NR 283 Exam 3 Concept Review
Hematology
RBC-function- Erythrocytes (or RBC’s) are the most abundant cell type in the body
Its primary job is tissue oxygenation
The cell has 2 unique properties:
o A biconcave shape which makes it optimal for gas transport
o The capacity to be reversible deformed. The cells can change shape to make it
through all the different size vessels in the body
Erythrocytes have a lifespan of 120 days
Hemoglobin is the oxygen carrying protein of the erythrocyte that gives RBC’s their
color
Each erythrocyte has over 300 hemoglobin molecules; 1 HGB can carry 4 oxygen
molecules
Erythropoiesis is the creation of erythrocytes from the bone marrow
Erythropoietin-produced, what does it do- Erythropoietin is the hormone that stimulates the
production of erythrocytes.
o It is produced by the kidneys
Epogen (epoetin alpha) is indicated for the treatment of anemia due to chronic kidney disease
(CKD), including patients on dialysis and not on dialysis to decrease the need for red blood cell
(RBC) transfusion
Anemias-types/ S/S of each- Anemia is a decreased total number of erythrocytes or a decrease in the
quality or quantity of hemoglobin
Causes of anemia are:
o Impaired erythrocyte production
o Acute or chronic blood loss
o An increase in the destruction of erythrocytes
o A combination of all 3
Types of anemia
, pernicious anemia -It is caused by a vitamin b12 deficiency
The main problem is the absence of intrinsic factor which is an enzyme needed to absorb
vitamin b12 in the stomach
Absence of this factor can be genetic or can be related to problems with the stomach
P.A. is most commonly caused by people who have had their stomach or a part of their
stomach removed, however a history of alcohol use or smoking can cause it as well
PA takes years to develop so initial symptoms can be very non-specific
When your hemoglobin starts to be affected (when it decreases) symptoms include
weakness, fatigue, and paresthesia’s of feet and hands
folate deficiency anemia
Folate is another vitamin necessary for DNA synthesis of erythrocytes
Folate deficiency anemia is commonly seen in alcoholics and malnourished people
With this type, there is no enzyme responsible for making sure we absorb the folate. We
are strictly lacking an adequate amount
Folate is found in dark, leafy green vegetables, citrus fruits, beans and nuts
o Folic acid is a synthesized form of folate
Clinical manifestations include:
o Cheilosis - fissures and scales in the mouth
o Stomatitis- inflammation of the mouth
painful ulcers of the tongue
Iron deficiency anemia- is the most common type of anemia
There are many causes, including insufficient iron in the diet, certain medications,
excessive menstrual bleeding in females, or ulcer’s
Iron is important because it is used for the production of HGB
The development occurs slowly through 3 stages:
o Body’s iron stores are depleted. Normal blood cell production occurs
o Now insufficient amounts of iron are transported to the marrow where iron deficit
RBC’s are produced with low amounts of HGB
o The HGB deficient cells enter circulation to replace the normal aging cells that
are getting ready to die
Clinical manifestations start occurring at stage 3
, Early symptoms are non-specific including fatigue, weakness, and SOB
As it become more severe, clinical manifestations can include:
o Koilonychias - the fingernails become brittle and concave or spoon shaped
o the tongue becomes sore and reddened
o the corners of the mouth become dry and sore
Sideroblastic anemia -is another type of anemia
It is characterized by a problem with the synthesis or creation of HGB
In SA, there is plenty of iron, but it is not used correctly to make the HGB
The erythrocytes end up with a little bit of HGB and a circle of iron in the RBC itself
SA’s can be classified as:
o Acquired: the most common and are idiopathic (no known cause)
o Hereditary: this is rare and is almost always found in men
o Reversible: this is associated with alcoholism because the alcohol impairs heme
synthesis
CM’s include those commonly seen with anemia
These people will also have signs of a syndrome called hemosiderosis or iron overload
Enlarged liver/spleen, deposits of iron in heart affecting its function
Polycythemia Vera- polycythemia which is the term for an excess production of RBC’s
There are many forms of Polycythemia
The main one I will focus on is primary absolute polycythemia, also known as
Polycythemia Vera.
