Saturday, June 11, 2005
Blood System
Introduction:
The primary function of blood is to maintain a constant environment for the other living tissues of the body. Blood transports foods, gases, and wastes to and from the cells of the body. Food, digested in the stomach and small intestine, passes into the bloodstream through the lining cells of the small intestine. Blood then carries these nutrients to all body cells. Oxygen enters the body through the air sacs of the lungs. Blood cells then transport the oxygen to cells throughout the body. Blood also helps to remove the waste products released by cells. It carries gaseous waste (such as carbon dioxide) to the lungs to be exhaled. It carries solid waste, such as urea, to the kidneys to be expelled in the urine.
Chemical messengers called hormones are also carried by the blood from their sites of secretion in glands, such as the thyroid or pituitary, to distant sites where they regulate growth, reproduction, and energy production.
Finally, blood contains proteins and white blood cells that fight infection, and platelets (thrombocytes) that help the blood to clot.
Composition and Formation of Blood
Blood is composed of cells, or formed elements, suspended in a clear, straw-colored liquid called plasma. The cells constitute 45% of the blood volume and include erythrocytes (red blood cells), leukocytes (white blood cells), and platelets, or thrombocytes (clotting cells). The remaining 55% of blood is plasma, a solution of water, proteins, sugar, salts, hormones, and vitamins.
Cells: Most blood cells originate in the marrow cavity of bones. Both the red blood cells that carry oxygen and the white blood cells that fight infection arise from the same immature cells called stem cells (hemocytoblasts). Under the influence of proteins found in the bloodstream and bone marrow, the primitive stem cells change their size and shape and assume a specialized, or differentiated, form. In this process, the cells change in size from large (immature cells) to small (mature forms) and the cell nucleus shrinks (in red cells, the nucleus actually disappears).
Erythrocytes: As a red blood cell matures (from primitive erythroblast to normoblast to reticulocyte and finally to erythrocyte), it loses its nucleus and the cell assumes the shape of a disk. This shape (a depressed or hollow surface on each side of the cell, resembling a cough drop with a thin central portion) allows for a large surface area on the erythrocyte so that absorption and release of gases (oxygen and carbon dioxide) can take place. Red cells contain the unique protein hemoglobin, which consists of an iron-containing pigment called heme and a protein part called globin. Hemoglobin in the erythrocyte enables the cell to carry oxygen. The combination of oxygen and hemoglobin (oxyhemoglobin) produces the right red color of blood.
Erythrocytes originate in the bone marrow. A hormone called erythropoietin (secreted by the kidney) stimulates their production (-poiesis means formation). Erythrocytes live and fulfill their role of transporting gases for about 120 days in the bloodstream. After this time, cells (called macrophages) in the spleen, liver, and bone marrow destroy the worn-out erythrocytes. Two to ten million red cells are destroyed each second, but because they are constantly replaced, the number of circulating cells remains constant (4 – 6 million per cu mm).
Macrophages breakdown erythrocytes and the hemoglobin within them into their heme and globin (protein) portions. The heme releases iron and decomposes into a dark green pigment called bilirubin. The iron in hemoglobin is reutilized to form new red cells or is stored in the spleen, liver, or bone marrow. Bilirubin is excreted into the bile by the liver, and from the bile it enters the small intestine where it can be excreted in the stool. The green color then turns brown in the stool.
Leukocytes: White blood cells (7000 – 9000 cells per cu mm) ar less numerous than erythrocytes, but there are five different types of mature leukocytes. Five mature types of white blood cells: three granulocytic leukocytes (basophil, neutrophil, and eosinophil) and two agranulocytic leukocytes (monocyte and lymphocyte).
The granulocytes, also known as polymorphonuclear leukocytes, are the most numerous (about 60%). Each is different and has a specialized function. Basophils contain dark-staining cytoplasmic granules that stain with a basic (alkaline) dye. The granules contain heparin (an anticlotting substance) and histamine (a chemical that is released in allergic responses). Eosinophils contain granules that stain with a red acidic dye called eosin. These granulocytes increase in numbers in allergic responses and are thought to engulf substances that trigger the allergies. Neutrophils contain granules that are neutral; that is, they do not stain intensely with either dye. Neutrophils are phagocytes (phag/o means to eat or swallow) that accumulate at sites of infection, where they ingest and destroy bacteria.
