Exam 2: Hematologic System: overviews and red blood cells Flashcards
1
Q
Functions of hematological system
A
Transportation
Regulation
Protection
2
Q
Characteristics of Hematological system
A
Liquid connective tissue Viscous PH 8% of total body weight Volume
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
4
Q
Regulation functions
A
PH
Temperature
Fluid content of cells
5
Q
Protection function
A
From hemorrhage
From microbes and toxins
6
Q
pH range
A
7.35 - 7.45
7
Q
Blood volume for women
A
4-5 liters
8
Q
Blood volume for men
A
5-6 liters
9
Q
Composition of whole blood
A
Plasma
Formed elements
10
Q
% of plasma in blood
A
55%
11
Q
% of Formed elements
A
45%
12
Q
is blood a type of connective tissue?
A
yes! it is a liquid connective tissue
13
Q
Plasma is made up of
A
Water
proteins
solutes
14
Q
% of water in plasma
A
91%
15
Q
% of proteins in plasma
A
8%
16
Q
% of other solutes in plasma
A
1%
17
Q
most precise assessment for patients oxygen statue
A
arterial blood gases (ABGS)
18
Q
Proteins in plasma consist of
A
Albumin
Globulins
Fibrinogen
Complement
19
Q
other solutes in plasma include
A
Regulatory substances (enzymes and hormones) Nutrients Respiratory gasses Electrolytes waste products
20
Q
Formed elements include
A
Red blood cells
White blood cells
Platelets
21
Q
erythrocytes =
A
red blood cells
22
Q
RBC shape
A
Thin, non-nucleated, biconcave discs
23
Q
Biconcave discs cause
A
- Increase in surface area for O2 diffusion
- Thin membrane cause increase in diffusion of respiratory gasses
24
Q
Reverse deformability
A
Flexible membrane causes reverse deformability, which allows them to squeeze through capillaries without rupturing
25
Do RBCs reproduce or carry out extensive metabolic activities?
No because there is no mitochondria and no nucleus
26
Lifespan of RBC
120 days
27
Average amount of RBCs for men
5.4 million/mm^3
28
Average amount go RBCs for women
4.8 million/mm^3
29
Erythropoiesis
Productions of red blood cells
30
Erythropoiesis steps
Hemocytoblast ----> Reticulocyte ----> erythrocyte
31
What determines the development of hemocytoblast
Based on hormone that acts on hemocytoblast determines what it becomes
32
Reticulocyte
Immature red blood cell that HAS RNA!
33
Erythrocyte is a
Matured RBC that has no RNA and no Nucleus
34
red blood cells require adequate supply of what nutrients
Proteins
Iron
Vitamins: C, E, niacin, riboflavin, Folic acid, B6, B12
Trace minerals
35
Hypoxemia
O2 concentration in BLOOD
36
Hypoxia
O2 at the tissue level
37
Erythropoiesis needs a functioning
Kidney
38
Erythropoiesis is triggered by
Reduced oxygen carrying capacity
39
The kidney produces _____ to stimulate erythropoiesis
Erythropoietin
40
Where are erythrocytes formed?
Red bone marrow of bones
41
Increased O2 carrying capacity is a negative feedback that
Turns off the secretion of erythropoietin
42
Go over the life cycle of RBC!!!
43
what vitamins are needed to be present for proper synthesis of RBC
B12 and folic acid (B9)
44
Heme components of a blood are
Recycled
45
What causes the pigment in RBCs
Hemoglobine
46
Each RBC has how many hemoglobin molecules
280
47
Each molecule consists of
4 heme complexes (iron containing pigment)
| 2 pairs of globin molecules (alpha & beta)
48
Blood carries dissolved respiratory gasses and in combination with
hemoglobin
49
Gasses will diffuse from an area of
higher concentration to lower concentration
50
1 molecule of hemoglobin can carry
4 molecules of O2
51
saturation is when
all 4 heme molecules are bound to O2
52
What can result in abnormal hemoglobin molecules
Genetic alternations
53
red blood count average for men
4.7 - 6.1 (10^6)/ uL
54
red blood count average for women
4.2-5.4 (10^6) / uL
55
Hemoglobin (Hgb) measures
Hemoglobin content of blood
56
Normal values of Hgb for men
14-18 g/dl
57
normal values of Hgb for women
12-16 g/dl
58
Hematocrit (Hit) is the
% of red cell mass (formed elements) in 100 ml
59
normal values of Hct for men
42-52%
60
normal Hct values for women
37-47%
61
Where are RBC stored
the spleen
62
Accumulation and removal of aged or damaged cells found to take place in the
liver
63
Mean corpuscular volume (MCV) measures the
relative SIZE of RBCs
64
microcytic
small RBC
65
Macrocytic
large RBC
66
Mean corpuscular hemoglobin concentration (MCHC) measures the
concentration of Hgb in RBCs regardless of size
67
Normochromic
normal color/concentration
68
Hypochromic
Low concentration/ pale color
69
Polycythemia
Excess RBCs
70
Excess RBCS causes
Increase in blood viscosity which causes clinical manifestations like hypertension or blood clotting
71
Types of Polycythemia
Polycythemia vera
Secondary polycythemia
Relative polycythemia
72
Polycythemia vera is caused by
overproduction, it is associated with neoplastic transformation of bone marrow and stem cells
73
Secondary polycythemia is due to
chronic hypoxemia, with a resultant increase in erythropoietin
74
Secondary polycythemia can be caused by
High altitude, smokers, etc.
