Chapter 7: Diseases and Disorders of the Blood

Chapter 7: Diseases and Disorders of the Blood CHAPTER OVERVIEW The anatomy and physiology of the blood and blood components is reviewed. Hematological diseases and disorders are explained. Diagnostic tests and procedures for diseases and disorders of the blood are introduced. The treatments for hematological diseases and disorders are identified. Preventative measures for hematological diseases and disorders are listed. TRANSITION GUIDE/NEW TO THE EIGHTH EDITION Chapter reviewed to ensure accuracy and to include any updates or changes in chapter content. New art was incorporated into the chapter to enhance student learning. Added a Promote Your Health feature in the chapter. Added a section on age-related diseases to the chapter. Expanded the Diseases at a Glance section at the end of the chapter. Updated and reviewed the professional references at the end of the chapter. CHAPTER OUTLINE Introduction Anatomy and Physiology Review Diagnostic Tests and Procedures Anemia Iron-Deficiency Anemia Anemia of Chronic Disease Anemia of Renal Disease Megaloblastic Anemia Vitamin B12-Deficiency Anemia Folic Acid–Deficiency Anemia Hemolytic Anemia Hemoglobinopathies Polycythemia Vera Disorders of Hemostasis Thrombocytopenia Coagulation Defects Hemophilia A Von Willebrand's Disease Disseminated Intravascular Coagulation Disorders of White Blood Cells Neutropenia Eosinophil Abnormalities Age-Related Diseases CHAPTER OBJECTIVES Distinguish between formed elements and plasma Describe the function of red blood cells, white blood cells, and platelets Identify the characteristics, diagnosis, and treatments of the main types of anemia Identify the characteristics, diagnosis, and treatments of hemoglobinopathies Identify the characteristics, diagnosis, and treatments of the main types of clotting disorders Identify the characteristics, diagnosis, and treatments of selected inherited disorders of the blood Identify the characteristics, diagnosis, and treatments of disorders affecting leukocytes INSTRUCTIONAL GOALS Objective 1: Distinguish between formed elements and plasma. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 2: Describe the function of red blood cells, white blood cells, and platelets. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 3: Indentify the characteristics, diagnosis, and treatments of the main types of anemia. Utilize the PowerPoint presentations as a starting point for your lecture. Review the feature —Prevention PLUS!: Anemia and Vegetarians. Review the feature —Healthy Aging: Preventing Vitamin B12 Deficiency. Objective 4: Indentify the characteristics, diagnosis, and treatments of hemoglobinopathies. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 5: Indentify the characteristics, diagnosis, and treatments of the main types of clotting disorders. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 6: Indentify the characteristics, diagnosis, and treatments of selected inherited disorders of the blood. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 7: Indentify the characteristics, diagnosis, and treatments of disorders affecting leukocytes. Utilize the PowerPoint presentations as a starting point for your lecture. WORKSHEET 1: Define the Terms anemia basophils consumptive coagulopathy disseminated intravascular coagulation (DIC) ecchymoses eosinophilia-myalgia syndrome eosinophils erythrocytes erythropoeisis erythropoietin globin heme hemoglobin hemoglobinopathies hemolysis hemostasis hypoxia idiopathic hypereosiniphilic syndrome intrinsic factor leukocytes lymphocytes monocytes neutrophils pernicious anemia petechiae plasma platelets polycythemia vera renal failure sickle cell anemia splenectomy thalassemia thrombocytopenia thrombus WORKSHEET 2: Testbank Questions and Asnwers 7.1 Multiple-Choice Questions 1) Plasma contains the protein _____, which promotes the blood's ability to hold water and maintain pressure inside the blood vessels. A) albumin B) hemoglobin C) lymphocytes D) platelets Answer: A Objective 1 2) _____, or red blood cells, make up about half of the blood's volume. A) Erythrocytes B) Leukocytes C) Lymphocytes D) Monocytes Answer: A Objective 2 3) _____ is the iron-containing molecule found