Granulocytes and their precursor cells are considered part of the myeloid (derived from bone marrow) line of cells. Their growth and proliferation in the bone marrow are stimulated by specific proteins called colony-stimulating factors (CSFs). G-CSF (granulocyte CSF), GM-CSF (granulocyte macrophage CSF), interleukin-1, and interleukin-3 have been produced commercially and are administered to promote or restore myeloid proliferation in cancer patients. Erythropoietin, like the colony-stimulating factors, is produced by recombination DNA techniques and it stimulates red blood cell production.
Although all granulocytes are polymorphonuclear (they have multilobed nuclei), the term polymorphonuclear leukocyte (poly) is used most often to describe the neutrophil, which is the most numerous of the granulocytes.
Agranulocytes are mononuclear (containing one large nucleus) leukocytes that do not have dark-staining granules in their cytoplasm. These are the lymphocytes and monocytes. Lymphocytes arise in lymph nodes and circulate both in the bloodstream and in the parallel circulating system, the lymphatic system.
Lymphocytes play an important role in the immune response that protects the body against infection. They can directly attack foreign matter and, in addition, make antibodies, which neutralize and destroy foreign antigens (bacteria and viruses). Monocytes are phagocytic cells that also fight disease. They move from the bloodstream into tissues (then they are called macrophages) and dispose of dead and dying cells and other tissue debris by phagocytosis.
Platelets: Platelets, or thrombocytes, are formed in the red bone marrow from giant multinucleated cells called megakaryocytes. Tiny fragments of the megakaryocyte break off from the cell to form platelets. The main function of platelets is to help in the clotting of blood.
Plasma: Plasma is the liquid part of the blood and consists of water, dissolved proteins, sugar, wastes, salts, hormones, and other substances. The four major plasma proteins are albumin, globulin, fibrinogen, and prothrombin (the last two proteins are clotting proteins).
Albumin maintains the proper proportion (and concentration) of water in the blood. Because albumin cannot pass easily through capillary walls, it remains in the blood and carries smaller molecules bound to its surface. It attracts water from the tissues back into the bloodstream and thus opposes the water’s tendency to leave the blood and leak out into tissue spaces. Edema (swelling) results when too much fluid from blood “leaks” out into tissues. This happens in a mild form when a person ingests too much salt (water is retained in the blood and seeps out into tissues) and in a severe form when a person is burned in a fire. In this situation albumin escapes from capillaries as a result of the burn injury. Then water cannot be held in the blood; it escapes through the skin and blood volume drops.
The globulin portion of plasma contains antibodies that destroy foreign substances called antigens. There are three different kinds of globulins in plasma. They are alpha, beta, and gamma, and they can be separated by the process of electrophoresis. Plasma is placed in a special solution and an electric current is passed through the solution. The different protein molecules in the plasma separate out as they migrate at different speeds to the source of the electricity. Specific gamma globulins called immunoglobulins are capable of acting as antibodies. Examples of immunoglobulin antibodies are IgG (found in high concentration in the plasma) and IgA (found in breast milk, saliva, tears, and respiratory mucus). Other immunoglobulins are IgM, IgD, and IgE.
Plasmapheresis (-apheresis means to remove) is the process of separating plasma from the formed elements in the blood. This separation is mechanical, not electrical, as electrophoresis is. In plasmapheresis, the entire blood sample is spun in a centrifuge machine, and the plasma, being lighter in weight than the blood cells, moves to the top of the sample.
Blood Groups
Transfusions of “whole blood” (cells and plasma) are used to replace blood lost after injury, during surgery, or in severe shock. A patient, who is severely anemic and needs only red blood cells, will receive a transfusion of packed red cells (whole blood with most of the plasma removed). Transfusions cannot occur between any two people at random. Human blood falls into four main groups called A, B, AB, and O, and there are harmful effects of transfusing blood from a donor of one blood group into a recipient who has blood of another blood group.
Each of the blood groups has a specific combination of factors (antigens and antibodies) that are inherited. These antigen and antibody factors of the various blood types are:
Type A, containing A antigen and anti-B antibody
Type B, containing B antigen and anti-A antibody
Type AB, containing A and B antigens and no anti-A or anti-B antibodies
Type O, containing no A or B antigens and both anti-A and anti-B antibodies
The problem in transfusing blood from a type A donor into a type B recipient is that A antigens (from the A donor) will react adversely with the anti-A antibodies in the recipient’s type B bloodstream. The adverse reaction is called agglutination, or clumping of the recipient’s blood. The agglutination is fatal to the recipient because it stops the flow of blood. Similar problems can occur in other transfusions if the donor’s antigens are incompatible with the recipient’s antibodies.
