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Common Disorders and Conditions Related to Phlebotomy

Common Disorders and Conditions Related to Phlebotomy

Chapter © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 7 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Common Disorders and Conditions© Jones Related & Bartlett Learning, to LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Phlebotomy

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE OBJECTIVES Introduction After studying this chapter, readers should be able to: Cardiovascular Disorders 1. Describe the condition known as angina pectoris. Coronary Disease 2. Explain major factors that cause myocardial Angina Pectoris © Jones & Bartlett Learning, LLC infarction. © Jones & Bartlett Learning, LLC Myocardial InfarctionNOT FOR SALE OR DISTRIBUTION3. Describe primary .NOT FOR SALE OR DISTRIBUTION Cardiac 4. Compare with . Hypertension 5. Distinguish among endocarditis, myocarditis, and Cardiomyopathy pericarditis. Carditis 6. Explain the various types of anemias. © Jones Failure & Bartlett Learning, LLC 7. Compare© Jones polycythemia & Bartlett and leukemias. Learning, LLC NOTCardiac FOR Arrest SALE OR DISTRIBUTION 8. DescribeNOT the FORvarious SALE types of OR . DISTRIBUTION 9. Explain the possible consequences of emboli. Rheumatic Fever 10. Describe disseminated intravascular coagulation. Valvular Heart Disease Mitral Valve Prolapse KEY TERMS Shock Abruptio placentae: A of pregnancy wherein the © Jones & BloodBartlett Vessel Learning, Disorders LLC © Jones & Bartlett Learning, LLC placental lining has separated from the uterus of the mother, NOT FOR SALEAtherosclerosis OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION causing late pregnancy , fetal heart rate effects, and Arteriosclerosis potential fetal or maternal death. Emboli Angina pectoris: Sharp pain usually felt in the chest or arm that occurs when the heart does not receive enough oxygen Phlebitis to support its workload. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Anoxia: Absence of oxygen supply to an organ or tissue. Varicose NOT FOR SALE OR DISTRIBUTIONArrhythmia: An irregular heartbeat,NOT which FOR can rangeSALE from OR mild DISTRIBUTION Blood Disorders to life-threatening; also called dysrhythmia. Anemias Arthralgia: Joint pain. Polycythemia Atherosclerosis: A form of arteriosclerosis characterized by Hemochromatosis deposits of and other on the sides of the Leukemias © Jones & Bartlett Learning, LLC . © Jones & Bartlett Learning, LLC Lymphatic Diseases NOT FOR SALE OR DISTRIBUTION Celiac disease:NOT An FORautoimmune SALE disorder OR of DISTRIBUTION the small intestine Transfusion Incompatibility Reaction that causes diarrhea, failure to thrive (in children), fatigue, Clotting Disorders and other effects upon multiple body systems; it is triggered Summary by a reaction to wheat gluten. Critical Thinking Dysrhythmia: Also called , meaning “irregular Websites © Jones & Bartlett Learning, LLC © Jonesheartbeat.” & Bartlett Learning, LLC Review Questions NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEKEY TERMS OR DISTRIBUTION continued NOTMastectomy: FOR SALE Partial OR or DISTRIBUTIONcomplete removal of one or both Eclampsia: An acute, life-threatening complication of breasts. pregnancy wherein the mother may experience tonic-clonic Megaloblastic anemia: An anemia that results from seizures and coma. inhibition of DNA synthesis in red blood cell production; it is Gastrectomy: Partial or complete surgical removal of the characterized by megaloblasts in the bone marrow. stomach. © Jones & Bartlett Learning, LLCMyocardial infarction: A heart ©attack; Jones sudden & death Bartlett of cells Learning, LLC in the heart muscle caused by an abrupt interruption of Graves’ disease: An autoimmuneNOT FOR condition SALE caused OR by DISTRIBUTION NOT FOR SALE OR DISTRIBUTION overactive thyroid (hyperthyroidism), causing “bulging” eyes, blood flow (and lack of oxygen) to part of the heart. bone damage, and central or peripheral nervous system Myxedema: A type of cutaneous and dermal edema symptoms. secondary to hypothyroidism and Graves’ disease. Hemarthrosis: Blood accumulation or hemorrhage in a joint. NSAID: Nonsteroidal anti-inflammatory drug; common Hematopoietic stem cells: Stem cells that develop into all examples include aspirin and . © Jones & Bartlett Learning, LLC Pancytopenia:© JonesA combination & Bartlett of anemia, Learning,leukopenia LLC theNOT different FOR types SALE of blood OR cells. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Hemochromatosis: caused by either repeated (decreased white blood cells), and thrombocytopenia transfusions or a genetic disorder. (decreased platelets). Hemoglobin S: An inherited type of abnormal adult Proliferation: Growth and reproduction of cells. hemoglobin, which mostly affects African Americans, Reed-Sternberg cells: Cells usually derived from B lymphocytes that are much larger than surrounding cells and © Jones & Bartlettcausing sickle-cell Learning, anemia. LLC © Jones & Bartlett Learning, LLC Hemophilia A: The most common form of hemophilia; it is are found via light microscopy in cases of Hodgkin’s disease NOT FOR SALEan inherited OR DISTRIBUTIONcondition primarily affecting males wherein NOT FORand certain SALE other OR disorders. DISTRIBUTION coagulation is much more prolonged than normal. Respiratory acidosis: A condition in which decreased Hypertrophied: Enlarged, due to an increase in cell size. respiration increases blood carbon dioxide and decreases Hypoplasia: Lack of development of a tissue or organ. pH. Hypoplastic anemia: Aplastic anemia; actually a variety of Sepsis: The presence of pathogenic bacteria in tissue. related anemias that ©result Jones from destruction & Bartlett of or Learning, to LLCThalassemia: An inherited autosomal© Jones recessive & bloodBartlett disorder Learning, LLC stem cells in the boneNOT marrow FOR or its SALE matrix. OR DISTRIBUTIONin which hemoglobin chains areNOT not synthesized FOR SALE normally, OR DISTRIBUTION Ischemia: A temporary reduction of blood supply to an organ leading to anemia. or tissue due to obstruction of a blood vessel. Thrombus: A blood clot that forms in the cardiovascular Lymph: Part of the interstitial fluid, which is referred to as system. Ventricular asystole: The absence of contraction of the lymph when it enters a lymph ; it picks up and carries© Jones bacteria & to Bartlett the lymph nodesLearning, to be destroyed. LLC ventricles.© Jones & Bartlett Learning, LLC : Abnormal discharge of electrical Lymphoblasts:NOT FOR Immature SALE cells OR that DISTRIBUTION form lymphocytes; in NOT FOR SALE OR DISTRIBUTION acute lymphoblastic leukemia, lymphoblasts proliferate nerve impulses that cause the heart to stop beating. uncontrollably and are found in large numbers in the peripheral blood.