The study of the physiology of the blood Hematology The study of the physiology of the blood

Blood components Erythrocytes (Red Blood Cells-RBC) Leukocytes (White Blood Cells-WBC) Platelets Plasma-Blood cells are suspended in this liquid (55% of blood volume) Gases: O2, Co2, Nitrogen

Stem Cells mature into 3 main types of Blood Cells RBC’s WBC’s Platelets Hemoglobin = Protein inside RBC that carries oxygen to the body tissues Hematocrit = % of RBC’s in the blood Bind to the site of a damaged vessel & cause a clot 150,000- 450,000 per microliter of blood Trigger immune responses caused by allergens, inflammation, infection, and disease

WBC’s (leukocytes) 3 Types of WBC”s: Monocytes- Granulocytes- Lymphocytes- orchestrate the immune system’s response to infection 2 Types: B cells-make antibodies T cells-Destroy infected cells Monocytes- make macrophages that destroy bacteria Granulocytes- Destroy bacteria 3 Types of Granulocytes: Neutrophils- First responders to site of infection Eosinophils- Parasitic infections Basophils- Allergic & Inflammatory reactions

RBC’s (Erythrocytes) Produced in the Bone marrow Destroyed in the Spleen & Liver Life Cycle is approximately 4 months Made from: Iron, Vitamin B-12 and Vitamin B-9 (Folate) (Synthetic form is Folic Acid)

Blood counts matter RBC’s WBC’s Platelets Too many: Not enough: Polycythemia = Heart attack or Stroke Not enough: Anemia = Fatigue, Vertigo, Syncope Too many: Leukemia Not enough: Leukopenia= infection Too many: Thrombocytosis = Heart attack or Stroke Not enough: Thrombocytopenia= Easy bruising or internal bleeding

What Blood disorder was one of the causes of Ima pashunt’s syncope?

Elderly people With anemia have twice the risk of experiencing physical declines that can end up robbing them of their independence. National Institute on Aging

Stats 13% of people over age 70 are Anemic. If not treated it can force the heart to work harder, leading to more serious consequences.

3 Causes of Anemia Which Type did Ima Pashunt have? Lysis or breakdown of the cell (RBC) Quantity made Rate of Loss Decreased production of RBC’s Loss of RBC’s more quickly than they can be replaced Destruction of RBC’s

Examples of Anemia types Decreased production Destruction of RBC’s Loss of RBC’s Iron Deficiency Pernicious (Vitamin B deficiency) Aplastic (Chemo) GI Bleed Hemorrhage Hemolytic Intrinsic Hyperslenism Extrinsic Heart Valve

Symptoms Did Ima have any of these? Fatigue/Weakness Pallor Tachycardia (Increased heart rate) Arrythmia (Irregular heart beat) Dyspnea (Shortness of Breath) Hypoxemia (Sp02 < 90) Cyanosis Vertigo (Dizziness)

Laboratory testing *Complete Blood Count (CBC): RBC’s, Hemoglobin (protein on the RBC that carries O2), Hematocrit (% of RBC’s compared to the total blood volume) *Serum iron-can be normal even if amount of iron in the body is low, therefore other tests: *Ferritin is a protein that binds to iron & can determine if it is an iron deficiency anemia *Transferrin is a protein that carries iron in the blood. Iron deficiency anemia will result in a high level of transferrin that has no iron *Reticulocyte count shows whether bone marrow is making RBC’s at the correct rate

Other tests Physical Assessment: Pallor, Dyspnea, Tachycardia, Arrythmia, Cold extremities, Cyanosis Determine source of bleeding if indicated (hemoccult stools, endoscopy, colonoscopy) RBC Size & Color can help determine cause –Blood Smear

Size and color Microcytic: iron deficiency anemia, RBC’s will be small and pale under microscope Normocytic: aplastic anemia which results in failure of the bone marrow to produce RBC’s Macrocytic: Pernicious anemia-body lacks intrinsic factor required to absorb vitamin B-12 from food

Treatment Treatment: Locate and stop source of bleeding if indicated (may involve surgery) Iron rich diet + iron supplements Folic acid supplements & vitamin B-12 injections if digestive system is unable to absorb vit. B-12 Vitamin C can help increase iron absorption Stimulate RBC production with injections of synthetic erythropoietin (produced in the kidneys) Blood transfusion to boost RBC levels Bone marrow transplant &/or chemotherapy if bone marrow is diseased and cannot make healthy RBC’s Oxygen

Blood Transfusions T2S

Leukemia ALL (Acute Lymphocytic)- children AML (Acute Myeloid)- older adults CLL (Chronc Lymphocytic)- older adults CML (Chronic Myeloid) Leukemia 4 Main Types

Acute Vs. Chronic Acute Chronic Progresses quickly if not treated Slow growing Asymptomatic in early stages

Lymphocytic Vs. Myeloid Cancer of the stem cells that produce lymphocytes that replicate quickly producing too many immature lymphocytes called BLASTS. Therefore crowding out space for other healthy blood cells Therefore, not as capable of defending against infections Myeloid Cancer of the bone marrow produces Myelocytes that do not develop into mature healthy Granulocytes = Myeloblasts or BLASTS Therefore crowding out space for other healthy blood cells Therefore, not as capable of defending against infections

Crowding out = Pancytopenia All 3 blood components are low RBC’s WBC’s Platelets If a patient has pancytopenia, are they anemic? What symptoms might you see? Did Ima have any of these symptoms?

All video (1:54) http://www.cancercenter.com/leukemia/types/tab/acute-lymphocytic- leukemia/

CML Video (2:13) http://www.cancercenter.com/leukemia/types/tab/chronic-myeloid- leukemia/

Standard Treatment options ALL CLL AML CML Chemo Radiation Stem Cell transplant Targeted Therapy Chemo Radiation Targeted Therapy Chemo Chemo Targeted Therapy Stem cell after chemo Surgery

Treatment Targeted Therapy- Biologic Drug Gleevec (imatinib) Not all Cancer types Attack specific cancer cells with less harm to normal cells CML Example: Gleevec Binds specifically with the Super Villain (BCR-ABL) that causes CML growth

Differential Diagnosis Susan Forrest and Ima Pashunt How would their labs differ? How would their treatment differ?