increase heart rate via sympathetic nervous system
How does the respiratory system respond to blood loss?
rate increases in rate and depth
increase release of oxygen
Why would you get a low grade fever from blood loss?
b/c ischemic tissues release pyrogens
What is macrocytic normochromic anemia?
unusually large stem cells in marrow that mature into unusually large RBCs
hemoglobin is normal
What is the most common form of macrocytic normochromic anemia?
PA (pernicious anemia)
What are two byproducts of RBC destruction?
indirect bilirubin (from heme breakdown)
What % of nursing home patients have anemia?
what are the causes of macrocytic normochromic anemia?
decreased precursor DNA synthesis
(genetic disorder of DNA synthesis)
congenital or acquired deficiency of intrinsic factor (IF)
DNA does not clump normally
RNA messed up--- unequal growth and development of cytoplasm and nucleus
How do megaloblastic RBCs cause anemia?
they are phagocytosed and there is a greater chance of them dying b/c they are so large = anemia
What is the main cause of pernicious anemia?
vitamin B12 deficient
What group of people are more likely to have pernicious anemia?
vegetarians b/c they don't eat meat, don't get B12
What is a disease that might cause pernicious anemia?
chronic atrophic gastritis (Type A)
who is at risk for chronic atrophic gastritis and therefore pernicious anemia?
over age 50
What is the cause of chronic atrophic gastritis?
lack of IF (intrinsic factor) from gastric parietal cells
Why do you need IF and B12 to prevent anemia?
b/c B12 and IF bind and travel to the ileum, where they are absorbed and the blood needs vitamin B12
What disease is a precursor to pernicious anemia, could be autoimmune, may show in family history, creates antibodies against parietal cells, and may be associated with achlorhydria and lowered digestive enzymes?
chronic atrophic gastritis type A
What are the major risks for getting pernicious anemia?
diet/habits (alcohol, smoking, hot tea)
H. pylori infection
Which anemia has a very slow onset and is hard to diagnose?
what are some signs and symptoms of pernicious anemia?
usually occur later in onset
atrophic glossitis: sore, beefy tongue
irreversible demyelination: loss of position or vibration sensation
What is the treatment for pernicious anemia?
B12 injections once a month or high oral doses
What is microcytic hypochromic anemia?
small and pale RBCs
low hemoglobin concentration
What are the 3 main causes of microcytic hypochromic anemia?
disorder of iron metabolism
disorder of porphyrin and heme synthesis
disorder of globin synthesis
What is the most common type of microcytic hypochromic anemia?
iron deficiency anemia (IDA)
What is the most common type of anemia in the world?
What are the causes of IDA?
malnutrition and blood loss due to gastritis or ulcers
pica (eating lead or minerals)
What disease affects 9% of infants in the US?
What is a major effect that IDA has on the body?
can cause irreversible cognitive impairment
parasites increase blood loss
What is the treatment for IDA?
oral iron replacement
IM iron dextran
How do you diagnose IDA?
test hemoglobin concentrations in blood
check bone marrow iron stores
What are the signs and symptoms of IDA?
can be gradual
brittle, spoon-shaped or concave nails
red, sore tongue
dry mouth corners: angular stomatitis
difficulty swallowing due to web in esophagus
What is the first line of defense?
(physical, biochemical, mechanical barriers)
What is the second line of defense?
What is the third line of defense?
acquired immunity (adaptive)
What are some of the physical and mechanical barriers to infection?
lower temp of extremities
directly expelled (cilia in lungs, coughing, sneezing, vomiting, urinating)
What are some biochemical barriers to infection?
sebaceous glands secrete fatty acids and lactic acids
sweat, tears and saliva contain lysozymes that attack the cell walls of gram + bacteria
skin is acidic
epithelial derived chemicals like defensins and cathelicidins
What is the structure of cathelicidins?
linear alpha helix
amphipathic (have both hydrophillic and hydrophobic parts)
Where are cathelicidins stored?
mast cells, epithelial cells, and neutrophils
How do cathelicidins kill bacteria?
they are able to insert and disrupt membranes because bacteria have cholesterol-free membranes
What type of bacteria can cathelicidins kill?
gram + and -
What can defensins do that cathelicidins cannot?
they can activate cells of both the innate and immune system (cathelicidins= only innate)