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Soriano, Michelle Ann A.

DMD3a

BLOOD

- a constantly circulating fluid providing thebody with nutrition, oxygen, and wasteremoval.- average person has about 5 liters of blood.- consists of variety of cells suspended in afluid medium called plasma.- circulated around the body through bloodvessels by the pumping action of the heart- hemoglobin is the principal determinant of the color of blood- is conducted through blood vessels(arteries and veins).- Whole blood is a mixture of plasma andblood cells

Functions:

1. Supply of oxygen to tissues2. Supply of nutrients such as glucose, amino

acids, and fatty acids(dissolved in the blood or bound

to plasma proteins (e.g., blood lipids)3. Removal of waste such as carbon

dioxide, urea, and lactic acid

4. Immunological functions, includingcirculation of white blood cells, anddetection of foreign materialby antibodies

5. Coagulation, which is one part of thebody's self-repair mechanism

6. Messenger functions, including thetransport of hormones and the signalingof tissue damage

7. Regulation of body pH8. Regulation of core body temperature9. Hydraulic functions

Blood Components:

1. Plasma- blood's liquid medium- straw-yellow in color.- makes up about half of the content of blood- It is essentially an aqueous solutioncontaining 92% water, 8% bloodplasma proteins, and trace amounts of othermaterials.- it circulates dissolved nutrients, suchas glucose, amino acids, and fatty (dissolved

NORMAL BLOOD VALUESParameter Value

Blood Volume8.5 -9.1% of total bodyweight

Acidity (pH) 7.35-7.45

Blood plasmavolume

2.7–3.0 litres (2.8–3.2quarts)

Red Blood CellCount (RBC)

4.2 - 6.9 million/µL/cumm

White Blood CellCount (WBC)

4,300-10,800 cells/µL/cumm

Platelet Count 150,000 - 350,000/mL

HemoglobinMale: 13 - 18 gm/dLFemale: 12 - 16 gm/dL

HematocritMale: 45 - 62%Female: 37 - 48%

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in the blood or bound to plasma proteins),and removes waste products, such as carbondioxide, urea, and lactic acid.

Other important components include: Serum albumin Blood-clotting factors (to

facilitate coagulation) Immunoglobulin (antibodies) lipoprotein particles Various other proteins Various electrolytes

(mainly sodium and chloride)

Serum- refers to plasma from which the clottingproteins have been removed. Most of theproteins remaining are albumin and

immunoglobulin.

2. Blood cells

a. Red blood cells (erythrocytes)- 45% of the whole blood (most abundantcells)- shaped like slightly indented, flatteneddisks- produced in the bone marrow- contain hemoglobin, an iron-containingprotein, which facilitates transportationof oxygen by reversibly binding tothis respiratory gas and greatly increasing itssolubility in blood

- blood gets its bright red color whenhemoglobin picks up oxygen in the lungs. As

the blood travels through the body, thehemoglobin releases oxygen to the tissues.- life span of about 4 months (120 days)Each day, the body produces new RBCs toreplace those that die or are lost from thebody.

- primarily involved in the transport of oxygenand carbon dioxide

- function exclusively within the vascularsystem

HEMATOLOGIC DISORDERANEMIA- most common condition affecting RBCs- lower-than-normal number of red cells in

the blood.- accompanied by a decrease in the amountof hemoglobin- typically is caused by either inadequateRBC production or unusually rapid RBCdestruction

 Three main bodily mechanisms that produceanemia are:1. Excessive destruction of RBCs2. Blood loss3. Inadequate production of RBCs

*Among many other causes, anemia canresult from inherited disorders, nutritionaproblems (such as an iron or vitamindeficiency), infections, some kinds of canceror exposure to a drug or toxin.

Anemia Caused by Destruction of RBCs

a. Hemolytic anemia- occurs when red blood cells are beingexcessively destroyed in the blood or spleenprematurely.-shorter RBC lifespan- happens for a variety of reasons: sonetimesinfections or certain medications (such asantibiotics or anti-seizure medicines)

Autoimmune hemolytic anemia

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-the immune system mistakes RBCs forforeign invaders and begins destroying them.

Common forms of inherited hemolyticanemia:

• Sickle cell anemia- is a severe form of anemia- red blood cells become crescent-shaped

because of a genetic defect.- they break down rapidly, so oxygen does

not get to the body's organs, causinganemia.

- the crescent-shaped red blood cells alsoget stuck in tiny blood vessels, causing pain.

•  Thalassemia- abnormal and short-lived RBCs.- Thalassemia major also called Cooley's

anemia, is a severe form of anemia in whichRBCs are rapidly destroyed and iron isdeposited in the skin and vital organs.

- Thalassemia minor involves only mildanemia and minimal red blood cell changes.

• Glucose6-phosphate dehydrogenase(G6PD)deficiency

- RBCs either do not make enough of theenzyme G6PD or the enzyme that isproduced is abnormal and doesn't work well.- when someone born with this deficiencyhas an infection, takes certain medicines, oris exposed to specific substances, the body'sRBCs suffer extra stress. Without adequateG6PD to protect them, many red blood cellsare destroyed prematurely.

• Hereditary spherocytosis- is a genetic disorder of the RBC'smembrane that can cause anemia, jaundice(yellow-tinged skin), and enlargement of thespleen.- the RBCs have a smaller surface area than

normal red blood cells, which can causethem to break open easily.- a family history increases the risk for thisdisorder

Anemia Caused by Blood Loss

a. Blood loss can also cause anemia

-excessive bleeding due to injury, surgery,or a problem with the blood's clotting ability.-slower, long-term blood loss, such as

intestinal bleeding from inflammatory bowe

disease (IBD)- heavy menstrual periods in teen girls and

women.- any of these factors will also increase thebody's need for iron because iron is neededto make new RBCs.

