This document provides an outline for a course on blood disorders. It covers topics like anatomy and physiology of blood, hematologic studies, conditions like anemia, sickle cell anemia and leukemia. Specific types of anemia discussed in detail include iron deficiency anemia, megaloblastic anemias (pernicious anemia and folic acid deficiency), and aplastic anemia. Hemolytic anemia and sickle cell anemia are also summarized.
This document provides an overview of hematologic disorders and summarizes several types of anemias and myeloproliferative disorders. It describes the components of blood and the process of hematopoiesis. Key points about iron deficiency anemia include its microcytic, hypochromic appearance and common causes like blood loss or dietary deficiencies. Pernicious anemia results from vitamin B12 deficiency due to lack of intrinsic factor. Folic acid deficiency can also cause megaloblastic anemia. Aplastic anemia is a bone marrow failure disorder causing pancytopenia. Polycythemia vera involves overproduction of all blood cell lines. Leukemias are malignant disorders involving accumulation of immature blood cells with
1. The document discusses various blood diseases including different types of anemia (microcytic, macrocytic, normocytic), their causes, signs and symptoms, and treatment approaches.
2. Microcytic anemias like iron deficiency anemia result in small red blood cells, while macrocytic anemias from folate or B12 deficiency produce large cells. Normocytic anemias maintain normal cell size.
3. Diagnostic tests include complete blood counts and smears to identify cell types and sizes. Management involves treating the underlying cause, blood transfusions, and supplements.
The document provides an overview of tests used to assess the hematology system. It discusses the composition of blood including erythrocytes, leukocytes, platelets, and hematopoiesis. Diagnostic tests are outlined including complete blood count, coagulation tests, platelet aggregation test, leukocyte alkaline phosphatase test, serum iron tests, bone marrow examination, lymph node biopsy, and radiological studies. The goal of these tests is to evaluate blood cellular components, clotting ability, and detect any abnormalities in the hematology system.
This document summarizes key information about red blood cells (RBCs), including their general features, composition, lifespan, counts in adults and newborns, functions in transporting gases, and regulation of erythropoiesis. It also covers RBC indices, the stages of erythropoiesis, factors that regulate RBC production, common anemias like iron deficiency and sickle cell anemia, jaundice, and physiological neonatal jaundice.
This document discusses hematological disorders involving red blood cells, including anemia and polycythemia. It defines different types of anemia such as iron deficiency anemia, pernicious anemia, and sickle cell anemia. For each type it discusses causes, signs and symptoms, diagnosis, treatment, and nursing considerations. It also covers polycythemia vera, defining it as a disorder where the bone marrow produces too many red blood cells, and discusses its pathophysiology, diagnostic tests, and treatment options.
The document defines anaemia and describes its classification and types. It is classified into morphological anaemia, based on changes seen in red blood cells, and etiological anaemia, based on the underlying cause. The key types of morphological anaemia are normocytic normochromic, microcytic hypochromic, and macrocytic normochromic. Etiological anaemia includes anaemia due to blood loss, nutritional deficiencies, bone marrow failure, and haemolytic anaemia. Common causes, clinical features, laboratory findings, and treatments are discussed for different types of anaemia.
This document provides an overview of hematologic disorders and summarizes several types of anemias and myeloproliferative disorders. It describes the components of blood and the process of hematopoiesis. Key points about iron deficiency anemia include its microcytic, hypochromic appearance and common causes like blood loss or dietary deficiencies. Pernicious anemia results from vitamin B12 deficiency due to lack of intrinsic factor. Folic acid deficiency can also cause megaloblastic anemia. Aplastic anemia is a bone marrow failure disorder causing pancytopenia. Polycythemia vera involves overproduction of all blood cell lines. Leukemias are malignant disorders involving accumulation of immature blood cells with
1. The document discusses various blood diseases including different types of anemia (microcytic, macrocytic, normocytic), their causes, signs and symptoms, and treatment approaches.
2. Microcytic anemias like iron deficiency anemia result in small red blood cells, while macrocytic anemias from folate or B12 deficiency produce large cells. Normocytic anemias maintain normal cell size.
3. Diagnostic tests include complete blood counts and smears to identify cell types and sizes. Management involves treating the underlying cause, blood transfusions, and supplements.
The document provides an overview of tests used to assess the hematology system. It discusses the composition of blood including erythrocytes, leukocytes, platelets, and hematopoiesis. Diagnostic tests are outlined including complete blood count, coagulation tests, platelet aggregation test, leukocyte alkaline phosphatase test, serum iron tests, bone marrow examination, lymph node biopsy, and radiological studies. The goal of these tests is to evaluate blood cellular components, clotting ability, and detect any abnormalities in the hematology system.
This document summarizes key information about red blood cells (RBCs), including their general features, composition, lifespan, counts in adults and newborns, functions in transporting gases, and regulation of erythropoiesis. It also covers RBC indices, the stages of erythropoiesis, factors that regulate RBC production, common anemias like iron deficiency and sickle cell anemia, jaundice, and physiological neonatal jaundice.
This document discusses hematological disorders involving red blood cells, including anemia and polycythemia. It defines different types of anemia such as iron deficiency anemia, pernicious anemia, and sickle cell anemia. For each type it discusses causes, signs and symptoms, diagnosis, treatment, and nursing considerations. It also covers polycythemia vera, defining it as a disorder where the bone marrow produces too many red blood cells, and discusses its pathophysiology, diagnostic tests, and treatment options.
The document defines anaemia and describes its classification and types. It is classified into morphological anaemia, based on changes seen in red blood cells, and etiological anaemia, based on the underlying cause. The key types of morphological anaemia are normocytic normochromic, microcytic hypochromic, and macrocytic normochromic. Etiological anaemia includes anaemia due to blood loss, nutritional deficiencies, bone marrow failure, and haemolytic anaemia. Common causes, clinical features, laboratory findings, and treatments are discussed for different types of anaemia.
This document provides information on the components and functions of blood and urine, as well as abnormal conditions that can arise. It discusses the main components of blood including plasma, erythrocytes, leukocytes, and platelets. For each, it describes their composition and role, as well as pathological states like anemia, leukemia, thrombocytopenia. The document also outlines normal and abnormal constituents of urine and diseases they can indicate such as diabetes, kidney damage, and jaundice.
This document provides information on hematological disorders including anemias, polycythemias, and bleeding disorders. It begins by defining hematological disorders as diseases affecting blood and blood forming tissues. It then discusses different types of anemias classified by cause or cell morphology. Common anemias described include iron deficiency anemia, anemia of chronic disease, and thalassemia. Symptoms, diagnostic tests, and treatment options for anemias are also outlined. The document also introduces polycythemias including definitions and types like primary and secondary polycythemia. Primary polycythemia vera is described in more detail regarding its cause, risk factors, signs and symptoms, and diagnostic evaluation. Finally, bleeding disorders
Blood, its Disorders & Investigations in Paediatric Dentistry.pptxDr. Mukesh Kumar Dey
This document discusses blood disorders and investigations relevant to pediatric dentistry. It covers the components and functions of blood, as well as disorders that affect red blood cells like polycythemia vera, iron deficiency anemia, aplastic anemia, sickle cell anemia, and thalassemia. For each disorder, it describes the etiology, clinical manifestations, oral manifestations, laboratory findings, and management considerations. The document provides an overview of several important blood disorders that pediatric dentists may encounter.
Mrs. Onyango presented to the hospital with chest pains, leg swelling, fatigue, shortness of breath, and dizziness. Tests found her hemoglobin level to be very low at 3.9g/dl, indicating severe anemia. She is currently receiving medications to treat the anemia, including iron supplements, and awaiting a blood transfusion.
