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ANAP 520 > Test 2 RBC, Hgb, Iron Metab, O2 Tx > Flashcards

Test 2 RBC, Hgb, Iron Metab, O2 Tx Flashcards

1
Q

Blood is ____% of total body weight, divided into __________ (55%) and __________(45%).

A

8% of tbw

Plasma 55%
Formed elements 45%

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2
Q

Plasma is divided into:
Proteins _____%
Water ______%
Other solutes ___%

A

Proteins 7%
Water 91%
Other solutes 2%

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3
Q

Most abundant protein in plasma?

A

Albumin 58%

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4
Q

Other proteins in plasma besides albumin?

A

Globulins 38%

Fibrinogen 4%

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5
Q

3 things that make up formed elements in blood

A

Platelets
WBC
RBC

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6
Q

Formed elements mainly constitutes _______, normal value ~45%

A

Hgb

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7
Q

A cubic mm is the same as what?

A

Microliter

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8
Q

Transports oxygen via iron in hgb from alveoli of lungs to cells

A

RBC fxn

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9
Q

RBC transport _________ from cells to alveoli of lungs for exhalation

A

CO2

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10
Q

CO2 is partially dissolved in ________ of RBC’s and partially bound with ______

A

Cytoplasm

Hgb

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11
Q

RBC contain this enzyme that plays a role in CO2 transport and regulation of acid-base balance.

A

Carbonic anhydrase (CA)

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12
Q

Normally the formation of carbonic acid is very _______, CA makes the process 5 x’s faster

A

Slow

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13
Q

Formula involving CA and CO2 tx.

A

CO2+H2O
H2CO3
H+ + HCO3-

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14
Q

This serves as a very powerful acid-base buffer to regulate pH of body fluids

A

Hgb

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15
Q

How does hgb regulate pH of body fluids?

A

And AA in the globin portion of the hgb can bind with H+ ions; release or bind when pH indicates.

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16
Q

What 2 things does an anemic pts have a decreased ability to do?

A

Decreased ability to tx O2

Decreased ability to regulate acid-base balance

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17
Q

What drives the CA equation and the direction it takes?

A

Concentration of the reactants

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18
Q

2 reasons men have higher RBC count than women

A

Testosterone levels favor bone marrow production of RBC

Menses

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19
Q

Normal H/H levels

A

Hgb: 12-18 gm/dl

Hct: 38-52%

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20
Q

Each ______ of hgb can combine with and transport _______ mL of O2

A

Gram

1.34 mL of o2

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21
Q

Production of RBC’s during prenatal period

A

Liver, spleen, lymph nodes

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22
Q

Production of RBC from birth-about 5 years

A

Shifts to all bone marrow

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23
Q

After about 20 years production of RBC is primarily where?

A

Bone marrow of proximal humerus and tibia, vertebrae, sternum and ilium

Mainly ilium!!

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24
Q

When doing anesthetic for bone marrow extraction, it is important to give plenty _________

A

Narcotics

Very painful procedures

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25
Q

Common ancestor of formed elements of RBC’s

A

Stem cell (pleura-potential hematopoietic stem cell)

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26
Q

First cell identified as belonging to RBC lineage

A

Proerythroblast

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27
Q

Formation of RBC from proerythroblast to RBC

A 
Proerythro 
Early erythroblast
Intermediate erythroblast
Late erythroblast
Reticulocyte
RBC
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28
Q

When is the nucleus extruded from the RBC

A

Between late erythroblast to reticulocyte

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29
Q

Blood cell can no longer replicate when?

A

When nucleus extruded

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30
Q

Rbc do not have mitochondria, how do they produce ATP?