People with type O blood are known as universal donors because their blood contains neither A nor B antigens. The anti-A and anti-B antibodies in O blood do not have an effect in the recipient because the antibodies are diluted in the recipient’s bloodstream. Those with type AB blood are known as universal recipients because their blood contains neither anti-A nor anti-B antibodies, so that neither the A nor the B group antigens will cause agglutination in their blood.
Besides A and B antigens, there are many other antigens located on the surface of red blood cells. One of these is called the Rh factor (named because it was first found in the blood of a rhesus monkey). The term Rh-positive refers to a person who is born with the Rh antigen on her or his red blood cells. An Rh-negative person does not have the Rh antigen. There are no anti-Rh antibodies normally present in the blood of an Rh-positive or an Rh-negative person. However, if Rh-positive blood is transfused into an Rh-negative person, the recipient will begin to develop antibodies that would agglutinate any Rh-positive blood if another transfusion were to occur subsequently.
The same reactions occur during pregnancy if the fetus of an Rh-negative woman happens to be Rh-positive.
Blood Clotting
Blood clotting, or coagulation, is a complicated process involving many different substances and chemical reactions. The final result (usually taking less than 15 minutes) is the formation of a fibrin clot from the plasma protein fibrinogen. Platelets are important in beginning the process following injury to tissues or blood vessels. The platelets clump, or aggregate, at the site of injury, releasing a protein, thromboplastin, which in combination with calcium and the sequential release of clotting factors (I – V and VII – XIII) promotes the formation of a fibrin clot. One of the clotting factors is a protein known as clotting factor VIII. It is missing in people who are born with hemophilia.
The fibrin threads form the clot by trapping red blood cells and platelets and plasma. Then the clot retracts into a tight ball, leaving behind a clear fluid called serum. Normally, clots (thrombi) do not form in blood vessels unless the vessel is damaged or the flow of blood is impeded. Anticoagulant substances in the bloodstream inhibit blood clotting, so thrombi and emboli (floating clots) do not form. Heparin, produced by tissue cells (especially liver cells), is an example of an anticoagulant. Other drugs (such as dicumarol) are given to patients with thromboembolic diseases to prevent the formation of clots.
Pathological Conditions
Any abnormal or pathological condition of the blood is generally referred to as a blood dyscrasia (disease). The blood dyscrasias discussed in this section are organized in the following manner: disease of red blood cells, disorders of blood clotting, diseases of white blood cells, and bone marrow disease.
Diseases of Red Blood Cells
Anemia–deficiency in erythrocytes or hemoglobin
The most common type of anemia is iron-deficiency anemia; it is caused by a lack of iron, which is required for hemoglobin production. Other types of anemia include:
1. aplastic anemia–Failure of blood cell production due to aplasia (absence of development, formation) of bone marrow cells. The cause of most cases of aplastic anemia is unknown (idiopathic), but some cases have been linked to benzene exposure and to antibiotics such as chloramphenicol. Pancytopenia occurs as stem cells fail to produce leukocytes, platelets, and erythrocytes. Blood transfusions prolong life until the marrow resumes its normal functioning, and antibiotics are used to control infections. Bone marrow transplants have been successful as therapy.
2. hemolytic anemia–Reduction in red cells due to excessive destruction. One example of hemolytic anemia is congenital spherocytic anemia (also called hereditary spherocytosis). Instead of their normal biconcave shape, erythrocytes are spheroidal. This shape makes them very fragile and easily able to be destroyed (hemolysis), which leads to anemia. The spherocytosis causes increased numbers of reticulocytes in the circulating blood as the bone marrow attempts to compensate for the hemolysis of mature erythrocytes. The excessive hemolysis leads to jaundice because of accumulation of bilirubin in the circulating bloodstream. Because cells in the spleen destroy red cells, the spleen may be removed with helpful results. In some ceases, hemolytic anemia is due to production of autoimmune antibodies that destroy red cells.
