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plasma vs rbc
- fluid left after cells removed can clot
- fluid after clot is removed
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albumin
from liver, smaller than globulins, maintain osmoic pressure and carry certain metabolites
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what is the only source for hematopoesis at birth?
bone marrow. Before birth stem cells in liver then migrate to bone marrow
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lympthoid vs myeloid vs erythmoud
- B/T cells
- vs nonspecific monocytes and DCs
- vs RBCs and platelets in bone marrow
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PSC goes to
lymphoid and myeloid progenitors
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what is required for erythropoiseis
erythropoietin, B-12, folate,
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RBC maturateion
P>B>P>normoblast>RBC
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RBC
giesma smear and 120 day life span. Removed by spleen and liver. Lose nucleus when mature
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reticulocyte
immature RBC with residual ribo RNA. Too high in these means his person is anemic and bone marrow is responding
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Values of RBCs
Hb, RBC count, PCV
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anemia
reduced oxygen carrying capacity
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anemia due to decreased RBC production
Iron/B12 deficiency
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anemia can be due to/......failure
- bone marrow
- liver
- globin synthesis: thalessemia
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Iron deficiency anemia
most common form, serum ferritin is low, hypochromic microcrytic anemia
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Iron absorption
in duodenum via DMT and ferroportin releases this into liver
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Iron metabolism via brown pigment in macrophages
hemosiderin
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Lab findings in iron deficiency
decreased iron, bone marrow stores, ferritin, increased TIBC
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chronic anemia
decreased, Iron, TIBC, increased bone marrow stores and ferritin
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iron deficiency
white hands, pupil, oral hesions, sore tongue, angular cheitltis
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clinical presentation
fatigue, breathlessness, sore mouth, angular stmatisits
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megaloblastic anemia
B12/folate. Impaied DNA synthesis, enlarged erythroid precursors. Megablasts in bone marrow
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cause for vitamin b12 deficiency
pernicious anemia
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vita b12 absorption
inadequte intrinsic factor. B12 is not absorbed from stomach. TranscobalminII delivers to rest of body
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causes b12 deficiency
autoimmune, malabsorption
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folate deficiency causes
diet poor in fruits and veggies, alcoholics, drugs, malabsorption, increased metabolis needs
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lab findings for vita b12 and folate deficiency
peripheral bld smear macrocytic anemia, hypersegmented neutrophils. hypercellular bone marrow, megaloblastic changes
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anemia of chronic disease pathology
response to inflammation. Liver produced Hepcidin which supresses feroportin, blunts bone marrow response.
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chronic anemia
reticulocyte count low
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aplastic anemia
Idopathic, infections, genetic, drugs
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aplastic anemia manesfestation
hypocellular bone marrow
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hemolytic anemia
intrinsic and extrinsic destruction of RBC
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RBC membrane disorders
membrane proteins stabilize the lipid bilayer
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Hereditary Spherocytosis
deficiency of cytoskeleton protein. Rigid membrane
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Causes hered. sphereo
autosomal domiant, Northern euriopean, hemolytic anemia, jaundice, low Hb, needs osmotic fragility test
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hereditary elliptocytosis
African and mediteranean descent. resistance to malaria. Due to spectrin defect
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red cell enzyme disorder
G6PD deficiency. Not enough glutathione reduction. hexose-monoP us sole source of NADPH in RBCs
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G6PD deficiency leads to
hemolysis, Heinz bdies, protection against malaria. Spectroometric analysis. Avoidance of oxidant stressors
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Pyrimidin 5 nucleotidase
autosomal recessive. degrades RNA in reticulocytes. ONLY rbc enzyme deficiency with consistent morphology...basophillic stippling due to rRNA. (lead poisioning anemia and thalessemia
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What causes vascular hemolysis or trauma to RBC
DIC, hypertension (malignant), hemlytic uremic syndrome, thermal injury
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autoimmune hemolytic anemia
IgG antibodies against RBCs. RBCs become sphereical. Increased reticulocytosis
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hemolysis lab eval
reticulocytosis-nucleated RBCs, polychromatophillia,
- freee serum Hb
- free urin Hb
- jaundice
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hemoglobinopathies
problem with globin chains...normally there are four. Thalassemia abnormal amount oof chain
Or can be globin chains with defects
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sickle cell sidease
genetic disorders with abnormal synthesis of HbS
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sicble cell anemia pathology
spleen enlarges then hypoxia, then auto-splenetomy
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thalassemia
quantativetive defects. Not enought globin chains produced so hyprochromic microcytic anemia
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thalassemia bone marrow
expansion to compensate for increased hematopoiesis
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polycytemia
increased RBC count. can be caused by dehydration. Or excess erythropoietin. responsive or pathologic as in tumors
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