2Hemopoietic System Consists of blood Lymphatic tissue Bone marrow Spleen
3Three Types of Blood Cells ErythrocytesRed blood cellsResponsible for transferring oxygen and CO2 to & from various organs in the bodyLeukocytesWhite blood cellsFormed within bone marrowPlay an important role in body’s defense systemThrombocytesPlateletsNecessary for blood to clot properly
4Erythrocytes Very small cells in relation to other blood cells Don’t contain a nucleusLive approx 120 daysIndividuals with less than 12g per 100ml of blood have anemiaContain various antigens or lack of which determines blood type
5Blood Types This rebuttal has been covered in point number 2 above. The difference in blood types are due to the presence or absence of certain protein molecules called antigens and antibodies. The antigens are located on the surface of the RBC’s and the antibodies are in the blood plasma. If you belong to Blood group A- you have “A” antigens on the surface of your RBC’s and “B” antibodies in your blood plasma. If you belong to Blood Group B- you have “B’ antigens on your RBC’s and “A” antibodies in your blood plasma. Blood group AB- you have both “A” and “B” antigens on your RBC’s and no “A” and “B” antibodies. Blood group “O” has neither “A” or “B” antigens but you have both “A” and “B” antibodies in your plasma.
6Agglutination Rejection of cells due to antigens Blood type “O” Can cause immediate shockDelayed symptomsBlood type “O”Universal donor (does not have antigens)Blood type “AB”Universal recipientNot all blood groups are compatible with each other. Mixing incompatible blood groups leads to clumping or agglutination, which is dangerous and possible fatal to individuals. For blood transfusions to be successful ABO and RH blood grousp must be compatible between donor and patients blood. Agglutination cells can clog blood vessels and stop the circulation of blood to various parts of the body. The RBC’s will rupture and its contents (hemoglobin) will leak out into the body. Hemoglobin becomes toxic when outside of the RBC’s, these can be fatal. The transfusion will work if a blood group does not have antibodies against the donor blood’s antigens.
7RH factor http://www.youtube.com/watch?v=7OWp8d8WKkg In addition to ABO blood types many people also have RH antigens. People who have this antigen are RH + and those who don’t are RH-. A person with RH- blood does not have RH antibodies naturally in the blood plasma. But a person with Rh – blood can develop RH antibodies in the blood plasma if he or she receives blood from a person with RH+ blood, whose RH antigens can trigger the production of RH antibodies. A person with RH+ blood can receive blood from a person with RH- blood without problems. So someone with RH+ can only give blood to someone who is RH+. But RH – can give blood to both RH+ and RH-.RH FACTOR: Your pregnancy needs special care if the woman is RH – and the baby’s father is RH +. During pregnancy , or more likely during delivery, some of your baby’s blood may mix with mothers blood. If you and the baby are RH+ then there is not a problem. If you are RH- and the baby is RH+, your body may produce RH antibodies after exposure. If you are RH- you may need a blood test, an antibody screening during your first trimeester and during the course of the pregnancy to make sure you haven’t starting producing antibodies. You will also need an injection to prevent your body from prodcuing RH antibodies during your pregnancy. If your body already is producing antibodies and injection will not help and the baby will need to be closely monitored. The baby may need a blood transfusion through the umbilical cord during pregnancy or immediately after delivery. If mother, father and child are RH+ there are no precautions or concerns. If mother, father and child are RH- there are no precattions or concerns. If mother is RH+ and father is Rh- and child can be RH + or RH-,and there are no concerns or precations. It is only when the mother is RH- and the father is RH+ and baby is RH+ that RH immume globin injections are needed with close monitoring of baby during pregnancy.
