Presenting problems in blood

disease and clinical examination

of patients

Albayan university / college of dentistry

:This seminar is presented by
Sana Sufyan mohammed
Sura abed salim
Saja haitham , sajad mortada , duha razaq ,sara auday , sara hassan and sama
.adnan
: The blood
Is a living tissue made up of liquid and solids, The liquid part, called plasma, is made of water,
salts, and protein. Over half of your blood is plasma. The solid part of your blood contains red
.blood cells, white blood cells, and platelets
Red blood cells (RBC) deliver oxygen from your lungs to your tissues and organs. White blood
cells (WBC) fight infection and are part of your immune system. Platelets help blood to clot
.when you have a cut or wound
.Blood disorders are conditions that impact the blood’s ability to function correctly
Blood disorders can be inherited or acquired. Sometimes you develop a blood disorder due to an
infection, toxic exposure, drug side effect, or lack of certain nutrients in your diet (such as iron,
.vitamin K, or vitamin B12)
:Conditions of blood disorder
Anemia -1
Anemia happens when you do not have enough red blood cells. The cells travel
with iron and hemoglobin, which is a protein that helps carry oxygen through
the bloodstream to your organs all through the body. When someone develops
anemia, they are said to be "anemic." Being anemic might mean that you feel
more tired or cold than you usually do, or if your skin seems too pale. This is
.due to your organs not receiving the oxygen they need to do their jobs
:kinds of anemia
There are several different types of anemia, but each of them causes the number of
red blood cells in circulation to drop. Red blood cell levels are low due to one of the
following reasons:
Your body cannot make enough hemoglobin (low hemoglobin).
Your body makes hemoglobin, but the hemoglobin doesn't work correctly.
Your body does not make enough red blood cells
Your body breaks down red blood cells too quickly.
The other most common type is iron deficiency anemia because of low levels of iron
in the body
:The last type is caused by
 Diets lacking in vitamin B12, or you can’t use or absorb Vitamin B12 (like pernicious
anemia).
 Diets lacking in folic acid, also called folate, or your body can’t use folic acid correctly
(like folate-deficiency anemia).
 Inherited blood disorders (like sickle cell anemia or thalassemia).
 Conditions that cause red blood cells to break down too fast (like hemolytic anemia).
 Chronic conditions causing your body to not have enough hormones to create red blood
cells. These include hyperthyroidism, hypothyroidism, advanced kidney disease and other
long-term diseases.
 Blood loss related to other conditions such as ulcer or gastritis.
: The other types of anemia
 Hemolytic anemia
 This type of anemia can be caused by inherited or acquired diseases that cause the body to make deformed
red blood cells that die off too quickly. (An acquired disease is one that you didn’t have when you were born.)
If it is not genetic, hemolytic anemia can be caused by harmful substances or reactions to certain drugs.
 Sickle cell anemia
 This genetic form of anemia happens because the shape of the red blood cells is faulty. They are sickle
shaped, which means that they can clog the blood vessels and cause damage. The hemoglobin does not work
correctly. This type of anemia is most often, but not always, found in African Americans.
Diamond-Blackfan anemia
 This is a rare blood disorder that may be inherited or acquired. In this type of anemia, the bone marrow does
not make enough red blood cells. Diamond-Blackfan anemia is diagnosed within the first year of life in
nearly 90% of people who have it.
 Aplastic anemia
 This is a type of anemia in that is caused by damaged bone marrow which is
unable to make enough red blood cells. It also may be congenital or acquired.
Another name for aplastic anemia is bone marrow aplasia (failure). Some
people might think of this condition as cancer, but it is not.
 Vegeterian or vegan anemia
This term refers to the idea that people who are vegetarians or vegans have a
difficult time getting enough iron because they don’t eat meat, poultry or
seafood. However, careful food planning makes this statement false. There are
plenty of ways to get enough iron with a plant-based diet.
Signs and symptoms

