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Blood and Blood-Forming Organs Diseases and Disorders 127
thought to have developed as a defense mechanism
against malaria. The parasite that causes malaria does
not grow in cells that sickle, giving these individu
als a health advantage in countries where malaria is
prevalent.
■ Etiology. The sickle cell has abnormal hemoglobin
that causes it to elongate, or sickle, when deoxygenated
(as it loses the oxygen load). The cell regains its nor
mal shape after it is reoxygenated (picks up an oxygen
load; Figure 7-2). The sickle shape causes a problem
because it does not allow the cell to travel smoothly
through small blood vessels. Sickle cells tend to stick
and clump together in small vessels, leading to occlu
sion of the vessel, ischemia, and infarction. This occlu
sion can occur in any vessel, causing multiple thrombi
(clots) and emboli (traveling clots) formations that can
lead to infarctions throughout the body, including the
vital organs.
■ Symptoms. Symptoms of the disease can vary from
mild to severe. Pain in the back, legs, and abdomen is
the most common symptom. Other symptoms include
fatigue, irritability, swollen joints, leg sores, and gum
disease. A classic mark of sickle cell anemia is a group
of symptoms called sickle cell crisis, marked by episodes
of pain in two or more locations. The pain is often com
pared in severity to cancer pain. This crisis generally
occurs any time the body has an increased need for oxy
gen, so increased activity, physical stress, and illness can
lead to a crisis. The crisis itself increases the body’s need
for oxygen and often sets off a vicious cycle of oxygen
demand and sickling of more cells. Individuals suffering
severe symptoms often die in infancy or childhood. Few
Figure 7-2 Sickled erythrocytes.
severely affected individuals live beyond age 20, and even
mildly affected individuals usually die before age 50.
■ Diagnosis. Diagnosis is made after history and blood
testing. Two blood tests determine sickle cell disease.
The first is hemoglobin electrophoresis, which mea
sures the amount of normal and abnormal hemoglobin
in the blood. The second is the Sickledex test, which
measures the percentage of red sickle cells after mixing
a small drop of blood with a deoxygenating agent. A
positive test is one in which 25% or more of cells sickle.
■ Treatment. There is no cure for sickle cell disease, and
treatment is symptomatic. Therapy with hydroxyurea, a
drug that increases levels of hemoglobin, and planned
blood transfusions have markedly improved the life
expectancy of individuals with sickle cell anemia. An
increase in fluid intake to twice the normal amount can
also help by increasing blood volume and improving
sickle cell movement.
■ Prevention. Because sickle cell anemia is a hereditary
disorder, the only prevention is through genetic coun
seling and the decision by potential carriers to avoid
childbearing.
Hemorrhagic Anemia
■ Description. This anemia is caused by the loss of
whole blood and can also be called blood loss anemia. A
common complication of losing large amounts of blood
is hypovolemic shock.
■ Etiology. Acute loss of large amounts of blood,
which can be caused by such activities as surgery and
any trauma or accident involving blood loss, leads to
hemorrhagic anemia. Accidents such as motor vehicle
accidents and accidental amputations of arms or legs
can easily lead to hemorrhagic anemia.
■ Symptoms. Symptoms include pallor, cool clammy
skin, tachypnea, and tachycardia. If large amounts of
blood have been lost, other symptoms can arise, includ
ing dizziness, fainting, and an extreme thirst as a result
of dehydration.
■ Diagnosis. Hemorrhagic anemia is easily diagnosed
when the blood loss is external. Internal bleeding also
leads to hemorrhagic anemia but is often more difficult
to diagnose. A history and physical are necessary, and a
CBC showing low cell mass, hemoglobin, and hemato
crit is indicative of hemorrhagic anemia.
■ Treatment. Treatment depends on the severity of the
condition. In acute blood loss, controlling or stopping
128 Chapter 7
the bleeding is the primary concern. Applying oxygen
immediately to increase the oxygen-carrying capacity
of the remaining blood supply is also important. Intra
venous fluids and liquids taken by mouth help restore
fluid volume. In severe cases of blood loss, a blood
transfusion might be needed.