10Leukocytes May be classified as granular and non-granular Granular has cytoplasmic granules and irregular nucleiNon-granular does not contain granules & has a regular nucleusMainly formed in lymphatic tissue and spleenAble to move out of capillaries and attack foreign substances
16Lymphocytes Most radiosensitive blood cells Most important in the development of immunityDerived from lymphatic tissue (T) and bone marrow (B)Both work together to ingest foreign substances and process the specific foreign antigensWith transplants- these cells along with macrophages see it as a foreign substanceTry to destroy the foreign antigens resulting in rejection of graft or organ
18Spleen Largest lymphoid organ Produces lymphocytes and plasma cells Cleanses blood & lymphocytes to fight infectious blood-borne microorganismsRemoves old or defective blood cells
19Anemia Decrease in the amount of oxygen carrying hemoglobin in blood Results in improper formation of new RBC’sIncreased rate of RBC destructionOr a loss of RBC as a result of prolonged bleedingPerson appears paleHas muscle weakness, fatigue, & SOB
20Types of Anemia Iron Deficiency Hemolytic Megoblastic Aplastic Myelophthisic
21Iron Deficiency Anemia Most common typeResults from chronic blood lossFrom an ulcer, malignant tumor, or menorrhagiaInadequate iron intakePregnancyTreatmentDietary changeFerrous sulfate supplements with vitamin CIron deficiency Anemia:Blood lacks adequate healthy red blood cells. Without iron your body cannot produce enough hemoglobin.SYMPTOMS:Extreme fatigue, pale skin, weakness, short of breath, headache, dizzziness, light headedness, cold hands and feet, irratibility, inflammation or soreness of tongue, brittle nails, fast heartbeat, unusual cravings for non-nutritive substances (ice, dirt and starch), poor appetite, resteless leg syndrome.CAUSES:Blood loss- heavy periods, bleeding peptic ulcer, hiatal hernia, colon polyps, colorectal cancer and GI bleed.Lack of iron intake- poor diet lacking sufficient ironInability to absorb- an intestinal disorder in which your intestines are not absorbing nutrients from digested food. By pass- surgery that bypasses small bowel.Pregnancy- baby needs extra hemoglobins and so if women don’t take supplements they could gt anemia.RISK FACTORS:Women- menustationInfants and children- premature birth, low birth weight, poor diet.Vegetarians- non enough iron in diet. Because they do not eat meat- which is rich in iron.COMPLICATIONS:Heart problems- can cause rapid or irregualr heart beat. Your heart tries to pump more blood to compensate for lack of oxygen, this can cause enlarged heart or heart failure.Pregnancy problems- premature birth- low birth weightGrowth problesm- infants and children do not grow properly and are more susceptible to infections.
22Hemolytic AnemiaShortened life span of the red blood cells with resulting hemolysis and the release of hemoglobin into the plasma3 hereditary defectsSpherocytosisSickle cell anemiaThalassemiaHemolytic Anemia:Shotened life span of RBC with resulting hemolysis and release of hemoglobin into the plasma. Three types of Hemolytic anemia: Spherocytosis, Sickle cell and Thalassemia.1) Spherocytosis-(SFER- o-si-to-sis)- A defect in the surface membrane (outer covering) of RBC’s causes them to take on sphere or ball like shape. Have a life span shorter than normal.
23Sickle Cell AnemiaHemoglobin molecule is abnormal and RBC’s are crensenticTend to ruptureX-ray demonstrates biconcave indentations on both the superior & inferior marginsSoftened vertebral bodiesAppear like fish vertebraeSickle Cell Anemia:There aren’t enough healthy RBC’s to carry adequate oxygen to body. Cells become rigid and sticky and are shaped like sickles or cresent moons. These blood cells get stuck in small blood vessels, which can slow or block oxygen and blood flow to parts of the body.SYMPTOMS:RBC’s live days causing a shortage of RBC’s.Crisis- episodes of pain when sickle cells block blood flow to chest, abdomen, and joints. Pain can vary in intensity and last from hours to weeks. Sometimes pain is so severe it requires hospitalization for pain management.Hand-foot syndrome- infants are born with swollen hands and feet because of lack of blood flow to these areas.Jaudine- liver filters out harmful substance from blood and becomes overwhelmed by rapdi breakdown of RBC’s.Frequent infections- this disease can damage spleen which fights infection, so it makes patients more vulnerable to infections. Commonly treated with antibiotics.Delayed Growth in children and delayed pubertyVision