Soriano, Michelle Ann A.

DMD3a

BLOOD

NORMAL BLOOD VALUES

Parameter Value
8.5 -9.1% of total body
Blood Volume
weight
Acidity (pH) 7.35-7.45
Blood plasma 2.7–3.0 litres (2.8–3.2
volume quarts)
Red Blood Cell 4.2 - 6.9 million/µL/cu
Count (RBC) mm
White Blood Cell 4,300-10,800 cells/µL/cu
Count (WBC) mm
Platelet Count 150,000 - 350,000/mL
Male: 13 - 18 gm/dL
Hemoglobin
Female: 12 - 16 gm/dL
Male: 45 - 62%
Hematocrit
Female: 37 - 48%

- a constantly circulating fluid providing the 4. Immunological functions, including

body with nutrition, oxygen, and waste circulation of white blood cells, and
removal. detection of foreign material
- average person has about 5 liters of blood. by antibodies
- consists of variety of cells suspended in a 5. Coagulation, which is one part of the
fluid medium called plasma. body's self-repair mechanism
- circulated around the body through blood 6. Messenger functions, including the
vessels by the pumping action of the heart transport of hormones and the signaling
- hemoglobin is the principal determinant of of tissue damage
the color of blood 7. Regulation of body pH
- is conducted through blood vessels 8. Regulation of core body temperature
(arteries and veins). 9. Hydraulic functions
- Whole blood is a mixture of plasma and
blood cells Blood Components:

