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NURSIN 4322health alt final exam.
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health alt final exam.1. You should know the normal WBC count as well as normal platelet normal
hemoglobin and hematocrit.
➢ WBC: The average in an adult is 5000 to 10,000 leukocytes/mm3 of blood
❖ (Leukocytes) – defend the body against infection and remove debris.
➢ Normal platelet concentration is approximately 150,000 to 400,000 platelets/mm3 of
circulating blood
❖ < 150,000/mm3 is defined as Thrombocytopenia.
❖ Irregular shaped anuclear cytoplasmic fragments.
❖ Essential for blood coagulation and control of bleeding.
➢ Normal hemoglobin: HGB (g/dL): males 14.0-17.4; females 12.0-16.0
➢ Normal hematocrit: HCT (%): males 42-52; females 36-48
2. Know the normal sites of hematopoiesis for adults and for the fetus.
➢ Hematopoiesis is the process of blood cell production
➢ Hematopoiesis is constantly on going and occurs in the liver and spleen of the fetus and
only in bone marrow after birth
➢ Hematopoiesis increases in response to hemolytic anemia.
➢ Extramedullary hematopoiesis is considered a sign of disease.
3. Know all the Functions of Platelets.
➢ Contribute to regulation of blood flow into a damaged site
➢ Initiate platelet-to-platelet interactions resulting in formation of a platelet plug
➢ Activate the coagulation (or clotting) cascade / control bleeding
➢ Initiate repair processes, including clot retraction and clot dissolution (fibrinolysis)
4. Know what will stimulate secretion of Erythropoietin.
➢ Hypoxia / Hypoxic environment
5. Vitamin is necessary to make red blood cells.
➢ Vitamin B12
➢ There is a lack of intrinsic factor, which is a transporter required for gastric absorption
of dietary vitamin B12, which is essential for nuclear maturation and DNA synthesis in
red blood cells.
6. Where is Iron stored in the body?
➢ Total body iron is bound to heme or stored bound to ferritin or hemosiderin or
in mononuclear phagocytes
➢ Liver, Spleen, and Marrow
, health alt final exam.
7. Know the meaning of hyperchromic, hypochromic, macrocytic and microcytic,
when might you see each of these.
➢ Hyperchromic: Higher than normal amount of hemoglobin in the red blood cells
➢ Hypochromic: Reduced amounts of hemoglobin
➢ Macrocytic: (cell size) Red blood cells are larger than their normal volume
➢ Microcytic: (cell size) Red blood cells that are abnormally small
8. Know the different types of anemia as indicated by the indices and what they
suggest (normochromic-normocytic, hypochromic macrocytic etc).
Macrocytic-Normochromic Anemia:
➢ Also called Megaloblastic anemias
➢ Characterized by unusually large stem cells
➢ Result of defective DNA synthesis:
❖ Caused by deficiencies in vitamin B12 or folate:
▪ Coenzymes for nuclear maturation and the DNA synthesis pathway
➢ Ribonucleic acid (RNA) processes occur at a normal rate.
➢ The unusually large stem cells mature into unusually large erythrocytes,
size (macrocytic), thickness and volume.
➢ The hemoglobin is normal in these cells, thus the term normochromic.
➢ We are seeing more of these with the increase in gastric surgeries for weight loss.
➢ Those that have had gastric bypasses or sleeves, need to take Vitamin B12 for the rest
of their life.
➢ Pernicious anemia –
❖ Most common
❖ Highly injurious or destructive – was once fatal
❖ Caused by lack of intrinsic factor from the gastric parietal cells
❖ Required for Vitamin B12 absorption
❖ Results in Vitamin B12 deficiency
❖ Develops Slowly (20-30 years)
❖ People ignore early symptoms until it becomes sever.
❖ Symptoms once Hemoglobin reaches 7-8 g/dl:
▪ Weakness, Fatigue, Paresthesias, Difficulty walking, Loss of appetite,
Abdominal pain, Weight loss, Sore tongue, Neurologic
manifestations
❖ Treatment:
▪ Evaluation is done utilizing blood tests, bone marrow aspiration, serologic
studies, gastric biopsy, and clinical manifestations.
▪ Parental or high oral doses of vitamin B12; Lifelong
▪ Can be given IM (intramuscular)
▪ CANNOT BE CURED, usually the result of Heart Failure
➢ Folate Deficiency anemia -
❖ Absorption of folate occurs in the upper small intestine
❖ Not dependent on any other factor
, health alt final exam.
❖ Similar symptoms to Pernicious anemia except neurologic manifestations
generally not seen
❖ Increased amounts of folate are required for Lactating and Pregnant females.
❖ Adequate amounts of folate can decrease the chances of Neural Tubes defects
in Fetuses.
❖ Alcoholics are also deficient in folate, as well as those that are
chronically malnourished.
❖ Manifestations:
▪ Cheilosis (scales and fissures of the mouth)
▪ Stomatitis (inflammation of the mouth)
▪ Painful ulcerations of the buccal mucosa
▪ Tongue characteristic of burning mouth syndrome.
❖ Treatment:
▪ Daily Oral administration of Folate
Microcytic-Hypochromic Anemia:
➢ Abnormally Small Red Blood Cells that have a reduced amount of hemoglobin.
➢ Can result from:
(1) Disorders of Iron Metabolism
(2) Disorders of Porphyrin and Heme synthesis
(3) Disorders of Globin synthesis.
Specific conditions include:
➢ Iron deficiency anemia
❖ Most common
❖ Nutritional iron deficiency or Blood loss
❖ Metabolic or Functional deficiency
❖ Manifestations when serum Hgb decreased to 7 or 8 gm/dl:
▪ Early: Fatigue, Weakness, Shortness of breath, Pale earlobes and
palms, Conjunctiva
❖ Occurs in Both developed and underdeveloped countries
❖ Can lead to cognitive impairment in Children, may be irreversible.
❖ Higher incidence in Females; w/ Peak occurring in Reproductive years and
decreasing during Menopause.
❖ Either Inadequate Dietary intake or Chronic blood loss
❖ Progression of iron deficiency causes:
▪ Brittle, thin, coarsely ridged, and spoon-shaped Nails (Koilonychia)
▪ A red, sore, and painful tongue
▪ Dry, sore corners of mouth (angular stomatitis)
➢ Sideroblastic anemia
❖ Group of disorders characterized by anemia of varying severity
❖ Presence of ringed Sideroblasts in the bone marrow
▪ Erythroblasts that contain iron-laden mitochondria arranged in a circle
around one third or more of the nucleus
❖ Acquired Sideroblastic anemias:
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