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31 Cards in this Set
- Front
- Back
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Electrolytes (examples)
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+ -
Na Cl K Bicarb Ca Phosphate Mg Albumin (Eq) |
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Proteins (how much in blood?)
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Total protein = 60-70g/dl
Albumin = 50g/dl Immunoglobulins 20-30g/dl Trace proteins <300mg/dl |
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Function of Proteins
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Albumin
-Oncotic Pressure -Negative Charge -Lipid Binding Protein Immunoglobulin = gamma globulin =antibody Trance Proteins -Coagulation/complement -Mineral Transport |
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White Cells
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Polymorphonuclear cells= granulocytes
Mononuclear cells = lymphocytes and monocytes |
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Angioedema
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leaky capillaries
mast cell degranulation complement activation |
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Oedema
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Outcomes
1. heart Failure - Increased venous pressure 2. Liver Failure- reduced albumin synthesis 3. Nephrotic Syndrome - lost albumin in urine Also features in 1. Lymphoedema - usually cancer 2. Angioedema - infection 3. Enteropathy malnutriton 3. Nephro |
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Erythropoietin
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Outcomes
1. O2 tension at proximal tubule- low stimulates EPO 2. stimulates series of RBC precursors - more RBC 3. Increased O2 capacity - negative feedback on EPO. |
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-penia or -cythameia/cytosis?
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Not Enough
-Anaemia/Leukopenia/Thrombocytopenia Too much -Polycythaemia/Leukocytosis/thrombocytosis. |
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Anaemia
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1. Bleeding
2. Dietary Iron Defciency 3. Chronic Disorders: chronic '-itis' Also: -Renal Failure -B12 and Folate Deficiency -Bone Marrow Failure N.B. Acute hypovolaemic bleeding does not cause anaemia- this only follows with redistribution/rehydration |
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Leukocytosis
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1. Infection
2. Infarction 3. Inflammation (acute '-itis') Also: Cancer Corticosteroid Therapy Leukaemia |
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Thrombocytosis
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1. Infection
2. Haemorrhage 3. Inflammation (acute '-itis') Also: Cancer Chronic disorders: chronic '-itis' Essential thrombocythaemia |
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What you need to make a red cell
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Haemoglobin
-iron, lots of -haem, cofactor -globin genes, for protein DNA synthesis (proliferation -dNTPS - thymidine thymidine - B12 and folate |
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Red Cells
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1. Biconcave Disk
2. haemoglobin 3. No nucleus, mitochondria or ER/golgi Also - Specialised membrane - enzymes for glycolysis and CO2 solubility - life span 120 days |
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Hb Structure
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1. Globin - polypeptide (protein)
2. Heme - a prosthetic group (chemical with special function) 3. Iron - essential cofactor of heme Also - multiplied by 4 - globin contains heme contains iron binds oxygen |
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Bisphosphoglycerate (2,3 BPG)
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1. Improves O2 dissociation
2. Found in tissues 3. Rises with altitude/lung disease/heart failure |
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Improving O2 delivery
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1. Low pH
2. High CO2 3. Increased 2,3- BPG Also pH effect = Bohr Effect CO2 effect = Haldane Effect |
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Haemoglobinopathy
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1. Mutation in B-globin - HbS= sickle haemoglobin
2. Lack of globin synthesis = thalassaemia |
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Sickle Cell Anaemia
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1. Hb polymerises into strands
2. Red cells become sickled 3. Capillaries block - tissue infarcts Also -Haemolytic anaemia - break up of red cells -In periphery - pain, osteomyelitis - In lung: hypoxia, 'sickle crisis |
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Thalassaemia
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1. Microcytic Anaemia
2. Ineffective erythropoiesis >hypoxia >EPO >huge marrow expansion >bone deformity |
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Treatment of Haemoglobinopathy
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1. Supportive
-Chelate Iron -prevent infections -treat pain 2. Transfusion -Problems with chronic iron overload 3. Epigenetic modification -induce expression of alternative globin genes 4. Stem cell transplantation |
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Iron Transport and Storage Proteins
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1. Tranferrin= plasma protein and transport molecule.
2. Ferritin = plasma protein but not a transport molecule. Intracellular storage molecule 3. Transferrin Receptor Also -HFE- High FE (regulator protein) -DMT- Divalent Metal ion Transporter |
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Hepcidin
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-hepcidin is released from the liver in response to high iron
-Hepcidin binds ferroportin -Ferroportin is internalised and degraded-iron excretion is reduced -enterocytes stop absorbing -Macrophages hold onto stores. |
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Factors favouring iron absorption
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-Ferrous form (2+)
-Acids - HCl, vitamin C -Iron deficiency -increased erythropoiesis -Pregnancy -Primary haemochromatosis |
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Factors reducing absorption
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-Ferric form (3+)
-Alkalis - pancreatic secretions -Iron Excess -Reduced erythropoiesis -Inflammation -Tea (tannins) Nuts and seed (phytic acid) |
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Iron Deficiency anaemia
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S and S
Pale Lethargic Lightheaded Breathless glossitis and stomatitis Laboratory ANAEMIA - low Hb Microcytic Hypochromic Thrombocytosis Low ferritin |
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Iron Deficiency Anaemia: Causes
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1. Increased Iron Requirement
-bleeding, pregnancy, growth 2. Inadequate Iron Suppy -diet, malabsorption, gastric surgery |
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Megaloblastic Anaemia
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-B12 and folate deficiency cause macrocytic anaemia
-B12 deficiency is largely due to 'pernicious anaemia' -Folate deficiency is largely dietary -B12 and folate are easily measured in the serum. -B12 is corrected by 3 monthly IM injection -Folate is corrected by daily oral supplement -Rarely B12 deficiency causes neurological complications |
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Nuclear Cytoplasmic Maturation
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1 DNA cannot replicate
-Cyoplasm increases 'waiting for nucleus -Megaloblasts accumulate -Large red cells created - macrocytosis -mcv 100-150 2. Haemoglobin cannot form -Nucleus divides before adequate Hb synthesised -Small pale red cells created - microcytosis |
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Other features of B12/folate deficiency
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General
-Lethargy -Fatigue -Depression -Glossitis and stomatitis Neurological -Numbness, nerve pains -Loss of proprioception -Ataxia -Dementia - controversial |
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Pernicious Anaemia
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Atrophic Gastritis
N.B, pernicious = not curable by dietary iron supplements |
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Folate Defiency
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-Poor diet
-'Anti-folate' drugs *methotrexate/trimethoprim -Red cell consumption -Pregnancy -Liver failure -Coeliac Disease -Dialysis |