Functions: 1. Plasma
- blood's liquid medium
1. Supply of oxygen to tissues - straw-yellow in color.
2. Supply of nutrients such as glucose, amino - makes up about half of the content of blood
acids, and fatty acids - It is essentially an aqueous solution
(dissolved in the blood or bound containing 92% water, 8% blood
to plasma proteins (e.g., blood lipids) plasma proteins, and trace amounts of other
3. Removal of waste such as carbon materials.
dioxide, urea, and lactic acid - it circulates dissolved nutrients, such
as glucose, amino acids, and fatty (dissolved
in the blood or bound to plasma proteins),
and removes waste products, such as carbon
dioxide, urea, and lactic acid.
Other important components include:
 Serum albumin
 Blood-clotting factors
facilitate coagulation)
 Immunoglobulin (antibodies)
 lipoprotein particles
 Various other proteins
 Various electrolytes
(mainly sodium and chloride)
Serum
- refers to plasma from which the clotting
proteins have been removed. Most of the
proteins remaining are albumin and
immunoglobulin.
2. Blood cells
a. Red blood cells (erythrocytes)
- 45% of the whole blood (most abundant
cells)
- shaped like slightly indented, flattened
disks
- produced in the bone marrow
- contain hemoglobin, an iron-containing
protein, which facilitates transportation
of oxygen by reversibly binding
this respiratory gas and greatly increasing its
solubility in blood
- blood gets its bright red color when
hemoglobin picks up oxygen in the lungs. As
the blood travels through the body, the
hemoglobin releases oxygen to the tissues.
- life span of about 4 months (120 days).
Each day, the body produces new RBCs to
replace those that die or are lost from the
body.
(to - primarily involved in the transport of oxygen
and carbon dioxide
- function exclusively within the vascular
system
HEMATOLOGIC DISORDER
ANEMIA
- most common condition affecting RBCs
- lower-than-normal number of red cells in
the blood.
- accompanied by a decrease in the amount
of hemoglobin
- typically is caused by either inadequate
RBC production or unusually rapid RBC
destruction
Three main bodily mechanisms that produce
anemia are:
1. Excessive destruction of RBCs
2. Blood loss
3. Inadequate production of RBCs
*Among many other causes, anemia can
result from inherited disorders, nutritional
problems (such as an iron or vitamin
deficiency), infections, some kinds of cancer,
or exposure to a drug or toxin.
Anemia Caused by Destruction of RBCs
a. Hemolytic anemia
- occurs when red blood cells are being
excessively destroyed in the blood or spleen
prematurely.
-shorter RBC lifespan
to - happens for a variety of reasons: sonetimes
infections or certain medications (such as
antibiotics or anti-seizure medicines)
Autoimmune hemolytic anemia
-the immune system mistakes RBCs for
foreign invaders and begins destroying them.
Common forms of inherited hemolytic
anemia:
• Sickle cell anemia
- is a severe form of anemia
- red blood cells become crescent-shaped
because of a genetic defect.
- they break down rapidly, so oxygen does
not get to the body's organs, causing
anemia.
- the crescent-shaped red blood cells also
get stuck in tiny blood vessels, causing pain.
• Thalassemia
- abnormal and short-lived RBCs.
- Thalassemia major also called Cooley's
anemia, is a severe form of anemia in which
RBCs are rapidly destroyed and iron is
deposited in the skin and vital organs.
- Thalassemia minor involves only mild
anemia and minimal red blood cell changes.
• Glucose6-phosphate dehydrogenase(G
6PD)deficiency
- RBCs either do not make enough of the
enzyme G6PD or the enzyme that is
produced is abnormal and doesn't work well.
- when someone born with this deficiency
has an infection, takes certain medicines, or
is exposed to specific substances, the body's
RBCs suffer extra stress. Without adequate
G6PD to protect them, many red blood cells
are destroyed prematurely.
• Hereditary spherocytosis
- is a genetic disorder of the RBC's
membrane that can cause anemia, jaundice
(yellow-tinged skin), and enlargement of the
spleen.
- the RBCs have a smaller surface area than
normal red blood cells, which can cause
them to break open easily.
- a family history increases the risk for this
disorder
Anemia Caused by Blood Loss
a. Blood loss can also cause anemia
-excessive bleeding due to injury, surgery,
or a problem with the blood's clotting ability.
-slower, long-term blood loss, such as
intestinal bleeding from inflammatory bowel
disease (IBD)
- heavy menstrual periods in teen girls and
women.
- any of these factors will also increase the
body's need for iron because iron is needed
to make new RBCs.
Anemia Caused by Inadequate
Production of RBCs
Red blood cells may be faulty or decreased
due to abnormal red blood cells or the a lack
of minerals and vitamins needed for red
blood cells to work properly.
a. Aplastic anemia
-occurs when the bone marrow can't make
enough RBCs.
-can be due to a viral infection, or exposure
to certain toxic chemicals, radiation, or
medications (such as antibiotics, antiseizure
drugs, or cancer treatments).
-some childhood cancers can also cause
aplastic anemia, as can certain chronic
diseases that affect the ability of the bone
marrow to make blood cells.
b. Iron-deficiency anemia
- occurs when the body isn't able to produce
enough healthy RBCs because of an iron-
deficiency
- an iron-poor diet, especially in infants,
children, teens and vegetarians
-the metabolic demands of pregnancy and
breastfeeding that deplete a woman's iron
stores
- menstruation
- frequent blood donation
- endurance training
- certain drugs, foods, and caffeinated drinks
c. Vitamin deficiency anemia
- may occur when vitamin B-12 and folate
are deficient.
- these two vitamins are needed to make red
blood cells.
- conditions leading to anemia caused by
vitamin deficiency include the following:
• Megaloblastic anemia: Vitamin B-12 or
folate or both are deficient
• Pernicious anemia: Poor vitamin B-12
absorption caused by conditions such
as Crohn's disease, an intestinal
parasite infection, surgical removal of
part of the stomach or intestine, or
infection with HIV
• Dietary deficiency: Eating little or no
meat may cause a lack vitamin B12,
while overcooking or eating too few
vegetables may cause a folate
deficiency
• Other causes of vitamin deficiency:
pregnancy, certain medications,
alcohol abuse, intestinal diseases
*During early pregnancy, sufficient folic acid
can prevent the fetus from developing neural
tube defects such as spina bifida.
SIGNS AND SYMPTOMS:
The symptoms of iron deficiency anemia (if
any) are:
• fatigue
• Irritability
• Paleness
• Weakness
• Tiredness
• dizziness, lightheadedness, and a
rapid heartbeat
• Chest pains (in severe cases)
• Shortness of breath (in severe cases)
• Heart palpitations (in severe cases)
• An increased heart rate especially
during exertion (in severe cases)
• Rapid breathing
• Low blood pressure
The symptoms of vitamin B12 anemia are
similar to those of iron deficiency anemia but
can also cause:
• Jaundice
• Numbness and tingling in the hands
and feet
• Equilibrium difficulties
• Confusion
• Personality changes and depression
DIAGNOSIS OF ANEMIA:
1. Patient's symptoms
2. Blood test that measures the level of
hemoglobin in the blood, as well as
substances such as folic acid, bilirubin and
vitamin B12.
3. the size of the red cells provide further
clues to the type of anemia.
4. bone marrow biopsy
5. levels of ferritin in the blood of
premenopausal women.
TREATMENT:
Treatment for anemia depends on its cause.
*Iron deficiency anemia
-increase iron intake
*Heavy or irregular menstrual periods
-hormonal treatment to help regulate the
bleeding.
*Vitamin b12 deficiency
-life-long regimen of monthly B-12 injections
*Folic acid deficiency
- frequently a dietary correction.
- Main sources of folic acid include meat,
poultry, cheese, milk, eggs, liver, green leafy
vegetables, raw fruits, lima and kidney
beans, and yeast.
*Depending on the cause, treatment for
more severe or chronic forms of anemia may
include:
• transfusions of normal red blood cells
taken from a donor
• removal of the spleen or treatment
with medications to prevent blood
cells from being removed from
circulation or destroyed too rapidly
• medications to fight infection or
stimulate the bone marrow to make
more blood cells
*In some cases of sickle cell anemia,
thalassemia, and aplastic anemia, bone
marrow transplantation may be used.
PATIENT’S COUNSELING
Sickle-cell Anemia
1. Genetic counseling - for affected patients
starting a family or parents of infected
children wishing to have more children.
2. Folic acid supplementation
2. Non-pharmacological Approach
- Iron-rich foods
PREVENTION OF ANEMIA:
Consumption of a healthy diet including iron-
containing foods and those with B-complex
vitamins is essential to developing and
maintaining a satisfactory blood count.

