Fatigue

Dyspnea

Pallor

Headache

Tachycardia

Heartburn
Symptoms & Signs
Edema, especially of the ankles

Jaundice & enlargemnt of spleen (<-

hemolysis)

Numbness & tingling sensations

Syncope

Excessive blood loss

Menstruation

Pregnancy
Iron loss, demand for iron outstrips supply
Rapid growth during adolscence

Malabsorption syndrome/chronic diseases

of intestines/stomach

Negative iron balance -> iron storage in

Iron-deficiency (the leading cause) body depletes -> synthesis of hemoglobin
becomes impaired -> RBCs lose shape,
appear cigar-/pencil-shaped upon
microscopic analysis

Oral iron supplementation

Treatment Injectable iron supplements for individuals

with malabsorption/intolerable with oral
supplementation

Severe cases associated with rheumatoid

Secondary to chronic inflammatory/ arthritis/TB
infectious/autoimmune diseases
-> Defect in erythropoiesis
Moderate cases associated with cardiac
conditions
Of chronic disease
Treat underlying disease
Treatment
Therapy with erythropoietin(EPO)

Kidney fails to produce adequate amounts

Of renal disease of EPO Severe cases may result from renal failure

caused by impaired DNA synthesis

- megablobalstic RBCs are large, immature
RBCs that contain an increased ratio of RNA
to DNA - reduced hemoglobins volume

Principle dietary sources of VB12: animal

摄入不足 （vegetarians susceptible） food products

吸收障碍 - 内因子缺乏 (先天/后天 - removal

Magablobalstic Anemia 巨幼细胞贫血 Pernicious Anemia (Vitamin B12-deficiency) 缺乏原因
of stomach/bowel)

利用障碍

Etiology - 叶酸
叶酸, 维生素 （DNA合成过程中的
维生素B12（ 合成过程中的 Principle dietary sources of folic acid:
重要参与部分）缺乏 摄入不足 fruits & veg

Alcohol Abuse

Inflammation of the bowel/Crohn’s disease

吸收障碍
Folic acid deficiency 缺乏原因
Adverse effects of certain medications eg.抗
癫痫药物

需求增加 eg. pregnancy

A reduction in the quantity of RBCs/

hemoglobin in a measured volum of blood
-> reduced blood’s ability to carry oxygen
to cells (tissue hypoxia)
Anemias
利用障碍
Types of anemia (classified by causative A reduction in circulating RBCs caused by
factor) accelerated destruction of RBCs

Heredity

Exposure to chemical toxins/certain

Etiology
bacterial toxins

Autoimmunity

Hemolytic Degradation降解 of heme in the destroyed

RBC -> accumulation of bilirubin ->
jaundiced appearance in tissues & urines &
feces

Splenectomy - decrease the risk of

gallstones, severe episodes of hemolysis,
For inherited cases pathological changes to bone marrow

For hemorrhage Blood transfusions

Treatment
For infectious causes Antibiotics & supportive therapies

For immune disorders Immune suppressive therapies

Results from an insult to the hematopoietic

cells in bone marrow - exposure to
Aplastic anemia再生障碍性贫血
再生障碍性贫血 myelotoxins

a chronic hereditary hemolytic form of

anemia, found predominately in black race

Heterozygous -> mild; Homozygous ->

severe

Sickle cell crises - painful episodes;

increased susceptibility to infections

RBCs assume a sickle shape, inflexible,

Presence of hemoglobin S along with
Sickle cell anemia hemoglobin A in erythrocytes -> as RBC
deoxygenated, hemoglobin S cross-links
with other hemoglobin S & develop long
Etiology crystals
rigid -> obstruct small arterioles &
capillaries -> ischemia -> tissue hypoxia,
great pain, organ failure
RBCs fragile -> hymolysis -> hemolytic
anemia

