Test 2

Hct levels

-can be used to assess a person's fluid status and how well they are responding to fluid replacement treatment. -often ordered with a hemoglobin test ("H & H")to verify accuracy of the Hct. If BOTH the Hct and the Hgb are decreased = blood loss.

Folate (B-9)

Also called Folic Acid, this key element is an integral part of cell growth, especially RBCs. Deficiencies during pregnancy can cause birth defects of baby's brain and spine. Low Folate levels are caused by: 1 -Overcooking or eating too few vegetables may cause a folate deficiency 2 -Other: Pregnancy, medications, alcohol abuse, intestinal diseases

Idiopathic Thrombocytopenia Purpura ITP :

Autoimmune disorder that causes an IgG antibody to bind with platelets, destroying their function. Results in low platelet count and s/s of bleeding. [Definition of IDIOPATHIC: arising spontaneously or from an obscure or unknown cause].

Non-Hodgkin's Lymphoma

B and T -lymphocytes > 50 years old(95% are adults) cervical, axillary, inguinal, femoral Extra-nodal Involvement Common Painless swollen lymph nodes Fever and night sweats, Generalized weakness Weight loss Bone Marrow damage (blood dyscrasias)•Pleural effusion •Abdominal pain• Splenomegaly Curability less than 25% Same GENERAL treatments as Hodgkin's disease but specific chemo and drugs are different

Hodgkin's Lymphoma

B-Cell lymphocytes, Reed-Sternberg Cells present 20-30years old(more common in younger population)and 60-70 years old Cervical, inguinal, axillary, and Retroperitoneal Extra-nodal Involvement Uncommon Painless swollen lymph nodes Fever and night sweats, Generalized weakness Weight loss Bone Marrow damage (blood dyscrasias) Curability Approximately 90% Radiation therapy -localized Chemotherapy -generalized Immunotherapy (MAB drugs)Bone marrow [stem cell] transplant

Lymphomas

Blood cancer that affects the lymphatic system-causes an overproduction of malfunctioning lymphocytes. This overload compromises the immune system. Lymphoma can develop in many parts of the body, including lymph nodes, bone marrow, blood, spleen, and other organs.

Multiple Myeloma SIGNS AND SYMPTOMS:

Calcium ⬆in blood(Hypercalcemia)due to calcium moving from damaged bone into the blood. •Renal Failure (Myeloma nephrosis)caused by damage to kidneys by paraproteins(that cause hyper viscosity of body fluids) -a distinctive feature of Myeloma. Tumor markers are -"M-proteins"(found in serum) and "Bence-Jones protein"(found in urine) •ANEMIA-BM not functioning AND kidney not producing Erythropoietin →s/s of blood dyscrasias. •Bone pain(1stsymptom) and pathological fractures [occur spontaneously w/o an injury].

Leukemias

Cancer of WHITE Blood Cells*

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance?

Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection. Although diet, reduced stress, and rest are valued in supporting health, the potentially fatal consequence of an acute infection places it as a priority for teaching the client about health maintenance. Animal meat and dark green leafy vegetables, good sources of vitamin B12 and folic acid, should be included in the daily diet. Yoga and meditation are good complimentary therapies to reduce stress. Eight hours of rest and naps are good for spacing and pacing activity and rest.

Anemia due to excessive RBC destruction

"Hemolytic Anemias" -RBCs die quicker than the bone marrow can replace them. Causes can be "Intrinsic" (inherited defective RBCs) or "Extrinsic" (everything else). -Inherited-sickle cell [also due to "faulty production"-#3 below] & thalassemia -Stressors-Infections, drugs, snake, or spider venom, etc. -Toxins-advanced liver or kidney disease -Autoimmune-Antibody mediated. Lupus; cancer; Rh factor; drugs -Spleen-blood moves more slowly thru an enlarged spleen, causing RBCs to become prematurely destroyed before they get through the spleen.

S/s of Iron Deficiency Anemia:

"lightheaded", dizzy, stomatitis, difficulty swallowing, headache, confusion, memory loss

White Blood Count

(Total WBC) 5,000 -10,000 (per microliter of blood)

Sickle cell anemia

(an autosomal recessive defect of hemoglobin)is the most common inherited blood disorder in the United States. Individuals with the single defective gene have sickle cell "TRAIT" [SCT] while those with 2 defective genes have sickle cell "DISEASE" [SCD]. SC Anemia is predominant in those of African descent(1 in 13 Black or African American babies is born with sickle cell trait; every 1 in 365 Black or African American births have SCD)and those of Mediterranean ancestry. SCD is diagnosed at birth with Newborn screens or through amniocentesis.

