Physiology: Red Blood Cells

Front 1

Hemoglobin; FUNCTION

Back 1

Transport oxygen from the lungs to the tissues and CO2 from the tissues back to the lungs

Front 2

The Bohr Effect

Back 2

Decreased 02 affinity in an acid environment, increased affinity in basic environment

Front 3

Tissues have ___ ph compared to lungs

Back 3

lower

Front 4

In lungs O2 taken up by Hb as environment is more ___

Back 4

alkaline

Front 5

beta globin gene cluster chromosome -

Back 5

11

Front 6

alpha globin gene cluster chromosome -

Back 6

16

Front 7

The combination of two alpha chains and two gamma chains form "fetal" hemoglobin, termed "

Back 7

hemoglobin F

Front 8

The combination of two alpha chains and two beta chains form "adult" hemoglobin, also called

Back 8

hemoglobin A

Front 9

The expression of the alpha and non-alpha genes is closely balanced by an unknown mechanism. Balanced gene expression is required for normal red cell function. Disruption of the balance produces a disorder called .

Back 9

thalassemia

Front 10

Term used to describe cell death

Back 10

SENESCENCE

In the steady state the rate of red cell production per day is equivalent to the rate of red cell senescence

Front 11

Complaints
Fatigue
Shortness of breath
Chest pain
Forgetfulness
Apathy

Physical Exam
Pale
Ill appearing
Icteric – yellow sclerae
Tachycardic (acute)
Pulmonary crackles (heart failure?)
Splenomegaly
Stomatitis, chelitis
Nail changes

Back 11

The Anemic patient

Front 12

A measure of the average size of the red blood cells

Back 12

MCV

Front 13

Measures the variation in red blood cell size present in a sample of blood

Back 13

Red cell distribution width

When the cells are uniform in size the RDW is normal
When the cells exhibit a lot of variation in their size the RDW is high

Front 14

means that the red blood cells have less color than normal when examined under a microscope or to be more scientific..
Lack of complete saturation of the erythrocyte stroma with hemoglobin, as judged by pallor of the unstained or stained erythrocytes when examined microscopically.

Back 14

Hypochromia

Front 15

The average normal North American diet contains ___ mg of iron. Most is present in meat and green vegetables.
Approximately 1.0 mg is absorbed each day and about an equal amount is lost in the feces and sweat.

Back 15

15-20

Front 16

a protein present in the blood essential in the transport of iron from the intestine into the bloodstream, making it available to the normoblasts in the bone marrow.
When not bound to iron, it is known as "_____"

Back 16

apo-transferrin

Front 17

a protein that stores iron and releases it in a controlled fashion

a "buffer" against iron deficiency

when it is combined with iron is called

Back 17

Ferritin

Front 18

What Type of Surgery Would Predispose A Patient To Iron Deficiency?

Back 18

Bariatric surgeryDuodenum surgery

Front 19

What Medications Would Impair Iron Absorption?

Back 19

Proton pump inhibitorsAntacids

Front 20

Iron is stored as either

Back 20

ferritin or hemosiderin

Ferritin is water soluble and found mainly in the bone marrow and liver. It is preferentially used before hemosiderin

Front 21

Most common anemia in the world

Back 21

Iron Deficiency Anemia

Front 22

Autosomal recessive
Most common genetic disorders in Northern Europeans
10% of the population are heterozygotes
0.5% homozygous (major problem)

Back 22

Hereditary Hemochromatosis

Front 23

Weakness,fatigue and chronic abdominal pain
Abnormal liver function with eventual cirrhosis
Congestive heart failure
Arthritis (metacarpal joints)
Diabetes
Hyperpigmentation “the bronzed diabetic”

Back 23

Hereditary Hemochromatosis

Front 24

___ is a must for absorption, as it releases B12 from protein *this is highly clinically significant

Back 24

Acid secretion

Front 25

recognizes UTP as a mismatch and excises it from DNA strand
No TTP available to replace UTP
DNA becomes fragmented leading to arrest of DNA synthesis at various stages

Back 25

Uracil glycosylase

Front 26

why is folate and B12 important

Back 26

bc it is important in oncology - without them, we will have fragmented DNA!

