Alterations in Cardiac and Hematologic Functions

Slide 2: Introduction 

There are numerous types of anemia which differ in the clinical manifestations, causes, and diagnosis. This presentation will delve at discussing the different types of anemia, their clinical manifestations, causes, and diagnosis. With regard to heart failure, the body usually employs compensatory measures to restore cardiac output. The presentation will also delve into discussing these compensatory measures and their effects. The two types of heart failure –right-sided heart failure and left-sided heart failure –will be differentiated. This presentation will also outline the causes, clinical presentations, and diagnosis of these two types of heart failure. Lastly, this presentation will differentiate the clinical presentations, prognosis, and management of acute and chronic leukemia. 

Slide 3: Types of Anemia 

Iron-deficiency anemia is a common type of anemia. It is characterized by a lack of adequate healthy RBCs in the blood. The disease is caused by inadequate iron intake, pregnancy, blood loss due to pregnancy, internal bleeding, inability to absorb iron, and endometriosis. An individual's bone marrow needs iron to make hemoglobin. If the amount of iron in the body is not enough, the body cannot produce enough hemoglobin for RBCs. Iron-deficiency anemia occurs due to a lack of iron in the body. The clinical presentations of iron deficiency anemia include fatigue, chest pain, soreness of the tongue, poor appetite, paleness of the skin, headache, dizziness, and shortness of breath. There numerous diagnostic tests that can be used to diagnose iron-deficiency anemia. These tests include the Complete Blood Count (CBC) test, Total Iron-Binding Capacity test, Fecal Occult test, Examination of RBCs size and color under a Microsoft, and esophagogastroduod endoscopy test. 

Slide 4: Types of Anemia (Contd.) 

Pernicious anemia is a type of anemia that is characterized by a decrease in RBCs. It occurs due to a lack of vitamin B-12 and a lack of intrinsic factor. Vitamin B-12 plays a role in creating RBCs. For this reason, the body requires an intake of vitamin B-12. More to this is that the body needs intrinsic factor, which is a type of protein that helps the body absorb vitamin B-12. Some of the clinical manifestations of pernicious anemia include fatigue, chest pain, paleness of skin, trouble focusing, loss of coordination, and shortness of breath. Primary care physicians do several tests to diagnose pernicious anemia. Some of the diagnostic tests for pernicious anemia include the CBC test to measure vitamin B-12 and iron levels, vitamin B-12 deficiency test to assess vitamin B-12 levels, bone marrow biopsy to examine stomach walls for any damage, and schilling tests. 

Slide 5: Types of Anemia (Contd.) 

Aplastic anemia is a rare and severe type of anemia that occurs when the body stops producing blood cells. Bone marrow failure and inheritance genes cause the condition. It can also be caused by some chemicals such as benzene and some pesticides. Aplastic anemia can make individuals feel fatigued and with a higher risk of infections and uncontrolled bleeding. Other clinical presentations of aplastic anemia include shortness of breath, paleness of the skin, dizziness, headache, nosebleeds, bleeding gums, leukopenia, and thrombocytopenia. Aplastic anemia is a rare and severe type of anemia. Thus, it requires prompt medical attention. To diagnose aplastic anemia, doctors conduct different diagnostic tests. These tests include the CBC test and bone marrow biopsy. 

Slide 6: Types of Anemia (Contd.) 

Hemolytic anemia is a type of anemia in which RBCs are destroyed at a rate that is faster than they can be made. Hemolytic anemia can be inherited or acquired. The condition is caused by premature rupture of RBCs, inherited genes, enlarged spleen, stressors like infections, drugs, and certain foods, and exposure to certain chemicals such as benzene. The signs and symptoms of hemolytic anemia vary from one person to another. Still, generally,, patients with this condition display the following clinical presentations –paleness of skin, fever, dizziness, dark-colored urine, enlarged spleen and liver, and tachycardia, which refers to increased heart rate. Based on the symptoms displayed by the patient, medical history, and physical exam, primary care physicians can tell if one is suffering from hemolytic anemia. Physicians use the CBC test, urine test, and bone marrow aspiration or biopsy to diagnose hemolytic anemia. 