In chronic or slower blood loss anemia, finding
the cause and stopping the bleeding are again the pri
mary focus. If the blood loss is not severe, blood fluid
will be replaced within a few hours. The decreased
number of circulating erythrocytes will stimulate the
bone marrow to step up production of them. Bone
marrow can replace large numbers of blood cells, thus
correcting this type of anemia. Consuming a healthy
diet that is especially high in protein and iron will
help restore the body’s blood reserves and return it
to a healthy state.
■ Prevention. Accident prevention and controlling
chronic bleeding are helpful in preventing hemorrhagic
anemia.
Aplastic Anemia
■ Description. Aplastic anemia is characterized by fail
ure of the bone marrow to produce blood components.
A severe decrease or total absence of erythrocytes,
leukocytes, and thrombocytes, called pancytopenia
(pan 5 all, cyto 5 cell, penia 5 decrease), is common.
■ Etiology. This anemia is due to injury or destruction of
the blood-forming area of the bone marrow. Causes include
chemotherapy, radiation, viruses, and chemical toxins.
■ Symptoms. This decrease in blood cells leads to ane
mia, infection, and hemorrhage, respectively.
■ Diagnosis. Aplastic anemia is diagnosed by using a
history and physical examination with blood testing.
A CBC will show a low hemoglobin and hematocrit,
indicative of anemia. Blood can also be tested for
iron and folic acid levels to rule out these types of
anemia.
A reticulocyte count test measures reticulocytes, or
immature RBCs, and helps determine whether the bone
marrow is producing RBCs as it should. In aplastic ane
mia, the reticulocytes numbers will be low.
Because blood cells are formed inside bone, a
bone marrow aspiration or biopsy can also be used. In
both tests, a large-bore needle or surgical instrument
removes small pieces of marrow and bone, respectively.
The cells are then examined under a microscope to look
for abnormal cells. In aplastic anemia, the red cell pro
duction and numbers are low.
Other tests that can be helpful in diagnosis include
X-ray, computed tomography (CT) scan, and ultra
sound. These tests help rule out cancer, infection, and
other types of anemia.
■ Treatment. Severe cases of aplastic anemia need emer
gency medical treatment to avoid a fatality. Treatment
includes discontinuing or avoiding the causative agent.
Other treatment might include a stem cell transplant, also
called a bone marrow transplant, and blood transfusions.
■ Prevention. Avoiding causative agents is helpful in
prevention, but too often, the causative agent is unknown
or unavoidable, making prevention impossible.
Polycythemias
Polycythemia (Primary or Vera)
■ Description. Polycythemia is also called primary
polycythemia or polycythemia vera. It is a condition of
too many blood cells.
■ Etiology. Primary polycythemia is caused by hyper
plasia (hyper 5 excessive, plasia 5 growth) of the
cell-forming tissues of the bone marrow, leading to an
increase in the production of erythrocytes, leukocytes,
and thrombocytes. This disease has an unknown etiology.
■ Symptoms. The increase in erythrocytes leads to an
increase in blood volume, which raises blood pressure
and causes an increase in the workload on the heart.
The spleen, an organ of blood cell storage, is enlarged.
The mucous membranes are reddened in color, and the
eyes often appear bloodshot. The palms of the hands are
noticeably a deeper red color (Figure 7-3).
Figure 7-3 Polycythemia — reddened palms.
Courtesy of Mark L. Kuss
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Blood and Blood-Forming Organs Diseases and Disorders 129
■ Diagnosis. Polycythemia can be accidentally discov
ered through routine blood testing before a person has
any symptoms. Hemoglobin (the protein that carries
oxygen in RBCs) will be abnormally high, as will the
hematocrit (the percentage of RBCs in the total blood
volume). Platelets and WBCs might also be increased.
