Model 3 complete study guide for nursing 8022

1. Understand basic physiology of hematopoiesis, erythropoiesis, and what erythropoietin is and what it does. • Hematopoesis o Blood cell production o Two stages – Mitosis and Maturation o Occurs in the bone marrow (my ...

1. Understand basic physiology of hematopoiesis, erythropoiesis, and what erythropoietin is and what it does. • Hematopoesis o Blood cell production o Two stages – Mitosis and Maturation o Occurs in the bone marrow (myeloid tissue) § RedmarrowproducesRBCs § Yellowmarrow–NORBCs o Stem cell pool – hematopoietic stem cell ®differentiate into myeloid cells (RBCs, megakaryocyte, WBCs) or lymphoid cells (B and T cells) o Either stored or functional § 100% of RBCs are functional § 30%plateletsarestored § 50% of WBCs are stored • Erythropoiesis o Development of RBCs o Derived from erythrocytes o Maturation is stimulated by erythropoietin (released by kidneys) o Each step ­ hemoglobin, ̄ nucleus o Erythroid progenitor ® Committed proerythroblast ® Normoblast ® Reticulocyte ® Erythrocyte o Reticulocyte is immature form, 24-28 hours after leaving bone marrow it becomes a erythrocyte o Negative feedback loop • Erythropoeitin o Hormone released by the kidney in response to low renal oxygenation o Produced in peritubular interstitial cells o 10% is produced in liver o Lifespan is 4-12 hours o Cause in ­ RBCs in 5 days o Always present in the plasma 5. Iron basics – transferrin and ferritin • Iron o 67% is stored to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin) o 30% is stored in macrophages o 3% is lost daily in urine, sweat, bile and minor bleeding o 25mg of iron is required for erythropoiesis (only 1- 2mg come from dietary/the remainder is from iron recycling) • Ferritin o MAJOR iron storage protein. o Apoferritin is the precursor to ferritin and does not have attached iron o Hemosiderin are ferritin micelles § normalinsmallamountsinthespleen(iftherearelargeamountsofhemosiderinin lungs or subcutaneous tissue this is a pathological condition). • Transferrin o iron bound to apotransferrin o responsible for transferring iron in circulation o Iron for Hgb production is carried by transferrin to the bone marrow o binds to transferrin receptors on erythroblasts. o She said “this transfer to immature erythroblasts is essential for development of red blood cells to carry O2 to the body itself” • Transferrin-iron complex o binds to transferrin receptor on erythroblast’s plasma membrane o complex is moved into the cell by endocytosis. o Once inside the cell, iron is released (dissociated) from transferrin o dissociated transferrin is returned to the bloodstream for reuse/recycling • Foods that help/enhance iron absorption o meat, poultry, fish. Foods that inhibit iron absorption - carbonates, tannate (tea), oxalate (spinach, rhubarb), phosphates (vegetables), clay • Iron absorption o liver secretes apotransferrin o apotransferrin binds with free iron and becomes transferrin o transferrin binds with receptors in intestinal epithelial cells (duodenum and upper jejunum) o released into blood capillaries as plasma transferrin o Excess iron goes into liver and bone marrow, → become apoferritin then ferritin (stored form of iron) 6. Roles of fibrin, thrombin • Blood clot is a meshwork of protein strands that stabilizes the platelet plug and traps other cells, such as erythrocytes, phagocytes, and microorganisms • Strands are made up of Fibrin, which is produced by the clotting system. o Fibrin is critical in the development of the clot since it binds all the components of the clot together. • Thrombin is the enzyme that converts fibrinogen to fibrin. • Sequence of events in the blood clot: o injury to the blood ve .....................................................................................continued......................................................................................