3. pernicious anemia–Lack of mature erythrocytes owing to inability to absorb vitamin B12 into the body. (Pernicious means ruinous or hurtful.) Vitamin B12 is necessary for the proper development and maturation of erythrocytes. Although vitamin B12 is a common constituent of food matter (liver, kidney, sardines, egg yolks, oysters), it cannot be absorbed into the bloodstream without the aid of a special substance called intrinsic factor that is normally found in gastric juice, and the result is unsuccessful maturation of red blood cells, with an excess of large, immature, and poorly functioning cells (megaloblasts) in the circulation. Treatment is administration of vitamin B12 for life.
4. sickle cells anemia–A hereditary condition characterized by abnormal shape of erythrocytes and by hemolysis. The crescent, or sickle, shape of the erythrocyte is caused by an abnormal type of hemoglobin (hemoglobin S) in the red cell. The distorted, fragile erythrocytes are poorly oxygenated and clump together, blocking blood vessels, leading to thrombosis and infarction (dead tissue). Symptoms include arthralgias, acute attacks of abdominal pain, and ulcerations of the extremities. The genetic defect (presence of the hemoglobin S gene) is particularly prevalent in black persons of African or African-American ancestry and appears with different degrees of severity, depending on the inheritance of one or two genes for the trait.
5. thalassemia–An inherited defect in the ability to produce hemoglobin, usually seen in persons of Mediterranean (thalassa is a Greek Word meaning sea) background. This condition presents in varying forms and degrees of severity (the most severe form is called Cooley’s anemia), usually leads to hypochromic anemia (diminished hemoglobin content in red cells).
hemochromatosis—Excessive deposits of iron throughout the body. Hepatomegaly occurs and the skin is pigmented, so that it has a bronze hue; diabetes can occur and cardiac failure commonly develops. The condition is usually seen in men over 40 years of age.
polycythemia vera–General increase in red blood cells (erythremia). Blood consistency is viscous (sticky) because of greatly increased numbers of erythrocytes. The bone marrow is hyperplastic, and leukocytosis and thrombocytosis accompany the increase in red blood cells. Treatment consists of reduction of red cell volume to normal levels by phlebotomy (removal of blood from a vein) and by suppressing production with myelotoxic drugs.
Disorders of Blood Clotting
hemophilia – Excessive bleeding caused by a congenital (hereditary) lack of one of the protein substances (factor VIII) necessary for blood clotting. Although, the platelet count of a hemophiliac patient is normal, there is a marked deficiency in a plasma-clotting factor (factor VIII), which results in a very prolonged coagulation time. Treatment consists of administration of the deficient factor.
purpura – Multiple pinpoint hemorrhages and accumulation of blood under the skin. Purpura means purple, and in this bleeding condition, hemorrhages into the skin and mucous membranes produce red-purple discoloration of the skin. The bleeding is caused by a fall in the number of platelets (thrombocytopenia). The cause of the disorder may be immunological, meaning the body produces an antiplatelet factor that harms its own platelets. Idiopathic thrombocytopenic purpura is a condition in which a patient makes an antibody that destroys his or her own platelets. Bleeding time is prolonged and the cause is unknown. Splenectomy (the spleen is the site of platelet destruction) and drug therapy with corticosteroids to discourage antibody synthesis are methods of treatment. Purpura is also seen in any other condition associated with a low platelet count, such as leukemia and drug reactions.
Diseases of White Blood Cells
leukemia – An increase in cancerous white blood cells. This is a disease of the bone marrow in which malignant leukocytes fill the marrow and bloodstream. There are several types of leukemia, determined according to the particular leukocyte involved. The terms acute and chronic are used to refer to a large number of immature (in acute forms) or mature, differentiated (in chronic forms) leukocytes in the blood.
Acute leukemias have several common clinical characteristics: abrupt, stormy onset of symptoms, fatigue, fever and bleeding, bone pain and tenderness, lymphadenopathy, splenomegaly and hepatomegaly, and CNS symptoms, such as headache, vomiting, and paralysis. Four types of leukemia are:
acute myelogenous (myelocytic) leukemia (AML) – Immature granulocytes (myeloblast) predominate. Platelets and erythrocytes are diminished because of infiltration and replacement of the bone marrow by large numbers of myeloblasts.
acute lymphocytic leukemia (ALL) – Immature lymphocytes (lymphoblast) predominate. This form is seen most often in children and adolescents; onset is sudden.
chronic myelogenous (myelocytic) leukemia (CML) – Both mature and immature granulocytes are present in the marrow and bloodstream. This is a slowly progressive illness with which patients may live for many years without encountering life-threatening problems.
chronic lymphocytic leukemia (CLL) – Abnormal numbers of relatively mature lymphocytes predominate in the marrow, lymph nodes, and spleen. This form of leukemia usually occurs in the elderly and follows a slowly progressive course.
