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Alter. in RBC function and Hemostasis
Alter. in RBC function and Hemostasis
53
Nursing
Undergraduate 2
09/22/2012

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Term
Normal Blood Composition
Definition
Cells-45%
-erythrocytes (most common) (Life span-120 days)
-leukocytes (5,000-10,000)
-platelets
Plasma-55%
-water >90%
-salts, lipids, enzymes, etc. 1.5%
-proteins- 7%
~Albumin- 54%
~Globulins- 38%
Term
Red Blood Cells
-shape
-amount
-precursor
Definition
** Non-nucleated, biconcave disk
-3.5-5.4 million cells/cubic mm
-precursor: reticulocytes (1.5%) (immature RBCS)
-contains hemoglobin (carries oxygen to tissues from lungs)
-responsible for carrying oxygen to the tissues
Term
Erythrocyte production: Erythropoiesis
Definition
-red blood cells are produced in the bone marrow in response to erythropoietin
Term
Erythropoietin
Definition
-realeased by the kidneys in response to hypoxemia (low in oxygen)
** compensatory mechanism:
kidney's sense hypoxemia, release erythropoietin, travels to bone marrow, to tell to make more RBCs; this will then collect oxygen and travel to tissues
Term
Life span of RBCS
Definition
100-120 days

-produce and destroy 200 billion RBC per minute
Term
Red Cell production requirements
Definition
-iron: hemoglobin
-folate (folic acid)- wall of blood cell
-vitamin B12- structure
-erythropoietin
-functional stem cells (in bone marrow needed to work properly)
Term
Red cell production
Definition
Stem cells--(erythropoeitin)-->erythroblasts-->reticulocytes--> red cells
Term
Adult Hemoglobin
Definition
hgba
-2 alpha & 2 beta chains
Term
Fetal Hemoglobin
Definition
hghf
-2 alpha & 2 gamma chains
-absorbs oxygen at lower tension-fetus picks up o2 from placenta not lungs which supplies more effectively
Term
Sickle Cell Hemoglobin
Definition
hghs
-defect in beta chain***
-change in 6th rung of beta chain
-causes serious problems
Term
Hemoglobin
Definition
-protein
-1 gram hg carries 1.36 ml oxygen
at birth: 75% hgbf and 5% hghf at 6 months (95% adult hemoglobin)
-hg measures the oxygen-carrying potential of the blood
Term
Lab values of hemoglobin
Definition
12-16 grams/dilution
Term
Hematocrit (Hct)
Definition
(% RBC's in the blood)= 37%-50%
-higher percentage, the more dehydrated (less plasma)
-lower percentage, more hydrated & more plasma)
Term
Mean Corpuscular voluve (MCV)
Definition
size of RBC
macrocytic (larger than normal)
normocytic (normal size)
microcytic (smaller than normal)
Term
Mean Corpuscular Hg (average amt of hg per RBC)
Definition
hypochromic (low amount of hemoglobin)
normochromic (normal amount of hemoglobin
Term
ABO and Rh blood groups
Definition
A, B, Rh are surface protein antigens
the immune system does not make antibody to its own blood group antigens
the immune system does make antibody to the antigens that it lakcs
Term
Anemia
Definition
not a specific disease
manifestation of a pathologic process
identified by classified laboratory diagnosis
Term
Anemia: definition
Definition
decrease in the oxygen-carrying capacity of blood due to:
- quality or quantity of RBC's
- amount of hemoglobin (iron)
-both

*not able to pick up oxygen and carry to tissues
Term
S&S of anemia
Definition
-Increase respiratory rate (low in 02, trying to get more)
-Increased heart rate (speed up to get more blood through
body- compensatory mechanism**)
-fatigue (lack of oxygen to muscle and tissues, tired)
-decreased activity tolerance
-pallor (RBC's and hemoglobin shows through skin but if low
light skinned people will be pale)
-heart murmur- irratic or irregular blood through heart- less
viscous-not normal 45% cells; will have less cells and
more watery context
-headache, dizziness, slow thoughts, irritability- brain not
getting enough o2
-dyspnea- short of breath
Term
Etiology of Anemia
Definition
Decreased RBC production
-iron deficiency
-aplastic ( decrease in production of erythrocytes)
Blood loss
Erythrocyte destruction
-sickle cell
-hemolytic
Morphology
size: normo, micro, macro
color: normochromic, hypochromic
Term
Iron Deficiency Anemia
Definition
Most common anemia
iron is necessary for hemoglobin synthesis
deficiency--> microlytic, hypchromic RBC's
May be due to poor intake, poor absorption by gi tract, or inadequate utilization by body
reticulocyte count should increase with iron therapy--> erythopoietin is released
Term
Anemia Due to Hemorrhage
Definition
acute blood loss
-orthostatic hypotension- sit/stands & blood pressure drops
-Increase Reticulocyte count
-no evidence of hemolysis on smear
Term
Aplastic anemia
Definition
-bone marrow unable to produce RBCs
-toxic, radiologic (radiation for cancer), or immunologic
injury to bone marrow
-anemia, leukopenia, thrombocytopenia
Term
Megaloblastic Anemias
Definition
Mega-large, blastic-young cells
-pernicious anemia (GI tract)
-lack of intrinsic factor--> no absorption of b12-->
can't make RBCs (b12 gives structure)
-cells macrocytic (megaloblastic)
-peripheral nerve degeneration
-folic acid deficiency: wall of RBC are floppy

