Final: Anemia and Polycythemia (2-4) Flashcards
Characteristics/manifestations of
Anemia
Decreased RBCs (i.e., Lack of B12, B9, FeSo4) Blood loss (i.e., ulcer, trauma) RBC destruction (i.e., sickle cell, incompatable.blood)
Polycythemia
opposite of anemia
Excess RBCs causing hyperviscosity and hypervolemia
Clotting Disorders
Hint: (2)
DIC
Thrombocytopenia
Can also cause bleeding and anemia
Neutropenia
Decreased WBC
specifically the neutrophils
Which are the 3 components of the body that are determinants of tissue oxygenation?
Heart - good pumping in order to adequately perfuse the tissue
RBC - carry oxygen throughout our blood
Lungs - exchange of O2 and CO2
Function of Red Blood Cells
Transport gases (O2 and Co2)
Hemoglobin binds with O2 and Co2
O2 attaches to iron on hemoglobin in lungs
Transported to tissues where it detaches
Co2 is picked up from the globin portion of the hemoglobin and transported to the lungs for exit
How are RBCs made?
Erythropoiesis
Erythropoiesis
Stimulated by
hypoxia (lack of o2)
Controlled by erythropoietin from
kidney
- Erythropoietin stimulates bone marrow to make more RBCs (aka: erythrocytes)
True or False:
RBCs live approximately 120 days
Requires vitamins B6 (pyridoxine), B9 (folic acid), and B12 (cyanocobalamin) and iron to make RBCs
Which nutrients are needed for erythropoeitin?
: protein, iron, folate, cobalamin, riboflavin, pyridoxine, panthothenic acid, niacin, ascorbic acid, copper and vitamin E.
Which endocrine hormones also affect RBC production?
thyroxine, corticosteroids, and testosterone also affect RBC production – for example – hypothyroidism is associated with anemia. In other words, low fx thyroid patients are very prone to anemia.
T or F? Having too much testosterone can lead to too many RBC’s in the system?
Can lead to polycythemia condition, which is an overload of RBC’s.
HGB - amount of oxygen carrying molecule in blood
- Male and Female values?
- What part does the oxygen molecule attach to?
- Globulin?
- Male = 14-18; Female = 12-16
(15 is the avg.) - O2 attaches to the heme
- CO2 to the globulin
3:1 relationship between HGB and HCT
15 hgb, hct expect to be about 45
HCT – % RBC in blood
Male = 40-50%
Female = 36-44% (decreased compared to males, due to menstruation, plus men have more testosterone gives them higher RBC count)
RBC Indice to focus on?
MCV
Mean Corpuscular Value
WBC’s
neutrophils, lymphocytes, monocytes, eosinophils, basophils
Platelets aka thrombocytes
Help with clottingform the initial platelet plug 150,000 – 450,000
Different degrees of HGB
What happens if a patient does not have enough 02 to their bloodstream?
Mild = Hgb (hemoglobin) of 10 – 12 g/dL Moderate = Hbg of 6 – 10 g/dL Severe = Hgb of < 6 g/dL
Critical organs such as heart muscle and brain, kidneys
What can occur if a patient has low Hgb?
Severe = Hgb of < 6 g/dL
Tissue damage/infarct can occur!
What Ingredients Are Needed for RBCs ?
Need all these to make that perfect “cookie”
Protein Iron Folate (B 9 folic acid) Cobalamin (Vit B 12) Riboflavin (B 2) Pyridoxine (B 6) Other components
If one ingredient is missing/omitted what will happen/which finding?
This will result in different types of anemia.
If iron is ommitted from the RBC, which type of anemia does this result in? Hint: small
Microcytic anemia
Which type of anemia will a patient have if they do not have enough Vit B12?
Hint: big RBC’s
Macrocytic
Do not fx well in the body
Hypocromic RBC’s lack what? Or do not carry enough of this….
Does not contain enough iron
MCV (aka: Mean corpuscular volume)
What does this measure?
This measures the relative size of RBCS
Normocytic 80 – 100 femtoliter (fL) normal
Microcytic < 80 fL (think small chocolate chip cookie – not enough eggs)
Macrocytic > 100 fL (think big chocolate chip cookie – not enough flour) - does not function well just like a big chocolate chip cookie with flour missing does not taste as good.
Normocytic Anemia(this is anemia with normal size red blood cells) Usual causes?
Sudden blood loss (body has not had enough time to compensate)
Prosthetic heart valves
Tumor
Long term disease
Decreased erythropoietin caused by renal failure
Blood loss can also be normocytic (gun shot wound, car accident)
MicrocyticAnemia Usual What are the causes?