Usually established in childhood, can’t be

cured

Hemoglobinopaties - affecting the Diagnosis & treatment Analgesics-> relieve pain

structure/function/production of Blood transfusions and fluid replacement->
hemoglobin expand blood volume & improve circulation
in blocked blood vessels

Inherited disorder, most common genetic

disorder

About 14% of African Americans are

carriers for alpha thalassemia

Beta thalassemia occurs among 10%~15%

of people from Mediterranean countries and
Occurence Southeast Asia
Thalassemia 地中海贫血 - 珠蛋白生成障碍

About 1000 severe cases occur annually in

the US

Life-threatening anemia, bone marrow

hyperactivity, enlargement of spleen, growth
Symptoms of most severe form retardation, bone deformities

Blood studies, may show reduced RBC

numbers/reduced hemoglobin levels/
hematocrit

Diagnosis changes in the morphology of the corpuscles

Bone marrow studies

Dizziness

Headaches

Visual disturbances
Neurologic symptoms
Syncope

Mental sluggishness

Irritability

Dyspnea

Symptoms & Signs - related to increased Hypertension

RBC mass (increased blood viscosity)
Itching & pain in fingers and toes

Splenomegaly

Night sweats

Weight loss

In severe cases - circulatory stagnation,

thromboembolism with death may occur

When plasma volume is reduced, no

decrease in RBCs

Dehydration
Relative polycythemia

Plasma loss
Possible causes
Fluid & electrolyte imbalance

An abnormal increase in the amount of of Etiology Burns

hemoglobin/the RBC count/hematocrit红细
红细
Polycythemia (Vera) 真性红细胞增 胞比容 -> an absolute increase in RBC mass
A rise in RBC accompanied by an increase
多 in WBCs & platelets

Most common in men 40-50 yrs old

Absolute polycythemia (Polycytheia Vera)
干细胞非控制的肿瘤性增生

病因尚不明确, 可能的发病机制 干细胞对红细胞生成素敏感度增强

造血干细胞基因突变 超过95%患者可见JAK2 V617F基因突变

An abnormal increase in RBC numbers &

hemoglbin levels & Hematocrit

Elevated leukocyte & thrombocyte counts

Diagnosis
Enlarged spleen

Clinical picture & total RBC mass evaluation

Periodic phlebotomy to reduce blood volume

Chemotherapeutic agents to help suppress

the production of blood cells by bone
Treatment Decreasing the thickness of blood
marrow

Pain medication
Managing symptoms
Antihistamine

Results from impaired production/increased

destruction of platelets

A common cause - cancer chemotherapy/

radiation treatment -> suppress platelet
formation by destroying bone marrow

Blood Dyscrasias Etiology

The most common bleeding problem among
hospitalized patients

Body vulnerable to prolonged bleeding

Spontaneous hemorrhages often visible on

skin as small, flat, red spots - petechiae 瘀
点; large purplish patches - ecchymoses 瘀
斑

Blood microscopic examination & bone

Diagnosis marrow examination
Thrombocytopenia 血小板减少症
Treat underlying causes

Preventive measures - avoid accidental

Treatment trauma

Platelet transfusions reserved for severe

condition/severe bleeding

An autoimmune disorder resulting in excess

destruction of platelets

Most commonly occurs as an acute problem

in children less than 5yrs following a viral
infection; in adults - chronic/rarely follows
viral infection

Characterized by the sudden appearance of

*A subtype - Idiopathic thrombocytopenia petechiae
purpura (ITP) 特发性血小板减少性紫癜
Based on appearance of severe
thrombocytopenia

