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

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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

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• 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

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• 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

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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

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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

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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

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• 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

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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

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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

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• 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

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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

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• 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

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• 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

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• 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

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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

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• 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

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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

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Hemophilia

• Pronounced– (hee-moh-FILL-ee-ah)

• Defined– Hereditary inadequacies of coagulation

factors resulting in prolonged bleeding times

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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

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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

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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

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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

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Leukemia

• Classifications of leukemia– AML

• Acute Myelogenous Leukemia

– ALL• Acute Lymphocytic Leukemia

– CML• Chronic Myelogenous Leukemia

– CLL• Chronic Lymphocytic Leukemia

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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

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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

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• 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

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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

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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

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• 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

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• 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

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• 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

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• 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

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• 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

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• Hematocrit– Assessment of RBC percentage in total blood

volume

• Hemoglobin test– Concentration measurement of hemoglobin in

peripheral blood

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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

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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

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• 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


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• 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

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• Lymphatic system is an important part of the immune system – Immune system consists of:

• Bone marrow• Thymus• Lymphoid tissues• Lymph nodes• Spleen• Lymphatic vessels

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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

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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

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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

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Lymph Vessels

• Lymphatic ducts– Thoracic duct

• Receives lymph drainage from remaining regions of the body

• Empties into left subclavian vein

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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

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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

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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

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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

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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

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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

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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

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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

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• 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

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• 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

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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

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• 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

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• 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

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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


• 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


blood and lymphatic systems chapter 9. 2 blood system overview blood transports oxygen and nutrients...

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