The document discusses the body fluids, blood, lymphatic system, and related disorders. It covers:
- The two main compartments of body fluids - intracellular fluid and extracellular fluid. Extracellular fluid includes interstitial fluid and blood plasma.
- The key functions of blood including transportation, regulation, and protection. It also discusses blood components, groups, formation of hemoglobin, and disorders.
- The lymphatic system which drains excess fluid, transports lipids, and enables immune responses. Lymph is transported via lymphatic vessels and contains lymphocytes.
- Lymphatic organs and tissues including the thymus, lymph nodes, and spleen. The document provides an overview of their
The document discusses blood cells and hematopoiesis. It describes the three main blood cells - red blood cells, white blood cells, and platelets. It details their production rates, lifespans, and the process of hematopoiesis where they are formed in the bone marrow. The document also discusses erythropoiesis, the formation of red blood cells, and the factors that regulate and influence red blood cell production including erythropoietin and iron metabolism. It concludes by covering red blood cell properties and functions, as well as causes and types of anemia.
Anemia is a condition in which there aren't enough healthy red blood cells to carry oxygen throughout the body.
The most common cause of Anemia is iron deficiency, and Anemia is the most common blood disorder in the world. This PDF is for those of you who are looking for a comprehensive overview of Anemia.
We'll go over the classification, clinical presentation, investigations, and mechanism of Anemia.
This document discusses various laboratory investigations used in dentistry, including biopsies, hematological tests, urinalysis, and blood chemistry screens. It describes 10 different types of biopsies and their purposes. It also explains common hematological tests like complete blood count, erythrocyte sedimentation rate, and tests used to investigate bleeding disorders. Urinalysis and various blood chemistry screens are outlined that can provide information about conditions like diabetes, kidney function, and lipid levels.
1. Hematologic disorders are those that produce quantitative or qualitative defects in blood cells or elements related to hemostasis.
2. Hematopoiesis begins in the yolk sac and liver in early gestation, then shifts to the bone marrow by mid-gestation, where it remains the primary site of blood cell production after birth.
3. Anemia is defined as a hemoglobin level below the reference level for age and sex, and can be caused by decreased production, increased destruction, or blood loss.
This document discusses pathology of blood and urine. It begins by defining pathology and describing the components of blood, including plasma, red blood cells, white blood cells, and platelets. It then discusses various blood disorders like anemias and leukemias. The document also covers the functions of white blood cells and disorders affecting white blood cell count. Finally, it discusses the composition of normal urine and pathological constituents indicating various diseases, such as glucose indicating diabetes and bile salts/pigments indicating liver dysfunction.
This document provides an overview of hematopoiesis, erythropoiesis, and anemia. It discusses where blood cell formation occurs, the lifespan and production rate of red blood cells, and how hypoxia stimulates erythropoietin production. It defines anemia, lists global and country prevalence data, and compensatory mechanisms. It describes classifications of anemia including morphological and etiological, and covers causes such as blood loss, bone marrow disorders, nutritional deficiencies, and hemolytic anemias. Laboratory evaluation of anemia and peripheral blood smear findings are also summarized.
This document provides an overview of blood disorders and their classification. It discusses red blood cell disorders such as polycythemia vera, iron deficiency anemia, sickle cell anemia, and thalassemia. It also covers white blood cell disorders, platelet disorders, coagulation disorders, and disease-related coagulopathies. The document defines each disorder, describes their signs and symptoms, laboratory findings, treatment considerations, and oral health implications.
This document provides an overview of blood disorders, focusing on disorders of red blood cells, white blood cells, platelets, and coagulation. It begins with an introduction to blood and then covers specific disorders such as polycythemia vera, iron deficiency anemia, sickle cell anemia, and coagulation disorders. For each disorder, it discusses causes, clinical manifestations, oral manifestations, laboratory findings, and treatment considerations. The document aims to give healthcare practitioners a comprehensive review of various blood disorders and their impacts.
This document provides an overview of blood disorders and summarizes key information about red blood cells, white blood cells, platelets, and coagulation disorders. It discusses specific disorders such as polycythemia vera, anemia including iron deficiency anemia and sickle cell anemia, thalassemia, and erythroblastosis fetalis. For each disorder, it describes characteristics, causes, clinical manifestations, oral manifestations, laboratory findings, and treatment considerations.
This document provides an overview of blood disorders and summarizes key information about red blood cells and related disorders. It discusses the structure and function of red blood cells, variations in red blood cell count, and disorders involving too many or too few red blood cells such as polycythemia, anemia, sickle cell anemia, thalassemia, and erythroblastosis fetalis. Specific conditions are defined and their signs, symptoms, causes, and treatments are outlined.
This document provides an overview of blood disorders and summarizes key information about red blood cells and related disorders. It discusses the structure and function of red blood cells, variations in red blood cell count, and disorders involving too many or too few red blood cells such as polycythemia, anemia, sickle cell anemia, thalassemia, and erythroblastosis fetalis. Specific conditions are defined and their signs, symptoms, causes, and treatments are outlined.
Blood contains plasma and cellular components. Plasma is 55% water and contains nutrients, waste, hormones, and proteins. Cells include red blood cells carrying oxygen, various white blood cells that fight infection, and platelets that promote clotting. Red blood cells contain hemoglobin which binds oxygen in the lungs and releases it in tissues. White blood cells include granulocytes and agranulocytes that destroy pathogens. Platelets form plugs to stop bleeding through clotting factors and fibrin formation. Together these components transport substances, regulate pH and temperature, and protect the body.
The document discusses various diagnostic tests and procedures. It begins by outlining the phases of diagnostic testing as pre-test, intra-test, and post-test phases. It then describes specific tests like the complete blood count, which measures components of blood, and serum electrolyte testing, which evaluates electrolyte levels important for various body functions. The document provides details on normal ranges and clinical implications of results for these common lab investigations.
This document provides information on the components and functions of blood and urine, as well as abnormal conditions that can arise. It discusses the main components of blood including plasma, erythrocytes, leukocytes, and platelets. For each, it describes their composition and role, as well as pathological states like anemia, leukemia, thrombocytopenia. The document also outlines normal and abnormal constituents of urine and diseases they can indicate such as diabetes, kidney damage, and jaundice.
This document provides information on hematological disorders including anemias, polycythemias, and bleeding disorders. It begins by defining hematological disorders as diseases affecting blood and blood forming tissues. It then discusses different types of anemias classified by cause or cell morphology. Common anemias described include iron deficiency anemia, anemia of chronic disease, and thalassemia. Symptoms, diagnostic tests, and treatment options for anemias are also outlined. The document also introduces polycythemias including definitions and types like primary and secondary polycythemia. Primary polycythemia vera is described in more detail regarding its cause, risk factors, signs and symptoms, and diagnostic evaluation. Finally, bleeding disorders
Blood, its Disorders & Investigations in Paediatric Dentistry.pptxDr. Mukesh Kumar Dey
This document discusses blood disorders and investigations relevant to pediatric dentistry. It covers the components and functions of blood, as well as disorders that affect red blood cells like polycythemia vera, iron deficiency anemia, aplastic anemia, sickle cell anemia, and thalassemia. For each disorder, it describes the etiology, clinical manifestations, oral manifestations, laboratory findings, and management considerations. The document provides an overview of several important blood disorders that pediatric dentists may encounter.
Mrs. Onyango presented to the hospital with chest pains, leg swelling, fatigue, shortness of breath, and dizziness. Tests found her hemoglobin level to be very low at 3.9g/dl, indicating severe anemia. She is currently receiving medications to treat the anemia, including iron supplements, and awaiting a blood transfusion.
