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78 Cards in this Set
- Front
- Back
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hemoglobin or Hb
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iron-containing oxygen-transport metalloprotein in the red blood cells of the blood In humans, the hemoglobin molecule is an assembly of four globular protein subunits. Each subunit is composed of a protein chain tightly associated with a non-protein heme group
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Oxyhemoglobin
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is formed during respiration when oxygen binds to the heme component of the protein hemoglobin in red blood cells. This process occurs in the pulmonary capillaries adjacent to the alveoli of the lungs. The oxygen then travels through the blood stream to be dropped off at cells where it is utilized in aerobic glycolysis and in the production of ATP
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Deoxyhemoglobin
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hemoglobin without the bound oxygen
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description of oxygen uptake and use.
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Oxygen diffuses through membranes and into red blood cells after inhalation into the lungs. The Heme group of hemoglobin by now already has carbon dioxide in its active site, but releases it for exhalation when oxygen is present. After being carried in blood to a body tissue in need of oxygen, it is handed-off from the Heme group to monooxygenase, an enzyme that also has an active site with an atom of iron.[22] Monooxygenase uses oxygen to catalyze many oxidation reactions in the body. Oxygen is also used as an electron acceptor in mitochondria to generate chemical energy in the form of adenosine triphosphate
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Oxygen hemoglobin dissociation curve
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how the affinity for oxygen to hemoglobin is described
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left shift of the oxygen curve is described as what
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the hemagobin having a greater affinity for the o2 at the lungs but it is also holds on to it longer
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Fetal hemoglobin
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is the main oxygen transport protein in the fetus during the last seven months of development in the uterus. Functionally, fetal hemoglobin differs most from adult hemoglobin in that it is able to bind oxygen with greater affinity than the adult form, giving the developing fetus better access to oxygen from the mother's bloodstream
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greater affinity for oxygen is explained by fetal hemoglobin's interaction
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Notably, the P50 value for fetal hemoglobin (i.e., the partial pressure of oxygen at which the protein is 50% saturated; lower values indicate greater affinity) is roughly 19 mmHg, whereas adult hemoglobin has a value of approximately 26.8 mmHg. As a result, the so-called "oxygen saturation curve", which plots percent saturation vs. pO2, is left-shifted for fetal hemoglobin in comparison to the same curve in adult hemoglobin.
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Factors shifting curve
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Many factors influence the affinity of this binding and alter the shape of the curve:
right shift left shift temperature high low DPG high low p(CO2) high low p(CO) low high pH low high adult hemoglobin fetal Left shift of the curve is a sign of hemoglobin's increased affinity for oxygen (eg. at the lungs). Similarly, right shift shows decreased affinity, as would appear with an increase in body temperature, hydrogen ion, 2,3-diphosphoglycerate or carbon dioxide concentration (the Bohr effect) |
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Right shift
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less affinity for o2 in the lungs but releases it in the tissues easier
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what is Vd
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this is anitomical dead space about 150ml of the 500ml of tidal volume or VT breathed in
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where does the air go after moving through the VD
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respiratory bfonchioles nd alveoli
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what is sufactant
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it is a lipoprotein that lowers the suface tension in the alveoli and reduces the amount of pressure needed to inflate the alveoli
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why do people sigh after every 5th breath
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this stretches the alveoli and promotes surfactant secretion
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what does PaO2 represent
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this is the amount of disolved oxygen that is in the plasma and is represented in mm hg (pressure)
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what is SaO2 representing
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this is the oxygen that is bound to the hemaglobin and is represented in a %
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Inhalation
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Inhalation is driven primarily by the diaphragm. When the diaphragm contracts, the ribcage expands and the contents of the abdomen are moved downward. This results in a larger thoracic volume, which in turn causes a decrease in intrathoracic pressure. As the pressure in the chest falls, air moves into the conducting zone. Here, the air is filtered, warmed, and humidified as it flows to the lungs.
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Exhalation
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The lungs have a natural elasticity; as they recoil from the stretch of inhalation, air flows back out until the pressures in the chest and the atmosphere reach equilibrium.[2]
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anemia
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is a deficiency of red blood cells (RBCs) and/or hemoglobin. This results in a reduced ability of blood to transfer oxygen to the tissues, causing tissue hypoxia.
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Erythrocytes
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red blood cells more a corpussal because it has no nucleaus just hemaglobin
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structures of the pulmonary system
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airways
blood vessels chest wall lungs -lobes -segments -lobules |
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first thing to look at is
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the airway, is it open and clear make sure to asses the LOC this is a direct refelction of the amount of O2 the patient is getting
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conducting airway
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nasopharynx or oropharynx
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structure of pulmonayr system
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gas exchange airways
respiratory bronchioles alveolar ducts alveoli Epithelial cells type 1 alveolar cells is the structure type 2 alveolar cells is the surfactant production |
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alveoli
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stretch upon inhalation giving more surface area to exchange gas
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alveolocapillary membrane
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what the
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chest wall pleura
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serous membrane
parietal and visceral layers pleural spce pleural fluid |
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mucus
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protection for the lung need to cough
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the brain and base of our brain is the base of our respiratory system
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people will stop breathing due to trauma
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mechanics of breathing
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diaphragm
external intercostals accessory muscles sternocleidomastoid and scalene muscles |
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development of the erythrocyte
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stimulated by erthropoietin
starts in bone marrow retididculocyte 24 to 48 hrs erthrocyte 120 days life span hemoglobin within the red blood cells |
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erythropoietin is glycoprotein primarily produced in the kidney
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ok
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anemia
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deficiency in the number of erythrocytes
quanity and volume |
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what causes anemia
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blood loss
impaired production of rbc increases desruction of rbc |
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clinical manifestations
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hemoglobin levels are used to determine the severity of anemia
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hypoxia causes
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increased heart rate and volume
acidosis edema |
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anemia
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is a result from a disease like blood loss or the change of the size of the rbc it is a complicaiton of somthing else
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mild anemia
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10 to 14
possible symptoms tired, palpitations |
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moderate anemia
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5 to 10
increased cardiopulmonary symptoms experienced at rest or during activity |
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anemia severe less than 6
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pulmonary
cardio |
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sickle cell
iron deficiancy blood loss enemia |
all of these cause impairment in transport of oxygen to the tissue
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norms for hematicrtis for adults females and males are different
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(Ht or HCT) or packed cell volume (PCV) are measures of the proportion of blood volume that is occupied by red blood cells. It is normally 45 ± 7 (38-52%) for males and 42 ± 5 (37-47%) for females.