Front 27

Defined as defect in DNA synthesis with a lesser effect on RNA and protein synthesis
Leads to unbalanced cell growth and impaired cell division

Back 27

MEGALOBLASTOSIS

Front 28

Bone marrow is hypercellular with a erythroid predominance

Back 28

MEGALOBLASTOSIS

Front 29

Pathognomonic of
megaloblastic anemias

Back 29

Hypersegmented Neutrophils

Normal neutrophils contain three or four nuclear lobes,
Hypersegmented
neutrophils contain five or more

Front 30

Anemia
Pallor
Lemon yellow tint to skin
Glossitis (SHINY PAINFUL TONGUE)
Neurologic abnormalities- loss of position sense, gait disturbances, weakness, spasticity

Back 30

MEGALOBLASTOSIS

Front 31

Lesions can be seen throughout the length of the spinal cord and white matter of the brain

Incoordination
Difficulty walking
Sensory disturbances
Diminished position and vibration sense
Weakness
Spasticity

Back 31

B12 Deficiency

Front 32

Making the Diagnosis of B12 and or Folate Deficiency

Back 32

Clinical suspicion
Measure serum B12 and folate levels prior to feeding patient
One meal can normalize serum folate levels in a deficient patient
Red blood cell folate will be low in folate deficiency
Red blood cell folate will be normal in B12

Front 33

T cell infiltrate gastric mucosa leads to Atrophy of gastric mucosa leading to absence of intrinsic factor and HCL acid secretion

Back 33

Pernicious Anemia

Front 34

The Schilling’s Test

Back 34

1.0 mcg of radioactively labeled B12 orally and 1000 mcg B12 IM
Determine radioactivity excretion in urine
If low, oral B12 not properly absorbed
Give Intrinsic factor, if corrects then PA
Part 2 give 7-10 d antibiotics, if corrects then bacterial overgrowth
Part 3 give pancreatic enzymes, if corrects then pancreatic dysfunction (insufficiency)

Front 35

Splenectomy as abnormal cells are destroyed in the spleen
Relapses due to accessory spleen
Life threatening infections can occur in splenectomized patients
Vaccines crucial

Back 35

Treatment of HS

Front 36

Most common type of AIHA


Autoantibodies attach to the RBC surface
Can occur w/o underlying cause but may also be first presentation of lymphoma, lupus and CLL, also infections such as TB and CMV, chronic inflammatory disorders such as Crohn’s disease

Back 36

IgG

Front 37

Used to determine if antibodies are present

Back 37

The Coombs test

Direct Coombs measures antibodies on the RBC
Indirect measures antibodies in the serum (used for blood typing for transfusion)

Front 38

tx of IgG AIHA

Back 38

Corticosteroids
Gamma globulin
Splenectomy
Immunosuppressive agents
Transfusions may be difficult because of presence of antibodies and cross reactivity with donor red blood cells

Front 39

a rare disorder of the coagulation system, causing extensive microscopic blood clots to form in the capillaries

Red blood cells passing the microscopic clots are subjected to shear stress which damages their membranes, leading to intravascular hemolysis.

Back 39

TTP

Thrombotic thrombocytopenic purpura (TTP

Front 40

Classically, the ("pentad") is indicative of TTP
**** know the pentad!

Back 40

Fluctuating neurological symptoms, such as bizarre behavior, altered mental status, stroke or headaches
Kidney failure
Fever
Thrombocytopenia, leading to bruising or purpura
Hemolytic anemia

Front 41

symptoms:
Fluctuating neurological symptoms, such as bizarre behavior, altered mental status, stroke or headaches
Kidney failure
Fever
Thrombocytopenia, leading to bruising or purpura
Hemolytic anemia

Back 41

TTP!!! ****

Front 42

tx of TTP

Back 42

Early and aggressive plasmapheresis
Steroids
Rituxan

Front 43

prognosis of TTP

Back 43

The mortality rate is approximately 95% for untreated cases ****************************************
(80-90%) for patients with idiopathic TTP diagnosed and treated early
Secondary TTP still has a dismal prognosis, with mortality rates despite treatment being reported as 59% to 100%.

Front 44

Mutation of B (beta) globin gene

Back 44

Sickle Cell Anemia

Front 45

Two major physiologic processes of sickle cell anemia

Back 45

Two major physiologic processes,
shortened red cell survival and
vasoocclusion, account for most of the clinical manifestations of sickle cell disease.

Front 46

Results from rigid, sickled red cells leading to the obstruction of blood vessels .

Back 46

Vasoocclusive

Front 47

in a hemolytic crisis why does the pt look yellow?

Back 47

The resulting increase in jaundice is associated with a falling hemoglobin level and an elevated reticulocyte count.

Front 48

Doesn't cure sickle cell disease, but it can reduce the number of painful events and other complications and may prolong life
Increases fetal hemoglobin(HbF) production and raises the total hemoglobin concentration

Back 48

Hydroxyurea

Front 49

stem cell disorder, characterized by increased progenitor cell sensitivity to growth-promoting cytokines and is strongly associated with an activating somatic mutation in the JAK2 tyrosine kinase.

Back 49

Polycythemia Vera

Front 50

Thrombosis and Bleeding are the major causes of morbidity and mortality from what

Back 50

polycythemia vera

Front 51

talk about creation of RBCs

Back 51

kidneys sense how much oxygen is in the blood... produces erythropoetin... sends it to BM which stimulated production of RBCs

Front 52

if more iron is required what happens to the amount of apoferritin manufactured in eat mucosal cell

Back 52

decreased apoferritein manufactured