chapter 47 care of the patient with a blood or lymphatic disorder -overview of

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Chapter 47

Care of the Patient with a Blood

or Lymphatic Disorder

-Overview of

Anatomy and Physiology

Chapter 47

Care of the Patient with a Blood

or Lymphatic Disorder

-Overview of

Anatomy and Physiology


Overview of Anatomy and Physiology:-Characteristics of blood


• Ancient times Referred to as “river of life” or “fluid of life”

• Contains RBC, WBC, platelets which are suspended in a light

yellow fluid called plasma

• Consistency 45% blood cells 55% blood plasma

• pH 7.35 to 7.45

• Volume 5 to 6 liters or 10 to 12 pints




• 3 Functions 1. transports oxygen and nutrition to cells and waste

products away from cells and transports hormones from endocrine glands to tissue cells

2. regulates acid-base balance (pH) with buffers, aids with body temperature because of its water content and controls the water content of its cells as a result of dissolved sodium ions

3. protects body against infection with special cells and prevents blood loss with special clotting mechanisms


Figure 47-1Figure 47-1

Human blood cells.

(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)




• Red blood cells (RBC) Erythrocytes

• Men = 5.5 million per cubic millimeter

• Women = 4.8 million per cubic millimeter Contains cytoplasm and Hgb

• Transport oxygen and carbon dioxide

• Men = 14 to 18 gm/dL

• Women = 12 to 16 gm/dL Life span of 120 days Produced in

• Red bone marrow in vertebrae, ribs, sternum, proximal ends of humerus and femur




• Erythropoiesis: RBC production depends on: health condition of BM; dietary

substances like rion and copper, plus essential AA; and vitamins like B12, folic acid, riboflavin (B2), pyridoxine (B6)

Feedback mechanism:• Decreased oxygen triggers release of erythropoietin

from the kidneys

• Erythropoietin increases maturation of RBC

• Increased RBC allows more O2 delivered to cells and signals RBC production to shut off

Hematocrit• Measure of packed cell volume of RBC




• Erythropoiesis: RBC production (cont’d) Hematocrit

• Measure of packed cell volume of RBC

• Men 42% to 52%

• Women 37% to 47% Hemoglobin falls below normal (anemia):

• Less hemoglobin, less oxygen transported to cells, slower breakdown and use of nutrients by cells, less energy produced by cells, decreased cellular function

• Anemic complains of feeling “tired all the time”




• White blood cells (WBC) – leukocytes Nucleated, colorless, live from few days to years Body defenses: destruction of bacteria and viruses Two broad categories:

• Granulocytes and agranulocytes Granulocytes:

• Neutrophils, eosinophils, basophils Agranulocytes

• Lymphocytes and monocytes




• White blood cells (WBC) – leukocytes (cont’d) Neutrophils

• Granular circulating leukocytes for phagocytosis

• Ingest bacteria and dispose of dead tissue

• Primary phagocytic cells in acute inflammatory response

• Mature are called segmental neutrophil or “seg”

• Release lysozyme

• Immature neutrophils Immature polymorphonuclear leukocytes (polys) called

bands in their final stages of development

• Presence of excess bands in the periphery is called shift to the left and indicates a severe infection




• White blood cells (WBC) – leukocytes (cont’d) Eosinophils

• Plays in allergic reaction and effective against parasitic worms

• Normal value is 1% to 4% Basophils

• Nonspecific immune response to inflammation because of role in releasing histamine (vasodilator)

• Cytoplasmic granules that contain heparin, serotonin, and histamine

• Normal values 0.5% to 1%




• Monocytes Function similar to neutrophils; circulate in blood

stream and move into tissue where they engulf antigens and cell debris

Second to arrive at scene of injury Useful in removing dead bacteria and cells in recovery

stage of acute bacterial infections Normal value is 2% to 6%




• Lymphocytes For antibody formation Two groups:

• B cells and T cells

• B cells: function to search out, identify and bind with specific antigens

• T cells: when exposed to antigen, divide rapidly and produce new T cells that are sensitized to that antigen

Normal values are 20% to 40%

• See Table 47-1, pg 1531-1532




• Thrombocytes (platelets) Smallest cell in the blood Circular cell fragments, do not have nuclei Life span of 5 to 9 days Normal value of 150,000 to 400,000 per cubic mm Initiate blood clotting and produced in the BM


Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology

• Hemostasis: A body process that arrests the flow of blood and

prevents hemorrhage 1. vessel spasm 2. platelet plug formation 3. clot formation Vessel tear, smooth muscle in the walls of vessel

causes it to contract Platelet rush to area and seals it




• Hemostasis Clot formation

• Injury

• Hemorrhage

• Grouping platelets

• Thromboplastin released (reacts along with calcium ions)

• Converts prothrombin to thrombin

• Links with fibrinogen

• Formation of fibrin

• Trap RBCs and platelets

• Forms clot



Blood clotting.