in red blood cells. A) Globin B) Heme C) Plasma D) Platelets Answer: B Objective 2 4) With no _____, red blood cells do not grow or repair themselves. A) cell wall B) cytoplasm C) Golgi apparatus D) nucleus Answer: D Objective 2 5) Old red blood cells are removed from the body by the _____. A) bone marrow and thymus B) kidneys and intestine C) liver and spleen D) stomach and spleen Answer: C Objective 2 6) In the lungs, hemoglobin binds to oxygen, becoming _____. A) carboxyhemoglobin B) erythropoeisis C) hemoglobinopathies D) oxyhemoglobin Answer: D Objective 2 7) Mature red blood cells emerge from the bone marrow as _____. A) erythrocytes B) leukocytes C) monocytes D) reticulocytes Answer: D Objective 2 8) The primary function of _____ is to defend tissues against infections and foreign substances. A) erythrocytes B) leukocytes C) plasmas D) platelets Answer: B Objective 2 9) _____ are produced in the bone marrow and are essential for blood clotting. A) Erythrocytes B) Leukocytes C) Plasmas D) Platelets Answer: D Objective 2 10) Vitamin _____ is required for the synthesis of the prothrombin and thrombin clotting factors. A) A B) D C) E D) K Answer: D Objective 2 11) _____ blood analysis provides qualitative information such as size, shape, and ratio of one cell type to another. A) Complete blood count B) D-Dimer C) Differential D) Serum chemistry Answer: C Objective 2 12) A _____ is used to diagnose malignant blood disorders and increases or decreases in blood counts. A) bone marrow smear B) CT scan C) MRI D) splenectomy Answer: A Objective 2 13) Risk factors for _____ anemia include excessive blood loss, menstruation, pregnancy, and rapid growth during adolescence. A) folic acid–deficiency B) iron-deficiency C) megaloblastic D) vitamin B12 Answer: B Objective 2 14) The _____ stage in the development of iron-deficiency anemia is a negative iron balance, in which the demands for iron exceed the body's ability to absorb iron from the diet. A) first B) second C) third D) fourth Answer: A Objective 2 15) The _____ of iron-deficiency anemia occurs when the iron stores of the body become depleted. A) first B) second C) third D) fourth Answer: B Objective 2 16) The most frequent cause of iron deficiency in men and postmenopausal women is _____. A) cardiovascular disease B) gastrointestinal bleeding C) infectious diseases D) vitamin B12 deficiency Answer: B Objective 2 17) What type of anemia is caused by the failure to produce adequate amounts of erythropoietin? A) Anemia of renal disease B) Hemolytic anemia C) Pernicious anemia D) Sickle cell anemia Answer: A Objective 3 18) In some cases of anemia of chronic disease, therapy with the hormone _____ may be used. A) antidiuretic hormone B) erythropoietin C) estrogen D) testosterone Answer: B Objective 3 19) In some blood disorders, treatment with erythropoietin, a hormone secreted by the _____, will be used. A) kidneys B) pancreas C) pituitary gland D) thyroid gland Answer: A Objective 3 20) The _____ are caused by impaired DNA synthesis. A) folic acid–deficiency anemias B) iron-deficiency anemias C) megaloblastic anemias D) vitamin B12 anemias Answer: C Objective 3 21) The underlying cause of impaired erythropoiesis in megaloblastic anemia is deficiency in vitamin _____ and/or folic acid. A) B12 B) C C) E D) K Answer: A Objective 3 22) Vegetarians who eat no animal products may develop _____. A) pernicious anemia B) polycythemia vera C) sickle cell anemia D) thalassemia Answer: A Objective 3 23) It would take approximately three to six _____ for a normal individual to become deficient in vitamin B12 if absorption were to cease abruptly. A) days B) weeks C) months D) years Answer: A Objective 3 24) Symptoms of _____ include abdominal distress, nausea and vomiting, and burning of the tongue. A) pernicious anemia B) polycythemia vera C) sickle cell anemia D) thalassemia Answer: A Objective 3 25) Folic acid is synthesized by many different types of plants and _____. A) bacteria B) fungi C) parasites D) viruses Answer: A Objective 3 26) _____ is a reduction in circulating red blood cells that is caused by accelerated destruction of red blood cells. A) Anemia of renal disease B) Hemolytic anemia C) Pernicious anemia D) Sickle cell anemia