A

Anerobic metabolism/glycolysis

Gross 4 ATP,. Net 2 ATP

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31
Q

Why do rbc not participate in oxidative metabolism

A

They would use the O2 up themselves and not give to the rest of the body

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32
Q

RBC do not have this, so they cannot produce enzymes

A

Endoplasmic reticulum

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33
Q

All the enzymes in RBC will be developed in the ___________ in earlier stages of development

A

Bone marrow

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34
Q

Point at which rbc moves from the bone marrow to the circulation

A

When becomes reticulocyte

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35
Q

This makes reticulocytes more predisposed to lysis than mature RBC

A

Larger size

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36
Q

Normal % of reticulocytes in the blood

A

1-3%

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37
Q

What could cause increased reticulocyte count?

A

Hemorrhage

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38
Q

Getting a reticulocyte count can be helpful in assessing treatment of anemia. TRUE/FALSE

A

TRUE

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39
Q

Shape of rbc

A

Biconcave disc; pliable

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40
Q

Principal factor that stimulates bone marrow RBC production

A

EPO

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41
Q

90% of EPO is produced by __________ cells of the kidneys

A

Peritubular epithelial cells

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42
Q

EPO is produced in response to __________ of the cells that secrete EPO

A

Hypoxia

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43
Q

These can cause hypoxia but are not what increases EPO secretion

A

RBC count
Hgb conc
Hct

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44
Q

EPO stimulates ________ and causes them to proceed through further stages of development more rapidly.

A

Proerythroblasts

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45
Q

EPO increases rate at which reticulocytes move from the _________ to _________

A

Bone marrow to circulating blood

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46
Q

With EPO secretion, there is initial increase in percentage of ________, then ________ will increase

A

Initial increase of reticulocyte

Then mature RBC count, H/H

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47
Q

As RBC’s increase and hypoxia decreased, ______________ will decrease amount of EPO secretion

A

Negative feedback

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48
Q

Maturation factors essential for RBC DNA synthesis and normal RBC maturation

A 
Vit B12 (cobalamin)
Folic acid (folate)
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49
Q

If you have insufficient Vit B12 and/or insufficient folic acid, you have RBC _________ failure and abnormally _______ RBC’s (_______ or ________)

A

Maturation failure

Abnormally large RBC

Megaloblasts or macrocytes

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50
Q

What types of anemia can you have with vit B12 deficiency?

A

Megaloblastic
Macrocytic
Pernicious

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51
Q

Both vit B12 and folate def anemias cause abnormal oxygen transport and easy hemolysis. TRUE/FALSE.

A

TRUE

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52
Q

Vit B12 extrinsic factor must bind with intrinsic factor, secreted by the ________ cells; vit B12 bound with intrinsic factor is absorbed from the ______

A

Secreted from gastric parietal cells

Absorbed from ileum

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53
Q

Causes of vit B12 def (5)

A

Inadequate dietary intake

Atrophy of gastric mucosa and inadequate intrinsic factor

Gastric bypass or gastric reduction operations

Small bowel resection, esp. of ileum

Malabsorption syndromes of small bowel

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54
Q

Who is at risk of inadequate dietary intake of B12

A

Vegetarians

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55
Q

Why des gastric bypass and gastric reduction sx’s put you at risk for vit b12 def

A

Decreases amount of intrinsic factor being secreted

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56
Q

What causes folic acid deficiency and anemia?

A

Usually inadequate dietary intake

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57
Q

A hgb molecule contains ___ AA chains, 2 _____ and 2_____ chains

A

4 AA chains
2 alpha
2 beta

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58
Q

AA chains are the _____ portion of hgb; each ends in a ______ with iron in the middle; this is where O2 binds.