■ Treatment. Treatment is to reduce the red cell count
and, thus, blood volume. Phlebotomy or removal of
blood, such as with blood donation, at regular intervals
will reduce the volume and is a common treatment.
■ Prevention. Polycythemia cannot be prevented. With
treatment, symptoms and complications can be pre
vented or delayed.
Secondary Polycythemia (Erythrocytosis)
■ Description. Secondary polycythemia, or erythrocy-
tosis (erythrocyte 5 red cell, osis 5 condition of), differs
from primary polycythemia in that only red cell num
bers are increased.
■ Etiology. Erythrocytosis is a protective mechanism
of the body to meet the need for extra oxygen, a nor
mal compensatory mechanism for people who are not
getting enough oxygen. It is seen as a positive change
in people in high altitudes where oxygen content of air
is low. Also, highly trained athletes can have erythro-
cytosis to meet the high oxygen demands of the body’s
muscle tissue. Certain respiratory conditions and circu
latory conditions cause a decrease in oxygen supply to
the tissues and thus stimulate erythrocytosis also. When
the conditions calling for extra oxygen are returned to
normal, the erythrocytosis disappears. For example, if
people living in high altitudes move to a lower altitude,
the red cell count will return to a normal level. Smoking,
which impairs RBCs’ ability to deliver oxygen to body
tissues, can cause secondary polycythemia.
■ Symptoms. Headaches, weakness, and fatigue are
often the first symptoms of secondary polycythemia;
lightheadedness and shortness of breath are also com
mon. If the polycythemia is due to disease of the lungs,
the face might be reddened and become blue during
exercise or other exertion.
■ Diagnosis. Following a history and physical exam,
diagnosis of secondary polycythemia is assisted by
blood testing. Arterial blood gases (ABGs) testing
shows the concentration of oxygen in an artery, and
low oxygen levels in this test can be indicative of sec
ondary polycythemia. Blood levels of erythropoietin, a
hormone that stimulates the bone marrow to produce
RBCs, can also be measured. Normal or low erythropoi
etin levels can indicate secondary polycythemia. X-ray
and CT imaging studies also can rule out liver, kidney,
or spleen disorders or tumors.
■ Treatment. Secondary polycythemia is treated by
addressing the cause of the disorder. For example, lung
disorders such as those caused by cigarette smoking
can cause secondary polycythemia; not smoking helps
treat the lung condition and improve the secondary
polycythemia.
■ Prevention. In some cases, secondary polycythemia
can be prevented by stopping the causative factor or by
not doing the things that deprive the body of needed
oxygen. Living at high altitudes and smoking, for exam
ple, can be avoided or stopped.
Disorders of White Blood Cells
Disorders of WBCs are common problems of the hema
tologic system. The common symptom of WBC disor
ders is a compromised immune response, leaving the
individual susceptible to infections. Unfortunately, the
etiology of most of these diseases is unknown.
Mononucleosis
Infectious mononucleosis, commonly called kissing
disease, is caused by the Epstein-Barr virus. This virus
affects lymphocytes, the WBC involved in providing
immunity. Symptoms include sore throat, fever, mal
aise, fatigue, and enlarged lymph nodes. This condition
is discussed in detail in Chapter 20, “Childhood Dis
eases and Disorders.”
Leukemia
■ Description. Leukemia is a malignant neoplasm
of the blood-forming organs (bone marrow, lymph
nodes, spleen). It is characterized by an abnormally
high production of immature leukocytes that function
abnormally and cause a decrease in the production of
erythrocytes and platelets.
Leukemia may be classified as acute or chronic.
Acute forms commonly affect children, progress rap
idly, and can be fatal. Chronic forms occur more com
monly in older adults, are often asymptomatic, and
might not be the cause of death. Leukemia is also clas
sified as myelogenous (affecting the bone marrow) and
lymphocytic (affecting the lymph nodes).
■ Etiology. The cause of leukemia is unknown.
