11

CHAPTER Blood and Immunity

Pretest
Multiple Choice. Select the best answer, and write the letter
of your choice to the left of each number. To check your
answers go to Appendix 11.

1. Erythrocyte is the scientific name for a

a. white blood cell
b. lymphocyte
c. red blood cell
d. muscle cell
2. Platelets, or thrombocytes, are involved in
a. digestion
b. inflammation
c. immunity
d. blood clotting
3. The white blood cells active in immunity are the
a. chondrocytes
b. lymphocytes
c. adipose cells
d. hematids
4. Substances produced by immune cells that
counteract microorganisms and other foreign
materials are called
a. antigens
b. antibodies
c. anticoagulants
d. Rh factors
5. A deficiency of hemoglobin results in the disorder
called
a. hypertension
b. chromatosis
c. anemia
d. hemophilia
6. A neoplastic overgrowth of white blood cells is
called
a. leukemia
b. anemia
c. fibrosis
d. cystitis

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 Learning Objectives
After careful study of this chapter, you should be able to:

1 Describe the composition of the blood plasma. P358 7 Identify and use roots pertaining to blood chemistry. P369
2 Describe and give the functions of the three types of blood 8 List and describe three major disorders of the
cells. P358 blood. P370
3 Differentiate the five different types of leukocytes. P360 9 Describe the major tests used to study blood. P370
4 Explain the basis of blood types. P361 10 List and describe three major disorders of the immune
system. P374
5 Define immunity, and list the possible sources of
immunity. P364 11 Interpret abbreviations used in blood studies. P380
6 Identify and use roots and suffixes pertaining to the blood 12 Analyze medical terms in several case studies involving the
and immunity. P367 blood. PP357, 388

Case Study: Nurse Anesthetist Olivia With Latex Allergy

Chief Complaint tachycardia, urticaria (hives), and rhinitis when she came
Olivia, a 36 y/o certified registered in contact with latex gloves.
nurse anesthetist (CRNA), noticed
Clinical Course
that her hands had a red patchy
Olivia was diagnosed with a type I hypersensitivity, IgE, T
rash when she removed her gloves
cell-mediated latex allergy, as shown by both immunologic
following cases in the OR. They began to itch after a few
and skin-prick tests. Although Olivia is a CRNA, she was
minutes of donning the gloves, so she figured she might
educated on the course of latex allergies. She was reminded
have developed an allergy to the latex they contained.
that there is no cure and that the only way to prevent an
When she began to have a runny nose and itchy swol­
allergic reaction is to avoid coming into contact with latex.
len eyes, she was worried and sought medical advice
This chapter describes the composition and charac­
from her primary care physician, who referred her to an
teristics of blood, the life-sustaining fluid that circulates
allergist.
throughout the body. A discussion of immunity is included
Examination because many components of the immune system are
The allergist examined Olivia’s hands and observed a carried in the blood. Olivia’s case of allergy is an example of
localized red crusty rash that stopped at the wrists. There immunologic hyperactivity. One of the symptoms, tachy­
were a few blisters spread over the hand region. Along cardia, was discussed in Chapter 10 and rhinitis will be
with the examination, a history indicated Olivia had introduced in the next chapter on the respiratory system.
noticed the contact dermatitis for a while when she wore
powdered latex gloves in the OR, and she more recently Case Study Revisited: Once you complete this
had noted generalized allergic symptoms during surgi­ chapter, please review the case follow-up on p. 381.
cal cases. During a recent case, she experienced some

Ancillaries At-A-Glance
Visit the web resource to access the following resources.

Chapter 11 ■ Blood and Immunity 357

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 358 Part II ■ Body Systems

Learning Resources
■ eBook ■ TestPrep
■ A&P Module with Heart & Lung Sounds ■ Animations
■ Image Bank ■ Audio Pronunciation Glossary

Introduction BLOOD PLASMA

Blood is the fluid that circulates through the vessels, bring­ Plasma is about 90% water. The remaining 10% contains
ing oxygen and nourishment to all cells and carrying away nutrients, electrolytes (dissolved salts), gases, albumin (a
carbon dioxide and other waste products. The blood also protein), clotting factors, antibodies, wastes, enzymes, and
distributes body heat and carries special substances, such as hormones. Laboratories test for a multitude of these sub­
antibodies and hormones. Certain blood cells are a major stances in blood chemistry tests. The pH (relative acidity) of
component of the immune system, which protects against the plasma remains steady at about 7.4.
disease. This chapter thus includes a discussion of the
immune system. BLOOD CELLS
The blood cells (FIG. 11-2) include erythrocytes, or red blood
cells (RBCs); leukocytes, or white blood cells (WBCs);
Blood and platelets, also called thrombocytes. All blood cells are
The total adult blood volume is about 5 L (5.2 qt). Whole produced in red bone marrow. Some WBCs multiply in
blood can be divided into two main components: the liquid lymphoid tissue as well. For Your Reference BOX 11-1 sum­
portion, or plasma (55%), and formed elements, more com­ marizes the different types of blood cells; BOX 11-2 discusses
monly known as blood cells (45%) (FIG. 11-1). time-saving acronyms, such as RBC and WBC.

Other 1%
Proteins 8%

Plasma
55% Water 91%
Whole
blood Leukocytes
and platelets
Formed 0.9%
elements
45% Erythrocytes
99.1%

FIGURE 11-1 Composition of whole blood. Percentages show the relative proportions
of the different components of plasma and formed elements.

Platelet

Leukocyte

Erythrocytes

FIGURE 11-2 Blood cells. When viewed under a microscope, all three types of formed
elements are visible.

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 Chapter 11 ■ Blood and Immunity 359

FOR YOUR REFERENCE BOX 111

Blood Cells

Number Per Microliter

Cell Type of Blood Description Function

Erythrocyte (red blood cell) 5 million Tiny (7 mcm diameter), biconcave Carries oxygen bound to
disk without nucleus (anuclear) hemoglobin; also carries some
carbon dioxide and buffers blood

Leukocyte (white blood cell) 5,000 to 10,000 Larger than red cell with Immunity; protects against
prominent nucleus that may pathogens and destroys foreign
be segmented (granulocyte) or matter and debris; located in
unsegmented (agranulocyte); blood, tissues, and lymphatic
types vary in staining properties system 11
Platelet (thrombocyte) 150,000 to 450,000 Fragment of large cell Hemostasis; forms a platelet
(megakaryocyte) plug and starts blood clotting
(coagulation)

FOCUSS ON WORDS
RD
DS BOX 112
Acronyms
ms

Acronyms are abbreviations that use the first letters of the assay); JAMA (Journal of the American Medical Association);
words in a name or phrase. They have become very popular NSAID (nonsteroidal antiinflammatory drug), pronounced
because they save time and space in writing as the number “en-sayd”; and CABG (coronary artery bypass graft), which
and complexity of technical terms increases. Some examples inevitably becomes “cabbage.” Few people even know that
that apply to studies of the blood are CBC (complete blood LASER is an acronym that means “light amplification by stimu­
count) and RBC and WBC for red and white blood cells. Some lated emission of radiation.”
other common acronyms are CNS (central nervous system An acronym is usually introduced the first time a phrase
or clinical nurse specialist), ECG (electrocardiogram), NIH appears in an article and is then used without explanation.
(National Institutes of Health), and STI (sexually transmitted If you have spent time searching back through an article in
infection). frustration for the meaning of an acronym, you probably
If the acronym has vowels and lends itself to pronunciation, wish, as do other readers, that all the acronyms used and
it may be used as a word in itself, such as AIDS (acquired immu­ their meanings would be listed at the beginning of each
nodeficiency syndrome); ELISA (enzyme-linked immunosorbent article.

Erythrocytes
The major function of erythrocytes is to carry oxygen to
cells. This oxygen is bound to an iron-containing pigment
in the cells called hemoglobin. Erythrocytes are small, disk-
shaped cells with no nuclei (FIG. 11-3). Their concentration of
about 5 million per microliter (μL or mcL) of blood makes
them by far the most numerous of the blood cells. The hemo­
globin that they carry averages 15 g/dL (100 mL) of blood.
An RBC gradually wears out and dies in about 120 days, so
these cells must be constantly replaced. Production of red
cells in the bone marrow is regulated by the hormone eryth­
ropoietin (EPO), which is made in the kidneys.

