Hematologic System (RBC Emphasis)

Chief functions of the hematologic system

1. Delivery of substances needed for cellular metabolism

2. Removal of wastes

3. Defense against microorganisms and injury

4. Maintenance of acid-base balance

Erythrocytes are derived from

Erythroblasts

Erythropoietin is produced in the

Kidneys

RBCs are produced in the

Bone marrow (erythropoiesis)

B12 requires ___ ___ secreted by parietal cells

Intrinsic factor

Erythropoiesis cannot proceed without vitamins

B12, folate, B6, and riboflavin

Anemia

Low RBCs in circulating blood volume

Reduced oxygen-carrying capacity

Thinner blood (less viscous)

Results in tissue hypoxia

High HR (thin blood + hypoxia + dilated vessels = increased HR)

Terms like “macrocytic” and “microcytic” are describing RBC

Size

Terms like “normochromic” and “hypochromic” describe hemoglobin

Concentration

Manifestations of anemia

Impaired healing, loss of skin elasticity, weakness, numbness, nausea, emesis, dizziness, SOB, syncope

Acute anemia

Associated with trauma

Shunting of blood to vital organs (blood stays in the heart, lungs, and brain)

Macrocytic-Normochromic anemias

Large RBCs, normal hemoglobin concentration

PA and folate deficiency

Pernicious anemia (PA)

Associated with stomach problems

B12 deficiency (B12 needs intrinsic factor from parietal cells in the stomach for absorption)

Causes of Pernicious Anemia (PA)

Destruction of parietal cells, alcoholism, gastrectomy, liver disease, hypothyroidism, cigarette smoking

Manifestations of Pernicious Anemia (PA)

Paresthesia, difficulty walking, beefy red tongue (atrophic glossitis), splenomegaly, hepatomegaly

Neurological symptoms

Folate deficiency anemia

Associated with diets

Folate deficiency because of diet

Manifestations of folate deficiency anemia

Burning mouth syndrome, dysphagia, flatulence, watery diarrhea

No neurological symptoms

Mircocytic-Hypochromic anemias

Small RBCs, low hemoglobin concentration

Iron deficiency anemia

Iron deficiency anemia

Associated with chronic blood loss

Iron deficiency and reduced hemoglobin

Early manifestations of iron deficiency anemia

Fatigue, weakness, SOB, pallor of ear lobes and palms, conjuctiva

Late manifestations of iron deficiency anemia

Brittle, thin, ridged, and spoon shaped nails (koilonychia)

Red, sore, and painful atrophied tongue

Dry, sore corners of mouth (angular stomatitis)

Normocytic-Normochromic anemias

Normal RBC size and hemoglobin concentration

Sickle Cell Disease and posthemorrhagic anemia

Posthemorrhagic anemia

Bleeding caused decreased blood volume

RBCs are being reproduced after blood loss

Sickle Cell Disease (SCD)

Poor oxygenation and dehydration causes RBCs to sickle (severity depends on the level)

Sickle Cell Disease (SCD) can cause

Increased blood viscosity, slower movement of blood, and vascular occlusion

Manifestations of sickled state

Pain, jaundice, weakness, fatigue

When clotting happens too slow, a nurse may see

Easy bruising, persistent bleeding from minor wounds, swollen joints, hematuria, and heavy menses

When clotting happens too quick, a nurse may see

Embolus leading to DVT, pulmonary embolus, and stroke

Classic hemophilia

Factor 8 deficiency (no thrombin activation, no fibrin conversion from fibrinogen, no blood clotting)

Von Willebrand Disease (VWD)

Von Willebrand factor deficiency (VWF works with Factor 8 to start the clotting process)

Thrombophilia

Blood is hypercoagulable (clot loving)

Factor V Leiden

Thrombophilia

Increased Factor 5 (increased thrombin, increased clotting)

Activated protein C (APC) does not inactivate Factor 5, which causes excessive clotting