130 Chapter 7
■ Symptoms. Symptoms of leukemia include fatigue,
headache, sore throat, dyspnea, bleeding of the mucous
membranes of the mouth and gastrointestinal system,
bone and joint pain, and enlargement of lymph nodes,
liver, and spleen. Infections are common because white
cells are not functioning properly. Bleeding disorders
and anemia are due to erythrocytopenia and thrombo
cytopenia, respectively.
■ Diagnosis. Leukemia is usually diagnosed by clinical
history and blood studies. A bone marrow biopsy is the
most definitive test for confirming the diagnosis.
■ Treatment. Treatment includes aggressive chemo
therapy using several neoplastic agents. When the
illness is in remission, a stem cell transplant (bone mar
row transplant) to replace the neoplastic tissue with
normal tissue can be performed. Pain from enlargement
of lymph nodes, spleen, and liver can be treated with
analgesics. Depending on the type of leukemia and the
individual’s tolerance of the treatment, overall survival
rate is approximately 61%.
■ Prevention. There is no known way to prevent leu
kemia, although avoiding toxic chemicals, cigarette
smoking, and radiation might prevent some types of
leukemia.
Lymphomas
Lymphoma refers to several types of neoplasms that
affect lymphoid tissue (lymph nodes, tonsils, spleen,
lymph fluid). There are many types of lymphoma, but
all affect normal lymphocyte production, leading to
impaired immunity. Lymphoma is the most common
type of blood cancer in the United States.
Hodgkin’s Lymphoma
■ Description. Hodgkin’s lymphoma is the most com
mon lymphoma. It is characterized clinically by the
orderly spread of disease from one lymph node group
to another.
■ Etiology. The cause is thought to be viral in nature.
■ Symptoms. Lymphoma is characterized by painless
enlargement of the lymph nodes in the neck, weight
loss, and fever. Hodgkin’s primarily affects young adults
with an average age of 35 years. Men are affected with
Hodgkin’s at a slightly higher rate than women.
■ Diagnosis. Diagnosis is made when a large connec
tive tissue cell called the Reed-Sternberg cell is present
in lymphatic tissue (Figure 7-4). The diagnosis can be
confirmed by a lymph node and bone marrow biopsy.
Figure 7-4 Reed-Sternberg cell.
Courtesy of Mark L. Kuss
■ Treatment. Treatment with radiation and chemo
therapy is usually effective in bringing about remis
sion. A stem cell transplant might also be done. If the
disease is kept in remission for 5 years or longer, com
plete cure might be possible. Overall survival rate is
approximately 90%, making it one of the most curable
forms of cancer.
■ Prevention. Because the cause of Hodgkin’s is
unknown, there are no known preventive measures.
Non-Hodgkin’s Lymphoma
■ Description. Non-Hodgkin’s lymphoma (NHL)
is a group of lymphomas not containing the Reed-
Sternberg cell characteristic of Hodgkin’s and more
widespread than Hodgkin’s. NHL affects older adults
more often than Hodgkin’s lymphoma, with the average
age of 50 years. Men are affected one and a half times
more often than women.
■ Etiology. The cause of NHL is unknown, but individu
als receiving, or who have received, immunosuppressive
medications have a greater chance of developing NHL.
■ Symptoms. Usually, there is a painless enlargement of
lymph nodes in the neck, axilla, and inguinal areas. Other
symptoms include fever, night sweats, and weight loss.
■ Diagnosis. Diagnosis is made when there is the
absence of the Reed-Sternberg cell in lymphatic tissue.
The diagnosis is confirmed by lymph node and bone
marrow biopsy.
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Blood and Blood-Forming Organs Diseases and Disorders 131
Hematologic
Disorders Treated
with Stem Cell
Transplants
Complementary and Alternative Therapy
S
tem cell transplants have been used in recent years to treat a variety of disorders.
