Blood and Lymphatic Systems CHAPTER 9. 2 Blood System Overview Blood transports oxygen and nutrients...
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Transcript of Blood and Lymphatic Systems CHAPTER 9. 2 Blood System Overview Blood transports oxygen and nutrients...
Blood and Lymphatic Systems
CHAPTER 9
2
Blood System Overview
• Blood transports oxygen and nutrients to body cells
• Blood removes carbon dioxide and other waste products from body cells for elimination
3
Composition of Blood
• Plasma– 90 percent water = liquid portion of blood
• Transports cellular elements of blood throughout circulatory system
– Remaining portion = solutes• Electrolytes, proteins, fats, glucose, bilirubin, and
gases • Most abundant solutes are plasma proteins:
albumins, globulins, and fibrinogen
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Composition of Blood
• Solid components– Formed elements = cells + cell fragments
• Erythrocytes, leukocytes, thrombocytes
5
Plasma Proteins
• Albumins– Constitute about 60 percent of the plasma
proteins– Help maintain normal blood volume and
blood pressure– Help to maintain balance between fluid in
the blood and fluid in the interstitial tissues
6
• Globulins– Constitute approximately 36 percent of
plasma proteins– Alpha and beta globulins transport lipids (fats)
and fat-soluble vitamins in blood– Gamma globulins are antibodies and function
in immunity
Plasma Proteins
7
• Fibrinogen– Constitutes approximately 4 percent of
plasma proteins– Largest of plasma proteins– Essential in process of blood clotting
Plasma Proteins
8
Blood Cells
• Erythrocytes– Known as red blood cells (RBC)
• Tiny biconcave-shaped disks• Thinner in center than around edges• No nucleus in mature red blood cell
– Average life span = approximately 120 days– Main component = hemoglobin– Primary function = transport oxygen to cells of
body
9
Blood Cells• Leukocytes
– Known as white blood cells (WBC)• Larger than erythrocytes, but fewer in number• Mature WBC has a nucleus; does not have
hemoglobin
– Two categories = granulocytes + agranulocytes
• Granulocytes have granules in their cytoplasm• Agranulocytes have no granules in their cytoplasm • Five different types of leukocytes within the
categories
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Blood Cells Granulocytes
• Neutrophils– Constitute approximately 60-70 percent of all
WBCs– Have multi-lobed nuclei– Phagocytic in nature– Do not absorb acid or base dye well
• Remain fairly neutral color
11
Granulocytes
• Eosinophils– Constitute approximately 2-4 percent of all
WBCs– Have a nucleus with two lobes– Increase in number in response to allergic
reactions– Stain a red, rosy color with an acid dye
12
Granulocytes
• Basophils– Constitute less than 1 percent of all WBCs– Have a nucleus with two lobes– Secrete histamine during allergic reactions– Secrete heparin – a natural anticoagulant– Stain a dark blue with a base dye
13
• Monocytes– Constitute approximately 3-8 percent of all
WBCs– Largest of all white blood cells– Have a kidney bean-shaped nucleus– Phagocytic in nature
Blood Cells Agranulocytes
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Agranulocytes
• Lymphocytes– Constitute approximately 20-25 percent of all
WBCs– Have a large spherical-shaped nucleus– Play important role in immune process– Some lymphocytes are phagocytic – Other lymphocytes produce antibodies
15
Cell Fragments
• Thrombocytes– Small, disc-shaped fragments of very large
cells called megakaryocytes– Also known as platelets– Contain no hemoglobin– Essential for normal clotting of blood
16
Blood Types
• Blood Type A– Has A-antigen present on RBC– Has Anti-B antibody present in plasma
• Blood Type B– Has B-antigen present on RBC– Has Anti-A antibody present in plasma
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Blood Types