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction is the leading cause of death in the Common disorders and conditions that are related to phle- United States. botomy include cardiovascular disorders such as coronary Coronary Artery Disease artery disease, , and hypertension as well as blood vessel disorders© Jones and & blood Bartlett disorders. Learning, Heart LLCCoronary artery disease is an abnormal© Jones condition & Bartlett that may Learning, LLC attack (myocardial infarction)NOT FOR is the leadingSALE cause OR of DISTRIBUTION death in affect the arteries of the heart andNOT produce FOR varying SALE pathologic OR DISTRIBUTION the United States. Hypertension is a major cause of cardiac effects, primarily reduced flow of oxygen and nutrients to the disease, renal failure, and stroke. Atherosclerosis (hardening myocardium. Atherosclerosis is the most common type of of the arteries) causes most myocardial and cerebral infarc- coronary artery disease (see Figure 7–1). Angina pectoris tions. Anemias are defined as conditions of reduced blood is the classic symptom of coronary artery disease; it results cells© orJones hemoglobin & Bartlett as well as Learning, the reduced abilityLLC to carry from myocardial© Jones ischemia. & Bartlett Learning, LLC oxygen to the cells. Leukemias are malignant neoplasms of theNOT bone marrow,FOR SALE spleen, andOR lymph DISTRIBUTION nodes. Diseases of the Angina PectorisNOT FOR SALE OR DISTRIBUTION lymphatic system include lymphedema, , and Angina pectoris is a sudden outburst of frequently various lymphomas. caused by myocardial anoxia as a result of atherosclerosis or coronary artery spasm. © Jones & CardiovascularBartlett Learning, Disorders LLC © JonesAngina & Bartlett pectoris attacksLearning, are often LLC related to emotional stress, eating, exertion, and exposure to intense cold. Com- NOT FOR SALECardiovascular OR DISTRIBUTION disease is described as any abnormal conNOT- plications FOR SALE of angina OR pectoris DISTRIBUTION include arrhythmias, myocardial dition characterized by heart or blood vessel dysfunction. infarction, and ischemic cardiomyopathy. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jonesby abnormal & Bartlett electrical Learning, conduction or LLC automaticity. Normally, NOTthe FOR sinoatrial SALE (SA) OR node DISTRIBUTION generates heart rhythms that travel NOT FOR SALE OR DISTRIBUTION through the heart’s conduction system. This causes the atrial and ventricular myocardium to contract and relax at a regular Damaged rate. This rate maintains circulation during various levels of endothelium physical activity. Arrhythmias range from mild and asymp- © JonesNormal smooth & Bartlett Learning, LLCtomatic such as sinus arrhythmia© toJones catastrophic & Bartlett ventricular Learning, LLC muscle cell fibrillation (which requires immediate resuscitation). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Fatty deposits accumulate in muscle cell Common causes of arrhythmias include the following: ■■ Congenital defects Fatty ■■ Drug toxicity streak ■■ Electrolyte imbalances ■■ Myocardial infarction or ischemia © Jones & Bartlett Learning, LLC ■■ Organic© heartJones disease & Bartlett Learning, LLC ■ NOT FOR SALE ORFibers DISTRIBUTIONFibrous ■ DegenerationNOT FOR of the conductiveSALE OR tissue DISTRIBUTION Fats plaque ■■ Connective tissue disorders ■■ Cellular hypoxia ■■ Hypertrophy of the heart muscle ■■ Acid–base imbalances © Jones & Bartlett Learning, LargeLLC plaque obstructing artery © Jones■■ Emotional& Bartlett stress Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTHypertension FOR SALE OR DISTRIBUTION Figure 7–1 Development of a deposition of -containing substances that form plaque and lead to arterial occlusion Hypertension is an elevation in either systolic or diastolic . It occurs as either essential (primary) hyper- tension or . Primary hypertension is © Jones & Bartlett Learning, LLCthe most common type and is of© unknown Jones cause. & Bartlett Secondary Learning, LLC Myocardial InfarctionNOT FOR SALE OR DISTRIBUTIONhypertension results from renalNOT disease FOR or other SALE identifiable OR DISTRIBUTION causes. Malignant hypertension is a severe form of hyperten- When coronary blood flow is interrupted for extended peri- sion that may be either primary or secondary. Hypertension ods, necrosis (tissue death) of part of the cardiac muscle is a major cause of cardiac disease, renal failure, and stroke. occurs. Necrosis results in myocardial infarction (see Figure 7–2). When the coronary© Jones arteries & are Bartlett obstructed, Learning, this LLC © Jones & Bartlett Learning, LLC mayNOT result FORin atherosclerosis, SALE OR a spasm, DISTRIBUTION NOT FOR SALE OR DISTRIBUTION or a thrombus. Myocardial infarction (MI) is also called heart attack. Heart attack is the leading cause of death in the United States. When © Jones & treatmentBartlett is delayed,Learning, mortality LLC is high. © Jones & Bartlett Learning, LLC NOT FOR SALENearly one-halfOR DISTRIBUTION of sudden myocar- NOT FOR SALE OR DISTRIBUTION dial infarction deaths occur before the patient can be hospitalized, usually within 1 h of the onset of symptoms. Risk factors for myocardial infarction include the following:© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■ ■ Family history ofNOT MI FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Aging ■■ Gender ■■ Hypertension ■■ Elevated total cholesterol Clot ■ ©■ JonesObesity & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■■ Lifestyle NOT■ FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ Smoking Damaged ■■ Stress or type A personality heart muscle ■■ Drug use (especially cocaine and ) © Jones & CardiacBartlett Arrhythmias Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEA dysrhythmia OR DISTRIBUTION (an arrhythmia) is a NOT FOR SALE OR DISTRIBUTION disturbance of heart rhythm caused Figure 7–2 Damage caused by myocardial infarction. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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Pulmonary Edema © Jones & BartlettRisks for Learning,hypertension increaseLLC with age. Hypertension© Jones & Bartlett Learning, LLC NOT FOR SALEis more prevalentOR DISTRIBUTION in the black population than in the whiteNOT Pulmonary FOR SALE edema OR involves DISTRIBUTION fluid that shifts into the extravas- population. It is also more prevalent in people with less edu- cular spaces of the lungs. Pulmonary circulation becomes cation and lower income. During young and middle adult- overloaded with excessive blood volume. It causes dyspnea; hood, men have a higher incidence of hypertension, but coughing; ; raised cardiac and respiratory rates; and thereafter, women have a higher incidence. bloody, frothy . Blood pressure may be reduced, and Risk factors for © essential Jones hypertension & Bartlett include Learning, the LLCthe skin feels cold and clammy.