Some success has been seen using allogenic hematopoietic stem cell transplanta
tion to disorders of the hematologic system. This means using stem cells from a related
or closely similar donor for the treatment. (Blood taken from the placenta or from
the umbilical cord is one of the sources for stem cell transplants, but the use of this
source has been a very controversial issue.) There are two types of transplants that can
be used: autologous and allogenic. Allogenic transplants are used for individuals with
blood-forming organ disorders, such as acute leukemia, aplastic anemia, and chronic
lymphocytic leukemia. Either type can be used for individuals diagnosed with Hodgkin
lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The point of this treatment
is to add new blood-forming stem cells to replace the individual’s unhealthy cells. It can
be an effective treatment for several types of cancer of the blood, but stem cell trans
plants are also used for many other noncancerous blood diseases, some genetic condi
tions, and other body system disorders.
Source: Memorial Sloan Kettering Cancer Center (2020)
■ Treatment. Treatment and prognosis depend on the
type of NHL, but some combination of radiation and
chemotherapy is usually beneficial. A stem cell trans
plant might also be done.
■ Prevention. Although the cause of NHL is unknown,
those at increased risk include those exposed to pesti
cides, solvents, and fertilizers. Avoiding these risk fac
tors might assist in prevention of the disease.
Multiple Myeloma
■ Description. Multiple myeloma is a malignant neo
plasm of plasma cells, or B-lymphocytes, in which the
plasma cells multiply abnormally in the bone marrow,
causing weakness in the bone and leading to pathologic
fractures and bone pain (Figure 7-5).
■ Etiology. The cause of multiple myeloma is unknown.
It occurs increasingly with age, peaking in the 70s, and
is more common in men. It is one of the most common
neoplasms affecting the bone.
■ Symptoms. Overgrowth of plasma cells leads to a
decrease in other blood components, causing anemia,
leukocytopenia, and thrombocytopenia. The breakdown
of bone leads to hypercalcemia (hyper 5 excessive, calc 5
calcium, emia 5 blood), excessive blood calcium levels.
Antibodies secreted by the plasma cells attach to kidney
tubules, causing tissue damage leading to kidney failure.
Figure 7-5 Multiple myeloma (X-ray) — extensive bone destruction caused by disease.
132 Chapter 7
■ Diagnosis. Diagnosis is confirmed by
■ X-ray exhibiting a honeycombed bone pattern due to
tumor involvement.
■ hypercalcemia due to the tumor breaking down bone.
■ evidence of Bence Jones protein (a special protein)
in the blood and urine.
■ a bone marrow biopsy confirming the presence of an
excessive number of plasma cells.
■ Treatment. Prognosis is poor for multiple myeloma
because this cancer usually causes no symptoms (and
hence goes undetected) until it reaches an advanced
stage. Chemotherapy and radiation are not very effec
tive, and death is usually within two to three years
as the result of infection and kidney failure. A stem cell
transplant may be done depending on the severity of
the disease process.
■ Prevention. Risk factors have been identified as her
bicides, petroleum products, heavy metals, and radia
tion. Avoiding these risk factors might aid in preventing
this disease.
Disorders of Platelets
Platelet and clotting disorders are varied in terms of
cause, severity, treatment, and prognosis. However,
they all share the common symptom of bleeding, which
might be mild or severe, depending on the particular
condition. Many of these disorders of platelets are
inherited diseases.
Hemophilia
■ Description. Hemophilia refers to a group of bleeding
disorders characterized by abnormally slow clotting and
long bleeding times. These characteristics make hemo
philiacs “love blood” or, more realistically, need trans
fusions. There are several types of hemophilia, but the
most common is type A.
■ Etiology. Hemophilia (hemo 5 blood, philia 5 lover)
is an X-linked hereditary bleeding disorder. Hemophilia
commonly occurs in boys and is passed on to these chil
dren, often, by their mother, who is usually asymptom
atic and unaffected. Hemophiliacs lack a blood protein
that plays a part in clot formation.
