BLOOD DISORDERS/DISEASES Diseases of the blood
ANEMIATHE MOST COMMON DISORDER OF THE BLOOD LACK OF RBC’S CARRYING OXYGEN • Main classes of etiology include: Excessive blood loss – hemorrhage Excessive blood cell destruction – hemolysis Deficient red blood cell production
ANEMIA Diagnosing the type of anemia is based on: Nutrient deficiencies Presence of immature RBC’s Characteristic color and volume of RBC’s Lab values
GENERAL SIGNS AND SYMPTOMS (of all anemias) • Pallor or lack of color-especially mucuous membranes • Fatigue • Dizziness • Headaches • Decreased exercise tolerance • Rapid heartbeat • Shortness of breath
GENERAL PROGNOSIS(if anemia is untreated) • Heart failure • Cardiovascular collapse • Shock
IRON DEFICIENCY ANEMIA(most common cause of anemia) ETIOLOGY: • Increased iron requirements, • Impaired iron absorption • Hemorrhage
WHAT DO I NEED TO KNOW ABOUT IRON DEFICIENT ANEMIA? • Iron is needed to synthesize hemoglobin---which is needed to transport oxygen • Iron requirements are greatest from birth to age two
WHAT DO I NEED TO KNOW ABOUT IRON DEFICIENT ANEMIA? • Pregnancy requires supplements to ensure fetus gets enough iron • Sudden growth spurts and onset of menstruation are risks for iron deficient anemia
WHAT ELSE DO I NEED TO KNOW ABOUT IRON DEFICIENT ANEMIA? Absorption takes place in the GI tract so diseases that affect the mucosa of the GI tract can put your patient at a risk for anemia because they limit the availability of Iron needed to synthesize hemoglobin
EXAMPLES OF CAUSES • Chronic diseases that cause inflammation (inflammatory changes can suppress red blood cell synthesis in bone marrow and shorten life of RBC’s) • Removal of the stomach • Chronic disease treatment • Bowel disorders
DIAGNOSIS CBC- low H&H Reports of signs and symptoms in
TREATMENT OF IRON DEFICIENCY ANEMIA • Diet rich in iron • Vitamin supplements with iron • IV Supplements if necessary • NOTE: iron supplements are constipating and oral doses should not be taken on an empty stomach
PERNICIOUS ANEMIA Etiology: • Vitamin B12 absorption or intake is deficient or utilization is inadequate • Deficiency in intrinsic factor (a protein in the stomach needed so B12 can be absorbed from the small intestine) • Removal of stomach or the bowel • Abnormal bacterial growth in small intestine • Strict vegetarianism
HOW does lack of B12 or intrinsic factor cause anemia HOW DOES LACK OF B12 OR INTRINSIC FACTOR CAUSE ANEMIA? • The deficiency causes the membranes of immature RBC’s to rupture easily leaving fewer RBC’s to carry oxygen
SYMPTOMS OFPERNICIOUS ANEMIA • Nausea, vomiting, burning of the tongue • Neurological disturbances such as numbness, weakness, poor reflexes • GENERAL SYMPTOMS OF ANEMIA SLIDE FOUR
DIAGNOSIS OFPERNICIOUS ANEMIA • Health history to rule out inherited lack of intrinsic factor • Physical exam shows jaundice, enlarged liver, irregular heart rate • CBC abnormal • Bone Marrow aspiration/biopsy(cells that make blood cells will be larger than normal)
TREATMENT OF PERNICIOUS ANEMIA • Vitamin B12 supplementation (injectable if it cannot be absorbed) • NOTE: Pernicious Anemia puts you at a higher risk for stomach cancer
HEMOLYTIC ANEMIA Etiology: Reduction in RBC’s by conditions that accelerate destruction of RBC’s such as: • Inherited abnormalities such as hemoglobin defects, enzyme defects and membrane defects that impair intrinsic factor physical properties • Infections/immune disorders (HIV, Lupus) • Medications (chemotherapy)
SIGNS AND SYMPTOMS OF HEMOLYTIC ANEMIA • Mild may have no signs or symptoms • General s/s of anemia see slide four • Increased serum bilirubin levels from the hemoglobin destruction in destroyed RBC’s • Jaundice, dark urine and feces due to accumulation of bilirubin system
DIAGNOSIS OF HEMOLYTIC ANEMIA • Enlarged spleen • CBC Includes H&H • Liver function blood tests • Bone Marrow Aspiration and or biopsy
TREATMENTS FOR HEMOLYTIC ANEMIA • Blood transfusions • Medication • Plasmaphoresis • Surgery • Stem Cell transplants
Blood transfusion reaction • Caused by antibodies forming and person rejecting blood being transfused. • Stop transfusion immediately.
