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83 Cards in this Set
- Front
- Back
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Blood Components and function
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The components of blood consists of three primary cell types Erythrocytes, Leukocytes, Platelets
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White blood cells
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fights infections
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Neutrophil
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Essential in preventing or limiting bacterial infection via phagocytosis
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Monocyte
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Enters tissue as macrophage highly phagocytic, especially against fungus. Immune surveillance
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Eosinophil
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Involved in allergic reactions ( neutralizes histamine it digests foreign proteins
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Basophil
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contains histamine, integral part of hypersensitivity release histamine and heparin
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Lymphocyte
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Integral compartment of immune system T-lymphocyte- Responsible for cell mediated immunity recognizes material as (foreign) its the surveillance system
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B Lymphocyte
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Responsible for humeral immunity many mature into plasma cells to form antibody
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Plasma cell
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Secrets immunogloblin (Ig, Antibody) most mature forms of B Lymphocytes
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Red Blood Cell
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carries hemoglobin to provide oxygen to tissues average life span in 120 days
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Bone Marrow
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The primary site for hematopoiesis is the bone marrow. During embryonic development and in other conditions liver and spleen may also be involved. under normal condition the adult bone marrow produces about 175 billion erythrocytes when the body needs more blood as in an infection when neutrophils are needed to fight the invading pathogen or bleeding when more RBC are needed. Thus under normal conditions the marrow responds and releases adequate number of cells into the circulation
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Blood Cells
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Erythrocytes is a biconcave disk that resembles a softball compressed between two fingers its flexible that is can pass easily through the capillaries.The disk shape provides a large surface area the absorption and release of oxygen molecules mature erythrocytes consist primarily of hemoglobin. Which contain iron and makes up 95% of the cell mass. large amount of hemoglobin the transport of oxygen between the lungs and tissues
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Reticulocytes
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marrow releases slightly immature forms of erythrocytes. This is a normal response to an increased demand for erythrocytes as bleeding in diseases states oxygen readily binds to hemoglobin in the lungs and is carried as OXYHEMOGLOBIN in atrial blood. The oxygen detaches from hemoglobin in the tissues where the oxygen is needed for cellular metabolism. In venous blood, hemoglobin combines with hydrogen ions produced by cellular metabolism and buffers excessive acid. The whole blood contains 15g of hemoglobin per 100ml of blood.
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Erythropoieses
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The mature erythrocyte is then released into the circulation under conditions of rapid erythropoieses reticulocytes and other immature cells may be released prematurely into the circulation. This is often seen when the liver or spleen takes over as the site of erythropoieses and more nucleated red cells appear within the circulation
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Erythropoietin
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A Hormone produced primarily by the kidney differentiation of the primitive myeloid stem cell into an erythroblast is stimulated. If the kidney detects low levels as occurs when fewer red cells are available to bind to oxygen ANEMIA. People living at high altitudes with lower atmospheric oxygen concentration erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of Erythropoiesis takes 5 Days.
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Iron
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0.5-1mg of ingested iron is absorbed from the small intestine
the rate of iron absorption is regulated by the amount of iron already stored in the body and by the rate of the erythrocyte production. Additional amounts of iron up to 2mg a day must be absorbed by women of child bearing age to be replaced during menstruation. Total body iron for average is 3g. most of which is present in hemoglobin or is one of its breakdown products. Iron is stored are FERRITIN and when required the iron is released into the membranes of the (normoblast) erythrocyte precursor cells within the marrow where it is incorporated into hemoglobin. |
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Iron cont.
