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43 Cards in this Set
- Front
- Back
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AP II HEMATOPOIETIC DISORDERS
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AP II HEMATOPOIETIC DISORDERS
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Erythropoiesis
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Erythron: rbc production
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Erythropoietin (EPO)
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Produced and released by kidney.
Functions in the presence of iron. |
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What is the stimulus for EPO?
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O2
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Hemoglobin has what binding capacity for O2?
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1.34mL O2/gram of Hb
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Structure of hemoglobin?
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Globin portion consists of 4 chains.
Each chain has a heme group. Each heme group has 4 pyrroles with ferrous Fe(+2) Each heme can bind 1 molecule of O2, therefore, each Hb can bind 4 molecules of O2. |
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O2 Carrying Capacity (CaO2) =
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Hbx1.34xSaO2 + PaO2(0.003mL O2/dL)
NOTE: unit of CaO2 is ml/dl |
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Acidosis
Inc 2,3 DPG Hyperthermia Pregnancy |
All shift curve to the right
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Anemia
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Reduction in number of RBCs
Losses of 10-15% of total blood lead to signs of vascular instability. 30-40%--> shock |
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How does the body compensate for anemia?
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1. inc CO and RR
2. inc 2,3 DPG 3. pull fluid from interstitium to expand plasma vol 4. redistribution of blood to vital organs. |
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Main cause of anemia?
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Iron deficiency
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At what level does serum iron fall to in order to incur impairment of Hb synthesis?
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15-20%
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Causes of iron deficiency
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1. when there is more demand for iron.
2. inc iron loss 3. dec iron intake |
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Sickle cell dz
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1. hemoglobinopathy resulting from abnormality of structure.
Defect in the globin fraction in HbA. 2. autosomal recessive disorder. 3. shape change on deoxygenation. 4. signs and symptoms result from vascular occlusion. |
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Shape of rbcs is altered by?
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Deoxygenation
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Aplastic
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Means defective in development
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Mutation of what causes sickle cell dz?
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In beta chain gene.
Leads to decreased solubility, deformity of RBC, and hemolysis. |
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What are the initiation conditions of sickle cell dz?
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1. hypoxia
2. hypothermia 3. dehydration 4. acidosis |
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Manifestations of sickle cell disease?
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1. hemolytic anemia
2. reticulocytosis/granulocytosis 3. painful crises 4. microinfarction (due to occlusion) |
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Tx for sickle cell disease?
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1. fluids, O2, folic acid supplementation, and narcotic analgesic.
2. blood transfusion |
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What are the examples of dyshemoglobinemias?
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1. methemoglobinemia
2. sulfhemoglobinemia 3. carboxyhemoglobinemia |
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Methemoglobinemia
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Ferric form (+3) causing it not being able to bind O2.
Cyanosis |
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MetHb causes which direction of shifting on the oxy-hb curve?
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Left
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What is the treatment for MetHb?
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Methylene blue 1mg/kg every 60 mins.
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Causes of SulfHb?
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1. sulfur atom gets incorporated into porphyrin ring.
2. drug induced 3. cyanosis |
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SulfHb shifts which direction on the oxy-hb curve?
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Right
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Tx for SulfHb?
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NONE
Eventually destroyed |
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CarboxyHb
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Occurs when CO binds to Hb molecule.
Pulse Ox gives false high reading NOTE: 200X greater binding than O2 |
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Tx for CarboxyHb
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1. supplemental O2
2. Hyperbaric chamber |
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Polycythemia and its types
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Vol exceeds normal
Primary Secondary Relative polycythemia |
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What is primary polycythemia?
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Myeloproliferative disorder
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Secondary polycythemia
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Hemoconcentration
Renal dysfunction |
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Relative polycythemia
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Smoker's polycythemia
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Neutrophils
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Increase in presence of infection.
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Lymphoma
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Malignancy of lymphatic system
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Thrombocytopenia
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Low platelet count
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Von Willebrand Disease (vWD)
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MOST COMMON hereditary coagulation abnormality.
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Tx of vWD
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DDAVP (desmopressin)
Prognosis: excellent |
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Thrombocytopenia can be caused from?
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Liver dz
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Aspirin
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Inhibits platelet aggregation and secretion.
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Heparin
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Antibody mediated
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Penicillin
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Interfere with platelet membrane and membrane receptors
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Dextran/Hetastarches
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Interferes with platelet surface membrane.
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