The document discusses the body fluids, blood, lymphatic system, and related disorders. It covers:
- The two main compartments of body fluids - intracellular fluid and extracellular fluid. Extracellular fluid includes interstitial fluid and blood plasma.
- The key functions of blood including transportation, regulation, and protection. It also discusses blood components, groups, formation of hemoglobin, and disorders.
- The lymphatic system which drains excess fluid, transports lipids, and enables immune responses. Lymph is transported via lymphatic vessels and contains lymphocytes.
- Lymphatic organs and tissues including the thymus, lymph nodes, and spleen. The document provides an overview of their
The document discusses blood cells and hematopoiesis. It describes the three main blood cells - red blood cells, white blood cells, and platelets. It details their production rates, lifespans, and the process of hematopoiesis where they are formed in the bone marrow. The document also discusses erythropoiesis, the formation of red blood cells, and the factors that regulate and influence red blood cell production including erythropoietin and iron metabolism. It concludes by covering red blood cell properties and functions, as well as causes and types of anemia.
Anemia is a condition in which there aren't enough healthy red blood cells to carry oxygen throughout the body.
The most common cause of Anemia is iron deficiency, and Anemia is the most common blood disorder in the world. This PDF is for those of you who are looking for a comprehensive overview of Anemia.
We'll go over the classification, clinical presentation, investigations, and mechanism of Anemia.
This document discusses various laboratory investigations used in dentistry, including biopsies, hematological tests, urinalysis, and blood chemistry screens. It describes 10 different types of biopsies and their purposes. It also explains common hematological tests like complete blood count, erythrocyte sedimentation rate, and tests used to investigate bleeding disorders. Urinalysis and various blood chemistry screens are outlined that can provide information about conditions like diabetes, kidney function, and lipid levels.
1. Hematologic disorders are those that produce quantitative or qualitative defects in blood cells or elements related to hemostasis.
2. Hematopoiesis begins in the yolk sac and liver in early gestation, then shifts to the bone marrow by mid-gestation, where it remains the primary site of blood cell production after birth.
3. Anemia is defined as a hemoglobin level below the reference level for age and sex, and can be caused by decreased production, increased destruction, or blood loss.
This document discusses pathology of blood and urine. It begins by defining pathology and describing the components of blood, including plasma, red blood cells, white blood cells, and platelets. It then discusses various blood disorders like anemias and leukemias. The document also covers the functions of white blood cells and disorders affecting white blood cell count. Finally, it discusses the composition of normal urine and pathological constituents indicating various diseases, such as glucose indicating diabetes and bile salts/pigments indicating liver dysfunction.
This document provides an overview of hematopoiesis, erythropoiesis, and anemia. It discusses where blood cell formation occurs, the lifespan and production rate of red blood cells, and how hypoxia stimulates erythropoietin production. It defines anemia, lists global and country prevalence data, and compensatory mechanisms. It describes classifications of anemia including morphological and etiological, and covers causes such as blood loss, bone marrow disorders, nutritional deficiencies, and hemolytic anemias. Laboratory evaluation of anemia and peripheral blood smear findings are also summarized.
This document provides an overview of blood disorders and their classification. It discusses red blood cell disorders such as polycythemia vera, iron deficiency anemia, sickle cell anemia, and thalassemia. It also covers white blood cell disorders, platelet disorders, coagulation disorders, and disease-related coagulopathies. The document defines each disorder, describes their signs and symptoms, laboratory findings, treatment considerations, and oral health implications.
This document provides an overview of blood disorders, focusing on disorders of red blood cells, white blood cells, platelets, and coagulation. It begins with an introduction to blood and then covers specific disorders such as polycythemia vera, iron deficiency anemia, sickle cell anemia, and coagulation disorders. For each disorder, it discusses causes, clinical manifestations, oral manifestations, laboratory findings, and treatment considerations. The document aims to give healthcare practitioners a comprehensive review of various blood disorders and their impacts.
This document provides an overview of blood disorders and summarizes key information about red blood cells, white blood cells, platelets, and coagulation disorders. It discusses specific disorders such as polycythemia vera, anemia including iron deficiency anemia and sickle cell anemia, thalassemia, and erythroblastosis fetalis. For each disorder, it describes characteristics, causes, clinical manifestations, oral manifestations, laboratory findings, and treatment considerations.
This document provides an overview of blood disorders and summarizes key information about red blood cells and related disorders. It discusses the structure and function of red blood cells, variations in red blood cell count, and disorders involving too many or too few red blood cells such as polycythemia, anemia, sickle cell anemia, thalassemia, and erythroblastosis fetalis. Specific conditions are defined and their signs, symptoms, causes, and treatments are outlined.
This document provides an overview of blood disorders and summarizes key information about red blood cells and related disorders. It discusses the structure and function of red blood cells, variations in red blood cell count, and disorders involving too many or too few red blood cells such as polycythemia, anemia, sickle cell anemia, thalassemia, and erythroblastosis fetalis. Specific conditions are defined and their signs, symptoms, causes, and treatments are outlined.
Blood contains plasma and cellular components. Plasma is 55% water and contains nutrients, waste, hormones, and proteins. Cells include red blood cells carrying oxygen, various white blood cells that fight infection, and platelets that promote clotting. Red blood cells contain hemoglobin which binds oxygen in the lungs and releases it in tissues. White blood cells include granulocytes and agranulocytes that destroy pathogens. Platelets form plugs to stop bleeding through clotting factors and fibrin formation. Together these components transport substances, regulate pH and temperature, and protect the body.
The document discusses various diagnostic tests and procedures. It begins by outlining the phases of diagnostic testing as pre-test, intra-test, and post-test phases. It then describes specific tests like the complete blood count, which measures components of blood, and serum electrolyte testing, which evaluates electrolyte levels important for various body functions. The document provides details on normal ranges and clinical implications of results for these common lab investigations.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
2. COURSE OUTLINE
• Course objectives
• Review of anatomy and physiology
• Hematologic studies
Conditions
Anaemia
Sickle cell anaemia
Leukaemia
Deep venous thrombosis
• End of sem 2 exam- total 100%.mcqs- 10mks, saq- 20mks,
laq- 20mks.
• Pass mark – 50%.NOTES- HANDOUT TO BE GIVEN
3. Anatomy and physiology
• Blood is a connective tissue consisting of cells,
surrounded by a liquid matrix(plasma).blood cells make
up 45% and plasma 55% of total blood volume.total
blood volume in adults is 5L.
• Plasma- consists of 91% water, 7%proteins and 2% of
other substances .plasma proteins include: albumin,
globulin &fibrinogen
• Cellular components include erythrocytes (red blood
cells), leukocytes and lymphocytes (white blood cells),
and platelets.
• These cells are derived from pluripotent stem cells in the
bone marrow, a process known as hematopoiesis.
4. Blood cells
• Red blood cells (erythrocytes). These carry oxygen from
the lungs to the rest of the body and carbon dioxide as a
waste product, away from the tissues and back to the
lungs
• Normal are disk shaped (biconcave)which increases the
surface area hence increased movement of gases into
and out red blood cells. life span is 120 days.
• 98% of O2 is transported in combination with
hemoglobin in red blood cells.
• Erythropoeisis – is the process by which new red blood
cells are produced.
5. • Hemoglobin is the pigmented protein & main
component of RBC.it is responsible for its red
color.the are four globin bound to 4 heme.each
heme contain one iron atom and assiociated with
each O2 molecule.iron is necessary for O2
transport
• The primary function of platelets, or
thrombocytes, is blood clotting. Platelets are
much smaller in size than the other blood cells.
