Block C - red blood cell anemia

Question 1

what is blood a mixture of ?

Answer 1

Blood is a mixture made up of cellular components suspended in a fluid called plasma.

Question 2

what does plasma contain ?

Answer 2

Plasma contains dissolved organic and inorganic substances, organic plasma components include proteins such as albumins (carrier proteins), globulins (immunoglobulins), and fibrinogen (blood clotting). Inorganic components include ions such as sodium, potassium and chloride.

Question 3

difference between blood and serum?

Answer 3

The difference between blood and serum, is that Serum is plasma with fibrinogen present and other proteins involved in clotting removed such as complements.

Question 4

3 categories of blood cells ?

Answer 4

Blood Cells have 3 main categories, Erythrocytes ( RBC), Leucocytes (WBC) and Platelets.

Question 5

what percent of normal blood does plasma take up and what percent of plasma is water

Answer 5

plasma makes up 55% of normal blood by volume and

water is 90% of the plasma by volume

Question 6

albumin is in plasma , why ?

Answer 6

albumin is important for pH buffer & osmotic pressure - protein within blood to maintain oncotic fluid balance – attract water.

Question 7

globulins , why ?

Answer 7

Globulins are binding proteins & antibodies.

Question 8

clotting proteins ?

Answer 8

Clotting proteins - prothrombin & fibrinogen as well as other proteins

Question 9

blood electorlytes ?

Answer 9

electrolytes - Na+, K+, Ca++, Mg++, Cl-, phosphate, sulfate, bicarbonate, others.

Question 10

how are red blood cells produced ?

Answer 10

Cells come from a pluripotent cell line in the bone marrow, the progenitor cells contain the capacity to be stimulated and produce different lineages of cells for example the erythrocytes. The progenitor cell is stimulated with the hormone erythropoietin produced by the kidneys which stimulates an increase in the RBC production.

Question 11

what occurs during an infection /

Answer 11

During an infection, there are several factors released from inflammatory and immune cells to stimulate the progenitor cell to produce a specific lineage of white blood cells.

Question 12

structure of RBC ?

Answer 12

The structure of the blood cells is highly correlated to their function, the erythrocytes are biconcave in shape, the white blood cells have a ‘furry’ rough exterior as they contain a lot of protein markers on the exterior of the cell such as antigens which allow it function efficiently and communicate with other cells. The platelets are smaller fragments which are used to prevent bleeding.

Question 13

importance of liver ?

Answer 13

it has many functions and contains hematologic functions: the liver synthesis plasma proteins including clotting factors and albumin as well as clearing damaged and non-functioning RBCs/erythrocytes from circulation.

Question 14

spleen ?

Answer 14

Spleen is in the upper left quadrant of the abdomen and it contains hematopoietic functions by produces fetal RBCs. It contains filter function to reuse certain cells by using the heme component to produce more RBC’s.

It contains Immune function as lymphocytes and monocytes are stored in the spleen around 30% platelets stored in spleen.

Question 15

RBC indices in females ?

Answer 15

On comparison of males and females, the RBC indices tend to be lower in females than males that’s a consequence of androgens such as testosterone which drives RBC production.

Question 16

WBC above 11 ?

Answer 16

If the WBC is above 11 this is a signal that infections are going on in the body,

Question 17

eosinophils and basophils associated with ?

Answer 17

eosinophils and basophils are associated with acute response such as allergic responses.

Question 18

neutrophils , lymphocytes and monocytes ?

Answer 18

While neutrophils, lymphocytes and monocytes are associated with longer infections which have been going on for a several days.

Question 19

Pack cell volume (PCV) ?

Answer 19

the pack cell volume (PCV) is the haematocrit and is a measurement of the proportion of blood that is made up of cells.

Question 20

when blood is centrifuged , where is plasma found ?

Answer 20

If a sample of blood is spun in a centrifuge, the heavy components would lie at the bottom and plasma lies on top. The PCV would be around half of the total volume (48%).

Question 21

MCH ?

Answer 21

MCH stands for mean corpuscular haemoglobin. MCH levels refer to the average amount of haemoglobin found in the red blood cells in the body. Haemoglobin is a protein in the blood that allows red blood cells to deliver oxygen to the cells and tissues in the body

Question 22

MCHC ?

Answer 22

MCHC is the mean corpuscular haemoglobin concentration, and this is measured in g/L. Both MCHC and MCH are important in diagnosing the disorder anaemia.

Question 23

RDW ?

