how large is an RBC?
7.7 um
when are RBCs increased?
infants, during the day activity temperature altitude
what is the normal blood volume?
5L
which chains does hemoglobin have?
2 alpha chains
2 beta chains
how does blood contribute to acid/base balance?
transports CO as bicarb
what is an average range of white cells?
5-10K
a WBC of >10K would indicate what?
infection, dx, reactive
a WBC of <5K would indicate what?
immunodeficiency or huge infection with depleted pool
what are normal values of neutrophils?
55-70%
2500-8000 ANC
how do neutrophils kill microorganisms?
releases toxic enzymes and phagocytisizes
what are normal values of lymphocytes?
20-30%, 1000-4000
what are normal values of monocytes?
2-8%, 100-700
what are normal values of eosinophils?
1-3%
50-5000
what is the role of eosinophils?
parasite invasions
allergic rxns
what are normal values of basophils?
<1%, 25-100
what is the role of basophils?
histamines
inflammatory response to injury (non specific immune response)
which cells are the first line of defense in inflammatory responses?
monocytes
which WBC is most responsible for viral infections?
lymphocytes
what are the normal values of platelets?
130K-400K
when do you have a bleeding risk?
20K
what is a microcytic cell?
MCV of <80
what is normal MCV?
80-96
what are the microcytic anemias?
TICS thalassemia Iron deficiency chronic dz/infllamation or copper def. spherocytosis/siderblastic/dec. synthesis
what is spherocytosis?
no area of central pallor,
small, round shape
what is sideroblast?
iron accumulation around nucleus (in membrane, not in hemoglobin molecule)
what is the MCV for macroblastic RBC?
> 100
what are causes of macrocytic anemia?
BIG FAT RED CELLS
what are causes of normocytic anemia?
NORMAL SIZE
what is myelophthistic?
bone marrow gets displaced by non-blood making tissue
what is hypochromia?
reduced Hgb content
what is hyperchromia?
excess pigmentation of hemoglobin
what is poikilocytosis?
way to describe the shape of red cells
used in anemias, myelofibrosis
what does an increase in reticulocytes indicate?
active erythropoeisis,
- posthemorrhage
- acclimating to increase altitude
- pulmonary dz with hypoxia
- all types of anemia
what will the RDW be if retic count is high?
elevated (retics are larger than RBC)
what is anemia of chronic dz?
overall the body is not functioning correctly and is not producing RBCs the way it is supposed to
what is the definition of anemia?
reduction in mass of circulating RBC
what are the factors that influence anemias?
- production
- destruction
- loss
what bone marrow disorders impact RBC production?
aplastic anemia
MDS
tumor infiltration
what things caused bone marrow suppression?
Meds (alopurinol)
Radiation
Chemo
what endocrine problems impact RBC production?
kidney dz (dec. epo)
hypothyroid
hypogonadism
how do angrogens impact RBC production?
increase
what are inherited hemolytic anemias?
hereditary spherocytosis
sickle cell
thal major
what are acquired hemolytic anemias?
Coombs positive AI TTP-HUS malaria meds
what is a common source of blood loss?
GI…think GI!
what are sxs of anemai?
SOB CP or angina fatigue bounding pulses, roaring in ears confusion HF (chronic low volumes where the heart out) PICA (crave ice?) syncope shock/death
How do you approach anemia?
- assess MCV
- ethnic background
- UTD with GI eval, gyn eval
what do you note on PE when eval anemai?
pallor jaundice lymphadenopathy hepatosplenomegaly bone tenderness (aplastic anema/leukemia) petechiae or ecchymosis sx of bleeding stool/DRE
what environment does iron need to be absorbed?
acidic (need to decrease pH, in order to get optimal absorption)
what does the ferritin level tell you?
iron stores over time
what is the desire to eat dirt?
geophagia
what is the desire to eat paper/starch?
amylophagia
what happens during acute blood loss?
extravascular fluid moves the intravascular space and the RBCs become diluted which leads to anemia
where is iron stored?
liver, spleen, marrow
