RBC Disorders

Question 1

Role of Hemoglobin

Answer 1

-reversibly binds oxygen and CO2 for transport
-adequate Hgb necessary for oxygen delivery to the tissues

Question 2

diseases of red blood cells

Answer 2

-relate to either quantity or quality
-all diseases of RBC’s mean less oxygen is able to be transported to the tissues

Question 3

macrocytic-normochromic

Answer 3

-large, abnormally shaped erythrocytes
-hemoglobin concentrations normal
-B12 and folate deficiencies

Question 4

microcytic-hypochromic

Answer 4

-small, abnormally shaped cells
-reduced hemoglobin concentrations
-Iron-deficiency

Question 5

normocytic-normochromic

Answer 5

-normal size
-normal hemoglobin function
-blood loss, sickle cell, aplastic anemia

Question 6

iron is essential for

Answer 6

normal hemoglobin function

Question 7

folate and vitamin B12 are necessary for

Answer 7

normal DNA synthesis of RBC’s

Question 8

normal Hemoglobin level

Answer 8

women: 12-16 g/dL
men: 14-18 g/dL

Question 9

lab values in anemia: mild

Answer 9

hgb women: 10-12 g/dL
hgb men: 10-13.5 g/dL

Question 10

lab values in anemia: moderate

Answer 10

hgb: 8- <10 g/dL

Question 11

lab values in anemia: severe

Answer 11

hgb: <8 g/dL

Question 12

clinical manifestations of ALL anemias

Answer 12

-decreased oxygen carrying capacity
-mild-may have no symptoms
-moderate: fatigue, weakness, tachycardia, dyspnea
-severe: increased HR and RR, hypotension, pallor, faintness, CV symptoms

Question 13

iron deficiency anemia: etiology

Answer 13

-most common anemia
-decreased intake of iron
-impaired absorption of iron
-increased demand for iron
-excessive loss (GI bleed, menstruation, etc.)

Question 14

iron deficiency clinical manifestations

Answer 14

-general s/s of anemia plus:
-smooth tongue/glossitis/mouth ulcers/cheilosis
-koilonychia “spoon nails”
-pica- craving non food items (ice mainly)

Question 15

anemia from B12 deficiencies

Answer 15

also called megaloblastic /macrocytic

Question 16

megaloblastic anemia

Answer 16

-condition in which the bone marrow produces unusually large, structurally abnormal, immature RBC’s
-leading cause is B12 and folic acid deficiency
-most common in the elderly

Question 17

causes of anemia r/t deficiency of vitamin B12

Answer 17

-atrophic gastritis- stomach lining has thinned
-conditions that affect the small intestine, such as Crohn’s, celiac, bacterial growth, or a parasite
-autoimmune disorder-pernicious anemia (most common cause)

Question 18

manifestations specific to B12 deficiency

Answer 18

-s/s of anemia plus:
-neuropathy
-ataxia
-glossitis
-dementia/psychosis

Question 19

anemia r/t folate deficiency

Answer 19

-folate is a B9 vitamin that is needed for RBC formation
-problem with decreased intake (alcoholism, diet, cirrhosis)
-increased need (pregnancy)

Question 20

anemia of CKD

Answer 20

-main etiology: impaired erythropoietin production
-hgb/hct correspond with the degree of kidney insufficiency
-clinical manifestations: general s/s of anemia

Question 21

aplastic anemia

Answer 21

-primary condition of bone marrow stem failure
-autoimmune most common cause
-classified as: congenital or acquired
-characterized my PANCYTOPENIA
-treatment: blood transfusions, bone marrow transplant, immunosuppressants, corticosteroids, drugs to stimulate erythropoiesis

Question 22

causes of aplastic anemia

Answer 22

-idiopathic
-high dose exposure to toxic agents
-autoimmune mechanisms

Question 23

increased destruction of RBC’s

Answer 23

-abnormal hemoglobin: acquired hemolytic anemia; sickle cell anemia; thalassemia

Question 24

acquired hemolytic anemia

Answer 24

premature destruction of RBC’s caused by some external agent

Question 25

causes of acquired hemolytic anemia

Answer 25

-autoimmune attack -blood incompatibilities -drug reactions

Question 26

hemolytic anemia

Answer 26

-formation of immune complexes -lysis -look for: low hgb, increased reticulocyte count, mild jaundice, hemoglobinuria

Question 27

anemia r/t abnormal hemoglobin

Answer 27

-sickle cell diseases -thalassemia

Question 28

sickle cell anemia

Answer 28

-genetic disorder -inability to bind hemoglobin normally -hemoglobin S distorts shape, especially when oxygen is low -easily clog blood vessels and break into pieces that disrupt blood flow leading to ischemia and necrosis

Question 29

clinical manifestations: sickle cell anemia

Answer 29

-s/s general anemia -swelling of hands and feet with a fever -painful episodes/crisis from ischemia and necrosis from clogged vessels -crisis triggers: dehydration, stress, high altitude, fever, extreme temps

Question 30

sickle cell anemia treatment

Answer 30

-oxygen therapy -hydration -pain management -infection control measures -antimetabolite drug: hydroxyurea -blood transfusions -bone marrow transplants

Question 31

thalassemia

Answer 31

-genetic- mostly mediterranean descent -abnormal hgb makes erythrocytes microcytic, hypochromic, and of carrying size -lack of one of two proteins that make up hemoglobin- alpha and beta globin

Question 32

thalassemia treatment

Answer 32

-blood transfusions -bone marrow transplants -splenectomy

Question 33

thalassemia clinical manifestations

Answer 33

-delayed growth -fatigue -dyspnea -hepatomegaly (enlarged liver) -splenomegaly (enlarged spleen) -bone deformities -jaundice

Question 34

acute blood loss

Answer 34

-500 ml- sx are rare; possibly syncope -1000 ml- increased HR with exercise -1500 ml- flat neck veins when supine; increased HR with exercise; decreased bp when sitting up/standing -2000 ml- increased HR, and decreased BP when supine; air hunger, cool, clammy skin -2500 ml- shock and death

Question 35

anemia due to blood loss

Answer 35

results from: gross or occult -rate of blood loss is important- acute vs. rapid

Question 36

disorder of too many RBC's polycythemia risk factors

Answer 36

-chronic hypoxia -living at high altitudes -long term cigarette smoking -familial and genetic predisposition -long term exposure to CO2

Question 37

relative polycythemia

Answer 37

-isolated decreased in plasma volume which elevates the Hgb, Hct, and RBC count -etiology: severe dehydration

Question 38

primary polycythemia

Answer 38

-polycythemia vera -typically >60 years -most often occurs in men

Question 39

polycythemia vera patho

Answer 39

a single stem cell mutates into a cell that overproduces all blood cells except for the lymphocytes

Question 40

polycythemia vera manifestations

Answer 40

-many complaints (headache, fatigue, weight loss, dyspnea) -HTN -clotting problems -ruddy color -intense/painful itching intensified by heat or exposure to water -biggest concern is CV events- stroke/heart attack from clots

Question 41

secondary polycythemia

Answer 41

-etiology: adaptive response to tissue hypoxia -purpose: provide more oxygen carriers by increasing RBC production

Question 42

secondary polycythemia manifestations

Answer 42

-increased blood viscosity and volume cause HTN (headache, inability to concentrate, dusky red coloring, possible cyanosis of lips, nails, mucous membranes -hyper-metabolism causes: night sweats and weight loss -increased RBC and h&h causes: itching and pain and fingers in fingers and toes