Block C - red blood cell anemia Flashcards
what is blood a mixture of ?
Blood is a mixture made up of cellular components suspended in a fluid called plasma.
what does plasma contain ?
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.
difference between blood and serum?
The difference between blood and serum, is that Serum is plasma with fibrinogen present and other proteins involved in clotting removed such as complements.
3 categories of blood cells ?
Blood Cells have 3 main categories, Erythrocytes ( RBC), Leucocytes (WBC) and Platelets.
what percent of normal blood does plasma take up and what percent of plasma is water
plasma makes up 55% of normal blood by volume and
water is 90% of the plasma by volume
albumin is in plasma , why ?
albumin is important for pH buffer & osmotic pressure - protein within blood to maintain oncotic fluid balance – attract water.
globulins , why ?
Globulins are binding proteins & antibodies.
clotting proteins ?
Clotting proteins - prothrombin & fibrinogen as well as other proteins
blood electorlytes ?
electrolytes - Na+, K+, Ca++, Mg++, Cl-, phosphate, sulfate, bicarbonate, others.
how are red blood cells produced ?
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.
what occurs during an infection /
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.
structure of RBC ?
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.
importance of liver ?
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.
spleen ?
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.
RBC indices in females ?
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.
WBC above 11 ?
If the WBC is above 11 this is a signal that infections are going on in the body,
eosinophils and basophils associated with ?
eosinophils and basophils are associated with acute response such as allergic responses.
neutrophils , lymphocytes and monocytes ?
While neutrophils, lymphocytes and monocytes are associated with longer infections which have been going on for a several days.
Pack cell volume (PCV) ?
the pack cell volume (PCV) is the haematocrit and is a measurement of the proportion of blood that is made up of cells.
when blood is centrifuged , where is plasma found ?
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%).
MCH ?
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
MCHC ?
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.
RDW ?
RDW is red blood cell width
what occurs to heamoglobin , clotting studies and platletes when we age
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.
eryhtropoisesi ?
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.
Iron ?
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 .
old RBC ?
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
anemia ?
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.
symptoms of anemia ?
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.
why does hypoxia occur in anemia ?
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).
morphologic anemia ?
Normocytic: MCV= 80-100fL ( normal range)
Macrocytic: MCV > 100 fL ( larger)
Microcytic : MCV < 80 fL ( smaller)
pathogenic anemai ?
Pathogenic (underlying mechanism)
Blood loss (bleeding) - piles and hemaroides
Decreased RBC production - imbalnce with destruction and production
Increased RBC destruction/ pooling
megaloblastic anemia ?
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.
iron deficiency anemia ?
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.
normocytic anemia ?
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.
B12 and folic acid ?
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.
chronic disease ?
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.
managment ?
Direct general management toward addressing the cause of anaemia and replacing blood loss as needed to sustain adequate oxygenation.
- Promote optimal activity and protect from injury.
- Reduce activities and stimuli that cause tachycardia and increase cardiac output.
- Provide nutritional needs. - iron , B12 and folic acid.
- Prescribed nutritional supplements.
- Patient and family education
etiology /
Etiology - the cause, set of causes, or manner of causation of a disease or condition
inadequate dietry intake ?
Inadequate dietary intake found in 30% of the world’s population , predominately found in females because of the menstrual cycle.
malabsoprtion ?
Malabsorption iron is absorbed in duodenum and problems here could be due to GI surgery, could affect the absorption.
hemolysis ?
hemolysis is the destruction of red blood cells prior to the end of their normal 120-day lifespan and leads to anaemia.
Clinical manifesttions of iron deficiency anemaia ?
Clinical Manifestations
Most common: pallor
Second most common: inflammation of the tongue (glossistis)
Cheilitis=inflammation/fissures of lips
Sensitivity to cold
Weakness and fatigue
diagnostic studies ?
Diagnostic Studies
WBC studies
Iron studies Diagnostics:
Iron levels: Total iron-binding capacity would rise (TIBC), while serum Ferritin would be low.
Endoscopy/Colonoscopy
collaborative care ?
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.
megaloblastic anemia ?
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.
coblalamin (vit b12) deficiency ?
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.
clinical manifestations ?
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).
family disposition ?
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.
folic acid deficiency ?
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.
clinical manifestations ?
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.
anemia of chronic disease ?
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.
anemia caused by acute blood loss ?
This results of sudden hemorrhage by trauma, surgery, vascular disruption. Collaborative Care includes replacing blood volume, identifying source of hemorrhage and stopping blood loss.
chronic blood loss ?
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