Diagnosis Suspected immune disorder -> analysis of

blood for presence of antibodies/phagocytic
cells

Hemorrhages usually controlled by

corticosteroids

Treatment Removal of spleen reserved for patients

who do not respond to medications/with
severe condition

Disorders of hemostasis 大多数凝血因子再肝脏合成

大多数凝血因子再肝脏合成, 少数在内皮细胞等
位置合成

维生素
维生素K依赖性凝血因子：
依赖性凝血因子：II因子（凝血酶原）
因子（凝血酶原）VII
因子 IX因子
因子 X因子
因子
一些physio
Interrupted synthesis of vitamin K/Impaired
absorption of vitamin K -> vitamin K
deficiency
Vitamin K - a fat soluble vitamin thats
synthesized by intestinal bacteria Vitamin K deficiency can occur in newborns - some have not yet
developed the intestinal bacteria that
synthesize the vitamin

An X-linked recessive disorder, primarily

affects males

Etiology - genetic, deficiency in clotting

factor VIII

Bleeding often occurs in the GI tract/in the Without proper treatment, chronic bleeding
joints of hip/knee/elbow/ankle -> inflammation -> joint fibrosis -> major
inflammation with acute pain & swelling disability
Hemophilia A 血友病
血友病A
Intracranial hemorrhage - a cause of death
in severe hemophilia

Regular replacement of factor VIII with

additional doses administered during
phases of acute bleeding

Coagulation Defects (deficiency/impairment
of one or more of the clotting factors)
Inherited bleeding disorders Mild cases - sometimes treated with
Treatment
desmopression (a synthetic hormone that
stimulates the release of the carrier for
factor VIII)

Caused by a deficiency in the von

Willebrand clotting factors (vWF)
Von Willebrand’s Disease (vWD) 血管性假血
友病 Defect in the adhesion of platelets

Reduced level of factor VIII

A potentially life-threatening condition that

involves destruction of the platelets &
consumption of clotting factors

Sepsis/blood infection

Endothelial damage

Shock
Etiology
Obstetrical complications associated with
delivery of a child
Disseminated Intravascular Coagulation (
DIC) 弥散性血管内凝血 Some types of cancer

Usually diagnosed on the basis of

underlying disease

Diagnosis Low platelet counts on a. Peripheral blood

test, increases in bleeding times, presence
of degradation products in blood plasma

Treating underlying disorder

Platelet transfusions
Treatment

Administration of concentrates of
Supportive treatment coagulation inhibitors

Administration of an intravenous
anticoagulant

Reduction of circulating neutrophils ->

increased risk for bacterial & fungal
infections

Classic signs eg swelling & pus formation

may be diminished/absent in a severely
neutropenic individual

Infectious complications depend on severity

of the condition -> symptoms eg fever, skin
inflammation

cancer chemotherapy or medical immune

suppression (suppress cellular proliferation
within bone marrow)
Agranulocytosis (Neutropenia) 粒细胞缺乏症 Frequently secondary to
Rheumatoid arthritis
Etiology

Primary condition with unknown causes

Complete blood count + bone marrow

Diagnosis examination

May resolve without treatment

For severe cases - hospitalization with

isolation & IV antibiotic therapy

Treatment For neutropenia secondary to cancer

treatment - Growth factors (colony-
stimulating factors) stimulates production of
WBCs

Autoimmune case - corticosteroids may help

*hypereosinophilia can occur in response to

Disorders of White Blood Cells a parasitic infection as a normal immune
response

IHS occurs mainly in males 20-50yrs

CHF

Myocarditis
Heart problems
Conduction defects
Persistent increases in blood eosinophils &
associated involvement of the heart and
Valve dysfunction
nervous system
Idiopathic Hypereosinophilic Syndrome
Altered behavior & cognitive function

Neurologic problems Spasticity痉挛状态

Ataxia(impaired coordination)

Eosinophill Abnormalities If without treatment - poor prognosis with

median survival of 1 yr; chemotherapy
recently reported to produce 70% survival at
10yrs

Related to the ingestion of L-tryptophan

Eosinophilia-Myalgia Syndrome 嗜酸性粒细胞
增多-肌痛综合症 Characterized by muscle pain, fatigue, skin
changes, nervous system abnormalities,
pulmonary hypertension