Blood and lymphatic

• Bone marrow
• Blood
• Blood components

• Lymph nodes and nodules
• Lymph vessels

Destroy pathogens

Return lymph back to the blood

• 1. Transport O2, nutrients, and waste
• 2.regulate body temp, ph, and fluids
• 3. Produce cells

4-6

The red bone marrow

• Flat bones
• Irregular bones
• Epiphyses of long bones

Plasma; makes up 46-53% of blood volume

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• Nutrients
• Waste
• Hormones
• Enzymes
• Electrolytes
• Gases

Albumin

Maintain blood volume and bp

7.35-7.45 slightly alkaline

Carry oxygen bonded to Iron in HGB

• Lack of iron
• Lack of hemoglobin
• Decreased RBC

• SOB
• Weakness

• Folic acid
• B12

Extrinsic Factor

• 1. Food
• 2. Intrinsic Factor

• B12 dietary deficiency
• Pernicious anemia

120

Used again or stored in the liver

Bilirubin

Bilirubin

Jaundice

Antigens present on the RBCs

O NEGATIVE

AB+

Only negative

Positive and negative

Macrophages

Pathogens

Neutrophils

Eosinophils

Basophils

T-CELL Lymphocytes

B CELL lymphocytes

Vascular spams, platelet plugs, chemical clotting

Vasoconstriction

Lymph,lymph vessels, nodes/nodules,the spleen, and the thymus

• Return fluid to maintain blood volume
• Protect against pathogens and foreign material

Lymph nodes

• Cervial
• Axillary
• Inguinal

Superficially beneath the mucous membranes

Tonsils

Upper L quad of ABD below the diaphragm, behind the stomach.

• B cells
• T cells
• Fix Macrophages

1/3

Pneumonia and bacterial meningitis

Inferior (below) the thyroid and anterior (behind) the trachea

Again

T cells lymphocytes

• Abnormal bleeding-
• Petechiae-
• Ecchymoses-
• Purpura-
• Fatigue-
• Weakness-
• Sob-
• Fever-

Males

African Americans

People of Northern European decent

Overwhelming gram-negative bacterial infection

Decreases blood volume or decreases O2 supply

• Hypoxia
• Fever
• Intracranial Bleeding

Anemia

Liver disease or hemolysis

Bleeding disorders

Anemia

Blood or lymph disorders

Anemia

Long term hypoxia

Bone marrow may be packed with abnormal cells

• Cbc
• Coagulation tests
• Blood typing

<1.3

Segs and Bands

Seg (segmented)

Banded

Lymphocytes

Chronic like with indwelling catheters (foreign objects in body cause immune response)

Bacterial

Viral

• Sternum
• Spinous processes of the vertebrae
• Anterior or posterior iliac crest

Sterile

Bone marrow

Lymphangiography

Lymph flow or blockages

Repeated after 24 hrs

Pressure dressing and immobilization of limb

Skin, urine, and feces may be really blue after the procedure for 2 days.

When node is enlarged to determine if cause is infection or cancer

4 hours

• Fever(most common)
• Increasing fever with shaking and chills
• Headache
• Back pain

Normal saline

• Minor allergic reaction due to antigens in plasma.
• Need to stop infusion and notify MD if occurs.
• Give anti-histamine if ordered and continue infusion

Deadly and rare reaction caused from incompatible blood products.

• Back and chest pain
• Chills
• Fever
• Sob
• N/v
• Feeling of impending doom

• Advanced symptoms:
• Shock, hypotension, oliguria, decreased LOC,DIC, death.

• Sensitivity to immune globulins passes from donor blood.
• May be seen more often to pts who’ve has many transfusion or pregnancies
• Respiratory and cv collapse may occur
• Common s/s:
• Gi cramping, vomiting, diarrhea

• Caused by rapid transfusion in a short period
• S/s:chest pain, cough, frothy sputum, distended neck veins,crackles, wheezes, increases HR

Expect administration of diuretics

Condition where there is a dificiency of RBCs, Hemaglobin, or both.

Aplastic anemia

Hemolytic or sickle cell anemia

Massive or chronic blood loss

• Caused by lack of intrinsic factor in stomach secretions
• Prevents absorption of b12

• Treated with b12 injections
• Straight to the blood instead of absorbed in the GI

Genetics or exposure to chain toxins

Hereditary anemia found in people from SE Asia, Africa, Italy, and Mediterranean islands.