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Iron is lost in the feces either in bile, blood, or mucosa cells from the intestines. Blood concentration in men is 75-175 and women 65-165.
with iron defiency bone marrow iron stores are rapidly delpleated hemoglobin sythesis is depressed. Iron deficiency |
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Iron Deficiency
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the iron deficiency bone marrow iron stores are rapidly depleted hemoglobin synthesis is depressed. Iron deficiency in adults generally indicate blood loss, bleeding in GI tract or heavy menstrual flow. The source of iron deficiency in an adult could be a sign of bleeding in the Gi trct or colon cancer
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Vitamin b12 and Folic Acid
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b12 and folic acid are needed for the synthesis of DNA in RBC. b12 and folic acid is absorbed in the proximal small intestine. Small amount is stored within the body if you don't get enough folic acid your reserves with deplete fast. b12 found in foods of animal origin strict vegge eaters may ingest little b12 vitamin b12 combines with the insintric factorcomplex is absorbed in the distal ileum.
partial or total removal of the stomach (gastrectomy) may have limited amounts of intrinsic factor therefore the absorption of b12 is diminished |
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b12 and folic acid production= Megaloblast
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Production of abnormally large erythrocytes. because these cells are abnormal many are sequestered while still in the bone marrow and their rate of release is decreased cells actually die in the marrow before they can be released into the circulation in result in MEGALOBLASTIC ANEMIA
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Red Cell destruction
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average life span is days. They loose their eslasticity and become trapped in small blood vessel and the spleen they are removed from the blood by the RETICULOENDNOTHEIAL cells. Particularly in the liver and spleen erythrocytes are destroyed and their hemoglobin is recycled some hemo breaks down to form bilirubin and is secreted in the bile. Most iron is recycled to form new hemoglobin molecules within the bone marrow.
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White Blood Cell
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4-11
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granulocytes
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60-80
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Lymphocytes
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20-40
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Granulocytes
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are divided into 2 sub groups which are characterized by staining.
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Eosinophil
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Stain Bright red granules
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Basophil
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Stain deep blue
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Neutrophil
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Stain Pink to violet
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Neutrophil
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a mature neutrophil has multiple lobes 2-5 connected by thin filaments or a segmented nucleaus band cell an increase number of band cells is sometimes called left shift or shift to the left.
Fully Mature neutrophil result from the gradual differention of myeloid blast cells. The process is clled myelopoiessis. Specific cytokines such as growth factors are present within the marrow as the blast cells changes from blue-violet. The shape of the nucleus changes takes up to 10 days once the neautrophil is released into the circulation it takes it takes about 6 hours before it migrates into tissue and start its function to ingest and digest of bacteria the number of circulation. |
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Monocytes
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single lobes granule free leaukocytes largest leukocytes are monocytes produced by the bone marrow. after they go into the tissue the transform into macrophages. they are active in the spleen liver peritoneum and alveoli they remove debris from these areas and phagocyte bacteria withing tissue
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Lymphocytes
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Large cells withing scanty cytoplasm immature lymphocytees aare produced in the marrow from the lymphoid stem cells they are also produced in the thymus known as T lymphocytes or t Cells. B cells are made in the bone marrow. they are in the lymph nodes and the lymphoid tissue of the intestine and spleen mature lymphocytes are principal cells of the immune system producing antibodies and identifying other cells and organisms as foreign
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Inflammatory process
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Neutrophil are phagocytosos 1 hour on onset of inflammatory reaction then monocytes follow for a longer period becoming macrophages this is the second line of defense
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Macrophages
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Fungi and viruses also digest aged and aging blood cells primary withing the spleen
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T- Lymphocytes
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Kills foreign cells directly or releases lymphokines cells also responsible for delayed allergic reactions rejection of foreign tissue. Example transplanted organ and destruction of tumor cells known as cellular immunity
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B- Cells
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is capable of differentiating into plasma cells. plasma cells in turn produce antibodies IG which are protein molecules that destroy foreign material known as humeral immunity
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Platelets
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Or thrombpcytes are not technically cells rather they are granular fragments of giant cells in the bone marrow called mega karyocye is regulated by thrombopoiten which stimulates the production of megakaryocytes with the myloid stem cell. IT nurtures the endothelium mantaing integrity of the vessel. Platelts collect the site and are activated forming a platlet plug composed of Fibrin Platlets have a life span of 7-10 days
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Hemostasis
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preventing blood loss from an intact vessel
primary- the severed blood vessel constricts circulation platelets aggregated and adhere the blood vessel from another and an unstable homeostatic plug is formed. Circulating inactive surface of the aggregated platelets at the site of the vessel injury |
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Secondary Hemostasis
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formation of fibrin which reinforces the platelet plugs anchored it to the injury site
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Clotting
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Clotting by the intrinsic pathway is activated when collagen that lines blood vessels are exposed. Intrinsic pathway is slower plaminogen is required to lyse(break down) the fibrin the plasmogin is activated to form plasmin
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Plasmin
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Digest the fibrogen and fibrin
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CBC
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Most common test used and the peripheral smear CBC identifies leukocytes erythrocyes and platelets, hemoglobin, hematocrit. the red blood cells shape is so important to diagnose a blood disorder a smear is used for this
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Bone Marrow Aspiration and Biopsy
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Essential to see what kind of cells re being made in the marrow. Infecion or tumore within the marrow. Bone marrow is in a semifluis state that can be aspirated through a large needed adults its the iliac crest and the sternum aspirate to check for anemia biopsys are sone in the posterior ilieac rest a marrow biopsy shows the architecture of the bone marrow as well as its degree of cell growth. anti anxiety meds are helpful for the procedure. Local anesthesia is used to sedate the area you can not sedate the bone. when the needle is felt in the outer cortex of the bone a small volume 5 ml of blood is aspirated tell patient to breathe and use relaxation techniques.