© Symptoms Jones often& Bartlett occur after Learning, LLC following: a patient goes to bed. Pulmonary edema is caused by left- ■ NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ The aging process sided heart failure, mitral valve disease, pulmonary embolus, ■ ■ Family history arrhythmias, renal failure, or systemic hypertension. Other ■ ■ Obesity causes include drug overdose, exposure to high altitudes, ■ ■ High intake of sodium and head trauma. ■■ High intake of saturated fat ■©■ SleepJones & Bartlett Learning, LLC Rheumatic© Fever Jones & Bartlett Learning, LLC ■NOT■ Stress FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Rheumatic fever affects the joints and cardiac tissue, and it ■■ Excessive alcohol consumption is a systemic inflammatory and autoimmune disease. It fol- ■■ Sedentary lifestyle lows a sore throat that is caused by group-A beta-hemolytic ■■ Diabetes mellitus streptococcus. This usually occurs in children, resulting in ■■ Tobacco use © Jones & Bartlett Learning, LLC © Jonesfever and & Bartlettpolyarthritis. Learning, The joints most LLC affected include the Cardiomyopathy knees, ankles, and fingers. Other symptoms include carditis, NOT FOR SALE OR DISTRIBUTION NOTcardiac FOR murmurs,SALE OR cardiomegaly, DISTRIBUTION and congestive heart failure. Cardiomyopathy is a term that generally applies to a disease Symptoms occur within 5 weeks after the upper respiratory of the heart muscle fibers. It is the second most common tract infection. Prompt assessment is required. Rheumatic direct cause of sudden death (after coronary artery disease). fever develops as antibodies against the bacteria cross-react The most common type of cardiomyopathy is the dilated with normal tissues. The body attacks its own cells to initiate form. Men and blacks© have Jones the greatest & Bartlett risk for dilatedLearning, car- LLCan inflammatory reaction, which© Jonesmigrates &to Bartlettthe endocar Learning,- LLC diomyopathy. Other riskNOT factors FOR include SALE coronary OR artery DISTRIBUTION dis- dium and heart valves. NOT FOR SALE OR DISTRIBUTION ease, hypertension, pregnancy, viral infections, and the use of alcohol or illegal drugs. Hypertrophic cardiomyopathy is Valvular Heart Disease different in that it is caused by a genetic abnormality. Valvular heart disease can affect all heart valves, and it may be Carditis acquired or congenital. If insufficient, the valves do not close © Jones & Bartlett Learning, LLC completely, and© Jones blood is forced& Bartlett back into Learning, the previous chamLLC- CarditisNOT is FOR defined SALE as OR DISTRIBUTION of the heart and its sur- ber as the heartNOT contracts. FOR SALE This increases OR DISTRIBUTION the heart’s work- rounding structures. The several types of carditis include load. occurs when the cusps of the valves harden, pericarditis, myocarditis, and endocarditis. Common causes preventing complete opening. Diagnosis of valvular heart of the various forms of carditis include viral infections, bacte- disease requires electrocardiogram, echocardiogram, cardiac rial infections, fungal infections, immune conditions, myocar- catheterization, and radiographic chest studies. Treatment © Jones & dialBartlett infarction, Learning, trauma, uremia, LLC , certain medications,© Jonesinvolves & digitalis Bartlett or quinidine, Learning, to treat LLC arrhythmias, and pro- radiation, and other causes. NOT FOR SALE OR DISTRIBUTION NOTphylactic FOR SALE antibiotics. OR DISTRIBUTION Heart Failure Mitral Valve Prolapse Heart failure is the inability of the heart muscle to contract Mitral valve prolapse is defined as one or both cusps of the with enough force to properly circulate the blood throughout mitral valve protruding back into the left atrium when the the body. Dysfunction© of Jones the left ventricle & Bartlett is the mostLearning, com- LLCventricles contract. It is usually© Jonesa benign &condition, Bartlett with Learning, LLC mon cause of heart failure. However, the right ventricle may patients being asymptomatic. When symptoms do exist, they also be dysfunctional, NOTespecially FOR in pulmonary SALE OR disease DISTRIBUTION (right include dyspnea, chest pain, fatigue,NOT dizziness, FOR SALE and syncope. OR DISTRIBUTION ventricular failure). The most common form of heart failure It affects all age groups and often results in severe anxiety. is congestive heart failure. It is called this because of the col- Mitral valve prolapse is usually diagnosed during a routine lection of fluid (congestion) in the lungs and extremities. physical examination, although a physician should evaluate any reports of chest pain promptly. Cardiac© Jones Arrest & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Shock CardiacNOT arrest FOR is SALEa sudden OR cessation DISTRIBUTION of cardiac output and NOT FOR SALE OR DISTRIBUTION effective circulation. It is usually precipitated by ventricu- Shock is defined as cardiovascular system collapse. It includes lar fibrillation or ventricular asystole. When fluid shifts and vasodilation along with inefficient cardiac occurs, the delivery of oxygen and removal of carbon dioxide output. The organs and tissues experience inadequate per- cease. Tissue cell metabolism becomes anaerobic, and meta- fusion, and the patient appears pale, cold, and clammy. The © Jones & bolicBartlett acidosis Learning, and respiratory LLC acidosis occur. Immediate ini©- Jonespulse is& rapid Bartlett (tachycardia), Learning, weak, and LLC thready, and there is NOT FOR SALEtiation of OR cardiopulmonary DISTRIBUTION resuscitation (CPR) is required.NOT rapid FOR SALE as OR well DISTRIBUTION as an altered level of consciousness. Cardiac arrest is also called cardiopulmonary arrest. Drops in blood pressure may cause anxiety, irritability, and © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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Arteriosclerosis © Jones &restlessness. Bartlett Learning, Other symptoms LLC include dizziness, extreme© Jones & Bartlett Learning, LLC NOT FOR SALEthirst, profuse OR DISTRIBUTIONsweating, and then dilation of the pupils, shakNOT- Arteriosclerosis FOR SALE is OR actually DISTRIBUTION a group of diseases characterized ing, and trembling. Shock is a true medical emergency. by the hardening of the arteries. The most common form Shock may be caused by , hemorrhage, respi- of arteriosclerosis is atherosclerosis. Some types of arterio- sepsis ratory distress, , heart failure, neurologic failure, sclerosis involve the destruction of muscle and elastic fibers emotional catastrophe, or severe metabolic insult. The vital as well as deposits of calcium. Arteriosclerosis occurs when organs eventually