The main cause is unknown but thought to be due to a genetic alteration of the
erythrocyte receptor
o So the receptor is not sensing that there are enough circulating erythrocytes and
just keeps producing them
The clinical manifestations of PV are due to an increase in the viscosity or thickness of
the blood
o The number of blood cells increase in the vessel but the amount of plasma or fluid
does not so you have an overcrowded vessel which makes the blood very thick
This can cause clogging and occlusion of blood vessels (think congested highways)
, Tissue injury and death are common as well as a high risk of developing blood clots
Another CM is plethora which is a ruddy, red coloring to the face, hands, and mucous
membranes
A unique CM of PV is a very intense painful itching that only gets worse with exposure
to heat or water
We mentioned that people with PV also have splenomegaly. Why? What is the spleen’s
job?
o Remember the spleen’s job is to filter and clean the blood. The more blood you
have the harder the spleen has to work, so it grows bigger.
o Remember cellular adaptations? Would this be atrophy or hypertrophy?
Pathologic or physiologic? Pathologic because it is getting bigger due to an
abnormal increase in erythrocytes
Secondary polycythemia is another form and results from an increased secretion of
erythropoietin from chronic hypoxia (such as people who live at high altitudes where
there is less oxygen or patient’s with COPD)
We said that if your body senses that you are hypoxic, it will secrete more erythropoietin
to create more RBC’s to get more oxygen to the tissues. This is the same thing
WBC-quantitative and qualitative-causes- Quantitative alterations refers to an increase or
decrease in the amount of leukocytes .
Quantitative disorders include:
Leukocytosis is an increase in the amount of circulating leukocytes
This is a normal response to infection, medications, stress, and medications
Neutrophilia is an increase in the number of neutrophils specifically
It is seen in the early signs of infection or inflammation
Lymphocytosis is an increase in the number of lymphocytes
Typically seen in viral infections
Leukopenia is a lower than normal amount of circulating leukocytes
This can occur in relation to autoimmune diseases or cancer treatments.
This is not normal and put someone at a high risk for developing infections
Neutropenia is a decrease in the number of neutrophils
Hematology
RBC-function- Erythrocytes (or RBC’s) are the most abundant cell type in the body
Its primary job is tissue oxygenation
The cell has 2 unique properties:
o A biconcave shape which makes it optimal for gas transport
o The capacity to be reversible deformed. The cells can change shape to make it
through all the different size vessels in the body
Erythrocytes have a lifespan of 120 days
Hemoglobin is the oxygen carrying protein of the erythrocyte that gives RBC’s their
color
Each erythrocyte has over 300 hemoglobin molecules; 1 HGB can carry 4 oxygen
molecules
Erythropoiesis is the creation of erythrocytes from the bone marrow
Erythropoietin-produced, what does it do- Erythropoietin is the hormone that stimulates the
production of erythrocytes.
o It is produced by the kidneys
Epogen (epoetin alpha) is indicated for the treatment of anemia due to chronic kidney disease
(CKD), including patients on dialysis and not on dialysis to decrease the need for red blood cell
(RBC) transfusion
Anemias-types/ S/S of each- Anemia is a decreased total number of erythrocytes or a decrease in the
quality or quantity of hemoglobin
Causes of anemia are:
o Impaired erythrocyte production
o Acute or chronic blood loss
o An increase in the destruction of erythrocytes
o A combination of all 3
Types of anemia
, pernicious anemia -It is caused by a vitamin b12 deficiency
The main problem is the absence of intrinsic factor which is an enzyme needed to absorb
vitamin b12 in the stomach
Absence of this factor can be genetic or can be related to problems with the stomach
P.A. is most commonly caused by people who have had their stomach or a part of their
stomach removed, however a history of alcohol use or smoking can cause it as well
PA takes years to develop so initial symptoms can be very non-specific
When your hemoglobin starts to be affected (when it decreases) symptoms include
weakness, fatigue, and paresthesia’s of feet and hands
folate deficiency anemia
Folate is another vitamin necessary for DNA synthesis of erythrocytes
Folate deficiency anemia is commonly seen in alcoholics and malnourished people
With this type, there is no enzyme responsible for making sure we absorb the folate. We