6. White blood cells
• The primary function is to fight infection. There are
several types of white blood cells and each has its own
role in fighting bacterial, viral, fungal, and parasitic
infections. Types of white blood cells that are most
important for helping protect the body from infection
and foreign cells include the following:
• Neutrophils
• Eosinophils
• Lymphocytes
• Monocytes
• Basophil
7. What is the function of blood?
• 1. Transport functions: it carries O2 and
nutrients to tissues and waste products of
metabolism, e.g. CO2 and urea to lungs and
kidney. hormones
• 2.Homeostatic functions: it distributes heat
around the body from warmer organs, e.g.
liver and gut to peripheral organs in order to
maintain the body temperature constant.
8. 3- Buffer functions: it keeps H+ concentration
of extracellular fluid constant at pH of 7.4 by
buffers like Hb, plasma proteins and
bicarbonate
4- Protective functions: against infection by
leucocytes and antibodies in the plasma.
5- Clotting functions: stops further loss of blood
during injury
9. Hematologic studies
CBC
Peripheral blood smear
Complete blood count
Identifies total number of blood
cells(leucocytes,erythrocytes and platelets),
and RBC indices. as well as the hemoglobin
levels,hematocrit.
hematocrit (percentage of blood consisting of
RBCs
10. ct
• Hemoglobin level- decreased in anaemia, increased in
polycethemia.male- 13.5-17.5g/dl,female- 11.5- 15.5g/dl.
• Mean corpuscular volume (MCV)- ndicates size of RBCs;
very useful in differentiating types of anemia .normal 81–
96 µm3
• Prothrombin time- Measure time elapsed until clot forms;
measures extrinsic and common pathways. increased in
liver disease, DIC
• International normalized ratio (INR)-A standard method of
measuring PT independent of the thromboplastin reagent
used in the test. Increased with anticoagulant excess and
conditions that cause increased PT.
11. Haematological disorders
ANEMIA
• It is not a specific disease state but a sign of an
underlying disorder.
• a condition in which the hemoglobin
concentration is lower than normal, reflects the
presence of fewer than normal RBCs within the
circulation. As a result, the amount of oxygen
delivered to body tissues is also diminished.
There are many different kinds of anemia
etiologic categories:
12. causes
• Loss of RBCs—occurs with bleeding, potentially from any
major source, such as the gastrointestinal tract, the uterus,
the nose, or a wound
• Decreased production of RBCs—can be caused by a defi-
ciency in cofactors (including folic acid, vitamin B12, and
iron) required for erythropoiesis; RBC production may also
be reduced if the bone marrow is suppressed (eg, by tumor,
medications, toxins) or is inadequately stimulated because
of a lack of erythropoietin (as occurs in chronic renal
disease).
• Increased destruction of RBCs—may occur because of an
overactive RES (including hypersplenism) or because the
bone marrow produces abnormal RBCs that are then de-
stroyed by the RES (eg, sickle cell anemia)
13. Hypoproliferative Anemias
IRON DEFICIENCY ANEMIA
• results when the intake of dietary iron is
inadequate for hemoglobin synthesis. Develops
when body iron stores are depleted.
causes
• inadequate intake of iron (seen with vegetarian
diets)
• Increased need for iron in the body –I.e in
children, adolescents, and pregnant women
14. blood loss
from intestinal hookworm.
bleeding (from ulcers, gastritis, inflammatory bowel
disease, or gastrointestinal tumors).
premenopausal women is menorrhagia (excessive
menstrual bleeding)
• Patients with chronic alcoholism often have chronic blood
loss from the gastrointestinal tract, which causes iron loss
and eventual anemia.
• malabsorption, as is seen after gastrectomy or with celiac
disease
• Certain drugs, food and caffeinated drinks
15. Clinical Manifestations
• Headache, dizziness, fatigue, tinnitus
• Fast or irregular heart beat
• Palpitations, dyspnea on exertion, pallor of skin
and mucous membranes
• Smooth, sore tongue; cheilosis (lesions at corners
of mouth)
• Pica (craving to eat unusual substances
• Koilonychia (spoon-shaped fingernails)
• In children:irritability,poor cognitive function and
decline in psychomotor development
16. Assessment and diagnostic findings
Bone marrow aspiration
There is complete absence of iron from
stores and erythroblasts.
Erythroblasts are small and have a ragged
cytoplasm
Labaratory tests
MCV and mean corpuscular hemoglobin
reduced in relation to the severity of anemia
17. Diagnostic Evaluation
• CBC and iron profile decreased hemoglobin,
hematocrit, serum iron, and ferritin;
• Determination of source of chronic blood loss
may include sigmoidoscopy, colonoscopy,
upper and lower GI studies, stool and urine for
occult blood examination.
18. Medical Management
• The cause of iron deficiency should be investigated. Stool
specimens should be tested for occult blood. colonoscopy,
endoscopy, or other examination of the gastrointestinal
tract to detect ulcerations, gastritis, polyps, or cancer.
• Several oral iron preparations—ferrous sulfate, ferrous
gluconate, and ferrous.
• In cases, oral iron is poorly absorbed or poorly tolerated,
or iron supplementation is needed in large amounts.
intravenous or intramuscular administration of iron dextran
may be needed. Several doses are required to replenish the
patient’s iron stores.
• Treat the underlying cause
• Provide diet rich in iron I,e red meat, leafy vegetables
19. Nursing management
Health education especially in high risk groups
e.g. pregnant women
Nutritional counseling on Iron rich foods
e.g.meat,liver,beans and leafy green
vegetables
Health education on iron therapy compliance
Advice the patient to take iron supplement an
hour before meals since iron is best absorbed
in an empty stomach
20. It can be taken with food in case of side effects. It can
also be taken in the liquid form though it stains the
teeth. To avoid staining, advice the client/patient to
use a straw or rinse the mouth with water after taking
it.
Antacids and dairy products should not be taken
together with iron because they diminish its absorption
To prevent gastrointestinal distress where more than
one is prescribed a day, start with one tablet for few
days, then increase to two
21. Nursing management
Increasing Activity Tolerance
• Assess level of fatigue and normal sleep pattern; determine
activities that cause fatigue.
• Assist in developing a schedule of activity, rest periods, and
sleep.
• Encourage conditioning exercises to increase strength and
endurance.
Maximizing Tissue Perfusion
• Assess patient for palpitations, chest pain, dizziness, and
shortness of breath; minimize activities that cause these
symptoms.
• Elevate head of bed and provide supplemental oxygen .
• Monitor vital signs and fluid balance.
22. MEGALOBLASTIC ANEMIAS
• The anemias caused by deficiencies of vitamin
B12 or folic acid, both vitamins are essential
for normal DNA synthesis.
• A megaloblast is a large, nucleated
erythrocyte with delayed and abnormal
nuclear maturation.
PERNICIOUS ANAEMIA
• a type of megaloblastic anemia associated
with vitamin B12deficiency
23. PATHOPHYSIOLOGY
• Vitamin B12 is necessary for normal DNA synthesis in
maturing RBCs.
• Normal gastric mucosa secretes a substance called
intrinsic factor, necessary for absorption of vitamin B12
in ileum. If a defect exists in gastric mucosa, or after
gastrectomy or small bowel disease, intrinsic factor
may not be secreted and orally ingested B12 not
absorbed.
• Some drugs interfere with B12 absorption, notably
ascorbic acid, cholestyramine, colchicine, neomycin,
cimetidine, and hormonal contraceptives.
• Primarily a disorder of older people
24. Clinical Manifestations
• pallor, fatigue, dyspnea on exertion, palpitations.
May be angina pectoris and heart failure in the
elderly or those predisposed to heart disease.