do ©not Jones receive enough& Bartlett oxygen Learning,and nutri- LLCthe walls of the thicken,© Jonesand a loss & of Bartlettelasticity and Learning, LLC ents to sustain life. Rapid blood loss or fluid loss, with hypo- contractility occurs. volemia, precipitates shock.NOT Another FOR SALE cause of shockOR DISTRIBUTION is failure NOT FOR SALE OR DISTRIBUTION of the heart to pump adequately. Emboli Types of shock include the following: Emboli are (usually) blood clots that lodge in blood vessels to ■ ■ Cardiogenic—decreased cardiac output with tissue inhibit blood flow. Symptoms vary, but usually include severe hypoxia in the presence of adequate intravascular vol- © Jones & Bartlett Learning, LLC pain in the area© Jones of the embolus. & Bartlett If an embolus Learning, lodges LLCin an ume; it is caused by heart failure (usually after myo- extremity, paleness, numbness, or coldness may develop. If NOTcardial FOR infarction) SALE OR DISTRIBUTION nausea, vomiting,NOT fainting,FOR SALE or shock OR occurs, DISTRIBUTION the patient is ■ ■ Hypovolemic—develops when intravascular volume in an emergency state. Emboli may also be composed of air has decreased by approximately 15%; it is caused by bubbles, clumps of bacteria, globules of fat, or pieces of tis- hemorrhage, burns, or loss of interstitial fluid sue. Venous in the deep veins of the legs is most ■ ■ Neurogenic—widespread vasodilation due to parasym- common. When a portion of a thrombus breaks loose, it © Jones & Bartlettpathetic Learning, overstimulation LLC or sympathetic understimu©- Jonestravels &through Bartlett the veins Learning, until it lodges LLC in a narrow vessel, NOT FOR SALElation; OR itDISTRIBUTION is caused by spinal cord or medulla trauma,NOT such FOR as aSALE vessel in OR the lungs.DISTRIBUTION Thrombi can form in the heart depressants, anesthetics, pain, or severe emotional because of cardiac arrhythmias. This can result in a myo- stress cardial infarction, or the thrombus can travel to the brain, ■ ■ Anaphylactic—results from a widespread hypersen- which results in a stroke. sitivity reaction (anaphylaxis); often caused by aller- Aneurysms gies and poisons—it© Jones may & lead Bartlett to death Learning, quickly if LLC © Jones & Bartlett Learning, LLC untreated NOT FOR SALE OR DISTRIBUTIONAneurysms are defined as abnormalNOT dilations FOR ofSALE blood vessels OR DISTRIBUTION ■■ Septic—part of the systemic inflammatory response located in distinctly limited areas (see Figure 7–3). Symptoms syndrome; it begins with an infection that progresses vary with location, and abdominal aortic is the most to bacteremia and sepsis, resulting in multiple organ common type. Aneurysms are often caused by a buildup of dysfunction syndrome atherosclerotic plaque that weakens vessel walls. If the aneu- © Jones & Bartlett Learning, LLC rysm is abdominal,© Jones a “bruit” & Bartlettsound is heard Learning, on . LLC BloodNOT Vessel FOR SALE Disorders OR DISTRIBUTION Phlebitis NOT FOR SALE OR DISTRIBUTION The vascular system contains the arteries, arterioles, capillar- Phlebitis is defined as inflammation of a . It occurs usually ies, venules, and veins. These vessels supply the tissues with in the lower legs, but it can affect any veins in the body. Pain oxygen and nutrients, which are carried in the blood. This and tenderness in the affected area develop first, followed system also moves carbon dioxide and waste products to the by intensifying discomfort, swelling, redness, and warmth. © Jones & appropriateBartlett organsLearning, for excretion. LLC The arteries carry oxygen©- JonesPhlebitis & canBartlett develop Learning, into thrombophlebitis. LLC Although the NOT FOR SALEated blood OR away DISTRIBUTION from the heart, and in general, the veins carryNOT exact FOR cause SALE is unknown, OR DISTRIBUTION it is possible that venous stasis, blood deoxygenated blood back to the heart. The are the disorders, obesity, injury to a vein during phlebotomy, and point of exchange at the cellular level. Blood vessel disorders may be related. include atherosclerosis, arteriosclerosis, emboli, aneurysms, phlebitis, thrombophlebitis, and . Thrombophlebitis Atherosclerosis © Jones & Bartlett Learning, LLCThrombophlebitis results from© phlebitis, Jones with & Bartlett a thrombus Learning, LLC NOT FOR SALE OR DISTRIBUTIONforming on the vessel wall. ItNOT interferes FOR with SALE blood ORflow DISTRIBUTION Atherosclerosis is defined as a form of arteriosclerosis char- and causes edema, pain, swelling, heaviness, warmth in the acterized by deposits of cholesterol and other fats on the affected area, and chills and fever. It is also influenced by sides of blood arteries (see Figure 7–1). Atherosclerosis venous stasis, blood disorders that cause hypercoagula- causes most myocardial and cerebral infarctions. Risk fac- bility, and injury to the venous wall. The tunica intima is tors© include Jones heredity, & Bartlett a sedentary Learning, lifestyle, a dietLLC high in fats affected, allowing© Jones the formation & Bartlett of clots. Learning, Often, there LLC will and cholesterol, smoking cigarettes, hypertension, diabetes be gross edema in one leg, with tenderness to the touch. mellitus,NOT andFOR obesity. SALE Infarction OR DISTRIBUTION becomes more likely as ThrombophlebitisNOT isFOR confirmed SALE with OR radiographic DISTRIBUTION venogra- plaque forms and thickens the arterial walls. Blood tests will phy and ultrasonography. It requires immediate treatment, indicate elevated cholesterol, triglyceride, and lipid levels, with immobilization of the affected part. is given to and hypertension is usually noted. Treatment consists of prevent enlargement of the clot, and antibiotics are used to changes in diet and exercise as well as stopping smoking. prevent infection. Surgery may be used to ligate the affected © Jones & DrugBartlett therapies Learning, are quite varied, LLC including hyperlipidemic© Jonesvessel so& thatBartlett collateral Learning, circulation canLLC develop. Prevention NOT FOR SALEagents and OR those DISTRIBUTION that inhibit cholesterol absorption in theNOT of FOR deep veinSALE thrombosis OR DISTRIBUTION during immobilization or reduced intestine. physical activity is essential. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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Anemias © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTAnemias FOR SALE are defined OR as DISTRIBUTIONconditions of reduced red blood cells or hemoglobin as well as the reduced ability to carry oxygen to the cells. Types of anemias include iron deficiency, folic acid deficiency, pernicious, aplastic, sickle cell, hemorrhagic, and hemolytic. Most anemic patients are pale and fatigued. © Jones & Bartlett Learning, LLCProgressive symptoms include ©dyspnea, Jones tachycardia, & Bartlett and the Learning, LLC NOT FOR SALE OR DISTRIBUTIONpounding of the heart, which NOTa physician FOR should SALE promptly OR DISTRIBUTION assess. Various causes include hemorrhage, heavy menstrual flow, the insufficient intake of iron, the insufficient intake of folic acid, oversized immature RBCs, autoimmune condi- tions, damaged stem cells, and exposure to certain cytotoxic © Jones & Bartlett Learning, LLC agents. Diagnosis© Jones shows &reduced Bartlett numbers Learning, of RBCs, hemo LLC- globin, and hematocrit. Treatment is based on the etiology NOT FOR SALE OR DISTRIBUTION of the anemia.NOT FOR SALE OR DISTRIBUTION

