Hemoglobin & Hematocrit

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moses1424
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69390
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Hemoglobin & Hematocrit
Updated:
2011-02-27 21:24:00
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Hematology
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Hemoglobin & Hematocrit
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  1. Who discovered Hemoglobin?
    • Felix Seyler 1862
    • Proved respritory Protein.
    • True coloring matter of blood.
    • O2 Transport pigment found in RBCs.
  2. Function of Hemoglobin.
    • O2 to tissues.
    • Returns CO2.
  3. HGB as a buffer.
    Acts as a proton acceptor and a proton donor.
  4. HGB Clinical significance.
    • O2 transport capacity.
    • RBC volume.
    • RBC Number.
  5. Normal HGB numbers
    • Female 14 (+/- 2 g/dl)
    • Male 16 (+/- 2 g/dl)
  6. Decreased HGB Anemias
    • Microcytic= Iron Deficiency
    • Normocytic= Acute Hemorrhage.
    • Macrocytic= Pernicious Anemia
  7. Decreased HGB (non Anemic)
    • All Leukemias except CML
    • Altitude (nonpathological)
    • Over age 50 (nonpathological)
  8. Increased HGB
    • Dehydration and Shock
    • Polycythemia Vera.
    • Hemochromacytosis
    • Newborns (nonpathological)
    • Altitude (nonpathological)
  9. HBG Compound.
    Composed of carbon & Hyrdrogen.
  10. HGB Structure.
    • 4% Heme (4 hemes)
    • 96% Globin (1 globin)
  11. Heme Structure.
    • Tetrapyrole Ring
    • 4 Pyrole rings connected by methane bonds.
    • Pyrole ring is 4 carbon ring + nitrogen.
    • Fe +2 in the center of ring.
  12. Structure of globin.
    • Tetramer
    • 4 polypeptide chains (monomers) in 2 polypeptide units (dimers)
    • 2 alpha chains and 2 beta chains.
  13. Globin formed by ?
    Cytoplasmic Ribosomes of RBCs
  14. Heme is formed in the?
    Mitochondria & Cytoplasm of RBCs
  15. Formation of HGB timeline.
    • Begins in the Rubricyte Stage.
    • 65% formed in the metarubricyte stage.
    • 35% formed in the reticulocyte stage.
    • None formed in mature erythrocyte.
  16. Formation of 4 monomers (polypeptide chains) occurs in?
    • Cytoplasmic Ribosomes.
    • 2 Alpha & 2 Beta arranged into Tetramer.
  17. Each monomer contains how many amino acids?
    141-146
  18. Synthesis of Heme
    • Begins in mytochondria from succinyl Coenz A (vit. B6 needed)
    • Converted to Delta ALA which diffuses into cytoplasm then converted to Protoporphyrin.
    • Protoporphyrin transported to the mitochondria where combined w/ Fe + 2 to form Heme.
    • Heme transported back to cytoplasm where combined with globin to for HGB.
  19. Embryonic HGB
    • First HGB formed
    • Formed during 1st 12 weeks of gestation.
    • globin is composed of 2 Zeta Chains +
    • 2 Beta, 2 Gamma or 2 Delta Chains.
  20. Fetal HGB
    • Called HGB F
    • Second formed HGB 3-6 months
    • 1-2% of Adult HGB is HGB F
    • Globin is 2 Alpha & 2 Gamma Chains.
  21. Adult HGB
    • 2 Types
    • 96% HGB A1
    • Globin is 2 Alpha & 2 Beta Chains
    • 2-3% HGB A2
    • Globin is 2 Alpha & 2 Delta Chains
  22. Abnormal HGB
    • HGB S
    • HGB C
    • HGB H
    • HGB E
    • Burt's HGB
  23. Gamma Chains
    Amino Acid #136 of beta chains is substituted w/ either Alanine or glycine.
  24. Delta Chains
    8 Amino acids on beta chains substituted.
  25. Heriditary Persistance of Fetal HGB (HPFH)
    • Rare Condition
    • Produces large amounts of HGB F into Adulthood
    • Homozygous (100% HGB F)
    • Heterozygous (30% HGB F)
    • Normal (1-2% HGB F)
  26. HGB S
    • #6 amino acid on beta chains is replaced with Valine.
    • HGB is insoluble in low O2 concentrations.
