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PBS 602 Pathophysiology > RBC's Lecture > Flashcards

RBC's Lecture Flashcards

1
Q

Blood plasma proteins

A

formed mainly in the liver and help regulate blood volume, blood pressure by contributing to colloid osmotic pressure, as well as body’s fluid balance

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2
Q

Three types of plasma proteins exist

A

1) serum albumin, which maintains blood volume and pressure,
2) serum globulin, which is composed of three fractions:
a) α fraction, which is important for the transport of bilirubin, lipids, and steroids,
b) β fraction, which is important for the transport of iron and copper in plasma,
c) ɣ fraction, which is the antibody molecules.
3) Fibrinogen is the third major type of plasma proteins and is the inactive precursor of fibrin, which forms the framework of blood clots.
4) Regulatory Proteins ( hormones and enzymes)

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3
Q

Blood cells:

A
  • Erythrocytes or RBCs
  • Leukocytes or white blood cells (WBCs)
  • Platelets
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4
Q

Erythrocytes or RBCs

A
  • Small biconcave cells ( 80-120 days)
  • RBCs are responsible for transporting oxygen from lungs to tissues and CO2 from tissues to lungs
  • RBCs also buffers blood pH and this buffering capacity is mediated by its constituent carbonic anhydrase.
  • RBCs have no nucleus, no cytoplasmic granules, no mitochondria, and no ribosomes. ⇒ cannot synthesize proteins or carry out oxidative reactions.
  • Hemoglobin is the main protein of RBCs and it enables the blood to transport 100 times more oxygen
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5
Q

WBC ( leukocytes)

A
  • are immune cells that protect the body from infections.
  • Nucleated cell
  • Days or years
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6
Q

Platelets

A
  • essential in the formation of blood clots and in bleeding control.
  • Not cells/ but circulating cytoplasmic fragments of megakaryocytes and are incapable of mitotic division.
  • They contain cytoplasmic granules that release biochemical mediators involved in hemostatic process ⇒ vascular injury
  • maintans vascular endothelium
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7
Q

Formation of Red Blood Cells

A
  • During fetal life, blood cells are produced in liver and spleen
  • in adults hematopoiesis is limited to bone marrow.
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8
Q

Erythropoiesis

A
  • the production of red blood cells from bone marrow precursors,
  • stimulated by erythropoietin (EPO) hormone (produced by kidney in response to low hemoglobin)
  • large nucleated cell (rich in ribosomes) to a reticulocyte which is a small disc that has lost its nucleus.
  • The reticulocyte leaves the bonemarrow, enters the bloodstream and matures into an erythrocyte in 24-48 hours. During this period, the mitochondria and ribosomes disappear with no longer ability to synthesize hemoglobin.
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9
Q

Hemoglobin synthesis

A
  • Hemoglobin that carries oxygen is called oxyhemoglobin.
  • Hemoglobin molecule is composed of two alpha chains and two beta chains-the globins.
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10
Q

__________ are responsible for the synthesis of protoporphyrin.

A

Mitochondria

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11
Q

After iron is absorbed in the duodenum and proximal jejunum, it is carried in plasma on _________.

A

transferrin protein.

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12
Q

The RBCs rely on _______ for energy production due to absence of mitochondria.

A

glycolysis

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13
Q

Red cell destruction

A
  • a decrease in enzyme activities,
  • decrease in amounts of membrane lipids,
  • levels of hemoglobin and methemoglobin increase, and
  • change in cell size
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14
Q

The aging RBCs are then removed by the___________ (in spleen and liver), and degraded

A

mononuclear phagocytic system

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15
Q

Globin is broken down into ________ and iron is recycled.

A

amino acids

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16
Q

Porphyrin is reduced to _______ , which is transported to the liver and conjugated by the enzyme________ to glucuronic acid which is then excreted in ______.

A

bilirubin; glucuronyl transferase; bile

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17
Q

Any condition which increases the RBCs breakdown will lead to increased levels of unconjugated bilirubin which leads to accumulation in blood resulting in _______

A

yellow skin or jaundice.

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18
Q

ERYTHROCYTE DISORDERS

A

1) Anemia, defined as decrease of RBCs,
2) Polycythemia, defined as increase in RBCs.

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19
Q

Anemic patient has__________ due to low oxygen carrying capacity of blood

A

tissue hypoxia

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20
Q

in polycythemia, the patient has ___________ and volume due to increase in number of RBCs.