• Blood Type AB– Has AB-antigens present on RBC– Has no antibodies present in plasma
• Blood Type O– Has no antigens present on RBC– Has both anti-A and Anti-B antibodies present
in plasma
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• Donor – Person who gives blood
• Recipient– Person who receives blood
Terms Related to Blood Transfusions
19
• Universal Donor Blood – Type O– No A antigens or B antigens present on its
RBCs
• Universal Recipient Blood– Type AB– No anti-A or Anti-B antigens present in its
plasma
Terms Related to Blood Transfusions
20
Rh Factor
• Rh Positive (Rh+)– Rh antigen is present on the RBC
• Rh Negative (Rh-)– Rh antigen not present on the RBC
• Concern: Rh- blood being exposed to Rh+ blood via transfusion
• Concern: Rh- mother giving birth to Rh+ baby and blood mixes during birth process
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Blood Clotting• Clotting of blood = coagulation
– Injury to blood vessel creates roughened area in vessel
– Platelets come in contact with rough spot and disintegrate
• Release substance called thromboplastin
– Thromboplastin converts prothrombin into thrombin
• In presence of calcium ions and other clotting factors
– Thrombin converts fibrinogen into fibrin• Fibrin threads form a mesh that forms the clot
PATHOLOGICAL CONDITIONS
The Blood
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• Pronounced– (an-NEE-mee-ah)
• Defined– Deficiency of oxygen being delivered to cells
due to decrease in quantity of hemoglobin or red blood cells
Anemia
24
• Similarities in all types of anemia– Fatigue– Paleness of skin– Headache– Fainting– Tingling sensations and numbness – Loss of appetite– Swelling in lower extremities– Difficulty breathing
Anemia
25
• Pronounced– (ah-PLAST-ik an-NEE-mee-ah)
• Defined– Form of anemia characterized by
pancytopenia, an inadequacy of all the formed blood elements (RBCs, WBCs, platelets)
• Also known as “bone marrow depression anemia”
Aplastic Anemia
26
• Pronounced– (he-moh-LIT-ik an-NEE-mee-ah)
• Defined– Form of anemia characterized by the extreme
reduction in circulating RBCs due to their destruction
Hemolytic Anemia
27
Iron Deficiency Anemia
• Pronounced– (EYE-urn dee-FIH-shen-see an-NEE-mee-
ah)
• Defined– Anemia that is characterized by deficiency of
hemoglobin level due to a lack of iron in the body
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• Pronounced– (per-NISH-us an-NEE-mee-ah)
• Defined– Form of anemia resulting from a deficiency of
mature RBCs and the formation and circulation of megaloblasts with marked poikilocytosis, and anisocytosis
• Distorted RBCs due to lack of vitamin B12 absorption necessary for maturation of RBCs
Pernicious Anemia
29
• Pronounced– (SIKL-SELL an-NEE-mee-ah)
• Defined– Chronic hereditary form of hemolytic anemia in
which RBCs become crescent-shaped in presence of low oxygen concentration
• Crescent-shaped RBCs clump together forming thromboses which occlude small blood vessels, causing much pain for the individual
Sickle Cell Anemia
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Granulocytosis
• Pronounced– (gran-yew-loh-sigh-TOH-sis)
• Defined– Abnormally elevated number of granulocytes
in the circulating blood as a reaction to any variety of inflammation or infection
31
Hemochromatosis
• Pronounced– (hee-moh-kroh-mah-TOH-sis)
• Defined– Rare iron metabolism disease characterized
by iron deposits throughout the body– Usually as a complication of one of the
hemolytic anemias
32
Hemophilia
• Pronounced– (hee-moh-FILL-ee-ah)
• Defined– Hereditary inadequacies of coagulation
factors resulting in prolonged bleeding times
33
Hemophilia
• Hemophilia A– Also called classic hemophilia– Result of a deficiency or absence of
antihemophilic factor VIII• Deficiency results in traumatic or spontaneous