• Of underlying GI dysfunction sore mouth,
glossitis, anorexia, nausea, vomiting, loss of
weight, indigestion, epigastric discomfort,
recurring diarrhea or constipation.
• Of neuropathy (occurs in high percentage of
untreated patients) paresthesia that involves
hands and feet, gait disturbance, bladder and
bowel dysfunction,.
25. Diagnostic Evaluation
• CBC and blood smear decreased hemoglobin
and hematocrit; marked variation in size and
shape of RBCs with a variable number of
unusually large cells
• Folic acid (normal) and B12 levels (decreased).
• Gastric analysis volume and acidity of gastric
juice diminished.
• Schilling test for absorption of vitamin B12
26. Management
• Parenteral replacement with hydroxocobalamin or
cyanocobalamin (B12) is necessary by I.M. injection from
health care provider, generally every month.
Nursing Interventions
• Improving Thought Processes BY Administering parenteral
vitamin B12.
• Provide patient with quiet, supportive environment; reorient
to time, place, and person if needed; give instructions and
information in short, simple sentences and reinforce
frequently..
• Refer patient for physical therapy and occupational therapy as
appropriate.
• Provide safe, uncluttered environment;
27. FOLIC ACID DEFICIENCY
• Chronic megaloblastic anemia caused by folic acid (folate)
deficiency.
causes
• Dietary deficiency, malnutrition, marginal diets, excessive
cooking of foods.
• Impaired absorption in jejunum (eg, with small bowel
disease).
• Increased requirements (eg, with chronic hemolytic
anemia, pregnancy).
• Impaired utilization from folic acid antagonists
(methotrexate) and other drugs (phenytoin, broad
spectrum antibiotics, alcohol, hormonal contraceptives).
28. Clinical Manifestations
• fatigue, weakness, pallor, dizziness, headache,
tachycardia.
• sore tongue, cracked lips.
Diagnostic Evaluation
• Vitamin B12 and folic acid level folic acid will be
decreased.
• CBC will show decreased RBC, hemoglobin, and
hematocrit with increased mean corpuscular volume
and mean corpuscular hemoglobin concentration.
29. Management
• Oral folic acid(5mg) replacement on daily
basis.
• Assess diet for inclusion of foods rich in folic
acid: beef liver, peanut butter, red beans
Complications
• Folic acid deficiency has been implicated in
the etiology of congenitally acquired neural
tube defects.
30. APLASTIC ANEMIA
• Aplastic anemia is a disorder characterized by bone
marrow hypoplasia or aplasia resulting in insufficient
numbers of RBCs, WBCs, and platelets.
Pathophysiology and Etiology
• Destruction of hematopoietic stem cells is thought to
be through an immune-mediated mechanism.
• May be idiopathic or caused by exposure to chemical
toxins; ionizing radiation; viral infections, particularly
hepatitis; certain drugs (eg, chloramphenicol).
• May be congenital.
31. Clinical Manifestations
• From anemia: pallor, weakness, fatigue,
exertional dyspnea, palpitations.
• From infections associated with neutropenia:
fever, headache, malaise; adventitious breath
sounds; abdominal pain, diarrhea; erythema,
pain, exudate at wounds or sites of invasive
procedures.
• From thrombocytopenia: bleeding from gums,
nose, GI or GU tracts; purpura, petechiae,
ecchymoses.
32. Management
• Removal of causative agent or toxin.
• Allogeneic bone marrow transplantation
• bone marrow regeneration;.
• Immunosuppressive treatment with
corticosteroids, cyclosporine,
cyclophosphamide,.
• Supportive treatment includes platelet and
RBC transfusions, antibiotics, and antifungals
33. Nursing management
• Minimizing Risk of Infection
strict hand washing and avoidance of any contaminants.
• Encourage good personal hygiene
• Monitor vital signs, including temperature,
Minimizing Risk of Bleeding
• Use only soft toothbrush o
• Avoid I.M. injections and other invasive procedures..
• Monitor pad count for menstruating patient; avoid use of
vaginal tampons.
• Control bleeding by applying pressure to site, using ice packs
and topical hemostatic agents.
• Administer blood product replacement ; monitor for allergic
34. Hemolytic anemia
Hemolytic anemia is a disorder in which the red
blood cells are destroyed faster than they can be
made. The term for destruction of red blood cells
is hemolysis
2 types of haemolytic anaemia intrinsic and
extrinsic.
intrinsic ( the destruction of the red blood cells is
due to a defect within the red blood cells
themselves. Intrinsic hemolytic anemias are often
inherited. Examples include sickle cell anemia and
thalassemia )
35. Extrinsic (Normal red blood cells are made but are later
destroyed by becoming trapped in the spleen, destroyed by
infection, or destroyed from drugs that can affect red blood
cells. In severe cases, the destruction takes place in the
circulation) possible causes
Infections e.g cytomegalovirus, hepatitis,typhoid fever
Medications e.g penicilin,antimalarials, sulfa medications
Leukemia or lymphomas
An overactive spleen hypersplenism
Autoimmune haemolytic disease
Autoimmune disorders e.g rheumatoid arthritis
36. common symptoms
• paleness of the skin
• fatigue
• fever
• confusion
• lightheadedness
• dizziness
• weakness or inability to do physical activity
37. Less common symptoms
• dark urine
• yellowing of the skin and the whites of the
eyes (jaundice)
• heart murmur
• increased heart rate
• enlarged spleen
• enlarged liver
38. Sickle cell anemia
Sickle cell anemia is a genetic disease of the
red blood cells (RBCs).It results from
inheritance of the sickle hemoglobin gene.
This gene causes the hemoglobin molecule to
be defective. The sickle hemoglobin (HbS)
acquires a crystal-like formation when
exposed to low oxygen tension.
39. • Normally RBCs are shaped like a disk. This
gives them the flexibility to travel through
even the smallest blood vessels. However, in
people with sickle cell, the RBCs have an
abnormal crescent shape. This makes them
sticky and rigid. They can get trapped in small
vessels and block blood from reaching
different parts of the body. This can cause
pain and tissue damage
40. Clinical manifestation
Anaemia 7- 10 g/dl
Jaundice –rapid haemolysis of sickle cell
Tachycardia
Cardiac murmurs
Cardiomegaly
Pt susceptible to pneumonia and osteomyelitis
Heart failure and dysrthymias occurs in adults.
41. • Acute and chronic pain in any body part: The
most common clinical manifestation of SCD is
vaso-occlusive crisis
• Bone pain: The long bones of the extremities are
often involved, often due to bone marrow
infarction
• life-threatening anemia with rapid enlargement
of the spleen and high reticulocyte count
• infections
42. • Growth retardation, delayed sexual maturation, being
underweight
• bilateral painful and swollen hands and/or feet in
children
• Acute chest syndrome: Young children present with
chest pain, fever, cough, tachypnea, leukocytosis, and
pulmonary infiltrates in the upper lobes;
• Pulmonary hypertension: Increasingly recognized as a
serious complication of SCD
• Avascular necrosis of the femoral or humeral head:
This is due to vascular occlusion
• CNS involvement: Most severe manifestation is stroke
43. Sickle cell crisis
• It is a painful episode that occurs in people
with sickle anemia.it happens when sickle cell
shaped red blood cells block blood
vessels.blood cant get into tissues causing
pain
44. Painful vaso-occlusive crises
Most frequent
results from tissue hypoxia and necrosis due to
inadequate blood flow to a specific region of
tissue or organ.