A

increased blood viscosity

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21
Q

Anemia may be the result of decreased production of RBCs or_____________.

A

increased destruction of RBCs

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22
Q

General Effects of Anemia

A
  • reduction in oxygen carrying capacity of blood
  • tissue hypoxia
  • compensatory mechanisms to restore tissue oxygenation.
  • Symptoms Include : fatigue, generalized weakness, loss of stamina, tachycardia, exertional dyspnea
23
Q

Increased 2,3-diphosphoglycerate (2,3-DPG) in RBCs will increase oxygen utilization by tissues by _________________.

A

decreasing affinity of hemoglobin to oxygen in tissues.

24
Q

Anemia Related to Decreased RBCs Production

A
  1. Aplastic Anemia
  2. Anemia due to Chronic Renal Failure
  3. Anemia related to folate or vit.B12 (cobalamin) deficiency
  4. Iron Deficiency Anemia
25
Q

Anemia Related to Inherited Disorders of the Red Cell

A
  1. Thalassemia
  2. Sickle Cell Anemia
  3. Anemia due to Glucose-6-Phosphate Dehydrogenase Deficiency
26
Q

Anemia due to Extrinsic Red Cell Destruction or Loss

A
  1. Immune hemolytic anemia
  2. Anemia mediated by antibodies due to drugs that bind to RBCs membranes
27
Q

Polycythemia

A

RBCs are present in excess leading to increased blood viscosity causing complications like hypertension.

28
Q

Polycythemia Vera (primary polycythemia)

A
  • Is a myeloproliferative disorder that causes panmyelosis
  • arises from the transformation of a single stem cell into a cell with a selective growth advantage that becomes the predominant source of marrow precursors.
  • Overproduction of RBCs, WBCs, and platelets.
  • Elevated serum vit.B12 levels and uric acid.
  • Headache, backache, weakness, fatigue, dizziness, sweating, weight loss, hypertension, thrombosis, and dyspnea. Liver and spleen become congested.
  • No cure
29
Q

Secondary polycythemia

A
  • Absolute erythrocytosis due to increased stimulation of RBCs production caused by hypoxia (high altitude and lung disease).
  • Renal or other organ tumors may cause secondary polycythemia due to increased erythropoietin production.
  • Cardiovascular disease, chronic lung disease, alveolar hypoventilation, and abnormal hemoglobin concentration
  • Phlebotomy may help in reducing cardiovascular work. Oxygen administration may help too.
30
Q

Complete Blood Count (CBC)

  • White cells
  • Red cells
  • Platelets
A
  • ​gives info about the cells in pt’s bloods.
  • monitor overall health, to screen for some diseases, to confirm a diagnosis of some medical conditions, to monitor a medical condition, and to monitor changes in the body caused by medical treatments.
  • For patients who need blood transfusion, a blood count may be used to get data which would help plan a treatment. In such cases, the person should have only one blood count for the day, and the transfusion of red blood cells or platelets should be planned based on that.
31
Q

Total white blood cells (compete)

A
  • Neutrophils
  • Lymphocytes
  • Monocytes
  • Eosinophils
  • Basophils
32
Q

Red cells

A
  • Total red blood cells
  • Hemoglobin
  • Hematocrit
33
Q

Lymphocyte

A
  • Mononuclear immunocyte
  • humoral and cell mediated immunity
  • gives rise to B and T cells.
34
Q

Neutrophil

A
  • Segmented polymorphonuclear granulocyte with neutrophilic granules
  • Phagocytosis, esp. during early phase
35
Q

Eosinophil

A
  • Segmented polymorphonuclear granulocyte with eosinophilic granules
  • Phagocytosis, antibody-mediated defense against parasites; mucosal immune response
36
Q

Basophil

A
  • Segmented polymorphonuclear granulocyte with basophilic granules
  • Transport and release of heparin and histamine; involved in immune and inlammatory responses
37
Q

Monocyte-macrophage

A
  • Large mononuclear phagocyte
  • Phagocytosis; process and present antigens
38
Q

Nutritional Requirement for Erythropoiesis

A
  • vit.B12, vit.B6, folate, vit.E, riboflavin, pantothenic acid, niacin, and ascorbic acid
  • Deficiencies of vit.B12 or folate lead to impaired DNA synthesis and defective erythropoiesis
39
Q