bleeding
– Characterized by bleeding in joints, gums, or mouth
– Hematuria is a common characteristic
34
Hemophilia
• Hemophilia B– Also called Christmas disease– Result of deficiency of a coagulation factor
called factor IX– Only distinguishable from Hemophilia through
laboratory differentiation of factor deficiencies
35
Leukemia• Pronounced
– (loo-KEE-mee-ah)
• Defined– Excessive uncontrolled increase of immature
WBCs in the blood eventually leading to infection, anemia, and thrombocytopenia
• Course of leukemia is subclassified as acute or chronic
36
Leukemia
• Acute leukemia– Rapid onset– Swiftly progresses to severe
thrombocytopenia, progressive anemia, infective lesions in throat and mouth, high fever, and severe infection
• Chronic leukemia– Gradual onset– Progression slower than with acute form
37
Leukemia
• Classifications of leukemia– AML
• Acute Myelogenous Leukemia
– ALL• Acute Lymphocytic Leukemia
– CML• Chronic Myelogenous Leukemia
– CLL• Chronic Lymphocytic Leukemia
38
Multiple Myeloma(Plasma Cell Myeloma)
• Pronounced– (MULL-tih-pl- my-eh-LOH-mah)
• Defined– Malignant plasma cell neoplasm causing an
increase in the number of both mature and immature plasma cells
• Often entirely replace the bone marrow and destroy the skeletal structure
39
Polycythemia Vera
• Pronounced– (pol-ee-sigh-THEE-mee-ah VAIR-ah)
• Defined– Abnormal increase in the number of RBCs,
granulocytes, and thrombocytes leading to an increase in blood volume and viscosity
40
• Pronounced– (PURR-pew-rah)
• Defined– Collection of blood beneath the skin in the
form of pinpoint hemorrhages appearing as red-purple skin discolorations
• Idiopathic thrombocytopenic purpura = antibodies formed by the individual that destroys his/her own platelets
Purpura
41
Thalassemia
• Pronounced– (thal-ah-SEE-mee-ah)
• Defined– Hereditary form of hemolytic anemia in
which the production of hemoglobin is deficient creating hypochromic microcytic RBCs
• Alpha or beta hemoglobin chains are defective
DIAGNOSTIC TECHNIQUES, TREATMENTS
AND PROCEDURES
The Blood
43
Diagnostic Techniques, Treatments, and Procedures
• Direct Antiglobulin Test (Coomb’s Test)– Blood test used to discover the presence of
antierythrocyte antibodies present in the blood of an Rh negative woman
• Production of these antibodies is associated with an Rh incompatibility between a pregnant Rh negative woman and her Rh positive fetus
44
Diagnostic Techniques, Treatments, and Procedures
• Bleeding time– Measurement of the time required for bleeding
to stop
• Blood transfusion– Administration of blood or a blood component
to an individual to replace blood lost through surgery, trauma, or disease
45
Diagnostic Techniques, Treatments, and Procedures
• Bone marrow biopsy– Microscopic exam of bone marrow tissue,
which fully evaluates hematopoiesis by revealing the number, shape, and size of the RBCs, WBCs, and platelet precursors
• Bone samples are obtained through aspiration or surgical removal
46
Diagnostic Techniques, Treatments, and Procedures
• Bone marrow transplant– Donor’s bone marrow cells are infused
intravenously into the recipient• After recipient receives an infusion of aggressive
chemotherapy or total-body irradiation to destroy all malignant cells and to inactivate the immune system
47
Diagnostic Techniques, Treatments, and Procedures
• Complete Blood Cell Count (CBC)– Series of tests performed on peripheral
blood, that inexpensively screens for problems in the hematologic system as well as several other organ systems
– CBC includes• RBC count, Hemoglobin, Hematocrit, RBC
indices, WBC count, WBC differential, Blood smear, Platelet count
48
Diagnostic Techniques, Treatments, and Procedures
• Erythrocyte Sedimentation Rate (ESR)– Test performed on blood, that measures the
rate at which red blood cells settle out in a tube of unclotted blood