Several signs and symptoms occur in all types of anemia, such as fatigue,
shortness of breath and feeling cold. Others include:
-Dizziness or weakness.
-Headache.
-Sore tongue.
-Pale skin, dry skin, or easily bruised skin.
-Unintended movement in the lower leg (restless legs syndrome).
-Fast heartbeat.
:Prevention of anemia
Some kinds of anemia, such as those that are inherited, cannot be prevented.
However, you can prevent anemia caused by iron deficiency, vitamin B12
deficiency and vitamin B9 deficiency by eating well. This includes eating a diet
with enough foods that provide iron and these vitamins, along with vitamin C
food sources to help with the absorption. Make sure of drink enough water.
.Some studies have indicated that this will help keep hemoglobin levels up
The treatment done by having enough food also do tests like
a medical exam and a complete medical history
blood tests
urine tests
bone marrow aspiration and biopsy.
hemophilia-2
Types of hemophilia
There are two major types of hemophilia — type A and type B. Both A and B
can be:
Mild: Approximately 25% of cases are mild. A person with mild hemophilia has
factor levels of 6–30%.
Moderate: Approximately 15% of cases a moderate, and a person with moderate
hemophilia will have factor levels of 1–5%.
Severe: Approximately 60% of cases are severe, and people with severe
hemophilia will have factor levels of less than 1%.
Hemophilia A occurs due to a lack of clotting factor VIII. This type of
hemophilia is four times more common than hemophilia B. Of those, more than
half of people with hemophilia A have the severe form.
Hemophilia B, colloquially known as Christmas disease, happens due to a lack
of clotting factor IX. Hemophilia B occurs in around 1 in every 25,000 males
born worldwide.
Signs and symptoms
signs of hemophilia include:
 bruising

 hematomas, which is when there is bleeding into the muscle or soft tissues

 bleeding from the mouth and gums

 bleeding after a circumcision

 blood in the stool

 blood in the urine

 nosebleeds that are frequent and difficult to stop

 bleeding after vaccinations or other injections

 bleeding into the joints

Diagnosing hemophilia
Diagnosis of hemophilia involves:
a review of symptoms
a clinical evaluation
a review of personal medical history
blood tests and other diagnostic testing
According to the National Organization for Rare Disorders, the severity of
hemophilia can also affect symptoms.
In mild cases, a person will most likely experience:
spontaneous nose bleeds
bleeding from the mouth or gums
easy bruising or hematomas
excessive bleeding following dental or other surgical procedures or injury
Symptoms for people living with the mild form may not show until adulthood.
In moderate cases of hemophilia, a person may experience:
easy and excessive bruising
excessive bleeding following surgeries or trauma
Doctors can often diagnose moderate cases by the time the person is 5 or 6.
In severe cases of hemophilia, a person may experience spontaneous bleeding, often
in the muscles or joints. This can lead to pain and swelling.
Without treatment, it can result in arthritis in the affected joints. Doctors can often
diagnose severe cases when the person is an infant.
Treatment for hemophilia
Though no cure exists for hemophilia, doctors can successfully treat the condition.
Treatment focuses on replacing the missing protein and preventing complications. It
involves giving or replacing the clotting factors that are too low or missing.
Scientists can derive clotting factor treatments for replacement therapy from human
blood or synthetically produce a form in a laboratory. Synthetically produced factors
are called recombinant clotting factors.
Doctors often consider recombinant clotting factors as their first treatment choice
because they further reduce the risk of transmitting infections that can be present in
human blood. However, modern screening techniques have decreased the likelihood
of disease transmission from human samples.
There are two main forms of replacement therapy:
Prophylactic therapy: Some patients will need regular replacement therapy in order
to prevent bleeding. This is called prophylactic therapy. Doctors typically recommend
regular treatment for people with severe forms of Hemophilia A.
Demand therapy: This will stop the bleeding on-demand. People living with mild
hemophilia may only need demand therapy, which is a treatment that doctors provide
only after bleeding begins and remains uncontrollable .