Answer: B Objective 3 27) Unlike other anemias, hemolytic anemia produces increased serum levels of _____. A) bilirubin B) erythrocytes C) heme D) iron Answer: A Objective 3 28) In hemolytic anemia, the accumulation of _____ causes a jaundiced or yellow-orange appearance in the tissues, urine, and feces. A) bilirubin B) erythrocytes C) hemoglobin D) platelets Answer: A Objective 3 29) Approximately _____ of African Americans have the sickle cell anemia trait. A) 10% B) 20% C) 30% D) 40% Answer: A Objective 6 30) In sickle cell disease, red blood cells contain an abnormal form of _____. A) bilirubin B) hemoglobin C) plasma D) platelets Answer: B Objective 4 31) In sickle cell disease, crystals continue to form as _____ is released, and the red cells assume a sickled shape. A) carbon dioxide B) heme C) oxygen D) platelets Answer: C Objective 4 32) In sickle cell disease, tissue death caused by _____ causes great pain and may lead to organ failure. A) ecchymosis B) hemolysis C) ischemia D) petechiae Answer: C Objective 4 33) Treatment for sickle cell anemia is aimed at preventing sickle cell _____. A) ecchymosis B) hemolysis C) ischemia D) petechiae Answer: B Objective 4 34) The most severe forms of thalassemia produce severe, life-threatening _____. A) anemia B) hemolysis C) ischemia D) petechiae Answer: A Objective 4 35) Polycythemia vera is most commonly seen in _____. A) children B) elderly C) men D) women Answer: B Objective 4 36) The signs and symptoms of _____ result from increased viscosity of the blood. A) polycythemia vera B) sickle cell anemia C) thalassemia D) thrombocytopenia Answer: A Objective 4 37) Because of the increased concentration of blood cells in patients with _____, a patient may experience itching and pain in their fingers and toes. A) polycythemia vera B) sickle cell anemia C) thalassemia D) thrombocytopenia Answer: A Objective 4 38) Treatment for polycythemia vera is aimed at _____. A) decreasing the destruction of red blood cells B) decreasing the thickness of the blood C) increasing the number of red blood cells D) increasing the production of erythropoietin Answer: B Objective 4 39) Disorders of _____ are commonly known as bleeding disorders. A) anemia B) hemolysis C) hemostasis D) ischemia Answer: C Objective 5 40) An abnormally small number of circulating _____ is the condition of thrombocytopenia. A) erythrocytes B) hemoglobin C) leukocytes D) platelets Answer: D Objective 5 41) A common cause of _____ is cancer chemotherapy or radiation treatment. A) polycythemia vera B) sickle cell anemia C) thalassemia D) thrombocytopenia Answer: D Objective 5 42) _____ can usually be corrected by treating the underlying cause. A) Hemophilia B) Sickle cell anemia C) Thalassemia D) Thrombocytopenia Answer: D Objective 5 43) Idiopathic thrombocytopenic purpura is an _____ disease. A) acute degenerative B) autoimmune C) infectious D) inflammatory Answer: B Objective 5 44) Idiopathic thrombocytopenic purpura most commonly occurs as an acute problem in _____ following a viral infection. A) children B) elderly C) men D) women Answer: A Objective 5 45) Coagulation factors VII, IX, X, and _____ require the presence of vitamin K for normal activity. A) bilirubin B) hemoglobin C) platelets D) prothrombin Answer: C Objective 5 46) Vitamin _____ is a fat-soluble vitamin that is synthesized by intestinal bacteria. A) A B) D C) E D) K Answer: K Objective 5 47) Hemophilia A is an X-linked _____. A) dominant disorder that primarily affects females B) dominant disorder that primarily affects males C) recessive disorder that primarily affects females D) recessive disorder that primarily affects males Answer: D Objective 6 48) Hemophilia A is caused by a deficiency in clotting factor A) VII B) VIII C) IX D) X Answer: B Objective 6 49) _____ is a frequent complication of cancer chemotherapy or medical immune suppression. A) Neutropenia B) Polycythemia vera C) Sickle cell anemia D) Thalassemia Answer: A Objective 6 50) Hypereosinophilia can occur in response to a _____ infection and is a normal immune response. A) bacterial B) fungal C) parasitic D) viral Answer: C Objective 7 7.2 True/False Questions 1) Red blood cells are the most abundant cells in the human body. Answer: True Objective 