Ch13-RBC

Ch13-RBC - RBC and BLEEDING DISORDERS RBC and Bleeding...

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RBC and BLEEDING DISORDERS
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RBC and Bleeding Disorders NORMAL NORMAL Anatomy, histology Anatomy, histology Development Development Physiology Physiology ANEMIAS ANEMIAS Blood loss: acute, chronic Blood loss: acute, chronic Hemolytic Hemolytic Diminished erythropoesis Diminished erythropoesis POLYCYTHEMIA POLYCYTHEMIA BLEEDING DISORDERS BLEEDING DISORDERS
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TABLE 13-2 -- Adult Reference Ranges for Red Blood Cells Measurement (units) Men Women Hemoglobin (gm/dL) 13.6–17.2 12.0–15.0 Hematocrit (%) 39–49 33–43 Red cell count (10 6 /µL) 4.3–5.9 3.5–5.0 Reticulocyte count (%) 0.5–1.5 Mean cell volume (µm 3 ) MCV 82–96 Mean corpuscular hemoglobin (pg) MCH 27–33 Mean corpuscular hemoglobin concentration (gm/dL) MCHC 33–37 RBC distribution width 11.5–14.5
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WHERE is MARROW? Yolk Sac: very early embryo Liver, Spleen: NEWBORN BONE CHILDHOOD: AXIAL SKELETON & APPENDICULAR SKELETON BOTH HAVE RED (active) MARROW ADULT: AXIAL SKELETON RED MARROW, APPENDICULAR SKELETON YELLOW MARROW
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MARROW FEATURES CELLULARITY 50% MEGAKARYOCYTES at least 1-2/hpf M:E RATIO 3:1 MYELOID MATURATION 1/3 bands or more ERYTHROID MATURATION nucleus/cytoplasm LYMPHS, PLASMA CELLS small percentage STORAGE IRON, i.e., HEMOSIDERIN
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MARROW “DIFFERENTIATION”
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ANEMIAS* BLOOD LOSS ACUTE CHRONIC IN-creased destruction (HEMOLYTIC) DE-creased production * A good definition would be a decrease in OXYGEN CARRYING CAPACITY, rather than just a decrease in red blood cells, because you need to have enough blood cells THAT FUNCTION, and not just enough blood cells.
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Features of ALL anemias Pallor, where? Tiredness Weakness Dyspnea, why? Palpitations Heart Failure (high output),
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Blood Loss Acute: trauma Chronic: lesions of gastrointestinal tract, gynecologic disturbances. The features of chronic blood loss anemia are the same as iron deficiency anemia, and is defined as a situation in which the production cannot keep up with the loss.
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HEMOLYTIC HEREDITARY MEMBRANE disorders: e.g., spherocytosis ENZYME disorders: e.g., G6PD deficciency HGB disorders (hemoglobinopathies) ACQUIRED MEMBRANE disorders (PNH) ANTIBODY MEDIATED, transfusion or autoantibodies MECHANICAL TRAUMA INFECTIONS DRUGS, TOXINS
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IMPAIRED PRODUCTION Disturbance of proliferation and differentiation of stem cells: aplastic anemias, pure RBC aplasia, renal failure Disturbance of proliferation and maturation of erythroblasts Defective DNA synthesis: (Megaloblastic) Defective heme synthesis: (Fe) Deficient globin synthesis: (Thalassemias)
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MODIFIERS MCV, microcytosis, macrocytosis MCH MCHC, hypochromic RDW, anisocytosis
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HEMOLYTIC ANEMIAS Life span LESS than 120 days Marrow hyperplasia (M:E), EPO+ Increased catabolic products, e.g., bilirubin, serum HGB, hemosiderin,
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HEMOLYSIS INTRA-vascular (vessels) EXTRA-vascular (spleen)
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M:E Ratio normally 3:1
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Ch13-RBC - RBC and BLEEDING DISORDERS RBC and Bleeding...

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