Precipitated by infection,acidosis,dehydration
or deoxygenation, changes in body temperature
Infarcts can occur in bones( hips, shoulders and
vertebrae are most affected),lungs and spleen
45. The most serious crisis is of the brain or spinal
cord
Doppler ultrasonography detects abnormal
blood flow indicative of arterial stenosis and
this predicts stroke in children
Can be largely prevented by blood
transfusions
Hand foot syndrome is the first presentation
of the disease
46. Visceral sequestration crises
Results from trapping of large amounts of red
cells in the spleen and liver.during the crisis
the sequestreted cell cause the spleen to
become grossily enlarged.
Most kids with this have had a splenic
infarction by 10 yrs where the spleen is no
longer funtional.in adults sequestration is in
liver & lungs.
The patient is severly anemic
47. • Treatment is with analgesia,oxygen,exchange
transfusion and ventilatory support
• .Transfuse and monitor at regular intervals
• Attacks tend to be recurrent and splenectomy
is often needed
48. Aplastic crises
• It results from infection with parvovirus or
from folate deficiency
• There is sudden fall in Hb and the marrow
cannot compensate as evidenced by absence
of reticulocytes
• Requires transfusion
49. Hemolytic crises
• Increased rate of hemolysis
• Fall in Hb
• Rise in reticulocytes
• Accompany a painful crises
50. Lab findings
• Hb 6-9g/dl
• The patient with sickle cell trait usually has a
normal hemoglobin level, a normal hematocrit,
and a normal blood smear. In contrast, the
patient with sickle cell anemia has a low
hematocrit
• Sickled cells
• Sickling test is positive.
• Hb electrophoresis:in Hb SS,no Hb A is seen
51. Diagnostic tests
• mandatory screening for HbS at birth in the
United States; prenatal testing can be
obtained via chorionic villus sampling
• Hemoglobin electrophoresis
• CBC count with differential and reticulocyte
count
• Hemoglobin solubility testing
• Peripheral blood smear
52. • Pulmonary function tests (transcutaneous O 2
saturation)
• Renal function (creatine, BUN, urinalysis)
• Hepatobiliary function tests, (ALT, fractionated
bilirubin)
• Blood cultures
• ABGs
• Imaging studies
53. treatment
• there are only three primary treatment
modalities for sickle cell diseases: Bone
marrow transplant, hydroxyurea, and long-
term RBC transfusion.
• Hydroxyurea (Hydrea), a chemotherapy agent,
has been shown to be effective in increasing
hemoglobin F levels in patients with sickle cell
anemia, thereby decreasing the permanent
formation of sickled cells.
54. Treatment
• daily folic acid replacements to maintain
the supply required for increased
erythropoiesis from hemolysis.
• Infections must be treated promptly
with appropriate antibiotics; infection
remains a major cause of death in these
patients.
• Analgesics to relieve pain
55. • Red blood cell transfusion
• Good general nutrition and hygiene
• Pneumococcal and meningococcal vaccine
should be given as well as oral penicillin
• Hepatitis B vaccine as blood transfusion is
sometimes needed
56. treatment
Acute chest syndrome
• prompt initiation of antibiotic therapy and
bronchodilators
• Administration of analgesics
• Administer supplemental oxygen
• vigorous hydration for vaso- oclusive crisis
• Corticosteroids may also be useful.
• Transfusions reverse the hypoxia
• Pulmonary function should be monitored
regularly to detect pulmonary hypertension early.
57. Other management
• Stem cell transplantation: Can be curative
• Transfusions: For sudden, severe anemia due
to acute splenic sequestration, parvovirus B19
infection, or hyperhemolytic crises
• Physical therapy
• Heat and cold application
58. Crisis
• Treat by rest
• rehydration by oral fluids or intravenous normal
saline 3 litres in 24 hours
• Supplemental oxygen may also be needed.
• Analgesics to relieve pain i.e asprin,NSAIDS and
opiates
Blood transfusion is given in very severe anaemia
59. Nursing management
MANAGING PAIN
• Any joint that is acutely swollen should be supported
and elevated until the swelling diminishes.
• Relaxation techniques, breathing exercises, and
distraction are helpful for some patients.
Preventing and managing infection
• monitoring the patient for signs and symptoms of
infection.
• antibiotics should be initiated promptly,
• assess the patient for signs of dehydration.
.
60. Nursing management
• Promoting coping skills
• Patient education- patient understanding on what
situations can precipitate a sickle cell crisis and the
steps they can take to prevent or diminish such
crises,i.e keeping warm &hydration
• Monitoring and managing potential complications. i.e
leg ulcers – ensure measures to prevent it from
trauma,referring to specialist
Priapism- The patient is taught to empty his bladder at
the onset of the attack, exercise, and take a warm bath.
Chronic pain and prevention of substance abuse
especially opioid analgesics
62. THALASSEMIA
• These are a group of hereditary disorders
associated with defective hemoglobin-chain
synthesis.
• the production of one or more globulin chains
within the hemoglobin molecule is reduced.
This increases the rigidity of the RBCs and thus
the premature destruction of these cells.
63. • classified into two major groups according to the
globin chain diminished: alpha and beta.
• If left untreated, severe beta-thalassemia can be
fatal within the first few years of life. If it is
treated with regular transfusion of RBCs, patients
may survive into their 20s and 30s. Patient
teaching during the reproductive years should
include pre-conception counseling about the risk
of congenital thalassemia major.
64. TYPES
Beta thalassemia
• Beta thalassemia occurs when your body can’t produce beta
globin. Two genes, one from each parent, are inherited to
make beta globin.
• Thalassemia major is the most severe form of beta
thalassemia. It develops when beta globin genes are missing.
The symptoms of thalassemia major generally appear before a
child’s second birthday. The severe anemia related to this
condition can be life-threatening. Other signs and symptoms
include:
• fussiness
• paleness
65. CT
• frequent infections
• a poor appetite
• failure to thrive
• jaundice, which is a yellowing of the skin or the whites of
the eyes
• enlarged organs
• This form of thalassemia is usually so severe that it requires
regular blood transfusions.
• Thalassemia intermedia is a less severe form. It develops
because of alterations in both beta globin genes. People
with thalassemia intermedia don’t need blood transfusions.
66. Alpha thalassemia
• Alpha thalassemia occurs when the body can’t make
alpha globin. In order to make alpha globin, you need
to have four genes, two from each parent.
• Hemoglobin H develops as when a person is missing
three alpha globin genes or experiences changes in
these genes. This disease can lead to bone issues. The
cheeks, forehead, and jaw may all overgrow.
Additionally, hemoglobin H disease can cause:
• jaundice
• an extremely enlarged spleen
• malnourishment
67. • Hydrops fetalis is an extremely severe form of
thalassemia that occurs before birth. Most
individuals with this condition are either stillborn
or die shortly after being born. This condition
develops when all four alpha globin genes are
altered or missing.
Thalassemia minor
• People with thalassemia minor don’t usually have
any symptoms. If they do, it’s likely to be minor
anemia.
68. Clinical features
• hypochromia(an abnormal decrease in the hemoglobin
content of RBCs)
• Paleness
• frequent infections
• poor appetite
• jaundice,
• extreme microcytosis (smaller-than-normal RBCs),
• destruction of blood elements (hemolysis)
• variable degrees of anemia
69. management
• blood transfusions
• a bone marrow transplant (BMT)
• medications and supplements
• possible surgery to remove the spleen or
gallbladder
70. DISORDERS OF WHITE BLOOD CELLS
LEUKEMIA
Leukemias are malignant disorders of the blood
and bone marrow that result in an accumulation
of dysfunctional, immature cells that are caused
by loss of regulation of cell division
the proliferation of leukemic cells leaves little
room for normal cell production.
These abnormal cells cause symptoms because of
bone marrow failure.
71. Predisposing factors
– Exposure to ionizing radiation.
– Exposure to certain chemicals and toxins (eg,
benzene, alkylating agents).