A

Globin portion

Heme

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59
Q

Hgb combines with O2 at this level

A

Alveolar-capillary level

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60
Q

Hgb releases O2 at this level

A

Capillary-tissue level

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61
Q

The iron in hgb combines loosely and reversible with O2. TRUE/FALSE

A

TRUE

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62
Q

Iron in the non-oxidized form that is able to release O2 to cells

A

Fe++

FERROUS form

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63
Q

Oxidized form of iron that cannon release O2 to cells

A

Fe+++

Ferric form

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64
Q

Type of anemia when iron in the heme portion is oxidized in the ferric form

A

Methemoglobinemia

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65
Q

Each Fe++ can combine with ____ Oxygen molecule (O2)

A

One

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66
Q

Since a Hgb molecule contains 4 ____, each hgb molecule can combine with 4 _______ of O2 or _____ atoms of oxygen.

A

Molecule has 4 Fe++

Hgb molecule combines with 4 molecules of O2 or 8 atoms of O2

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67
Q

Drugs that cause MetHb

A 
Prilocaine
Lidocaine (large amount)
Benzocaine (cetacaine)
Nitroglycerine, sodium nitroprusside
Phenytoin
Sulfonamides
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68
Q

How does prilocaine cause MetHb?

A

Generates Ortho-toluidine which oxidizes hemoglobin

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69
Q

Lidocaine in large amounts can cause MetHb, how many mg?

A

~600 mg

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70
Q

When can nitroglycerine or sodium nitroprusside cause MetHb?

A

Prolonged administration or hepatic/renal failure

71
Q

With MetHb, you will have low ______ in the setting of a normal _________.

A

Low SPO2

Normal arterial PO2

72
Q

Measures O2 dissolved in the plasma portion of blood

A

PO2

73
Q

Why will you have low SPO2 reading?

A

Oxyhemoglobin, will not pick up ferric form

74
Q

Color of arterial blood with MetHb

A

Chocolate, dark-red, brownish to blue

75
Q

Can have ______ urine with MetHb

A

Brown

76
Q

How can we diagnose MetHb?

A

Direct measurement of MetHb by co-oximetry (normal <2-3%)

Clinical cyanosis in the presence of normal arterial PaO2

Pulse ox: sats will hover around 85% regardless of intervention

77
Q

Asymptomatic with MetHb level

A

<20%

Discontinuation of the offending agent
No other therapy

78
Q

Symptomatic or a MetHb level of >__%

Treatment??

A

> 20%

Methylene blue (first line treatment) 1-2 mg/kg IV over 5 min

Blood transfusion

Hyperbaric oxygen

79
Q

Dose for methylene blue tx of MetHb

A

1-2mg/kg IV over 5 min

80
Q

How does methylene blue treat metHb?

A

Reverses ferric form back to ferrous form of iron

81
Q

Lab taken in adults that measures a component of hgb that will bind to glucose over time

A

HgbA1c

82
Q

HgbA1c is indicative of avg blood glucose over about _______ weeks

A

6-8

83
Q

Tissues where iron is store

A

Liver

Spleen

84
Q

storage form of iron; easily released as free iron

A

Ferritin

85
Q

When ferritin is saturated, iron is stored as this; very hard to convert back into free iron

A

Hemosiderin

86
Q

Iron deposits seen in skin; can be from massive blood transfusions

A

Hemosiderosis

87
Q

When iron is absorbed, binds with ____________, the transport form of iron; most readily available pool of iron to be used by bone marrow for EPO

A

Trasferrin

88
Q

Protein synthesized in the liver; storage form of iron

A

Ferritin

89
Q

Fe++ is easily absorbed by the small intestine. TRUE/FALSE.

A

FALSE.

Poorly absorbed

90
Q

Fe++ is absorbed from the small intestine into the ______ first and stored as trasferrin; readily available for hgb and tissues.

A

Plasma

91
Q

Fe is excreted ____mg daily, by ______ and ______.

A

0.6 mg daily

Menses and stool

92
Q

How is free iron utilized in the tissues?

A

Stored as ferritin

Stored as hemosiderin

Heme

Enzymes

93
Q

Phagocytose RBC, degrade hgb into bilirubin and free iron

A

Macrophages

94
Q

Macrophages break down RBC into ______ portion and ________.

