Alterations in Hematological Functions

Question 1

Types of Blood Cells (Slide 3)

Answer 1

• Erythrocytes
• Leukocytes
• Thrombocytes

Question 2

Erythrocytes

Answer 2

Red Blood Cells (which carry hemoglobin to provide oxygen to tissues)

Question 3

Leukocytes

Answer 3

• Neutrophil(phagocytic)
• Monocyte(phagocytic)
• Eosinophil(allergic response)
• Basophil(contains histamine for hypersensitivity responses)
• Lymphocyte—T lymphocyte(cell-mediated response and provides surveillance) and B lymphocyte(mature into plasma cells to form antibodies; part of humoral immunity)

Question 4

Thrombocytes

Answer 4

Platelets; involved in blood clotting(provides a basis for coagulation to occur; also maintains homeostasis)

Question 5

What do red blood cells contain?

Answer 5

Hemoglobin

Question 6

Hemoglobin on a red blood cell allows it to do what?

Answer 6

-Hemoglobin(Hgb) allows RBCs to carry oxygen from the lungs to the rest of the body

Question 7

A red blood cell must have what two things to have hemoglobin?

Answer 7

Iron and Oxygen

Question 8

Where is the Iron located in a RBC

Answer 8

On the hemoglobin(Hgb)

Question 9

Erythropoiesis vs. Hematopoiesis

Answer 9

**Erythropoiesis: this is the creation of red blood cells, which is controlled by a substance in the kidneys and is stimulated when there is low oxygen in the blood

*Hematopoiesis: the creation of all blood cells not just RBCs

Question 10

Anemia

Answer 10

Reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin

Question 11

Symptoms of anemia

Answer 11

Fatigue, Weakness, Dyspnea(difficult/labored breathing), Pallor

Question 12

A physiological manifestation of anemia is hypoxemia, what is hypoxemia?

Answer 12

reduced oxygen-carrying capacity in the arterial blood

Question 13

Microcytic
vs.
Macrocytic
vs.
Hypochromic

Answer 13

Microcytic(size): small, pale RBCs
Macrocytic(size): extra large RBCs
Hypochromic(color): pale RBCs

Question 14

Macrocytic Normochromic Anemia(a.k.a megaloblastic anemia)

Answer 14

Large erythrocytes; normal Hgb(color)

• characterized by defective DNA synthesis
• caused by deficiencies in Vitamin B12 or Folate

Question 15

Pernicious Anemia (What is it caused by, what does it result in, and how is it treated?)

*(this is a type of Macrocytic-Normochromic Anemia)

Answer 15

• Caused by a lack of intrinsic factor from the gastric parietal cells; chronic gastritis, alcoholism, malnutrition, gastric bypass
  * Required for vitamin B12 absorption
  * Results in vitamin B12 deficiency
• Treatment: Parenteral or high oral doses of vitamin B12, ***Vitamin B12 injections(goes directly into the bloodstream) are usually taken for people with pernicious anemia

Question 16

What are the functions of Vitamin B12? And how do you obtain it?

Answer 16

• Red Blood Cell formation
• Brain function
• DNA synthesis

Vitamin B12 must be consumed in diet

Question 17

What is the Schilling’s test used for?

Answer 17

To determine if a patient is absorbing B12 by giving them radioactive B12. If the radioactive B12 is absorbed, the patient will have radioactive urine. If no radioactive B12 is absorbed, then B12 will be excreted in feces.

Question 18

Normal Ranges for Hemoglobin

Answer 18

13. 5-17.5 grams/deciliter in men

12. 0-15.5 grams/deciliter in women

Question 19

Vitamin B12 Deficiency Signs and Symptoms

Answer 19

• Numbness and tingling
• Anemia (fatigue/weakness)
• Infections
• Sore tongue, bleeding gums
• Yellowed skin
• Memory Loss
• Fatigue
• Irritability
• Diarrhea

Question 20

What is Intrinsic Factor?

Answer 20

Glycoprotein secreted by the stomach which enables the body to absorb vitamin B12

Question 21

Folate(Vitamin B9) Deficiency Anemia

**This is a type of Macrocytic-Normochromic Anemia

Answer 21

• Insufficient production of folate results in large RBCs that are unable to divide
• Similar symptoms to pernicious anemia except for neurologic manifestations generally not seen
• Treatment requires daily oral administration of folate

Question 22

Why is the adequate production of folate(Vitamin B9) important?