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Biopsy
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Well advanced into the portion of the marrow is cored out patient should not feel pain bleeding can happen or infection tell the patient to notify the dr immidietly. if the platelt count is low patient could have neem taking asprin. warm bath tubs and tylenol sicne the biopsy will be sore for 2-3 days with aspiration the pain should be less and go away faster.
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Iron Deficiency Anemia
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In Men and post menopausal women the cause is bleeding ulcers, gastritis, inflammatory bowel disease or gi tumors. For Pre Menopausal women exessive menstrual period. Pregnancy with inadequate iron sump limitation chronic alcoholism often have chronic blood loss from Gi tract which causes Iron Loss and anemia. Iron absorption after gastronomy or celiac disease
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Manifestation (iron Def Anemia)
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Smooth sore tongue, brittle ridged nails angular cheilosis GI bleeding, Pica
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Assessment (iron Def anemia)
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Bone marrow aspiration however a few patients with suspected are diagnosed with other test history of conditions that can give you anemia. Also craving non food items and multiple pregnancy Lab values Iron depleted is reflected by low serum ferritin levels and hemoglobin falls the diminished iron stages cause small erythrocytes to be produced by the marrow The MVC which measures the size of the erythrocytes also decreases.. The Hemocrit and RBC- are low in relation to the hemoglobin level low serum iron levels and am elevated TIBC which measures the transport protein supplying the marrow with iron as needed also as tranferrin the most reliable way of evaluation for iron deficiency are the ferritin and hemo globin values. pregnancy anemia should not be investigated anemia could be a sign of Gi cancer uterine fibroid stool sample for occult blood. over 50 and endoscopy colonscopy and an xray exam
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Megaplastic Anemia
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hyperplasia- abnormal in crease of cell formation. precurser erythriod and myloid cells are destroyed within the marrow so the mature cells that leave the marrow are a few.
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Pancytopenia
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a decrease in all myeloid derived cells
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Lab Values for Megaloplastic anemia
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Low Hemoglobin 4-5
leukocyte- 2000-3000 Platlet=50000 cells that are sent into the circulation are abnormally shaped. Neutrophils are hyper segmented Platlets abnormally large Erythrocytes- abnormally shaped (poikilo cytosis) |
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Folic Acid
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Folic acid is stored as compounds reffered to as folated folate is found in green veg and liver. People who rarley eat uncooked veg, alcholol and pregnancy increase folic acid demands and chronic hemolytic anemia that need for erythro production is increased patients with small intestine disease such as spruce may not absorb folic acid normally
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Vit B12
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No meat no dairy products fault absorption of Gi tract is more common chrons disease or ilean resection or gastectomy absence of intrinisic factor. B12 binds to the insintric factor b12 can be abosribed PRENICIOUS ANemia tends to run in family particulary in elderly. b12 has a large storage so it will be years before the sign of b12 defecincy shows. PRENCIOUS ANEMIA is the main cause of gastric cancer
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Folic Acid Def
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Increase the serum folate measuring amount of folate with in the red cell
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b12 Def
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Neurological Manifestation body shows signs of anemia
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Pernicious Anemia (shilling Test)
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Smooth sore red tongue and mild diarrhea. pale mucosa, confused parenthesis, propriception( no balance). Shilling test for vitamin b12 receieves a small oral dose of radio acive substance if the radio active substance does not excreate after 24 hours in urine the body is not absorbing it. the test is then repeated with intrinsic factor so see if this then comes out in the urine.
