The blood

By

Associate Prof. Atallah Elenezi

2024
Learning Objectives

Upon completing this lecture students should be able to:

 Definition of key terms
 Overview of blood and blood vessels
 Discuss certain blood disorders such as
anemia, DVT, leukemia, & thrombocytopenia.
 The blood vessel network of the body is
composed of arteries, arterioles (small
arteries), veins, venules (small veins), and
capillaries. Arteries carry blood from the
heart; veins carry blood to the heart;
capillaries link the arteries and the veins.

Blood transports hormones, nutrients, and

waste products; it defends the body against
Overview infection; and its ability to clot prevents
blood loss.

Blood circulation is either pulmonary or

systemic. Pulmonary circulation pumps
blood from the heart into the lungs,
systemic circulation pumps
blood from the heart to the remainder of the
body.
 Blood is made of plasma and blood cells.
Although thicker than water, blood is about
92% water. Plasma is the transportation
system for the hormones, nutrients, and waste
products.

It also consists of important proteins,

including prothrombin and fibrinogen,
important in blood clotting; albumin, which
Overview helps to keep blood from leaking out of the
blood vessels; and three types of globulins
that assist in the immune response.

The blood cell types are the erythrocytes,

leukocytes, and platelets. Erythrocytes, or red
blood cells (RBCs), carry oxygen on the
protein
hemoglobin.
 The leukocytes, or white blood cells
(WBCs), protect the body from
infection and provide immunity
against some diseases.

The five types of WBCs are

Overview neutrophils, eosinophils, basophils,
lymphocytes, and monocytes.

The platelets or thrombocytes are

pieces of cells that contribute to
blood clotting and hemostasis.
 It is considered as the ‘fluid of life’ because it
carries oxygen from lungs to all parts of the
body and carbon dioxide from all parts of the
body to the lungs.

The blood It is known as ‘fluid of growth’ because it

carries nutritive substances from the digestive
as a fluid system and hormones from endocrine gland
to all the tissues.

The blood is also called the ‘fluid of health’

because it protects the body against the
diseases.
 1. Nutritive function
2. Respiratory function
3. Excretory function
4. Transport of hormones and
enzymes
Function
5. Regulation of water balance
of blood 6. Regulation of acid base balance
7. Regulation of body temperature
8. Storage function
9. Defensive function
 Anemias are a very common
blood disorder affecting more
than 3 million Americans.

Anemia Anemia is the result when there

is either insufficient red blood
cells or red blood cells not
working properly.
 Anemia

Anemia is the blood disorder, characterized by the reduction in:

1. Red blood cell (RBC) count
2. Hemoglobin content
3. Packed cell volume (PVC).
Generally, reduction in RBC count, hemoglobin content and PCV occurs
because of:
4. Decreased production of RBC
5. Increased destruction of RBC
6. Excess loss of blood from the body.
 Etiological Classification

On the basis of etiology, anemia is divided into five

types:
1. Hemorrhagic anemia
2. Hemolytic anemia
3. Nutrition deficiency anemia
4. Aplastic anemia
5. Anemia of chronic diseases
 Hemorrhagic Anemia

Hemorrhage refers to excessive loss of blood.

It occurs both in acute and chronic hemorrhagic

conditions.
 Hemolytic Anemia

Hemolysis means destruction of RBCs.

It is classified into two types:
A. Extrinsic hemolytic anemia. It is caused by destruction
of RBCs by external factors.

B. Intrinsic hemolytic anemia. It is caused by destruction of

RBCs, and productions of unhealthy RBCs, which are short,
lived and are destroyed soon.
 Nutrition Deficiency Anemia

It is occurring due to deficiency of a nutritive

substance necessary for erythropoiesis.

The substances which are necessary for

erythropoiesis are iron, proteins and vitamins like
C, B12 and folic acid.
 Aplastic Anemia

Aplastic anemia is due to the disorder of red bone marrow.