Iron Deficiency Anemia Iron deficiency anemia is a disorder of oxygen transport. © Jones & Bartlett Learning, LLC © JonesHemoglobin & Bartlett synthesis Learning, is deficient LLC in this disease, which affects between 10 and 30% of adults in the United States. It NOT FOR SALE OR DISTRIBUTION NOTis FOR the most SALE common OR type DISTRIBUTION of anemia, and IT occurs in all ages. Replacement therapy usually reverses the condition. Possible causes of iron deficiency anemia include the following: ■■ Inadequate dietary intake of iron ■■ Blood loss (due to drugs, heavy menses, hemorrhag- © Jones & Bartlett Learning, LLC ing, peptic ulcers, etc.) © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION■■ Iron malabsorption (fromNOT chronic FOR diarrhea, SALE gastrec OR -DISTRIBUTION tomy, celiac disease, etc.) ■■ Various types of hemoglobinuria (the presence of free hemoglobin in the urine) ■■ Pregnancy (wherein iron is carried from the mother © Jones & Bartlett Learning, LLC to the ©fetus) Jones & Bartlett Learning, LLC ■ FigureNOT 7–3 FOR Large SALEarteriosclerotic OR aneurysmDISTRIBUTION extending from renal ■ MechanicalNOT redFOR blood SALE cell trauma OR DISTRIBUTION(due to prosthetic arteries (above) to iliac arteries (below) heart valves or vena cava filters)

Folic Acid Deficiency Anemia Folic acid deficiency anemia is a slowly progressing form of megaloblastic anemia © Jones & VaricoseBartlett Veins Learning, LLC © Jones & Bartlett Learning,. It is very common, LLC usually occur- NOT FOR SALE OR DISTRIBUTION NOTring FOR in infants,SALE adolescents, OR DISTRIBUTION pregnant or lactating women, Varicose veins usually occur in the lower legs and appear swol- alcoholics, elderly people, and patients with malignancies or len, tortuous, and knotted. They usually develop gradually, intestinal diseases. It is caused by the following: causing leg fatigue and then a continuous dull ache. Eventu- ■■ Alcohol abuse, which suppresses the metabolic effects ally, the veins become harder and thicker, with pain worsen- of folate ing. They are easily diagnosed© Jones by their & Bartlettappearance. Learning, Although LLC■■ Poor diet © Jones & Bartlett Learning, LLC the cause is not clearly identified, absent or defective valves ■ NOT FOR SALE OR DISTRIBUTION■ Impaired absorption dueNOT to intestinal FOR dysfunctionSALE OR or DISTRIBUTION in the veins are suspected. When the patient has adequate diseases exercise, the blood in the legs moves normally. When the ■■ Overcooking of food, destroying much of the con- patient is standing or sitting for extended periods, gravity tained folic acid causes the blood to be pushed downward, causing pressure ■■ Prolonged drug therapy (including anticonvulsants on the valves. When advanced, varicosities cause skin around © Jones & Bartlett Learning, LLC and estrogens)© Jones & Bartlett Learning, LLC the affected vessels to become brownish. Treatment involves ■■ Increased need for folic acid (during pregnancy, frequentNOT rest FOR with SALE the legs OR raised, DISTRIBUTION exercise, submergence in increasedNOT periods FOR of SALE growth ORthroughout DISTRIBUTION life, and in warm water, and wearing support stockings. Surgery may be patients with skin diseases or neoplastic diseases) indicated if these treatments are not adequate. Pernicious Anemia Blood Disorders Pernicious anemia is the most common form of megaloblas- © Jones & TheBartlett common Learning, blood disorders LLC include anemias, leukemias,© Jonestic anemia. & Bartlett It is mainly Learning, caused by malabsorption LLC of vitamin

NOT FOR SALElymphatic OR diseases, DISTRIBUTION transfusion incompatibility reaction, andNOT B FOR12. It usually SALE affects OR people DISTRIBUTION between the ages of 50 and 60, clotting disorders. and incidence increases with age. It is a fatal condition if not © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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© Jones &treated. Bartlett When Learning, treated properly, LLC its sub©- Jonesanemia & occurs Bartlett when theLearning, bone marrow LLC cannot produce more side, although certain neurologic deficits may be permanent.NOT red FOR blood SALE cells than OR are DISTRIBUTION being destroyed. Hemolytic anemias NOT FOR SALEPossible ORcauses DISTRIBUTION of pernicious anemia include the following: are seen in disorders such as malaria and thalassemia. These ■■ Genetic predisposition may be due to protein abnormalities or differences. ■■ Thyroiditis, myxedema, or Graves’ disease ■■ Partial gastrectomy Polycythemia ■■ Lack of adequate dietary consumption of vitamin B © Jones & Bartlett Learning,12 LLCPolycythemia is an abnormal increase© Jones in the number& Bartlett of eryth Learning,- LLC (usually in the elderly) NOT FOR SALE OR DISTRIBUTIONrocytes in the blood. It may be NOTprimary FOR or secondary SALE to OR pul -DISTRIBUTION Aplastic Anemia monary disease, heart disease, or prolonged exposure to high altitudes. It may also be idiopathic. Symptoms include head- hypoplastic anemia Aplastic anemia is also called . These aches, dyspnea, irritability, mental sluggishness, dizziness, terms actually describe a variety of related anemias. Aplas- syncope, night sweats, and weight loss. Diagnosis is made via tic anemia results from the destruction of or injury to stem blood tests, spleen enlargement, and total RBC mass evalu- © Jones & Bartlett Learning, LLCpancytopenia © Jones & Bartlett Learning, LLC cells in the bone marrow or its matrix. It causes ation. Periodic phlebotomy is used to reduce blood volume, hypoplasia andNOT bone marrowFOR SALE OR. Pancytopenia DISTRIBUTION actually results as are myelosuppressiveNOT FOR drugs SALE and radiation.OR DISTRIBUTION from the decreased functioning of hypoplastic fatty bone marrow. Aplastic anemia usually results in fatal bleeding or Hemochromatosis infection, with the death rate for severe cases being between Hemochromatosis is defined as an iron overload that may be 80 and 90% of patients. Possible causes of aplastic anemia caused by either repeated transfusions or a genetic condition. © Jones & includeBartlett the following:Learning, LLC © Jones & Bartlett Learning, LLC When