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316 Pharmacology > Exam 2: Hematologic System: overviews and red blood cells > Flashcards

Exam 2: Hematologic System: overviews and red blood cells Flashcards

1
Q

Functions of hematological system

A

Transportation
Regulation
Protection

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2
Q

Characteristics of Hematological system

A 
Liquid connective tissue 
Viscous 
PH 
8% of total body weight 
Volume
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3
Q

Transportation function

A

O2 from lungs to the cells/CO2 from cells to lungs
Nutrients from GI tract to cells/waste from cells for removal
Essential elements & Molecules to cells

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4
Q

Regulation functions

A

PH
Temperature
Fluid content of cells

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5
Q

Protection function

A

From hemorrhage

From microbes and toxins

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6
Q

pH range

A

7.35 - 7.45

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7
Q

Blood volume for women

A

4-5 liters

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8
Q

Blood volume for men

A

5-6 liters

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9
Q

Composition of whole blood

A

Plasma

Formed elements

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10
Q

% of plasma in blood

A

55%

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11
Q

% of Formed elements

A

45%

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12
Q

is blood a type of connective tissue?

A

yes! it is a liquid connective tissue

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13
Q

Plasma is made up of

A

Water
proteins
solutes

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14
Q

% of water in plasma

A

91%

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15
Q

% of proteins in plasma

A

8%

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16
Q

% of other solutes in plasma

A

1%

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17
Q

most precise assessment for patients oxygen statue

A

arterial blood gases (ABGS)

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18
Q

Proteins in plasma consist of

A

Albumin
Globulins
Fibrinogen
Complement

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19
Q

other solutes in plasma include

A 
Regulatory substances (enzymes and hormones) 
Nutrients 
Respiratory gasses
Electrolytes 
waste products
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20
Q

Formed elements include

A

Red blood cells
White blood cells
Platelets

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21
Q

erythrocytes =

A

red blood cells

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22
Q

RBC shape

A

Thin, non-nucleated, biconcave discs

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23
Q

Biconcave discs cause

A
  • Increase in surface area for O2 diffusion

- Thin membrane cause increase in diffusion of respiratory gasses

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24
Q

Reverse deformability

A

Flexible membrane causes reverse deformability, which allows them to squeeze through capillaries without rupturing

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25
Q

Do RBCs reproduce or carry out extensive metabolic activities?

A

No because there is no mitochondria and no nucleus

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26
Q

Lifespan of RBC

A

120 days

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27
Q

Average amount of RBCs for men

A

5.4 million/mm^3

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28
Q

Average amount go RBCs for women

A

4.8 million/mm^3

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29
Q

Erythropoiesis

A

Productions of red blood cells

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30
Q

Erythropoiesis steps

A

Hemocytoblast —-> Reticulocyte —-> erythrocyte

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31
Q

What determines the development of hemocytoblast

A

Based on hormone that acts on hemocytoblast determines what it becomes

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32
Q

Reticulocyte

A

Immature red blood cell that HAS RNA!

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33
Q

Erythrocyte is a

A

Matured RBC that has no RNA and no Nucleus

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34
Q

red blood cells require adequate supply of what nutrients

A

Proteins
Iron
Vitamins: C, E, niacin, riboflavin, Folic acid, B6, B12
Trace minerals

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35
Q

Hypoxemia

A

O2 concentration in BLOOD

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36
Q

Hypoxia

A

O2 at the tissue level

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37
Q

Erythropoiesis needs a functioning

A

Kidney

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38
Q

Erythropoiesis is triggered by

A

Reduced oxygen carrying capacity

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39
Q

The kidney produces _____ to stimulate erythropoiesis

A

Erythropoietin

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40
Q

Where are erythrocytes formed?

A

Red bone marrow of bones

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41
Q

Increased O2 carrying capacity is a negative feedback that

A

Turns off the secretion of erythropoietin

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42
Q

Go over the life cycle of RBC!!!