Slide 7: Types of Anemia (Contd.) 

Sickle cell anemia is a type of anemia in which RBCs become rigid and sticky. In other words, the RBCs are irregularly shaped and can get stuck in small blood vessels. A mutation in the gene causes this condition. The disease is also passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. The signs and symptoms of sickle cell anemia vary from one person to another. More to this is that the signs and symptoms change over time. Some of the signs and symptoms of sickle cell anemia are paleness of skin, dizziness, shortness of breath, tachycardia, weakness, headache, and chest pain. A physician uses a number of diagnostic tests, including CBC test, blood smears examination, and hemoglobin electrophoresis, to diagnose sickle cell anemia. 

Slide 8: Types of Anemia (Contd.) 

Thalassemia is a type of anemia characterized by less hemoglobin and fewer RBCs in the body than normal. The condition is mainly passed down from one generation to another. In other words, thalassemia is mostly inherited. Thalassemia occurs when there is a defect in the genes that help the production of alpha-globin and beta-globin, which the two proteins that make up hemoglobin. Some of the signs and symptoms of thalassemia are bone deformities, shortness of breath, dark urine, fatigue, fast heartbeat, paleness of skin, and delayed growth and development. Physicians usually take blood samples when diagnosing thalassemia. The sample is then tested in the laboratory for anemia and abnormal hemoglobin. Some of the tests carried out to diagnose thalassemia include the CBC test, Chronic Villus Sampling test, and Amniocentesis. 

Slide 9: Body Compensatory Measures in Restoring Cardiac Output 

The compensatory measures employed by the body in order to restore cardiac output include –increasing heart rate and increasing blood pressure. With heart failure, the heart does not pump sufficient blood to the body. As a result, the body does not get enough oxygen and blood. This, in turn, makes the body believe that there is no enough fluid inside its vessels. Because of this, the body and the nervous system tried to make up for this by increasing the heart rate and by increasing blood pressure. 

Slide 10: Effects of Body Compensatory Measures to Cardiac Output 

The body has a remarkable ability to compensate for heart failure. As stated in the previous slide, the body does this by increasing the heart rate and blood pressure. The body can carry out these noble tasks promptly, making it difficult for people even to feel the symptom of early stages of heart failure. This is because the compensatory measures help the body adjust to the effects of heart failure in the early stages. However, in the long-run, the compensatory measures can result in adverse effects, which include making heart failure worse by enlarging the heart and reducing the pumping ability of the heart. 

Slide 11: Right-Sided and Left-Sided Heart Failure –Differences 

Heart failure is a condition marked by the inability of the heart to pump enough blood to the body. This usually affects the normal functioning of the body. There are two types of heart failure –right-sided heart failure and left-sided heart failure. With regard to the left-sided HF, the left ventricle of the heart is too weak to pump enough blood around the body. This condition results in the accumulation of blood in the pulmonary vein. This can cause coughing or difficulty in breathing. Right-sided HF is the exact opposite of left-sided HF. In this case, the right ventricle of the heart no longer pumps enough blood around the body. This condition makes the blood to accumulate in the veins, which increases pressure inside the veins. As a result, blood may be pushed out of the vein into the surrounding tissue. 

Slide 12: Causes of Right-Sided HF and Left-Sided HF 

There are numerous factors or conditions which can lead to right-sided or left-sided heart factor. Some of the causes of right-sided heart failure include coronary artery disease, high blood pressure, obesity, diabetes, sleep apnea, heavy alcohol use, tobacco use, and cocaine use. Some of the causes of left-sided artery disease include coronary artery disease, cardiomyopathy, high blood pressure, diabetes, obesity, cocaine use, heavy alcohol use, tobacco use, and sleep apnea. When an individual has coronary artery disease, plaque blocks the arteries, and thus enough blood is not supplied to the heart muscles. 