 
:blood clotting -3
Blood clots are healthy and lifesaving when they stop bleeding. But they can also form when they
.aren't needed and cause a heart attack, stroke, or other serious medical problems
What Causes Blood Clots?
The process begins whenever flowing blood comes into contact with specific substances in your skin
or in blood vessel walls. When they touch, it usually means the skin or blood vessel wall is broken.
Waxy cholesterol plaques that form in arteries have these things inside, too. If the plaque breaks
open, they'll start the clotting process. Most heart attacks and strokes happen when a plaque in your
heart or brain suddenly bursts.
Blood clots can also form when your blood doesn't flow properly. If it pools in your blood vessels or
heart, the platelets are more likely to stick together. Atrial fibrillation and deep vein thrombosis are
two conditions where slowly moving blood can cause clotting problems
  How Does Blood Clot?
The life cycle of a normal blood clot depends on a series of chemical interactions.
1. Platelets form a plug. Tiny bits in your blood called platelets get "turned on" by triggers released when a blood
vessel is damaged. They stick to the walls in the area and each other, changing shape to form a plug that fills in the
broken part to stop blood from leaking out.
When activated, platelets also release chemicals to attract more platelets and other cells, and to set off the next step.
2. The clot grows. Proteins in your blood called clotting factors signal each other to cause a rapid chain reaction. It
ends with a dissolved substance in your blood turning into long strands of fibrin. These get tangled up with the
platelets in the plug to create a net that traps even more platelets and cells. The clot becomes much tougher and
more durable.
3. Reactions stop its growth. Other proteins offset extra clotting factor proteins so the clot doesn't spread farther
than it needs to.
4. Your body slowly breaks it down. As the damaged tissue heals, you don't need the clot any more. The tough
fibrin strands dissolve, and your blood takes back the platelets and cells of the clot.
The most common anticoagulant medications include:
Unfractionated heparin
Unfractionated heparin (UFH) works with antithrombin — a protein in the body
— to prevent new clots from forming.
A doctor will administer UFH intravenously or via an injection just beneath the
skin to allow the drug to work quickly.
Blood levels of UFH may change intermittently throughout the day. For this
reason, a person receiving UFH will require several blood tests daily.
Low molecular weight heparin
Low molecular weight heparin (LMWH) comes from UFH. The effects of LMWH on the body last
longer than those of UFH and are more predictable.
People taking LMWH can self-inject it at home, and they do not require routine blood monitoring.
Warfarin
Warfarin works by interfering with the production of vitamin K. The liver uses vitamin K to make
proteins necessary for blood clotting.
A doctor may prescribe warfarin pills for people who are transitioning from heparin treatment.
Throughout the first week of treatment, a person will require several blood tests so that doctors can
determine the correct dosage. Once a person has an established dosage, routine blood monitoring
will be necessary to prevent the risk of uncontrolled bleeding.
Direct oral anticoagulant medications
Direct oral anticoagulants (DOACs) are a newer class of anticoagulants. These drugs directly
target the specific proteins responsible for blood clotting.
DOACs act rapidly, and their effects on the body are short lasting. Missing a dose can increase
the risk of blood clots.
When a person takes them correctly, DOACs carry fewer risks than warfarin. They are less
likely to cause bleeding and to interact with foods, supplements, and other medications.
However, they tend to be more expensive. It is also vital that people do not miss their regular
doses.
Some DOAC drugs include:
apixaban
betrixaban
dabigatran
edoxaban
rivaroxaban
Immune thrombocytopenia (ITP)

is a type of platelet disorder. In ITP, your blood does not clot as it should, because you have a low
platelet count. Platelets are tiny blood cells that are made in the bone marrow. When you are injured,
platelets stick together to form a plug that seals your wound. This plug is called a blood clot. When you
have a low platelet count, you may have trouble stopping bleeding.

ITP can be acute (short-term) or chronic (long-term).

Acute ITP often lasts less than 6 months. It mainly occurs in children — both boys and girls — and is
the most common type of ITP. Chronic ITP lasts 6 months or longer and mostly affects adults.
However, some teens and children do get this type of ITP
Chronic ITP affects women two to three times more often than it affects men
ITP may not cause any symptoms. However, ITP can cause bleeding that is hard to stop. This bleeding
can be inside your body, underneath your skin,
or from your skin.

Signs of bleeding may include:

-Petechiae, which are small, flat red spots under the skin caused by blood leaking from blood vessels
-Purpura, which is bleeding in your skin that can cause red, purple, or brownish- yellow spots
-Clotted or partially clotted blood under your skin (called a hematoma) that looks or feels like a lump
-Nosebleeds or bleeding from your gums
-Blood in your urine or stool
-Heavy menstrual bleeding

Purpura and petechiae in the skin. The photograph shows two types of bruising that are common in people who have ITP. The
larger red, brown, and purple dots are purpura, and the smaller red and purple dots are
To diagnose ITP, your provider will ask about your medical and family history. They will
also ask about your symptoms and do a physical exam to look for signs of bleeding.

