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Hemopoietic System Spring 2013.

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Presentation on theme: "Hemopoietic System Spring 2013."— Presentation transcript:

1 Hemopoietic System Spring 2013

2 Hemopoietic System Consists of blood Lymphatic tissue Bone marrow

3 Three Types of Blood Cells
Erythrocytes Red blood cells Responsible for transferring oxygen and CO2 to & from various organs in the body Leukocytes White blood cells Formed within bone marrow Play an important role in body’s defense system Thrombocytes Platelets Necessary for blood to clot properly

4 Erythrocytes Very small cells in relation to other blood cells
Don’t contain a nucleus Live approx 120 days Individuals with less than 12g per 100ml of blood have anemia Contain various antigens or lack of which determines blood type

5 Blood 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.

6 Agglutination Rejection of cells due to antigens Blood type “O”
Can cause immediate shock Delayed symptoms Blood type “O” Universal donor (does not have antigens) Blood type “AB” Universal recipient Not 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.

7 RH factor
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.

8 Pathologies of RBC’s

9 Erythrocytes

10 Leukocytes May be classified as granular and non-granular
Granular has cytoplasmic granules and irregular nuclei Non-granular does not contain granules & has a regular nucleus Mainly formed in lymphatic tissue and spleen Able to move out of capillaries and attack foreign substances

11 Leukocytes

12 Leukocytes

13 Thrombocytes Necessary for blood to clot and coagulate in seconds
Formed in bone marrow Live for 10 days Critical for preventing hemorrhage

14 Thrombocytes

15 Lymphatic System

16 Lymphocytes Most radiosensitive blood cells
Most important in the development of immunity Derived from lymphatic tissue (T) and bone marrow (B) Both work together to ingest foreign substances and process the specific foreign antigens With transplants- these cells along with macrophages see it as a foreign substance Try to destroy the foreign antigens resulting in rejection of graft or organ

17 Spleen

18 Spleen Largest lymphoid organ Produces lymphocytes and plasma cells
Cleanses blood & lymphocytes to fight infectious blood-borne microorganisms Removes old or defective blood cells

19 Anemia Decrease in the amount of oxygen carrying hemoglobin in blood
Results in improper formation of new RBC’s Increased rate of RBC destruction Or a loss of RBC as a result of prolonged bleeding Person appears pale Has muscle weakness, fatigue, & SOB

20 Types of Anemia Iron Deficiency Hemolytic Megoblastic Aplastic

21 Iron Deficiency Anemia
Most common type Results from chronic blood loss From an ulcer, malignant tumor, or menorrhagia Inadequate iron intake Pregnancy Treatment Dietary change Ferrous sulfate supplements with vitamin C Iron 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 iron Inability 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- menustation Infants 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 weight Growth problesm- infants and children do not grow properly and are more susceptible to infections.

22 Hemolytic Anemia Shortened life span of the red blood cells with resulting hemolysis and the release of hemoglobin into the plasma 3 hereditary defects Spherocytosis Sickle cell anemia Thalassemia Hemolytic 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.

23 Sickle Cell Anemia Hemoglobin molecule is abnormal and RBC’s are crensentic Tend to rupture X-ray demonstrates biconcave indentations on both the superior & inferior margins Softened vertebral bodies Appear like fish vertebrae Sickle 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 puberty Vision 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 gene Descent- African, Spanish, Mediteraean, Middle Easter, Indian and Hispanics COMPLICATIONS: Stroke Acute chest syndrome- blockage of blood vessels to lungs Pulmonary Hypertesnion- Organ damage due to blocked blood flow Blindness Skin ulcers- this disease can cause open sores called ulcers on legs Gallstones- 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

24 Thalassemia Defect in hemoglobin formation
Occurs in persons living near Mediterranean Sea Jaundiced Extensive hyperplasia X-ray demonstrates widening of medullary spaces and thinning of the cortices Localized radiolucency simulating osteolytic lesions Thalassemia (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 urine RISK FACTORS: Family history Descent- Greek, Italian, Middle Eastern, Asian and African. COMPLICATIONS: Iron overload- form frequent blood transfusions, which can cause damage to heart, liver and endocrine system Infection- increased infection and especially if spleen is removed Severe 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 puberty Heart problems- CHF and arrythmias

25 Megaloblastic A deficiency of Vitamin B12 and folic acid
Can be from malnutrition, strict vegetarianism & alcoholism Leads to defective DNA synthesis Decreased 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.

