Patho 2

albumin (Mg and Ca), globulins (antibodies), clotting factors (mainly fibrinogen)

• carry oxygen
• lives about 120 days
• biconcavity- for optimal SA/volume for optimal gas exchange
• reversible deformity- 7-8 microns able to squeeze through 2 micron capillary to release the oxygen and go back to original shape

4.2-6.2 million (~5 million)

12-17 g/dl (~15grams)

36-52% (~45%)

• 5 mil RBC  x3
• 15 grams Hgb   x3
• 45% Hct

5,000-10,000

phagocytes (they all eat stuff)

immunocytes

57-67 %

• eat bacteria
• segments- adults
• bands/stabs- teens

1-4%

• eat parasites/worms
• involved with allergies

<1% involved with inflammation

• 3-7%
• chronicity

• 140,000-340,000
• live 5-7 days

Pluripotent stem cell- renews itself before it commits, then proliferation, and differentiation.  The stem cell has the potential to be anything

Ex: bacterial infection signals bone marrow to make more neutrophil (polys)

• uncommited pluripotent stem cell
• erythroblast--> normoblast--> retic ( good indication of erythropoietic activity)

• 2 pairs of polypeptic chains (globulins
• four colorful iron complexes
• adult hemoglobin A- 2 alpha and 2 beta chains

IF- intrinsic factor needed for absorption-- gastric issues= B12 abs issues

no storage and shows acutely deficiencies

• Macrophages of MPS-- spleen and liver
• leaves behind the heme and thereleases bilirubin which unprocessed goes on to the liver to be excreted.  a build up of bilirubin in tissues = jaundice)

• reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin
• impaired production
• acute or chronic blood loss
• increases destruction
• combination of all

• volume or size of the RBC
• macrocytic, microcytic, or normcytic
• 80-90fl

27-31 pg

32-36%

red cells are present in various sizes

red cells are present in any shape

• pallor
• fatigue
• weakness
• dyspnea on exertion (DOE)
• dizziness

• tend to be adrenergic- tachycardia (Beta 1) chronotropic
• palpation inotropic (beta 1)
• vasocontriction Alpha
• increase breathing
• increased production of ADH- retain water, dilute sodium

B12 (pernicious anemia) and folate deficiecies

• iron def
• sidero

• aplastic anemia
• pasthemorrhagic anemia
• hemolytic anemia
• anemia of chronic disease/inflammation

values that would be low RBC Hgb and Hct-- but they would all be normal just not enought of them

macrocytic normochromic anemia

• LOW hct, high MCV (large)
• vitamin b12 def- malabsorption
• sore tongue, hyperbilirubinanemia--jaundice, hepatosplenomeagly- enlarged lvier and spleen

• macrocytic, normochromic
• low hct
• high MCV (large)

• body stores almost no folate
• alcholics are at risk

• microcytic hypochromic 
• 6 low values: RBC, hemo, hct, MCV, MCH, MCHC

• bleeding or paracsitic infection
• impaired capillary circulation
• neuromuscular changes- numbness or tingling
• koilonychia- spoon shaped nails

• mostly nonspecific symptoms
• responding to treatment? reticulocytes would increase

• normocytic normochromic
• (bone marrow failure)
• classic signs
• PANCYTOPENIA- aeverything is low RBC, WBC and platelets
• most commonly secondary

• normocytic normochronic
• acute blood loss- surgery, trauma, GI bleed

• volume depeletion- fluid vol deficit
• hypovolemic shock0 stage II adrenergic

treat- stop bleeding, treat shock (need volume and oxygen), transfusion

• normocytic normochromic
• premature destruction of RBC-- bilirubin, can't be handeled in a positive way goig into the tissues and results in jaundice
• erythropoient is normale and sometime accelerated to compensate for destruction
• acquired
• hereditary- sickle cell anemia* most common
• drug induced

• remove cause
• blood transfusions
• remove spleen?

• most common in hosp patient
• mild to moderate-- infection, malignancies..... AIDS, bacterial endocarditis, chronic inflamm disease, RA, Lupus, IBS, others
• manifestations of iron ded anemia , could be micro hypo KOLINKYIA (mostly nonspecific symptomsresponding to treatment? reticulocytes would increase)
• RBC life span, disurbance of iron cycle
• process of elimination

• long-term emotional state that affects perception of self and world
• patients complain about mood not affect
• anger, fear, disgust, sadness, depression, and other

observed or reported feeling state, typically transient, not the smae as mood, shorter term

• primary emotion
• other emotions may be generated by anxiety
•     shame, guilt, grief
• universal emotion
• 25% of population
• everyone has experienced this

• enhanced ability to deal with stress
• heightened awarenes, problem solving abilities
• attention to detail- over looked detail
• increased curosity
• alert, a little more confident
• logic intact

