13 Alterations in Oxygen Transport

Question 1

Erythrocyte/RBC

Answer 1

count: 4.2-6.2 million cells/mm3

- buffers blood pH: carbonic anhydrase

Question 2

hematopoiesis

Answer 2

stem cells> reticulocytes/erythroblast> mature RBC/erythrocytes

Question 3

erythropoietin/EPO

Answer 3

made in kidney (adult)

• fetus + newborn made in liver + kidney
• renal disease causes anemia

Question 4

nutritional requirements for erythropoiesis

Answer 4

-requires adequate amounts of iron, protein, vitamins, + minerals

Question 5

folate + B12 deficiencies lead to…

Answer 5

impaired DNA synth in erythroid cells bs vitamins are coenzymes of key rxns in cell metab

Question 6

absorption of B12 in sm intestines require…

Answer 6

intrinsic factor

-produced by parietal cells of stomach

Question 7

Bilirubin

Answer 7

• rbc destruction
• porphyn is reduced to bilirubin in liver + excreted in bile
• intestinal bacteria convert bilirubin into URObilirubin which is excreted mostly in stool but also in urine
• too much bilirubin=jaundice

Question 8

Anemia

Answer 8

deficit of RBC

-lox O-carrying capacity leads to hypoxia

Question 9

Polycythemia

Answer 9

excess of RBC

• primary or acquired
• incr in blood viscosity + volume

Question 10

general effects anemia

Answer 10

• reduction in O-carrying capacity (tissue hypoxia)
• compensatory mechanism to restore tissue oxygenation
• –SNS: incr heart rate, CO, circ rate, flow to vital organs

Question 11

aplastic anemia

Answer 11

• stem cell disorder characterized by reductin of hematopoietic tissue, fatty marrow transplant, + pancytopenia
• disease of young or old (15-25; 60+)

Question 12

pancytopenia

Answer 12

low RBC, WBC, + platelets

Question 13

aplastic anemia

cause + diagnosis

Answer 13

• caused by toxic, radiant, immunologic injury to the bone marrow stem cells
• diagnosed w bone marrow biopsy

Question 14

aplastic anemia

treatment

Answer 14

• bone marrow transplantation

- administer immunosuppressive therapy or stim hematopoiesis + bone marrow regeneration

Question 15

anemia of chronic renal failure

Answer 15

failure of renal endocrine function impairs ERYTHROPOIETIN PRODUCTION + bone marrow compensation

Question 16

anemia of chronic renal failure

treatment

Answer 16

-dialysis
-administer erythropoietin
(only used until Hgb is 12g/dl)
-replacement of iron, folate, + B12

95% respond to erythropoietin therapy

Question 17

cobalamin

Answer 17

B12

Question 18

anemia related to B12 or folate deficiency

Answer 18

-disrupt DNA synth of blast cells produces megaloblast

Question 19

macrocytic

Answer 19

type of anemia related to B12 deficiency

-more overly large RBC (megaloblasts) than normal RBC

Question 20

pernicious anemia

Answer 20

type of anemia related to B12 deficiency

-due to lack of intrinsic factor

Question 21

folate deficiencies are usually from…

Answer 21

dietary deficiencies, alcoholism, cirrhosis, pregnancy, or infancy

Question 22

pernicious anemia

clinical manifestations

Answer 22

• decreased RBC, WBC, + platelet counts
• increased MCV, megaloblastic dysplasia
• peripheral nerve degeneration
• shillings test indicates low B12
• gastric analysis reveals achlordydria
• megoblastic madness

Question 23

achlordydria

Answer 23

absence of hydrochloric acid in gastric secretions

- a manifestation of pernicious anemia

Question 24

Iron Deficiency Anemia

Answer 24

• insufficient iron for hemoglobin synth
• hypochromic, microcytic RBC, low MCV, MCH, + MCHC
• dec in serum ferritin level, serum iron level
• incr in total iron binding capacity

Question 25

most common nutritional deficiency in the world

Answer 25

iron deficiency anemia

Question 26

microcytic

Answer 26

smaller than normal RBC

Question 27

MCV, MCH, MCHC

Answer 27

MCV: mean corpuscular vol MCH: mean corpuscular hemoglobin MCHC: mean corpuscular hemoglobin concentration

Question 28

Iron Deficiency Anemia manifestations

Answer 28

- PICA - koilonychias (spoon-shaped nails) - blue sclerae

Question 29

Pica

Answer 29

cravings for nonfood substances like dirt, clay, ice, cardboard, hair

Question 30

Iron Deficiency Anemia treatment + prognosis

Answer 30

- oral administration of FERROUS SULFATE or IV FERRIC GLUCONATE (only in severe cases) - -cont for 4-6 months - treat underlying cause -prognosis is excellent

Question 31

Thalassemia

Answer 31

- incr hemolysis - hypochromic, microcytic RBC - autosomal recessive - classifies by polypeptide chains w deficient synth (a or b-thalassemia - low MCV, MHC, MCHC - erythroblastic hyperplasia

Question 32

hemolysis

Answer 32

RBC destruction

Question 33

autosomal recessive

Answer 33

assoc. w mutant genes that suppress the rate of globin chain synth

Question 34

most clinically severe form of thalassemia

Answer 34

thalassemia MAJOR

Question 35

Sickle Cell Anemia

Answer 35

- genetically determined defect of hemoglobin synth - results w hemoglobin instability + insolubility - sickled cell causes vascular occlusion

Question 36

sickle cell anemia is found exclusively in which population

Answer 36

black race

Question 37

Sickle Cell Anemia treatment + prognosis

Answer 37

- crisis: major medical event - treatment of choice is stem cell transplant prognosis is death if no/unsuccessful transplant

Question 38

hemolytic disease of newborn

Answer 38

- fetal RBCs cross placenta, stim production of MATERNAL ANTIBODIES AGAINST Rh+ antigen on fetal RBC - --not inherited fr mother; mother is Rh- - maternal antibodies cross into fetal circulation causing destruction of fetal cells - --ABO compatibility is most common - ---Rh incompatibility more clinically relevant

Question 39

hemolytic disease of newborn treatment + prognosis

Answer 39

- standard dose of anti Rh- immune globulin [RhoGAM] is given to mother before or after delivery - severe cases, in utero blood transfusion + early delivery prognosis: death, possible retardation, barely perceptible hemolytic process

Question 40

RhoGAM

Answer 40

anti-Rh immune globulin | -given to mother before or after delivery when Rh incompatible

Question 41

vocab checklist: ``` 1 polycythemia 2 pancytopenia 3 macrocytic 4 megaloblast 5 pernicious A. 6 aplastic A. 7 achlordydria 8 pica 9 thalassemia 10 hemolysis ```

Answer 41

``` 1 excess RBC (opp of "anemia") 2 low RBC, WBC, platelet 3 B12 related anemia 4 large RBC 5 B12 related anemia due to lack of intrinsic factor 6 stem cell disorder 7 absence of HCl acid in gastric secretion (due to pernicious A) 8 craving of nonfood 9 incr hemolysis 10 destruction of RBC ```