A
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43
Q

what vitamins are needed to be present for proper synthesis of RBC

A

B12 and folic acid (B9)

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44
Q

Heme components of a blood are

A

Recycled

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45
Q

What causes the pigment in RBCs

A

Hemoglobine

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46
Q

Each RBC has how many hemoglobin molecules

A

280

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47
Q

Each molecule consists of

A

4 heme complexes (iron containing pigment)

2 pairs of globin molecules (alpha & beta)

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48
Q

Blood carries dissolved respiratory gasses and in combination with

A

hemoglobin

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49
Q

Gasses will diffuse from an area of

A

higher concentration to lower concentration

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50
Q

1 molecule of hemoglobin can carry

A

4 molecules of O2

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51
Q

saturation is when

A

all 4 heme molecules are bound to O2

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52
Q

What can result in abnormal hemoglobin molecules

A

Genetic alternations

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53
Q

red blood count average for men

A

4.7 - 6.1 (10^6)/ uL

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54
Q

red blood count average for women

A

4.2-5.4 (10^6) / uL

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55
Q

Hemoglobin (Hgb) measures

A

Hemoglobin content of blood

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56
Q

Normal values of Hgb for men

A

14-18 g/dl

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57
Q

normal values of Hgb for women

A

12-16 g/dl

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58
Q

Hematocrit (Hit) is the

A

% of red cell mass (formed elements) in 100 ml

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59
Q

normal values of Hct for men

A

42-52%

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60
Q

normal Hct values for women

A

37-47%

61
Q

Where are RBC stored

A

the spleen

62
Q

Accumulation and removal of aged or damaged cells found to take place in the

A

liver

63
Q

Mean corpuscular volume (MCV) measures the

A

relative SIZE of RBCs

64
Q

microcytic

A

small RBC

65
Q

Macrocytic

A

large RBC

66
Q

Mean corpuscular hemoglobin concentration (MCHC) measures the

A

concentration of Hgb in RBCs regardless of size

67
Q

Normochromic

A

normal color/concentration

68
Q

Hypochromic

A

Low concentration/ pale color

69
Q

Polycythemia

A

Excess RBCs

70
Q

Excess RBCS causes

A

Increase in blood viscosity which causes clinical manifestations like hypertension or blood clotting

71
Q

Types of Polycythemia

A

Polycythemia vera
Secondary polycythemia
Relative polycythemia

72
Q

Polycythemia vera is caused by

A

overproduction, it is associated with neoplastic transformation of bone marrow and stem cells

73
Q

Secondary polycythemia is due to

A

chronic hypoxemia, with a resultant increase in erythropoietin

74
Q

Secondary polycythemia can be caused by

A

High altitude, smokers, etc.

  • basically anything that decreases O2 capacity will cause the body to compensate and increase RBC
75
Q

relative polycythemia is due to

A

dehydration, which causes a spurious increase in the RBC count

76
Q

Anemia

A

Deficiency of RBCs

Abnormal low Hgb, number of circulating RBCs OR both!

77
Q

Anemia clinical manifestations depend on

A

Severity of the disease
Rapidity of its development
Patients age and health status

78
Q

Anemia results in

A

decrease in O2 carrying capacity of blood

79
Q

Causes of anemia

A 
Excessive blood loss 
Increase hemolysis (destruction) 
Decrease RBC production (nutritional, bone barrow failure, renal failure) 
Disorders of hemoglobin synthesis 
Dilutional
80
Q

decreased blood viscosity due to anemia can cause

A

selective tissue perfusion which can cause normal tissue oxygenation

81
Q

If O2 level is low, in an attempt to increase O2 delivery, the body will

A

Increase HR/CO
Increase RR
Increase work of breathing
Increase erythropoiesis

82
Q

Decreases Hgb causes

A

Decrease O2 carrying capacity, which causes hypoxemia, which causes hypoxia

83
Q

General clinical presentation of anemia

A

Fatigue, weakness, H/A, dizziness, visual disturbances, irritability, confusion

84
Q

Respiratory clinical presentation of anemia

A

Dyspnea on exertion

85
Q

Cardiac clinical presentation of anemia

A 
Tachycardia 
Angina
Palpitations 
LV hypertrophy 
Orthostatic hypotension
86
Q

Skin and mucous membrane clinical presentation of anemia

A 
pallor 
jaundice of skin 
brittle 
spoon shakes nails 
angular cheilitis
brittle hair 
smooth tongue
87
Q

