Blood Disorders

Blood disorders have an impact on the main components of the bloodred blood cells, which carry oxygen throughout the body; white blood cells, which fight infection; and platelets, which help through their blood clotting mechanism. Some blood disorders are caused by genes. However, blood disorders can also result from other diseases, medications, or lack of nutritional intake.

Diagnostic Tests for Blood Disorders

  • CBC (Complete Blood Count) – haemoglobin, haematocrit, reticulocyte count, red blood cell indices, MCV (mean corpuscular volume i.e. RBC size), and RDW (RBC distribution width)
  • Blood Chemistry Tests – Electrolytes, Fats, Proteins, and Glucose
  • Blood Enzyme Tests – Myoglobin, Troponin, and Creatine-Kinase
  • Blood Clotting Tests – PT (Prothrombin Time), aPTT (activated partial thromboplastin time), TT (Thrombin Time)
  • Serum Vitamin B12 and folate levels, haptoglobin, erythropoietin levels
  • Bone Marrow aspiration
Retrieved from https://www.rch.org.au/clinicalguide/guideline_index/Anaemia/ on 19th May 2022

Anaemia

Anaemia is a blood disorder in which there is a deficiency in erythrocytes or haemoglobin, leading to tissue oxygen deprivation.

Causes

  • bleeding (eg. menstruation, childbirth, NSAIDs overuse [may cause ulcers and gastritis], GI conditions [ulcers, haemorrhoids, gastritis and cancer]
  • decreased or abnormal RBC production (eg. sickle-cell anaemia, iron-deficiency anaemia, vitamin deficiency, problems related to the bone marrow and/or stem cells)
  • premature RBC destruction (RBCs inability to withstand circulation stress, leading to premature rupture, causing haemolytic anaemia)

Possible complications

  • Confusion
  • Parathesias (a burning or prickling sensation usually felt in the hands, arms, legs, or feet, but can also extend to other body parts)
  • Congestive Heart Failure
  • Death

1. Iron-Deficiency Anaemia

Iron-Deficiency Anaemia is a type of anaemia in which there is lack of iron in the body. Iron is required for the production of haemoglobin for red blood cells to carry oxygen throughout the body.

2. Pernicious Anaemia

Pernicious Anaemia is a type of anaemia in which the intrinsic factor is missing. This results in lack of Vitamin B12 absorption. While Pernicious Anaemia is very common in older individuals and individuals who have had a gastric resection, it may also result from malnutrition in which B12 intake is low, such as in vegetarian diets or lack of dairy products intake.

3. Aplastic Anaemia

Aplastic Anaemia is caused by a deficiency of all blood cell types due to bone marrow development failure. Aplastic Anaemia is considered to be a rare disease.

4. Thalassemia

The term ‘Thalassemia’ refers to a group of hereditary disorders in which there is defective haemoglobin-chain synthesis. In Thalassemia there is an abnormal decrease in RBCs’ haemoglobin (hypochromia), small RBCs (microcytosis), blood element destruction (haemolysis) and anaemia.

Anaemia Clinical Manifestations

Retrieved from https://medlineplus.gov/genetics/condition/iron-refractory-iron-deficiency-anemia/ on 19th May 2022
Retrieved from https://www.kindpng.com/imgv/hiRwoTJ_symptoms-of-anaemia-symptoms-of-anemia-hd-png/ on 19th May 2022

Anaemia Nursing Care

Assessment

  • What type of anaemia is involved?
  • What symptoms is it exhibiting, and to what extent?
  • How are these symptoms leaving an impact on the patient’s daily life?
  • What medication has the patient been on – past and present? Was the patient on medications which may have caused a reduction in bone marrow activity, caused haemolysis, or affected folate metabolism?

Diagnosis

  • Fatigue (due to haemoglobin decrease i.e. reduced oxygen saturation)
  • Malnutrition (lack of required nutrition and nutrient intake)
  • Decreased Tissue Perfusion (due to reduced blood volume – hematocrit)
  • Poor Medication Compliance

Implementation

  1. ensure adequate rest to reduce fatigue along with periods of feasible activities to promote physical activity, whilst also assessing for other conditions such as pain, depression, and insomnia, which may further exacerbate fatigue
  2. encourage and/or ensure adequate nutritional intake through a healthy diet comprising of adequate iron, vitamin B12, folic acid, and protein intake (if required supplements may be recommended), whilst avoiding alcohol
  3. ensure adequate tissue perfusion through blood transfusions, IV fluids, and if required supplemental oxygen (monitor vital signs and SPO2)
  4. educate about the importance of medication compliance and management of side effects
  5. promote complication avoidance by assessing for heart failure, assessing the patient neurologically, evaluating the patient’s gait and balance, and complaints of parathesias

Evaluation

  1. assess for signs and symptoms of heart failure
  2. measure and document the patient’s weight on a daily basis
  3. intake and output charting
  4. assess for possible need of diuretics in the case of fluid retention

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Blood Components and Functions

The internal environment of the human organism is made up of blood within the blood vessels, interstitial fluid surrounding the body cells, and lymph inside the lymph vessels.