Bone marrow disorder occurs in the following conditions:
➢ Repeated exposure to X ray or gamma ray radiation.
➢ Presence of bacterial toxins, benzene, radium, etc.
➢ Tuberculosis.
➢ Viral infections like hepatitis and HIV infection
 Anemia of Chronic Diseases

It is characterized by short lifespan of RBCs, caused by

disturbance in iron metabolism or resistance to
erythropoietin action.
 • Common signs and symptoms
include extreme fatigue, pallor,
headache, cold hands and feet, and
irritability.
Symptom
s of • If the anemia progresses, symptoms
become more severe and may
anemia include dyspnea, tachycardia,
increased infections, and brittle
nails.
Symptoms of anemia
 A detailed health history may reveal
multiple pregnancies or GI bleeding.
Diagnostic Blood testing typically indicates
abnormally low hemoglobin and
Test hematocrit values. Levels of serum
iron and serum ferritin (the protein
that helps to store iron in the blood)
may be low as well.
 The RBC count typically reveals unusually
high numbers of microcytic red cells. If it is
necessary to rule out other difficulties, an
endoscopy can look for GI bleeding, a
colonoscopy can check for tumors or cancer
Diagnostic of the colon, and ultrasound may be able to
determine reasons for excessive menstrual
Test flow.

In extreme cases, bone marrow aspiration

may be performed to differentiate iron-
deficiency anemia from closely related blood
disorders.
 Treatment depends on the
severity and cause of the
anemia.

Iron-deficiency anemia may be

treated with oral or parenteral
Treatment (intramuscular or intravenous)
iron supplements. Dietary
modifications are often sufficient
to restore lost bodily iron
reserves.
 Treatment depends on the severity
and cause of the anemia.

Folic acid supplements, iron chelation,

and, for some people, blood transfusions
and bone marrow transplants.

Treatment Treatment for aplastic anemia involves

blood transfusions or bone marrow
transplants.

The treatment plan may include

immunosuppressant drugs, treatments for
infections, and plasmapheresis, which
filters the blood.
 Deep vein thrombosis (DVT) is
the formation of blood clots
Deep Venous (thrombi) in the deep veins. It
Thrombosis commonly affects the deep leg
veins (such as the calf veins,
femoral vein, or popliteal vein)
or the deep veins of the pelvis.
It is a potentially dangerous
condition that can lead to
preventable morbidity and
mortality.
 The term thrombosis refers to
the formation, from constituents
Deep Venous of blood, of an abnormal mass
Thrombosis within the vascular system of a
living animal. When this
process occurs within the deep
veins, it is referred to as deep
vein thrombosis (DVT)
 An accurate diagnosis of DVT
is extremely important to
Deep Venous prevent potentially fatal acute
Thrombosis complication of pulmonary
embolism (PE) and long-term
complications of post-phlebitis
syndrome and pulmonary
hypertension.
 The clinical conditions most
closely associated with DVT are
Pathogenesis fundamentally related to the
elements of Virchow’s Triad;
these include surgery or trauma,
malignancy, prolonged
immobility, pregnancy,
congestive heart failure,
varicose veins, obesity,
advancing age, and a history of
DVT
 While the cause for this remains
unsettled, several factors related
to aging have been observed:
Etiology greater prevalence of obesity,
increased frequency of illness
and periods of prolonged
immobility, comorbid medical
conditions, and an increase in
the level of procoagulants
without a commensurate
increase in anticoagulants such
as protein C
 Symptoms and signs of leg or
pelvis DVT include leg pain,
swelling, erythema and dilated
superficial veins. Arm DVT has
Signs and similar symptoms localized to
the arm.
symptoms
Some DVTs are asymptomatic.
Differential diagnoses for limb
DVT include cellulitis,
lymphoedema, chronic venous
insufficiency, hematoma and,
for leg DVT, ruptured Baker
cyst
 Diagnosis of deep vein thrombosis
(DVT) requires a multifaceted
approach that includes clinical
assessment, evaluation of pre-test
Diagnosis probability, and objective diagnostic
testing
The clinical presentation of DVT
varies with the extent and location of a
thrombus. The cardinal signs and
symptoms of DVT includes
asymmetrical swelling, warmth, or
pain in an extremity, and a high index
of suspicion should be present in
patients with the aforementioned risk
factors.
 A number of scoring systems
have been devised to estimate
the pre-test probability of DVT.
Diagnosis
Diagnostic imaging is often
employed to confirm the
presence of DVT.
 Anticoagulation is an essential
Medical component of therapy for DVT.
treatment With a few notable exceptions,
patients with DVT can be
treated with oral anticoagulants
alone.
 In cases of extensive thrombus
burden involving proximal deep
Medical veins, mechanical- and catheter-
treatment directed thrombolysis (CDT)
may be indicated in the acute
phase to rapidly induce clot
lysis and reduce the risk of post-
thrombotic syndrome
 Thrombocytopenia is
the result of falling the
Thrombocytopenia
number of platelet from
150,000/microL.
 The average of the platelet
counts should be 150,000 -
450,000/microL.