■ Symptoms. Symptoms of frequent epistaxis (nose
bleeds), bruising, and prolonged bleeding in a boy
might be indicative of hemophilia. This condition
can vary from mild to severe—a hemophiliac might
experience severe and prolonged bleeding with a minor
injury. Severe hemophilia often leads to hemarthrosis
(hem 5 blood, arthro 5 joint, osis 5 condition) or
bleeding into joints, which is extremely painful, and
recurrent episodes often lead to joint deformity.
■ Diagnosis. Diagnosis is confirmed by obtaining a
detailed medical history, physical examination, and blood
testing. Blood tests include measurement of clotting time
and the presence of clotting proteins. An extended or
lengthy clotting time and low levels or absence of clot
ting proteins can be indicative of hemophilia.
■ Treatment. There is no cure for hemophilia. Treat
ment includes prevention of injury and treatment of
symptoms. The main form of treatment is replacement
therapy, which includes intravenous injection of con
centrated clotting factor. Whole-blood transfusions may
also be needed.
■ Prevention. Because hemophilia is an inherited
genetic disease, the only way it can be prevented is by
genetic testing of possible carriers with the decision not
to have children.
Thrombocytopenia
■ Description. Thrombocytopenia, also known as
thrombocytopenia purpura, is a decrease in platelets
that leads to an inability to clot blood normally.
■ Etiology. Thrombocytopenia can be due to inade
quate or abnormal platelet production or destruction.
In the case of abnormal destruction, platelet life might
be reduced to hours instead of days. The cause of this
disorder is frequently unknown. In these cases, the
condition may be called idiopathic thrombocytopenia
purpura.
■ Symptoms. This condition is characterized by
abnormal bleeding in the skin, mucous membranes,
and internal organs. The skin might exhibit small
hemorrhagic spots called petechiae or larger purplish
hemorrhagic spots called ecchymoses. This purple
coloring of the skin leads to another descriptive term,
purpura (PER-pew-rah; purplish color of the skin
caused by hemorrhaging). Symptoms of thrombocyto
penia include gastrointestinal hemorrhages, frequent
epistaxis (nosebleeds), and hematuria (HEM-ah-
TOO-ree-ah; hema 5 blood, uria 5 urine, blood in
the urine).
■ Diagnosis. Diagnosis is made from individual clini
cal history along with platelet count and bleeding time.
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Blood and Blood-Forming Organs Diseases and Disorders 133
A low platelet count and an extended or longer than
normal bleeding time can be indicative of the disease.
■ Treatment. Treatment includes avoiding tissue
trauma to reduce the potential for bleeding, adminis
tering vitamin K to improve clotting, and a transfusion
of platelets. If the disorder persists, a splenectomy might
alleviate symptoms because the spleen is the main site
of platelet destruction. Splenectomy is usually the last
treatment of choice but is very effective.
■ Prevention. Certain cases of thrombocytopenia might
be preventable, but most are not. Two steps that can be
taken to prevent complications include
■ avoiding medications that decrease platelet aggregation
or stickiness, thus making them less likely to clot. This
includes but is not limited to aspirin and ibuprofen.
■ avoiding heavy drinking because alcohol slows plate
let production.
Disseminated Intravascular Coagulation
■ Description. Disseminated intravascular coagulation
(DIC) is a condition of abnormal clotting followed by
abnormal bleeding. It is a disease process by which
blood starts to coagulate or clot throughout the entire
body. This overall clotting depletes platelets and clotting
factors, allowing the body then to bleed freely. These
two activities set up a potentially catastrophic situation
in which the body can have clotting (thrombosis) and
massive bleeding (hemorrhage) at the same time.
■ Etiology. DIC usually follows some major trauma,
such as blood transfusion reaction, surgery, septicemia,
complicated childbirth, and trauma involving massive
tissue destruction, shock, malignancy, or snakebite.