Answer 22

It is key in the formation of RBCs and helps aid in DNA synthesis. It also works with B12 and Vitamin C to help the body digest and utilize proteins.

Question 23

Is folate dependent on anything to get absorbed?

Answer 23

NO

Question 24

Where is Vitamin B12 absorbed? Where is Folate (Vitamin B9) absorbed?

Answer 24

Vitamin B12 is absorbed in the stomach.

Folate is absorbed in the small intestine.

Question 25

The insufficient production of folate results in what?

Answer 25

Results in large red blood cells that are unable to divide.

Question 26

Microcytic-Hypochromic Anemias (Slide 17)

Answer 26

Characterized by red cells that are abnormally small and contain reduced amounts of hemoglobin

Question 27

Iron Deficiency Anemia

Answer 27

-It is a type of microcytic hypochromic anemia -it is the most common type of anemia worldwide **Iron is needed to form hemoglobin(which is an oxygen-carrying protein inside RBCs) -Caused by nutritional iron deficiency or significant blood loss -Metabolic or functional deficiency -Blood loss: body usually reuses iron, bleeding creates an increased need for iron -Manifestations when serum Hgb decreased to 7 or 8 gm/dl

Question 28

What two things are located in the hemoglobin of a RBC?

Answer 28

Iron and Oxygen binding sites

Question 29

True/False when the body lacks iron, it makes less hemoglobin and fewer RBCs, so the blood delivers less oxygen to tissues

Answer 29

True

Question 30

What are the early signs and symptoms of iron deficiency anemia? (manifestations occurs when serum Hgb decreases to 7-8 gm/dl)

Answer 30

fatigue; weakness; shortness of breath; pale ear lobes, palms, and conjunctiva

Question 31

Signs and Symptoms with the Progression of Iron Deficiency Anemia

Answer 31

``` -Brittle, thin, coarsely ridged, and spoon-shaped nails (koilonychia) -A red, sore, and painful tongue -Dry, sore corners of the mouth leaving cracks (angular stomatitis) -Glossitis Inflammation/fissure of tongue -Cheilitis Inflammation of lips -Cold sensitivity -Weak and fatigued -Restless leg syndrome ```

Question 32

Normocytic-Normochromic Anemias

Answer 32

Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number

Question 33

What are the two types of normocytic-normochromic anemias?

Answer 33

Aplastic Anemia and Hemolytic Anemia

Question 34

Aplastic Anemia (Description and Treatment)

Answer 34

- a primary condition of bone marrow depression, results in reduction of all 3 hematopoietic cell lines (red, white, platelets) - Treatment: bone marrow transplantation, transfusions, steroids

Question 35

Signs/Symptoms of Aplastic Anemia

Answer 35

-fatigue -pallor -petechiae (tiny little red dots on the skin's surface as a result of ruptured vessels) -bruising(contusion; type of hematoma) -bleeding (gums, nose, GI) -infections

Question 36

Hemolytic Anemia

Answer 36

-accelerated destruction of RBC; autoimmune -Congenital RBC are defective Ex: sickle cell anemia -Acquired Spleen traps and destroys RBC

Question 37

Sickle Cell Anemia

Answer 37

* *The lack of tissue oxygen can cause attacks of sudden, severe pain, called pain crises. These pain attacks can occur without warning, and a person often needs to go to the hospital for effective treatment. * *Sickle cells can’t change shape easily, so they tend to burst apart or hemolyze. Normal red blood cells live about 90 to 120 days, but sickle cells last only 10 to 20 days. * *In sickle cell disease, the spleen doesn’t work properly or doesn’t work at all. This problem makes people with SCD more likely to get severe infections * *Sickle hemoglobin is not like normal hemoglobin. It can form stiff rods within the red cell, changing it into a crescent, or sickle shape. * *Sickle-shaped cells are not flexible and can stick to vessel walls, causing a blockage that slows or stops the flow of blood. When this happens, oxygen can’t reach nearby tissues