Total WBC Count Differential Values: Neutrophils: Lymphocytes

-5,000 -10,000 -47 -63% -24 -40%

Other conditions associated with decreased or faulty RBCs

-Advanced kidney disease-See KIDNEY CONNECTION below* -Hypothyroidism-causes lowered iron levels in the blood -Chronic diseases-INFLAMMATION causes production of cytokines that then destroy all blood cells including erythrocytes. EXAMPLES: cancer, infection, autoimmune disorders (i.e., lupus or rheumatoid arthritis).

Red blood cell count is decreased for the following reasons : Anemia

-Anemias -Hemolysis -Chronic renal failure -Hemorrhage -Failure of marrow production

Red blood cell count is elevated for the following reasons : Polycythemia

-Cardiovascular disease -Stress -Polycythemia vera -Smokers -High altitude -Hemoconcentration and dehydration -Renal cell carcinoma and other erythropoieten-producing neoplasms

Anemia due to blood loss

-Gastrointestinal (GI) Conditions -upper or lower GI bleeds -NSAID overuse (Risk factor: Patients with chronic pain) -Excessive menstruation or childbirth complications

Clinical manifestations common to ALL anemias

-Low hemoglobin & hematocrit levels in addition to reduced RBC's-Plasma expansion→ "watery" blood, i.e., less viscous blood. This causes more turbulent blood flow, and "pale" look of blood.

Anemia due to decreased or faulty RBC production

-Nutritional Deficiencies: (Iron, Vitamin B-12, and Folate are necessary components of RBC production) -Bone marrow & Stem cell problems: Leukemia and lymphoma are examples. Also, aplastic anemia, osteomyelitis, etc. -Sickle Cell Anemia

All Blood Components originate in the bone marrow. Bone marrow stem cells differentiate into one of the following blood cells

-Red blood cell(erythrocytes) -White blood cell(leukocytes) - Platelet(thrombocytes)

LOCAL SYSTEMIC ACUTE CHRONIC

-S.H.A.R.P. -Increased WBC, CRP, or Fever/chills -Resolves completely -Exacerbations & Remissions

WBC lab tests

-WBC count -WBC differential

Vitamin B-12

Cobalamin[Vitamin B-12] is a necessary vitamin required to make RBCs. Vitamin B12is used to treat many conditions which include: memory loss; Alzheimer's disease; boosting mood, energy, concentration and the immune system; and slowing aging. It is also used for heart disease, lowering high homocysteine levels (which may contribute to heart disease), male infertility, diabetes, sleep disorders, depression, mental disorders, weak bones (osteoporosis), swollen tendons, AIDS, inflammatory bowel disease, asthma, allergies, a skin disease called vitiligo, preventing cervical and other cancers, and skin infections

Aplastic Anemia

Destruction of bone marrow [BM]stem cells (affects ALL blood components). Damaged BM is diagnosed as either aplasticor hypoplastic —meaning that it's empty (aplastic) or contains very few blood cells (hypoplastic).Causes "pancytopenia" = ALL blood cells are depressed Aplastic anemia develops because of bone marrow damage. The damage may be present at birth or occur after exposure to radiation, chemotherapy, autoimmune disease, toxic chemicals, some drugs, or infection. Viruses that have been linked to the development of aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.

Multiple Myeloma Prognosis

Early diagnosis and treatment = 3-5 years survival. Late diagnosis and treatment = 50% of patients die within 3 months and 90% within 2 years

Which of the following blood components is decreased in anemia?

Erythrocytes

KIDNEY CONNECTION

Erythropoietin (made in kidneys) signals bone marrow to make more RBCs, so if kidneys are damaged, erythropoietin is not excreted, and RBCs are not made. NOTE: Erythropoietin injections[EPO]are given to patients with severe anemia caused by kidney failure or bone marrow failure (AIDS/blood or bone marrow cancers/aplastic anemia/chemotherapy).These injections increase RBC production and may eliminate the need for a blood transfusion.