- basically anything that decreases O2 capacity will cause the body to compensate and increase RBC
75
relative polycythemia is due to
dehydration, which causes a spurious increase in the RBC count
76
Anemia
Deficiency of RBCs
| Abnormal low Hgb, number of circulating RBCs OR both!
77
Anemia clinical manifestations depend on
Severity of the disease
Rapidity of its development
Patients age and health status
78
Anemia results in
decrease in O2 carrying capacity of blood
79
Causes of anemia
```
Excessive blood loss
Increase hemolysis (destruction)
Decrease RBC production (nutritional, bone barrow failure, renal failure)
Disorders of hemoglobin synthesis
Dilutional
```
80
decreased blood viscosity due to anemia can cause
selective tissue perfusion which can cause normal tissue oxygenation
81
If O2 level is low, in an attempt to increase O2 delivery, the body will
Increase HR/CO
Increase RR
Increase work of breathing
Increase erythropoiesis
82
Decreases Hgb causes
Decrease O2 carrying capacity, which causes hypoxemia, which causes hypoxia
83
General clinical presentation of anemia
Fatigue, weakness, H/A, dizziness, visual disturbances, irritability, confusion
84
Respiratory clinical presentation of anemia
Dyspnea on exertion
85
Cardiac clinical presentation of anemia
```
Tachycardia
Angina
Palpitations
LV hypertrophy
Orthostatic hypotension
```
86
Skin and mucous membrane clinical presentation of anemia
```
pallor
jaundice of skin
brittle
spoon shakes nails
angular cheilitis
brittle hair
smooth tongue
```
87
2 Types of anemia that we are learning
Iron deficiency
| Megaloblastic
88
Most common type of anemia for all age groups
iron deficiency anemia
89
Causes of iron deficiency anemia
```
Dietary deficiency
Loss or iron from blood loss
Increase demand (pregnancy and menstrual flow
```
90
Nature of RBCs in iron deficiency anemia
Microcytic and hypochromic
Poikilocytosis (irregular shape)
Anisocytosis (irregular size)
91
Clinical presentation of iron deficiency anemia
```
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
Megaloblastic anemia nature of RBCs
Macrocytic and normochromic
93
Types of megaloblastic anemias
vitamin B12 deficiency anemia
| Folic acid deficiency anemia
94
Nutrients necessary for DNA synthesis
Vitamin B12
| Folic Acid
95
Nutritional deficiency causes
Impaired DNA synthesis which causes megaloblastic trans-formation of RBCs
- -- large immature poorly functional RBCs
- -- Poikilocytosis
- -- Flimsy membranes & shorter life span
96
poikilocytosis =
abnormally shaped RBCS
97
Nutritional deficiency causes membranes to be
Flimsy and RBC shorter life span
98
Causes of Vitamin B12 Megaloblastic anemia
1. Inadequate INTAKE (vegans); B12 found
| 2. Lack of Intrinsic factor
99
A lack of intrinsic factor causes
Pernicious anemia ( a type of megaloblastic anemia )
100
causes of pernicious anemia
- decrease secretion by gastric parietal cells
- hereditary atrophic gastritis
- gastrectomy
- defects in B12 - intrinsic factor pathway
101
daily absorption of B12 is
5 mcg
102
Dietary vitamin B12 must be bound to
Intrinsic factor in order to reach the circulation and to be utilized by the body
103
Vitamin B12 is needed for
Proper function of brain and nervous tissue
104
Unique to vitamin B12-deficient anemia: neurologic signs because of
defective myelination of peripheral nerves causes TRIAD of signs and symptoms
105
Triad of signs and symptoms for vitamin B12 deficient anemia includes
Weakness, sore tongue, parenthesis of feet and fingers
- -- also "metaloblastic madness"
- disease develops slowly: adaptation until severe
106
Megaloblastic madness
Paranoid ideation
Dementia
Cognitive dysfunction
delusions and hallucinations
107
Vitamin B12 deficient anemia develops
Slowly, there is adaptation until severe
108
Folate deficiency megaloblastic anemia can be deficient (especially if accompanied by increase need) in individuals like
Elderly
alcoholics
pregnancy
Lactation
109
Daily requirement of folic acid is
50-100 mcg, usually met in the diet
110
Antagonistic drugs of folic acid
Phenytoin (seizure mediation)
Phenobarbital (seizure medication)
