Red Blood Cells, Anemia and Polycythemia

Question 1

What is the volume of blood in the average adult?

Answer 1

~5.5 L

Question 2

RBC do not have what important organelles?

Answer 2

• Nucleus

- Mitochondria

Question 3

Hematocrit

Answer 3

%RBC/Volume

Question 4

Normal Hematocrit in Males

Answer 4

40-50%

Question 5

Normal Hematocrit in Females

Answer 5

36-47%

Question 6

Organs that produce RBC in adults

Answer 6

Bone Marrow

Question 7

Organs that produce RBC in the fetus

Answer 7

Yolk, PAS/AGM, Liver, Blood, Thymus bone marrow

Question 8

Life span of the RBC

Answer 8

120 Days

Question 9

Life span of the RBC in sickle cell anemia

Answer 9

10-15 days

Question 10

Name of the primary stem cell for blood components

Answer 10

Pluripotent Hematopoietic Stem cell (PHSC)

Question 11

Name the two important progenitor cells PHSC divides into

Answer 11

• Common Myeloid Progenitor

- Common Lymphoid Progenitor

Question 12

What is the first recognizable cell in the genesis of RBC

Answer 12

Proerythrocyte

Question 13

What is the name of immature RBCs?

Answer 13

Reticulocyte

-retain residual RNA/Mitochondria

Question 14

How long does it take a reticulocyte to mature into a mature RBC?

Answer 14

2 days

Question 15

When are elevated counts of reticulocytes found in the blood?

Answer 15

In patients who’s condition requires accelerated RBC production (bleeding)

Question 16

Erythropoetin

Answer 16

Hormonal control of RBC production

Question 17

What organs release EPO and to what stimuli?

Answer 17

Kidneys, and to hypoxia.

-Kidneys sense decreased oxygen levels and release erythropoetin that act on the progenitor cells in bone marrow to increase production of RBC

Question 18

Steps in Hemoglobin formation (Busy Card)

Answer 18

1. Succinyl Coa + 2 Glycine –> 4 Pyrrole
2. 4 Pyrrole –> Protoporphyrin IX (Key step)
3. Protoporphyrin IX + Fe2+ –> Heme
4. Heme + Polypeptide–> Hemoglobin Chain (alpha, beta)
5. 2 Alpha + 2 Beta Chains –> Hemoglobin A

Question 19

Fetal Hemoglobin (Hgb F)

Answer 19

Alpha2, Gama2

Question 20

Hemoglobin A

Answer 20

Alpha2, beta2

Question 21

Why is Iron important in the RBC?

Answer 21

It is important for Hgb to carry oxygen

Question 22

Ferritin

Answer 22

Where iron is stored in the tissues

-primarily liver and spleen

Question 23

Transferrin

Answer 23

Where Fe is bound in the blood

Question 24

Hemosiderin

Answer 24

Pathological form of iron storage. The iron is not readily available.

Question 25

What is the most important consequence of Anemia?

Answer 25

not transferring enough oxygen

Question 26

Causes of anemia

Answer 26

1-blood loss 2-increased RBC destruction (hemolysis) 3-Decreased production (malnutrition)

Question 27

In acute bleeding, H/H stay normal until?

Answer 27

Plasma volume is restored

Question 28

Each mL of blood loss is associated with what measurable loss in iron?

Answer 28

0.5mg

Question 29

Anemias associated with increased destruction of RBCs

Answer 29

- Membrane defects - abnormal hemoglobin (SCD) - Immune hemolysis - mechanical injury (burns, prosthetic valves) - normoblasts being destroyed (thalessemia)

Question 30

Ongoing hemolysis will result in what 3 things?

Answer 30

- Increased total body iron - jaundice and bilirubin gallstones - expansion of marrow space, increased reticulocyte count

Question 31

What percent of iron is stored in hemoglobin?

Answer 31

65%

Question 32

Anemias associated with decreased production of RBCs

Answer 32

1. Lack of Iron, Folate, B12 2. Low levels of EPO, thyroid hormones, androgens - renal disease 3. Nought enough heme rings on globin chains 4. Bone marrow dysfunction 5. Infiltrative disease of bone marrow

Question 33

What nutritional deficiencies can lead to anemia?

Answer 33

Iron, B12, Folate

Question 34

What population is Iron deficiency anemia most commonly seen?

Answer 34

- Women of child bearing age as a manifestation of hemorrhage - 4-8% of premenopausal women - GI neoplasm with GI bleeds- may remain undetected for a while

Question 35

Dietary lifestyles leading to iron deficiency anemia

Answer 35

1- vegetarians 2-Old people 3- Picca

Question 36

Pernicious anemia

Answer 36

-Vit. B12

Question 37

Sources of dietary Vit. B 12

Answer 37

Meat/Dairy

Question 38

Causes of pernicious anemia

Answer 38

- Vegan lifestyle (70% of vegans B12 deficient) | - GI malabsorption (chronic atrophic gastritis)

Question 39

Most common symptom of Vit. B12 deficiency

Answer 39

loss of proprioception - will also see paresthesia and eventually dementia - Due to demylenation of posterior columns of the spinal cord

Question 40

Anemia in the elderly

Answer 40

- While common is still ABNORMAL - do not have a lower normal range - increased risk for mortality

Question 41

Polycythemia

Answer 41

Too many RBCs - Factor intrinsic to RBC precursors - Functional hypoxia

Question 42

Hematocrit greater than what % can be life threatening and why?

Answer 42

60% due to the increased blood viscosity

Question 43

Polycythemic patients should be monitored for what condition?

Answer 43

Thrombus formation | -Should be on VTE prophylaxis

Question 44

Increased reticulocytes in the presence of normal CBC is indicative of what RBC disorder?

Answer 44

Polycythemia Vera