Leukemia S/S:

Fatigue, low fever, night sweats, weight loss (none of these s/s are specific for leukemia). ➢Lymphadenopathy-Swelling lymph nodes. May swell without any other s/s or swell in random patterns. ➢Anemia, Infection, Bleeding problems(due to bone marrow damage that affects all blood cells) ➢Pallor-malignant leukocytes crowding the bone marrow and leading to decreased erythrocyte and thrombocyte production(causing a pale skin color).

The nurse would instruct the client to eat which of the following foods to obtain the best supply of Vit B12?

Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin C).

Leukocytes (WBCs)are found throughout the body, including the blood and lymphatic system. WBC's can be divided into 5 main types:

Granulocytes:[all end in "phil"]1. Neutrophils-↑'d in ACUTE bacterial infection2. Eosinophils-↑'d Allergyattacks3. Basophils-↑'d during Stress/Allergy Agranulocytes: [all end in "cytes"]4.Lymphocytes-↑'d in CHRONIC bacterial or viral infection. •T-cells[Killer, Helper, Suppressor, Memory, etc.].•B-cells[antibodies]5. Monocytes-Non-specific phagocytes that can become macrophages when needed to fight infection in tissue. Associated Organs: Bone Marrow, Thymus, Spleen

The only way to deliver O2to tissues is for hemoglobin(found in RBCs) to bind to red blood cells and go through gas exchange in the lungs. When there are not enough red blood cells, tissues develop _____________. When hemoglobin formation is defective, the hemoglobin molecule may not be able to bind O2or even survive. This results in various forms of anemia.

HYPOXIA

Thrombocytopenia Treatment:

Immunosuppression Treatments (Treatment for TTP) •Plasmapheresis* (Treatment for TTP) •Eliminate the causative drug •Platelet infusion

Associated Organ for platelets

LIVER -Platelet production is regulated by THROMBOPOIETIN (A hormone produced in the liver) In general, a low platelet count occurs because:1.The body's bone marrow doesn't make enough platelets.2.The bone marrow makes enough platelets, but the body destroys them or uses them up.3.The spleen holds on to too many platelets.

The 3 general types of blood cancers are:

Leukemias, Lymphomas, and Multiple Myelomas

CANCERS Affecting WBCs

Leukemias, Lymphomas, and Multiple Myelomas are all cancers of the blood-forming organs. They arise due to errors in the genetic information of an immature blood cell. Because of these errors, the cell's development is arrested so that it does not mature further, but is instead replicated over and over again, resulting in a proliferation of abnormal blood cells. Nearly every stage of the hematopoietic process can give rise to a distinct type of cancer.

Red blood cell indices-

MCV=Mean corpuscular volume→ measurement of the average size of RBCs. ▪MCH= Mean corpuscular hemoglobin→ calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell. ▪MCHC=Mean corpuscular hemoglobin concentration (MCHC)→calculation of the average percentage of hemoglobin inside a red cell. ▪RDW=Red cell distribution width (RDW)→calculation of the variation in the size of RBCs.

Leukemia

Malignant growth of leukocytes → Over-production of nonfunctioning white blood cells in the bone marrow that grows faster than the functioning cells. Eventually the leukemia cells crowd out all the functioning blood cells in the bone marrow which leads to the various s/s of leukemia(anemia, infections, and bleeding problems).

MCHC

Mean corpuscular hemoglobin concentration (MCHC)→ calculation of the average percentage of hemoglobin inside a red cell.

MCH

Mean corpuscular hemoglobin→ calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell.

MCV

Mean corpuscular volume→ measurement of the average size of RBCs.

Aplastic Anemia Treatment

Medications, blood transfusions, and stem-cell transplants.

Which of the following would be expected with hemoglobin of 10 g/dl?

Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.

Iron Replacement:

Mineral supplements/ Iron injections; Foods-soybeans, lentils and beans, red meat, chicken, turkey, eggs, lentils, fish, fortified foods, cereals

Iron

Most common nutritional deficiency Bone marrow needs iron to make hemoglobin. Iron deficiencies are caused by lack of iron in the diet or by blood loss.Examples:1-Metabolic demands of pregnancy and breastfeeding2-Blood loss through excessive menstruation, childbirth, or blood3-Digestive conditions (Crohn's) OR removal of stomach/small intestines4-Medications, excess caffeine

Anemias

NOT ENOUGH RBC's There are more than 400 types of anemias, which are divided into three groups: 1) Anemia caused by blood loss. 2) Anemia caused by decreased or faulty red blood cell production. 3) Anemia caused by destruction of red blood cells.