Leukocytes FIGURE 11-3 Erythrocytes (red blood cells). The cells are
All WBCs show prominent nuclei when stained. They total seen under a scanning electron microscope, which gives a three-
about 5,000 to 10,000/μL, but their number may increase dimensional view.

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 360 Part II ■ Body Systems

during infection. There are five types of leukocytes that ■ Granulocytes, or granular leukocytes, have visible gran­
vary in their relative percentages and their functions. The ules in the cytoplasm when stained. A granulocyte has a
different types are identified by the size and appearance of segmented nucleus. There are three types of granulocytes,
the nucleus, by their staining properties, and by whether named for the kind of stain (dye) the granules take up:
or not they show visible granules in the cytoplasm when ■ Neutrophils stain weakly with both acidic and basic
stained. The five types are illustrated and compared in dyes.
BOX 11-3. Classified as granulocytes or agranulocytes, they ■ Eosinophils stain strongly with acidic dyes.
are as follows: ■ Basophils stain strongly with basic dyes.

FOR YOUR REFERENCE BOX 113

Leukocytes (White Blood Cells)

Cell Type Relative Percentage (Adult) Function

GRANULOCYTE

Neutrophil 54 to 62 percent phagocytosis

NU-tro-fil
Nucleus
Granules

Erythrocyte

Eosinophil 1 to 3 percent allergic reactions; defense against

Erythrocyte
e-o-SIN-o-fil parasites
Granules
Nucleus

Basophil less than 1 percent allergic reactions

BA-so-fil

Nucleus
Granules

AGRANULOCYTE

Lymphocyte 25 to 38 percent immunity (T cells and B cells)

Platelet
LIM-fo-site
Nucleus

Erythrocyte

Monocyte 3 to 7 percent phagocytosis

Erythrocyte
MON-o-site

Nucleus

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 Chapter 11 ■ Blood and Immunity 361

■ Agranulocytes do not show visible granules when stained. (FIG. 11-4). Large numbers of band cells in the blood indi­
An agranulocyte’s nucleus is large and either round or cate an active infection.
curved. There are two types of agranulocytes:
■ Lymphocytes are the smaller agranulocytes. Platelets
■ Monocytes are the largest of all the WBCs. The blood platelets (thrombocytes) are not complete cells,
but fragments of large cells named megakaryocytes, which
WBCs protect against foreign substances. Some engulf form in bone marrow (FIG. 11-5). They number from 200,000
foreign material by the process of phagocytosis (see Fig. 3-3); to 400,000/μL of blood. Platelets are important in hemosta­
others have different functions in the immune system. In sis, the prevention of blood loss, which includes the process
diagnosis, it is important to know not only the total num­ of blood clotting, or coagulation.
ber of leukocytes but also the relative number of each type, When a vessel is injured, platelets stick together to form
because these numbers can change in different disease con­ a plug at the site. Substances released from the platelets
ditions. Laboratories report these numbers as a differen­ and from damaged tissue then interact with clotting factors
tial count (Diff), which is part of a complete blood count in the plasma to produce a wound-sealing clot. Clotting
(CBC). factors are inactive in the blood until an injury occurs. To
The most numerous WBCs, neutrophils, are called protect against unwanted clot formation, 12 factors must 11
polymorphs because of the various shapes of their nuclei. interact before blood coagulates. The final reaction is the
They are also referred to as segs, polys, or PMNs (poly­ conversion of fibrinogen to threads of fibrin that trap blood
morphonuclear leukocytes). A band cell, also called a stab cells and plasma to produce the clot (FIG. 11-6). The plasma
cell, is an immature neutrophil with a solid curved nucleus that remains after blood coagulates is serum.

Erythrocytes

Platelets

Nucleus

A Platelets
A Mature neutrophil

Platelets

Nucleus

B Band cell B Megakaryocyte

(immature neutrophil)
FIGURE 11-5 Platelets (thrombocytes). A. Platelets seen in a
FIGURE 11-4 Band cell. A. A mature neutrophil. B. A band cell, or blood smear under the microscope. B. A megakaryocyte releases
stab cell, is an immature neutrophil with a thick curved nucleus. platelets.

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 362 Part II ■ Body Systems

Injury and
platelet plug

Preliminary steps
in clotting

Prothrombin
Prothrombinase Ca++

Thrombin

Fibrinogen Fibrin threads

+
Blood cells
and plasma

B Clot

Fibrin

Cell

C
FIGURE 11-6 Blood clotting (coagulation). Blood coagulation involves a complex series of reactions that leads to formation of fibrin
threads. The fibrin traps blood cells to form a clot. A. Substances released from damaged tissue start the clotting process. B. The final steps
in formation of fibrin. One of these steps requires calcium (Ca2+). C. Microscopic view of blood cells trapped in fibrin.

Rh negative (Rh−). Blood is typed by mixing samples sep-

BLOOD TYPES arately with different prepared antisera. Red cells in the
Genetically inherited proteins on the surface of RBCs deter- sample will agglutinate (clump) with the antiserum that
mine blood type. More than 20 groups of these proteins corresponds to the blood type, as shown in FIGURE 11-7 for
have now been identified, but the most familiar are the the ABO system.
ABO and Rh blood groups. The ABO system includes types In giving blood transfusions, it is important to use
A, B, AB, and O. The Rh types are Rh positive (Rh +) and blood that is the same type as the recipient’s blood or a

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 Chapter 11 ■ Blood and Immunity 363

ANTI-A ANTI-B

Anti-A serum Anti-B serum

11
Type A

Type B

Type AB
No agglutination
(negative reaction)

Type O Agglutination
A B (positive reaction)
FIGURE 11-7 Blood typing. Blood type is determined by mixing samples separately with antisera prepared against the different red cell
antigens. Clumping (agglutination) with an antiserum indicates the presence of the corresponding antigen. A. Labels at the top of each
column denote the kind of antiserum added to the blood samples. Anti-A serum agglutinates red cells in type A blood, but anti-B serum does
not. Anti-B serum agglutinates red cells in type B blood, but anti-A serum does not. Both sera agglutinate type AB blood cells, and neither
serum agglutinates type O blood. B. Photographs of blood typing reactions.

type to which the recipient will not have an immune reac- donor red cells are mixed with recipient serum to test for
tion. In an emergency, type O, Rh-negative blood can be a reaction.
used because these red cells will not induce an immune Whole blood may be used to replace a large volume of
response. When there is time, laboratories perform more blood lost, but in most cases requiring blood transfusion, a
complete tests for compatibility that take additional blood blood fraction, such as packed red cells, platelets, plasma, or
proteins into account. In this process of cross-matching, specific clotting factors, is administered.

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 364 Part II ■ Body Systems

foreign substance. Protection against measles, for example,

Immunity
will not protect against chickenpox or any other disease.
The adaptive immune response involves complex inter­
actions between components of the lymphatic system and
the blood. Any foreign particle, but mainly proteins, may
act as an antigen, a substance that provokes an immune
Innate Adaptive response. This response comes from two types of lympho­
(inborn) (acquired) cytes that circulate in the blood and lymphatic system:
■ T cells (T lymphocytes) mature in the thymus. They are
capable of attacking a foreign cell directly, producing
cell-mediated immunity. Immune cells known as antigen-
presenting cells (APCs), which take in and process for­
Natural Artificial eign antigens, are important to T cell function. A T cell is
activated when it contacts an antigen on an APC’s surface
in combination with some of the body’s own proteins.
Examples of APCs are dendritic cells and macrophages,
which are descendants of monocytes.
Active Passive Active Passive
■ B cells (B lymphocytes) mature in bone marrow. When
Contact Placenta, Vaccine Immune
they meet a foreign antigen, they multiply rapidly and
with a mother’s serum
disease milk
mature into plasma cells. These cells produce antibodies,
also called immunoglobulins (Ig), that inactivate antigens
FIGURE 11-8 Types of immunity. (FIG. 11-9). Antibodies remain in the blood, often provid­
ing long-term immunity to the specific organism against

Immunity Antigen A Antigen B

Immunity is protection against disease. It includes defenses
against harmful microorganisms, their products, or any
other foreign substance. These defenses may be inborn or The invading organism
acquired during life (FIG. 11-8). with antigen A and
antigen B on its cell
surface.
INNATE IMMUNITY
Innate defense mechanisms protect against any invading
organism or harmful foreign substance, not any particular
one. Thus, they are described as nonspecific. These defenses Antibody A Antibody B
are inborn and are based on an individual’s inherited genetic
makeup. Most of these protections are physical barriers or Antibodies A and B
are produced in
chemical defenses and include the following:
response to antigens
■ Unbroken skin, which acts as a barrier A and B, respectively.
■ Cilia, tiny cell projections that sweep impurities out of Antibody bound
the body, as in the respiratory tract to antigen
■ Mucus that traps foreign material
■ Bactericidal body secretions, as found in tears, skin,
digestive tract, and reproductive tract
■ Reflexes, such as coughing and sneezing, which expel
The specific antibodies
impurities
bind with the specific
■ Lymphoid tissue, which filters impurities from blood and corresponding antigens
lymph, as described in Chapter 10 to render the invading
organism harmless.
■ Phagocytes, cells that attack, ingest, and destroy foreign
organisms

ADAPTIVE IMMUNITY FIGURE 11-9 The antigen–antibody reaction. Antibodies

Adaptive immunity is acquired during life and is specific, that produced by immune cells bind with specific antigens to aid in their
is, directed toward a particular disease organism or other inactivation and elimination.