related to heredity, the disorder causes the small intes- ■■ Drugs (antibiotics, anticonvulsants) or toxic agents NOT FOR SALE OR DISTRIBUTION NOTtine FOR to absorb SALE excessive OR DISTRIBUTION iron. Symptoms include arthralgia, ■■ Radiation (nearly one-half of all cases are related to decreased libido, and fatigue, followed by cirrhosis of the radiation exposure) liver, diabetes, excessive melanin-related skin pigmentation, ■■ Severe disease (especially ) and heart failure. The excess iron is stored in muscles and ■■ Preleukemic and neoplastic infiltration of bone mar- organs such as the liver, pancreas, and heart. Liver damage row © Jones & Bartlett Learning, LLCmay result in liver carcinoma. Symptoms© Jones usually & Bartlett develop inLearning, LLC ■■ Congenital (idiopathic) causes NOT FOR SALE OR DISTRIBUTIONthe fifth or sixth decade of life, withNOT clinical FOR signs SALE being ORmore DISTRIBUTION Sickle-Cell Anemia prevalent in males. Sickle-cell anemia is a congenital condition caused by defec- Leukemias tive hemoglobin molecules. The sickle-cell trait results from Leukemias are malignant neoplasms of the bone marrow, mutations of the hemoglobin S gene. The disease is initially © Jones & Bartlett Learning, LLC spleen, and lymph© Jones nodes. & They Bartlett produce Learning, an abnormal prolifLLC- asymptomatic. However, about 50% of patients die by their NOT FOR SALE OR DISTRIBUTION eration of certainNOT lymphoid FOR SALE or myeloid OR cells, DISTRIBUTION causing reduced early twenties from this condition. Very few will live to middle production and function of normal blood cells. They are age. Sickle-cell anemia mainly affects people of African or classified by the proliferating cell type and degree of differ- Mediterranean descent. It is also commonly seen in Puerto entiation of the neoplastic cells. Leukemias may be acute or Rico, India, the Middle East, and Turkey. chronic. Common types of leukemias include acute lympho- © Jones & HemorrhagicBartlett Learning, Anemia LLC © Jonescytic leukemia, & Bartlett chronic Learning, lymphocytic LLCleukemia, acute myelog- NOT FOR SALE OR DISTRIBUTION NOTenous FOR leukemia, SALE andOR chronic DISTRIBUTION myelogenous leukemia. A hemorrhage is a loss of a large amount of blood in a short period, either externally or internally. Hemorrhaging may Acute Lymphocytic Leukemia occur in arteries, veins, or capillaries. An untreated hemor- Acute lymphocytic leukemia causes an overproduction of rhage may result in anemia. This is referred to as hemorrhagic immature lymphoid cells (lymphoblasts) in the lymph nodes anemia. Hemoglobin levels© Jones are lowered & Bartlett severely due Learning, to rapid, LLCand bone marrow. Common signs© Jones and symptoms & Bartlett include Learning, LLC massive hemorrhage. Most commonly, hemorrhagic anemia NOT FOR SALE OR DISTRIBUTIONbone pain, sore throat, fatigue,NOT night sweats,FOR weakness,SALE OR and DISTRIBUTION is seen after car accidents, major surgery, gunshot or stab weight loss. Prompt assessment by a physician is required. wounds, and other severe forms of tissue damage. Surgery to This type of leukemia usually affects children and people over repair the bleeding tissues or organs is usually indicated, as age 65. It is the most common childhood leukemia. are blood transfusions. If prompt treatment is not given, the patient goes into shock, which leads to coma and death. Chronic Lymphocytic Leukemia © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chronic lymphocytic leukemia is a neoplasm that usually Hemolytic Anemia NOT FOR SALE OR DISTRIBUTION affects the BNOT lymphocytes. FOR SALE It progresses OR slowly,DISTRIBUTION resulting in Hemolytic anemia is a disorder characterized by the chronic mature-appearing but hypofunctional lymphocytes. There premature destruction of red blood cells. Anemia may be min- are often no symptoms prior to the disease being revealed in imal or absent and may reflect the ability of bone marrow to a . When symptoms develop, they usu- increase red blood cell production. The process of the destruc- ally include fever, night sweats, extreme fatigue, a noticeable © Jones & tionBartlett of red blood Learning, cells is called LLC hemolysis. The condition may© Jonesswelling & of Bartlett lymph nodes, Learning, and weight loss.LLC Prompt assessment NOT FOR SALEbe associated OR DISTRIBUTIONwith an infectious disease, certain inheritedNOT by FOR a physician SALE is ORrequired. DISTRIBUTION There are five stages of chronic red blood cell disorders, or neoplastic diseases. Hemolytic lymphocytic leukemia: © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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■■ Stage 0—low risk—lymphocytosis exists © Jonesthe extremities. & Bartlett It is Learning,characterized byLLC fine red streaks that © Jones & Bartlett■ Learning, LLC ■ Stage I—intermediate risk—lymphocytosis plusNOT extend FOR from SALE the infectedOR DISTRIBUTION area to the axilla or groin. Other NOT FOR SALEenlarged OR DISTRIBUTION lymph nodes symptoms include chills, fever, headache, and myalgia. Risk ■■ Stage II—intermediate risk—lymphocytosis plus an factors include chronic steroid use, diabetes mellitus, long- enlarged liver or spleen, with or without lymphade- term placement of a peripheral venous catheter, immuno- nopathy compromise, bites (from insects, animals, or humans), and ■ ■ Stage III—high ©risk—lymphocytosis Jones & Bartlett plus anemia Learning, LLCany skin trauma. © Jones & Bartlett Learning, LLC ■■ Stage IV—high risk—lymphocytosis plus thrombo- cytopenia NOT FOR SALE OR DISTRIBUTIONLymphomas NOT FOR SALE OR DISTRIBUTION Lymphomas are neoplasms of the lymphatic tissue that origi- Acute Myelogenous Leukemia nate in the lymphatic system. They are usually malignant, but Acute myelogenous leukemia is a rapidly progressive neo- in rare cases may be benign. A lymphoma normally appears plasm of myeloid-related cells. In this condition, leukemic initially as a single, painless, enlarged lymph node, usually cells© accumulate Jones & in Bartlettthe bone marrow, Learning, peripheral LLC blood, and in the neck. ©Signs Jones and symptoms & Bartlett progress Learning, to include LLCfever, otherNOT tissues. FOR It is alsoSALE known OR as acuteDISTRIBUTION myeloid, granulocytic, weakness, anemia,NOT andFOR weight SALE loss. TheOR disease DISTRIBUTION may spread or myelocytic leukemia. Rapidly accumulating myeloblasts to the liver, bones, spleen, and gastrointestinal tract. Lympho- lead to pancytopenia and anemia. This type of leukemia is mas are usually categorized as Hodgkin’s or non-Hodgkin’s the most common adult leukemia and represents about 20% lymphoma. Hodgkin disease is caused by clonal proliferation of childhood leukemias. of transformed B lymphocytes. The presence of Reed-Stern- © Jones & Bartlett Learning, LLC © Jonesberg cells & Bartlett on a pathologic Learning, examination LLC is all that is needed Chronic Myelogenous Leukemia NOT FOR SALE OR DISTRIBUTION NOTto FOR confirm SALE diagnosis OR of DISTRIBUTION this disease (see Figure 7–4). The Chronic myelogenous leukemia is a slowly progressing neo- disease spreads first to continuous lymphoid tissue and then plasm arising in early progenitor cells or hematopoietic stem to nonlymphoid tissue. cells. It results in excessive mature-appearing but hypofunc- tional neutrophils. Most cases are genetic in origin, identi- Transfusion Incompatibility Reaction fied because of the Philadelphia© Jones chromosome& Bartlett. This Learning, type of LLCIt is extremely important that blood© Jones components & Bartlett to be trans Learning,- LLC leukemia accounts forNOT 15 to 20%FOR of adultSALE leukemias. OR DISTRIBUTION Nearly fused be compatible with the individualNOT FOR receiving SALE the transOR -DISTRIBUTION one-half of patients are asymptomatic at diagnosis. It is usu- fusion. The correct individual must be identified prior to ally diagnosed because of leukocytosis or thrombocytosis the transfusion process. Transfusion incompatibility reac- found during routine blood tests. The disease usually occurs tion occurs when a transfused blood product has antibodies in adults over the age of 40. The only chance for a complete to the recipient’s red blood cells, or when the recipient has cure© is Jones bone marrow & Bartlett transplantation. Learning, LLC antibodies to© the Jones donated & blood’s Bartlett red blood Learning, cells. Individu LLC- LymphaticNOT FOR Diseases SALE OR DISTRIBUTION als must be NOTcarefully FOR monitored SALE for OR a transfusion DISTRIBUTION reaction. The hypersensitivity reaction can range from mild to fatal. Diseases of the lymphatic system include lymphedema, lymp- Therefore, vital signs should be checked every 5 min during hangitis, and various lymphomas. the procedure, and signs and symptoms such as chills, fever, Lymphedema facial flushing, tachycardia, cold or clammy skin, and itching should also be checked. More intensive symptoms may lead to © Jones & LymphedemaBartlett Learning, is an abnormal LLC collection of lymph (usually© Jonescirculatory & Bartlett collapse. This Learning, type of reaction LLC produces hemolysis NOT FOR SALEin the extremities) OR DISTRIBUTION that results in a painless swelling. It isNOT or FOR agglutination SALE of OR blood DISTRIBUTION cells. Any further transfusion must usually due to an obstruction, but may also be caused by be quickly stopped, and antihistamines are indicated. inflammation or the removal of lymph channels. Congeni- tal lymphedema (Milroy’s disease) is a hereditary condition Clotting Disorders characterized by chronic lymphatic obstruction. Second- ary lymphedema may© follow Jones the surgical & Bartlett removal Learning, of lymph LLCClotting disorders include hemophilia© Jones and disseminated & Bartlett intra Learning,- LLC vascular coagulation. Hemophilia results from a deficiency of channels in mastectomyNOT, the FORobstruction SALE of lymph OR DISTRIBUTIONdrainage NOT FOR SALE OR DISTRIBUTION caused by malignant tumors, or adult filarial parasite infesta- tion of lymph vessels. Lymphedema is most common in the lower limbs. It can also occur in the arms, face, trunk, and external genitalia. Lymphedema may be primary or second- ary.© There Jones is no & cure Bartlett for lymphedema, Learning, but lymph LLC drainage © Jones & Bartlett Learning, LLC fromNOT the extremitiesFOR SALE can beOR improved DISTRIBUTION if the patient sleeps NOT FOR SALE OR DISTRIBUTION with the foot of his or her bed elevated 4 to 8 in. Other helpful measures include the wearing of elastic stockings and regu- lar moderate exercise. Surgery may be performed to remove hypertrophied lymph channels and disfiguring tissue. © Jones & LymphangitisBartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALELymphangitis OR DISTRIBUTIONis an inflammation of the lymph vessels thatNOT FOR SALE OR DISTRIBUTION may be caused by an acute streptococcal infection in one of Figure 7–4 Reed-Sternberg cells © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

99069_ch07_6101.indd 74 2/6/12 1:32:46 PM Summary 75

© Jones &clotting Bartlett factors, Learning, and it is a hereditarily LLC linked disorder. It affects© Jonesobstructed, & Bartlett this may Learning,result in atherosclerosis, LLC a spasm, or a male children and is signified by prolonged bleeding afterNOT thrombus. FOR SALE A dysrhythmia OR DISTRIBUTION (arrhythmia) is a disturbance of NOT FOR SALEinjury, easy OR bruising, DISTRIBUTION hematomas, and excessive . heart rhythm caused by abnormal electrical conduction or automaticity. Cardiac arrest is a sudden cessation of cardiac Hemophilia output and effective circulation, which is usually precipitated Hemophilia is a group of hereditary bleeding disorders char- by ventricular fibrillation or ventricular asystole. Common acterized by a deficiency© Jones of one &of Bartlettthe factors Learning,necessary LLCvascular disorders include phlebitis,© Jones thrombophlebitis, & Bartlett and Learning, LLC varicose veins. for blood coagulation.NOT The two FOR most SALE common OR forms DISTRIBUTION of the NOT FOR SALE OR DISTRIBUTION disorder are hemophilia A and hemophilia B. Hemophilia Shock may be caused by anaphylaxis, hemorrhage, respi- A is also known as classic hemophilia. It is the result of a ratory distress, sepsis, heart failure, neurologic failure, emo- deficiency or absence of antihemophilic factor VIII. Hemo- tional catastrophe, or severe metabolic insult. There are many philia B (Christmas disease) represents a deficiency of plasma types of anemia, some of which have high fatality rates. Aplas- tic anemia usually results in fatal bleeding or infection, with thromboplastin© Jones &component. Bartlett The Learning, greater the deficiency,LLC the © Jones & Bartlett Learning, LLC more severe the disorder will manifest. Patients with hemo- the death rate for severe cases being between 80 and 90% of philiaNOT experience FOR aSALE greater thanOR normalDISTRIBUTION loss of blood during patients. AcuteNOT myelogenous FOR SALE leukemia OR is theDISTRIBUTION most common dental procedures, epistaxis, hematoma, and hemarthrosis. adult leukemia, while acute lymphocytic leukemia is the most Severe nonsurgical internal hemorrhage and hematuria are common childhood leukemia. less common. The primary treatment for hemophilia is the replace- CRITICAL THINKING © Jones & mentBartlett of deficient Learning, factors with LLC recombinant factor products© Jones & Bartlett Learning, LLC A woman who has been pregnant for 32 weeks has been NOT FOR SALEor plasma. OR Treatment DISTRIBUTION may be prophylactic, or to stop bleedNOT- FOR