problems- Tiny blood vessels that supply your eyes may become blocked with sickle cells. This can damage retina – the portion that processes images.RISK FACTORS:Both parents must carry the sickle cell geneDescent- African, Spanish, Mediteraean, Middle Easter, Indian and HispanicsCOMPLICATIONS:StrokeAcute chest syndrome- blockage of blood vessels to lungsPulmonary Hypertesnion-Organ damage due to blocked blood flowBlindnessSkin ulcers- this disease can cause open sores called ulcers on legsGallstones- breakdown of RBC’s produces a substance called bilirubin. Bilirubin is responsible for the jaundice. A high level of bilirubin can lead to gallstones.Priapism- painful erections due to blockage of blood vessels and can evntually lead to impotence
24Thalassemia Defect in hemoglobin formation Occurs in persons living near Mediterranean SeaJaundicedExtensive hyperplasiaX-ray demonstrates widening of medullary spaces and thinning of the corticesLocalized radiolucency simulating osteolytic lesionsThalassemia (thal-uh-see-me-uh):Inherited blood disorder by less hemoglobins and RBC’s than normal.SYMPTOMS: fatigue, weakness, SOB, pale, irritable, jaundice, facial bone deformities, slow growth, abdomen swelling, dark urineRISK FACTORS:Family historyDescent- Greek, Italian, Middle Eastern, Asian and African.COMPLICATIONS:Iron overload- form frequent blood transfusions, which can cause damage to heart, liver and endocrine systemInfection- increased infection and especially if spleen is removedSevere cases:Bone deformities- bone marrow expands and causes bones to widen which can cause deformities especially in face and skull. Bne marrow expansion also makes bones thin and brittle and causes and increase in number of fractures.Enlarged spleen- due to the spleen filtering out damaged RBC’s. Spleen works harder to removed the blood cells that are damaged and gets enlarged- can lead to spleen removal.Slowed growth rates of children and delayed pubertyHeart problems- CHF and arrythmias
25Megaloblastic A deficiency of Vitamin B12 and folic acid Can be from malnutrition, strict vegetarianism & alcoholismLeads to defective DNA synthesisDecreased number if RBC’s (normal hemoglobin)Megaloblastic Anemia:Blood disorder with anemia and larger than normal RBC’s but contain normal amount of hemoglobins.CAUSES: A deficiency in B12 or folic acid. Less common causes include alcohol abuse, inherited disorders, chemotherapy, leukemia, poor diet, vegetarianism, and malabsorption.Radiographically the pathology is demonstrated as gastric atrophy with absence of rugae.TREATMENT:Vitamin B12 injections and oral folic acid supplements. Blood transfusion if severe.
26Aplastic Anemia Failure of bone marrow to function Results in a decrease in RBC’s, leukocytes, and plateletsCannot fight infection and have a bleeding tendencyCauses include exposure to chemical agents, drugs, infections and invasion of bone marrow by cancerAplastic Anemia:Failure of bone marrow to functionResults in a decrease in RBC’s, leukocytes, and plateletsCannot fight infection and have a bleeding tendencyCan come on suddenly or be chronic and can lead to death.TREATMENTS:Regular blood transfusions for survival and decreased symptoms.Preventative antibiotics because they are more prone to infections.Medications to stimualte bone marrow to produce more blood cells.Bone marrow transplantationSYMPTOMS: Fatigue, SOB with exertion, fast or irregular heart rate, prolonged infections, unexplained bruising or easy bruising, nose bleeds, bleeding gums, prolonged bleeding from cuts, skin rash, dizziness and headaches.CAUSES: Any factors that affect temporary or permanent injury to bone marrow and affect blood cell production.Radiation and chemotherapyToxic chemicalsUse of certain drugs- some of which treat rheumatoid arthritis and certain antibioticsAutoimmune disordersViral infection- hepatitis, Epstein Barr and HIVPregnancy- your immune system sometimes atttacks your bone marrow when pregnantRISK FACTORS:Radiation therapy and chemotherapyToxic substancesSome prescriptioin drugsCertain blood diseases, autoimmune disorders and serious infectionsPregnancy –(rare)
27Myelophthisic AnemiaInfiltration of bone marrow by cancer, metastases, and carcinomasCauses cortical thickening and can cause a severe decrease in red and white blood cells and platelets in the bone marrowMyelophthisic Anemia-Infiltration of bone marrow by certain types of infections and cancers. This causes abnormal tissue to be formed which prevents a sufficient amount of RBC’s and platelets to be formed by the bone marrow.