– Human T-cell leukemia lymphoma virus
– Familial susceptibility.
– Genetic disorders (e.g., Down syndrome, Fanconi's
anemia).
– smoking
72. pathogenesis of acute leukemia
Malignant transformation occurs in the
haemopoietic stem cell or early progenitors
There is an increased rate of proliferation,
reduced apoptosis and a block in cellular
differentiation
Together these events cause accumulation of
blast cells resulting to bone marrow failure
although organ infiltration also occurs
73. Clinical manifestations
• Fever or chills
• Persistent fatigue,weakness
• Frequent/severe weakness
• Swollen lymph nodes
• Enlarged liver or spleen
• Easy bleeding or bruising
• Recurrent nosebleeds
• Tiny red spots on your skin
• Bone pain or tenderness
74. Classification of leukemia
The leukemias are commonly classified according to
the stem cell line involved, either lymphoid or
myeloid.
They are also classified as either acute or chronic,
based on the time it takes for symptoms to evolve
and the phase of cell development that is halted.
In acute leukemia, the onset of symptoms is abrupt,
often occurring within a few weeks. WBC
development is halted at the blast phase, so that
most WBCs are undifferentiated or are blasts. Acute
leukemia progresses very rapidly; death occurs
within weeks to months without aggressive
treatment. In chronic leukemia, symptoms evolve
over a period of months to years, and the majority of
WBCs produced are mature
75. Acute lymphoblastic leukemia
Caused by accumulation of lymphoblasts in
the bone marrow
Most common malignancy of childhood
Origin is precursor to B lymphocyte in
approximately 75% and t lymphocyte in 25%
of all cases
Its incidence is highest at 3-7years,falling off
by 10 years with a secondary rise after the age
of 40 years
76. Clinical features
Clinical features are a result of the following:
1) Bone marrow failure:anaemia(pallor,lethargy,
dyspnoea),
2) neutropenia(fever,malaise,soreness of
mouth,throat,skin,respiratory,perianal or
recurrrent infections)
thrombocytopenia(spontaneous
bruises,purpura,bleeding gums and
menorrhagia)
77. 2)Organ infiltration:
bone and joint pain, splenomegaly,
hepatomegaly, lympoadenopathy,neurologic
dysfunction. And meiningeal
syndrome(headache,blurring vision)
78. Diagnosis
History taking
Physical examination
• CBC and blood smear peripheral WBC count
varies widely from 1,000 to 100,000/mm3 and
may include significant numbers of abnormal
immature (blast) cells; anemia may be
profound; platelet count may be abnormal
and coagulopathies may exist.
79. • Bone marrow aspiration and biopsy cells also
studied for chromosomal abnormalities
(cytogenetic) and immunologic markers to
classify type of leukemia further.
• Lymph node biopsy to detect spread.
• Lumbar puncture and examination of
cerebrospinal fluid for leukemic cells
(especially in ALL).
80. Management
• To eradicate leukemic cells and allow restoration of normal
hematopoiesis.
– Leukapheresis (or exchange transfusion in infants) may
be used when abnormally high numbers of white cells
are present to reduce the risk of leukostasis and tumor
burden before chemotherapy.
– Radiation, particularly of central nervous system (CNS)
in ALL.
– Autologous or allogeneic bone marrow or stem cell
transplantation.
– Lymphoid blast cells are typically very sensitive to
corticosteroids and to vinca alkaloids; therefore, these
medications are an integral part of the initial induction
therapy
• Supportive care and symptom management.
81. Central nervous system directed therapy: high
dose methotraxate is given intravenously.
Stem cell transplantation
Treatment protocols are complex using a wide
range of chemotherapeutic agents. This is
given up to three years
82. Acute myeloid leukemia
Occurs in all age groups
AML results from a defect in the hematopoietic stem cell
that differentiates into all myeloid cells
Most common in adults and increasingly common with old
age
Clinical manifestations
Anemia and thrombocytopenia
Fever and infection
DIC
Gum hypertrophy and infiltration
Bone pain due to expansion of marrow
hepatosplenomegally
83. Diagnostic findings
General hematological and biochemical findings similar to
those seen in ALL.
Test for DIC is positive
Treatment
Supportive therapy: Multiple platelet transfusions and
replacement of clotting factors with fresh frozen plasma
Specific therapy: Intensive chemotherapy usually given in
four blocks each of approximately one week
Bone marrow & Stem cell transplantation: used in patients
under 65 years old.
Results of therapy in patients over 70 years is poor
84. supportive care may be the only option if the patient
has significant comorbidity, such as extremely poor
cardiac, pulmonary, renal, or hepatic function. In such
cases, aggressive antileukemia therapy is not used;
occasionally, hydroxyurea (eg, Hydrea) may be used
briefly to control the increase of blast cells. Patients are
more commonly supported with antimicrobial therapy
and transfusions as needed
Complications
Bleeding
Infection
85. Chronic myeloid leukemia
Occur at any age
Chronic myeloid leukemia (CML) arises from a
mutation in the myeloid stem cell. Normal
myeloid cells continue to be produced, but there
is a preference for immature (blast) forms
involving more mature cells than acute leukemia
clinical features
Many patients are asymptomatic
Symptoms include dyspnea,weight loss,
anorexia or night sweats,hepatomegally.
86. Splenomegally
Features of anemia such as pallor
Bruising,epistaxis,menorrhagia or hemorrhage
Gout or renal impairment caused by
hyperuricaemia
Visual disturbances
priapism
87. Lab findings
Leucocytosis:A complete spectrum of myeloid
cells is seen in the peripheral blood
Bone marrow aspiration and biopsy:
hypercellular, usually demonstrates
Philadelphia (Ph1) chromosome
88. Treatment
imatinib. A protein-tyrosine kinase inhibitor, it
works by inhibiting proliferation of abnormal cells
and inducing cell death (apoptosis) in abnormal
cells.
alpha interferon frequently eliminates the Ph1
chromosome and blasts
chemotherapy with such agents as busulfan or
hydroxyurea
irradiation;
splenectomy.
89. Chronic lymphocytic leukemia
Peak incidence is between 60 and 80 years
is characterized by proliferation of
morphologically normal but functionally inert
lymphocytes. Classified according to cell
origin, it includes B cell (accounts for 95% of
cases), T cell
90. Assessment and diagnostic finding
• CBC and blood smear: large numbers of
lymphocytes; may also be anemia,
thrombocytopenia, hypogammaglobulinemia.
• Bone marrow aspirate and biopsy:
lymphocytic infiltration of bone marrow.
• Lymph node biopsy to detect spread.
91. Clinical features
Symmetrical enlargement of cervical,axillary or
inguinal lymph nodes. The nodes are discrete and
non-tender .Tonsillar enlargement may be a
feature
Features of anemia
Bruising due to thrombocytopenia
Purpura
Hepatosplenomegally
Immunosuppression: bacterial infections but later
Viral and fungal infections such as herpes zoster.
92. Treatment
Cure is rare and so the approach to therapy is
conservative aiming for symptom control rather
than normal blood count
Chemotherapy:Chlorambucil 4-6mg/day
Corticosteroids:Treat them with prednisolone
alone
Radiotherapy
Combination
Immunoglobulin replacement
Stem cell transplantation
93. Supportive Care
• Transfusion therapy to replace platelets and
RBCs.
• Antibiotics, antivirals, and antifungals as
needed to control infections.
• I.V. immunoglobulins or gamma globulin to
treat hypogammaglobulinemia
94. NURSING MANAGEMENT
Preventing Infection
• Especially monitor for pneumonia, pharyngitis, esophagitis,
perianal cellulitis, urinary tract infection, and cellulitis,
• Monitor for fever,.