2 Types of anemia that we are learning

A

Iron deficiency

Megaloblastic

88
Q

Most common type of anemia for all age groups

A

iron deficiency anemia

89
Q

Causes of iron deficiency anemia

A 
Dietary deficiency 
Loss or iron from blood loss 
Increase demand (pregnancy and menstrual flow
90
Q

Nature of RBCs in iron deficiency anemia

A

Microcytic and hypochromic
Poikilocytosis (irregular shape)
Anisocytosis (irregular size)

91
Q

Clinical presentation of iron deficiency anemia

A 
Decrease hemoglobin and hematocrit 
Decrease RBCs
Decrease Mean corpuscular volume (MCV) 
Decrease mean corpuscular hemoglobin concentration (MCHC)
Nature of RBCs 
Symptoms of impaired O2 transport
92
Q

Megaloblastic anemia nature of RBCs

A

Macrocytic and normochromic

93
Q

Types of megaloblastic anemias

A

vitamin B12 deficiency anemia

Folic acid deficiency anemia

94
Q

Nutrients necessary for DNA synthesis

A

Vitamin B12

Folic Acid

95
Q

Nutritional deficiency causes

A

Impaired DNA synthesis which causes megaloblastic trans-formation of RBCs

  • – large immature poorly functional RBCs
  • – Poikilocytosis
  • – Flimsy membranes & shorter life span
96
Q

poikilocytosis =

A

abnormally shaped RBCS

97
Q

Nutritional deficiency causes membranes to be

A

Flimsy and RBC shorter life span

98
Q

Causes of Vitamin B12 Megaloblastic anemia

A
  1. Inadequate INTAKE (vegans); B12 found

2. Lack of Intrinsic factor

99
Q

A lack of intrinsic factor causes

A

Pernicious anemia ( a type of megaloblastic anemia )

100
Q

causes of pernicious anemia

A
  • decrease secretion by gastric parietal cells
  • hereditary atrophic gastritis
  • gastrectomy
  • defects in B12 - intrinsic factor pathway
101
Q

daily absorption of B12 is

A

5 mcg

102
Q

Dietary vitamin B12 must be bound to

A

Intrinsic factor in order to reach the circulation and to be utilized by the body

103
Q

Vitamin B12 is needed for

A

Proper function of brain and nervous tissue

104
Q

Unique to vitamin B12-deficient anemia: neurologic signs because of

A

defective myelination of peripheral nerves causes TRIAD of signs and symptoms

105
Q

Triad of signs and symptoms for vitamin B12 deficient anemia includes

A

Weakness, sore tongue, parenthesis of feet and fingers

  • – also “metaloblastic madness”
  • disease develops slowly: adaptation until severe
106
Q

Megaloblastic madness

A

Paranoid ideation
Dementia
Cognitive dysfunction
delusions and hallucinations

107
Q

Vitamin B12 deficient anemia develops

A

Slowly, there is adaptation until severe

108
Q

Folate deficiency megaloblastic anemia can be deficient (especially if accompanied by increase need) in individuals like

A

Elderly
alcoholics
pregnancy
Lactation

109
Q

Daily requirement of folic acid is

A

50-100 mcg, usually met in the diet

110
Q

Antagonistic drugs of folic acid

A

Phenytoin (seizure mediation)
Phenobarbital (seizure medication)
Methotrexate (chemotherapy)
—- these medications can produce folic deficiency by inhibiting the enzyme

111
Q

Neoplastic disease for folate deficiency anemia

A

Tumor cells compete for folate

112
Q

other causes of megaloblastic anemia

A

Inborn errors of metabolism
Long term pharmacological treatment with drugs
— anticonvulsants, methotrexate (folic acid antagonist)
Gastric or ileal resection
Bariatric surgery (shrinking stomach size = decrease intrinsic factor)
Fish tapeworm infestation
Zollinger-Ellison syndrome

113
Q

Other types of anemia

A

Aplastic Anemia
Sickle cell anemia
Thalassemia
Anemia secondary to renal failure
Chronic blood loss
Glucose-6-phosphate dehydrogenase deficiency
Hemolytic disease of newborn (mom blood vs. newborn blood)

