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Pathophysiology > Ch. 13 > Flashcards

Ch. 13 Flashcards

1
Q

What is in our blood?

A

Fluid (plasma)

Particulate

    • proteins (like albumin)
    • antibodies
    • cytokines

cellular components:

    • platelets
    • white blood cells (lekocytes and lymphocytes)
    • red blood cells (erythrocytes)
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2
Q

Which stem cell line does RBCs and platelets come from?

A

myeloid stem cell line

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3
Q

What is erythropoiesis?

A

red blood cell production

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4
Q

describe red blood cells.

A

most abundant cell in our body

biconcavity and reversible deformity makes them flexible

120 day life cycle

takes oxygen to tissue

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5
Q

What is the purpose of a RBC?

A

carry oxygen!

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6
Q

What does a RBC need to carry oxygen?

A

hemoglobin

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7
Q

What does hemoglobin need to be made?

A

IRON

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8
Q

What does an adult hemoglobin contain?

A

Two alpha chain proteins

two beta chain proteins

EACH PROTEIN CONTAINS ONE IRON CONTAINING HEME GROUP THAT THE OXYGEN BINDS TO

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9
Q

What does a fetal hemoglobin contain?

A

two alpha chain proteins

two gamma chain proteins

also has the iron containing heme groups that oxygen binds to

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10
Q

What are some nutritional requirements to synthesize RBCs?

A

Proteins: amino acids

Vitamins: B (12,6,2), E, and C; folic acid; pantothenic acid; niacin BIG ONES ARE B12 AND FOLIC ACID

minerals: iron and copper

folate

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11
Q

What are some facts she gave about iron?

A

Absorbed in the gut (smaller quantity) or recycled from old RBCs (where most comes from)

Less than 1mg is loss per day through urine, sweat, epithelial cells or from the gut

Transferrin: the iron transporting protein in the circulation

iron is stored in the liver as ferritin

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12
Q

What are vitamins B12 and Folic acid meant for?

A

DNA synthesis and maturation of RBC.

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13
Q

How much of our iron is in our hemoglobin?

A

65% (rest is mostly stored in the liver)

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14
Q

What is the iron cycle?

A
  1. Iron that is taking in by the diet is stored in the liver

or red blood cells are taken in by the spleen to be recycled.

  1. The hemoglobin from the red blood cell is broken down into the heme and the globin, the heme is broken down into bilirubin and iron

the iron is either stored in the liver or spleen, or taken directly to the bone marrow for hemoglobin synthesis

the bilirubin is taken to the liver and secreted with the bile

Iron in the liver or spleen can be released to the bone marrow at any time as well

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15
Q

What stimulates erythropoiesis and maturation of RBCs?

A

erythropoietin.

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16
Q

What secretes erythropoietin?

A

kidneys in response to low oxygen levels.

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17
Q

What is the main thing to take from the maturation of RBCs?

A

In each step of erythropoiesis the nucleus gets smaller and the number of hemoglobins gets larger.

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18
Q

What is the difference between a reticulocyte and a erythrocyte?

A

A reticulocyte has less hemoglobin than a erythrocyte.

reticulocytes also still have their endoplasmic reticulum

19
Q

Why are the kidneys dumb when it comes to erythropoietin secretion?

A

The kidneys will secrete more erythropoietin in response to low oxygen levels, NO MATTER WHAT THE CAUSE MAY BE.

So lets say that someone has chronically low oxygen levels because of a lung disease, the kidneys only know that there has been a decrease in oxygen levels, so it releases that erythropoietin in attempt to increase the amount of RBCs to carry more oxygen, even if we have plenty. Elevated RBC count is called POLYCYTHEMIA. (gives patient reddy red color)

20
Q

What is the feedback loop for the kidneys and erythropoiesis?

A
    • -decreased population of mature RBC
      • decreased hemoglobin synthesis
      • decreased blood flow
      • hemorrhage
      • increased oxygen consumption by tissues
  2. decreased arterial PO2
  3. increased secretion of erythropoietin by kidney cells
  4. increased proliferation of erythroblasts in bone marrow
  5. increased population of mature erythrocytes in circulation
  6. increased arterial PO2
  7. decreased secretion of erythropoietin
21
Q

What happens after the RBCs 120 day life span, how do they get damages and die?