A

Heme

Globin

95
Q

Further Broken down in to AA and returned to the AA pool of the body

A

Globin portion of hgb

96
Q

______ can be released from the heme portion and be returned to the bone marrow to be incorporated into new RBC, or transferred to storage sites such as the ______ and ______.

A

Heme

Liver and spleen

97
Q

The rest of the heme (besides iron) is converted to _______, then to bilirubin, then to free or ________ bilirubin and transferred to the liver.

A

Biliverdin

Unconjugated

98
Q

Free bilirubin is _______ by the liver and released into the _____ and transported through the GI tract and excreted.

A

Conjugated

Bile

99
Q

Some bilirubin will be absorbed from the intestines into the blood and excreted by the kidneys; this is what gives color to what two things excreted from the body?

A

Brown to poop

Yellow to pee

100
Q

What is important to know if bilirubin level is elevated?

A

Whether it is conjugated or unconjugated

101
Q

Elevated Free bilirubin could be caused by what?

A

Anemias where RBC are hemolyzing faster than liver can conjugate it (most common)

Very diseased liver

102
Q

Obstruction to the bile duct or any other obstruction in the liver will cause elevated ________ bilirubin levels

A

Conjugated

103
Q

~_____% of oxygen is dissolved in the plasma of arterial blood (ABG)

A

~2-3%

104
Q

Component from which PaO2 is measure for arterial blood gases

A

~2-3% of O2 dissolved in the plasma of the arterial blood

105
Q

ABG measurement of O2 may or may not represent amount of oxygen transported to cells and released to cells. TRUE/FALSE

A

TRUE

106
Q

~______% of O2 combines with Fe++ on hgb in RBC’s

A

97-98%

107
Q

Decreased RBC count and decreased hgb will decrease oxygen ______

A

Transport

108
Q

PO2 on venous end of pulmonary capillary is ____; PO2 in alveolus is _____

A

Venous 40

Alveolus 104

109
Q

Based on partial pressure gradient O2 will move how at the venous end of pulmonary capillary?

A

O2 will move from alveoli to pulmonary capillary

110
Q

PCO2 at pulmonary capillary and alveolus at venous end of capillary

A

Alveolar PcO2 40

Capillary PCO2 45

111
Q

Arterial side of pulmonary capillary; what are the PO2 levels and PCO2 levels for the blood and the alveolus?

A

Alveolus
Po2: 104
PCO2: 40

Blood
Po2: 104
PCO2: 40

112
Q

As blood approaches left side of heart PO2 drops from 104 to ____. Why?

A

95

Bronchial circulation

113
Q

When blood reaches left atrium Po2 will probably decrease even further, why?

A

Thebesian veins

114
Q

At the tissue capillary what are the PO2 and PCO2 levels at the arterial side of the blood, tissue and interstitium?

A

Blood:
PO2: 95
PCO2: 40

Interstitium
Po2: 40
PCO2: 45

Tissue:
Po2: 20
PCO2: 46

115
Q

PO2 and pco2 levels at venous side of tissue capillary of the blood and interstitium

A

Blood:
Po2: 40
PCO2: 45

Interstitium:
Po2: 40
PCO2: 45

116
Q

Depicts relationship between Po2 and saturation of hemoglobin with o2 of affinity of hgb for o2

A

Oxyhemoglobin dissociation curve

117
Q

HIGH/LOW po2: affinity of hgb for O2 is high; e.g., pulmonary capillaries

A

High po2

118
Q

HIGH/LOW PO2: affinity of hgb for o2 is low; e.g., tissue capillaries

A

Low po2

119
Q

What PO2 is when O2 sat is 50%; about _____ mmhg

A

P50

~27mmHg

120
Q

If P50 is <27, what shift do you have in the curve?

A

Left shift

121
Q

Is P50 is >27, what type of shift is present?