are strictly lacking an adequate amount
Folate is found in dark, leafy green vegetables, citrus fruits, beans and nuts
o Folic acid is a synthesized form of folate
Clinical manifestations include:
o Cheilosis - fissures and scales in the mouth
o Stomatitis- inflammation of the mouth
painful ulcers of the tongue
Iron deficiency anemia- is the most common type of anemia
There are many causes, including insufficient iron in the diet, certain medications,
excessive menstrual bleeding in females, or ulcer’s
Iron is important because it is used for the production of HGB
The development occurs slowly through 3 stages:
o Body’s iron stores are depleted. Normal blood cell production occurs
o Now insufficient amounts of iron are transported to the marrow where iron deficit
RBC’s are produced with low amounts of HGB
o The HGB deficient cells enter circulation to replace the normal aging cells that
are getting ready to die
Clinical manifestations start occurring at stage 3
, Early symptoms are non-specific including fatigue, weakness, and SOB
As it become more severe, clinical manifestations can include:
o Koilonychias - the fingernails become brittle and concave or spoon shaped
o the tongue becomes sore and reddened
o the corners of the mouth become dry and sore
Sideroblastic anemia -is another type of anemia
It is characterized by a problem with the synthesis or creation of HGB
In SA, there is plenty of iron, but it is not used correctly to make the HGB
The erythrocytes end up with a little bit of HGB and a circle of iron in the RBC itself
SA’s can be classified as:
o Acquired: the most common and are idiopathic (no known cause)
o Hereditary: this is rare and is almost always found in men
o Reversible: this is associated with alcoholism because the alcohol impairs heme
synthesis
CM’s include those commonly seen with anemia
These people will also have signs of a syndrome called hemosiderosis or iron overload
Enlarged liver/spleen, deposits of iron in heart affecting its function
Polycythemia Vera- polycythemia which is the term for an excess production of RBC’s
There are many forms of Polycythemia
The main one I will focus on is primary absolute polycythemia, also known as
Polycythemia Vera.
The main cause is unknown but thought to be due to a genetic alteration of the
erythrocyte receptor
o So the receptor is not sensing that there are enough circulating erythrocytes and
just keeps producing them
The clinical manifestations of PV are due to an increase in the viscosity or thickness of
the blood
o The number of blood cells increase in the vessel but the amount of plasma or fluid
does not so you have an overcrowded vessel which makes the blood very thick
This can cause clogging and occlusion of blood vessels (think congested highways)
, Tissue injury and death are common as well as a high risk of developing blood clots
Another CM is plethora which is a ruddy, red coloring to the face, hands, and mucous
membranes
A unique CM of PV is a very intense painful itching that only gets worse with exposure
to heat or water
We mentioned that people with PV also have splenomegaly. Why? What is the spleen’s
job?
o Remember the spleen’s job is to filter and clean the blood. The more blood you
have the harder the spleen has to work, so it grows bigger.
o Remember cellular adaptations? Would this be atrophy or hypertrophy?
Pathologic or physiologic? Pathologic because it is getting bigger due to an
abnormal increase in erythrocytes
Secondary polycythemia is another form and results from an increased secretion of
erythropoietin from chronic hypoxia (such as people who live at high altitudes where
there is less oxygen or patient’s with COPD)
We said that if your body senses that you are hypoxic, it will secrete more erythropoietin
to create more RBC’s to get more oxygen to the tissues. This is the same thing
WBC-quantitative and qualitative-causes- Quantitative alterations refers to an increase or
decrease in the amount of leukocytes .
Quantitative disorders include:
Leukocytosis is an increase in the amount of circulating leukocytes
This is a normal response to infection, medications, stress, and medications
Neutrophilia is an increase in the number of neutrophils specifically
It is seen in the early signs of infection or inflammation
Lymphocytosis is an increase in the number of lymphocytes
Typically seen in viral infections
Leukopenia is a lower than normal amount of circulating leukocytes
This can occur in relation to autoimmune diseases or cancer treatments.
This is not normal and put someone at a high risk for developing infections
Neutropenia is a decrease in the number of neutrophils