■ Symptoms. The individual with DIC might initially
have microthrombi in the fingers and toes, turning these
extremities blue to black in color, or larger thrombus
formation, often leading to life-threatening pulmonary
embolism. Lodging of clots in the small and large blood
vessels and in body organs slows blood supply, often
resulting in organ damage. As platelets and clotting fac
tors are used, other symptoms appear, including oozing
of blood, resulting in petechiae; ecchymosis; hematoma
and hematuria; gastrointestinal bleeding that causes
hematemesis (HEM-ah-TEM-eh-sis; hema 5 blood,
emesis 5 vomiting); blood in the stool; and symptoms
associated with anemia.
■ Diagnosis. Diagnosis is made based on a history of
trauma and blood studies. Important blood studies
include CBC showing platelet levels, bleeding time,
and fibrinogen level (a clotting factor). A positive test
for DIC will reveal a decreased number of platelets,
increased or long bleeding time, and low fibrinogen
levels.
■ Treatment. Identifying and treating the underlying
cause usually stops DIC. In addition to treating the
cause, other treatment includes heparin, an anticoagu
lant medication, to halt the formation of thrombi, and
platelet administration to stop hemorrhage or increase
clotting ability. This disorder is very difficult to man
age because one administers agents both to clot and to
prevent clotting at alternating intervals. The condition
is usually life-threatening.
■ Prevention. A preventive measure includes getting
prompt medical treatment for any condition that might
bring on this disorder.
Trauma
Any traumatic injury to the bone marrow, spleen, or
lymph nodes can lead to a decrease in the production
of blood cells. Enlargement of the spleen, or splenomeg
aly, can lead to premature breakdown of blood cells,
and chemotherapy and radiation treatments affecting
bone marrow often lead to symptoms of anemia and
infection related to decreased production of red cells
and white cells, respectively.
Rare Diseases
Thalassemia
Thalassemia is a hereditary hemolytic anemia. The
RBCs are fragile and thin and form defective hemoglo
bin. These RBCs do not function normally and lead to
symptoms of anemia. One form of thalassemia is called
Cooley’s anemia, or thalassemia major. This is the most
severe form of the disease and presents in childhood.
Von Willebrand’s Disease
Von Willebrand’s disease is a hereditary, congenital
bleeding disorder caused by a deficiency in clotting
factor and platelet function. It is also called angiohe-
mophilia and affects females as well as males.
Lymphosarcoma
Lymphosarcoma is a type of lymphoma also known
as NHL. Symptoms are similar to those found in
134 Chapter 7
Hodgkin’s disease and occur more frequently in males
of all age groups. Prognosis is good if treatment leads
to remission. Without remission, the prognosis is poor.
Effects of Aging on the System
Older adults might be more prone to developing dis
eases of the hematologic system because of the age-
related changes occurring in other systems such as
the immune or digestive system, leaving them more
susceptible to infections and nutritionally related
blood disorders. However, total serum iron, total
iron-binding capacity, and intestinal iron absorption all
decrease with age. Aging does not change the number
of lymphocytes, but their functioning decreases to some
degree over time.
The most common disorder of the blood in older
adults is anemia. This is not usually due to a defect in
the system but rather to poor nutrition (iron deficiency
anemia) or inability to absorb the needed nutrients
(pernicious anemia). The anemia problem often com
plicates other chronic diseases of the affected individual.
Some types of leukemia are more common in the
older adult. Problems can arise during treatment for
the condition due to decreased gastric motility and
impaired circulation. These age-related changes can
reduce the effectiveness of some therapies and increase
the chance of experiencing side effects of the treatment.
Summary
T
he blood and blood-forming organs (hematologic system) form the body’s life fluid by transporting oxygen and
nutrients to cells, removing wastes, and helping prevent infection. The main components of the system include the
blood, lymph nodes, bone marrow, spleen, and liver. Common signs and symptoms of diseases of the blood and blood
forming organs are fatigue, shortness of breath, bleeding, lesions, pain, and increased susceptibility to infections. The
most common disorder of the system is anemia. Although there are several types of anemia, they all have some common
symptoms. WBC disorders include mononucleosis and leukemia as the most common. Disorders of platelets include
the major bleeding diseases of the blood and blood-forming organs, such as hemophilia. The older adult can develop
problems of the hematologic system such as anemia, but it is usually due to other problems or disorders in other systems.