A

Right shift

122
Q

Po2 in the tissue at rest is about __ mmHg; oxygen released to the tissues at rest is about ___%

A

40mmHg

23%

123
Q

Oxyhgb dissociation curve during exercise; % of O2 released to tissues?

A

73%

25% remains in the blood

124
Q

Shift of oxyhgb curve to the right = ________ affinity of hgb for O2; for a given Po2, % O2 sat is LESS/MORE than expected.

A

Decreased

Less than expected

125
Q

Changes in pH, CO2, temp, and 2,3 DPG with righward shift?

A

Decreased pH
Increased CO2
Increased temperature
Increased 2,3 DPG

126
Q

Oxyhgb curve shift up and to the left = ________ affinity of hgb for O2; for a given PO2, %O2 sat is HIGHER/LOWER than expected

A

Increased affinity

Higher than expected

127
Q

Changed in pH, CO2, temp and 2,3 DPG associated with leftward shift

A

Increased pH
Decreased CO2
Decreased temp
Decreased 2,3 DPG

128
Q

How do opioid shift he oxyhgb curve and why?

A

Rightward shift

Hypoventilation and increased CO2, decreased affinity of O2 for hgb

129
Q

Normal physiologic shifting of oxyhgb dissociation curve; how CO2 affects transport of O2.

A

Bohr effect

130
Q

Bohr effect at alveolar-capillary interface

A

CO2 diffuses out of the capillary

blood becomes more alkaline

3% shift to the left

Favors O2 affinity for hemoglobin

131
Q

Bohr effect at the capillary-cell interface

A

CO2 diffuses into the blood

Blood becomes more acidic

3% shift to the right

Favors O2 release to cells

132
Q

How O2 affects transport of CO2

A

Haldane effect

133
Q

Haldane effect at alveolar capillary interface

A

O2 diffuses into the blood (RBC)

Displaces CO2 from hgb

CO2 can be exhaled from lungs

134
Q

Haldane effect at capillary- cellular interface

A

O2 diffuses into cells

Frees up hgb for CO2 binging

Allows for CO2 transport

135
Q

At capillary-tissue interphase; release of CO2 from cells into blood; phase ____ of CO2 tx.

A

Phase 1 of CO2 transport

136
Q

At alveolar-capillary interphase, release of CO2 from the blood into the alveoli to be expelled; phase ____ of CO2 transport

A

Phase 2

137
Q

Body cells generate CO2 from ______

A

Metabolism

138
Q

CO2 is transported from cells, across capillary wall and into capillary; 5% dissolves in ______ as free CO2, and 95% enters ______

A

Plasma

RBC

139
Q

Of the 95% of CO2 that enters the rbc, what happens after in the cell first?

A

Small amount of CO2 dissolves in intracellular water

30% of CO2 bings with hgb to produce carbamino hgb

65% reacts with water to form carbonic acid

140
Q

After CO2 reacts with water to form carbonic acid, carbonic acid dissociated to form ______ and _______

A

Bicarbonate (hco3-)

Hydrogen ions

141
Q

What happens to the H+ ions after carbonic acid dissociates in the rbc?

A

Immediately buffered and carried by globin portion of hgb

142
Q

When carbonic acid dissociates in the rbc, the bicarb conc increases; some diffuses into _______, and _______diffuses from plasma into the rbc; what is this called?

A

Plasma

Chloride

(Phase 1) Chloride shift or “Hamburger shift”

143
Q

What is the purpose of the hamburger shift?

A

Anion for anion to maintain electric neutrality

144
Q

During phase 2 of CO2 transport, what happens to the 5% of free CO2 in the plasma?

A

Diffuses into alveoli and is exhaled

145
Q

In phase 2 of CO2 tx, CO2 is released from _____ as oxygen diffuses into the RBC

A

Hgb

146
Q

After CO2 is released from rbc in phase 2 of CO2 tx, it diffuses into the _______ to be exhaled; this is ___% of the CO2.