The blood is able to pick up:

  • nutrients (from the digestive tract)
  • oxygen (from the lungs)
  • hormones (from the endocrine glands)
  • enzymes (from multiple body sites)

The blood can also act as a transportation means for disease-causing organisms. For this reason, the lymphatic system helps in picking up wastes from the interstitial fluid, cleansing them of bacteria, and returning them bacteria-free into the blood.

Physical Characteristics of the Blood

blood components
Retrieved from https://quizlet.com/96941163/56-what-is-the-normal-ph-of-blood-181b-physical-characteristics-of-blood-flash-cards/ on 12th May 2022

Blood Functions

1. Transportation

Blood helps in the transportation of:

  • Oxygen (from the lungs to the body’s cells)
  • Carbon Dioxide (from the cells to the lungs)
  • Nutrients (from the digestive organs to the cells)
  • Waste Products (from the cells to the kidneys, lungs, and sweat glands)
  • Hormones (from the endocrine glands to the cells)
  • Enzymes (to various cells)

2. Regulation

Blood helps in the regulation of:

  • pH (through buffers)
  • Body Temperature (through heat-absorbing and coolant properties of its water content)
  • Water within the Cells (mainly through dissolved sodium ions)

3. Protection

Blood helps in protecting the body against:

  • Blood Loss (through the blood clotting mechanism)
  • Toxins and Foreign Microbes (through special combat-unit cells such as white blood cells)

Blood Composition

blood components
Retrieved from https://classnotes123.com/composition-of-blood-class-10/ on 12th May 2022

Blood is made up of 2 portions:

1. Formed Elements

  • make up 45% of the total blood volume
  • include Red Blood Cells, White Blood Cells (Granular – neutrophils, eosinophils & basinophils; and Agranular – lymphocytes & monocytes), and Platelets.

2. Plasma

  • makes up 55% of the total blood volume
  • water (91.5% of total plasma)
  • proteins (7% of total plasma)
  • other solutes (1.5% of total plasma)
blood components
Retrieved from https://twitter.com/drkeithsiau/status/1435631529372393476 on 12th May 2022

Haematopoiesis – Blood Cell Formation

Haematopoiesis a.k.a. blood cell formation takes place within the Red Bone Marrow (myeloid tissue in the humerus, femur, sternum, ribs, vertebrae & pelvis) and Lymphoid Tissue (in the spleen, tonsils & lymph nodes).

  • Red Blood Cells, Leucocytes & Platelets are produced within the Bone Marrow.
  • Agranular Leucocytes (lymphocytes & monocytes) are produced by the Bone Marrow and the Lymphoid Tissue.
blood components
Retrieved from https://www.pngkit.com/view/u2w7u2u2t4e6o0w7_hematopoiesis-is-the-formation-of-blood-cellular-components/ on 12th May 2022
blood components
Retrieved from https://www.researchgate.net/publication/324848224_An_In_Vitro_Model_of_Hematotoxicity_Differentiation_of_Bone_Marrow-Derived_StemProgenitor_Cells_into_Hematopoietic_Lineages_and_Evaluation_of_Lineage-Specific_Hematotoxicity/figures?lo=1 on 12th May 2022

Red Blood Cells a.k.a. Erythrocytes

  • do not contain a nucleus
  • cannot reproduce
  • cannot carry on extensive metabolic activities
  • plasma membrane is selectively permeable
  • plasma membrane encloses cytoplasm and haemoglobin
  • have a biconcave shape which promotes increased surface area for diffusion purposes
  • contain a lot of haemoglobin molecules which increase their capacity for oxygen transportation
  • allow transportation of a small amount of carbon dioxide along with haemoglobin

Normal Haemoglobin Values

Infants14-20gm/dl
Adult Females12-15gm/dl
Adult Males14-16.5gm/dl

Erythropoiesis – Erythrocyte Production

  • erythropoiesis and erythrocyte destruction usually proceed at the same pace
  • if the balance between erythropoiesis and erythrocyte destruction is disrupted, a homeostatic mechanism is initiated to promote erythrocyte production
  • in oxygen deficiency, particular kidney cells release the enzyme Renal Erythropoietic Factor which converts plasma protein into the hormone erythropoietin, which, when reaching the red bone marrow, stimulates haemocytoblasts to develop into red cells

NOTE: Blast is a short name for an immature WBC, such as a lymphoblast or myeloblast. In normal circumstances, less than 5% of the cells in healthy bone marrow at any one time are blasts. Within the bone marrow, normal blasts develop into mature, functioning blood cells and are then released into the bloodstream.