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Insintric factor antibody test,
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If the test is positive than the b12 is binding to the antibody and it wont be digested.
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Nursing Intervention (prencious anemia)
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inspect skin mucous membrane, mild jaundice
Vitiligo- patchy loss of skin pigmintation loss of skin pigmitation greys a good neurological assessment |
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Interventions for Iron Def
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Ferrous solfate, ferrous gluconate ferrour fumarate are available to treat iron Def anemia the hemo globin can increase in only a few weeks anemia can be corrected in a few months patient needs to stay on iron much longer 6-12 months before giving iron shots you have to administer the shot a little and wait 30 administer the rest later
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Immune Hemolytic Anemia
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Can result in exposure of erythrocytes and antibodies together. Immunization of the patient with foreign antigens. an example is an immunization of a patient that is rh - getting antibodies from a Rn + person. all antibodies are large and cause immediate death of the blood vessels intravascular hemolysis and example of hemolytic anemia is when a patient has had a hemolytic blood transfusion. other times the patients immune system is not working properly and the body recognizes the red blood cells as foreign and creates antibodies for it and attaches to it. it has been seen in lymphatic anemia in adults and a deficiency in suppressor lymphocytes. Autoimmune hemolytic anemia is associated with warm type antibodies
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Immune HemoLytic Anemia (manifestation)
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Speenomegaly is the most common physical finding because when there is small amount of dying cells the body replenishes its self. Heptomegaly lymhphadenopathy and jaundice are also commen
Bilirubin level is elevated and if the hemolysis is severe the haptoglobin level is low or abset the COOMBS test also reffered to as the direct antiglobulin test which detects antibodies on the surface of the erythrocytes shows a positive result. Medical Management is to give aptient Corticosteriod it decreases the macrophages ability to clear the antbody erythrocytes. if that deosnt work a removal of the spleen is needed and if that doesnt work immunosepressive agents are used cytoxan- rapid effect or Imuran that has a slower effect but less toxitiy. Danocrine can be used as a combo with a corticosteroids. for patients that have cold antibody hemolytic anemia it is just recommended to relocate in a warmer place pateints that have had there spleen taken out must be vaccinated with the pneumovax and informed that they will always be at greater risk of infection |
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Polycythemia Vera
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the bone marrow is hyper cellular the erythrocytes leukocytes and platelets in the peripheral blood is elevated eventually the bone marrow become fibroidic
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Plycthemia vera (manifestation)
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headache dizziness fatigue parethesias and blurred vision and increased blood viscosity and may include angina dyspnea and thrombophelbitis blood pressure is elevated and uric acid is also elevated causing gout and renal stone formation. Pruritus (itching) due to the large amount of histamine due to the increase number of basophils. Erythromyalgia burning sensation finger and toes is common Diagnosis is based on a large erythrocyte count an enlarged spleen
withdrawing blood once or twice a week can help a patient |
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Thrombocytopemia
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Causes to have an increase level of platelet count. 60,000 and higher red, warm, painful distal extremities hemorrhages can occur and usually happens in gums or skin like ecchymoses bleeding usually doesnt occur until the platlet count reaches the 1.5 million. in younger patients the use of low dose asprin can be it. but aspein can cause hemmoraging in patients that have had an history of gi bleeding
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Idiopathic Thrombocytopenic Purpura
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ITP usually happens with children and younger women. an antibody binds to the platet and destroys it. Acute ITP appears 1-6 weeks after a viral illness. remission just happens after 6 months alone. Chronic ITP is diagnosed by excluding other things. Anti Platlet autobodies are found in the blood.