Answer 23

RDW is red blood cell width

Question 24

what occurs to heamoglobin , clotting studies and platletes when we age

Answer 24

WBC as we age this causes a decrease in the levels of hemoglobin (Hb or Hgb) , furthermore there is a decrease in the response to infection (WBC). However, there is no change in platelets with age. Clotting Studies show a decrease with age in the ability to form a clot within the pathway but the platelet numbers do not change.

Question 25

eryhtropoisesi ?

Answer 25

RBCs are synthesized in red bone marrow by the process called Erythropoiesis. They are filtered by the spleen and the liver. Erythropoietin (hormone from the kidneys) triggers differentiation of pluripotent stem cells to erythrocytes.

Question 26

Iron ?

Answer 26

RBC are produced from the bone marrow by the Erythropoietin protein, along with iron and the iron transferrin protein, to transfer iron to the tissue and allow the RBC to be manufactured.

Iron comes from our diet and it is absorbed in the small intestine where it enters our blood. Iron is stored as ferratin in our liver .

Question 27

old RBC ?

Answer 27

Old RBC are broken down and the bi products are bilirubin which is metabolised within the liver to produce bile fluids which are secreted via the gallbladder to neutralise acidic environments and aid fat absorption.

Bilirubin metabolites are excreted in urine

Question 28

anemia ?

Answer 28

Anaemia is a reduction in the number of circulating red blood cells, many people will have anaemia but be unaware due to the compensatory mechanisms in the body such as an increased cardiac output.

Question 29

symptoms of anemia ?

Answer 29

Most common symptoms are fatigue, respiratory issues such as shortness of breath especially during exertion. Severe symptoms are fainting, chest pain and angina as well as yellowing of the eyes and skin due to bilirubin being present from haemolysis. It is not the anaemia that causes these but the compensatory mechanisms that occur.

Question 30

why does hypoxia occur in anemia ?

Answer 30

Anemia is a reduction in the number of RBCs, the quantity of hemoglobin, or the volume of RBCs. Because the main function of RBCs is oxygenation, anemia results in varying degrees of hypoxia which drives ischemic pathologies such as coronary heart disease ( CHD).

Question 31

morphologic anemia ?

Answer 31

Normocytic: MCV= 80-100fL ( normal range)

Macrocytic: MCV > 100 fL ( larger)

Microcytic : MCV < 80 fL ( smaller)

Question 32

pathogenic anemai ?

Answer 32

Pathogenic (underlying mechanism)

Blood loss (bleeding) - piles and hemaroides

Decreased RBC production - imbalnce with destruction and production

Increased RBC destruction/ pooling

Question 33

megaloblastic anemia ?

Answer 33

Megaloblastic

RBC will have a red colour when viewed under a microscope after a blood smear however with anaemia due to the lack of haemoglobin they will be less red.

Question 34

iron deficiency anemia ?

Answer 34

Iron deficiency anaemia, there will be a reduction in the total iron, the mean cell volume will be reduced, along low MCH. This is a classic microcytic anaemia and hypochromic anaemia.

Question 35

normocytic anemia ?

Answer 35

If there is acute blood loss and haemolysis, the MCV and MCH will probably be unaffected, and will normally be normocytic, normochromic anaemia. The cells aren’t affected its normally to do with blood loss happening quite quickly.

Question 36

B12 and folic acid ?

Answer 36

B12 and folic acid are essential for maturation for a cell, therefore if there is a deficiency in these there will be an increase in the MCV and because of this size increase there may be an increase in MCH. This is common in macrocytic, hyperchromic megablastic anaemia. The total number of RNC will be reduced but the haemoglobin per cell is increased.

Question 37

chronic disease ?

Answer 37

Chronic disease will affect the normal function and leads to a reduction on the MCV and MCH due to the production in the bone marrow. There will be no change in B12 or storage of ferritin.

Question 38

managment ?

Answer 38

Direct general management toward addressing the cause of anaemia and replacing blood loss as needed to sustain adequate oxygenation.

2. Promote optimal activity and protect from injury.
3. Reduce activities and stimuli that cause tachycardia and increase cardiac output.
4. Provide nutritional needs. - iron , B12 and folic acid.
5. Prescribed nutritional supplements.
6. Patient and family education

Question 39

etiology /

Answer 39

Etiology - the cause, set of causes, or manner of causation of a disease or condition

Question 40

inadequate dietry intake ?

Answer 40

Inadequate dietary intake found in 30% of the world’s population , predominately found in females because of the menstrual cycle.

Question 41

malabsoprtion ?