A

After the 120 days in circulation, RBCs membranes become weakened.

Because they don’t have any nucleus, they can’t make new membrane components

Because their membrane stays weakened, they will eventually break as they squeeze through capillaries, mainly the capillaries in the spleen because they are designed to make that happen

WBCs eat the RBCs in the spleen, liver, bone marrow, or lymph nodes

The RBCs are processed and unconjugated bilirubin, iron, and amino acids are recycled

22
Q

What do we have to do with unconjugated bilirubin?

A

It needs to be conjugated and secreted in bile by the liver.

23
Q

What is hemoglobin A-1C?

A

Gives the average blood sugar over the last 120 days of the lifespan of red cells tested. Gives a good test to see how well diabetics have been regulating their sugars over the last few months.

24
Q

What would happen if someone had to process a lot of red blood cells?

A

They could get an enlarged liver or spleen because of the extra work they have to do.

25
Q

How does the unconjugated bilirubin get conjugated?

A

The liver links it to gluconuride, gets excreted in bile.

26
Q

What causes jaundice?

A

If the liver can’t conjugate or it can’t keep up with the amount of unconjugated bilirubin, it ends up out in our blood stream and in tissues.

27
Q

Is it normal for a 2 week old to have jaundice?

A

Yes, if it is being breastfed. Something in the breast milk causes it (especially when the infant is low on fluids). BUT IF IT IS IN THE FIRST 24 HOURS OF BIRTH THERE SHOULD BE SOME CONCERN FOR POSSIBLE HEMOLYTIC ANEMIA.

28
Q

How is jaundice treated in those infants?

A

Phototherapy, take them outside for a little bit.

29
Q

What happens when RBCs are destroyed outside of the spleen?

A

It can turn the plasma red (hemoglobinemia)

If it goes into the urine then it turns the urine coca-cola color (hemoglobinuria). This happens when it is filtered through the kidneys

30
Q

Why is it not ideal to have red blood cells destroyed outside of the spleen?

A

It doesn’t allow for the cells to be recycled. Can possibly lead to an iron deficiency.

31
Q

What are the the normal number of red cells for a man and a woman?

A

men - 4.2-5.4 (x 10^6 x L)

women - 3.6-5.0 (x 10^6 x L)

32
Q

What should our normal number of reticulocytes be? (shows the rate of red cell production)

A

1.0% - 1.5% of total RBC

33
Q

What is our normal hemoglobin count? (men and women)

A

men - 14-16.5 g/dl

women - 12-15 g/dl

34
Q

What is our normal hematocrit (volume of cells in 100ml of blood)? (man and woman)

A

men - 40%-50%

women - 37%-47%

35
Q

What is the mean corpuscular volume and its normal value?

A

Size of the red cell

85-100 fl/cell

36
Q

What is the mean corpuscular hemoglobin concentration and its normal value?

A

The concentration of hemoglobin in the red cell.

31-35 g/dl

37
Q

What is the mean cell hemoglobin and its normal value?

A

Red cell mass

27-34 pg/cell

38
Q

What happens to an infants blood cell count at birth and why?

A

It’s increased!

The intrauterine environment is hypoxic so it stimulates erythropoietin production, which results in polycythemia.

39
Q

What lowers the blood cell count at birth?

A

The trauma of birth and the cutting of the umbilical cord.

40
Q

Based on what you know about an infants hematologic system at birth, what color would they be and why?

A

They would be very red in color because of their polycythemia.

41
Q

Describe a childs lymphocytes.

A

They tend to have more atypical lymphocytes because of frequent viral infections after birth.

Usually see more atypical lymphocytes in the 18 month-5 year range. ESPECIALLY IF IN DAYCARE.

42
Q

What happens to our erythrocytes and erythropoiesis when we age?

Why?

A

The life-span of erythrocytes is normal but we replace them slower.

Possible causes:
Iron depletion

Decreased total serum iron

iron-binding capacity decreases

intestinal iron absorption decreases

decreased lymphocyte function leads to decreased iron recycling

43
Q

What happens to our lymphocyte function as we age?

A

It decreases.

44
Q

What happens to our humoral immune system as we age?

A

It becomes less responsive.

Pathophysiology (13 decks)

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