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Idiopathic Thrombocytopenic Purpura (manifestation)
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easy brusing heavy menses and petechiae (dry Purpura) on extremities or trunk. Patients with wet Purpura have a greater risk for intra cranial bleeding the patient has a low platelet 20,000 or less patients with h pylorie seam to continue to bring the platelet count lower. the normal count is 150,00- 450, 000 if the patient gets to the amount of 30,000-50,000 may just be observed without any interventions.
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Von Williebrand's Disease
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Bleeding disorder that is usually inherited the disease is caused by the difenceny in vWf which is nesecary for factor VIII activity. Type 1 of VWD the most commen its the decrease in structurally normal vwf.... Type 2 shows variable defects based on the specific vWs subtype. type 3 very rare is characterized by the severe defeicnecy in vWD and significant Def. in factor VIII..
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Von Williebrand's Disease (manifestation)
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bleeding tends to be mucosal patients commonly have nose bleeds and easily bruising, Heavy Menses, prolonged bleeding from cuts and postoperative bleeding. tissue or joint hemorrhaging unless its type 3 The Ristocetin cofactor or the vwf colligin binding assay. also you can check the vwf antigen DDAVP is a medication that is used to suppress blood in a dental or surgical procedure but this can cause an mi
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Heparin
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Anti coagulant, that enhances AT III and inhibits platelet functions. to PREVENT thrombosis this is given 2-3 times A DAY SUB Q to TREAT thrombosis its given INTRAVENOUSLY the heprin monitored by the aPTT to mantain the range 1.5-2.5
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Heprin Induced Thrombocytopenia
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ia the complication of heprin based therapy it involves antibodies that are formed against the heprin complex Refludan and argatroban are medication used for this problem
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Low molecular weight heparin therapy
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Lovenox is a special form of heparin you can administer this once or twice daily without having to moniter the patient for dose adjustment LMWHT have an % contraindicating reaction with heprin induced Thrombocytopenia antibodies. if warfin was being used before a procedure it is stopped and LMWHT is used until after the procedure.
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Warfarin Coumadin
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are anti coagulates they are antagonists (they work against) of vitamin k dependent clotting factors. Warfarin is extremely strong and the patient needs to watch how they eat and food with high vitamin K that antagonize he effects of warfarin these foods include spinach broccoli and lettuce the intent dosage is 2.0-3.0 but it varies in each patient.
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Autologous blood donation
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a patients blood is collected before surgery like an orthopedic surgery that has a high demand of blood. collected 4-6 weeks before surgery. iron supplements are prescribed so that these stores would not be depleted
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Intraoperative Salvage
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this is for patients that could not give up blood before the surgery or for those undergoing vascular ortho or thoracic surgery blood loss into a sterile cavity is suctioned into a cell saver machine the blood is washed with saline solution and then administered back in through iv line
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Blood transfusion Therapy and Pharmacological alternatives
platelets or (FFP) |
Administration of blood and blood components requires knowledge of correct administration you have to know the hospitals policy.
you have to confirm the transfusion has been ordered make sure the consent is signed explain the procedure to the patients explain to the patient the symptoms and reactions (itching, hives, swelling shortness of breath fever chills) take the patients Vitals to establish a baseline 22 gauge needle used |
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Procedure of Platelets or fresh frozen plasma transfusion
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obtain the platelets from the bank only after the intravenous line has started (from the blood bank)
double check the lables with anther nurse or physician to make sure that the ABO groups match Identify the patient check the blood for any excessive redness that can indicate contamination with large amount of red blood cells Make sure the platelets or FFP units are administered immediately after being obtained infuse each unit of FFP over 30-60 minutes per patient tolerance. Administer the platelets as fast as the patient can tolerate it you don't want the platelets to clump observe the patient for circulatory overload decrease rate of infusion monitor the patient closley to make sure there is no adverse reaction restleness, hives nausea vomiting torso or back pain flushing hematuria fever or chills should any adverse reaction happen stop the infusion immediately notify physician and follow the agencies blood transfusion standard monitor vitals at the end of the transfusion compare to base line and flush the tubing with saline water |
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Patient History (Pre transfusion Assessment)
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patient history is important to ask the patient if he or she has had prior blood transfusion and for a women of she has had prior pregnancies a women has had because a high number can increase her risk of reaction due to antibodies developed from exposure to fetal circulation. Other concurrent health problems should be noted with careful attention to cardiac pulmonary and vascular disease.
