Chapter 17
Blood
657
normal range at that time, but four weeks later it was substantially
elevated beyond that. When asked if any circumstances had
changed in her life, she admitted to taking up smoking. How might
her new habit explain her higher RBC count?
9.
Mr. Chu has been scheduled for surgery to have his arthritic hip
replaced. His surgeon tells him he must switch from aspirin to
acetaminophen for pain control before his surgery. Why?
7.
In 1998, the U.S. Food and Drug Administration approved the
nation’s first commercial surgical glue to control bleeding during
certain surgeries. Called Tisseel, it forms a flexible mesh over an
oozing blood vessel to help stem bleeding within five minutes.
±is sealant is made from two blood proteins that naturally cause
blood to clot when they react together. Name these proteins.
8.
Jenny, a healthy young woman, had a battery of tests during a
physical for a new job. Her RBC count was at the higher end of the
Related Clinical Terms
Blood chemistry tests
Chemical analysis of substances in the blood,
e.g., glucose, iron, calcium, protein, bilirubin, and pH.
Blood fraction
Any one of the components of whole blood that has
been separated out from the other blood components, such as
platelets or clotting factors.
Bone marrow biopsy
A sample of red bone marrow is obtained
by needle aspiration (typically from the anterior or posterior
iliac crest), and examined to diagnose disorders of blood-cell
formation, leukemia, various marrow infections, and anemias
resulting from damage to or failure of the marrow.
Exchange transfusion
A technique of removing the patient’s
blood and infusing donor blood until a large fraction of the
patient’s blood has been replaced; used to treat fetal blood
incompatibilities and poisoning victims.
Hematology
(hem
0
ah-tol
9
o-je) Study of blood.
Hematoma
(hem
0
ah-to
9
mah) Accumulated, clotted blood in the
tissues usually resulting from injury; visible as “black and blue”
marks or bruises; eventually absorbed naturally unless infections
develop.
Hemochromatosis
(he
0
mo-kro
0
mah-to
9
sis) An inherited disorder of
iron overload in which the intestine absorbs too much iron from
the diet. ±e iron builds up in body tissues, where it oxidizes
to form compounds that poison those organs (especially joints,
liver, and pancreas).
Myeloproliferative disorder
All-inclusive term for a group of
proliferative disorders (disorders in which normal cell division
controls are lost) including leukoerythroblastic anemia involving
fibrosis of the bone marrow, polycythemia vera, and leukemia.
Plasmapheresis
(plaz
0
mah-fĕ-re
9
sis) A process in which blood is
removed, its plasma is separated from formed elements, and
the formed elements are returned to the patient or donor. ±e
most important application is removal of antibodies or immune
complexes from the blood of individuals with autoimmune
disorders (multiple sclerosis, myasthenia gravis, and others).
Also used by blood banks to collect plasma for burn victims and
to obtain plasma components for therapeutic use.
Septicemia
(sep
0
tĭ-se
9
me-ah;
septos
5
rotten) Excessive and harmful
levels of bacteria or their toxins in the blood. Also called blood
poisoning.
AT T H E C L I N I C
Earl Malone is a 20-year-old passenger
on the bus that crashed on Route 91.
Upon arrival at the scene, paramedics
make the following observations:
Right upper quadrant (abdominal) pain
Cyanotic
Cool and clammy skin
Blood pressure 100/60 and falling, pulse 100
Paramedics start an IV to rapidly infuse a 0.9% sodium
chloride solution (normal saline). They transport him to a small
rural hospital where Mr. Malone’s blood pressure continues to fall
and his cyanosis worsens. The local physician begins infusing O
negative packed red blood cells (PRBCs) and arranges transport by
helicopter to a trauma center. She sends additional PRBC units in
the helicopter for transfusion en route. After arrival at the trauma
center, the following notes were added to Mr. Malone’s chart:
Abdomen firm and distended
Blood drawn for typing and cross matching; packed A positive
blood cells infused
Emergency FAST (Focused Assessment with Sonography for
Trauma) ultrasound is positive for intraperitoneal fluid
A positive FAST scan indicates intra-abdominal bleeding. Mr.
Malone’s condition continues to deteriorate, so he is prepared for
surgery, which reveals a lacerated liver. The laceration is repaired,
and Mr. Malone’s vital signs stabilize.
1.
Mr. Malone was going into shock because of blood loss, so
paramedics infused a saline solution. Why would this help?
2.
Mr. Malone was switched from saline to PRBCs. What problem
does infusion of PRBCs address that the saline solution could not?
3.
Why was the physician able to use O negative blood before the
results of the blood type tests were obtained?
4.
Mr. Malone’s blood type was determined to be A positive. What
plasma antibodies (agglutinins) does he have, and what type of
blood can he receive?
5.
What would happen if doctors had infused type B PRBCs into
Mr. Malone’s circulation?
(Answers in Appendix H)
Case Study
Blood
17
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