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 Chapter 11 ■ Blood and Immunity 365

which they were formed. Antibody-based immunity is ■ Passive—by transfer of antibodies from a mother to
referred to as humoral immunity. her fetus through the placenta or through the mother’s
milk
■ Artificial adaptive immunity
TYPES OF ADAPTIVE IMMUNITY ■ Active—by administration of a vaccine, which may be
Adaptive immunity may be acquired either naturally or arti­ a killed or weakened organism, part of an organism,
ficially (see FIG. 11-8). In addition, each avenue for acquir­ or an altered toxin (toxoid)
ing such immunity may be either active or passive. In active ■ Passive—by administration of an immune serum
immunity, a person makes his or her own antibodies in obtained from other people or animals
response to contact with an antigen. In passive immunity, an Immunology has long been a very active area of research.
antibody, known as an immune serum, is transferred from The above description is only the barest outline of the events
an outside source. Immune sera may come from other peo­ that are known to occur in the immune response, and there
ple or from immunized animals. The portion of the blood is still much to be discovered. Some of the areas of research
plasma that contains antibodies is the gamma globulin frac­ include autoimmune diseases, in which an individual pro­
tion. The types of adaptive immunity are: duces antibodies to his or her own body tissues; hereditary 11
■ Natural adaptive immunity and acquired immunodeficiency diseases; the relationship
■ Active—from contact with a disease organism or between cancer and immunity; and the development of tech­
other foreign antigen niques for avoiding rejection of transplanted tissue.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Normal Structure and Function
agranulocyte A white blood cell that does not have visible granules in its cytoplasm; agranulocytes
A-gran-u-lo-site include lymphocytes and monocytes (see BOX 11-3)

albumin A simple protein found in blood plasma

al-BU-min

antibody A protein produced in response to and interacting specifically with an antigen

AN-tih-bod-e

antigen A substance that induces the formation of an antibody

AN-tih-jen

antigen-presenting cell (APC) Immune cell that takes in a foreign antigen, processes it, and presents it on the cell surface
in combination with the body’s own proteins, thus activating a T cell; examples are
dendritic cells and macrophages, which are descendants of monocytes

B cell A lymphocyte that matures in bone marrow and is active in producing antibodies;
B lymphocyte (LIM-fo-site)

band cell An immature neutrophil with a nucleus in the shape of a band; also called a stab cell;
band cell counts are used to trace infections and other diseases (see FIG. 11-4)

basophil A granular leukocyte that stains strongly with basic dyes; active in allergic reactions
BA-so-fil

blood The fluid that circulates in the cardiovascular system (roots: hem/o, hemat/o)
blud

coagulation Blood clotting

ko-ag-u-LA-shun

cross-matching Testing the compatibility of donor and recipient blood in preparation for a transfusion;
donor red cells are mixed with recipient serum to look for an immunologic reaction;
similar tests are done on tissues before transplantation

(continued)

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 366 Part II ■ Body Systems

Terminology Key Terms (Continued)

electrolyte A substance that separates into charged particles (ions) in solution; a salt; term also
e-LEK-tro-lite applied to ions in body fluids

eosinophil A granular leukocyte that stains strongly with acidic dyes; active in allergic reactions and
e-o-SIN-o-fil defense against parasites

erythrocyte A red blood cell (roots: erythr/o, erythrocyt/o) (see FIGS. 11-2 and 11-3)
eh-RITH-ro-site

erythropoietin (EPO) A hormone produced in the kidneys that stimulates red blood cell production in the bone
eh-rith-ro-POY-eh-tin marrow; this hormone is now made by genetic engineering for clinical use

fibrin The protein that forms a clot in the blood coagulation process
FI-brin

fibrinogen The inactive precursor of fibrin

fi-BRIN-o-jen

formed elements The cellular components of blood

gamma globulin The fraction of the blood plasma that contains antibodies; given for passive transfer of
GLOB-u-lin immunity

granulocyte A white blood cell that has visible granules in its cytoplasm; granulocytes include
GRAN-u-lo-site neutrophils, basophils, and eosinophils (see BOX 11-3)

hemoglobin (Hb, Hgb) The iron-containing pigment in red blood cells that transports oxygen
HE-mo-glo-bin

hemostasis The stoppage of bleeding

he-mo-STA-sis

immunity The state of being protected against a disease (root: immun/o)

ih-MU-nih-te

immunoglobulin (Ig) An antibody; immunoglobulins fall into five classes, each abbreviated with a capital letter:
im-u-no-GLOB-u-lin IgG, IgM, IgA, IgD, IgE

leukocyte A white blood cell (roots: leuk/o, leukocyt/o)

LU-ko-site

lymphocyte An agranular leukocyte active in immunity (T and B cells); found in both the blood and in
LIM-fo-site lymphoid tissue (roots: lymph/o, lymphocyt/o)

megakaryocyte A large bone marrow cell that fragments to release platelets

meg-ah-KAR-e-o-site

monocyte An agranular phagocytic leukocyte

MON-o-site

neutrophil A granular leukocyte that stains weakly with both acidic and basic dyes; the most
NU-tro-fil numerous of the white blood cells; a type of phagocyte

phagocytosis The engulfing of foreign material by white blood cells

fag-o-si-TO-sis

plasma The liquid portion of the blood

PLAZ-mah

plasma cell A mature form of a B cell that produces antibodies

platelet A formed element of the blood that is active in hemostasis; a thrombocyte (root:
PLATE-let thrombocyt/o)

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 Chapter 11 ■ Blood and Immunity 367

Terminology Key Terms (Continued)

serum The fraction of the plasma that remains after blood coagulation; it is the equivalent of
SERE-um plasma without its clotting factors (plural: sera, serums)

T cell A lymphocyte that matures in the thymus and attacks foreign cells directly; T lymphocyte

thrombocyte A blood platelet (root: thrombocyt/o)

THROM-bo-site

Word Parts Pertaining to Blood and Immunity

See TABLES 11-1 to 11-3. 11

Table 11-1 Suffixes for Blood

Suffix Meaning Example Definition of Example
-emia,a -hemia condition of blood polycythemia increase of cells (cyt) in the blood
pol-e-si-THE-me-ah
-penia decrease in, deficiency of cytopenia deficiency of cells
si-to-PE-ne-ah
-poiesis formation, production hemopoiesis production of blood cells
he-mo-poy-E-sis
a
A shortened form of the root hem plus the suffix -ia.

Exercise 11-1
Complete the exercise. To check your answers go to Appendix 11.

Define the following terms.

1. thrombocytopenia (throm-bo-si-to-PE-ne-ah) __________________________________________________________

2. bacteremia (bak-ter-E-me-ah) ________________________________________________________________________
3. leukocytopenia (lu-ko-si-to-PE-ne-ah) _________________________________________________________________
4. erythropoiesis (eh-rith-ro-poy-E-sis) __________________________________________________________________
5. toxemia (tok-SE-me-ah) ____________________________________________________________________________
6. hypoproteinemia (hi-po-pro-tene-E-me-ah) ____________________________________________________________
7. hyperalbuminemia (hi-per-al-bu-mih-NE-me-ah) _______________________________________________________

Use the suffix -emia to write words for the following definitions.