Anemia Caused by InadequateProduction of RBCs

Red blood cells may be faulty or decreaseddue to abnormal red blood cells or the a lack

of minerals and vitamins needed for redblood cells to work properly.

a. Aplastic anemia-occurs when the bone marrow can't make

enough RBCs.-can be due to a viral infection, or exposure

to certain toxic chemicals, radiation, omedications (such as antibiotics, antiseizuredrugs, or cancer treatments).

-some childhood cancers can also causeaplastic anemia, as can certain chronic

diseases that affect the ability of the bonemarrow to make blood cells.

b. Iron-deficiency anemia- occurs when the body isn't able to produce

enough healthy RBCs because of an irondeficiency- an iron-poor diet, especially in infantschildren, teens and vegetarians-the metabolic demands of pregnancy andbreastfeeding that deplete a woman's ironstores- menstruation- frequent blood donation- endurance training- certain drugs, foods, and caffeinated drinks

c. Vitamin deficiency anemia- may occur when vitamin B-12 and folate

are deficient.

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- these two vitamins are needed to make redblood cells.- conditions leading to anemia caused byvitamin deficiency include the following:

• Megaloblastic anemia: Vitamin B-12 or

folate or both are deficient• Pernicious anemia: Poor vitamin B-12

absorption caused by conditions suchas Crohn's disease, an intestinalparasite infection, surgical removal of part of the stomach or intestine, orinfection with HIV

• Dietary deficiency : Eating little or nomeat may cause a lack vitamin B12,while overcooking or eating too fewvegetables may cause a folatedeficiency

• Other causes of vitamin deficiency :pregnancy, certain medications,alcohol abuse, intestinal diseases

*During early pregnancy, sufficient folic acidcan prevent the fetus from developing neuraltube defects such as spina bifida.

SIGNS AND SYMPTOMS:

 The symptoms of iron deficiency anemia (if any) are:

• fatigue• Irritability• Paleness• Weakness•  Tiredness• dizziness, lightheadedness, and a

rapid heartbeat• Chest pains (in severe cases)• Shortness of breath (in severe cases)• Heart palpitations (in severe cases)• An increased heart rate especially

during exertion (in severe cases)• Rapid breathing• Low blood pressure

 The symptoms of vitamin B12 anemia aresimilar to those of iron deficiency anemia butcan also cause:

•  Jaundice

• Numbness and tingling in the handsand feet

• Equilibrium difficulties• Confusion• Personality changes and depression

DIAGNOSIS OF ANEMIA:1. Patient's symptoms2. Blood test that measures the level ofhemoglobin in the blood, as well assubstances such as folic acid, bilirubin andvitamin B12.3. the size of the red cells provide furtherclues to the type of anemia.4. bone marrow biopsy5. levels of ferritin in the blood ofpremenopausal women.

TREATMENT: Treatment for anemia depends on its cause.*Iron deficiency anemia-increase iron intake*Heavy or irregular menstrual periods-hormonal treatment to help regulate thebleeding.*Vitamin b12 deficiency-life-long regimen of monthly B-12 injections*Folic acid deficiency- frequently a dietary correction.- Main sources of folic acid include meatpoultry, cheese, milk, eggs, liver, green leafyvegetables, raw fruits, lima and kidneybeans, and yeast.*Depending on the cause, treatment formore severe or chronic forms of anemia mayinclude:

• transfusions of normal red blood cellstaken from a donor

• removal of the spleen or treatmentwith medications to prevent bloodcells from being removed fromcirculation or destroyed too rapidly

• medications to fight infection ostimulate the bone marrow to makemore blood cells

*In some cases of sickle cell anemiathalassemia, and aplastic anemia, bonemarrow transplantation may be used.

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PATIENT’S COUNSELING

Sickle-cell Anemia

1. Genetic counseling - for affected patientsstarting a family or parents of infected

children wishing to have more children.

2. Folic acid supplementation

3. Medications:

- Epoetin alfa - Pentoxil- Epogen - Trental- Procrit - Fixoten- Eprex - Kentadin- Epomax - Peridane- Pentoxifylline - Sufisal- Vasofyl

Iron-deficiency Anemia

1. Pharmacotherapeutic Approacha. Oral route:• Ferrous sulphate capsules• Ferrous fumarate capsules• Ferrous succinate capsules• Ferrous gluconate syrup• Colloidal Ferrous Hydroxide syrup

- can cause irritation on empty stomach

- cause constipation- Laxatives should be administered alongwith it (combined drug therapy).- Iron containing syrups cause staining of teeth. They must be taken directly at theback of the tongue.- Other common side-effects are nausea,vomiting, metallic taste in mouth andepigastric pain.

b. Parenteral route• Iron dextran intramuscular injection

• Iron sorbitol intramuscular injection

- it cause localized pain at the site of injection, metallic taste in mouth, fever,headache, joint ache.- In patients having kidney disease, iron-sorbitol injection must be avoided.

2. Non-pharmacological Approach- Iron-rich foods

PREVENTION OF ANEMIA:Consumption of a healthy diet including iron-containing foods and those with B-complex

vitamins is essential to developing andmaintaining a satisfactory blood count.

References: Jablonski, Dictionary of Dentistry Revised EditionWheaters, Functional Histology 5th Editionhttp://www.pharmainfo.net/guptashubhranshu/patient-councelling-anaemia-part-ihttp://kidshealth.org/parent/general/body_basics/blood.html#http://www.webmd.com/heart/anatomy-picture-of-blood?page=2