2 2) Unlike white blood cells, red blood cells have a nucleus. Answer: False Objective 2 3) Red blood cells have a short lifespan of only 120 days. Answer: True Objective 2 4) Erythropoeisis is regulated by the hormone erythropoietin. Answer: True Objective 2 5) Mature red blood cells emerge from the bone marrow as reticulocytes. Answer: True Objective 2 6) The symptoms of anemia are due to tissue hypoxia. Answer: True Objective 3 7) In physical examinations, the major sign of anemia is pallor. Answer: True Objective 3 8) Iron deficiency is the leading cause of anemia worldwide. Answer: True Objective 3 9) In iron-deficiency anemia, the red blood cells appear cigar-shaped or pencil-shaped. Answer: True Objective 3 10) The etiology of anemia of chronic disease most often is a defect in erythropoesis. Answer: True Objective 3 11) Patients with anemia of renal disease usually have normal serum iron. Answer: True Objective 3 12) The principal dietary sources of vitamin B12 include fruits and vegetables. Answer: False Objective 3 13) Of the various folic acid stores in the body, half of folic acid amounts are located in the liver. Answer: True Objective 3 14) Patients who have heterozygous sickle cell trait have the more severe form known as sickle cell anemia. Answer: False Objective 6 15) Patients with sickle cell disease suffer from hemolytic anemia. Answer: True Objective 6 16) Thalassemias are the most common genetic disorder in the world. Answer: True Objective 6 17) In relative polycythemia, the increase in red blood cell mass is due to a loss of plasma volume. Answer: True Objective 4 18) Thrombocytopenia makes the body vulnerable to prolonged bleeding. Answer: True Objective 5 19) The diagnosis of ITP is based on the appearance of severe thrombocytopenia. Answer: True Objective 5 20) Von Willebrand's disease is an inherited bleeding disorder that is most often diagnosed in children. Answer: False Objective 6 21) The pathogenesis of DIC involves the release of thrombin into the systemic circulation. Answer: True Objective 5 22) One of the treatments for DIC involves the administration of intravenous anticoagulants. Answer: True Objective 5 23) Patients with chronic neutropenia may experience chronic infections. Answer: True Objective 7 24) The prognosis for idiopathic hypereosinophilic syndrome is poor without treatment, with medium survival of approximately 1 year. Answer: True Objective 7 25) Eosinophilia-Myalgia syndrome has been related to ingestion of the dietary supplement L-tryptophan. Answer: True Objective 7 7.3 Short-Answer Questions 1) _____ consists mostly of water, which carries nutrients, wastes, ions, hormones, clotting factors, albumin and antibodies. Answer: Plasma Objective 1 2) Hemoglobin is composed of a protein called _____ and an iron-containing molecule. Answer: globin Objective 2 3) The process of red blood cell formation is called _____. Answer: erythropoeisis Objective 2 4) _____, or white blood cells, include neutrophils, eosinophils, basophils, monocytes, and lymphocytes. Answer: Leukocytes Objective 2 5) Platelets and _____ form a dense mesh at a wound, preventing blood loss. Answer: fibrin Objective 2 6) _____ is a condition of an abnormally low number of red blood cells. Answer: Anemia Objective 3 7) Jaundice and enlargement of the spleen occurs with anemia caused by _____, or red blood cell death. Answer: hemolysis Objective 3 8) Vitamin B12 deficiency anemia, or _____ anemia, is caused by inadequate absorption or intake of vitamin B12. Answer: pernicious Objective 3 9) _____ factor is produced in the stomach and is essential for the absorption of vitamin B12 from the small intestine. Answer: Intrinsic Objective 3 10) The surgical removal of the _____ is recommended in cases of inherited causes of hemolytic anemia. Answer: spleen Objective 3 11) The _____ are disorders affecting the structure, function, or production of hemoglobin. Answer: hemoglobinopathies Objective 4 12) _____ is an inherited blood disorder in which there is deficient synthesis of one or more protein chains. Answer: Thalassemia Objective 6 13) _____ describes a condition in which red blood cell mass is increased. Answer: Polycythemia Objective 4 14) Absolute polycythemia is