1. The study of the physiology of the blood
Hematology
The study of the physiology of the blood

2. 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

3. 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 per microliter of blood
Trigger immune responses caused by allergens, inflammation, infection, and disease

4. 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

5. 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)

6. 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

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

8. 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

9. 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.

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. Blood Transfusions
T2S

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

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

20. 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

21. 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?

22. All video (1:54)
leukemia/

23. CML Video (2:13)
leukemia/

24. 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

25. 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

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