Pathophysiology Exam #2 Flashcards
What percentage of body weight does blood make up?
8%
What percentage of blood does the plasma make up?
55%
What percentage of blood does the formed elements make up?
45%
Most of the plasma is formed of ____?
Water, 91%
Proteins make up what percentage of plasma?
7%
What is the main contributor to the protein of the blood?
Albumin
Other solutes such as gases, ions, nutrients and waste make up what percentage of plasma?
2%
When we measure the “formed elements” in the blood we are measuring its?
hematocrit
Most of the formed elements are made up of these ____?
RBCs
What is the normal range of RBCs in the blood?
4.2 - 6.2 million/cubic millmeter(or microliter[microl])
What are the two main functions of RBCs?
Transport oxygen to the tissues via iron molecules
Transport carbon dioxide to lungs to be exhaled(CO2 is partially dissolved in the cytoplasm of RBCs and partially bound with hemoglobin
Oxygen binds with the ___ portion of hemoglobin, while carbon dioxide binds with the ___ portion of hemoglobin.
- heme
- globin
Red Blood Cells contains this enzyme that is responsible for?
-carbonic anhydrase(metabolizes the reaction of CO2 and Water)
-a weak acid that allows for carbon dioxide to be transported in the cytoplasm of RBCs
CO2 + H2O H2CO3 H+ HCO3-
How does hemoglobin serve as a powerful acid-base buffer to regulate the pH of body fluids?
By binding to excess H+ ions if there is an increase in them….if there is a deficit of H+ ions then Hgb will release H+ increasing the concentration of them in body fluids
When carbonic anhydrase is present with CO2 and water, what will be formed?
- Carbonic acid(H2CO3)
- carbonic acid can be formed of water/CO2 without carbonic anhydrase, but it happens much slower
Carbonic anhydrase increases the reaction between CO2 and Water about _____ times.
5000
Carbonic acid is a weak acid that disassociates weakly…forming what?
- H+
- HCO3-
CO2 + H2O H2CO3 H+ HCO3-
These elements can go either way either left to right or right to left. What is different when H+ and HCO2 become carbonic acid as opposed with CO2+H2) becomes carbonic acid?
H+ and HCO2 do not need carbonic anhydrase to form carbonic acid
CO2 + H2O H2CO3 H+ HCO3-
What determines which way the reaction takes place?
The number of reactants on each side. For example…if CO2 increases it is going to combine with water with CA and become H2CO3….if HCO2 increases it drives the reaction the other way.
What is the all important Acid Base formula?
CO2 + H2O H2CO3 H+ HCO3-
What is the normal RBC in men?
5,200,000/mm^3(or microl)
What is the normal RBC in women?
4,700,000/mm^3(or microl)
What are two factors why there is a higher RBC in men than women?
- men have higher testosterone which stimulates RBC
- women have menses
What is the normal percentage of the formed elements(Hct.) part of the total blood volume?
38 - 52%
What is the normal hemoglobin?
12 -18 gm/dl
1 dl = 100 ml
Each GRAM of hemoglobin can bind to and transport how many mls of oxygen?
1.34 ml
RBCs are produced in different places during our lifetime, where are RBCs produced during the prenatal period(3)?
- liver
- spleen
- lymph nodes
RBCs are produced in different places during our lifetime, where are RBCs produced from birth until about 5 years old?
shifts to all bone morrow
RBCs are produced in different places during our lifetime, where are RBCs produced after 20 years of age(5)?
Primarily in the bone marrow of the : -vertebrae -sternum -ilium with some being produced in the: -proximal humerus and the tibia
What is the definition of erythropoiesis?
production of RBCs
What is the common ancestor shared by all the formed elements of the blood(RBC/WBC/Platelets)?
bone morrow stem cell(pleura potential hematopoietic stem cell)
-has the potential to be any of the formed elements of the blood
After the bone morrow stem cell, what is the first cell located in the RBC lineage?
Pro-erythroblast
The pro-erythroblast goes through 3 stages called ___, ____, ____ where the ___ is extruded before forming a ___?
- early erythroblast, intermediate erythroblast and late erythroblast
- nucleus
- reticulocyte
What is the significance of the nucleus being extruded from the erythroblast?
- mature RBC do not have a nucleus which means they cannot produce(they have a single life span)
- mature RBC do not have mitochondria, so they cannot participate in aerobic metabolism(cannot produce ATP through aerobic means)
What is the life span of RBC?
~120 days
How do RBC get ATP?
through glycolysis—>pyruvic acid(net yield of ATP=net of 2)
-They produce ATP through Glycolysis (conversion of
G-6-P > pyruvic acid > net of 2 ATP
What happens when a reticulocyte transforms into a mature RBC?
- It shrinks
- Hemoglobin concentration will increase (the amount of hemoglobin will NOT increase just the %, because the cell shrunk)
- the concentration of Hgb increases
If there is an increase reticulocyte count, what does that indicate(2)?
- Normal response to hemorrhage
- Pharmacological treatment of anemia that works
- Because reticulocytes are larger than mature RBCs, they are prone to hemolyze (they have harder time traveling in capillaries)
T or F: RBCs are biconcave discs.