POLYCYTHEMIA treatment

Periodic phlebotomy i.e. "blood-letting" to siphon off some excess blood! Also, O2, CPAP, aspirin to prevent blood clotting. Radioactive phosphate also used.

Which of the following nursing assessments is a late symptom of polycythemia vera?

Pruritus is a late symptom that results from abnormal histamine metabolism. Headache and dizziness are early symptoms from engorged veins. Shortness of breath is an early symptom from congested mucous membrane and ineffective gas exchange.

ABC Priorities:

Recognize that Sickle Cell Crisis is a "Circulation" issue

RDW

Red cell distribution width (RDW)→calculation of the variation in the size of RBCs.

POLYCYTHEMIA

Signs & symptoms: caused by reduced blood flow of viscous blood and clotting-Plethora: ruddy complexion; Fatigue; Dizziness; Headache. Thick blood increases workload on the heart →high B/P →decreased perfusion to the brain due to sluggish blood flow of thick blood.

Sickle cell anemia treatment

There are several drug therapies and bone marrow transplants available (with complications of rejection i.e. septicemia or Host vs Graft disease)

Thrombotic Thrombocytopenia Purpura TTP:

Thought to be caused by widespread endothelia damage that triggers thrombosis and platelet destruction. S/s are: Fever, hemolytic anemia, renal failure, neurologic decline.

Platelets

Thrombocytes cell fragments(not cells) that are vital for normal blood clotting. A person who does not have enough platelets may be at an increased risk of excessive bleeding and bruising. The CBC measures the number and size of platelets present. 150,000 -400,000

Causes of THROMBOCYTOPENIA

Thrombocytopenia (platelet count < 140,000) -REDUCED number of thrombocytes leading to impaired clotting ability. Idiopathic Thrombocytopenia Purpura ITP : Autoimmune disorder that causes an IgG antibody to bind with platelets, destroying their function. Results in low platelet count and s/s of bleeding. [Definition of IDIOPATHIC: arising spontaneously or from an obscure or unknown cause]. Thrombotic Thrombocytopenia Purpura TTP: Thought to be caused by widespread endothelia damage that triggers thrombosis and platelet destruction. S/s are: Fever, hemolytic anemia, renal failure, neurologic decline. Drug Induced THROMBOCYTOPENIA: A hypersensitivity reaction causes platelet destruction. Heparin can induce a Type III Hypersensitivity reaction that can quickly be resolved after eliminating drug.

*Plasmapheresisis

a blood purification procedure used to treat several autoimmune diseases. Blood is removed from the body and spun in a centrifuge to filter out the plasma. The red blood cells are returned to the body, and the plasma may be treated and reintroduced, or replaced, depending on the condition which the plasmapheresis is designed to treat.

White blood cell (WBC) count

a count of the total number of white blood cells in a sample of blood.

Red blood cell indices

are calculations that provide information on the physical characteristics of the RBCs (MCV, MCH, MCHC, RDW-see box below). RBC Indices lab tests are used to determine if a person has ANEMIA(low red blood cells) and what type of anemia. (NOTE: you do not need to learn the lab values for these indices, just be able recognize that they are used to diagnose types of anemia).

Causes of Anemia

blood loss, decreased RBC production, excessive RBC destruction

Lymphoma

cancer originating in the lymphatic system (lymphocytes).

Myelomas

cancer that affects type of B-Cell[that make antibodies]

Multiple Myelomas

cancer that starts in a type of B-Cell Lymphocyte called plasma cells in the bone marrow. These are protein-making cells which normally make all the different kinds of proteins that comprise the antibodies[immunoglobulins] of the immune system.

Red blood cell (RBC)

count is a count of the actual number of RBCs in a person's sample of blood.

In MM, the bone marrow stops making different forms of

immunoglobulin proteins[IgG, IgA, etc.] and instead starts to produce a single abnormal type of protein referred to as a "monoclonal" or M protein. Collections of MM cells called plasmacytoma scan erode the hard outer shell or cortex of the bone that normally surrounds the marrow. These weakened bones show thinning of the bone such as is seen in nonmalignant osteoporosis or what or lytic ("punched out") bone lesions.