8. Presence of viruses in the blood ______________________________________________________________________

9. Presence of excess white cells (leuk/o) in the blood ______________________________________________________
10. Presence of pus in the blood _________________________________________________________________________

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 368 Part II ■ Body Systems

Many of the words relating to blood cells can be formed The remaining types of blood cells are designated by easily
either with or without including the root cyt/o, as in erythro- recognized roots such as agranulocyt/o, monocyt/o, granul/o,
penia or erythrocytopenia, leukopoiesis or leukocytopoiesis. and so on (TABLE 11-2).

Table 11-2 Roots for Blood and Immunity

Root Meaning Example Definition of Example
myel/o bone marrow myelogenous originating in bone marrow
mi-eh-LOJ-eh-nus
hem/o, hemat/o blood hemopathy any disorder of blood
he-MOP-ah-the
erythr/o, erythrocyt/o red blood cell erythroblast immature red blood cell
eh-RITH-ro-blast
leuk/o, leukocyt/o white blood cell leukocytosis increase in the number of
lu-ko-si-TO-sis leukocytes in the blood
lymph/o, lymphocyt/o lymphocyte lymphocytic pertaining to lymphocytes
lim-fo-SIT-ik
thromb/o blood clot thrombolytic dissolving a blood clot
throm-bo-LIT-ik
thrombocyt/o platelet, thrombocyte thrombopoiesis formation of platelets
throm-bo-poy-E-sis
immun/o immunity, immune system immunization production of immunity
im-u-nih-ZA-shun

Exercise 11-2
Complete the exercise. To check your answers go to Appendix 11.

Identify and define the root in the following words.

1. leukocytosis (lu-ko-si-TO-sis) ________________________________________________________________________

2. ischemia (is-KE-me-ah) _____________________________________________________________________________
3. preimmunization (pre-im-u-nih-ZA-shun) _____________________________________________________________
4. hematology (he-mah-TOL-o-je) ______________________________________________________________________
5. prothrombin (pro-THROM-bin)______________________________________________________________________
6. panmyeloid (pan-MI-eh-loyd) ________________________________________________________________________

Fill in the blanks.

7. Lymphokines (LIM-fo-kines) are chemicals active in immunity that are produced by ________________________ .
8. A hematoma (he-mah-TO-mah) is a swelling caused by collection of _____________________________________ .
9. Hemorrhage (HEM-or-ij) is a profuse flow (-rhage) of __________________________________________________ .
10. Myelofibrosis (mi-eh-lo-fi-BRO-sis) is formation of fibrous tissue in ______________________________________ .
11. Erythroclasis (er-ih-THROK-lah-sis) is the breaking (-clasis) of __________________________________________ .
12. An immunocyte (im-u-no-SITE) is a cell active in ______________________________________________________ .
13. The term thrombocythemia (throm-bo-si-THE-me-ah) refers to a blood increase in the number of ____________ .
14. Leukopoiesis (lu-ko-poy-E-sis) refers to the production of _______________________________________________ .

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 Chapter 11 ■ Blood and Immunity 369

Exercise 11-2 (Continued)

Write words for the following definitions.

15. Decrease in white blood cells _____________________________________________

16. Tumor of bone marrow _____________________________________________
17. Immature lymphocyte _____________________________________________
18. Dissolving (-lysis) of a blood clot _____________________________________________
19. Formation (-poiesis) of bone marrow _____________________________________________

The suffix -osis added to a root for a type of cell means an increase in that type of cell in the blood. Use this suffix to
write a word that means each of the following. 11
20. Increase in granulocytes in the blood _____________________________________________
21. Increase in lymphocytes in the blood _____________________________________________
22. Increase in red blood cells _____________________________________________
23. Increase in monocytes in the blood _____________________________________________
24. Increase in platelets in the blood _____________________________________________

Table 11-3 Roots for Blood Chemistry

Root Meaning Example Definition of Example
azot/o nitrogenous compounds azoturia increased nitrogenous compounds in the
aze-o-TU-re-ah urine (-uria)
calc/i calcium (symbol Ca) calcification deposition of calcium salts
kal-sih-fih-KA-shun
ferr/o, ferr/i iron (symbol Fe) ferrous pertaining to or containing iron
FER-ous
sider/o iron sideroderma deposition of iron into the skin
sid-er-o-DER-mah
kali potassium (symbol K) hyperkalemiaa excess of potassium in the blood
hi-per-kah-LE-me-ah
natri sodium (symbol Na) natriuresis excretion of sodium in the urine (ur/o)
na-tre-u-RE-sis
ox/y oxygen (symbol O) hypoxia deficiency of oxygen in the tissues
hi-POK-se-ah
a
The i in the root is dropped.

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 370 Part II ■ Body Systems

Exercise 11-3
Complete the exercise. To check your answers go to Appendix 11.

Fill in the blanks.

1. A sideroblast (SID-er-o-blast) is an immature cell containing ____________________________________________ .
2. The term hypokalemia (hi-po-kah-LE-me-ah) refers to a blood deficiency of _______________________________ .
3. The bacterial species Azotobacter is named for its ability to metabolize ___________________________________ .
4. Hypoxemia (hi-pok-SE-me-ah) is a blood deficiency of _________________________________________________ .
5. Ferritin (FER-ih-tin) is a compound that contains ______________________________________________________ .
6. A calcareous (kal-KAR-e-us) substance contains _______________________________________________________ .

Use the suffix -emia to form words with the following meanings.
7. Presence of sodium in the blood _____________________________________________
8. Presence of nitrogenous compounds in the blood _____________________________________________
9. Presence of potassium in the blood _____________________________________________
10. Presence of calcium in the blood _____________________________________________

or from cells that are too small (microcytic) or have too

Clinical Aspects of Blood little hemoglobin (hypochromic). Key tests in diagnosing
anemia are blood counts, mean corpuscular volume (MCV),
ANEMIA and mean corpuscular hemoglobin concentration (MCHC).
Anemia is defined as an abnormally low amount of hemo­ BOX 11-4 describes these and other blood tests. BOX 11-5 has
globin in the blood. Anemia may result from too few RBCs information on careers in hematology.

FOR YOUR REFERENCE BOX 114

Common Blood Tests

Test Abbreviation Description

red blood cell count RBC number of red blood cells per microliter of blood

white blood cell count WBC number of white blood cells per microliter of blood

differential count Diff relative percentage of the different types of leukocytes

hematocrit (FIG. 11-10) Ht, Hct, crit relative percentage of packed red cells in a given volume of blood

packed cell volume PCV hematocrit

hemoglobin Hb, Hgb amount of hemoglobin in g/dL (100 mL) of blood

mean corpuscular volume MCV volume of an average red cell

mean corpuscular hemoglobin MCH average weight of hemoglobin in red cells

mean corpuscular hemoglobin MCHC average concentration of hemoglobin in red blood cells
concentration

erythrocyte sedimentation rate ESR rate of erythrocyte settling per unit of time; used to detect infection or
inflammation

complete blood count CBC series of tests including cell counts, hematocrit, hemoglobin, and cell
volume measurements

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 Chapter 11 ■ Blood and Immunity 371

HEALTH PROFESSIONS BOX 115

Careers in Hematology

Hematologists are physicians and other scientists who spe­ with laboratory safety policies and procedures and must exer­
cialize in the study of blood and blood diseases. In medical cise appropriate precautions when working with body fluids
practice, hematology is often combined with the study and and tissues. For information on careers in medical laboratory
treatment of blood cancers as the specialty of hematology– technology, contact the American Society for Clinical Labora­
oncology. tory Science at ascls.org.
Other healthcare professionals who work in hematol­ A phlebotomist is a healthcare professional who draws
ogy perform different roles depending upon their academic blood for testing, transfusions, or research. Phlebotomists
preparation. These careers include medical technologists, work in hospitals, laboratories, private physicians’ offices,
medical technicians, and phlebotomists, who are employed clinics, and blood banks. They often draw blood from a vein
in hospitals, clinics, outpatient laboratories, and private (venipuncture), but may also draw it from an artery or by
offices.
Medical technologists and technicians may specialize in
skin puncture, such as a finger or heel stick. Phlebotomists
must be trained in sterile techniques and safety precautions
11
various clinical settings, such as blood banks and microbiology to prevent the spread of infectious diseases. They must take
and chemistry laboratories. Each of these positions requires an specimens without harming the patient or interfering with
advanced skill set and working knowledge of electronic equip­ medical care and must accurately label and transport spec­
ment, instrumentation, and computers. Those working in imens to the proper laboratory. Educational requirements
hematology test blood for abnormalities or infections and may vary among states. Often, in-house training with certifica­
do cross-matching for transfusions. They examine blood cells tion by the National Phlebotomy Association is acceptable
for signs of cancer and other diseases. They must be familiar (nationalphlebotomy.org).

