Lecture 28 - Anemia

Question 1

Name the hormones and growth factors that stimulate the production of:

erythrocytes

Answer 1

Erythropoietin = Hormone secreted by kidney’s in response to low blood O2 to increase production of RBC’s.

Question 2

Name the hormones and growth factors that stimulate the production of:

Megakaryocytes

Answer 2

Thrombopoietin = hormone that regulates the production of platelets and the production and differentiation of megakaryocytes

Question 3

Name the hormones and growth factors that stimulate the production of:

white blood cells

Answer 3

GM - CSF = Granulocyte Macrophage colony stimulating factor

• -> functions as a cytokine
• -> it is a white blood cell growth factor
• -> stimulates stem cells to produce neutrophils, eosinophils, basophils, and monocytes

G-CSF = granulocyte colony stimulating factor

–> stimulated bone marrow to produce granulocytes and stem cells and secrete them into the bloodstream

IL3 = stimulates the proliferation of cells in the myeloid lineage (E/Mega/Baso)

SCF = stem cell factor

–> plays an important role in hematopoiesis (formation of blood cells)

Question 4

Describe the function of each of the following proteins in processing Fe++ in the body and their role in erythropoiesis

Transferrin

Answer 4

Transferrin grabs the iron from the Hb

Question 5

Describe the function of each of the following proteins in processing Fe++ in the body and their role in erythropoiesis

Ferrritin

Answer 5

What iron is stored as.

Person is anemic when these stores are depleted.

Question 6

Describe the function of each of the following proteins in processing Fe++ in the body and their role in erythropoiesis

Hemosiderin

Answer 6

What iron is stored as.

Person is anemic when these stores are depleted.

Question 7

Describe the function of each of the following proteins in processing Fe++ in the body and their role in erythropoiesis

lactoferrin

Answer 7

Secreted from the neutrophils and macrophages

• -> bind to the iron and makes it unavailable
• –> protects against Fe+ binding bacteria

Question 8

Define anemia

Answer 8

Reduction in the total number of erythrocytes
Reduction in the quantity of Hgb
Altered structure or function of Hgb

Question 9

Describe the pathophysiology of anemia

Answer 9

Etiology:

a) Impaired erythrocyte production
b) Increased rate of erythrocyte destruction
c) Hemorrhage (acute or chronic)

Pathophysiology:

a) Decreased O2 carrying capacity of blood
b) Tissue Hypoxia
c) Decreased blood viscosity
d) Hypoxic dilation of aa., veins, capillaries

Question 10

Describe how general changes listed below compensate for anemia:

Increased cardiac output

Answer 10

Increased CO, Increased HR, and Increased SV to try to deliver more oxygen in the absence of O2.

Question 11

Describe how general changes listed below compensate for anemia:

Peripheral vasodilation

Answer 11

Vasodilation due to local control factors:

a) Hypoxia
b) Lactic acid (anaerobic metabolism)
c) Acidosis
d) Increased K+
e) Decreased BP

Question 12

Describe how general changes listed below compensate for anemia:

Fluid shift from intracellular space, in hemorrhagic anemia

Answer 12

Due to hemorrhage after 24 hrs.

Expands blood volume but doesn’t increase O2 carrying capacity

Blood becomes less viscous, less resistance, and decreased BP

Question 13

Describe how general changes listed below compensate for anemia:

Right shift of the O2-Hemoglobin dissociation curve.

Answer 13

Hypoxic tissues release 2,3 DPG –> causes a right shift of the Hgb O2 curve, releases O2 to the tissue

Increased H+ from anaerobic metabolism will do the same

Question 14

Describe how general changes listed below compensate for anemia:

Increased respiratory rate.

Answer 14

Increased respirator rate (hyperventilation)

• -> causes respiratory alkalosis
• -> L shift of Hgb curve
• –> Hgb binds tighter to O2 and doesn’t let go
• -> not good for your hypoxic tissues

*** Not true compensation

It’s compensating for your anaerobic metabolism from decreased O2 –> trying to breathe other co2 to raise pH

Question 15

Differentiate between true compensation vs physiological response in these areas:

a. Increased cardiac output
b. Peripheral vasodilation
c. Fluid shift from intracellular space, in hemorrhagic anemia
d. Right shift of the O2-Hemoglobin dissociation curve.
e. Increased respiratory rate.

Answer 15

a) increased CO is true compensation
b) Peripheral vasodilation is a physiological response
c) Fluid shift from ICF is a true compensation
d) right shift is a true compensation
e) increased respiratory rate is a physiological response

*** underlying objective of compensation = get O2 to tissues!!!

Question 16

Define/differentiate the difference types of anemia classified in table 25-1 chapter 25. Note the similarities and differences Note how they are differentiated or diagnosed and treated.

Macrocytic - Normochromaitc

Answer 16

Macrocytic - Normochromatic (large RBC and normal Hgb)

Question 17

Define/differentiate the difference types of anemia classified in table 25-1 chapter 25. Note the similarities and differences Note how they are differentiated or diagnosed and treated.

Microcytic - hypochromatic:

Answer 17

Microcytic - hypochromatic (small/abnormal RBC shape and with low Hb concentration)

1. Pernicious Anemia
   Etiology - malabsorption of Vit B 12 = defective DNA precursor synthesis

–> cause is defective secretion of intrinsic factor by the parietal cells (required for absorption of Vit B12)

Congential - defective mechanism for synthesis or secretion
Aquired - autoimmune with genetic predisposition; 90% have parietal cell antibodies in serum; later stages have intrinsic factor antibodies also; could be a secondary response to helicobacter infection

Question 18

Define/differentiate the difference types of anemia classified in table 25-1 chapter 25. Note the similarities and differences Note how they are differentiated or diagnosed and treated.

Normocytic - Normochromatic

Answer 18

Normocytic- Normochromatic (normal RBC shape and normal Hb concentration)