28AIDS It is caused by HIV 1 and HIV 2 HIV 1 more virulent HIV 2 Paralyzes the normal immune mechanisms resulting in severe immunosuppressionIn the majority of cases in western hemisphereHIV 2Converts viral RNA to a DNA copyEach time cell divides retroviral DNA is duplicatedAIDS:Chronic life threatening condition caused by HIV. HIV damages your immune system and intereferes with your body’s ability to fight organisms that cause disease.SYMPTOMS:First few weeks- Fever, headache, sore throat, swollen lymph nodes and rashYears later- You may remain symptom free for years. But as the virus continues to multiply and destroy immune cells, you may develp mild infections or chronic symptoms such as: swollen lymph nodes, diarrhea, weight loss, fever, cough and SOB.Progression of AIDS:If you receive no treatment HIV progresses to AIDS in about 10 years. By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections- diseases tha would not trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include:Soaking night sweatsShaking, chills and fever higher than 100F for several weeksCough and SOBChronic diarrheaPersistent white spots or unusual lesions on your tongue or in your mouthHeadachesChronic fatigueBlurred and distrurbed visionSkin rashes or bumpsCAUSES:HIV destroys CD4 cells, which is a specific type of WBC that plays a role in helping your body fight disease. Your immunie system weakens as more CD4 cells are destroyed. CD4 count below 200 indicates one has AIDS and you will start to get pneumonia, TB, taxoplasmosis, cryptosporidiosis.Trasnmitted through blood, semen, and vaginal secretions. Can it through sexual intercourse, blood transfusions, sharing needles, and mother to child.RISK FACTORS:Having unprotected sexHaving other STD’s that may cause open sores in genitalsIV drug abuseUncircumcised malesCOMPLICATIONS:Infections common to HIV/AIDS1)TB2) Salmonellaosis (food transmitted)3) Herpes virus- which can be transmitted in saliva, blood, urine, semen and breast milk.4) Candidiasis- inflammation and thick white coating of mucous membranes of mouth, tongue, esophagus and vagina.5) Meningitis6) Toxoplasmosis- parasite spread by cats in their stool and these parasites spread to other animals7) Cryptosporidiosis- intestinal parasite found in animals caused by contaminated food and water. Grows in intestines and bile ducts and leads to sever and chronic diarrhea.Cancers common to HIV /AIDSKaposi’s Sarcoma- tumor of blood vessel walls. Pink, purple or red lesions on skin and mouth.Lymphomas- cancer in the EBC’s that usually begin in your lymph nodesOther ComplicationsWasting Syndrome- loss of 10% of body weight accompanied by diarhea, chronic weakness and fever.Neurological complications- confusion, forgetfulness, depression, anxiety, trouble walking, behavioral changes and diminished mental functioning.TREATMENT: control the virus by use of anti-HIV drugs. Best way is to combine 3 drugs from 2 different classes to avoid creating strains of HIV that are immune to single types of drugs.Classes of drugs:Non-nucleoside reverse transcriptase inhibitors (NNRTI’s)- disable a protein needed b y HIV to make copies of itselfNucleoside reverse transcriptase inhibitors (NRTI’s) are faulty versions of buidling blocks that HIV needs to make copies of itselfProtease inhibitors (PI’s) disable protease, another protein needed by HIV to produce itselfEntry or Fusion inhibitors block HIV’s entry into CD4 cellsIntegrage inhibitors disable integrase, a protein that HIV uses to insert its genetic material in CD4 cells4)
29HIV and TissuesOne major sign in the presence of unusual opportunistic infectionsSymptoms include fever, lymphadenopathy, malaise, joint pain w/in 1-4 weeks of infection
30Encephalitis : AIDS Contrast enhanced lesions Will be shown via CT and MRI
31Kaposi’s Sarcoma Most common malignanancy In AIDS pts Especially in homosexual malesCo-infected with herpesPresent in 25-30% of AIDS pts
32AIDS X-rays demonstrate hilar Adenopathy Nodular pulmonary Infiltrates Pleural effusionAnteroposterior chest radiograph after placement of right chest tube shows bilateral ill-defined opacities with large left pleural effusion. Right pleural effusion has been drained, and parenchymal opacities due to Kaposi's sarcoma involvement are highlighted
33Case Study REVIEW Pneumocystitis carinii pneumonia Chest radiograph of patient with dyspnea, hypoxia, and HIV infection.The pattern of diffuse interstitial infiltrates as seen suggests a diagnosis of PCP.