100 100 100

Hematocrit (%)

FIGURE 11-10 Hematocrit. The hematocrit tests Plasma 100

the volume percentage of red cells in whole blood. 60
The tube on the far left shows a normal hematocrit. 50
The two middle tubes illustrate abnormal 60
hematocrits. One shows a low percentage of red 30
blood cells, indicating anemia, and the other shows RBCs
an excessively high percentage of red blood cells,
as seen in polycythemia. The tube on the far right
shows a relatively high percentage of red cells due Normal Anemia Polycythemia Dehydration
to dehydration. (45%) (30%) (60%) (60%)

The general symptoms of anemia include fatigue, short­

ness of breath, heart palpitations, pallor, and irritability.
There are many different types of anemia, some of which
are caused by faulty production of red cells and others by
loss or destruction of red cells.

Anemia due to Impaired Production of Red Cells

■ Aplastic anemia results from bone marrow destruc­
tion and affects all blood cells (pancytopenia). It may
be caused by drugs, toxins, viruses, radiation, or bone
marrow cancer. Aplastic anemia has a high mortality
rate but has been treated successfully with bone marrow
transplantation.
■ Nutritional anemia may result from a deficiency of
vitamin B12 or folate, B vitamins needed for RBC devel­
opment. Most commonly, it is caused by a deficiency FIGURE 11-11 Iron deficiency anemia. Red cells are small
of iron, needed to make hemoglobin (FIG. 11-11). Folate (microcytic) and are lacking in hemoglobin (hypochromic).

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 372 Part II ■ Body Systems

deficiency commonly appears in those with poor diet,

in pregnant and lactating women, and in those who
abuse alcohol. Iron deficiency anemia results from
poor diet, poor iron absorption, or blood loss. Both
folate deficiency and iron deficiency respond to dietary
supplementation.
■ Pernicious anemia is a specific form of B12 deficiency. Sickle-
It results from the lack of intrinsic factor (IF), a sub­ shaped
stance produced in the stomach that aids in the intesti­ cell
nal absorption of B12. Pernicious anemia must be treated
with regular B12 injections.
■ In sideroblastic anemia, adequate iron is available, but
the iron is not used properly to manufacture hemoglo­ FIGURE 11-12 A blood smear in sickle cell anemia. Abnormal
bin. This disorder may be hereditary or acquired, as by cells take on a crescent (sickle) shape when they give up oxygen.
exposure to toxins or drugs. It may also be secondary
to another disease. The excess iron precipitates out in
immature red cells (normoblasts). and deprive tissues of oxygen, an episode termed sickle
cell crisis. The misshapen cells are also readily destroyed
Anemia due to Loss or Destruction of Red Cells (hemolyzed). The disease predominates in black pop­
■ Hemorrhagic anemia results from blood loss. This may ulations. Genetic carriers of the defect, those with one
be a sudden loss, as from injury, or loss from chronic normal and one abnormal gene, show sickle cell trait.
internal bleeding, as from the digestive tract in cases of They usually have no symptoms, except when oxygen is
ulcers or cancer. low, such as at high altitudes. They can, however, pass the
defective gene to offspring. Sickle cell anemia, as well as
■ Thalassemia is a hereditary disease that appears mostly
many other genetic diseases, can be diagnosed in carriers
in Mediterranean populations. A genetic mutation
and in a fetus before birth.
causes abnormal hemoglobin production and hemolysis
(destruction) of red cells. Thalassemia is designated as α Reticulocyte counts are useful in diagnosing the causes
(alpha) or β (beta), according to the part of the hemoglo­ of anemia. Reticulocytes are immature RBCs that normally
bin molecule affected. Severe β thalassemia is also called appear as a small percentage of the total erythrocytes. An
Cooley anemia or thalassemia major. increase in the reticulocyte count indicates increased red cell
■ In sickle cell anemia, a mutation alters the hemoglobin formation, as in response to hemorrhage or cell destruction.
molecule so that it precipitates (settles out) when it gives A decrease in reticulocytes indicates a failure in red cell
up oxygen, distorting the RBCs into a crescent shape production, as caused by nutritional deficiency or aplastic
(FIG. 11-12). The altered cells block small blood vessels anemia (BOX 11-6).

CLINICAL PERSPECTIVES BOX 116

Use of Reticulocytes in Diagnosis

As erythrocytes mature in the red bone marrow, they go reticulocytes suggests a problem with red cell production, as
through a series of stages in which they lose their nuclei and in cases of deficiency anemias or suppression of bone marrow
most other organelles, maximizing the space available for activity.
hemoglobin. In one of the last stages of development, small
numbers of ribosomes and some rough endoplasmic retic­ Mature erythrocyte
ulum remain in the cell and appear as a network, or reticu­
lum, when stained. Cells at this stage are called reticulocytes.
Reticulocytes leave the red bone marrow and enter the
bloodstream, where they become fully mature erythrocytes
in about 24 to 48 hours. The average number of red cells
maturing through the reticulocyte stage at any given time
is about 1 to 2%. Changes in these numbers can be used in
diagnosing certain blood disorders.
When erythrocytes are lost or destroyed, as from chronic Reticulocytes
bleeding or some form of hemolytic anemia, red cell produc­
tion is “stepped up” to compensate for the loss. Greater num­
bers of reticulocytes are then released into the blood before
reaching full maturity, and counts increase to above normal.
On the other hand, a decrease in the number of circulating

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 Chapter 11 ■ Blood and Immunity 373

COAGULATION DISORDERS ■ Lymphocytic leukemia affects B cells and the lymphatic

system, causing lymphadenopathy (lymph node disease)
The most common cause of coagulation problems is a defi­
and adverse effects on the immune system.
ciency in the number of circulating platelets, a condition
termed thrombocytopenia. Possible causes include aplastic Leukemias are further differentiated as acute or chronic
anemia, infections, bone marrow cancer, and agents that based on clinical progress. Acute leukemia is the most com­
destroy bone marrow, such as x-rays or certain drugs. This mon form of cancer in young children. The acute forms are:
disorder results in bleeding into the skin and mucous mem­
branes, variously described as petechiae (pinpoint spots), ■ Acute myeloblastic (myelogenous) leukemia (AML). The
ecchymoses (bruises), and purpura (purple lesions). prognosis in AML is poor for both children and adults.
In disseminated intravascular coagulation (DIC), wide­ ■ Acute lymphoblastic (lymphocytic) leukemia (ALL).
spread clotting in the vessels obstructs circulation to the With treatment, the ALL remission rate is high.
tissues. This is followed by diffuse hemorrhages as clotting
factors are removed and the coagulation process is impaired. The chronic forms of leukemia are:
DIC may result from a variety of causes, including infection, ■ Chronic myelogenous leukemia, also called chronic gran­
cancer, hemorrhage, injury, and allergy. ulocytic leukemia, affects young to middle-aged adults 11
Hemophilia is a hereditary deficiency of a specific clot­ (FIG 11-13A). Most cases show the Philadelphia chromo­
ting factor. It is a genetically sex-linked disease that is passed some (Ph), an inherited anomaly in which part of chro­
from mother to son. There is bleeding into the tissues, espe­ mosome 22 shifts to chromosome 9.
cially into the joints (hemarthrosis). Hemophilia must be
■ Chronic lymphocytic leukemia (CLL) appears mostly in
treated with transfusions of the necessary clotting factors,
the elderly and is the most slowly growing form of the
which are now produced in purified form from blood prod­
disease (FIG. 11-13B).
ucts or by genetic engineering. Genetic engineering may
one day provide a cure by inserting a normal gene into the Leukemia treatment includes chemotherapy, radiation
patient’s body to produce the deficient clotting factor. therapy, and bone marrow transplantation. Bone marrow
BOX 11-7 lists tests done for these and other coagulation contains stem cells, immature cells that can develop into
disorders. mature, functional cells. After the patient’s bone marrow stem
cells are destroyed, donor bone marrow can repopulate the
NEOPLASMS recipient’s bone marrow with normal, healthy blood-forming
Leukemia is a neoplasm of WBCs. The rapidly dividing cells. Another option for transplantation is the use of umbil­
but incompetent white cells accumulate in the tissues and ical cord blood to replace blood-forming cells in bone mar­
crowd out the other blood cells. The symptoms of leukemia row. This blood is more readily available than bone marrow
include anemia, fatigue, easy bleeding, splenomegaly, and and does not have to match as closely to avoid rejection.
sometimes hepatomegaly (enlargement of the liver). The Hodgkin lymphoma is a cancer of the B cells in lymph
causes of leukemia are unknown but may include exposure nodes. In the U.S. population the incidence of the disease
to radiation or harmful chemicals, hereditary factors, and peaks at about 20 years of age and again at about 65
perhaps viral infection. years of age. The cause is unknown, but in some cases may
The two main categories of leukemia are determined by involve a viral infection. The disease appears as painless
origin and the cells involved: enlargement of a lymph node or group of nodes, often in
the neck, armpit, thorax, and groin. If untreated, it may
■ Myelogenous leukemia originates in the bone marrow spread throughout the lymphatic system to other tissues.
and involves mainly the granular leukocytes. Early signs are weight loss, fever, night sweats, fatigue,