If the numbers go down

Thrombocytopenia 150,000/microL, it causes
thrombocytopenia. 2.5 percent
of the normal population have
got thrombocytopenia.
 There can be bleeding after
mild trauma at patients with
thrombocytopenia.
Thrombocytopenia The deficiency of platelets or
functional out of order causes
some symptoms.
 - Easy bruising
- Abnormal bleeding (
nosebleeds, bleeding gums,
heavy heavy periods)
Signs and symptoms - Blood in your poo or urine
(wee)
- Pinpoint bleeding in your skin
that looks like a purplish-red
rash (known as petechiae) cuts
that keep bleeding
 Thrombocytopenia is not a
disease but is a diagnosis. The
detailed knowledge must be
acquired from patients who
have been suffering from the
thrombocytopenia.
Diagnosis

Detailed examining and the test

of laboratory should be done
which are related to etiology.
Some of the situation about
thrombocytopenia must be
checked.
 New drugs or drugs that are
only taken intermittently, recent
infection, previously diagnosed
hematologic disease,
Diagnosis nonhematologic diseases known
to decrease platelet counts (eg,
eclampsia, sepsis, DIC,
anaphylactic shock,
hypothermia, massive
transfusions), positive family
history of bleeding and/or
thrombocytopenia, recent
 There are three major
pathophysiological
mechanisms in
thrombocytopenia:
The Physio-
pathological reduced producing, rapid
Classification of demolishing and
Thrombocytopenia sequestration
 Treatment will depend on
Treatment the cause of your
thrombocytopenia.
 Dangerous bleeding can
Complication sometimes occur if you
have thrombocytopenia.
 Leukemias are progressive,
malignant diseases of the blood-
forming organs and are marked
by the unrestrained growth of
abnormal leukocytes and their
precursors in the blood and
Leukemia
bone marrow.

The term leukemia refers to a

neoplasm of hematopoietic
tissue or tissue that is related to
the blood cells in the bone
marrow.
 Leukemia is classified according to
the dominant abnormal cell type and
the severity of the disease.

Except for chronic lymphocytic

leukemia (CLL), leukemia is not
staged numerically (I, II, III, or IV)
Classification
the way many other cancers are
staged.

Rather, it is classified as acute (usually

fatal in less than 6 months if not
treated) or chronic (develops more
slowly), depending on the maturity
of the cell.
 The exact cause of leukemia is
unknown.
Sometimes primary care providers are
able to explain why a particular person
gets leukemia; more often, the risk
factors may include the following:
Etiology
1. Exposure to high levels of certain
chemicals, such as formaldehyde or
benzene
2. Chemotherapy, especially in those
with cancer who are treated with
alkylating agents.
 3. Exposure to very high levels of
radiation (the atomic bomb in World War
II and nuclear power plant accidents such
as that at Chernobyl, Ukraine). Radiation
treatments may be another source of high-
level exposure
4. Certain genetic diseases caused by
abnormal chromosomes such as Down
Etiology syndrome. Chromosomal alterations are
often evidenced in ALL.
5. Human T-cell leukemia virus-1 can
cause a rare type of leukemia
6. Myelodysplastic syndrome, which
causes defects in blood cell formation, has
been linked to an increased incidence of
leukemia.
 • A complete physical examination
may be the mechanism whereby
leukemia is initially suspected.
• Laboratory tests are ordered to
check the level of blood cells.
These
• A biopsy of the bone marrow from
Diagnosis the hip bone or another large bone
is necessary to diagnose leukemia.
• A spinal tap and chest x-rays may
be ordered.
 • Treatment depends on the
type of leukemia, the extent
of the leukemia, and the
person’s general health status
and age.
Treatment
• Chemotherapy, biological
therapy, radiation therapy, or
bone marrow transplant may
be ordered either alone or in
combination.
 • Those with acute leukemia
need immediate treatment
with the hope of bringing
about a remission and a
possible cure.
Treatment
• Those with the chronic forms
may require no treatment,
especially if they exhibit no
symptoms and can be
monitored closely.
 • Addressing the risk
factors of leukemia is
Prevention essential.