35Multiple Myeloma X-ray plays an important role as 90% of cases has bone involvementX-ray demonstrates osteoporosis withDiscrete punched out osteolytic lesionsMRI can be useful in early stageThere are lytic areas in the metaphysis and diaphysis of the right humerus. Similar distributed lytic areas are present in the clavicle, scapula and ribs. The lytic lesions are predominantly in a medullary location and undermine the bone cortex from below, cortical scalloping. There is a fracture crossing the proximal metaphysis of the right humerus.Multiple Myeloma:Cancer of the plasma cells, that normally make proteins called antibodies to help you fight infections. With this disease a group of abnormal plasma cells (myeloma cells) multiplies raising the number of plasma cells to a higher than normal level. Since these cells normally make proteins, the level of abnormal proteins in your blood also increases.SYMPTOMS:Bone pain- particularly in your back, pelvis, ribs and skullPresence of abnormal protein cells in blood and urineHigh levels of calcium in blood. This occurs when calcium from bones is dissolved into the blood. This will cause excessive thirst, constipation, nausea, loss of appetite, and mental confusion.AnemiaBone fracturesRepeated infections such as pneumonia, sinusitus, bladder infection and UTI’s, skin infections, and shinles.Weight lossWeakness or numbness in legsRISK FACTORS:Over age 50MaleAfricanObeseExpsure to radiationWorking with petroleumCOMPLICATIONS:Impaired immunityBone problems such as erosion and fracturesImpaired kidney function
36Multiple MyelomaDisease of plasma cells that results in cell proliferationUsually confined to bone marrowForms tumors with weakened bone
37Leukemia Neoplastic disease of leukocytes May lead to anemia, bleeding & infectionAll forms require destruction of cells through radiation therapy or chemotherapyLeaves pt severely immunosuppressedSurvival rates depends on complete remissionMay bone marrow transplantRadiography plays limited roleLeukemia:Cancer of the body’s blood forming tissues including bone marrow and lymphatic system. Overproduction of abnormal WBC’sSYMPTOMS:Fever and chillsPersistent fatigue and weaknessFrequent infectionsLosing weight without tryingSwollen lymph nodesSwelling of liver and spleenEasy bleeding or bruisingTine red spots on skinExcessive sweating- especailly at nightBone pain and tendernessRISK FACTORS:Previous cancer treatment such as chemotherpay and radiation therapyGenetic disease- one of which being Down syndromeCertain blood disorders- myelodysplastic syndromeExposure to certain chemicals- benzene, which can be found in gas and used in the chemical industrySmokingFamily history
38Leukemia Acute Quick onset May have hemorrhage Children primarily 33% of all cancer deaths in children under 15Without treatment die in 6 monthsPoor differentiated cellsChronicSlow onsetNon specific signsFatigue & weaknessOver age 60 yearsMature differentiated cells
39Non-Hodgkin’s Lymphoma CT of abdomen & pelvis is used to stage diseaseTreatment consists of chemo and/or Rad therapySymptoms varyLymphadenopathy and anemiaNon- Hodkins LymphomaIs cancer that originates in your lympahtic system, the disease fighting network spread throughout your body.SYMTPOMS:Chest apin, coughing, trouble breathingFatigueFeverNight sweatsWeight lossCAUSES: Not sure what causes it. In this disease your lmphocytes don’t die, but continue to grow and idvidce. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell.RISK FACTORS:Organ transplant- due to immonosuppressive drugsInfection weith certain viruses and bacterias- HIV, Hepatitits C, Epstein Barr syndrome an d Helicobacter pylori.Chemicals- certain chemcials that kill insects and weeds, pesticies.Older age- 60 years and older
