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40 Cards in this Set

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What is erythropoiesis?
the production of RBCs
What is erythropoietin?
a hormone
- secreted by the kidneys
- increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.
What is CBC?
Complete Blood Count - count of all the cells in the bloodstream
What is Hgb?
Hemoglobin
- the amount of RBCs in a given WEIGHT of blood
What is Hct?
Hematocrit
- the percentage of RBCs in a given volume of blood
What is MCV?
Mean Corpuscular Volume
- cell size (cytic)
ex. normocytic, macrocytic, or microcytic
What is MCHC?
Mean Corpuscular Hemoglobin Concentration
- amount of hemoglobin in each RBC (chromic)
What does normochromic mean?
normal volume to hgb ratio
What is anemia?
a reduction in the total number of circulating erythrocytes or RBCs
and/or
a decrease in the quality or quantity of hub
What causes anemia?
1. ALTERED PRODUCTION of RBCs
2. blood LOSS
3. increased DESTRUCTION of RBCs
4. a combination of any or all 3
What are the different types of anemia?
1. iron deficiency anemia
2. pernicious (vitamin B12) anemia
3. folate deficiency anemia
4. post-hemorrhagic anemia
5. others (aplastic anemia, hemolytic anemia, and anemia of chronic disease)
How does decreased hemoglobin lead to decreased ATP?
decreased hgb --> decreased O2 carrying capacity --> decreased O2 at tissues --> decreased ATP (causing negative effects & compensation)
What are the negative effects of decreased ATP?
- decreased energy (overall) ex. fatigue
- decreased energy and function in the cell (ex. impaired wound healing)
What compensation occurs as a result of decreased ATP?
decreased ATP activates the HPA axis causing:
- increased RR - catecholamines stimulate respiratory control center (medulla) to increase RR
- increased HR - epinephrine stimulates SA node to increase firing rate --> increases HR
- increased SV - catacholamines cause dilation of the skeletal muscle vasculature and vasoconstriction of peripheral smooth muscle which shunts blood to the core and increases SV
- VSM constriction - catacholamines cause peripheral smooth muscle contraction which shunts blood to core, leaving the periphery pale and cool
What are common signs and symptoms of all types of anemia?
HPA effects:
- breathlessness
- pale/cool
- increased HR

Decreased ATP effects:
- loss of tissues function
- fatigue/lethargy
- dizziness
- fainting
What causes iron deficiency anemia?
1. blood loss: chronic small amounts (ex. menstruation, ulcers, bowel cancer, NSAID [non-steroidal anti-inflammatory disease]
2. decreased absorption of iron
3. low dietary intake
Where is iron stored?
iron is stored in the heme in hemoglobin
- also stored in bone marrow, liver and spleen
What are serum ferritin levels?
provides an indicator of iron stores in the body
How does iron deficiency anemia develop?
iron stores are depleted --> insufficient iron in the marrow for hgb synthesis --> altered RBC development --> hemoglobin deficient cells replace circulating normal RBCs --> hypochromic and microcytic cells
What are Hypochromic cells?
cells that have less hemoglobin per cell (low MCHC)
What are microcytic cells?
cells that are small in size
- they reduce their volume to maintain a normal volume to hgb ratio (Low MCV)
If there are small RBCs circulating the bloodstream, how will that affect hgb and hematocrit levels?
fewer formed, so low hgb and hct
What are S&S of iron deficiency anemia?
- fatigue
- weakness
- fainting
- pale/cool skin
- SOB

- specific:
- no iron for cell maintenance/repair --> brittle, thin and concave fingernails, sore, red tongue, stomatitis, esp. of corners of mouth
How is iron deficiency diagnosed?
- combination of:
- clinical manifestations
- blood work: CBC & serum ferritin levels
How is iron deficiency treated?
- stop blood loss
- dietary corrections (ex. red meats, legumes, iron fortified foods, etc.)
- iron replacement - higher amounts than multivitamin
- blood transfusions - depends on circumstances, benefit/risk ratio
- monitor - lab values & signs and symptoms
***just because hgb returns to normal does not mean that Fe deficiency anemia is cured!
What causes vitamin B12 deficiency?
- decreased dietary vitamin B12 or folate intake
- malabsorption of vitamin B12 [intrinsic factor is needed for B12 absorption; may be a congenital disease or atrophy of gastric mucosa]
- gastrectomy - surgical removal of a part or the whole of the stomach.
- small bowel disease or loss (ex. Chron's)
How does vitamin B12/folate deficiency anemia develop?
- both deficiencies interfere with DNA synthesis
- vitamin B12 converts folic acid to an active form --> active folic acid is a key component of nucleotides that make up DNA --> therefore, cell division is disrupted
What is the pathway of a developing RBC?
uncommitted stem cell --> [erythropoietin - hormone converts stem cell to committed proerythroblast --> [DNA synthesis occurs] --> normoblast cell is formed (nucleus shrinks and is reabsorbed) & hemoglobin is formed during the normoblast stage --> converted to reticulocyte (cell leaves marrow and enters bloodstream) --> converted to erythrocyte (cell achieves final size & shape - hemoglobin synthesis ceases)
What is the result of Vitamin B12/folate deficiency?
- macrocytic (large, abnormally shaped erythrocytes) - high MCV
- normochromic cells - hgb content of cells is normal (they may be hyperchromic or hypochromic) - MCHC usually normal or high
***when in circulation, these cells are defective and die prematurely - so low hct and low hgb [even though they are larger, they will not survive, causing low hgb)
How does vitamin B12 deficiency affect MCHC?
vitamin B12 deficiency does not affect MCHC
What are the S&S of vitamin B12 deficiency?
- fatigue
- weakness
- pale/cool
- confusion

specific S&S:
- parasthesia (numbness/tingling) of feet and fingers [b/c lack of normal myelin maintenance which surrounds nerves], difficulty walking, death
What are the S&S of folate deficiency?
same as B12 (EXCEPT)
- NO neurological symptoms R/T demyelination
How is vitamin B12/folate deficiency diagnosed?
- clinical manifestations
- blood work:
- CBC
- serum B12
- serum folate
How is vitamin B12/folate deficiency treated?
- dietary corrections
- oral supplementation
- SQ/IM injections of B12/folate MONTHLY
What is post-hemorrhagic anemia?
- loss of large amounts of blood (ex. hemorrhage)
What are the signs and symptoms of post-hemorrhagic anemia?
- same as hypovolemia, hypoxia and anemia
What are the lab values of post-hemorrhagic anemia?
hgb - low
hct - low
MCV - normocytic
MCHC - normochromic
How is post-hemorrhagic anemia treated?
- replace fluids
- blood transfusion
- give iron
What are some other types of anemia?
1. hemolytic - RBCs lysed or destroyed
2. Aplastic - stem cells destroyed (ex. leukemia)
3. Anemia of chronic disease (ex. altered iron recycling)
What questions should always be answered regarding anemia?
1. where does the defect occur?
2. what is the result to cell size and shape?
3. what is the result to total hgb & # of RBCs?