FOR YOUR REFERENCE BOX 117

Coagulation Tests

Test Abbreviation Description

activated partial thromboplastin time APTT Measures time required for clot formation; used to evaluate
clotting factors and monitor heparin therapy

bleeding time BT Measures capacity of platelets to stop bleeding after a

standard skin incision

partial thromboplastin time PTT Evaluates clotting factors; similar to APTT, but less sensitive

prothrombin time PT, pro time Indirectly measures prothrombin; used to monitor
anticoagulant therapy; also called Quick test

thrombin time (thrombin clotting time) TT (TCT) Measures how quickly a clot forms

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 374 Part II ■ Body Systems

A B
FIGURE 11-13 Leukemia. Leukemia is a malignant overgrowth of white cells originating in the bone marrow (myelogenous) or lymphatic
system (lymphocytic). A. Chronic myelogenous leukemia showing overproduction of all categories of white cells. B. Chronic lymphocytic
leukemia showing numerous lymphocytes.

anemia, and a weakened immune system. A feature of Clinical Aspects of Immunity

Hodgkin lymphoma is giant cells in the lymph nodes called
Reed–Sternberg cells (FIG. 11-14). Symptoms include fever, HYPERSENSITIVITY
night sweats, weight loss, and skin itching (pruritus). Most
Hypersensitivity is any harmful overreaction of the immune
cases can be cured with radiation and chemotherapy.
system. Its forms include allergy, autoimmune disease, and
Non-Hodgkin lymphoma (NHL) is also a malignant
transplantation reactions. In cases of allergy, a person is more
enlargement of lymph nodes but does not show Reed–
sensitive to a particular antigen than the average individual.
Sternberg cells. It is more common than Hodgkin disease
Common allergens are pollen, animal dander, dust, and foods,
and has a higher mortality rate. Cases vary in severity and
but there are many more. A seasonal allergy to inhaled pol­
prognosis. It is most prevalent in the older adult popula­
lens is commonly called “hay fever.” Responses may include
tion and in those with AIDS and other forms of immuno­
itching, redness, or tearing of the eyes (conjunctivitis), skin
deficiency. NHL involves the T or B lymphocytes, and some
rash, asthma, runny nose (rhinitis), sneezing, urticaria (hives),
cases may be related to infection with certain viruses. It
and angioedema, a reaction similar to hives but involving
requires systemic chemotherapy and sometimes bone mar­
deeper layers of tissue.
row transplantation.
An anaphylactic reaction is a severe generalized allergic
Multiple myeloma is a cancer of the blood-forming
response that can rapidly lead to death as a result of shock
cells in bone marrow, mainly the plasma cells that produce
and respiratory distress. It must be treated by immediate
antibodies. The disease causes anemia, bone pain, and bone
administration of epinephrine (adrenaline) and maintenance
weakening. Patients have a greater susceptibility to infection
of open airways. Oxygen, antihistamines, and corticoste­
because of immunodeficiency. Abnormally high levels of cal­
roids may also be given. Common causes of anaphylaxis are
cium and protein in the blood often lead to kidney failure.
drugs, especially penicillin and other antibiotics, vaccines,
Multiple myeloma is treated with radiation and chemother­
diagnostic chemicals, foods, and insect venom.
apy, but the prognosis is generally poor.
A delayed hypersensitivity reaction involves T cells and
takes at least 12 hours to develop. A common example is
the reaction to contact with plant irritants such as those of
poison ivy and poison oak.

IMMUNODEFICIENCY
The term immunodeficiency refers to any failure in the
immune system. This may be congenital (present at birth)
or acquired and may involve any components of the system.
The deficiency may vary in severity but is always evidenced
by an increased susceptibility to disease.
Acquired immunodeficiency syndrome (AIDS) is acquired
by infection with human immunodeficiency virus (HIV),
which attacks certain T cells. These cells have a specific sur­
face attachment site, the CD4 receptor, for the virus. HIV is
spread by sexual contact, use of contaminated needles, blood
FIGURE 11-14 Reed–Sternberg cell. These cells are typical of transfusions, and passage from an infected mother to her fetus.
Hodgkin disease. It leaves the host susceptible to opportunistic infections such

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 Chapter 11 ■ Blood and Immunity 375

as pneumonia caused by the fungus Pneumocystis jirovecii; AUTOIMMUNE DISEASES

thrush, an oral fungal infection caused by Candida albi­
A disorder that results from an immune response to one’s
cans; and infection with Cryptosporidium, a protozoon
own tissues is classified as an autoimmune disease. The cause
that causes cramps and diarrhea. It also predisposes the
may be a failure in the immune system or a reaction to body
patient to Kaposi sarcoma, a once-rare form of skin cancer.
cells that have been slightly altered by mutation or disease.
AIDS may also induce autoimmunity or attack the nervous
The list of diseases that are believed to be caused, at least in
system.
part, by autoimmunity is long. Some, such as systemic lupus
AIDS is diagnosed and monitored by CD4+ T lym­
erythematosus (SLE), systemic sclerosis (scleroderma), and
phocyte counts, a measure of cells with the HIV receptor.
Sjögren syndrome, affect tissues in multiple systems. Others
A count of less than 200/μL of blood signifies severe immu­
target more specific organs or systems. Examples are perni­
nodeficiency. HIV antibody levels and direct viral blood
cious anemia, rheumatoid arthritis, Graves disease (of the
counts are also used to track the disease’s course. At present
thyroid), myasthenia gravis (a muscle disease), fibromyalgia
there is no vaccine or cure for AIDS, but drugs can delay its
syndrome (a musculoskeletal disorder), rheumatic heart dis­
progress.
ease, and glomerulonephritis (a kidney disease). These dis­
eases are discussed in more detail in other chapters. 11

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Disorders
acquired immunodeficiency Immune system failure caused by infection with HIV (human immunodeficiency virus); the
syndrome (AIDS) virus infects certain T cells and thus interferes with immunity
ah-KWI-erd im-u-no-de-FISH-en­
se SIN-drome

allergen A substance that causes an allergic response

AL-er-jen

allergy Hypersensitivity
AL-er-je

anaphylactic reaction An exaggerated allergic reaction to a foreign substance; it may lead to death caused by
an-ah-fih-LAK-tik circulatory collapse and respiratory distress if untreated; also called anaphylaxis (from Greek
phylaxis, meaning “protection”)

anemia A deficiency in the amount of hemoglobin in the blood; may result from blood loss,
ah-NE-me-ah malnutrition, a hereditary defect, environmental factors, and other causes (see FIGS. 11-11
and 11-12)

angioedema A localized edema with large hives (wheals) similar to urticaria but involving deeper layers of
an-je-o-eh-DE-mah the skin and subcutaneous tissue

aplastic anemia Anemia caused by bone marrow failure resulting in deficient blood cell production, especially
a-PLAS-tik of red cells; pancytopenia

autoimmune disease A condition in which the immune system produces antibodies against an individual’s own
aw-to-ih-MUNE tissues (prefix auto means “self”)