Causes the inability to synthesize hemoglobin

• Male:13.2-17.3
• Female 11.7-15.5

You’re globin (glowing) during your TEEN* years

• Male: 43-49
• Female- 38-44

You might feel like Crit (sh*T) in your 40’s*

***NO OFFENSE*** :)

• Sob
• Tachypnea
• Tachycardia
• Pallor
• Irritability
• Fatigue

• Red beefy tongue
• Numb hands or feet
• Weakness

*b12 deficiency= neuro symptoms

• Fissures at corner of mouth
• Inflamed tongue
• Spoon shaped nails
• **most common type of anemia**

• CBC
• Serum Iron, Ferris, and total iron binding capacity (iron defic anemia)
• Serum folate (folic acid defic)
• Bone marrow biopsy and analysis
• Gastric acid levels and antibodies for pernacious anemia

• Eliminate contributing factors
• Control chronic diarrhea to help with folic acid defic
• Blood transfusion
• Monitor h&h
• Monitor response to therapy

• Bone marrow becomes fatty and cant produce enough RBC
• AKA Hypoplastic anemia
• Causes pancytopenia
• Can be fatal

Reduced number of all formed elements for the bone marrow

• Congenital
• Exposure to toxins
• Chemo
• Cardiopulmonary bypass
• TB
• Infections

• Early s/s: progressive weakness, fatigue, pallor, sob, HA
• Advanced: tachycardia, HY, ecchymoses, petechiae, blood from mucous membranes, bleeding in organs.

Pt can die from infection or bleeding

• Bone marrow transplant
• Control bleeding
• Steroids

Inherited anemia where RBC have a specific mutation that makes HBG in the cells very sensitive to O2 changes.

Cells to tangle in vessels and organs causing congestion, clumps, and clots.

Bilirubin production from easily damaged and broken RBC’s causing jaundice

• Gallstones
• Spleen and liver enlargement

15-20 days

Sluggish blood collecting in capillaries, veins, or organs of chest and abd and joints.

Sickle cell

• Severe pain and swelling in joints
• Abdominal pain from organ swelling
• Continuous painful erection
• S/s renal failure due to clogged kidneys from all the dead cells
• Hand foot syndrome

Infection, stroke, or organ involvement

• Blood smear
• Sickledex
• Hemoglobin electrophoresis to see abnormal hemoglobin
• Decreases hemoglobin, decreases RBC, increases WBC, decreased ESR

• No cure
• Teach how to avoid crisis
• Low dose PCN to prevent infections
• During crisis: pt may be admitted for 5-7 days to treat pain, receive blood, o2, and fluids

• Rbc,platelets and wbc are over produced and bone marrow becomes packed.
• Organs become congested
• Skin appears dark and flushed
• Can cause clots and blockage
• Usually found in pts over 50

*cause unknown*

• Result of long term hypoxia steaming from chronic conditions like hf, copd, high altitudes, and smoking.
• Body makes more RBC in response to low o2
• Is a compensatory mechanism

• Hypervolemia
• Hyperviscosity
• Engorment of capillary beds
• HTN, visual changes, HA, vertigo, dizziness, tinnitus
• Nose bleeds, bleeding gums, retinal hemorrhage, dyspnea, chest pain
• Dark, flushed complexion
• Intense itching
• Abdominal pain

Panmyelosis- increased level of all bone marrow components

• Blood draw to remove excess volume. 350-500 ml at a time.
• Repeat every other day until HCT is 45 then can repeat every 2-3 months

• Second stage treatment is Chemo drugs/radiation if increased wbc and platelets aren’t reduced by blood draws.
• Can cause leukemia

• Pt needs to be up and moving to prevent clots
• If bed resting do rom
• Assess for bleeding or HYPO volemia
• Teach s/s of bleeding and to report it
• Pt needs to drink 3 l of water to thin blood
• Report chest pain, joint pain, decreases activity tolerance, fever

• Massive clotting in blood vessels that leads to organ and limb necrosis
• Most often effects kidneys and brain but can also effect lungs, pituitary and adrenal glands and Gi mucosa

• Abnormal bleeding without history of blood disorders
• Early signs: petechiae, ecchymoses, bleeding from VP sites

Ptt, prolonged ptt, decreased platelet count, increased evidence of fibrin degradation products

• Correct underlying issue
• Blood transfusion
• Iv heparin****** stops platelets from clotting and being used up if used early on.