Slide 13: Clinical Features of HF 

As stated in the previous slides, heart failure causes a reduction in the heart's ability to pump blood. Heart failure may arise due to the failure of the left ventricle muscle or right ventricle failure to pump blood around the body. Right-sided heart failure (backward failure) is caused by vena cava congestion, congestion of the liver, and ascites. In contrast, left-sided heart failure (backward failure) is caused by congestion in the pulmonary vein and pulmonary oedema. The two conditions make the heart feel challenging to pump blood adequately around the body. As a result, the heart starts to function abnormally to compensate. Reduced output causes forward failure. More to this is that an inadequate supply of blood from the left side automatically causes the right-side to reduce its output, and vice versa. 

Slide 14: Clinical Presentations of Right-Side and Left-Sided HF 

Right-sided and left-sided heart failure have common clinical manifestations. A patient with either right or left-sided heart failure usually experiences shortness of breath, coughing, wheezing, fatigue, swelling of ankles, legs, and feet (Pazos-Lopez, Peteiro-Vazquez, Carcia-Campos, Garcia-Bueno, de Torres, Castro-Beiras (2011). 

Slide 15: Diagnostics Tests 

The diagnostic tests for right-sided heart failure include blood tests, Cardiac CT Scan, Chest X-ray, Cardiac Catheterization, Coronary Angiography, Echocardiogram (EKG), Myocardial biopsy, pulmonary functional studies, and Stress Testing. The diagnostic tests for left-handed heart failure include Cardiac Catheterization, chest X-ray, Echocardiogram, Electrocardiogram, Electrophysiology study, Radionuclide Imaging, and Treadmill Exercise Test. 

For cardiac catheterization, physicians usually thread a long thin, flexible tube through a blood vessel. The tube can be threaded in the arm or groin and to the heart. The tube is then injected with contrast material. Once this is done, an X-ray video is taken to show how the heart functions. The video is also taken to look for heart blockages. An electrocardiogram measures the electrical activity of the heart. This test can help determine parts of the heart that are either damaged, enlarged, or overworked. An echocardiogram is a test that uses sound waves to take moving pictures of the heart's chambers and valves. 

Slide 16: Acute and Chronic Leukemia 

Leukemia is not just one type of cancer but a group of blood cancers that affects the blood cells. The disease usually starts in the bone marrow. Both children and adults can be diagnosed with leukemia, which forms when blood cells in the bone marrow malfunction and form cancerous cells. Leukemia cells tend to interfere with the normal functioning of the body. This is because it interferes with the ability of the body to fight infections, control belling, ad supply oxygen to normal blood-making cells. Generally, leukemia is divided into two categories. These categories are acute leukemia and chronic leukemia. These two categories of leukemia differ in the way they spread or grow in the body. Chronic leukemia is slow-growing leukemia, whereas acute leukemia is fast-growing leukemia. Acute leukemia targets immature cells, whereas chronic leukemia targets mature cells. 

Slide 17: Clinical Presentations of Acute and Chronic Leukemia 

With regard to acute leukemia, the clinical manifestations can be caused by the infiltration of bone marrow. It can also be caused by the infiltration of extramedullary sites by blasts. For this reason, the initial clinical manifestations of acute leukemia may be due to the presence of anemia, neutropenia, or thrombocytopenia. Symptoms tend to vary from one patient to another. Still, patients generally present nonspecific clinical presentations, which include low white blood cells, tiredness, weakness, shortness of breath, paleness of skin, night sweats, a slight fever, and swollen lymph nodes. Generally, the signs and symptoms of chronic leukemia occur as a result of the leukemia cells trying to replace the normal blood-making cells of the bone marrow. Due to this, patients with chronic leukemia do not have enough blood cells and platelets. Patients with chronic leukemia generally have the following symptoms –tiredness, bone and joint pain, night sweats, spontaneous bruising, fever, anemia, nosebleeds, weight loss, and loss of appetite. 