SALE OR DISTRIBUTION complaining of weakness, tiredness, and lack of appetite. ing episodes. Acetaminophen or codeine is used to control Her physician orders blood tests to see if she has any type of pain. Both aspirin and NSAID use, as well as intramuscular anemia. The results confirm this. injections, should be avoided because they may precipitate 1. What is the most common type of anemia during preg- bleeding. When hemophiliacs need surgery or dental work, nancy once iron deficiency anemia is ruled out? extreme care must be© exercised. Jones &Gene Bartlett transfer Learning,therapy is LLC © Jones & Bartlett Learning, LLC 2. Under what form of anemia is this type classified? being experimented withNOT to FORdevelop SALE methods OR of replacingDISTRIBUTION NOT FOR SALE OR DISTRIBUTION the absent gene. WEBSITES Disseminated Intravascular Coagulation http://digestive.niddk.nih.gov/ddiseases/pubs​ Disseminated intravascular coagulation occurs as a complica- /hemochromatosis tion of diseases and conditions that accelerate clotting. When © Jones & Bartlett Learning, LLC http://www.americanheart.org/presenter© Jones & Bartlett Learning,​.jhtml​ LLC clotting accelerates, it causes occlusion of small blood vessels NOT FOR SALE OR DISTRIBUTION ?identifier=4440NOT FOR SALE OR DISTRIBUTION and organ necrosis. Clotting in the microcirculation usually affects the lungs, kidneys, extremities, and brain. Dissemi- http://www.heartfailure.org/eng_site/hf.asp nated intravascular coagulation is caused by the following: http://www.labtestsonline.org/understanding/conditions​ ■■ Infection (gram-negative septicemia, gram-positive /anemia.html © Jones & Bartlettsepticemia, Learning, or from viruses,LLC fungi, rickettsiae, or pro©- Joneshttp://www.mayoclinic.com/health/high-blood-pressure & Bartlett Learning, LLC ​ tozoans) /DS00100 NOT FOR SALE■■ Neoplastic OR DISTRIBUTION disease (including acute leukemia, aplasticNOT FOR SALE OR DISTRIBUTION http://www.medicinenet.com/heart_attack/article.htm anemia, and metastatic carcinoma) ■■ Necrotic disorders (including brain tissue destruc- http://www.merckmanuals.com/professional/sec07.html tion, extensive trauma or burns, hepatic necrosis, and http://www.nlm.nih.gov/medlineplus​ transplant rejection) /bloodandblooddisorders.html ■ © Jones & Bartlettabruptio Learning,placentae LLC © Jones & Bartlett Learning, LLC ■ Obstetric complications (including , http://www.nlm.nih.gov/medlineplus/ency/article/001124 eclamp- amniotic fluid embolismNOT FOR, retained SALE dead ORfetus, DISTRIBUTION .htm NOT FOR SALE OR DISTRIBUTION sia, and septic abortion) http://www.oncologychannel.com/leukemias/index.shtml ■■ Other conditions (including heatstroke, poison- ous snakebite, cirrhosis, fat , incompatible http://www.wrongdiagnosis.com/medical/blood_vessel blood transfusion, cardiac arrest, shock, severe venous _disorder.htm © Jonesthrombosis, & Bartlettand surgery Learning, requiring cardiopulmonary LLC © Jones & Bartlett Learning, LLC NOTbypass) FOR SALE OR DISTRIBUTION REVIEW QUESTIONSNOT FOR SALE OR DISTRIBUTION Summary Multiple Choice Common disorders related to phlebotomy include those 1. An area of dead cells due to lack of oxygen is called that affect the cardiovascular system, including the blood A. ischemia © Jones & andBartlett blood vessels. Learning, Atherosclerosis LLC is the most common type© Jones B.& Bartlettinfarction Learning, LLC NOT FOR SALEof coronary OR artery DISTRIBUTION disease. Necrosis of heart tissue resultsNOT FORC. SALEatresia OR DISTRIBUTION in myocardial infarction. When the coronary arteries are D. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett2. The most Learning, common type LLC of anemia in the United States© Jones C.& Bartlettvarious cardiac Learning, arrhythmias LLC is NOT FORD. SALEcomplication OR DISTRIBUTION of syphilis NOT FOR SALEA. ORsickle DISTRIBUTION cell 10. The presence of Reed-Sternberg cells can confirm diag- B. pernicious nosis of C. folic acid deficiency A. chronic lymphocytic leukemia D. iron deficiency B. acute myelogenous leukemia 3. Thrombophlebitis© Jonesoccurs most & Bartlett commonly Learning,in the LLC C. Hodgkin’s disease © Jones & Bartlett Learning, LLC A. lower legs D. hemophilia B. lower armsNOT FOR SALE OR DISTRIBUTION11. Which of the following isNOT a major FOR cause SALE of cardiac OR dis -DISTRIBUTION C. lower abdomen ease, renal failure, and stroke? D. lungs A. emphysema 4. When the heart is pumping inadequately to meet the B. heart failure needs of the body, the condition is called C. hypertension © A.Jones cor pulmonale & Bartlett Learning, LLC D. © Jones & Bartlett Learning, LLC NOTB. heartFOR failure SALE OR DISTRIBUTION 12. WhichNOT of the FOR following SALE does ORnot cause DISTRIBUTION disseminated C. arrhythmia intravascular coagulation? D. myocardial infarction A. neoplastic diseases such as acute leukemia and 5. Which of the following is a sign of shock? metastatic carcinoma A. bradycardia B. abruptio placentae and septic abortion © Jones & BartlettB. tachycardia Learning, LLC © Jones C.& Bartlettsevere dehydration Learning, and low LLC potassium in the NOT FOR SALEC. ORbradypnea DISTRIBUTION NOT FOR SALEblood OR DISTRIBUTION D. hypertension D. brain tissue destruction and hepatic necrosis 6. In which of the following types of anemia may you find 13. Which of the following cardiovascular disorders is the hemoglobin S? leading cause of death in the United States? A. hemolytic A. myocardial infarction B. aplastic © Jones & Bartlett Learning, LLC B. hypertension © Jones & Bartlett Learning, LLC C. sickle cell NOT FOR SALE OR DISTRIBUTIONC. stroke NOT FOR SALE OR DISTRIBUTION D. megaloblastic D. angina pectoris 7. Stasis of blood flow from immobility, injury to a ves- 14. Thrombophlebitis results from sel, or predisposition to clot formation increases the A. inflammation of veins risk of B. inflammation of the sac enclosing the heart © JonesA. pulmonary & Bartlett embolism Learning, LLC C. hypertension© Jones & Bartlett Learning, LLC B. emphysema D. myocardial infarction NOTC. pneumothoraxFOR SALE OR DISTRIBUTION 15. The diagnosisNOT FOR of anemia SALE indicates OR DISTRIBUTIONthat the patient is D. chronic obstructive pulmonary disease experiencing a reduction in 8. What is the most common type of coronary artery A. platelets disease? B. leukocytes A. dysrhythmia C. antibodies or albumin © Jones & BartlettB. atherosclerosis Learning, LLC © Jones D.& Bartlettred blood cells Learning, or hemoglobin LLC NOT FOR SALEC. ORanoxia DISTRIBUTION NOT FOR SALE OR DISTRIBUTION D. pancytopenia 9. Aneurysms are often caused by A. buildup of atherosclerotic plaque that weakens vessel walls B. an inflammation© Jones of a vein & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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