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Heme and Lymph Exam 2 > RBC and bleeding disorders - SRS > Flashcards

RBC and bleeding disorders - SRS Flashcards

1
Q

What is the unique ability of hemoglobin?

A

Bind O2 in high pO2 environment and releases O2 in low pO2 setting.

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2
Q

What regulates RBC progenitor cells?

A

EPO - a glycoprotein produced and released by peritubular capillary lining cells.

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3
Q

What regulates EPO?

A

pO2 - amount of oxygen available to the kidney

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4
Q

When Hb levels fall below a certain level the plasma EPO levels increase logarithmically in inverse proportion to the severity of the anemia.

At what level does this occur?

A

Below 10 grams/dL

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5
Q

What does RDW stand for?

A

Red cell distribution width

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6
Q

What does hematocrit measure?

A

Red cell mass expressed as a % of whole blood volume

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7
Q

What is the standard US measurement of anemia?

A

Hematocrit

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8
Q

What is the european standard for anemia measurement?

A

Hemoglobin

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9
Q

What is the normal relationship between hematocrit and hemoglobin?

A

3

Divide hematocrit by 3 to get hemoglobin

multiply hemoglobin by 3 to get hematocrit

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10
Q

What does the RDW provide useful insight for?

A

Degree of anisocytosis

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11
Q

What are two quick anatomical checks you can make to identify anemia?

A

Palmar crease

Conjunctiva

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12
Q

What is anemia?

A

A laboratory finding clinically defined quantitatively as a patient value for hemoglobin or hematocrit which is less than 2.5 percentile value of reference range.

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13
Q

What factors play into the reference ranges upon which anemia is judged?

A

Age

Sex

measuring technique used by the laboratory

geographic factors including altitude

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14
Q

What are the four factors that clinical findings in RBC function deficiencies are related to?

A
  1. Adequate normal hemoglobin vs. impaired hemoglobin
  2. Acute (rapid) vs. Chronic (slow) loss of RBCs
  3. Amount or extent of RBC volume loss
  4. Indirect effects of red cell destruction (iron accumulation in thalassemia or splenic infarction in sickle cell anemia)
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15
Q

Whatever its cause, anemia, when sufficiently severe leads to certain clinical findings. What are some of these?

A

Pale appearance

Weakness

Malaise

Fatigue

Dyspnea on exertion

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16
Q

What changes can hypoxia cause in the liver, myocardium and kidney?

A

Fatty change

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17
Q

What is a possible manifestation of myocardial hypoxia?

A

Angina pectoris, particularly if complicated by pre-existing coronary artery disease.

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18
Q

In the event of acute blood loss and shock, what can develop d/t renal hypoperfusion?

A

Oliguria and anuria

19
Q

What are some symptoms of CNS hypoxia?

A

headache

dimness of vision

faintness

20
Q

What are the three mechanisms behind anemia?

A

Blood loss

Increased RBC destruction

Impaired Production

21
Q

When stressed, by what factor and over what timeline does the bone marrow upregulate red cell production?

A

4-5 fold within 7 to 10 days

22
Q

Where does hematopoiesis normally occur?

A

Red marrow - medullary cavity of flat bones in adults

23
Q

Where does hematopoiesis occur in exceptional circumstances?

A

Extramedullary hematopoiesis - Liver, spleen or even lymph nodes

24
Q

What are the effects of acute blood loss mainly due to?

A

Loss of intravascular volume

25
Q

What component of blood is primarily lost in acute blood loss?

A

plasma for the most part

26
Q

In acute blood loss a patient may experience hypovolemic shock. What kind of anemia are they likely to have?

What will their EPO levels be?

A

Normochromic/normocytic anemia

EPO levels normal

27
Q

What happens to white blood cell count in acute blood loss? Why?

A

Increases d/t epinephrine and decreased marginalization

28
Q

What happens to platelet count in acute blood loss?

A

Increases

29
Q

In acute blood loss what is the reticulocyte count like?

A

Normal

30
Q

Adult humans will experience symptoms with a 10-15% blood volume loss in under an hour. What are some examples of these symptoms?

A

Rapid pulse

Increased respirations

shortness of breath - with effort especially

Light headed

(all due to defects in vascular volume)

31
Q

Describe the findings you might expect if a patient has lost more than 20% blood volume in less than one hour?

A

Vascular shock, postural hypotension

32
Q

What would you expect in a patient with more than 30% blood volume loss in less than one hour?

A

Profound shock with confusion, air hunger and hypotension

33
Q

How long after an acute blood loss does it take for the reticulocyte count to increase?

A

7 days

34
Q

What are some common sources of chronic blood loss?

What does this lead to?

A

GI causes

Gynecological causes

Iron loss

35
Q

In an older male with anemia, what should you think of as a likely cause?

A

Colon cancer

36
Q

When does chronic blood loss induce anemia?

A
  1. Rate of loss exceeds the regenerative capacit of the marrow
  2. Iron reserves are depleted and iron deficiency anemia appears
37
Q

Chronic anemia does not decrease vascular volume blood pressure suffiently to cause acute symptoms of hypotension. Gradual physiologic accomodation of deficient red cells can occur. What is an example of this?

A

Increased levels of high energy phosphates (2,3-DPG)

38
Q

What are some examples of chronic RBC loss/deficiency?

A

Sickle cell anemia

G6PD deficiency

Thalassemia

Blood loss from large bowel adenocarcinoma

39
Q

What are four determinants of signs/symptoms in chronic RBC loss/deficiency?

A
  1. overall severity of RBC loss
  2. Rate at which loss occurs
  3. duration of loss
  4. associated physical health and age
40
Q

In chronic blood loss, most adults are asymptomatic until hemoglobin is what level?

A

under 7

41
Q

What is going on in this patient?

Why is hematocrit high?

A

Normocytic anemia

Acute blood loss

High hematocrit because lost more plasma than RBC’s

42
Q

What is going on with the patient whom this panel is from?

A

hypochromic Microcytic anemia

Chronic blood loss

43
Q
A

Heme and Lymph Exam 2 (9 decks)

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