- True
- They have to be a certain size and a certain shape, and pliable
- They have need to squeeze through capillaries
Describe Erythropoietin (EPO).
- Principal factor that stimulates bone marrow RBC production in the regulation of RBC production
- 90% produced by peritubular epithelial cells of kidneys
- Produced in response to HYPOXIA of the cells that secrete EPO
*NOT specifically RBC count or hemoglobin conc. or hematocrit; however, these conditions may cause HYPOXIA, which will then increase EPO secretion**
- EPO stimulates proerythroblasts and causes them to proceed through further stages of development more rapidly:
- increases rate at which reticulocytes move from bone marrow to circulating blood
- percentage circulating retics will increase initially
- mature RBC count, hgb, and hct will increase
-As RBCs increase, and hypoxia decreases, negative feedback will decrease amount of EPO secretion
What stimulates the production and secretion of EPO?
-Hypoxia of the peritubular epithelial cells of the kidneys
List the steps in order of Erythropoietin secretion.
- Decreased blood O2 (Hypoxia)
- Hypoxia of the peritubular epithelial cells of kidneys
- Secretion of EPO
- Increased EPO in blood
- EPO stimulates bone marrow (proerythroblasts)
- Increased RBC production
- Mature RBC
- Increased blood oxygen
- Negative feedback to kidneys…stop secretion of EPO
Maturation Factors for RBCs: What is the significance of vitamin B-12 (cobalamin) and what is the outcome of insufficient B-12?
- Essential for RBC DNA synthesis and normal RBC maturation
- Insufficient B-12: RBC maturation failure and abnormally large RBCs (megaloblasts or macrocytes) which leads to
- Megaloblastic Anemia or Macrocytic Anemia or Pernicious Anemia which causes *Abnormal O2 transport and easy hemolysis
What are the causes of Vitamin B-12 deficiency and anemia?
- Inadequate dietary intake of B-12 (uninformed vegetarians)
- Atrophy of gastric mucosa and inadequate intrinsic factor secretion
- Gastric bypass or gastric reduction operations
- Small bowel resection, esp. of ileum
- Malabsorption syndromes of small bowel
Maturation Factors for RBCs: What is the significance of folic Acid (folate)?
-Essential for RBC DNA synthesis and normal RBC maturation
How do you differentiate from folic acid and vitamin B-12 deficient anemias?
-Draw Vit B-12 and folic acid blood levels
Describe a Hemoglobin molecule.
- Composed of a heme portion and a globin portion
- Each has 4 globins, alpha-1, a-2, beta-1, b-2 (polypeptide chains, amino acid sequences)
- Each has 4 heme (center of it is Fe)
What attaches to globin?
-CO2
What attaches to the Fe portion of the heme?
-O2
Describe the hemoglobin O2 transport system.
-HGB combines with O2 at the Alveolar-Capillary level and releases the O2 at Capillary-Tissue level!!!!
**The iron in hemoglobin combines loosely and reversibly with O2. The iron remains in the Fe++ (ferrous) form. It is not oxidized to Fe+++ (ferric) by O2. Oxidation to ferric is irreversible, so the hemoglobin/iron could not release the O2 to cells
EACH FE++ CAN COMBINE WITH ONE O2 MOLECULE (O2). SINCE A HGB MOLECULE CONTAINS FOUR FE++, EACH HGB MOLECULE CAN COMBINE WITH 4 MOLECULES OF OXYGEN (O2)/8 ATOMS OF OXYGEN
What is it called when ferrous (Fe++) is oxidized to ferric?
Methemoglbin (MetHb)
-About 1-3% of iron is in ferric (Fe+++) form normally
List the drugs that cause MetHb.
- Prilocaine: generates O-toluidine which oxidizes hemoglobin
- Lidocaine: Large amount needed (about 600 mg)
- BENZOCAINE: Hurricaine spray, Cetacaine…BIGGEST CULPRIT
- Nitroglycerine, Na nitroprusside: (prolonged administration or hepatic/renal failure)
- Phenytoin —>Dilantin
- Sulfonamides
What are the clinical clues for MetHb and how is it diagnosed?
- Low SpO2 in the setting of a normal arterial PO2 (pO2 is just the amount of O2 dissolved in the blood)
- “chocolate, dark-red, brownish to blue” colored arterial blood
- Brown urine
Diagnosis:
- Direct measurement of MetHb by co-oximetry
- Clinical cyanosis in the presence of normal arterial PaO2
- Pulse oximetry?? (pulse ox does not pick up/measure methb)…will read 85%
What is the Treatment of MetHb?
- Asymptomatic w/MetHb level 20%:
- Methylene blue (1st line Tx) 1-2 mg/kg IV over 5 min
- Blood transfusion
- Hyperbaric Oxygen
How does methylene blue work in treating MetHb?
-It converts ferric form back into the ferrous form of iron
How many liters of blood does the average 21 yo, 70 kg male have?
- 6 liters
- One liter = 1 million muL
- About 5 million RBC/muL of blood
- each RBC has about 300 million hemoglobin molecules
- 4 O2 molecules/hemoglobin molecule
- Thus, about 36 septillion O2 molecules per person