Chapter 13
kidenys, RBCs, spleen, bilirubin
Erythropoietin, made in the ___, stimulates the bone marrow to produce ___. Eventually, RBCs break up in the capillaries of the ___, and their hemoglobin is processed as ___ in the liver.
sickling; prone
Hypoxia, which is more likely to occur in lung/pulmonary disease, is an important exacerbating factor associated with increased ___ and vessel occlusion so patients with sickle cell anemia who also suffer from lung diseases are more ___ to sickling
RBC
anemias from deficient ___ production: iron deficiency, megaloblastic, aplastic, chronic disease
erythropoiesis
making RBCs (make more if don't have enough oxygen like in hypoxemia)
true
Patients with sickle cell anemia who also suffer from lung diseases are more prone to sickling. True or false?
iron deficiency anemia
RBCs are paler, not as red bc doesnt have hemoglobin (which has a pigment) and not enough iron attaches to hemoglobin
c
Red blood cells (erythrocytes) are made in the ________ and destroyed in the _________. a. kidneys, liver b. kidneys, spleen c. bone marrow, spleen d. bone marrow, liver
liver; bilirubin
man with ___ failure develop jaundice bc if my liver doesn't work, i can't store ___ so have too much in the blood so then i'm jaundice
sickle cell anemia; inherited; common; reversibly; irreversible; African Americans
___ ___ ___ is a mutation that is ___; it's recessive; can be either heterozygous (much more ___ and not as many RBCs affected) or homozygous (worse prognosis); if ___ sickled - can give o2 and go back to normal blood cell but can only do this process so many times before it goes to ___ sickled; these cells make clots (sticking together); more common in ___ ___
sickle cell; chronic; capillaries; blood; any; pulmonary; stroke
___ ___ consequences: ___ hemolytic anemia (sickled cells more likely to be destroyed) - jaundice, pigment gallstones; sickled cells block ___ - acute pain, infarctions (no ___ flow) cause chronic damage to the liver, spleen, heart, kidneys, eyes, bones (basically ___ organ), ___ infarction --> acute chest syndrome (if occluding smaller blood vessels then shortness of breath, but if main blood vessel then dead), cerebral infarction --> ___; all these happen a little while after having sickle cell
absolute polycythemia; primary; bone marrow; secondary; hypoxia; common; thicker
___ ___ is increased RBCs; primary and secondary; ___ (polycythemia vera) - proliferative disease of ___ ___, mutation of making too many RBCs (rare); ___ - increased erythropoietin levels due to chronic ___, pretty ___, if i'm hypoxic then need more hemoglobin so need more RBCs; blood is ___ in this so high blood pressure
hemolytic anemia; hemoglobin; hemoglobinemia; urine; darker; straw; hemoglobin
___ ___ is when RBC destruction occurs in blood; ___ binds to haptoglobin and albumin; if too much hemoglobin: free hemoglobin in blood = ___ (makes plasma turn red) excreted in ___ = hemoglobinuria (makes urine ___ in color); if i have too much hemoglobin then it shows up in blood or urine; plasma is normally pale yellow like ___, turns red bc of pigmented hemoglobin; when RBCs are destroyed, so is ___ = anemic
hemolytic; RBCs; iron; reticulocytes; bone marrow; breath; lungs; heart; brain
___ anemias : premature destruction of ___ (aka before 120 days); retention of ___ (recycle it); compensatory increase in erythropoiesis so have more ___ which increases percentage in the blood; ↓ RBC life span -> hyperactive ___ ___ -> more reticulocytes S/S: fatigue, dyspnea (shores of ___, not enough o2 to ___), dysrhythmias (not enough o2 to ___), confusion (not enough o2 to ___), etc.; if RBCs don't last as long then bone marrow makes more
anemia; hemoglobin; destruction; production
___ is abnormally low levels of RBCs, hemoglobin, or both (for sure low levels of ___ but could be both); caused by: blood loss (losing RBCs and hemoglobin duh), hemolysis/___ of RBCs, and impaired RBC ___ (lack of nutrients or bone marrow depression/failure
thalassemias; alpha; beta; anemic; inherited
___ is making less hemoglobin bc either have defect in producing ___ or ___ chains; doesn't matter which it is bc no matter what you'll be ___ bc not making enough hemoglobin; both alpha and beta are an ___ mutation
hemoglobin, red, blue
___ is pigmented in the presence of iron (?); if you have lots of oxygen then it appears ___ and if you don't have as much then it appears ___
polycythemia; 50
___ is too many molecules of hemoglobin or RBCs; increased RBC count and hematocrit greater than ___%; relative and absolute; do this in response to something
diagnosis; signs and symptoms; infections; prevent; cure; 16; normal; heterozygous
___ of sickle cell anemia: test of amniotic fluid, blood test, and clinical presentation; treatment: manage ___ ___ ___ and prevent ___/complications - full immunization (to ___ infections), bone marrow transplant is the only potential ___ (works best if you're under ___); can live relatively ___ life with this, especially if ___; used to live to 20-30s but now its much better
hypoxemia; kidneys; liver; immature; reticulocytes; mature; 1; 1-2
___ or hypoxia is not enough oxygen; the ___ secrete erythropoietin (90%); ___ makes the other 10%; if you're in kidney failure and can't make enough RBCs then can give synthetic ones; bone marrow stimulated to produce: ___ RBCs (nucleated), ___ (once in circulation then they lose nucleus become this), and ___ RBCs; ___ week from bone marrow to reticulocyte and then ___ more days to mature RBCs
anemia; oxygen; blood; perfused; oxygen
