The pandemic diseases bring from the Space: the continuity ...
Diseases of the blood
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Transcript of Diseases of the blood
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Diseases of the blood
BLOOD DISORDERS/DISEASES
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ANEMIATHE MOST COMMON
DISORDER OF THE BLOOD
LACK OF RBC’S CARRYING OXYGEN• Main classes of etiology include:
Excessive blood loss – hemorrhageExcessive blood cell destruction – hemolysisDeficient red blood cell production
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ANEMIADiagnosing the type of anemia is based on:
Nutrient deficienciesPresence of immature RBC’sCharacteristic color and volume of RBC’sLab values
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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
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GENERAL PROGNOSIS(if anemia is untreated)
• Heart failure • Cardiovascular collapse• Shock
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IRON DEFICIENCY ANEMIA(most common cause of anemia)
ETIOLOGY:• Increased iron requirements,• Impaired iron absorption• Hemorrhage
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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
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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
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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
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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
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DIAGNOSIS
CBC- low H&HReports of signs and symptoms in
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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
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PERNICIOUS ANEMIAEtiology:• 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
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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
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SYMPTOMS OFPERNICIOUS ANEMIA
• Nausea, vomiting, burning of the tongue• Neurological disturbances such as
numbness, weakness, poor reflexes• GENERAL SYMPTOMS OF ANEMIA
SLIDE FOUR
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DIAGNOSIS OF PERNICIOUS 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)
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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
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HEMOLYTIC ANEMIAEtiology: 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)
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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
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DIAGNOSIS OF HEMOLYTIC ANEMIA
• Enlarged spleen• CBC Includes H&H• Liver function blood tests• Bone Marrow Aspiration and or biopsy
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TREATMENTS FOR HEMOLYTIC ANEMIA
• Blood transfusions• Medication• Plasmaphoresis• Surgery• Stem Cell transplants
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Blood Transfusions
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Blood transfusion reaction
• Caused by antibodies forming and person rejecting blood being transfused.
• Stop transfusion immediately.
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MEDICATIONS
• Corticosteroids (Prednisone) - limit immune system from making antibodies(proteins) against RBC’s
• Rituximab, Cyclosporine – drugs that suppress your immune system
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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.
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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.
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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
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ACQUIRED APLASTIC ANEMIA ETIOLOGY
• Exposure to toxins—pesticides
• Radiation and chemotherapy• Antibiotics like chloramphenicol
• Hepatitis, HIV,CMV, Eptstein-Barr virus• Lupus, rheumatoid arthritis
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SIGNS AND SYMPTOMS OF APLASTIC ANEMIA
• General s/s from slide four
• Decreased RBC’s, WBC’s and platelets
• Nausea
• Skin rashes
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DIAGNOSIS OF APLASTIC ANEMIA
• History and physical
• CBC
• Reticulocyte count (# of young blood cells)
• Bone marrow aspiration/biopsy
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TREATMENT OF APLASTIC ANEMIA
• Removal of known cause if possible
• Blood transfusions
• Blood and marrow stem cell transplants
• Medications
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Blood and Marrow Stem Cell Transplants
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MEDICATIONS
• Stimulate bone marrow-Erythropoieten and colony stimulating factors
• Suppress immune systemAntihymocyte globulin (ATG), cyclosporine and methylprednisone – all three given togeth
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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.
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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
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FACTS ABOUT SICKLE 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
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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
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DIAGNOSIS
• Blood testing at newborn screening.• Amniotic fluid sampling before birth.
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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
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COMPLICATIONS
• Stroke• Eye damage• Multiple organ failure• Leg ulcers• Gall stones• Priapism (painful erection in males)
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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
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Disseminated Intravascular Coagulation (DIC)
ETIOLOGY:SepsisEndothelial damageshock
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Signs and symptoms
• Bleeding into intravascular spaces due to destruction of platelets and clotting factors.
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Diagnosis
• Blood test • Physical exam
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Treatment
• Platelet transfusions
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Hemophilia• An inherited clotting disorder due to a
deficiency of clotting factor VIII
• X linked recessive disorder primarily affects males
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Signs and symptoms
• Bleeding • If bleeding into joints can cause joint
fibrosis• Intracranial hemorrhage often cause of
death
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Diagnosis
• Genetic testing• PT/PTT• Platelet count• H&H
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Treatment
• Replacement of factor VIII
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Leukemia• Cancer of the blood• Proliferation of immature forms of WBC’s• Classified based on whether cells affected
are B Cells, T Cells (lymphoid tissue) or Myeloid cells (bone marrow)
• Occurs 10x more often in children than adults
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Etiology
• Etiology is unknown, however research indicates some cases of leukemia are caused by treatment of other cancers, environmental factors and possibly pre-exposure to viruses
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Signs and symptoms
• Fatigue• Weight loss• Easy bruising• Repeated infections• low grade fevers• Nosebleeds• hemorrhages
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Diagnosis
• CBC• Bone marrow biopsy
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Treatment
• Chemotherapy• Bone marrow transplantation