Methotrexate (chemotherapy)
---- these medications can produce folic deficiency by inhibiting the enzyme
111
Neoplastic disease for folate deficiency anemia
Tumor cells compete for folate
112
other causes of megaloblastic anemia
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
Other types of anemia
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
Pharmacological goals of anemia
Increase RBC and Hgb levels, which will improve oxygen carrying capacity, alleviate symptoms, increase quality of life and prevent complications
115
epoetin alpha is a
synthetic glycoprotein to help increase RBC and hemoglobin counts
116
Erythropoietic stimulating agents (ESAs) stimulate
Production of erythrocytes
117
epoetin alpha is a glycoprotein produced by
recombinant DNA technology
118
Epoetin alpha is administered
IV or SQ
119
ePoetin alpha is a biological modifier that is commonly referred to as
Erythrocyte stimulating factor
120
Biologic modifier
modifies normal biology or bodies
121
Erythrocyte stimulating factor is indicated for
Anemia due to various causes (renal failure, chemotherapy, etc.)
122
ESAa blackbox warning (epoetin alpha)
- increase risk of CV event, thromboembolic events, stroke, mortality
- Increase risk of thromboembolism in surgical patients
123
ePoetin alpha should be given to individuals with
chronic anemia, not used for something like blood loss due to an accident (which would use blood transfusion)
124
Ferrous sulfate is a
Iron supplement
125
Ferrous sulfate indication
Iron deficiency anemia
126
MOA ferrous sulfate
Replaces iron, found in hemoglobin, myoglobin, and various enzymes; increasing the transport of oxygen via hemoglobin
127
adverse effects of ferrous sulfate
GI discomfort, constipation, dark stool
| -Advise patient to increase fiber and fluids
128
PO formulation of ferrous sulfate should be taken
with or before meals, if tolerated; after meals and with fluids to prevent stomach upset
129
Do not take ferrous sulfate with
Tea, coffee, milk, or antacids (decreased absorption)
130
What should be done after taking ferrous sulfate liquid
Since our mouth after to avoid teeth staining
131
what can increase absorption of iron
Foods high in Vitamin C
132
Black box warning for ferrous sulfate
accidental overdose is a leading cause of fatal poisoning in children under 6 years old
133
Cyanocobalamin indication
B12 deficient anemia
134
Cyanocobalmin is a
Vitamin, water soluble
**co-enzyme for numerous metabolic functions, including fat, carbohydrate metabolism, protein synthesis, cell replication, and hematopoiesis
135
Cyanocobalamin is indicated treatment of
Pernicious anemia
136
When should you administer cyanocobalamin PO?
if there is a decrease in B12 because of decrease INTAKE, then PO will work
137
Why is cyanocobalamin administered IV, IM, or SQ for pernicious anemia
Because pernicious anemia is due to a lack of intrinsic factor, PO will not work
138
What should be measured before and after cyanocobalamin treatment
Vitamin B12, hematocrit, reticulocyte count, serum potassium, folate, and iron levels should be measured prior to treatment & periodically thereafter
139
Nurse should observe what for cyanocobalamin
Nurse observe for improved lab values (reticulocyte count, RBCs, Hgb, Hct) as well as increased appetite and strength
140
What is indicated treatment for folate-deficiency anemia (and also a dietary supplement to prevent neural tube defects)
Pteroyglutamic acid (folic acid)
141
Pteroyglutamic acid (folic acid) is a
Vitamin, water soluble
142
Folic acid is necessary for the formation of a
number of coenzymes, particularly DNA synthesis and hematopoiesis
143
How to pteroyglutamic acid administered
PO,IM, SQ, IV
144
Preferred method of administration for pteroyglutamic acid
Oral is preferred UNLESS malabsorption is present
145
For pteroyglutamic acid in a parenteral form, we must protect it from
light and heat
146
What should be measured when giving pteroyglutamic acid
Hematocrit, reticulocyte count, serum potassium, folate, and iron levels
147
Poikilocytosis
Irregular shape
148
Ansiocytosis
Irregular size