• Results from increased platelet death by the immune system causing an increased risk for bleeding.
• Acute ITP affects kids 2-6 yrs and occurs after some viral infections like rubella or chickenpox
• Chronic affects mostly adult women 20-40 years
• May be drug induced or associated with pregnancy

• Petechiae, ecchymoses, and bleeding from mouth, nose, or Gi
• Acute causes easy bruising, nosebleeds, and bleeding gums

• Platelets low <20,000 (normal 150,000 -450,000) and small/immature
• Prolonged bleeding time

• Acute: may resolve self
• Steroids
• Chemo drugs
• Remove spleen
• Blood transfusion and vit K for bleeding

• Group of hereditary bleeding disorders resulting from sever lack of clotting factors
• Common types: A (classic hemophilia) and B (Christmas disease)
• Affects mostly males and rarely does it affect women,but can carry the genes for it

• Deficiency of clotting factor VIII (8)
• Is responsible for 80% of all hemophilia

A for eight and eighty

• Deficiency of clotting factor IX. (9)
• Responsible for 15% of all hemophilia

Mild hemophilia

• Bleeding due to injury or is spontaneous
• Bleeding into muscle or joints causing deformity
• Mild hemophilia may have excessive bleeding after trauma
• Moderate may have occasional spontaneous bleeding
• Severe has frequent spontaneous bleeding and can cause large sub-q and intramuscular hematomas (blood pooling)

Prolonged ptt, various factor levels measured to determine whats missing

• If pt says they are bleeding but there are no obvious signs that they are bleeding-TRUST THEM, THEY ARE BLEEDING
• Treat by giving missing clotting factors

• Malignant disease of the WBC
• Causes cells to be abnormal and unable to fight infection
• Cells collect in body tissue and organs like oral mucous membranes, anus, sinuses, and lungs causing inflammation,pain and infection.
• Pt are diagnosed after infection does not clear up easily

• ALL:Leukemia that affects children younger than 15 and involves abnormal growth of lymphocyte precursors
• AML:usually affects people older than 20 and have poor prognosis

Acute leukemia’s may present with sudden high fever, abnormal bleeding, petechiae, ecchymoses, and easy bruising

Death usually from infection

• CLL affects the B and T cell lymphocytes: occurs in adults older than 40
• CML is characterized by Philadelphia chromosomes and occurs most often between he ages 40 - 45

• Chronic usually develops in three stages
• 1. Anemia and bleeding abnormalities- pt feels fine
• 2 and 3: progresses to accelerated and acute phases with scenarios similar to the events seen in acute leukemia’s

Chronic is almost always fatal but pts may have 10+ more years left after diagnosis

• Deadly cancer of the plasma cells in the bone marrow
• Almost half the pts die within 3 months of diagnosis because it is silent and deadly
• Early detection could prolong life 3-5 years
• Effects men age 50-70
• Tumors eat the bone tissue
• X ray shows holes in bones
• Death is often caused from sepsis
• Unknown cause

• Skeletal pain. Constant severe back pain that increases with movement
• Achiness in long bones, joint swelling, tenderness, low-grade, fever, general malaise
• May not feel temperatures well; burns easily
• Pathological fractures of long bones occurring without trauma. (Roll over in bed and break a leg)

• Cbc, x ray, bone marrow biopsy
• Manage disease and symptoms
• High-dose steroids
• Chemo

• Cancer of the lymph system that has Reed Sternberg cells making it very different from other forms of lymphoma
• More prevalent in men and occurs in young adults 15-40
• Most curable type of lymphoma
• Usually starts in clerical lymph nodes of neck
• Unknown cause

• Painless swelling in common lymph node chains
• Alcohol causes pain at site of disease
• Pt may have cough, dysphasia, or stridor
• Low grade fever, night sweats, fatigue, weight loss, and malaise

Lymph node and bone marrow biopsy, CXR, and bone scan. Lymphangiography- blue dye.

• Treat with radiation and chemo.
• Manage symptoms

• All other types excluding Hodgkin’s lymphoma
• Differ from Hodgkins by NOT have Reed sternberg cells
• These arise from B and t lymphocyte cells
• Cause is unclear but some viruses such as Epstein Barr and herpes play a role

• Enlarged painless rubbery nodes in cervical and Supra clavicular areas
• Enlarged tonsils and adenoids
• Occasional dyspnea and cough

• Biopsied lymph nodes,tonsils, bone marrow, liver, bowel, skin, or other affected tissue
• Bone scans
• CXR
• Lymphangiography -blue dye
• Liver and spleen scans
• Ct of abdomen
• Cbc
• Treatment: chemo, radiation, stem cell transplant
• Manage symptoms