• ESR is determined by measuring the settling distance of RBCs in normal saline over one hour
49
Diagnostic Techniques, Treatments, and Procedures
• Hematocrit– Assessment of RBC percentage in total blood
volume
• Hemoglobin test– Concentration measurement of hemoglobin in
peripheral blood
50
Diagnostic Techniques, Treatments, and Procedures
• Lipid profile– Measurement of the lipids in the blood
• Partial thromboplastin time (PTT)– Blood test used to evaluate the common
pathway and system of clot formation within the blood
51
Diagnostic Techniques, Treatments, and Procedures
• Platelet count– Blood test that provides the count of
platelets per cubic millimeter of blood
• Prothrombin time (PT)– Blood test used to evaluate common
pathway and extrinsic system of clot formation
52
Diagnostic Techniques, Treatments, and Procedures
• Red Blood Cell Count (RBC)– Measurement of the circulating number of
RBCs in one millimeter of peripheral blood
• Red blood cell morphology– Examination of the RBC on a stained blood
smear that enables the examiner to identify the form and shape of the RBCs
53
Diagnostic Techniques, Treatments, and Procedures
• Reticulocyte count– Measurement of the number of circulating
reticulocytes, immature erythrocytes, in a blood specimen
• Rouleaux– Aggregation of RBCs viewed through the
microscope that may be an artifact, or may occur with persons with multiple myeloma as a result of abnormal proteins
54
Diagnostic Techniques, Treatments, and Procedures
• Schilling test– Diagnostic analysis for pernicious anemia
• White Blood Cell Count (WBC)– Measurement of the circulating number of
WBCs in one cubic millimeter of peripheral blood
55
Diagnostic Techniques, Treatments, and Procedures
• White blood cell differential– Measurement of the percentage of each
specific type of circulating WBCs present in one cubic millimeter of peripheral blood drawn for the WBC count
56
Lymphatic System Overview
• Lymphatic system functions to produce antibodies and lymphocytes important to immunity
• Lymphatic system also functions to maintain a balance of fluid in the internal environment
57
• Lymphatic system– Lymph fluid
• Stems from the blood and tissue fluid
– Lymph vessels• Similar to blood vessels – designed to return
tissue fluid to bloodstream
– Lymph nodes• Located along path of collecting vessels
– Lymphatic organs• Thymus, spleen, and tonsils
Lymphatic System Overview
58
Lymphatic System Overview
• How lymph vessels differ from blood vessels– Lymph vessels do not form a closed circuit as
does the cardiovascular system– Lymph vessels originate in intercellular
spaces of soft tissues of the body
59
Lymphatic System Overview
• Lymphatic system is an important part of the immune system – Immune system consists of:
• Bone marrow• Thymus• Lymphoid tissues• Lymph nodes• Spleen• Lymphatic vessels
60
Lymph Vessels
• Lymph capillaries– Smallest lymphatic vessels– Originate in tissue spaces as blind-ended
sacs– Capillaries pick up accumulated interstitial
fluid and return it to the blood– Fluid inside the lymphatic vessels is known
as lymph
61
Lymph Vessels
• Lymph vessels– Larger than capillaries– Receive lymph from lymphatic capillaries– Valves prevent backward flow of fluid– Transport fluid in only one direction
• Away from the tissues toward the thoracic cavity
62
Lymph Vessels
• Lymphatic ducts– Only points of entry of lymph into blood
vessels of body– Right lymphatic duct
• Receives lymph drainage from right side of head and neck
• Also receives lymph drainage from right upper extremity, and right side of chest
• Empties into right subclavian vein
63
Lymph Vessels
• Lymphatic ducts– Thoracic duct
• Receives lymph drainage from remaining regions of the body
• Empties into left subclavian vein
64
Lymph Nodes