3. Medications: References:
Jablonski, Dictionary of Dentistry Revised Edition
Wheaters, Functional Histology 5th Edition
- Epoetin alfa - Pentoxil http://www.pharmainfo.net/guptashubhranshu/patient-
- Epogen - Trental councelling-anaemia-part-i
- Procrit - Fixoten http://kidshealth.org/parent/general/body_basics/blood.
- Eprex - Kentadin html#
- Epomax - Peridane http://www.webmd.com/heart/anatomy-picture-of-
blood?page=2
- Pentoxifylline - Sufisal
- Vasofyl

Iron-deficiency Anemia

1. Pharmacotherapeutic Approach
a. Oral route:
• Ferrous sulphate capsules
• Ferrous fumarate capsules
• Ferrous succinate capsules
• Ferrous gluconate syrup
• Colloidal Ferrous Hydroxide syrup

- can cause irritation on empty stomach

- cause constipation
- Laxatives should be administered along
with it (combined drug therapy).
- Iron containing syrups cause staining of
teeth. They must be taken directly at the
back of the tongue.
- Other common side-effects are nausea,
vomiting, metallic taste in mouth and
epigastric pain.

b. Parenteral route
• Iron dextran intramuscular injection
• Iron sorbitol intramuscular injection

- it cause localized pain at the site of

injection, metallic taste in mouth, fever,
headache, joint ache.
- In patients having kidney disease, iron-
sorbitol injection must be avoided.