Answer 41

Malabsorption iron is absorbed in duodenum and problems here could be due to GI surgery, could affect the absorption.

Question 42

hemolysis ?

Answer 42

hemolysis is the destruction of red blood cells prior to the end of their normal 120-day lifespan and leads to anaemia.

Question 43

Clinical manifesttions of iron deficiency anemaia ?

Answer 43

Clinical Manifestations

Most common: pallor

Second most common: inflammation of the tongue (glossistis)

Cheilitis=inflammation/fissures of lips

Sensitivity to cold

Weakness and fatigue

Question 44

diagnostic studies ?

Answer 44

Diagnostic Studies

WBC studies

Iron studies Diagnostics:

Iron levels: Total iron-binding capacity would rise (TIBC), while serum Ferritin would be low.

Endoscopy/Colonoscopy

Question 45

collaborative care ?

Answer 45

Collaborative Care

Treatment of underlying disease/problem

Diet

Drug Therapy

Iron replacement

Oral iron

Ferrous sulphate, etc

Absorbed best in acidic environment

GI effects

Parenteral iron not common

Intra muscular (IM) or IV

Less desirable than PO as can have an allergic reaction.

Question 46

megaloblastic anemia ?

Answer 46

Characterized by large RBCs which are fragile and easily destroyed, the MCV is the giveaway which is greater than 100 fL.

Common forms of megaloblastic anaemia

Cobalamin deficiency (b12)

Folic acid deficiency

Due to the deficiency in folic acid and B12 this means there is a loss in control for the development of RBC.

Question 47

coblalamin (vit b12) deficiency ?

Answer 47

Cobalamin Deficiency-also known as pernicious anaemia is difficult to diagnose. Vitamin B12 (cobalamin) is an important water-soluble vitamin and requires Intrinsic factor (IF) for cobalamin (B12) absorption. Causes of cobalamin deficiency include gastric mucosa not secreting IF. GI surgery ®loss of IF-secreting gastric mucosal cells. Long-term use of H2-histamine receptor blockers cause atrophy or loss of gastric mucosa. Nutritional deficiency and hereditary defects of cobalamin utilization.

Question 48

clinical manifestations ?

Answer 48

Clinical manifestations include general symptoms of anaemia , sore tongue, Anorexia, weakness, Paresthesia of the feet and hands (altered sensation), Altered thought processes such as confusion ® pseudo dementia (extreme cases).

Question 49

family disposition ?

Answer 49

Familial disposition, early detection and treatment can lead to reversal of symptoms, potential for Injury r/t patient’s diminished sensations to heat and pain. Compliance with medication regime and an ongoing evaluation of GI and neuro status. Evaluate patient for gastric carcinoma frequently.

Question 50

folic acid deficiency ?

Answer 50

Folic Acid Deficiency also causes megablastic anaemia (RBCs that are large and fewer in number). Folic Acid is required for RBC formation and maturation. Causes can include poor dietary intake, malabsorption syndromes, drugs that inhibit absorption and alcohol abuse. Hemodialysis is used to clean blood of waste products but can remove some essential products such as minerals and vitamins and can be a factor for folic acid deficiency.

Question 51

clinical manifestations ?

Answer 51

Clinical manifestations are similar to those of cobalamin deficiency it has an insidious onset: progress slowly, there is an absence of neurologic problems, treated by folate replacement therapy. Encourage patient to eat foods with large amounts of folic acid such as leafy green vegetables, liver, mushrooms, oatmeal, peanut butter and read beans.

Question 52

anemia of chronic disease ?

Answer 52

This anaemia is associated with underproduction of RBCs, shortening of RBC survival . It is the 2nd most common cause of anaemia (after iron deficiency anaemia) Generally develops after 1-2 months of sustained disease, it is more common in men over 65 when compared to females. Causes include impaired renal function, chronic, inflammatory, infectious or malignant disease, chronic liver disease, folic acid deficiencies, splenomegaly and hepatitis.

Question 53

anemia caused by acute blood loss ?

Answer 53

This results of sudden hemorrhage by trauma, surgery, vascular disruption. Collaborative Care includes replacing blood volume, identifying source of hemorrhage and stopping blood loss.

Question 54

chronic blood loss ?

Answer 54

Sources/Symptoms similar to iron deficiency anaemia , symptoms include GI bleeding, hemorrhoids, menstrual blood loss. Diagnostic Studies include identifying source, stopping bleeding could be menstrual. Collaborative care includes supplemental iron administration