• Collections of lymphatic tissue• Also called lymph glands• Located at intervals along course of
lymphatic system vessels• Lymph passes through stationary lymph
nodes– Old, dead cells and bacteria present in
lymph are filtered out– Macrophages engulf and destroy any
bacteria present
65
Thymus
• Located in mediastinum
• Secretes thymosin – stimulates red bone marrow to produce T lymphocytes– T- cells important in immune response– T-cells mature in the thymus
66
Spleen • Located in upper left quadrant of
abdomen: just below diaphragm, behind stomach
• Largest lymphatic organ in the body• Plays an important role in the immune
response– Filters blood– Macrophages of spleen remove pathogens
from circulating blood– Macrophages also remove old red blood
cells from circulation
67
Tonsils
• Masses of lymphatic tissue
• Located in protective ring, just under the mucous membrane
• Surround the mouth and back of the throat
• Serve as first line of defense from the external environment
68
Tonsils• Three groups
– Pharyngeal tonsils or adenoids• Located near opening of the nasal cavity into
pharynx (throat)
– Palatine tonsils• Located on each side of the throat, near opening
or oral cavity into pharynx• Commonly known as ‘the tonsils’
– Lingual tonsils• Located near the base of the tongue
69
Immunity • Natural
– Immunity with which we are born; genetic
• Acquired – Body has developed ability to defend itself
against a specific agent• Can occur as result of having had the particular
disease • Can be result of having received immunizations
against a disease• Can be passive acquired immunity or active
acquired immunity
70
Immunity
• Passive Acquired Immunity– Acquired artificially by injecting antibodies into
a person’s body– Protects person from a specific disease– Short-lived immunity – lasts only a few weeks– Example: gamma globulin
• Given to individuals exposed to viruses such as measles and infectious hepatitis
71
Immunity
• Active Acquired Immunity– Acquired naturally as result of having had a
disease– Acquired artificially by being inoculated with a
vaccine, antigen, or toxoid• Immunization = process of creating immunity to a
specific disease
72
• Immune reaction = Immune response– Defense mechanism of the body
• Produces antibodies to destroy invading antigens and malignancies
• Humoral immune response– B lymphocytes come in contact with specific
invading antigens• Produce antibodies known as immunoglobulins
Immune Reaction
73
• Cell-mediated immune response– T lymphocytes come in contact with specific
invading antigens– T lymphocytes multiply rapidly and engulf and
digest the antigen• Multiplication of cells produces memory cells• Memory cells provide the body with resistance
Immune Reaction
74
Hypersensitivity
• Abnormal condition characterized by an excessive reaction to a particular stimulus
• Body’s immune system fails to protect itself against foreign material
• Allergic reaction is triggered by an allergen– Examples of allergens:
• Ingested foods, penicillin and other antibiotics, grass, ragweed pollen and bee or wasp stings
75
• Hypersensitive reactions– Local reaction
• Occurs at the site where treatment or medication was administered
– Systemic reaction• Evidenced by generalized body symptoms such
as runny nose, itchy eyes, hives, and rashes
Hypersensitivity
76
• Hypersensitive reactions – Anaphylactic shock
• Also known as anaphylaxis• Antigen-antibody reaction stimulates a massive
secretion of histamine• Example causes: insect stings, contrast media
containing iodide, aspirin, antitoxins prepared with animal serum, allergens used in testing
Hypersensitivity
PATHOLOGICAL CONDITIONS
Lymphatic System
78
Acquired ImmunodeficiencySyndrome (AIDS)
• Pronounced– ( acquired ih-mew-noh-dee-FIH-shen-see
SIN-drom)
• Defined– Clinical conditions that destroy the body’s
