Nursing Care of Clients with Hematologic Problems Part 1 of 2 : Anatomy and Physiology Review, Erythrocytes (RBCs)

1. Maria Carmela L. Domocmat
Instructor
Northern Luzon Adventist College

2. Consists of blood and the bone marrow
blood - the major body fluid tissue
bone marrow - manufactures new blood cells
(hematopoiesis)

3. transports vital substances
maintains stability of interstitial fluid
distributes heat
14-2

4. changes in fluid concentration
changes in electrolyte concentration
amount of adipose tissue
about 8% of body weight or about 5 liters

6. Let us watch
Human Physiology How Does the Body Make Blood.avi
Contents of Blood.avi

9. Water
Ions
Glucose
Proteins

12. Water
3 L in average adult; constitutes 90% of plasma
Ions:
Sodium, potassium, calcium, phosphorous, and
other elctrolytes
Glucose
Prime oxidative metabolite of body cells

13. Proteins: act as buffers
Albumin
Largest component of plasma protein
Principally responsible for plasma colloid osmotic
pressure (COP)
Reversibly combines with and transports certain lipids,
bilirubin, thyroxin, and certain drugs, such as
barbiturates

14. Proteins
Alpha and beta globulins
Help establish COP
Transport certain vitamins, iron, copper, and cortisol
Hemostasis (prothrombin and fibrinogen are in this
blood fraction)
Gamma globulins
Antibodies

15. • straw colored
• liquid portion of blood
• 55% of blood

16. Albumins Alpha and Beta Globulins
• most numerous plasma proteins • originate in liver
• originate in liver • transport lipids and fat-soluble
• help maintain osmotic pressure of vitamins
blood
Gamma Globulins
Fibrinogen
• originate in lymphatic
• originate in liver
tissues
• plays key role in blood
• constitute the antibodies
coagulation
of immunity
14-22

22. Gases Nutrients
• oxygen • amino acids
• carbon dioxide • simple sugars
• nitrogen • nucleotides
• lipids
• lipoproteins
14-23

23. Chylomicrons VLDLs
• high • relatively high
concentration of concentration of
triglycerides triglycerides
• transport dietary • produced in the liver
fats to muscles and • transport triglycerides
adipose cells from liver to adipose cells
LDLs
• relatively high
HDLs
concentration
• relatively high
of cholesterol
concentration of proteins
• formed from
• relatively low
VLDLs
concentration of lipids
• deliver
• transport remnants of
cholesterol to
chylomicrons to liver
various cells 14-24

24. molecules containing nitrogen but are not proteins
urea – product of protein catabolism; about 50% of NPN
substances
uric acid – product of nucleic acid catabolism
amino acids – product of protein catabolism
creatine – stores phosphates
creatinine – product of creatine metabolism
BUN – blood urea nitrogen; indicate health of kidney
14-25

25. • sodium
• potassium
• calcium
• magnesium
• chloride
• bicarbonate
• phosphate
• sulfate
• sodium and potassium most abundant
14-26

27. Red blood cells or
erythrocytes
Platelets or
thrombocytes
White blood cells
or leukocytes

29. Mostly in bone marrow from stem cells
Rate regulated by cytokines & growth factors

31. 14-5

32. Description
Normal Values
Function
Erythropoiesis
Hemolysis

36. odeformable
7.5 µm in diameter
in 1 cm – you can put ›1,500 RBCs side by
side
Average life span: 120 days
unique shape
biconcave disk shape
thin center, thick edges – ideal for gas
exchange
deformable

37. 1 RBC has 200-300 million Hb
1 Hb has 4 globin chains (1 pair of ά chain
and 1 pair of β chain)
1 globin is bound to 1 heme (red pigment)
1 heme has 1 iron atom
Iron binds O2

38. Transport O2 and CO2 to and from body
tissues
Contains hemoglobin
participate in acid-base balance

40. The process begins in the embryonic yolk sac
maturing fetus - liver, spleen and lymph
nodes
end of pregnancy and after birth- restricted
to bone marrow
As time progresses, the contribution from
long bones decreases
Adult life - only the marrow of membranous
bones is involved
vertebrae, ribs and pelvis,.