Review Questions
Multiple Choice
1. Which of the following are major functions of blood? (Select all that apply.)
a. Transportation of nutrients
b. Metabolism of nutrients
c. Removal of wastes
d. Protection from infection
e. Production of lymphocytes
f. Production of erythrocytes
2. Which of the following are common signs and symptoms of disorders of the blood and blood-forming organs?
(Select all that apply.)
a. Inflammation
b. Fatigue
c. Shortness of breath
d. Paralysis
e. Urinary frequency
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Blood and Blood-Forming Organs Diseases and Disorders 135
f. Bleeding
g. Pain
h. Lesions
3. The individual with a bleeding disorder should avoid which of the following activities?
a. Shaving with a straight razor
b. Using mouthwash
c. Eating solid foods
d. Jogging
4. The purpose of the screening test for sickle cell anemia is to determine
a. whether the individual is a carrier of the sickle cell trait.
b. the presence of the sickled hemoglobin.
c. the severity of the disease.
d. whether the individual will eventually develop sickle cell anemia.
5. Bone marrow biopsies are performed to
a. determine the presence and number of platelets.
b. diagnose cancers, anemias, and bone marrow functional disorders.
c. diagnose vitamin B
12
deficiency.
d. test for antigens to prevent antigen-antibody reactions.
6. Foods recommended for the individual with a folic acid deficiency would include
a. milk and cheeses.
b. beef and chicken.
c. green and yellow vegetables.
d. breads and grains.
7. In which of the following ways does primary polycythemia differ from secondary polycythemia (erythrocytosis)?
a. The most common symptom of the primary type is shortness of breath, and fatigue is the most common
symptom of the secondary type.
b. The primary type responds to phlebotomy, whereas the secondary type does not.
c. The primary form of the disease is considered a type of cancer, but the secondary form is not.
d. Both red and white cell numbers are increased in the primary type, but just red cell numbers are increased in
the secondary type.
8. Which of the following statements is true about hemophilia?
a. It is most common in older adults.
b. It results in continuous minor bleeding internally.
c. It is caused by a deficiency of clotting factor.
d. It is found in boys of mothers who carry the defective gene.
9. Which of the following statements is true about leukemia?
a. It is considered a group of disorders with a cancerous development occurring in the bone marrow.
b. It is the most common cause of death in young children.
136 Chapter 7
c. Chemotherapy is ineffective against leukemia.
d. There are several types of leukemias, but most types are diagnosed in young or middle-aged adults.
Short Answer
10. List some of the common tests used to diagnose disorders of the blood and blood-forming organs.
11. List some diseases of the blood or blood-forming organs that are transmitted through an inherited trait.
12. Describe the common effects of a hemorrhagic disorder on an individual.
13. Why would an individual with Hodgkin’s disease be instructed to avoid individuals with coughs, colds, and fever?
14. What diagnostic test would probably be used to diagnose leukemia?
15. Why are older adults with hematologic disorders more susceptible to infections?
Case Studies
■ Ms. Sloan is a 27-year-old who is complaining of fatigue, shortness of breath, stomach pain, and overall
weakness. She is diagnosed with iron deficiency anemia. What could you tell her about this condition? What
specific nutritional needs does she have, based on her diagnosis, gender, and age?
■ Joe Butler has a friend who is having surgery and wants to donate blood for his friend in case he needs a
transfusion during the surgery. Joe knows his blood type is O positive but does not know his friend’s blood type.
He asks you to explain to him some details about donating and receiving blood. What should you tell him? Will
his blood be compatible with his friend’s blood type? Which blood type is considered the universal recipient?
Which blood type is considered the universal donor?
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