All forms of leukemia are treated with chemotherapy, using drugs that prevent cell division and selectively injure rapidly dividing cells. Effective treatment can lead to a remission (disappearance of signs of disease). Relapse occurs when leukemia cells reappear in the blood and bone marrow, necessitating further treatment.
Transplantation of normal bone marrow from closely related donors is successful in restoring normal bone marrow function in some patients with acute leukemia. This procedure is performed following high-dose chemotherapy, which is administered to eliminate the leukemic cells.
granulocytosis – Abnormal increase in granulocytes in the blood. An increase in granulocytes in the blood may occur in response to infection or inflammation of any type. Eosinophilia is an increase in eosinophilic granulocytes, which is seen in certain allergic conditions, such as asthma, or in parasitic infections (tapeworm, pinworm). Basophilia is an increase in basophilic granulocytes seen in certain types of leukemia.
mononucleosis – An infectious disease evidenced by increased numbers of lymphocytes and enlarged cervical lymph nodes. This disease is caused by the Epstein-Barr virus (EBV). Lymphadenitis is present, with fever, fatigue, asthenia (weakness), and pharyngitis. Atypical lymphocytes are present in the blood, liver (hepatomegaly), and spleen (splenomegaly).
Mononucleosis is usually transmitted by direct oral contact (salivary exchange during kissing) and affects primarily young adults. No treatment is necessary for EBV infections. Antibiotics are not effective for self-limited viral illnesses. Rest during the period of acute symptoms and slow return to normal activities is advised.
Diseases of Bone Marrow Cells
multiple myeloma – Malignant tumor of bone marrow. This is a progressive tumor of antibody-producing cell (called plasma cells). The malignant cells invade the bone marrow and destroy bony structures. The tumors cause overproduction of immunoglobulins and Bence Jones protein, an immunoglobulin fragment found in urine. Often, the condition leads to osteolytic lesions, hypercalcemia, anemia, renal damage, and increased susceptibility to infection. Treatment is with analgesics, radiotherapy, palliative (relieving, not curing) doses of chemotherapy, and special orthopedic supports.
Laboratory Tests, Clinical Procedures, and Abbreviations
Laboratory Tests
Antiglobulin test (Coombs test) – Demonstrates whether the patient’s erythrocytes are coated with antibody and is useful in determining the presence of antibodies in infants of Rh- women or in patients with autoimmune hemolytic anemia.
bleeding time – The time it takes for a small puncture wound to stop bleeding. Normal time is 8 minutes or less. Bleeding time is prolonged with use of aspirin and in platelet disorders such as thrombocytopenia. There are several testing methods, but the most widely used is the Simplate (an incision is made while constant pressure is applied using a sphygmomanometer).
complete blood count (CBC) – This usually includes the following studies: red blood cell count, white blood cell count (with differential), platelet count, hemoglobin test, hematocrit, and red cell indices—MCH, MCV, MCHC. These routine tests are performed by automatic machines.
coagulation (clotting) time – Time required for venous blood to clot in a test tube. Normal time is less than 15 minutes.
erythrocyte sedimentation rate (sed rate or ESR) – Speed at which erythrocytes settle out of plasma. Venous blood is collected, anticoagulant is added, and the blood is placed in a tube in a vertical position. The distance that the erythrocytes fall in a given period of time is the sedimentation rate. The rate is altered in disease conditions, such as infections, joint inflammation, and tumor, that increase the immunoglobulin content of the blood.
hematocrit (Hct) – Percentage of erythrocytes in a volume of blood. A sample of blood is spun in a centrifuge so that the erythrocytes fall to the bottom of the sample.
hemoglobin test (Hb, Hgb) – Total amount of hemoglobin in a sample of peripheral blood.
partial thromboplastin time – Measures the presence of factors that act at early points in the coagulation pathway. This test is used to follow patients taking certain blood thinners (anticoagulants).
platelet count – Number of platelets per cu mm. Platelets normally average between 200,000 and 400,000 per cu mm.