Your provider may order one or more of the following blood tests.
Complete blood count (CBC): This test measures your platelet count and the number of
other blood cells in your blood.
Blood smear: For this test, some of your blood is put on a slide. A microscope is used to
look at your platelets.
Bone marrow test These tests check whether your bone marrow is healthy. You may need
this test to confirm that you have ITP
Thalassemias

are inherited blood disorders. "Inherited" means that the disorder is passed from parents to children through
genes.

Thalassemias cause the body to make fewer healthy red blood cells and less hemoglobin than normal.
People who have thalassemias can have mild or severe anemia. Anemia is caused by a lower than normal
number of red blood cells or not enough hemoglobin in the red blood cells.

diagnose thalassemias using blood tests. The disorders are treated with blood transfusions, medicines, and
other procedures.Treatments for thalassemias have improved over the years. People who have moderate or
severe thalassemias are now living longer and have better quality of life.
-Blood transfusions
-Iron chelation therapy
-Folic acid supplements
-Blood and marrow stem cell transplant
Venous thromboembolism (VTE)

is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as
deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary
embolism, PE).

Types of Thrombosis

-Deep vein thrombosis (DVT): A blood clot that forms

in a deep vein, usually the leg, groin or arm.
-Pulmonary embolism (PE): A blood clot that occurs
when a DVT clot breaks free from a vein wall
and travels to the lungs blocking some or
all of the blood supply. PE can often be fatal.
-DVT + PE = VTE: DVT and PE are collectively referred to as VTE

Signs and Symptoms

VTE can occur without any warning signs or symptoms and can go unrecognized and undiagnosed by a
.healthcare professional. Symptoms that do appear may be associated with either DVT or PE
Pulmonary Embolism (PE)
-Unexplained shortness of breath
-Rapid breathing
-Chest pain (may be worse upon deep breath)
-Rapid heart rate
-Light headedness or passing out
Treatment
Blood thinners (anticoagulants): Blood thinners keep blood clots from getting larger and stop new
clots from forming. Conventional blood thinners include warfarin and heparin, but newer blood-thinning
medicines are also available. To take them, you might get an injection, take a pill, or have an IV tube
inserted. Possible side effects include bleeding, especially if you are taking other medicines that also thin
your blood, such as aspirin.
Medicines to interfere with the process of clot formation (thrombin inhibitors): These
medicines may be given to people who cannot use heparin. Your doctor will give you this medicine as an
injection (shot).
Medicines to dissolve blood clots (thrombolytics): These medicines are used for large blood clots
that cause severe symptoms or other serious complications. Because thrombolytics can cause sudden
bleeding, they are used only for serious and potentially life-threatening VTE events, such as pulmonary
embolism. You will get this medicine
through an IV
immunoglobulin A (IgA) vasculitis
is a disease that causes the antibody immunoglobulin A to collect in small blood vessels, which then become inflamed
and leak blood. Nearly all people with IgA vasculitis develop a red or purple rash NIH external link. Some people with
IgA vasculitis also develop problems with their gastrointestinal (GI) tract, joints, and kidneys because of inflamed
blood vessels in the intestines, joints, and kidneys. In rare cases, the lungs, nervous system, or other organs may be
affected.

The number of new cases of IgA vasculitis is approximately 3 to 27 cases per 100,000 in children and infants and
fewer than 2
new cases per 100,000
The symptoms of IgA vasculitis include
-Rash.
-GI tract problems. Abdominal pain can range from mild to severe, with nausea or vomiting..
-Joint pain and swelling. Pain and swelling often occur in the knees and ankles, and sometimes occur in
the elbows, wrists, and small joints of the fingers.
causes IgA vasculitis-Kidney problems.
-bacteria and viruses
-foods
immunizations-
insect bites-
diagnose IgA vasculitis
medical history, a physical exam, and lab tests to confirm your diagnosis of IgA vasculitis.(skin biobsy-
Blood and urine tests-kidney biobsy)
Treatments for different symptoms

Joint pain and swelling. professional may prescribe a nonsteroidal anti-inflammatory drug (NSAID), such as
ibuprofen, or a corticosteroid to ease joint pain and swelling. You should not take NSAIDs if decreased
kidney function

GI tract problems. To ease abdominal pain, professional may prescribe a corticosteroid—a medicine that lowers
immune system activity and decreases swelling

Rash. Your rash will usually go away without any specific treatment

Abdominal pain is a common symptom of IgA vasculitis. If your pain is severe, talk to your health care professional about how
to manage the pain