Cooley anemia A form of thalassemia (hereditary anemia) that affects production of the β (beta) hemoglobin
chain; thalassemia major

delayed hypersensitivity reaction An allergic reaction involving T cells that takes at least 12 hours to develop; examples are
various types of contact dermatitis, such as poison ivy or poison oak; the tuberculin reaction
(test for TB); and rejections of transplanted tissue

disseminated intravascular Widespread clot formation in the microscopic vessels; may be followed by bleeding caused by
coagulation (DIC) depletion of clotting factors

ecchymosis A collection of blood under the skin caused by leakage from small vessels (root chym means
ek-ih-MO-sis “juice”)

(continued)

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 376 Part II ■ Body Systems

Terminology Key Terms (Continued)

hemolysis The rupture of red blood cells and the release of hemoglobin (adjective: hemolytic)
he-MOL-ih-sis

hemophilia A hereditary blood disease caused by lack of a clotting factor resulting in abnormal bleeding
he-mo-FIL-e-ah

hemorrhagic anemia Anemia that results from blood loss, as from an injury or internal bleeding
hem-o-RAJ-ik

human immunodeficiency virus The virus that causes AIDS

(HIV)

Hodgkin lymphoma A neoplastic disease of B cells that involves the lymph nodes, spleen, liver, and other tissues;
characterized by the presence of giant Reed–Sternberg cells (see FIG. 11-14)

hypersensitivity An immunologic reaction to a substance that is harmless to most people; allergy

hi-per-sen-sih-TIV-ih-te

immunodeficiency A congenital or acquired failure of the immune system to protect against disease
im-u-no-de-FISH-en-se

intrinsic factor A substance produced in the stomach that aids in the intestinal absorption of vitamin B12,
In-TRIN-sik necessary for the manufacture of red blood cells; lack of intrinsic factor causes pernicious anemia

Kaposi sarcoma Cancerous lesion of the skin and other tissues, seen most often in patients with AIDS
KAP-o-se

leukemia Malignant overgrowth of immature white blood cells; may be chronic or acute; may affect
lu-KE-me-ah bone marrow (myelogenous leukemia) or lymphoid tissue (lymphocytic leukemia)

lymphadenopathy Any disease of the lymph nodes

lim-fad-eh-NOP-ah-the

multiple myeloma A tumor of the blood-forming tissue in bone marrow

mi-eh-LO-mah

non-Hodgkin lymphoma (NHL) A widespread malignant disease of lymph nodes that involves lymphocytes; it differs from
Hodgkin disease in that giant Reed–Sternberg cells are absent

nutritional anemia Anemia resulting from a dietary deficiency, usually of iron, vitamin B12, or folate
nu-TRISH-un-al

Philadelphia chromosome (Ph) An abnormal chromosome found in the cells of most individuals with chronic granulocytic
(myelogenous) leukemia

pernicious anemia Anemia caused by failure of the stomach to produce intrinsic factor, a substance needed for
per-NISH-us the absorption of vitamin B12; this vitamin is required for the formation of erythrocytes

petechiae Pinpoint, flat, purplish-red spots caused by bleeding within the skin or mucous membrane
pe-E-ke-e (singular: petechia)

purpura A condition characterized by hemorrhages into the skin, mucous membranes, internal organs,
PUR-pu-rah and other tissues (from Greek word meaning “purple”); thrombocytopenic purpura is caused
by a deficiency of platelets

sickle cell anemia A hereditary anemia caused by the presence of abnormal hemoglobin; red blood cells become
SIK-l sickle-shaped when they give up oxygen and interfere with normal blood flow to the tissues
(see FIG. 11-12); most common in black populations of West African descent

sideroblastic anemia Anemia caused by inability to use available iron to manufacture hemoglobin; the excess iron
sid-eh-ro-BLAS-tik precipitates in normoblasts (developing red blood cells)

Sjögren syndrome An autoimmune disease involving dysfunction of the exocrine glands and affecting secretion
SHO-gren of tears, saliva, and other body fluids; deficiency leads to dry mouth, tooth decay, corneal
damage, eye infections, and difficulty in swallowing

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 Chapter 11 ■ Blood and Immunity 377

Terminology Key Terms (Continued)

splenomegaly Enlargement of the spleen
sple-no-MEG-ah-le

systemic lupus erythematosus Inflammatory connective tissue disease affecting the skin and multiple organs; patients are
LU-pus er-ih-the-mah-TO-sus sensitive to light and may have a red butterfly-shaped rash over the nose and cheeks

systemic sclerosis A diffuse connective tissue disease that may involve any system causing inflammation,
degeneration, and fibrosis; also called scleroderma because it causes thickening of the skin

thalassemia A group of hereditary anemias mostly found in populations of Mediterranean descent (the
thal-ah-SE-me-ah name comes from the Greek word for “sea”)

thrombocytopenia A deficiency of thrombocytes (platelets) in the blood

throm-bo-si-to-PE-ne-ah 11
urticaria A skin reaction consisting of round, raised eruptions (wheals) with itching; hives
ur-tih-KAR-e-ah

Diagnosis and Treatment

adrenaline See epinephrine
ah-DREN-ah-lin

CD4+ T lymphocyte count A count of the T cells that have the CD4 receptors for the AIDS virus (HIV); a count of less
than 200/μL of blood signifies severe immunodeficiency

epinephrine A powerful stimulant produced by the adrenal gland and sympathetic nervous system;
ep-ih-NEF-rin activates the cardiovascular, respiratory, and other systems needed to meet stress; used as a
drug to treat severe allergic reactions and shock; also called adrenaline

reticulocyte counts Blood counts of reticulocytes, a type of immature red blood cell; reticulocyte counts are
re-TIK-u-lo-site useful in diagnosis to indicate the rate of erythrocyte formation (see BOX 11-6)

Reed–Sternberg cells Giant cells that are characteristic of Hodgkin disease; they usually have two large nuclei and
rede SHTERN-berg are surrounded by a halo (see FIG. 11-14)

Terminology Enrichment Terms

The terms listed below expand on the key terms to increase your knowledge of this chapter topic.
Normal Structure and Function
agglutination The clumping of cells or particles in the presence of specific antibodies
ah-glu-tih-NA-shun

bilirubin A pigment derived from the breakdown of hemoglobin and eliminated by the liver in bile
bil-ih-RU-bin

complement A group of plasma enzymes that interacts with antibodies

COM-pleh-ment

corpuscle A small mass or body; a blood corpuscle is a blood cell

KOR-pus-l

hemopoietic stem cell A primitive bone marrow cell that gives rise to all varieties of blood cells
he-mo-poy-EH-tik

heparin A substance found throughout the body that inhibits blood coagulation; an anticoagulant
HEP-ah-rin

(continued)

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 378 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

plasmin An enzyme that dissolves clots; also called fibrinolysin
PLAZ-min

thrombin The enzyme derived from prothrombin that converts fibrinogen to fibrin
THROM-bin

Symptoms and Conditions

agranulocytosis A condition involving a decrease in the number of granulocytes in the blood; also called
a-gran-u-lo-si-TO-sis granulocytopenia

erythrocytosis Increase in the number of red cells in the blood; may be normal, such as to compensate for
eh-rith-ro-si-TO-sis life at high altitudes, or abnormal, such as in cases of pulmonary or cardiac disease

Fanconi syndrome Congenital aplastic anemia that appears between birth and 10 years of age; may be
fan-KO-ne hereditary or caused by damage before birth, as by a virus

graft versus host reaction (GVHR) An immunologic reaction of transplanted lymphocytes against tissues of the host; a common
complication of bone marrow transplantation

hairy cell leukemia A form of leukemia in which cells have filaments, making them look hairy

hematoma A localized collection of blood, usually clotted, caused by a break in a blood vessel
he-mah-TO-mah

hemolytic disease of the newborn Disease that results from incompatibility between the blood of a mother and her fetus,
(HDN) usually involving Rh factor; an Rh-negative mother produces antibody to an Rh-positive
fetus that, in later pregnancies, will destroy the red cells of an Rh-positive fetus; the problem
is usually avoided by treating the mother with antibodies to remove the Rh antigen; also
called erythroblastosis fetalis

hemosiderosis A condition involving the deposition of an iron-containing pigment (hemosiderin) mainly in

he-mo-sid-er-O-sis the liver and the spleen; the pigment comes from hemoglobin released from disintegrated red
blood cells

idiopathic thrombocytopenic A clotting disorder caused by destruction of platelets that usually follows a viral illness;
purpura (ITP) causes petechiae and hemorrhages into the skin and mucous membranes