• hesitation, procrastination, BLOCKING
• narrow perception field- tunnel vision
• change in voice pitch accelerated rate of speech
• selective attention- block out pain
• frequent change in topics
• repetitive questioning
• joking
• increased RR, HR
• dry mouth
• palpitations- pounding, almost see heart beating
• restlessness

• highly disoriented perceptual and cognitive function- sense
• focus on small detail, irrevelent details
• cannot see connection
• cannot concentrate as well
• fear of losing control- want to get up and leave or run
• sense of impending doom, know something is wrong but dont know exactly what
• diaphoretic, hyperventilation, urinate, nausea, tremors, dizziness, headache, dialted pupils
• cannot learn at this level
• extreme discomfort, vomiting, incontinence

• threats to biologic integrity- actual or impending interferance with basic needs (food,drink, shelter, warmth, safety, health)
• threats to self security or self esteem- unmet expectations, unmet needs for status and prestige, anticipated disapproval from SO, inability to gain or reinforce self respect, suddent unexpected sever treat to sense of security, self esteem, and well-being, guilt, discrepancies with self identity/behavior

constructive- problem solving (coping behaviors)destructive- destructive- defense mechanisms (never solve problem, reemerges again and again

• almost all are generated unconsciously
• not aware of source of behaviors that are troubling
• can contribute to problems in functioning

when defense reduces uncomfortable anxiety it reinforces the use of the mechanism

• defense mechanism
• remove experience or feeling form some upsetting
• event/ from consciousness and pretend its not there
• EX: sleep

• defense mechanism
• transferring blame for one's own unacceptable ideas,
• feeling to someone else
• EX: delusions

• defense mechanism
• reverting to an earlier level of behavior
• EX: childlike

• defense mechanism
• actions opposite of true unacceptable feelings
• EX: i like that class, then not show up... do the
• opposite of what you say

• defense mechanism
• displace feelings and fears to an object symbolic of
• one that is feared
• EX:"I hate this textboo!" or take it out
• on people who are unrelated to the situation

• defense mechanism
• replacing acceptable reasons for treatening true
• reasons

• defense mechanism
• dismissing unacceptable thoughts, feelings, memories
• from consciousness
• EX: i'll worry about that later

• defense mechanism
• expressing repressed desires in a sociall acceptable
• way
• EX: surgeon wants to cut, cuts the table.. like
• people being dependent on you, become nurse

• platelets
• vascular endothelium
• clotting/coag factors

• smooth texture
• negative charge that repel platelets and coltting things
• secretes anticoagulation substance

automatic, programmed time clock break down of clot to facilite blood flow (7-10 days)

form and stay put for healing to take place and then disappeare to allow blood flow

• immedate vasoconstriction/vasospasm- narrows thing very briefly
• platelete are first responders to plug hole ( anything more than minor hole coagulation cascades happen next)
• intrinsic pathway- triggered by inside of vessel
• extrinsic pathway- stimulated by tissue thromboplastim (in tissues)
• final common pathway- fibrin thread across platelet plug

fibrinolysis 7-10 days after

in the liver-- liver patients bleed!

• FDPs- consequence of clot breakdown
• D-dimer lab test
• increase=excessive FDP=increase fibrinolysis (clot breakdown)
• could be dangerous-- bleeding (DIC)

• measures the intrinsic and final common pathways
• monitors coagulation in persons thaking th e coagulation med Haparin
• mean of 60 seconds-- rarely used
• aPTT mean is 30 seconds

people who have liver problems and not on coags

0.3-0.7 units/ml

IV heparin

• extrinsic and final common pathway (use INR)
• coumadin warfarin
• normal mean= 12 seconds

a lot of variability in lots (maniufacturer) look at INR

• clinical decisions better and more often made on INR
• normal is 1
• extrinsic pathway****

nose bleed

bleeding gums

mucosal bleeding

cough up blood ( pulmonary blood)

• vomit bright red blood- frest upper gi bleed
• fromt he stomach or esophagus

vomit digested old blood

• bright red bloody stools
• lower gi bleed

• black tarry
• digested blood, upper gi bleed

blood in the urine

platelet counts <140,000

• <50,000 bleeding potential
• <20,000 spon bleeding

• cause:
• defective platelet production
• desordered platelet distribution
• acclerated platelet destruction (DIC)

• enought platelets but htey dont operate normally
• congenital
• acquired- meds-- inhibits ADP, and related to uremia- BU*N and creat increased- dont behave normally in dirty blood

• thrombocytosis >340,000
• primary= myeloproliferative disorder of precursor cell
• secondary- splenectomy
• CLOTTING

• Vitamin K deficiency
• dependent factors: 2, 7, 9, 10