Nurses assess patients for anemia by checking

inside of person's mouth for pale colored mucosa and gums

Leukemia is classified by

its speed of progression and the type of cells involved. There are 4 main types of leukemia, based on whether they are acute or chronic, and myeloid or lymphocytic: Acute myeloid (or myelogenous) leukemia (AML) Chronic myeloid (or myelogenous) leukemia (CML) Acute lymphocytic (or lymphoblastic) leukemia (ALL), and Chronic lymphocytic leukemia (CLL).

A low Hct means patient is

losing blood (either internally or externally)

White blood cell differential

may or may not be included as part of the panel of tests. It identifies and counts the number of the various types of white blood cells present. The five types include neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The percentages of each type of WBC can give a clue about what the body is fighting.

Reticulocyte count

measures the absolute count or percentage of immaturered blood cells in blood(if elevated, it means that mature RBCs are depleted, and the body is now relying on immature RBCs).

Hemoglobin

measures the amountof the oxygen-carrying protein in the blood.Measured in grams.

Hematocrit.

measures the percentage of a person's blood that consists of red blood cells

Multiple Myelomas may cause

pain and pathological [spontaneous] fractures of the bones affected by the cancer. [NOTE: Myeloma is NOT leukemia].

Myelomas are classified by

the type of immunoglobulin being attacked. The myeloma proteins crowd out the normally functioning immunoglobulins, resulting in high levels of protein in blood. More common in men than women; develops after 40 years of age.

Polycythemia

too many RBC's >>> The opposite of anemia <<< Can cause hyper viscosity or thrombosis ➢Primary(Absolute)-Polycythemia vera is an inherited condition affecting primarily Caucasians with European Jewish ancestry. Onset of s/s could occur at any age but usually over 60 years. Mostly men.➢ Secondary(Relative)-physiologic response to chronic hypoxia that triggers the body to make more RBCs for oxygen transport in an effort to get more oxygen to the cells of the body.

Signs & symptoms of ThrombocytOPENIA

~ Epistaxis ~ Purpura ~GI Bleeds ~Menorrhagia~ Bleeding gums ~Petechiae

Platelet count is decreased in the following conditions: [thrombocytopenia]

•Autoimmune disorder •Medications such as aspirin, ibuprofen, acetaminophen (damages liver →bleeding problem) •"G" herbs (garlic, ginger, ginkoba, ginseng) •Chemotherapy/radiation•Cancers that damage the bone marrow (leukemia/lymphoma) •DIC (disseminated intravascular coagulation)

White blood cell count is elevated in the following conditions: [leukocytosis]

•Neutrophils →ACUTE bacterial infections •Lymphocytes →viral infection and/or CHRONIC bacterial infection •Eosinophils →allergies or parasitic infection.

Platelet count is Increased in the following conditions: [thrombocytosis]

•Some cancers •Inflammatory conditions •Birth control pills •Recovery phase of trauma/surgery

White blood cell count is decreased in the following conditions: [Leukopenia]

•Steroids (or medicines containing them, i.e., prednisone) •Chemotherapy •Bone marrow failure (aplastic anemia or cancer such as Leukemia,) •Use of Antiseizure medication such as Tegretol.

Drug Induced THROMBOCYTOPENIA:

A hypersensitivity reaction causes platelet destruction. Heparin can induce a Type III Hypersensitivity reaction that can quickly be resolved after eliminating drug.

THROMBOSIS Blood clots can occur in the arteries or veins

1. Abnormal blood flow 2. Injured vessel walls 3. Altered blood constituents

S/S OF BLEEDING:

1. Hemorrhage-Blood leaving the blood vessel (internal or external bleeding) 2.Menorrhagia-Heavier than normal menstrual bleeding 3.Epistaxis-Bleeding from the nose 4. Petechiae-pinpoint hemorrhages of small capillaries in the skin, conjunctiva of the eyes, or mucous membranes. 5. Purpura-red or purple discolorations on the skin that do not blanch on applying pressure. 6. Ecchymosis-Blood leaks into tissues under the skin causing bruising. 7. Hematoma-Collection of blood, usually clotted, in organs, body spaces or under the skin.

The first type of classification is by how fast the leukemia progresses:

1.Acute leukemia. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can't carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment. 2.Chronic leukemia. There are many types of chronic leukemias. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.