41. Red Blood Cell Production
Requirements in production of healthy RBCs
Precursor cells (reticulocytes)
Adequate supplies of iron, Vitamin B12, folic
acid or folate, protein, pyridoxine, and
traces of copper

43. 1. Pluripotent stem cells or hemocytoblast
2. Proerythroblast
3. Erythroblast
4. Normoblast
5. Reticulocyte
6. Erythrocyte – mature RBC

46. hemocytoblast reticulocyte
3-7 days (in bone marrow)
reticulocyte erythrocyte
24-48 hrs (in blood)
erythrocyte lifespan 100-120 days

47. STIMULUS: Decreased oxygen level in blood
(hypoxia) due to:
Less RBCs from bleeding
Less RBCs from excess RBC destruction
Low oxygen levels (high altitude, illness)
Increased oxygen demand (exercise)
Causes kidneys and liver to release of
erythropoietin
Kidneys produce 90%; liver 10%

49. Erythropoietin: the hormone that stimulates
RBC production
Takes several days to effect
Red bone marrow increases production of
RBC
Reach maximum production after 5 days from
stimulation

50. Increased number of RBC in the circulation
result to increased oxygen-carrying capacity
of the blood
Detected by the liver and kidneys
Negative feedback to the kidney and liver :
Inhibition of the erythropoietin production
Note: if with kidney failure – hypoxia has little or
no effect on RBC production

51. RBC lacks mitochondria –no source of energy
Relies on glucose ad glycolytic pathway for
its metabolic needs
Enzyme-mediated anaerobic metabolism of
glucose
Generate the ATP needed for normal membrane
function and ion transport
Depletion of glucose or functional deficiency
of one of glycolytic enzymes leads to
premature death of RBC (G6PD deficiency)
14-7

53. RBC destruction
Rate of RBC destruction: 2.5 million/sec or
1% of RBCs per day
RBC destruction = RBC production
RBC circulate for about 120 days
macrophages ingest and destroy worn out
and defective RBCs in spleen, liver, bone
marrow and lymph nodes
hemoglobin is broken down into heme and
globin

54. Let’s watch Crenation: the
Hemoysis and formation of
crenation of RBC abnormal notching
around the edge of
an erythrocyte; the
notched appearance
of an erythrocyte
due to its shrinkage
after suspension in a
hypertonic solution.

56. Let’s watch Hb breakdown

57. Heme
in the spleen - heme is converted to unconjugated bilirubin
heme attaches to plasma protein for transport in the blood
removed from the blood by the liver and conjugated with
glucuronide
becomes conjugated bilirubin
conjugated bilirubin and biliverdin are secreted in bile and
excreted in feces and urine
Globin: neutralized or recycled into amino acids

58. heme releases iron
iron attaches to biliverdin for transport
return to bone marrow to be reused or stored in
the spleen and liver for future use

62. 33% of cell mass
the O2-carrying substance that gives blood its
red color
1 liter of water has 3ml of dissolved O2
hemoglobin can transport 70 times this amount
20ml of O2= 100ml of blood

63. large molecules with globin and hemes
heme group – iron-containing pigment part of
hemoglobin to which oxygen binds
globin - complex protein with 4 polypeptides
(2 alpha and 2 beta polypeptide chain)
each polypeptide has one heme group; each
heme carries one O2

65. oxyhemoglobin - when oxygen is bound to
iron
deoxyhemoglobin - no oxygen bound to iron
carbaminohemoglobin - when carbon dioxide
is bound (to polypeptide chain) to iron

68. essential for hemoglobin to carry oxygen
Found in several compartments
80% is in heme of blood
‹20% stored in bone marrow, liver, spleen, other
organs
Small amount in myoglobin in muscles,
cytochromes, iron-containing enzymes
daily Fe loss: 0.9 mg men/l.7 mg women

69. Dietary iron helps maintain body stores
Absorbed in small intestines (especially
duodenum) (10-15% is absorbed)
Most iron enter the circulation
Some are sequestered in intestinal epithelial
cells and is lost in feces as these cells slough off
Fe in blood bound to transferrin
Iron – transferrin complex
Those iron that enter the circulation combines
with betaglobulin transferrin in order to be
transported to the plasma

70. Iron – transferrin complex is then transported
to plasma where:
(1) Bone marrow uses iron to make Hb
(2) Excess iron is stored in the liver as ferritin