40Case study: Hodgkin’s Disease CT exams show enlarged retroperitoneal nodesNM and MRI can be useful in staring of this disease as well59-year-old man with adenovirus infection after hematopoietic stem cell transplantation for Hodgkin's disease. Transverse thin-section (1-mm collimation, lung window) CT scan at level of suprahepatic inferior vena cava shows bilateral multifocal small nodules (arrowhead), branching multiple ill-defined bilateral nodules (black arrow), and thickening of small bronchial walls (white
41Hodgkin’s Disease Treatment includes RAD therapy And chemotherapy Symptoms include malaise, fever,Anorexia, enlarged lymph nodesHodkin’s Lymphoma:Cancer of the lympahtic system which is part of your immune system. Cells of the lymphatic system grow abnormally and spread beyhond the lymphatic system. Compromises your ability to fight infection.SYMPTOMS:Painless swelling of the lymph nodes in your neck, armpits and groin.Persistent fatigueFever and chillsNight sweatsUnexplained weight loss as much as 10% of your body weightCoughing, trouble breathing or chest painLoss of appetiteItchingIncreased sensitity to the affects of alcohol or pain in your lymph nodes after drinking alcohol.CAUSES: The exact cause is unknown.RISK FACTORS:Afe years of ageFamily historySex- males are more likely to develop thisPast Epstein barr syndromeCompromised immune systemGeography- United States, Canada and northern EuropeSocioeconomic status- higher socioeconmic statusCOMPLICATIONS:Cardiovascular diseaseThyroid dysfucntionSterility
42Infectious Mononucleosis Viral diseaseOften associated with Epstein Barr syndromeInfectious mononucleosis:Often called the kissing disease beacause it can be spread with saliva. It can be spread by kissing but also through a sneeze, cough, sharing food utensils and glasses with someone who has this disease.SYMPTOMS:FatigueWeaknessSwollen lymph nodes in neck and armpitsSwollen tonsilsHeadachesSkin rashLoss of appetiteSoft and swollen spleenNight sweatsHas an incubation period of 4-8 weeks.CAUSES:Epstein barr virusCytomegalovirusCOMPLICATIONS:Enlargement of spleen- in exteme cases spleen can ruptureLiver issues- hepatitis and jaundiceLess common complications:Inflammation of the heartMeningitis or encephalitisSwollen tonils so bad it obstructs breathingUsually goes away on its on with rest and a good balanced diet.
43Infectious Mononucleosis X-rays can demonstrate this byDemonstrating lymphadenopathy andSplenomegalyHilar lymph node enlargement bilateral
44Hemophilia Hemophilia: Disorder of your blood clotting system, which causes prolonged bleeding. If you havea cut you may bleed for a longer time. The greater health concern is the deep internal bleeding and bleeding into the joints. It is a lifelong disease but with proper treatment most people can maintain active productive lifestyles.SYMPTOMS:Unexplained bleeding or bruising.Blood in urine or stoolProlonged bleeding form cuts or injuriesNosebleeds with no obvious causeTightness in your joints.EMERGENCY SYMPTOMS:Sudden pain, welling and warmth of joints such as the kneesBleeding from an injuryPainful or alsting headacheRepeated votmitingExtreme fatigueNeck painDouble visionCAUSES:1)HereditaryCOMPLICATIONS:Deep internal bleedingDamage to jointsInfectionAdverse reaction to clotting factor treatment
45HemophiliaInherited anomaly of blood coagulation that only affects malesX-ray demonstrates recurrent bleeding in jointsMost commonly knee, elbows and anklesSoft tissue prominenceSynovial hypertrophyCauses destruction of bone leading to segments of severe osteoporosis
47Imaging Considerations X-ray plays a limited roleExcept in cases of multiple myeloma, some types of leukemia and AIDSCT is valuable in determining lymph node involvement of neoplastic diseaseCT and MRI of brain can assist in diagnosis and treatment of CNS problems associated with HIVMRI useful in diseases of the blood marrow