26 Aplastic Anemia Failure of bone marrow to function
Results in a decrease in RBC’s, leukocytes, and platelets Cannot fight infection and have a bleeding tendency Causes include exposure to chemical agents, drugs, infections and invasion of bone marrow by cancer Aplastic Anemia: Failure of bone marrow to function Results in a decrease in RBC’s, leukocytes, and platelets Cannot fight infection and have a bleeding tendency Can 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 transplantation SYMPTOMS: 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 chemotherapy Toxic chemicals Use of certain drugs- some of which treat rheumatoid arthritis and certain antibiotics Autoimmune disorders Viral infection- hepatitis, Epstein Barr and HIV Pregnancy- your immune system sometimes atttacks your bone marrow when pregnant RISK FACTORS: Radiation therapy and chemotherapy Toxic substances Some prescriptioin drugs Certain blood diseases, autoimmune disorders and serious infections Pregnancy –(rare)

27 Myelophthisic Anemia Infiltration of bone marrow by cancer, metastases, and carcinomas Causes cortical thickening and can cause a severe decrease in red and white blood cells and platelets in the bone marrow Myelophthisic 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.

28 AIDS It is caused by HIV 1 and HIV 2 HIV 1 more virulent HIV 2
Paralyzes the normal immune mechanisms resulting in severe immunosuppression In the majority of cases in western hemisphere HIV 2 Converts viral RNA to a DNA copy Each time cell divides retroviral DNA is duplicated AIDS: 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 rash Years 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 sweats Shaking, chills and fever higher than 100F for several weeks Cough and SOB Chronic diarrhea Persistent white spots or unusual lesions on your tongue or in your mouth Headaches Chronic fatigue Blurred and distrurbed vision Skin rashes or bumps CAUSES: 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 sex Having other STD’s that may cause open sores in genitals IV drug abuse Uncircumcised males COMPLICATIONS: Infections common to HIV/AIDS 1)TB 2) 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) Meningitis 6) Toxoplasmosis- parasite spread by cats in their stool and these parasites spread to other animals 7) 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 /AIDS Kaposi’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 nodes Other Complications Wasting 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 itself Nucleoside reverse transcriptase inhibitors (NRTI’s) are faulty versions of buidling blocks that HIV needs to make copies of itself Protease inhibitors (PI’s) disable protease, another protein needed by HIV to produce itself Entry or Fusion inhibitors block HIV’s entry into CD4 cells Integrage inhibitors disable integrase, a protein that HIV uses to insert its genetic material in CD4 cells 4)

29 HIV and Tissues One major sign in the presence of unusual opportunistic infections Symptoms include fever, lymphadenopathy, malaise, joint pain w/in 1-4 weeks of infection

30 Encephalitis : AIDS Contrast enhanced lesions
Will be shown via CT and MRI

31 Kaposi’s Sarcoma Most common malignanancy In AIDS pts
Especially in homosexual males Co-infected with herpes Present in 25-30% of AIDS pts

32 AIDS X-rays demonstrate hilar Adenopathy Nodular pulmonary Infiltrates
Pleural effusion Anteroposterior 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

33 Case 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.

34 Neoplastic Diseases

35 Multiple Myeloma X-ray plays an important role as
90% of cases has bone involvement X-ray demonstrates osteoporosis with Discrete punched out osteolytic lesions MRI can be useful in early stage There 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 skull Presence of abnormal protein cells in blood and urine High 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. Anemia Bone fractures Repeated infections such as pneumonia, sinusitus, bladder infection and UTI’s, skin infections, and shinles. Weight loss Weakness or numbness in legs RISK FACTORS: Over age 50 Male African Obese Expsure to radiation Working with petroleum COMPLICATIONS: Impaired immunity Bone problems such as erosion and fractures Impaired kidney function

36 Multiple Myeloma Disease of plasma cells that results in cell proliferation Usually confined to bone marrow Forms tumors with weakened bone