71. When RBC age or destroyed in spleen heme
releases iron into circulation
Returned to:
(1) to bone marrow to be reused for heme
synthesis or
(2) to spleen and liver for storage
If there is iron overload – there will be
increased iron excretion

72. Serum ferritin levels
blood measurement which provide an index of
body iron stores
If decreased –indicate a need for iron
supplements

74. Antigens - substances that trigger formation
of antibodies that interact specifically with
that antigen
Determine a person’s blood group or blood type

75. Type A
RBCs contain A antigen
antibodies to B in plasma
Compatible with type A or O
Type B
RBCs contain B antigen
antibodies to A in plasma
Compatible with type B or O

76. Type AB
RBCs contain A and B antigens
no antibodies in plasma
Compatible with type A, B, AB or O
Type O
RBCs do not contain A or B antigens
antibodies to both A and B in plasma
Compatible with type O

81. Rh-positive
blood with Rh antigen
Rh-negative
blood without Rh antigen
no antibodies to Rh+ unless exposed to Rh+
antigen)
hemolytic disease of newborn
Rh- mom and Rh+ fetus (treatment) Rhogam

83. plasma contain antibodies
(immunoglobulins) that interact with these
antigens—causing cells to agglutinate
(clump together)
But plasma cannot contain antibodies to its
own cell antigen—or it would destroy itself
Thus- type A blood –does not have anti-A
antibodies; but have anti-B antibodies

84. Anemias
Polycythemias

86. Normal RBCs
RBCs of person with
hemolytic anemia

87. Patient's peripheral blood smear illustrating marked hypochromic
microcytic red cells, numerous target cells, polychromasia,
poikilocytosis, and anisocytosis with numerous small teardrop forms,
ovalocytes, and schistocytes (red cell fragments).

88. • sickle cell anemia
• iron deficiency anemia
• abnormal shape of RBCs
• hemoglobin deficient
• defective gene
• lack of iron
• thalassemia
• pernicious anemia
• hemoglobin deficient
• excess of immature RBCs
• RBCs short-lived
• inability to absorb B12
• defective gene
• hemolytic anemia • aplastic anemia
• RBCs destroyed • bone marrow damaged
• toxic chemicals • toxic chemicals
• radiation

89. Table 16-3: Causes of Anemia

92. chelitis
Riboflavin deficiency mostly manifests itself
at the edge of the mucosa.

93. Spoon-shaped Nails

94. Beefy red tongue

95. poikilocytosis anisocytosis

106. Excellent sources of iron: beans, carrots,
cauliflower, celery, egg yolk, graham bread,
kidney, lettuce, liver, oatmeal, soybeans,
spinach, whole wheat
Good sources of iron: beef, beets, cabbage,
cucumbers, dates, duck, goose, lamb,
molasses, mushrooms, oranges, peanuts,
peas, peppers, potatoes, prunes, radishes,
raisins, pineapples, tomatoes

112. Thalassemia major is an
inherited form of hemolytic
anemia, characterized by red
blood cell (hemoglobin)
production abnormalities.
This is the most severe form
of anemia, and the oxygen
depletion in the body
becomes apparent within the
first 6 months of life. If left
untreated, death usually
results within a few years.
Note the small, pale
(hypochromic), abnormally-
shaped red blood cells
associated with thalassemia
major. The darker cells likely
represent normal RBCs from
a blood transfusion.

113. Thalassemia minor is an
inherited form of
hemolytic anemia that is
less severe than
thalassemia major. This
blood smear from an
individual with
thalassemia shows small
(microcytic), pale
(hypochromic), variously-
shaped (poikilocytosis) red
blood cells. These small
red blood cells (RBCs) are
able to carry less oxygen
than normal RBCs.

115. Frontal bossing
Prominence of facial bones
Forward protrusion of upper teeth and
depression of nasal bridge

120. Chelation therapy is the administration
of chelating agents to remove heavy
metals from the body
Deferoxamine acts by binding free iron in the
bloodstream and enhancing its elimination in
the urine. By removing excess iron, the agent
reduces the damage done to various organs
and tissues, such as the liver. A recent study
also shows that it speeds healing of nerve
damage (and minimizes the extent of recent
nerve trauma).

124. Let’s watch