treated by replacement therapy- replace B12 or folic acid
*chronic gastritis type A
Term
Hemolytic Anemia
Definition
Causes:
-sick cell disease
-ABO or Rh incompatibility
-drug induced
** JAUNDICE (in addition to other anemia S&S's) -more bilirubin b/c hemoglobin is breaking down
cells normocytic and normochromic
Term
Thalassemia
Definition
Group of inherited disorders of hemoglobin synthesis
-not synthesizing globin
Term
Sickle Cell Disease
Definition
***inherited disorder in which the presence of hemoglobin S causes erythrocytes to sickle when deoxygenated
- more likely to get caught and cause a clot-sickle cells break apart
Term
Polycythemia vera
Definition
leads to stroke
Term
secondary polcythemia
Definition
-kidney's make extra erythropoietin not true disease
Term
Polycythemia
Definition
-more than normal level of erythrocytes (RBCS)
-increased hematocrit
-stroke
Term
Relative polycythemia
Definition
dehydrated because too many red blood cells in blood and not enough plasma
Term
Transfusion Reactions and S&S
Definition
immune response to transfusion of wrong blood type
acute intravascular hemolysis
S&S:
-flank pain (vessel blocked)
-dyspnea (hard to breath)
-shock
-DIC (Disseminated intravasular coagulation- widespread clotting cascade then bleeding)
-chest pain
-nasuea, vomiting, headache
Term
Normal Hemostasis
Definition
arrest of bleeding
-platelets
-clotting factors (coagulation cascade; thrombin and fibrinogen)
-vessel endothelium

-five stages of clotting
Term
Platelet physiology
Definition
-Platelets are bits of megakarocyte membrane containing cytoplasm but no organelles
-platelets circulate for 7-14 days
-platelet production is stimulated by thrombopoietin made by the kidneys and liver
**normal platelets: 150,000-400,000
Term
Normal Hemostasis: stage 1
Definition
Vascular damage
-constriction of vessel to slow flow
-***requires thromboxane
Term
Thromboxane
Definition
required during Vascular damage stage to constrict vessels to slow the flow of blood
Term
Normal Hemostasis: Stage 2
Definition
Platelet plug
-platelets change shape-spiny spheres (prickly)
-platelets aggregate and adhere to subendothelial wall
-Von Williebrand factor (stick to eachother)
-platelets degranulate (release chemicals to trigger clotting cascade)
Term
Normal Hemotasis: Stage 3
Definition
Blood coagulation
-coagulation cascade
~intrinsic pathway-triggered by vessel damage
~ extrinsic pathway- triggered by tissue damage
-Factors become activated in sequence
-FACTOR IV-CALCIUM******* Reason for coagulation
Term
Normal Hemostasis: Stage 4
Definition
Clot retraction
-fibrin strands seal site, then shorten and become stronger (RBCS trapped in fibrin)
Term
Normal hemostasis: Stage 5
Definition
Fibrinolysis
-heparin stops clotting
-clotting factors absorbed or inactivated
-fibrin clot split (broken down, dissolved, reabsorbed
Term
Causes of bleeding
Definition
-platelet dysfunction
~thrombocytopenia (decreased # of platelets)
~Thrombocytopathia (impaired platelet functions)
-coagulation defects
~decrease clotting factors
~inherited defects
~abnormal consumption (DIC)
~vascular defects (vessel wall)
Term
Lab analysis of hemostasis: platelet disoders
Definition
Thrombocytopenia (platelet count)

Platelet dysfunction (bleeding time)
Term
Lab analysis of hemostasis: Clotting factor disorders
Definition
Intrinsic pathway (PTT)

Extrinsic (PT, INR)
Term
Bleeding due to Thrombocytopenia
Definition
Under 20,000 platelets/ microliter
Normal is 150,000-400,000
-decrease production in bone marrow (same in leukemia)
-decreased platelet survival
-excess pooling of platelets in spleen
-increased consumption (as in DIC)
Term
Ecchymosis
Definition
bruising
Term
purpura/petchial
Definition
purple, red, or blue pigment on skin
Term
Bleeding due to Clotting Factor Deficits
Definition
-diseased liver
-Vitamin K deficiency
-decreased calcium intake
Term
Inherited Factor VIII Deficiency: Hemophilia A
Definition
- a recessive, sex-linked inherited deficit of Factor VIII (clotting factor)
-90% produce insufficient quantities of Factor VIII
-severe and spontaneous bleeding
-huge eccheymosis (bruising)
Term
Hemorrhage due to Consumption of Clotting factors
Definition
-Disseminated intravascular clotting (DIC)--> hemorrhages b/c all platelets and clotting factors are used up
Term
Neutropenia
Definition
low in neutrophils
leukopenia and neutropenia (same thing): reduction in number of WBC or neutrophils (<1,000-1,500)
Absolute neutrophil count (ANC)-->
total number of WBCs x percentage of neutrophils
eg. 6,000 WBCs x 40%= 2400
Term
Neutropenia etiology
Definition
-chemotherapy and other drugs (wipes out WBCs-->
infecton
-aplastic anemia- not making enough RBCs
-leukemia- over production of immature WBC
-SLE, RA
-Some infections
-Severe sepsis
-nutritional deficiencies
Term
Band cells
Definition
increase in WBC
band cells- immature neutrophils
- sent out when infection is really severe
Term
Neutropenia manifestations
Definition
-frequent infection (no WBCs), especially in respiratory tract, skin, mouth
-may be fatal if untreated
-no signs or symptoms of inflammation
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