prothrombin time – This is a test of the ability of blood to clot. It measures the time elapsed between the addition of calcium to a plasma sample and the appearance of a visible clot. The test is also used to follow patient’s taking certain blood thinners (anticoagulants).
red blood cell count (RBC) – Number of erythrocytes per cu mm of blood. The normal number is 4 – 6 million per cu mm.
red blood cell morphology – A stained blood smear is examined to determine the shape or form of individual red cells. The presence of anisocytosis, poikilocytosis, sickle cells, and hypochromia can be noted.
white blood cell count (WBC) – This is the number of leukocytes per cu mm. Automatic counting devices can record the numbers within seconds. Leukocytes normally average between 5000 and 10,000 per cu mm.
white blood cell differential – This test determines the numbers of different types of leukocytes (immature and mature forms). The cells are stained and counted under a microscope by a technician. A minimum of 100 cells is counted, and the percentages of neutrophils, lymphocytes, monocytes, basophils, and eosinophils are given.
The term “left shift” is used to describe a condition in which there is an increase in immature neutrophils and a decrease in mature forms in the blood.
Clinical Procedures
apheresis – Separation of blood into its parts. It is performed to remove toxic substances or autoantibodies from the blood or to harvest blood cells. Leukapheresis, plateletpheresis, and plasmapheresis are examples.
blood transfusion – In this procedure, whole blood or cells are taken from a donor, and after appropriate testing to ensure a close match of red cell or platelet type, the whole blood or cells are infused into a patient. Also prior to transfusion, tests are performed to ensure that the specimen is free of hepatitis and the acquired immunodeficiency syndrome (AIDS) virus. Autologous transfusion is the collection and later reinfusion of a patient’s own (auto-means self) blood or blood components.
bone marrow biopsy – A needle is introduced into the bone marrow cavity, and a small amount of marrow is aspirated and examined under a microscope. This procedure is helpful in the diagnosis of blood disorders such as anemia, cytopenias, and leukemia.
bone marrow transplant – Bone marrow cells from a donor whose tissue and blood cells closely match those of the recipient are infused into a patient with leukemia or aplastic anemia. First the patient is given total-body irradiation or aggressive chemotherapy to kill all diseased cells and much of the normal bone marrow. The donor’s marrow is then intravenously infused into the patient, and it repopulates the patient’s marrow space with normal cells. Problems encountered subsequently may be serious infection, graft versus host disease (immune reaction of the donor’s cells to the recipient’s), and relapse of the original disease (such as leukemia) despite the treatment.
- posted by gopi @ 8:41 AM
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Chemicals used in industries gives me Leukemia and it's all started when I wanted to get off my job to get another job that when I got diagnose, at that very point I was so scared to die because it has infected my blood cells also I was prescribed drugs like Cyclophosphamide,Busulfan,Bosutinib,Cytarabine, Cytosar-U (Cytarabine),Dasatinib in all that was just to keep me waiting for my dying day. I got inspired by what I read from a lady on blog spot on how Dr God hands cure her HIV/Aids with herbal medicine then they were lettered below that says he can cure Cancer so I pick his contact on the testimony she wrote then I emailed Dr God hands hopefully he replied swiftly to my mail then I purchased his Herbal medicine also it was shipped to me here in Texas, I went to pick it at post office so he instructs me on how the treatment will take me three weeks to cure my Leukemia Disease, Joyfully I was cured by this Dr God hands Herbal Medicine.
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I will advise you too to give a try to Dr God hands Herbal Medicine with the following diseases that he can help you cure permanently such diabetes, Herpes, HIV/Aids, Bladder Cancer, Breast Cancer,Parkinson's disease,Lung Cancer, Breast Cancer, Colo-Rectal Cancer, Blood Cancer, Prostate Cancer,Arthritis,Fibromyalgia,Adrenocortical carcinoma. Asthma, Cold, Glaucoma, Cardiovascular disease, Lung disease, Enlarged prostate, Alzheimer's disease, Dementia, Vaginal Cancer, Kidney Cancer, Lung Cancer, Skin Cancer, Uterine Cancer, Prostate Cancer, Colo_Rectal Cancer, Leukemia Cancer, Hepatitis, Brain Tumors, Love Spell, Infertility, Hpv. GoodLuck, XoXo****Dr Owo Ibuku Also known as Doctor God hands Contact Information:::Email (doctorgodhands@gmail.com) WhatsApp-(+2349057214220)
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