Introduction to Anemia wk 7 mon8am Flashcards
- blood definition
- plasma definition
- Differentiated cells, generally nondividing, suspended in a solution called plasma
- Plasma is composed of coagulation proteins in solution with other proteins and solutes known as Serum
Bone marrow definition
- Source of multipotential stem cells and their differentiated progeny
- source of cellular material of blood
- source of immunologically active cells of the body (reticuloendothelial system)
- source of an adherent bed of cells essential to hematopoietic proliferation, immunomodulation, and cell survival (stroma)
Erythropoiesis
pronormoblast->basophlic normoblast->polychromatophiilic normoblast->orthochromic normoblast->reticulocyte->mature erythrocyte (red blood cell)
Blood formation- embryology
19 days- yolk sac (early precursors)
6 wks- liver ( main site wks 9-24), Spleen (blood, nodes, thymus)
10-11 wks- bone marrow (main site >24 wks)
- cord blood has many hematopoietic stem cells
by 2 week postpartum- hematopoiesis usally confined to marrow
As erythrocyte cell matures:
- cytoplasm initally blue with increased protein synthesis and then takes more and more red color as hemoglobin is produced– (pink cytoplasm)
2. mitochondria lost and protein syn stops
- nuceus becomes inactive, condense, shrunken and clumped (pyknotic) and eventually extruded from cell.
- when loses its nucleus becomes a reticulocyte. Young cells can have blueish tint. Contains somes residual RNA
- RNa lost after 1-2 days in circulation and becoes mature erythrocyte.
- Red blood cell count
- hemoglobin
- hematocrit
- retic count
1. RBC count
Men 4.4-6
women 4.2-5.5
**2. hemoglobin **
men 14-18
women- 12-16
3. hematocrit
men 40-54%
women 37-47%
- retic count
.6-1.9%
Retic index
2 corrections:
- retic % x HgB (patient)/Hgb (control)
- if nucleated RBCs are present, correct for 2 day lifespan of retic (/ 2)
RBC terminology
- microcytic
- macrocytic
- hypochromic
- anisocytosis
- poikylocytosis
- polythemia
- polycythemia
- anemia
- RBC smaller than normal
- RBC larger than normal
- Less HG/ Cell (larger central clear area)
- variation in size of RBC
- Variation in shape of RBCs
- Too many RBCS
- too few RBCS
hypoproliferative anemia
- most common type
- charecterized by reticulocytipenia
- charecterized by low or NL MCV
- induced by elements that impair the production of intact heoglobin or regulators of hematopoiesis
- disorders of erythrocyte production, of production of mature hemoglobin, of hematopoietic stem cell, of bone marrow microenviroment
disorders of erythrocyte production
congenital
acquired
- deficiencies on erthropoietin
- chronic renal insufficiency
- pure erthrocyte aplasia
disorders of production of mature hemoglobin
- disorders of iron
- iron deficiency
- iron sequestration (anemia of chronic disease/inflammation, sideroblastic anemia) - Disorders of heme
- thalassemia
- lead intoxication
- Hemoglobin E
- sideroblastic anemia
Iron regulation in the body
- HgB 67%
- plasma <.2%
- stores 30%
- heme enzymes, myoglobin 3%
- no active secretion mechs
- lost only when cells lost (urine, skin, gut) about 1mg a day
- 20-30 mg turnover between RBC destruction and production
- regulation mainly by absorption
- overload= oxidant damage
- deficiency= O2 transport, e- transport
Iron deficeincy anemia- most common cause of anemia
chronic blood loss
infancy
lactation
pregancy
Mechanisms of iron deficiency
- GI blood loss
- mentrual blood loss
- blood loss in pregnancy and lactation
- urinary blood loss
- dietary deficiency
- intestinal malabsorption
- atransferrinemia
clinical manifestation of iron deficiency
- anemia
- hypoproliferative, reticulocytopenic, microcytic - epithelial changes
- koilonychia, depapillated toungue, esophageal webs and strictures - skeletal changes
- growth retardation
- skull changes