  27. HGB C
    # 6 Amino Acid on beta chains is replaced w/ lysine.
  28. HGB Inheritance
    • Inheritant 1 gene for HGB from each parent.
    • Co-dominant genes.
  29. Oxyhemoglobin
    O2 bound to HGB.
  30. HGB Inheritance Patter
    • Normal A-A
    • Sickle Cell Disease S-S
    • Sickle Cell Trait A-S
  31. Deoxyhemoglobin
    CO2 Bound to HGB
  32. Reduced Hemoglobin
    H bound to HGB
  33. Carboxyhemoglobin
    • CO bound to HGB
    • Can't carry O2
    • 0.5% normal
    • 1-10% in smokers
    • 20-30% CO poisoning
    • >40% ussually deadth
  34. Sulfhemoglobin
    • Sulfer bound to HGB.
    • Sulfa Drugs oxidize HGB wich perpetuate out as heinz bodies.
    • Can't carry O2
  35. Methemoglobin
    • Iron in HGB oxidized to ferric state.
    • Can't carry O2.
    • May be inherited as autosomal dominant trait (HGB M disease) in which Tyrosine substituted for histadine on either alpha or beta chains.
  36. Breakdown of HBG
    • Iron returns to bone marrow.
    • Globin breaks down into amino acids.
    • Porphyrin ring oxidized to Biliverdin (green) to unconjugated biliruben (yellow)
    • Biliruben detoxified in the liver then released into intestines.
    • Bacteria reduce it to Urobilinogen then Urobilin.
    • Some reabsorbed and excreted by kidneys.
    • Most excreted as feces.
  37. Gravity method of HGB Measurment.
    • 2 Solutions of Copper Sulfate
    • Males is SP GR 1.055
    • Females with SP GR 1.053
    • If the drop sinks HGB is >13.5 for men and >12.5 for woman.
    • If drop floats HGB is too low.
  38. Sources of Error with Hemoglobincyanide
    • Lipemic Sample
    • HGB S/HGB C
    • High WBC count
    • Doesnt measure SulfHGB
  39. 3 Normal A1 Fractions
    • HGB A1a
    • HGB A1b
    • HGB A1c
    • HGB A1c is predominant fraction 3-6% is normal
  40. Glycosylated Hemoglobin.
    • HGB with glucose attached to terminal Valine.
    • Formed over weeks of continuously elevated blood sugar.
    • Diabetics have 6-12% GHgb
    • <10% is good control for diabetic
    • >10% is out of control.
  41. Hematacrit definition
    Ratio of RBC volume to total blood volume.
  42. Calculation of HCT
    RBC Volume / Total Volume x 100%
  43. Calculation of Hgb from HCT
    1/3 HCT is Hemoglobin
  44. Hematocrit Increase
    • Dehydration and Shock
    • Burns
    • Polycythemia
    • Altitude (nonpathological)
  45. Pathological decrease of Hct
    • Anemia
    • Hemorrhage
    • Pregnancy
    • Edema
    • Cirrhosis
  46. Nonpathological Decrease of HCT
    • Surgery with Blood Loss
    • Blood Donation
    • Over 50 years of age
    • Altitude
    • Recumbent Patient
    • After Meals
    • Long Distance Runners
  47. Age affecting Values
    • Higher in Newborns
    • Lower in kids 1-12
    • lower over age 50
    • Lower in Females
    • higher in males
  48. Normal HCT Ranges
    • Men 42 +/- 6
    • Female 47 +/- 8
    • Surgery 30
    • Nonsurgery 24
    • Panic Value 11
  49. Collection Method for HCT
    • Heparinized Micro Tubes
    • May collect in edta container
    • Centrifuge Stat
  50. Centrifuge Microhematocrit.
    • 3 minutes @ 12000 g
    • Measure within 10 minutes.
    • Duplicate tests must agree within 1-2%
    • Look for Hemolysis, Jaundice, Lypemia.
  51. Trapped Plasma
    Plasma that surrounds RBCs after spun
  52. Buffy Coat
    Layer in between RBCs and plasma composed of WBC and platelets.
  53. Calculate RBC from MCV Values
    HCT= RBC x MCV / 10
  54. PCV
    Packed Cell Volume
  55. MCV
    mean cell volume

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