Biggest cause = iron deficiency Why? Due to Chronic blood loss Lead poisoning Thallassemia Inflammation
Why is this patient anemic? Which organ function are you going to look at?
What will be decreased?
Renal function (chronic disease of the kidneys means reduced production or erythropoietin) Decreased stimulation of the bone marrow. Therefore, decreased mfg of RBC's
MAcrocyticAnemiA
Usual Causes Chemotherapy Folate deficiency Cobalamin (Vit B12) (Lacking Intrinsic Factor = Pernicious Anemia) Deficiency *Alcoholism
RBC Indices
Decreased MCV, MCH, MCHC Possible causes?
<80
Iron deficiency anemia
Anemia of chronic illness
Chronic blood loss
Increased MCV
Possible causes are? >80
Vitami B12 deficiency
Normocytic, normochromic anemia
Acute blood loss
Sickle-cell disease
MCH (aka: mean corpuscular hemoglobin)
Measures mass of…..
Average mass of hemoglobin in a red blood cell – related to color of RBC
Shows how much o2 it is carrying due to amount of HGB
Normochromic 27-33 picograms (pg)/cell
Microchromic < 27 pg
Macrochromic > 33 pg
*MCH closely follows MVC values so…if one is low the other will likely be low
T or F? If you have a microcytic (small RBC) are you going to also have a lower MCH as well?
TRUE
MCHC measures…..?
The mean corpuscular hemoglobin concentration, a measure of the concentration of Hgb in a volume of packed red blood cells
Arrived at by dividing hemoglobin by hematocrit
i.e., Hgb of 7 divided by hematocrit of 21 = 33%
This value closely follows MCV and MCH…so if MCV or MCHCis low, the MCHC is usually low too! Focus on MCV values.
How do RBC’s appear when they are missing HGB?
They appear pale, and this is called hypochromic
RDW (red cell distribution)
Measures…….?
Normal reference range?
size variation of RBCs
Normal reference range in human red blood cells is 11.5-14.5%
Greater the number means greater variation in RBC size
Lower the number means less variation in RBC size
Is used in correlation with MVC to diagnose cause of anemia – can be a complex analysis!
If there is a large variation in RDW, this can mean an acute problem (bone marrow making new RBCs)
This will likely happen when someone is actively losing blood for > than several days
If your bone marrow is spitting out a lot of RBC’s and initially they are immature bc maybe you are having blood loss, you’re going to have a wider variation than if your body was in homeostasis and everything was just interchanging at the normal rate which is at 120 days. What is occurring?
larger variation in size of red blood cells signifies blood loss!
An anemic patient would present with?
Older adult
Pale skin, maybe slight yellowing due to liver disease, recall that the liver is responsible for blood clotting factors
T or F? A decrease in the function in the liver will sometimes signify the presence of anemia concurrently with jaundice?
True
recall that the liver is responsible for blood clotting factors
Gerontologic Considerations
Common in older adults
Men in their 70s have decreased testosterone which inhibits erythropoiesis
Chronic disease
A hematological cancer such as colon cancer
Nutritional deficiencies
GI issues: i.e., difficult to absorb B12
Signs and symptoms may go unrecognized or may be mistaken for normal aging changes.
May be misdiagnosed as depression
Gerontologic Considerations
Aging:
Decreased bone marrow –90% of bone marrow is made of hematopoietic tissue at birth,
this is reduced to 50% at age 50 and 30% at age 70.
Adults are more vulnerable to problems with clotting, transporting o2, fighting infection.
Iron deficiency, gi bleeding, renal disease, testosterone deficiency or bone marrow dysfunction can impact
Unexplained anemia in the elderly
Probable blunted response to erythropoietin.
WBC is not usually affected but older adult may only have a minimal elevation in the total WBC count
Platelets may have increased adhesiveness
What is the leading cause for anemia in older adults?
What would you notice in older adult men?
Decreased bone marrow
In older adult males, you will notice decreased testosterone production, due to inhibited erythropoiesis
Anemia Assessments
CNS: dizziness, fatigue,
fainting (in severe anemia)
Blood: Low BP
(Heart is trying by compensating: heart is working OT to get blood to circulate) In severe anemia you will see: chest pain, angina, heart attack
Palpitations, Rapid heart rate
Spleen enlargement, due to the unusual size of the RBC they can get caught in the spleen.
Muscular - weakness, due to poor oxygenation
Yellowing of the eye
Skin- pale, cold, yellow
Respiratory (SOB) as compensatory mechanism