___ signs and symptoms: impaired ___ transport, reduction in ___ values (RBCs, hemoglobin, hematocrit are all decreased), pallor (ashy looking bc skin isn't ___), tachycardia, palpitations; signs and symptoms are associated with the pathologic process that caused the anemia; all these signs and symptoms are associated with things that didn't get enough ___ (lung - shortness of breath, heart - palpitations, muscles - weak, fatigued)
aplastic anemia
bone marrow depression; typically bc of chemotherapy or radiation
iron deficiency anemia; diet; making; destroying; iron; small; oxygen; shape; size; B
causes of ___ ___ ___ - blood loss or deficient ___; low hemoglobin and hematocrit (either not ___ enough or ___ too much); low serum iron levels; hypochromic (don't have enough ___) and microcytic erythrocytes (too ___ so can't carry enough ___ so like carrying 2 instead of 4); poikilocytosis (irregular ___); anisocytosis (irregular ___); if you're vegan and not taking ___ vitamins then you can get this
chronic disease anemias
chronic inflammation --> inflammatory cytokines
alpha thalassemia
defective gene for alpha chain synthesis; 1-4 defective genes; affects both fetal and adult Hb; severe hemolytic anemia; treatment: rare blood transfusions; folic acid (B9) QD
beta thalassemia
defective gene for beta chain synthesis; >100 different mutations; affects only adult Hb; ineffective hematopoiesis and hemolysis; treatment: regular blood transfusions; stem cell transplant
iron deficiency anemia ; oxygen ; fix
don't have enough iron can't get heme group done so can't get ___ (since oxygen binds to iron); this is the easiest to ___
bilirubin; conjugated; liver; bilirubin; urine
during RBC destruction, heme is converted to ___ (___ - combine with something else): (bilirubin is) water soluble, removed from circulation by the ___ & excreted in bile; if i have too much ___ then i have to change it to water soluble form so i can get rid of it and eliminate some of it in ___
unconjugated; greater; jaundice; conjugated
during RBC destruction, if something goes wrong then - ___ bilirubin - if RBC destruction/bilirubin production ___ than bilirubin removal via liver -> ___; if something goes wrong in the liver or spleen then i'll be jaundice (color of school bus/lines on the road); treatment is light which changes it to ___ form
RBCs
goal of ___ is to carry oxygen
dehydrated, 45
hematocrit (HCT) - percent blood volume of RBCs per 100 mL of blood; if it's increased/higher then you're ___; normal level is ___%
iron, oxygen, iron, oxygen
heme groups in hemoglobin contain an ___ atom and that is able to bind to one ___; so 4 heme groups, 4 ___ atoms, 4 possibilities to bind to ___
megaloblastic anemia
huge cells but its a blast so its not actually functioning and doesnt divide
40
if you're heterozygous for sickle cell anemia then ___% of your hemoglobin is sickled hemoglobin
80-95; sicker
if you're homozygous for sickle cell anemia then ___-___% of hemoglobin is sickled; homozygous are way ___ than heterozygous
megaloblastic anemias; pernicious; baby
impaired DNA synthesis --> abnormal RBC maturation and division - vitamin B12 deficiency (___ anemia - treated with B12 pills or shots); folic acid (B9) deficiency; these don't mature so stuck as ___ and can't divide so anemic
relative polycythemia
loss of plasma volume
hemolytic
lysis of blood cels
hepatosplenomegaly; destroy; stores
man with defective RBCs develop ___; spleen gets bigger bc its worker harder since function is to ___ RBCs and want to destroy the defective ones; liver gets bigger bc ___ RBCs so has to work harder to store more
decreases, decreases, fragile, break, capillaries; phagocytes; recycled
metabolic activity ___ with RBC age (basically as you get old your metabolic activity ___ for everything; cell membranes become ___; eventually, RBCs ___ as they squeeze through the spleen ___; ___ from the spleen, liver, bone marrow, lymph nodes ingest and destroy RBCs; heme & amino acids are ___
sickle cell anemia
misshapen RBCs so can't do things well; stick together and clot
phagocytic; jaundice
most common type of hemolytic anemias - extravascular hemolysis in ___ cells of liver and spleen; may produce ___
RBC
normal ___ count for men is 4.2-5.4 and women 3.6-5
14
normal hemoglobin (hb) labs are ___
reticulocytes; 1; 30;
percentage of ___ = rate of RBC production; normal lab is ___%; when you have leukemia, you're making a lot more WBCs than you need to so release more; could go as high as ___% of blood volume bc if you're anemic then you're making a lot more RBCs to get more oxygen out so crank out a lot of reticulocytes
iron; spleen; iron; bilirubin; iron; RBCs; storage
rate of synthesis (how much iron you're making) for hemoglobin (HbA) depends on the amount of ___ available; lives 120 days then destroyed in ___, then ___ is released back into circulation and returned to bone marrow or liver; biproduct of destruction is ___ and when I destroy it then i recycle the ___ and either go to bone marrow (to make more ___) or to liver (for ___)
polycythemia; hypertension; chemotherapy; function; clots; childs; quick
signs and symptoms of ___: increased blood volume leads to increased viscosity leads to ___; if it gets too high then gives drugs that they give to cancer patients; treatment - ___ drugs to depress bone marrow ___, aspirin to prevent formation of ___ (it decreases likelihood of clotting but should take ___ dose), phlebotomy may relive signs and symptoms (___ fix, not permanent)
megaloblastic anemias; DNA; large
vitamin B12 and folic acid deficiencies; impaired ___ synthesis --> enlarged red cells; erythrocytes are ___, often with oval shape; so caused by B vitamin deficiencies or mutation (transcription error)