CHAPTER 9 Blood and Lymphatic Systems Blood System

CHAPTER 9 Blood and Lymphatic Systems

Blood System Overview • Blood transports oxygen and nutrients to body cells • Blood removes carbon dioxide and other waste products from body cells for elimination 2

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 3

Composition of Blood • Solid components – Formed elements = cells + cell fragments • Erythrocytes, leukocytes, thrombocytes 4

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 5

Plasma Proteins • 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 6

Plasma Proteins • Fibrinogen – Constitutes approximately 4 percent of plasma proteins – Largest of plasma proteins – Essential in process of blood clotting 7

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 8

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 9

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 10

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 11

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 12

Blood Cells Agranulocytes • Monocytes – Constitute approximately 3 -8 percent of all WBCs – Largest of all white blood cells – Have a kidney bean-shaped nucleus – Phagocytic in nature 13

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 14

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 15

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 16

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 17

Terms Related to Blood Transfusions • Donor – Person who gives blood • Recipient – Person who receives blood 18

Terms Related to Blood Transfusions • 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 19

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 20

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 21

PATHOLOGICAL CONDITIONS The Blood

Anemia • Pronounced – (an-NEE-mee-ah) • Defined – Deficiency of oxygen being delivered to cells due to decrease in quantity of hemoglobin or red blood cells 23

Anemia • 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 24

Aplastic Anemia • 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” 25

Hemolytic Anemia • 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 26

Iron Deficiency Anemia • Pronounced – (EYE-urn dee-FIH-shen-see an-NEE-meeah) • Defined – Anemia that is characterized by deficiency of hemoglobin level due to a lack of iron in the body 27

Pernicious Anemia • 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 B 12 absorption necessary for maturation of RBCs 28

Sickle Cell Anemia • 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 29

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 30

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 31

Hemophilia • Pronounced – (hee-moh-FILL-ee-ah) • Defined – Hereditary inadequacies of coagulation factors resulting in prolonged bleeding times 32

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 33

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 34

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 35

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 36

Leukemia • Classifications of leukemia – AML • Acute Myelogenous Leukemia – ALL • Acute Lymphocytic Leukemia – CML • Chronic Myelogenous Leukemia – CLL • Chronic Lymphocytic Leukemia 37

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 38

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 39

Purpura • 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 40

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 41

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES The Blood

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 43

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 44

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 45

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 46

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 47

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 48

Diagnostic Techniques, Treatments, and Procedures • Hematocrit – Assessment of RBC percentage in total blood volume • Hemoglobin test – Concentration measurement of hemoglobin in peripheral blood 49

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 50

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 51

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 52

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 53

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 54

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 55

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 56

Lymphatic System Overview • 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 57

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 58

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 59

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 60

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 61

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 62

Lymph Vessels • Lymphatic ducts – Thoracic duct • Receives lymph drainage from remaining regions of the body • Empties into left subclavian vein 63

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 64

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 65

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 66

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 67

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 68

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 69

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 70

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 71

Immune Reaction • 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 72

Immune Reaction • 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 73

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 74

Hypersensitivity • 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 75

Hypersensitivity • 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 76

PATHOLOGICAL CONDITIONS Lymphatic System

Acquired Immunodeficiency Syndrome (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 CD 4 receptors 78

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 79

Hypersensitivity • Pronounced – (high-per-sens-sih-TIV-ih-tee) • Defined – Tissue damage resulting from exaggerated immune responses • Ig. E-mediated-Type I hypersensitivity response • Cytoxic-Type II hypersensitivity reaction • Immune complex-mediated-Type III sensitivity response • Delayed-Type IV hypersensitivity responses 80

Hypersplenism • Pronounced – (high-per-SPLEN-izm) • Defined – Syndrome involving a deficiency of one or more types of blood cells and an enlarged spleen 81

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 82

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 83

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 84

Lymphoma • Non-Hodgkin’s lymphoma – Classification for any kind of malignant lymphoma besides Hodgkin’s disease – Includes histiocyte lymphoma and lymphocytic lymphoma 85

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) 86

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 87

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 88

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 89

Systemic Lupus Erythematosus (SLE) • Pronounced – (sis-TEM-ik LOO-pus er-ih-them-ah-TOHsus) • 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 90

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES Lymphatic System

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 92

Diagnostic Techniques, Treatments, and Procedures • 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 93