Retrieved from https://labpedia.net/erythropoiesis-rbc-maturation-rbc-counting-procedure/ on 12th May 2022

Haemoglobin in Erythrocytes

  • erythrocyte life span is around 120 days long
  • the plasma membrane of depleted cells are removed from the circulation by macrophages in the spleen, liver, and bone marrow
  • haemoglobin is broken down into Haemosiderin (iron-containing pigment which is stored or used in the bone marrow for the production of new haemoglobin for new RBCs), Bilirubin (pigment secreted by the liver into bile) and Globin (protein metabolised in the liver).
haemoglobin
Retrieved from https://www.vedantu.com/question-answer/the-protein-part-of-haemoglobin-is-a-globin-b-class-10-biology-cbse-5f7da8c25c3c1346af535ef9 on 12th May 2022

White Blood Cells a.k.a. Leucocytes

  • there is a much lesser amount of WBCs than RBCs in the human body: 700 RBCs per 1 WBC
  • leucocytes contain nuclei
  • leucocytes do NOT contain haemoglobin
  • leucocytes have surface proteins called Human Leucocyte Associated Antigens (HLA) which are unique to each and every person

There are 2 types of WBCs:

GRANULAR LEUCOCYTES:

  • NEUTROPHILS (POLYMORPHS) – make up the biggest amount of total leucocytes; involved in phagocytosis of bacterial pathogens and the release of antimicrobial chemicals
  • EOSINOPHILS – involved in phagocytosis of antigen-antibody complexes, allergens and inflammatory chemicals, and the release of enzymes which help weaken or destroy parasites
  • BASOPHILS – involved in the secretion of histamine which promotes blood flow to a particular tissue, and the secretion of heparin which promotes mobility of other WBCs by clotting prevention
  • develop from red bone marrow
  • have granules in the cytoplasm
  • have a lobed nuclei

AGRANULAR LEUCOCYTES:

  • MONOCYTES – turn into macrophages; phagocytise pathogens, dead neutrophils, and dead cells debris; and present antigens that activate other cells within the immune system
  • LYMPHOCYTES – assist with immune memory, secrete antibodies, present antigens for the activation of other cells within the immune system, and help in destroying cancer cells, virus-infected cells, and foreign cells
  • develop from lymphoid and myeloid tissue
  • do not have granules in the cytoplasm
Retrieved from https://www.pinterest.com/pin/452752568781425426/ on 13th May 2022

Differential Blood Count

Type of White Blood CellNormal Differential CountHigh WBC Count Implication
Neutrophils60% – 70%damage caused by invading bacteria
Eosinophils2% – 4%allergic reaction
Basophils0.5% – 1%allergic reaction
Lymphocytes20% – 25%antigen-antibody reaction
Monocytes3% – 8%chronic infection

Life Span of Leucocytes

  • leucocytes can live from just a few days to a few months, depending on what type of leucocytes they are
  • during infection, white blood cells become very active, usually living for only a few hours

Platelets

  • platelets contain no nucleus
  • platelets have a life span of between 5 to 9 days
  • platelets help prevent fluid loss through a chain of reaction leading in blood clotting
  • stem cell development from haemocytoblast to platelets takes place in the red bone marrow
Stem cell developmental pathway. Retrieved from https://slideplayer.com/slide/12774626/ on 14th May 2022

Plasma

Plasma is made up of:

  • WATER – 90% of total amount of water in plasma is derived from the GI tract; 10% is derived from cellular respiration; water absorbs heat and acts as a solvent and suspending medium for the blood’s solid components
  • SOLUTES – makes up 8.5% of the total plasma volume
  • PROTEINS – ALBUMINS (55% of plasma proteins) are produced by the liver; provide viscosity in the blood which helps maintain blood pressure; exert osmotic pressure to help in maintaining water balance between the blood and the tissues; help regulate blood volume; GLOBULINS (38% of plasma proteins) a.k.a. antibodies; FIBRINOGEN (7% of plasma proteins) is produced by the liver; it helps in the blood clotting process
blood plasma components
Retrieved from https://www.austincc.edu/apreview/PhysText/Blood.htm on 14th May 2022

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