Reduced erthropoetin due to renal failure could lead to

A
  • reduced production of RBC’s
  • Anemia
40
Q

Aplastic Anemia

A
  • reduced hematopoietic tissue in the bone marrow
  • Pancytopenia which is characterized by low RBCs, WBCs, and platelets counts
  • weakness, fatigue, lethargy, dyspnea, palpitations, and tachycardia. Fever, chills, and bacterial infections are seen secondary to neutropenia. Thrombocytopenia may lead to nosebleeds, retinal hemorrhage, and increased menstrual flow.
41
Q

Treatment of Aplastic Anemia

A

1) Avoidance of future toxin exposure,
2) Bone marrow transplantation if possible,
3) Maintenance of minimal essential levels of hemoglobin and platelets,
4) Prevention and management of infections,
5) Stimulation of hematopoiesis and bone marrow regeneration.

42
Q

Anemia due to Chronic Renal Failure

A
  • Treatment:
    • Dialysis
    • Erythropoietin is administered
43
Q

Anemia related to folate or vit.B12 (cobalamin) deficiency

A
  • Impaired DNA synthesis in blast cells of bone marrow ⇒ megaloblasts
  • RBCs are macrocytic;
  • Granulocytes are hyper-segmented while numbers of RBCs, WBCs, and platelets are decreased.
  • dementia, cognitive dysfunction, delusions, and hallucinations or “megaloblastic madness”
44
Q

Iron Deficiency Anemia

A
  • Most common cause in men is gastrointestinal bleeding while menorrhagia is the main cause in women
  • smaller and paler RBCs because of reduced hemoglobin levels. RBCs are described as hypochromic, microcytic red cells. Normal WBCs count
  • No usual anemia symptoms.
  • Crave dirt, clay, cardboard and hair
45
Q

Thalassemia

A
  • mutant gene that suppress the rate of synthesis of globin chains. (either beta or alpha chains)
  • microcytic and hypochromic RBCs.
  • globin chains imbalance causes normal chains to accumulate and precipitate in the cytoplasm. ⇒ cell membrane damage and cell destruction.
  • iron absorption is increased.
  • heterozygous thalassimia is resistant to malaria
  • Bone marrow transplantation. Symptomatic treatment involves regular blood transfusion, iron chelation therapy, and splenectomy
46
Q

Sickle Cell Anemia

A
  • mutation in beta-globin gene that causes hemoglobin polymerization
  • Glu → Valine in 6th position of the beta chain ⇒ Hb insoluble and under decrease oxygen tension.
  • Chronic hemolytic anemia, acute and chronic organ dysfunction particularly of spleen, bones, brain, kidneys, lungs, skin, and heart.
  • Stem cell transplantation or blood transfusion for treatment.
47
Q

Glucose-6-Phosphate Dehydrogenase Deficiency Anemia

A
  • deficiency of NADPH2 which is required to maintain the reduced form of glutathione (GSH). Due to reduced GSH, any agent that increases the levels of oxidizing radicals will lead to hemolysis of RBCs e.g. antimalarial drug primaquine.
  • Hemolytic anemia is triggered by drug administration, infection, diabetic acidosis, and exposure to fava beans.
  • Treatment: Avoidance of the causative agents. Transfusion therapy incase of hemolysis.
48
Q

Immune hemolytic anemia

A
  • Due to antibodies that react to antigens on the surface of RBCs e.g. Rh and ABO. (hemolytic disease of the newborn (HDNB) )
  • Anti-Rh immunoglobulin (Rho-GAM) is given to mother before or after delivery ⇒ destroys the infant’s RBCs that leaked to the mother’s blood before they stimulate the mother’s immune system to produce anti-Rh antibody.
49
Q

Hematocrit

A

Hematocrit or packed cell volume (PCV): This is the fraction of whole blood volume that consists of red blood cells.

50
Q

Mean corpuscular volume (MCV)

A
  • the average volume of the red cells
  • Anemia is classified as microcytic or macrocytic if the MCV value is above or below the expected normal range
  • thalassemia, reticulocytosis, alcoholism, chemotherapy, vitamin B12 deficiency, and/or folic acid deficiency affects MCV
51
Q

Mean corpuscular hemoglobin (MCH):

A

the average amount of hemoglobin per red blood cell, in picograms

52
Q

Mean corpuscular hemoglobin concentration (MCHC):

A

the average concentration of hemoglobin in the cells.

53
Q

Red blood cell distribution width (RDW):

A

variation in cellular volume of the RBC population.

54
Q

Mean platelet volume (MPV):

A

a measurement of the average size of platelets

PBS 602 Pathophysiology (13 decks)

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