MEDICATIONS • Corticosteroids (Prednisone) - limit immune system from making antibodies(proteins) against RBC’s • Rituximab, Cyclosporine – drugs that suppress your immune system
PLASMAPHORESIS • A procedure that removes antibodies from the blood using a needle inserted into a vein. The plasma is separated from the rest of the blood and then donor plasma is put back into the blood.
SURGERY • Spleenectomy – removal of spleen. An enlarged or diseased spleen may remove more RBC’s than normal. Removing it can help reduce high rates of RBC destruction Note : a healthy spleen helps fight infection and filters out old or damaged blood cells.
APLASTIC ANEMIA • bone marrow doesn’t make enough new blood cells because stem cells are damaged (Also caused bone marrow failure) • Can be acquired or inheirted
ACQUIRED APLASTIC ANEMIA ETIOLOGY • Exposure to toxins—pesticides • Radiation and chemotherapy • Antibiotics like chloramphenicol • Hepatitis, HIV,CMV, Eptstein-Barr virus • Lupus, rheumatoid arthritis
SIGNS AND SYMPTOMS OF APLASTIC ANEMIA • General s/s from slide four • Decreased RBC’s, WBC’s and platelets • Nausea • Skin rashes
DIAGNOSIS OF APLASTIC ANEMIA • History and physical • CBC • Reticulocyte count (# of young blood cells) • Bone marrow aspiration/biopsy
TREATMENT OFAPLASTIC ANEMIA • Removal of known cause if possible • Blood transfusions • Blood and marrow stem cell transplants • Medications
MEDICATIONS • Stimulate bone marrow-Erythropoieten and colony stimulating factors • Suppress immune system Antihymocyte globulin (ATG), cyclosporine and methylprednisone – all three given togeth
SICKLE CELL ANEMIA • Blood cells are crescent shaped instead of round, because of abnormal hemoglobin. • It is thready and cells are stiff and sticky. • Sickled cells block blood flow, causing pain, infection and organ damage.
WHAT CAUSES THE ANEMIA? • After 10-20 days sickle cells die. Bone marrow can’t make new RBC’s fast enough to replace the dying ones
FACTS ABOUTSICKLE CELL ANEMIA • It is inherited-one sickle gene from each parent • People who have the disease are born with it • If sickle cell gene from one parent and normal gene from other parent you have sickle cell trait. • Most common in African Americans
SIGNS AND SYMPTOMS OF SICKLE CELL DISEASE • General anemia s/s from slide four • Acute Pain throughout body is called sickle cell crisis • Chronic pain in bones • Multiple organ failur • Infections and dehydration can contribute to a sickle cell crisis
DIAGNOSIS • Blood testing at newborn screening. • Amniotic fluid sampling before birth.
TREATMENT • If in sickle cell crisis treatment involves pain management with NSAIDS and or opiates, fluids and oxygen if levels are low. • Hydroxyurea – medication that causes body to make fetal hemoglobin which helps blood cells from sickling and improves anemia • Blood transfusions
COMPLICATIONS • Stroke • Eye damage • Multiple organ failure • Leg ulcers • Gall stones • Priapism (painful erection in males)
EMERGING TRENDS • Research on blood and marrow stem cell transplants and gene therapy is ongoing. • New medications: Decitabine – prompts body to make Fetal hemoglobin Adenosine A2a receptor agonists – may reduce pain related complications
Disseminated Intravascular Coagulation (DIC) ETIOLOGY: Sepsis Endothelial damage shock
Signs and symptoms • Bleeding into intravascular spaces due to destruction of platelets and clotting factors.
Diagnosis • Blood test • Physical exam
Treatment • Platelet transfusions
Hemophilia • An inherited clotting disorder due to a deficiency of clotting factor VIII • X linked recessive disorder primarily affects males
Signs and symptoms • Bleeding • If bleeding into joints can cause joint fibrosis • Intracranial hemorrhage often cause of death
Diagnosis • Genetic testing • PT/PTT • Platelet count • H&H