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Physical Assessment (pre transfusion)
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physical assessment and measurement of baseline vital signs are important before transfusion any blood products. The Resp should be assessed carefull inpection of any edema as well as signs of cardiac failure ( jugular venous distention) the skin should be observed for rashes petechiae, and ecchymoses.
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Patient Teaching
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Tell the patient the signs and symptoms reaction is advised fever, chills, respiratory, low back pain, nausea, pain at the Iv site or anything unusual. make sure you have to re assure the patient that the blood is carefully cross matched to diminish the likelihood of any untoward reaction. Re assure the patient that there is a very low possibility of contracting HIV from the transfusion
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Febrile Nonhemolytic reaction
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reaction is caused by antibodies to donor leukocytes that remain in the unit of blood or blood components. its the most common type of transfusion. it occurs more with patients that have had transfusion prior to this exposure to multiple antigens from previous transfusion. and to rh negative women who have had previous blood products. this diagnosis comes with the excluding to hemolytic reactions and bacterial contamination S/S= are chills followed by fever typically begins within 2 hours after the transfusion has begun you can reduce it by using a leukocyte reduction filter and antipyretics but this is not always used because it can mask a serious infection.
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Acute Hemolytic reaction
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this is the most dangerous and potentially life threatning type of transfusion reaction occurs when the donor blood blood is incompatible with that of the recipient. antibodies already present in the recipients plasma rapidly combine with antigens on donor erythrocytes and the erythrocytes are destroyed in the circulation the most rapid hemolyisis occurs in ABO incompatibility can occure after transfusion. The most common causes of acute hemolytic reaction is becuase of errors in labeling and patient identification that result in ABO incompatible transfusion. Symptoms are fever, chills, low back pain, nausea, tight chest pain dyspenea and anxiety. as erythrocytes are destroyed the hemoglobin is released form the cells and excreated in the urine ( hemoglobnuria) hypertension broncho spasm and vascular collapse may happen and acute renal failure the transfusion has to sop immediately.
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Allergic Reaction
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some patients develop urticaria (hives) or generalized itching during a transfusion. it is a sensitivity reaction to the plasma protein. the patient can be given antihistamines and then the blood transfusion can resume for a severe reaction the blood components are washed away and antihistamine are given
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Circulatory over load
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if too much blood is infused too quickly hypervolemia can occur. anti directs are used after or during unit administration. S/S dyspnea, orthopnea, tachycardia, sudden anxiety crackles in the lungs jugular vein distention. if continued pulmonary edema and the coughing of pink frothy sputum
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Bacterial Contamination
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this often results from organisms in the donors skin, because blood is stored in such cold temp most organisms cant survive platelets have a greater chance since it is stored in a warmer temp. fever chills and hypo tension are the Signs and symptoms these signs may not occur until several hours after the transfusion. if the condition is not treated with fluids and broad spectrum antibiotics septic shock can occur and mortality rate is high. the doctor and blood back are notified and blood container is sent to the lab for culture test. Corticosteroids and vassopressors are often also necessary.
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Hodgkins Lymphoma
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Hodgkins Lymphoma is more common in men than women. it initiates in one single node. When lymohicytes predominate with few Reed- Sternberg cells and minimal involvement is has a better outcome than when lyphocytes is low and the tumor cells have replaced it. Hodgkins Lymphona is sub grouped in two types. Nodular Sclerosis and mixed Cellularity usually happens in women at an earlier stage but has a worse prognosis than mixed cellulaity which occurs more common in men at a later stage but with better prognosis. usually happens with one or more lyphnodes inflamed in one side of the neck. When drinking alcohol usually gets pain at the cells. a mild anemia is most common hematological finding pain in the abdominal.
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