Altered Hematologic Function
Dr. Mohamed Seyam Ph.D PT
Erythrocytes
Abnormalities Anemias
• Anemia is the
inability of the blood
to carry sufficient
oxygen to the body
due to:
•
low numbers of
RBCs
•
lack of
hemoglobin
Cinical Manifestations
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Fatigue
Pallor (Whiteness)
Weakness; exercise intolerance
Dyspnea (Shortness of breath)
Syncope (fainting ‫ )إغماء‬and dizziness (‫)دوخة‬
Angina (chest pain)
Tachycardia (increased heart rate)
Organ dysfunctions
• Identified by their causes or by the changes that
affect the size, shape of the erythrocyte
• Terms that end with –cytic refer to cell size, and
those that end in –chromic refer to hemoglobin
content.
1-Macrocytic / Megaloblastic Anemia
• Characterized by abnormally large stem cells
(megaloblasts) that are unusually large in size, thickness
and volume (macrocytic).
• The hemoglobin content is normal, so these are
normochromic anemias.
• These anemias are the result of:
– Ineffective DNA synthesis
• Commonly due to folate and B12 (cobalamin)
deficiencies – malabsorption or malnutrition
• These cells die prematurely, decreasing the
numbers of RBC’s in circulation
2-Pernicious Anemia
• Common megaloblastic anemia
• Caused by a Vitamin B12 deficiency
• Pernicious means highly injurious or
destructive – this condition was once fatal
• Can be congenital – baby born with
a deficiency in a protein , intrinsic
factor, necessary to absorb B12
from the stomach
• Adult onset – one example is an
autoimmune dysfunction - type A
chronic atrophic gastritis – where
there is destruction of the gastric
mucosa
• Most commonly affects people
over 30
• Females are more prone to
Pernicious Anemia
Pernicious Anemia is also associated with:
1. Heavy alcohol consumption
2. Hot tea
3. Cigarette smoking
4. Other autoimmune conditions
5. Complete or partial removal of the
stomach can cause intrinsic factor
deficiency
3-Folate deficiency anemias
• Folic acid also needed for DNA synthesis
• Demands are increased in pregnant and
lactating females
• Absorbed from small intestine and does
not require any other elements for
absorption.
• Folate deficiency is more common than
B12 deficiency
Specific manifestations include:
1- cheilosis, (scales and
fissures of the mouth),
2-inflammation of the mouth,
3- ulceration of the buccal
mucosa and tongue.
4- Microcytic – Hypochromic Anemias
• Characterized by abnormally small RBC’s
that contain reduced amounts of hemoglobin.
• Possible causes:
– Disorders of iron metabolism
– Disorders of porphyrin and heme synthesis
– Disorders of globin synthesis
5- Iron Deficiency Anemia
• Most common type of anemia throughout the world.
• High risk:
– Individuals living in poverty
– Females of childbearing age
– Children
• Common causes
– Insufficient iron intake
– Chronic blood loss – even 2- 4 ml/ day
– In men –gastrointestinal bleeding
– In women – profuse menstruation, pregnancy
Myeloproliferative Disorders
• The opposite of anemias – here we have too
many RBC’s.
• Polycythemia – excessive production of RBC’s
– Primary polycythemia – cause is unknown,
but is in effect, a benign tumor of the marrow,
leading to increased numbers of stem cells
and therefore RBC’s, and splenomegally.
Secondary Polycythemia
• Due to the overproduction of erythropoietin
caused by hypoxia. This is more common.
• Seen in:
– Persons living at high altitudes
– Smokers
– COPD patients
– Congestive heart failure patients
• Polcythemia leads to :
– Increased blood volume and viscosity
– Congestion of liver and spleen
– Clotting
– Thrombus formation
– (last two may be due increased numbers of
platelets along with the increase in RBC’s due
to bone marrow dysfunction.)
Clinical manifestation of
Polycythemia
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Headache
Dizziness
Weakness
Increased blood pressure
Itching / sweating
Treatment of polycythemia
• Reduce blood volume by phlebotomy –
300-500 ml.
• Treat underlying condition - Stop smoking
• Radioactive phosphorus injections
• Prevent thrombosis
Alterations in Leukocytes and
Blood Coagulation
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WBC Abnormalities
• Leukocytosis – increased numbers of WBC’s
– May be a normal protective response to
physiological stressors
– Or may signify a disease state – a
malignancy or hematologic disorder
• Leukopenia – decreased numbers of WBC’s –
this is never normal
– Increases the risk of infections.
– Agranulocytosis = granulocytopenia
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Leukeopenia may be due to:
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Radiation
Anaphylactic shock
Autoimmune disease
Chemotherapeutic agents
Idiosyncratic drug reactions
Splenomegaly
infections
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Leukemia
• A malignant disorder in which the bloodforming organs lose control over cell
division, causing an accumulation of
dysfunctional blood cells.
• Uncontrolled proliferation of non-functional
leukocytes crowds out normal cells from
the bone marrow and decreases
production of normal cells.
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Clinical manifestations
• Signs and symptoms :
– Fatigue
– Bleeding
– Fever
– Anorexia and weight loss
– Liver and spleen enlargement
Abdominal pain and tenderness – also
breast tenderness
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• Neurologic effects are common:
– Headache
– Vomiting
– Papilledema – swelling of the optic nerve
head – a sign of increased intracranial
pressure
– Facial palsy
– Visual and auditory disturbances
– Meningeal irritation
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• Early detection is difficult because it is
often confused with other conditions.
• Diagnosis is made through blood tests
and examination of the bone marrow.
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Treatment
• Chemotherapy
• Blood transfusions and antimicrobial,
antifungal and antiviral medications
• Bone marrow transplants
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Disorders of platelets
• Thrombocytopenia – decreased numbers
of platelets (below 100,000/mm3)
• Can lead to spontaneous bleeding, if low
enough, and can be fatal if bleeding
occurs in the G.I. Tract, respiratory system
or central nervous system.
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• Can be congenital or acquired;
• acquired is more common.
• Seen with:
– Generalized bone marrow suppression
– Acute viral infection
– Nutritional deficiencies of B12, folic acid and iron
– Bone marrow transplant
– drugs, especially heparin, and toxins, thiazide
diuretics, gold, ethanol…
– Immune reactions
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Thrombocythemia
• This is an increased number of platelets.
• 1- primary thrombocytothemia – cause unknown
• 2- Secondary thrombocytothemia – occurs after
splenectomy when platelets that would normally
be stored in the spleen remain in blood.
– Also due to rheumatoid arthritis and cancers.
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Disorders of Coagulation
• Clotting factor disorders prevent clot formation.
• May be genetic:
– Hemophilia – genetic absence or
malfunction of one of the clotting factors
• Or acquired - usually due to deficient
production of clotting factors by the liver:
– Liver disease
– Dietary deficiency of vitamin K
– Long treatment with anti-biotics
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