also known as polycythemia _____. Answer: vera Objective 4 15) Several components are essential for _____, or the arrest of bleeding. Answer: hemostasis Objective 5 16) _____ are small, flat red spots visible on the skin caused by spontaneous hemorrhages. Answer: Petechiae Objective 5 17) _____ are large purplish patches on the skin caused by spontaneous hemorrhages. Answer: Ecchymosis Objective 5 18) Blood clotting, or _____, involves many different plasma proteins that form a blood clot. Answer: coagulation Objective 5 19) A blood clot, or _____, prevents blood loss from damaged tissues, blood vessels, or organs. Answer: thrombus Objective 5 20) In the many forms of von Willebrand's disease, there is a defect in the adhesion of _____. Answer: platelets Objective 6 21) _____ intravascular coagulation is a potentially life-threatening condition that involves destruction of platelets. Answer: Disseminated Objective 5 22) In DIC the depletion of platelets and clotting factors, also known as _____ coagulopathy, results in extensive bleeding. Answer: consumptive Objective 5 23) _____ is a reduction of circulating neutrophils, which increases the risk for certain infections. Answer: Neutropenia Objective 7 24) _____ hypereosinophilic syndrome occurs mainly in males between the ages of 20 and 50. Answer: Idiopathic Objective 7 25) Eosinophilia-_____ syndrome is a chronic, multisystem disease with a spectrum of clinical symptoms and a progressive and potentially fatal illness. Answer: myalgia Objective 7 WORKSHEET 3: Discussion Questions and Answers 7.4 Discussion Questions 1. Briefly describe what blood is and what it does. Answer: Blood is the medium for transporting oxygen, carbon dioxide, water, nutrients, proteins, hormones, and cells throughout the body. Blood also transports waste products to excretory organs of the body. Blood consists of a fluid portion called plasma, and formed elements, which include red blood cells, white blood cells, and platelets. 2. Identify and briefly explain what is used to reach a clinical diagnosis of anemia. Answer: The clinical diagnosis of anemia requires a microscopic examination and analysis of red blood cells. A detailed medical history, including information on dietary habits, family history of anemia, and information regarding the patient's medical problems, provide data for the diagnosis. 3. Explain why iron-deficiency anemia may be present during pregnancy and why iron-deficiency anemia is common in young children. Answer: During pregnancy, the demands for red blood cell production by the fetus exceed the mother's ability to provide iron. Iron deficiency in young children occurs when intake of iron does not keep pace with rapid growth and development. 4. Explain what type of persons may require vitamin B12 supplementation. Answer: Vitamin B12 supplementation is required for strict vegetarians and for those with chronic bowel disorders or individuals who have had their stomach or bowel partially or fully removed. 5. Identify who is at risk for developing folic acid–deficiency anemia. Answer: Folic acid–deficiency anemia is common in the Western world, where consumption of raw fruits and vegetables is low. Folic acid absorption can be impaired by inflammation of the bowel, as in Crohn's disease, and adverse effects of certain medications. Pregnant and lactating females, those who abuse alcohol, and individuals with kidney disease are susceptible to folic acid–deficiency anemia. 6. In addition to sites of trauma, identify where bleeding for hemophilia A is likely to occur and what the resulting signs and symptoms are. Answer: Bleeding often occurs in the gastrointestinal tract and in the joints of the hip, knee, elbow, and ankle. The bleeding causes inflammation with acute pain and swelling. Without proper treatment, chronic bleeding and inflammation can cause joint fibrosis that can progress to major disability. Intracranial hemorrhage is a cause of death in severe hemophilia. 7. Identify some of the disorders that can cause disseminated intravascular coagulation. Answer: DIC occurs during sepsis or blood infection, endothelial damage as in states of shock, obstetrical complications associated with delivery of a child, and some types of cancer.