A

Alveoli

30%

147
Q

When oxygen combines with hgb, it displaces _____

A

H+

148
Q

The H+ that is displaced from hgb recombined with ______ for form carbonic acid which separates into _____ and _____.

A

Hco3-

CO2 and h2o

149
Q

What happens to the CO2 and H20 from the dissociation of carbonic acid in phase 2 of CO2 tx? This CO2 is the ____% from phase 1.

A

Diffuse from the rbc through the plasma into the alveoli to be exhaled

65%

150
Q

As hco3- decreases in phase 2 of CO2 tx, bc of the recombination with H+, hco3- moves into the ____ from the ______, and ________ shifts from the rbc back into the plasma; this is phase 2 of the ________ shift.

A

Hco3 moves into the RBC

From the PLASMA

CHLORIDE

Phase 2 of chloride shift

151
Q

The majority (65%) of CO2 is transported in the blood as _______

A

Bicarb

152
Q

Why do we see water and CO2 levels after intubation and correct tube placement?

A

Dissociation of carbonic acid in phase 2 of CO2 tx into CO2 and water

153
Q

Average volume/size of RBC; femtoliters (fl)

A

Mean corpuscular volume (MCV)

154
Q

Average amount of hgb; picograms

A

Mean corpuscular hgb

MCH

155
Q

How concentrated is RBC with hgb

A

Mean corpuscular hgb concentration

MCHC

156
Q

Variability in the size of RBC

A

Red cell distribution width (RDW)

157
Q

If MCV stayed the same and MCH increased, then this lab value would increase.

A

MCHC

158
Q

What could cause an increase in RDW?

A

Lots of reticulocytes

159
Q

Normal serum iron level

A

50-150 micrograms/dl

160
Q

Total iron binding capacity level (TIBC)

A

250-450 micrograms/dl

161
Q

Serum ferritin levels?

A

20-300 ng/ml

162
Q

Serum ferritin is the storage form of iron; acute phase protein. What will increase serum ferritin and what adjunct test can we use to see if elevated serum ferritin levels are accurate?

A

Any illness/infection/inflammation will increase serum ferritin sevens

C-reactive protein

163
Q

Normal percentage transferrin saturation

A

~30%

164
Q

Formula to calculate percentage transferrin saturation

A

Serum iron/TIBC x 100

165
Q

Inflammatory protein; assesses presence of inflammation/infection and accuracy of serum ferritin as a reflection of iron stores

A

C-reactive protein

166
Q

Normal RBC size term

A

Normocytic

167
Q

Normal RBC hgb content term

A

Normochromic

168
Q 
Anemia type?
Low H/H
Low reticulocyte
High MCV
High plasma iron
Normal TIBC
High serum ferritin 
Low serum B12
Folate normal
Sl. High bilirubin
A

Pernicious anemia

B12 deficiency

169
Q

Which type of anemia is more prone to hemolysis, B12 def or folate def?

A

B12 deficiency anemia

170
Q 
Anemia type?
Low H/H
Low reticulocytes
High Mcv 
High plasma iron
Normal TIBC
Normal serum ferritin
Normal B12
Low folate
Sl. High bilirubin
A

Folate def. anemia

171
Q 
Type of anemia: 
Low H/H
Normal, high, or low reticulocytes
Low MCV
Low plasma iron
High TIBC
Low serum ferritin
Normal: b12, folate and bilirubin
A

Iron deficiency anemia

172
Q

Type of anemia?
Low H/H
High reticulocyte count
NORMAL: MCV, plasma iron, TIBC, serum ferritin, b12, folate, bilirubin

A

Posthemorrhagic anemia

173
Q 
Type of anemia?
Low h/h
High reticulocytes
Normal or high MCV
Normal/high plasma iron
Normal: TIBC, Serum ferritin, b12, folate
High bilirubin
A

Hemolytic anemia

ANAP 520 (6 decks)

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