(From Thibodeau, G.A., Patton, K.T. [2005]. The human body in health and disease. [4th ed.]. St. Louis: Mosby.)



• Blood types (groups) Determined by the presence or absence of specific

antigens on the outer surface of the RBC• Type A

• Type B

• Type AB Universal recipient

• Type O Universal donor

In certain types of blood, the Ag on RBCs are accompanied by Ab found in blood plasma



• Blood types (groups) Type A blood:

• RBCs contain type A antigen and the plasma contains anti-B antibodies

Type B:• RBCs contain type B antigen and the plasma contains

anti-A antibodies Type AB:

• RBCs contain bothe type A and type B antigens, and the plasma contains neither anti-A nor anti-B antibodies

Type O:• RBCs contain neither type A nor type B antigens and

plasma contains both anti-A and anti-B



• Harmful effects or death result from a blood transfusion if donor’s RBCs become agglutinated by antibodies in recipient’s plasma (fig. 47-3, pg 1534)

• Two types of reaction: Agglutination and hemolyzation Agglutination

• Donor cells clump together because of the antibodies

• Occludes arteries resulting to death Hemolyzation

• Antibodies cause RBCs of recipient to rupture, releasing their contents

• Can lead to death



• Rh factor Rh antibodies may be located on the surface of the

RBC• Rh positive: antibodies are present

• Rh negative: antibodies are not present 85% are Rh +; 15% are Rh – Rh incompatibility seen commonly in pregnancy If Rh antibody is present in mother then given IM dose

of RhoGAM, a desensitization drug• Enables her to carry next infant without complications



• Rh factor Normally, plasma does not contain Rh antibodies;

develop in response to individual’s receiving wrong type of blood

• Develop Rh antibodies develop in 2 weeks and remain in the blood

• Rh – person receives more Rh + blood , reaction occurs because Rh + antibodies react with donor blood, hemolysis occurs


Overview of Anatomy and Physiology:-Lymphatic System


• Consist of lymphatic vessels, lymph fluid and lymph tissue

• Functions Maintenance of fluid balance Production of lymphocytes Absorption and transportation of lipids from the

intestine to the bloodstream




• Lymph and lymph vessels• Lymph is a specialized fluid formed in the tissue

spaces transported by way of the lymphatic vessels and reenters the circulatory system

• Substances that cannot enter or return through capillary walls, including excess fluid and protein molecules, are returned to blood as lymph




• Lymphatic tissue• Lymph nodes

Two functions: 1) filter impurities from lymph; 2) produce lymphocytes (WBCs)

Act as filters, keeping particulate matter such as bacteria from entering bloodstream

Small bean shaped structures appearing in groups Body contains 500 to 600 nodes Most numerous in axilla, groin, abdomen, thorax,

cervical regions


Overview of Anatomy and Physiology-Lymphatic System


• Lymphatic tissue (continued) Tonsils

• Masses of lymphoid tissue embedded in mucous membrane of oral cavity and pharynx

• Produce lymphocytes and antibodies

• Trap bacteria and become enlarged

• Larger in children and begin to atrophy at age 7




• Lymphatic tissue (continued) Spleen

• Reservoir for blood (1 pint of blood) which can be released during emergencies like hemorrhage in less than 60 seconds

• Main functions: 1) reservoir for blood 2) forms lymphocytes, monocytes, and plasma cells 3) destroys worn-out RBCs 4) removes bacteria by phagocytosis 5) produce RBCs before birth




• Lymphatic tissue (continued) Thymus

• Functions in utero (before birth) and a few months after birth to develop immune system

• Responsible for development of T lymphocytes of cell-mediated immune response before they migrate to lymph nodes and spleen

• Atrophies at puberty and replaced by fat and connective tissue



Principal organs of the lymphatic system.(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)

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