37 Leukemia Neoplastic disease of leukocytes
May lead to anemia, bleeding & infection All forms require destruction of cells through radiation therapy or chemotherapy Leaves pt severely immunosuppressed Survival rates depends on complete remission May bone marrow transplant Radiography plays limited role Leukemia: Cancer of the body’s blood forming tissues including bone marrow and lymphatic system. Overproduction of abnormal WBC’s SYMPTOMS: Fever and chills Persistent fatigue and weakness Frequent infections Losing weight without trying Swollen lymph nodes Swelling of liver and spleen Easy bleeding or bruising Tine red spots on skin Excessive sweating- especailly at night Bone pain and tenderness RISK FACTORS: Previous cancer treatment such as chemotherpay and radiation therapy Genetic disease- one of which being Down syndrome Certain blood disorders- myelodysplastic syndrome Exposure to certain chemicals- benzene, which can be found in gas and used in the chemical industry Smoking Family history

38 Leukemia Acute Quick onset May have hemorrhage Children primarily
33% of all cancer deaths in children under 15 Without treatment die in 6 months Poor differentiated cells Chronic Slow onset Non specific signs Fatigue & weakness Over age 60 years Mature differentiated cells

39 Non-Hodgkin’s Lymphoma
CT of abdomen & pelvis is used to stage disease Treatment consists of chemo and/or Rad therapy Symptoms vary Lymphadenopathy and anemia Non- Hodkins Lymphoma Is cancer that originates in your lympahtic system, the disease fighting network spread throughout your body. SYMTPOMS: Chest apin, coughing, trouble breathing Fatigue Fever Night sweats Weight loss CAUSES: 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 drugs Infection 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

40 Case study: Hodgkin’s Disease
CT exams show enlarged retroperitoneal nodes NM and MRI can be useful in staring of this disease as well 59-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

41 Hodgkin’s Disease Treatment includes RAD therapy And chemotherapy
Symptoms include malaise, fever, Anorexia, enlarged lymph nodes Hodkin’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 fatigue Fever and chills Night sweats Unexplained weight loss as much as 10% of your body weight Coughing, trouble breathing or chest pain Loss of appetite Itching Increased 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 age Family history Sex- males are more likely to develop this Past Epstein barr syndrome Compromised immune system Geography- United States, Canada and northern Europe Socioeconomic status- higher socioeconmic status COMPLICATIONS: Cardiovascular disease Thyroid dysfucntion Sterility

42 Infectious Mononucleosis
Viral disease Often associated with Epstein Barr syndrome Infectious 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: Fatigue Weakness Swollen lymph nodes in neck and armpits Swollen tonsils Headaches Skin rash Loss of appetite Soft and swollen spleen Night sweats Has an incubation period of 4-8 weeks. CAUSES: Epstein barr virus Cytomegalovirus COMPLICATIONS: Enlargement of spleen- in exteme cases spleen can rupture Liver issues- hepatitis and jaundice Less common complications: Inflammation of the heart Meningitis or encephalitis Swollen tonils so bad it obstructs breathing Usually goes away on its on with rest and a good balanced diet.

43 Infectious Mononucleosis
X-rays can demonstrate this by Demonstrating lymphadenopathy and Splenomegaly Hilar lymph node enlargement bilateral

44 Hemophilia 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 stool Prolonged bleeding form cuts or injuries Nosebleeds with no obvious cause Tightness in your joints. EMERGENCY SYMPTOMS: Sudden pain, welling and warmth of joints such as the knees Bleeding from an injury Painful or alsting headache Repeated votmiting Extreme fatigue Neck pain Double vision CAUSES: 1)Hereditary COMPLICATIONS: Deep internal bleeding Damage to joints Infection Adverse reaction to clotting factor treatment

45 Hemophilia Inherited anomaly of blood coagulation that only affects males X-ray demonstrates recurrent bleeding in joints Most commonly knee, elbows and ankles Soft tissue prominence Synovial hypertrophy Causes destruction of bone leading to segments of severe osteoporosis

46 Hemophilia

47 Imaging Considerations
X-ray plays a limited role Except in cases of multiple myeloma, some types of leukemia and AIDS CT is valuable in determining lymph node involvement of neoplastic disease CT and MRI of brain can assist in diagnosis and treatment of CNS problems associated with HIV MRI useful in diseases of the blood marrow

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