• Check results of granulocyte counts. Concentrations less than
500/mm3 put the patient at serious risk for infection.
• Avoid invasive procedures and trauma to skin or mucous
membrane to prevent entry of microorganisms.
• Care for patient in private room with strict hand-washing
practice.
• Encourage and assist patient with personal hygiene, bathing,
and oral care.
• administer antimicrobials promptly as directed
95. Preventing and Managing Bleeding
• Watch for signs of minor bleeding, such as petechiae,
ecchymosis, conjunctival hemorrhage, epistaxis,
bleeding gums, bleeding at puncture sites, vaginal
spotting, heavy menses.
• Be alert for signs of serious bleeding, such as headache
with change in responsiveness, blurred vision,
hemoptysis, hematemesis, melena, hypotension,
tachycardia, dizziness.
• Test all urine, stool, emesis for gross and occult blood.
• Monitor platelet counts daily.
• Administer blood components as directed.
• Keep patient on bed rest during bleeding episodes
96. • easing pain and discomfort – by giving analgesics,positon
changes.shoulder and back massage
• managing mucositis- by encouraging oral hygiene, use soft
brush, normal saline rinse
• improving nutritional intake- by ensuring oral hygiene,
analgesisc before & after meals,small frequent meals, high
caloric diet, antiemetics
• decreasing fatigue and deconditioning-. Nursing interven-
tions should focus on assisting the patient to establish a
balance between activity and rest.
97. • maintaining fluid and electrolyte balance
. In- take and output need to be measured accurately,
and daily weights should also be monitored. The
patient should be assessed for signs of dehydration
as well as fluid overload, with particular attention to
pulmonary status. Laboratory test results UECS, and
hematocrit, should be monitored.
managing anxiety and grief – by providing information
about the disease
98. Venous thrombo embolism
• deep vein thrombosis is the formation of blood
clot in one of the deep veins of the body usually
the leg.
• DVT usually originates in the lower extremity
venous level, starting at the calf vein level and
progressing proximally to involve popliteal,
femoral or iliac system
• Superficial thrombosis blood clot develops in
veins close to the surface of the skin.they do not
usually travel to the lungs.
99. Risk factors of dvt
• Virchow’s triad, are believed to play a significant
role in its development:
stasis of blood (venous stasis), vessel wall injury,
and altered blood coagulation
• At least two of the factors seem to be necessary
for thrombosis to occur.
1. Venous stasis- occurs when blood flow is
reduced i.e in heart failure or shock; when veins
are dilated, paralysis of the extremities, or
anaesthesia, acast on the leg.
• Prolonged bed rest,obesity, spinal cord injury
100. Damage to the intimal lining of blood
vessels
• Direct trauma to the vessels i.e fractures or
dislocation, diseases of the veins, and chemical
irritation of the vein from intravenous
medications or solutions
• Surgery ,
• Pacing wires ,Central venous catheters Dialysis
access catheters
• Local vein damage ,Repetitive motion injury,
chemotherapy ports, or parenteral nutrition lines
101. • Increased blood coagulability
• occurs most commonly in patients who have
been abruptly with drawn from anticoagulant
medications.
• Oral contraceptive use, pregnancy, obesity
pregnancy
• An inherited blood-clotting disorder.
• cancers
102. Clinical Manifestations
• pain, swelling and tenderness in one of your
legs (usually your calf muscle)
• With obstruction of the deep veins comes
edema and swelling of the extremity because
the outflow of venous blood is inhibited
• Homans’ sign (pain in the calf after the foot is
sharply dorsiflexed) positive
103. • a feeling of heaviness, functional impairment,
ankle engorgement;
• differences in leg circumference bilaterally
from thigh to ankle;
• increase in the surface temperature of the
leg, particularly the calf or ankle; and areas of
tenderness or superficial thrombosis
• red skin, particularly at the back of your leg
below the knee
104. Diagnostic Evaluation
• Venous duplex/color duplex(doppler ultrasound)
ultrasound is commonly done. This noninvasive test
allows for visualization of the thrombus, including any
emboli.
• Venography: I.V. injection of a radiocontrast agent. The
vascular tree is visualized and obstruction is identified.
• Coagulation profiles: PTT, PT/INR,
• D-dimer test- detects pieces of blood clot that have
been broken down and are loose in your bloodstream.
The larger the number of fragments found, the more
likely it is that you have a blood clot in your vein
105. Medical Management
• The objectives of treatment for deep vein
thrombosis are to prevent the thrombus from
growing and fragmenting (risking pulmonary
embolism) and to prevent recurrent
thromboemboli.
Preventing embolization
• ANTICOAGULATION THERAPY Measures for
preventing or reducing blood clotting within
the vascular system
106. Unfractionated Heparin
• Unfractionated heparin may be given I.V. Or
subcutaneously initially, followed by 3 to 6
months of oral anticoagulant therapy.
• Medication dosage is regulated by monitoring
the partial thromboplastin time, the
international normalized ratio (INR), and the
platelet count.
107. Subcutaneous low-molecular- weight
heparin
It has a longer half-life than unfractionated heparin,
so doses can be given in one or two
subcutaneous injections each day. LMWH
prevents the extension of a thrombus and
development of new thrombi and is associated
with fewer bleeding complications than
unfractionated heparin. LMWH may be used
safely in pregnant women, and the patients may
be more mobile and have an improved quality of
life.
108. Thrombolytic Therapy
• (eg, tissue plasminogen activator, streptokinase) May
be used in life- or limb-threatening situations.
• Most effective in dissolving existing clots within the
first 24 hours of thrombolic event.is given within the
first 3 days after acute thrombosis. Therapy initiated
beyond 5 days after the onset of symptoms is
significantly less effective
• However, thrombolytic therapy results in
approximately a threefold greater incidence of
bleeding than heparin. If bleeding occurs and cannot
be stopped, the thrombolytic agent is discontinued.
109. Nonpharmacologic Therapies
• Bed rest is used only with unfractionated heparin. When
treating a superficial thrombosis or using low-molecular-
weight heparin, the patient is encouraged to walk.
• Elevation of affected extremity: at least 10 to 20 degrees
above the level of the heart to enhance venous return and
decrease swelling.
• Compression: promotes venous return and reduces
swelling.
– Electrically or pneumatically controlled stockings, boots, or
sleeve
– Elastic stockings or garments (20 to 30 mm Hg with arterial
disease secondarily, 30 to 40 mm Hg for isolated venous
disease)
111. relieving pain
• Elevate legs as directed to promote venous
drainage and reduce swelling.
• Apply warm compresses or heating pad as
directed to promote circulation and reduce pain.
• Administer acetaminophen (Tylenol), codeine, or
other analgesic and as needed. Avoid the use of
aspirin (or aspirin-containing drugs) and NSAIDs
during anticoagulant therapy to prevent further
risk of bleeding.
112. Preventing Bleeding
• Follow precautions to prevent bleeding.
– Handle patient carefully while turning and positioning.
– Maintain pressure on I.V. and venipuncture sites for at
least 5 minutes. Apply ice if patient is prone to
bleeding.
– Assist with ambulation and keep walkways/hallways
free from clutter to prevent falls.
• Observe carefully for any possible signs of
bleeding and report immediately so that
anticoagulant dosage may be reviewed and
altered if necessary:
113. Surgery
• Placement of a filter into the inferior vena
cava to prevent pulmonary embolism in a
patient who cannot tolerate prolonged
anticoagulant therapy or who has recurrent
emboli in the presence of adequate
anticoagulation.
• Thrombectomy may be necessary for severely
compromised venous drainage of the
extremity.