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life cycle of red blood cell
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The process by which red blood cells are produced is called erythropoiesis. Erythrocytes are continuously being produced in the red bone marrow of large bones, at a rate of about 2 million per second. (In the embryo, the liver is the main site of red blood cell production.) The production can be stimulated by the hormone erythropoietin (EPO), synthesised by the kidney; which is used for doping in sports. Just before and after leaving the bone marrow, they are known as reticulocytes which comprise about 1% of circulating red blood cells.
Erythrocytes develop from committed stem cells through reticulocytes to mature erythrocytes in about 7 days and live a total of about 120 days. |
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study from learning objectives chapter 23
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why do we care that the crit is low, why do we want to know that.
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study from learning objectives chapter 23
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why do we care that the crit is low, why do we want to know that.
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hematopoiesis
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blood cell production
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reticulocyte
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is an immature erythrocyte
will mature in 48 hours |
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hemolysis
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destruction of rbcs by monocytes and macrophages, removes abnormal, defective, damaged and old rbcs from circulation, occurs in liver spleen and bone marrow
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normal life span of a erythrocyte is
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120 days
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four functions of the spleen
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produce rbcs during fetal development
filter rbcs and reuse of iron, filter bacteria storage of rbcs and platlets about 30% of of the platlet mass is stored in the spleen |
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three causes of anemia
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decreased rbc production
blood loss increased rbc destruction |
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where does iron absorbtion occure
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duodenum and proximal jejunum
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what causes iron loss in pregnancy
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demands for iron by the fetus
blood loss at delivery lactation |
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when should iron be taken
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an hour before meals due to the acid needed to absorb it
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hemolytic anemia
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destruction of rbcs at a rate that exceeds production
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what does hemolytic anemia manifest
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jaundice because of the increas of bilirubin levels. the spleen and liver enlarge due to the overactivity of macrophage of the defective erythrocytes
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what is sickle cell disease
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the presence of an abnormal form of hemoglobin in the erythrocyte this causes the erythrocyte to stiffen and elongate causing a sickle shape
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what are the clinicle hallmarks of sickle cell disease
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vasoocclusive phenomena and hemoysis
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what is the primary symptom associated with sickling
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pain and swelling, tenderness
tachypnea hypertenson and nausea and vomiting |
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describe the two different types of blood supply in the lungs
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the pulmonary for gas exchange
the bronchial for supplying the lungs with O2 for its tissue |
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what is the tissue PaO2
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30 to 40 mmhg this explains why it is so important to have artirial O2 above 60mmhg so it can off load to the tissue
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left shift is caused by
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hypothermia
low pco2 alkalosis think of a person who is cold and breathing fast easy for them to pick up oxygen but not enough pressure to offload to tissue |
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right shift is caused by
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hyperthermia
increased pco2 acidosis think of a person hot breathing slow like a pressure cooker pressure in the arteries is high but you cant add any O2 to the pot pressure is too high |
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what happens to a person at high alltitude
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at higher altitudes the pressure is lower causing resulting in lower inspired O2 pressue resluting in lower PAO2
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what does acidosis cause the medula to do
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increase respirations rate and tidal volume
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what regulates ventilation
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the ph of the cerebral spinal fluid
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what causes pregnancy induced anemia
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because the plasma increase is greater than the increase of rbcs causing hemodilution
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how much does blood volume and plasma increase during pregnancy
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about40 to 50% above pregnancy values 1500 ml
100ml plasma 500ml rbcs depending upon the amount of iron available |
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what values consider a pregnant women anemic
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hemaglobin below 10g/dl
hematocrit decreases to 35% or less |
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what complications does anemia cause during birth
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blood loss at birth is not well tollerated
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what are 90% of the cases of anemia during pregnancy caused by
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iron deficiancy
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what is a shift to the left in a cbc
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this is an abnormal presance of neutraphills in the blood from hyperfunction of the bone marrow
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how long is the iron stores in an infant good for
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5 to 6 months full term
2 to 3 premature |
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what vitamin facilitates iron absorbtion
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vit c
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iron supplements should not be given with what
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milk products due to the fact that it binds with iron making it inafective
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when is breast mild a poor source of iron
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after 5 or 6 months
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sickle cell anemia
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when HBa is replaced with HBs
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describe the path of injury for SCA
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1st stasis with enlargement
2nd infarction with ischemia and destruction 3rd replacement with fibrous tissue (scarring) |