Slide 18: Prognosis of Acute and Chronic Leukemia 

The exact cause of leukemia is not yet known. More to this is that no one knows why some people have acute leukemia, and others have chronic leukemia. However, it is thought that genetic factors and environmental factors can cause leukemia. With regard to acute leukemia, cigarette smoking, exposure to radiation, genetic abnormalities, and family history of leukemia are thought to be some of the causes of acute leukemia. With regard to chronic leukemia, cancer is thought to be caused by old age, being Caucasian, and exposure to chemicals and high levels of radiation. 

Slide 19: Management of Acute and Chronic Leukemia 

Acute leukemia is treated as soon as the disease is diagnosed. This is because acute leukemia progresses quickly. The treatment options for acute leukemia include chemotherapy, targeted therapy, and stem cell therapy, which help control cancer. However, the type of therapy used depends on the type of leukemia one has. The goal of these therapies is to kill the leukemia cells. 

In many cases, the patients are hospitalized, and doctors usually take regular blood and bone marrow tests to check the progress of the treatment. More specifically, the test is used to determine how well the treatment is killing the leukemia cells. Chronic leukemia progresses slowly. For this reason, this type of cancer may not be diagnosed in the early stages. However, when diagnosed, chronic leukemia can be controlled through chemotherapies, corticosteroids, and monoclonal antibodies. In order to treat the decrease in the number of platelets and RBCs, primary care physicians use platelet transfusions and blood transfusions. This helps increase the number of platelets and RBCs in the body. With regard to enlarged lymph nodes, doctors usually use radiations to reduce the size of lymph nodes of patients with chronic leukemia. 

Slide 20: Conclusion 

There are numerous types of anemia. Some of the types that types that were discussed in this presentation include iron-deficiency anemia, pernicious anemia, aplastic anemia, hemolytic anemia, sickle cells anemia, and thalassemia. The clinical presentations, causes, and diagnosis differ in each type of anemia. The two measures employed by the body to restore cardiac output include –increasing the heart rate and increasing blood pressure. In the short term, the two compensatory measures can help the body adjust to the effects of lung failure. However, in the long-run, these compensatory measure enlarge the heart thus making it worse and reduce the pumping ability of the heart. 

Slide 21: Conclusion 

The two types of heart failure include –right-sided heart failure and left-sided heart failure. Left-sided heart failure occurs whn the left ventricle of the heart is too weak to pump enough blood around the body. Ri ght-sided heart failure occurs when the right ventricle of the heart no longer pumps enough blood around the body. Lastly, leukemia is divided into two categories –acute and chronic leukemia. Acute leukemia spreads fast in the body while chronic leukemia spreads very slowly. 

Slide 22: References 

Grigoropoulos, N., Roger, P., Van ‘t Veer, M., Scott, M., Follows, G. (2013). Leukemia update. Part 1: Diagnosis and Management: BMJ: p346:f1660. 

Koshy, J., John, M., Thomas, S., Kaur, G., Batra, N., & Xavier, W. (2015). Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian Journal of Ophthalmology, Vol. 63 (8): 659-664. 

McCance, K., & Huerther, S. (2010). Pathophysiology: The biologic basis for disease in adults and children. St. Lous: Mosby. 

Slide 23: References 

Pazos-Lopez, P., Peteiro-Vazquez, J., Carcia-Campos, A., Garcia-Bueno, L., de Torres, J., & Castro-Beiras, A(2011). The causes, consequences, and treatment of left or right heart failure. Vascular Health and Risk Management, Vol. 7: 237-254. 

U.S. Department of Health and Human Services. (2011). Anemia: Healthy lifestyle changes: Prevent, teat, control: National Institute of Health. [Online]. Retrieved from: https:// www.nhlbi.nih.gov/files/docs/public/blood/anemia-yg.pdf . Accessed October 23, 2019. 

Yasmeen, T., Ali, J., Khan, K., & Siddiqui, N. (2019). Frequency and causes of anemia in Lymphoma patients. Pakistan Journal of Medical Sciences, Vol. 35 (1): 61-65.