114
Q

Pharmacological goals of anemia

A

Increase RBC and Hgb levels, which will improve oxygen carrying capacity, alleviate symptoms, increase quality of life and prevent complications

115
Q

epoetin alpha is a

A

synthetic glycoprotein to help increase RBC and hemoglobin counts

116
Q

Erythropoietic stimulating agents (ESAs) stimulate

A

Production of erythrocytes

117
Q

epoetin alpha is a glycoprotein produced by

A

recombinant DNA technology

118
Q

Epoetin alpha is administered

A

IV or SQ

119
Q

ePoetin alpha is a biological modifier that is commonly referred to as

A

Erythrocyte stimulating factor

120
Q

Biologic modifier

A

modifies normal biology or bodies

121
Q

Erythrocyte stimulating factor is indicated for

A

Anemia due to various causes (renal failure, chemotherapy, etc.)

122
Q

ESAa blackbox warning (epoetin alpha)

A
  • increase risk of CV event, thromboembolic events, stroke, mortality
  • Increase risk of thromboembolism in surgical patients
123
Q

ePoetin alpha should be given to individuals with

A

chronic anemia, not used for something like blood loss due to an accident (which would use blood transfusion)

124
Q

Ferrous sulfate is a

A

Iron supplement

125
Q

Ferrous sulfate indication

A

Iron deficiency anemia

126
Q

MOA ferrous sulfate

A

Replaces iron, found in hemoglobin, myoglobin, and various enzymes; increasing the transport of oxygen via hemoglobin

127
Q

adverse effects of ferrous sulfate

A

GI discomfort, constipation, dark stool

-Advise patient to increase fiber and fluids

128
Q

PO formulation of ferrous sulfate should be taken

A

with or before meals, if tolerated; after meals and with fluids to prevent stomach upset

129
Q

Do not take ferrous sulfate with

A

Tea, coffee, milk, or antacids (decreased absorption)

130
Q

What should be done after taking ferrous sulfate liquid

A

Since our mouth after to avoid teeth staining

131
Q

what can increase absorption of iron

A

Foods high in Vitamin C

132
Q

Black box warning for ferrous sulfate

A

accidental overdose is a leading cause of fatal poisoning in children under 6 years old

133
Q

Cyanocobalamin indication

A

B12 deficient anemia

134
Q

Cyanocobalmin is a

A

Vitamin, water soluble
**co-enzyme for numerous metabolic functions, including fat, carbohydrate metabolism, protein synthesis, cell replication, and hematopoiesis

135
Q

Cyanocobalamin is indicated treatment of

A

Pernicious anemia

136
Q

When should you administer cyanocobalamin PO?

A

if there is a decrease in B12 because of decrease INTAKE, then PO will work

137
Q

Why is cyanocobalamin administered IV, IM, or SQ for pernicious anemia

A

Because pernicious anemia is due to a lack of intrinsic factor, PO will not work

138
Q

What should be measured before and after cyanocobalamin treatment

A

Vitamin B12, hematocrit, reticulocyte count, serum potassium, folate, and iron levels should be measured prior to treatment & periodically thereafter

139
Q

Nurse should observe what for cyanocobalamin

A

Nurse observe for improved lab values (reticulocyte count, RBCs, Hgb, Hct) as well as increased appetite and strength

140
Q

What is indicated treatment for folate-deficiency anemia (and also a dietary supplement to prevent neural tube defects)

A

Pteroyglutamic acid (folic acid)

141
Q

Pteroyglutamic acid (folic acid) is a

A

Vitamin, water soluble

142
Q

Folic acid is necessary for the formation of a

A

number of coenzymes, particularly DNA synthesis and hematopoiesis

143
Q

How to pteroyglutamic acid administered

A

PO,IM, SQ, IV

144
Q

Preferred method of administration for pteroyglutamic acid

A

Oral is preferred UNLESS malabsorption is present

145
Q

For pteroyglutamic acid in a parenteral form, we must protect it from

A

light and heat

146
Q

What should be measured when giving pteroyglutamic acid

A

Hematocrit, reticulocyte count, serum potassium, folate, and iron levels

147
Q

Poikilocytosis

A

Irregular shape

148
Q

Ansiocytosis

A

Irregular size

316 Pharmacology (19 decks)

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