immune system in the last or final phase of a human immunodeficiency virus (HIV) infection, which primarily damages helper T cell lymphocytes with CD4 receptors
79
Cytomegalovirus
• Pronounced– (sigh-toh-meg-ah-loh VY-rus)
• Defined– Large species-specific, herpes-type virus with
a wide variety of disease effects – causes serious illness in persons with AIDS, in
newborns, and in individuals who are being treated with immunosuppressive drugs
80
Hypersensitivity • Pronounced
– (high-per-sens-sih-TIV-ih-tee)
• Defined– Tissue damage resulting from exaggerated
immune responses• IgE-mediated-Type I hypersensitivity response• Cytoxic-Type II hypersensitivity reaction• Immune complex-mediated-Type III sensitivity
response• Delayed-Type IV hypersensitivity responses
81
Hypersplenism
• Pronounced– (high-per-SPLEN-izm)
• Defined– Syndrome involving a deficiency of one or
more types of blood cells and an enlarged spleen
82
Kaposi’s Sarcoma
• Pronounced– (KAP-oh-seez sar-KOH-mah)
• Defined– Locally destructive malignant neoplasm of the
blood vessels associated with AIDS typically forming lesions on the skin, visceral organs, or mucous membranes
• Lesions appear initially as tiny red to purple macules and evolve into sizable nodules or plaques
83
Lymphoma
• Pronounced– (LIM-foh-mah)
• Define– A lymphoid tissue neoplasm that is typically
malignant, beginning with a painless enlarged lymph node(s) and progressing to anemia, weakness, fever, and weight loss
84
Lymphoma
• Burkitt’s lymphoma– Malignant neoplasm in the jaw or abdomen
and seen chiefly in Central Africa
• Hodgkin’s disease– Characterized by progressive, painless
enlargement of a malignant tumor of the lymph tissue in the lymph nodes and spleen typically noted first in the cervical region
85
Lymphoma
• Non-Hodgkin’s lymphoma– Classification for any kind of malignant
lymphoma besides Hodgkin’s disease– Includes histiocyte lymphoma and
lymphocytic lymphoma
86
Mononucleosis
• Pronounced– (mon-oh-noo-klee-OH-sis)
• Defined– A benign, self-limiting acute infection of the B
lumphocytes– Usually caused by the Epstein-Barr virus
(EBV)
87
Myasthenia Gravis
• Pronounced– (my-ass-THEE-nee-ah GRAV-is)
• Defined– An autoimmune disease in which antibodies
block or destroy some acetylcholine receptor sites
– Results in muscle weakness
88
Pneumocystis Carinii Pneumonia (PCP)
• Pronounced– (noo-moh-SIS-tis kah-rye-nee-eye noo-
MOH-nee-ah)
• Defined– Pneumonia caused by a common worldwide
parasite, Pneumocystis carinii, for which people have immunity if they are not severely immunocompromised
89
Sarcoidosis
Pronounced– (sar-koyd-OH-sis)
• Defined– Systemic inflammatory disease resulting in
the formation of multiple small, rounded lesions (granulomas) in the lungs, lymph nodes, eyes, liver, and other organs
90
• Pronounced– (sis-TEM-ik LOO-pus er-ih-them-ah-TOH-
sus)
• Defined– Inflammatory connective tissue disease,
chronic in nature, in which immune complexes are formed from the reaction of SLE autoantibodies and their corresponding antigens
• These immune complexes are deposited in the connective tissues of lymphatic vessels, blood vessels, and other tissues
Systemic Lupus Erythematosus (SLE)
DIAGNOSTIC TECHNIQUES, TREATMENTS
AND PROCEDURES
Lymphatic System
92
Diagnostic Techniques, Treatments, and Procedures
• Enzyme-Linked Immunosorbent Assay (ELISA)– Blood test used for screening for an antibody
to the AIDS virus
• Western Blot– Blood test to detect the presence of the
antibodies to HIV, the virus that causes AIDS
93
• CT (CAT) scan– Collection of x-ray images taken from various
angles following an injection of a contrast medium
• Lymphangiogram– X-ray assessment of the lymphatic system
following injection of a contrast medium into the lymph vessels in the hand or foot
Diagnostic Techniques, Treatments, and Procedures