Slide 1 ight © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Chapter 47 Care of the Patient with a B or Lymphatic Disorder -Overview of Anatomy and Physiology
Jan 21, 2016
Slide 1Copyright © 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
Slide 2Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
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
Slide 3Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 4Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Figure 47-1Figure 47-1
Human blood cells.
(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)
Slide 5Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 6Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 7Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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”
Slide 8Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 9Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 10Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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%
Slide 11Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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%
Slide 12Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 13Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 14Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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
Slide 15Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Characteristics of blood
Overview of Anatomy and Physiology:-Characteristics of blood
• 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
Slide 16Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Figure 47-2Figure 47-2
Blood clotting.
(From Thibodeau, G.A., Patton, K.T. [2005]. The human body in health and disease. [4th ed.]. St. Louis: Mosby.)
Slide 17Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• 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
Slide 18Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• 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
Slide 19Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• 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
Slide 20Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• 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
Slide 21Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• 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
Slide 22Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Lymphatic System
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
Slide 23Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Lymphatic System
Overview of Anatomy and Physiology:-Lymphatic System
• 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
Slide 24Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology:-Lymphatic System
Overview of Anatomy and Physiology:-Lymphatic System
• 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
Slide 25Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology-Lymphatic System
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
Slide 26Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology-Lymphatic System
Overview of Anatomy and Physiology-Lymphatic System
• 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
Slide 27Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Overview of Anatomy and Physiology-Lymphatic System
Overview of Anatomy and Physiology-Lymphatic System
• 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
Slide 28Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Figure 47-4Figure 47-4
Principal organs of the lymphatic system.(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)