical condition characterized by a reduction or absence of all three blood types

- Pancytopenia = decrease of all circulating cells (idiopathic or chemical cause "radiation)

- Insufficient erythropoiesis

- Depressed stem cell proliferation -> bone marrow aplasia

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Three Mechanisms Involved in Anemia Associated with Chronic Disease

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1) Decreased erythrocyte life span

2) Reduced production of erythropoietin

3) Ineffective bone marrow response to erythropoietin

4) Iron sequestration in macrophages

Pro-inflammatory cytokine IL-6 increases hepatocyte release of hepcidin, which suppresses ferroportin transport of iron out of macrophage

Front 15

Infectious Mononucleosis Manifestations

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1) Sore throat and Fever (7 to 10 days) caused by inflammation at primary site of viral entry. Lymphadenopathy


2) Enlargement and tenderness of cervical lymph nodes

3) Self-limiting

4) Flu like symptoms: headache, malaise, fatigue, arthralgia, fever, chills, dysphagia.

5) Some asymptomatic

6) Pharyngitis - whitish greenish thick exudate


Complications:
1) Generalized lymph node, spleen and liver enlargement

2) Hepatic failure, Extensive bacterial infection, viral myocarditis

3) Meningitis, encephalitis, GB syndrome, Bell palsy, optic neuritis, mental impairment, transverse myelitis, cerebellar ataxia, demyelinating disease, pneumonia, respiratory failure

Front 16

Leukemia

Back 16

Malignant disorder of the blood and blood-forming organs lose control over cell division causing accumulation of dysfunctional blood cells.

- Uncontrolled proliferation of leukocytes
- Overcrowding to the bone marrow
- Results in decreased production and function of other blood cell lines

Front 17

Acute Leukemia VS Chronic

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Acute - presence of undifferentiated or immature cells, usually blast cells. Onset is abrupt and rapid with short survival time

Chronic - predominant cells are mature but do not function normally. Slow progression. Associated with a longer life expectancy than are acute leukemia's. Progress differently and advance slowly w/o warning. Presence of Philadelphia chromosome

Front 18

Multiple Myeloma

Back 18

Clonal plasma cell cancer characterized by slow proliferation of malignant cells as tumor cell masses in the bone marrow that usually result in destruction of bone.

PATHO
1) aneuploidy, chromosomal translocations (oncogenes, fibroblast growth factor receptor)

2) Proto-oncogene mutations, inactivations of tumor-suppressor genes

3) Precise timing and reason for genetic alteration and accumulation are unknown; occur late in B-cell development after exposure to antigen

4) Malignant plasma cells arise from one clone of B cells that produce abnormal large amounts of IgG.

5) IL-6 act as osteoclast-activating factor and stimulate osteoclasts to reabsorb bone; bone lesions and hypercalcemia resulting from release of calcium from breakdown of bone.

6) M-Protein = abnormal antibody contributes to CM

7) Bence Jones Proteins - produce free immunoglobulin light chain present in blood and urine; damage of renal tubular cells


CM:
1)Hypercalcemia, Renal failure, anemia, bone lesions

2) Destruction of bone tissue causes Pain; weakness, fatigue, weight loss, anorexia


3) Recurrent infections caused by suppression of humoral immune response and renal disease as a result of Bence Jones proteinuria