Low Vit B12 levels are caused by:

1.Dietary: Eating little or no meat may cause alack of B-12 2.Lack of Intrinsic Factor(IF): Intrinsic factor[a protein excreted by the stomach]is needed for Vitamin B12 absorption(B-12 is destroyed in gastric juices if not bound to Intrinsic Factor). If stomach/upper intestine is damaged or removed, Intrinsic factor is not secreted, so there is no absorption of Vit B-12. a. Conditions causing lack of I Fare Crohn's Disease, Gastric by-pass, Cancer b.** Requires lifelongB12 replacement injections **

S/S of anemia are a result of HYPOXIA(low oxygen levels in blood)

1.Fatigue (→decreased energy production) 2.Tachypnea(increased respiratory rate) 3.Tachycardia(increased heart rate to circulate red blood cells more freely) 4.Pallor(pale skin & mucous membranes caused by low hemoglobin or RBCs)

Aplastic Anemia S/S may develop slowly or suddenly

1.Fatigueand rapid heart rate (due to low RBCs) 2.Frequent infections (due to low WBCs) 3.Bleeding tendencies (due to low platelets)as evidenced by bleeding gums/nose bleeds/petechiae, easy bruising, heavy menstrual cycles, G.I. bleeding, etc.

TREATMENT: Nursing Consideration for treating all types of sickle cell CRISIS:

1.Give oxygen(to relieve hypoxia)2.IVfluids(to treat dehydration and prevent sickled cells sticking together) 3.PAIN MEDS(patient will develop painful clotting throughout the body and go into shock)NOTE the difference between S.C. Anemia and S. C. CRISIS !NOTE: SC crisis is one of the few times when pain is considered PHYSIOLOGICAL and not PSYCHSOCIAL on NCLEX

The second type of classification is by type of white blood cell affected:

1.Lymphocytic leukemia. This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system. 2.Myelogenous leukemia. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells.

CAUSES OF POLYCYTHEMIA

1.Sleep Apnea -Due to either Obstructive Sleep Apnea (airway "collapses" during sleep →blockage of air and snoring) or Central Sleep Apnea (the brain does not signal the lungs to breathe). Both types result in oxygen deprivation. 2.COPD -Chronic Obstructive Pulmonary Diseases [asthma and emphysema]that hamper gas exchange in the lungs. 3.Heart failure-reduces tissue profusion, which create hypoxic tissue even if the blood volume and concentrations are normal. The low oxygenation will trigger an increase in production of RBCs. 4.Pulmonary disease-gas exchange between lungs and vasculature may be impaired. The decrease in O2exchange will produce hypoxia and trigger an increase in production of RBCs. 5.High Altitude-body compensates for lower O2 levels at higher altitudes by making more RBCs to carry oxygen. Takes 6-8 weeks to build up enough erythrocytes.6.EPO (erythropoietin) shots -Example: "Blood doping" by athletes for performance enhancement or who abuse anabolic steroids.

3 types of sickle cell CRISIS can occur

1.Vaso-occlusive-occurs when the sickled red blood cells trigger the formation of blood clots within the circulation. Tissue damage is minor and can resolve within a week. Dehydration and infection are an initiating cause. More serious results can include-Stroke, Pulmonary infarction, Myocardial infarction, Gangrene. 2.Sequestration-When the sickled red blood cells are removed from the general circulation by the spleen. The severity depends on the amount of blood removed and held in the spleen and liver thereby reducing the amount of circulating red blood cells. Can produce hypovolemic shock. 3.Aplastic-Caused by exhaustion of the bone marrow. Erythropoiesis cannot keep up with the constant need to replace red blood cells. Sickled red blood cells have a lifespan of 10-20 days. This constant stress on bone marrow stems cells can eventually lead to bone marrow failure.

Hemoglobin

12 -16.5 (x 106/microliter of blood)

Platelets

150,000 -400,000 (per microliter of blood)

Lymphocytes

24% -40% (% of total WBCs)

Types of Vitamin Deficiency Anemia

3 vitamins/minerals that are required to produce RBC's, and therefore will cause an anemia if not available to the body in sufficient amounts. They are folate, Vit B12, and iron.

Red Cell Count (RBC)

3.6 -5.4 (x 106/microliter of blood)

Hematocrit

37 -50 %

Neutrophils

47% -63% (% of total WBCs)

Critical Low hematocrit

<15% →heart failure Low Hct is caused by FLUID OVERLOAD

Critical High hematocrit

>60% →blood clotting problems High Hct is caused by DEHYDRATION