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)