infectious mononucleosis An acute infectious disease caused by Epstein–Barr virus (EBV); characterized by fever,
mon-o-nu-kle-O-sis weakness, lymphadenopathy, hepatosplenomegaly, and atypical lymphocytes (resembling
monocytes) (see FIG. 11-10)

lymphocytosis An increase in the number of circulating lymphocytes

lim-fo-si-TO-sis

myelodysplastic syndrome Bone marrow dysfunction resulting in anemia and deficiency of neutrophils and platelets;
mi-eh-lo-dis-PLAS-tik may develop in time into leukemia; preleukemia

myelofibrosis Condition in which bone marrow is replaced with fibrous tissue

mi-eh-lo-fi-BRO-sis

neutropenia A decrease in the number of neutrophils with increased susceptibility to infection; causes
nu-tro-PE-ne-ah include drugs, irradiation, and infection; may be a side effect of treatment for malignancy

pancytopenia A decrease in all cells of the blood, as in aplastic anemia

pan-si-to-PE-ne-ah

polycythemia Any condition in which there is a relative increase in the percent of red blood cells in whole
pol-e-si-THE-me-ah blood; may result from excessive production of red cells because of oxygen lack, as caused by
high altitudes, breathing obstruction, heart failure, or certain forms of poisoning. Apparent
polycythemia results from concentration of the blood, as by dehydration (FIG. 11-15)

polycythemia vera A condition in which overactive bone marrow produces too many red blood cells (see
pol-e-si-THE-me-ah VE-rah FIG. 11-15) that interfere with circulation and promote thrombosis and hemorrhage;
treated by blood removal; also called erythremia and Vaquez–Osler disease

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 Chapter 11 ■ Blood and Immunity 379

FIGURE 11-15 Infectious mononucleosis. Atypical lymphocytes 11

characterize this viral disease.

Terminology Enrichment Terms (Continued)

septicemia Presence of microorganisms in the blood
sep-tih-SE-me-ah

spherocytic anemia Hereditary anemia in which red blood cells are round instead of disk shaped and rupture
sfer-o-SIT-ik (hemolyze) excessively

thrombotic thrombocytopenic An often fatal disorder in which multiple clots form in blood vessels
purpura (TTP)

von Willebrand disease A hereditary bleeding disease caused by lack of von Willebrand factor, a substance necessary
for blood clotting

Diagnosis (see also BOXES 11-4 and 11-7)

Bence Jones protein A protein that appears in the urine of patients with multiple myeloma

Coombs test A test for detection of antibodies to red blood cells, such as those appearing in cases of
autoimmune hemolytic anemias

electrophoresis Separation of particles in a liquid by application of an electrical field; used to separate

e-lek-tro-fo-RE-sis components of blood

ELISA Enzyme-linked immunosorbent assay; a highly sensitive immunologic test used to diagnose
HIV infection, hepatitis, and Lyme disease, among others

monoclonal antibody A pure antibody produced in the laboratory; used for diagnosis and treatment
mon-o-KLO-nal

pH A scale that measures the relative acidity or alkalinity of a solution; represents the amount of
hydrogen ion in the solution

Schilling test Test used to determine absorption of vitamin B12 by measuring excretion of radioactive B12
SHIL-ing in the urine; used to distinguish pernicious from nutritional anemia

seroconversion The appearance of antibodies in the serum in response to a disease or an immunization

se-ro-con-VER-zhun

Western blot assay A very sensitive test used to detect small amounts of antibodies in the blood

Wright stain A commonly used blood stain; see FIGURE 11-2 shows blood cells stained with Wright stain

(continued)

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 380 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

Treatment
anticoagulant An agent that prevents or delays blood coagulation
an-ti-ko-AG-u-lant

antihistamine A drug that counteracts the effects of histamine and is used to treat allergic reactions
an-tih-HIS-tah-meme

apheresis A procedure in which blood is withdrawn, a portion is separated and retained, and the
af-eh-RE-sis remainder is returned to the donor; apheresis may be used as a suffix with a root meaning
the fraction retained, such as plasmapheresis, leukapheresis

autologous blood A person’s own blood; may be donated in advance of surgery and transfused if needed
aw-TOL-o-gus

cryoprecipitate A sediment obtained by cooling; the fraction obtained by freezing blood plasma contains
kri-o-pre-SIP-ih-tate clotting factors

desensitization Treatment of allergy by small injections of the offending allergen, causing an increase of
de-sen-sih-tih-ZA-shun antibody to destroy the antigen rapidly on contact

homologous blood Blood from animals of the same species, such as human blood used for transfusion from one
ho-MOL-o-gus person to another; blood used for transfusions must be compatible with the recipient’s blood

immunosuppression Depression of the immune response; may be correlated with disease but also may be induced
im-u-no-su-PRESH-un therapeutically to prevent rejection in cases of tissue transplantation

protease inhibitor An anti-HIV drug that acts by inhibiting an enzyme the virus needs to multiply
PRO-te-ase

Terminology Abbreviations
The abbreviations listed below are emphasized in this chapter. These are also found, collectively, with all chapter
abbreviations in Appendix 2.

Ab Antibody CLL Chronic lymphocytic leukemia

Ag Antigen, also silver CML Chronic myelogenous leukemia

AIDS Acquired immunodeficiency syndrome crit Hematocrit

ALL Acute lymphoblastic (lymphocytic) leukemia DIC Disseminated intravascular coagulation

AML Acute myeloblastic (myelogenous) leukemia Diff Differential count

APC Antigen-presenting cell EBV Epstein–Barr virus

APTT Activated partial thromboplastin time ELISA Enzyme-linked immunosorbent assay

BT Bleeding time EPO, EP Erythropoietin

CBC Complete blood count ESR Erythrocyte sedimentation rate

CGL Chronic granulocytic leukemia FFP Fresh frozen plasma

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 Chapter 11 ■ Blood and Immunity 381

Terminology Abbreviations (Continued)

Hb, Hgb Hemoglobin PCV Packed cell volume

Hct, Ht Hematocrit pH Scale for measuring hydrogen ion

concentration (acidity or alkalinity)
HDN Hemolytic disease of the newborn
Ph Philadelphia chromosome
HIV Human immunodeficiency virus
PMN Polymorphonuclear (neutrophil)
IF Intrinsic factor
poly Neutrophil
Ig Immunoglobulin
polymorph Neutrophil
ITP Idiopathic thrombocytopenic purpura
PT Prothrombin time; pro time
lytes Electrolytes
PTT Partial thromboplastin time
11
MCH Mean corpuscular hemoglobin
RBC Red blood cell; red blood (cell) count
MCHC Mean corpuscular hemoglobin concentration
seg Neutrophil
μL, mcL Microliter
SLE Systemic lupus erythematosus
μm, mcm Micrometer
T(C)T Thrombin (clotting) time
MCV Mean corpuscular volume
TTP Thrombotic thrombocytopenic purpura
MDS Myelodysplastic syndrome
vWF von Willebrand factor
mEq Milliequivalent
WBC White blood cell; white blood (cell) count
NHL Non-Hodgkin lymphoma

Case Study Revisited

Olivia’s Case Study Follow-Up Olivia spoke to the OR manager who said “Latex
After her diagnosis, Olivia did some further research gloves were removed over 3 months ago in compliance
on her type I hypersensitivity to latex. She understands with the hospital’s latex-free guidelines.” But another
that she needs to avoid latex products. She also knows nurse stepped forward holding up a stack of sterile
that the cornstarch used in powdered latex gloves latex gloves. It was discovered that some of the latex
serves as a carrier for allergenic proteins from latex. gloves had not been removed from all of the ORs. By
The powder may become airborne resulting in inhala­ the end of the shift, any latex gloves that were acci­
tion and subsequent allergic response in a sensitized dently overlooked were removed from all areas of the
person. However, Olivia remembers that her hospital hospital.
has been latex-free for over 3 months. Too many people Latex safety is important for Olivia in performing
are allergic to it so the hospital established latex-free her job as a CRNA but she also needs to be aware to
guidelines for employee and patient safety. For exam­ avoid all contact with any natural rubber latex in her
ple, there are signs by the elevators reminding visitors home and out in the community. She wears a medical
not to bring in latex balloons for patients and the alert bracelet, uses a bronchodilator inhaler at the first
hospital gift shop only sells mylar (a nonlatex product) symptom of bronchospasm, and carries a syringe of
balloons. epinephrine at all times.

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