Red Blood Cells
Disorders of the Red Blood Cells
Unit 2 Assignment (160 points)
MN551-2: Apply knowledge of tissue and organ structure and function to physiologic alterations in systems and analyze the cause and effect relationship in response to disease.
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Case Study 8
Disorders of Red Blood Cells
Henry is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure, but likes to get out whenever he can to work in his daughter’s backyard garden. Over the last few months, he began to go outside less often. He said he was feeling unusually tired and he was running out of breath doing the simplest of tasks. He also said his head ached and he often felt dizzy. His daughter took him to his doctor who performed a complete physical examination and diagnosed Henry with anemia.
- From what you know of Henry’s history, what type of anemia do you suspect he has? How would Henry’s red blood cells appear on a peripheral blood smear?
- What is the physiological basis that would explain why Henry’s anemia would cause him to have the symptoms he is experiencing?
- Predict the cellular adaptations erythrocytes undergo when chronic hypoxia is present. How would this be evident on an oxygen–hemoglobin dissociation curve?
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Disorders of the Red Blood Cells
I suspect that Henry is suffering from anemia of chronic disease. Anemia is a general term that refers an insufficient amount of red cells in the general circulation. Conditions that cause anemia, therefore, include reduction of hemoglobin levels, reduced RNB count and hematocrit (Panwar & Gutiérrez, 2016, p. 1). There are various causes of anemia, which translates to the different type of anemia. The transferring value in this type of anemia ranges from normal to low. The ranges of ferritin, however, can be elevated or normal, and the count of erythrocytes is usually low. There three etiological classifications of anemia. These include the blood loss, the increase in the number of red cells destroyed and a decrease in the production of red blood cells. The anemia of chronic diseases in renal failure cause the reduction of the number of red blood cells produced. It falls under the category of normochromic and normocytic anemia when classified based on the morphology of red blood cells (Grossman et al., 2014, p. 227). Erythropoietin (EPO)is a hormone produced by the kidney. Anemia in patients with renal kidney disease progress slowly, as the condition of the renal disease worsen, anemia also worsens. The hormone EPO plays a significant role the production of red blood cells.
The hormones are usually receptors that bind specific receptors in their body to produce a given effect. Such interaction causes specific signals that activate a specific pathway that is dictated by the hormone or the ligand upon interaction with a specific receptor. The EPO hormone is produced when the rate of red blood cells in the body is low. The kidney produces over 90%to 95% of the EPO hormone (Panwar & Gutiérrez, 2016, p. 2). The hormone interacts with hematopoietic stem cells. Such productions trigger the production of red blood cells (Grossman et al., 2014, p. 227). Henry is suffering from renal failure, which means that his kidney is not healthy. Henry’s kidney produces a small amount of EPO, which leads to less production of RBC because less hematopoietic cells are activated. Other factors that could lead to anemia of chronic disease in the Henrys body include retained nitrogen and other uremic toxins that interfere with the survival and of RBS and action of EPO. In a peripheral smear, the blood of Henry would have a lower number of RBC. Additionally, the red cells will look normal and with a normal shape.
Red blood cells contain hemoglobin that combines with oxygen to form oxyhemoglobin. These facilitate the transportation of oxygen to all the cells of the body. Oxygen is needed in the last phase of glucose metabolism (Swain & Palai, 2016, p. 1) in tissue metabolism. Hemoglobin structure is composed of four polypeptide chains associated with iron-containing heme (Grossman et al., 2014, p. 223). The globulin protein is also part of the hemoglobin. The oxygen binds with the heme for transportation. It means therefore that, each hemoglobin molecule carried for oxygen molecules. For heme to be synthesized, iron is a key requirement. The lack of iron in the boy results in the decreased amount of hemoglobin produced. These results in insufficient transportation of oxygen in the body (Collins, Rudenski, Gibson, Howard, & O’Driscoll, 2015, p. 1). Patients with the Chronic renal disease are usually iron deficiency. As a result, hypoxia signs and symptoms are observed. The hypoxia is the reason why Henry is having such kind of signs and symptoms that include a headache, dizziness, short of breath, getting tired first as a result of the general weakness of the body.
Different conditions cause hypoxia and this cause changes in metabolic needs of different types of tissues. Additionally, the affinity for oxygen by hemoglobin during hypoxia changes. Red blood cells depend on glucose for energy requirement, and it is metabolized via glycolytic pathway (Grossman et al., 2014, p.219). Hemoglobin affinity for oxygen reduces during hypoxia. This is because the rate of tissue metabolism is very high and these results in releasing of the oxygen molecule to take part in the tissue metabolism. The intermediate 2,3-diphosphoglycerate in red cells also affect the affinity of hemoglobin for oxygen. The intermediate combines with hemoglobin molecule thus reducing the affinity of hemoglobin for oxygen. The oxygen is therefore released to take part in tissue metabolism. At the tissue level, the increase of 2,3-diphospoglycerate cause increase in diffusion of oxygen from hemoglobin to the tissue as a result of low affinity. The concentration of the intermediate in red cells is increased by hypoxia condition. Additionally, chronic lung cancer also increases the concentration of the intermediate in red cells (Grossman et al., 2014, p. 219).
The oxygen-hemoglobin dissociation curve is normally S-shaped (Grossman et al., 2014). At the top, it is usually flats as a result if the combination of oxygen and hemoglobin in the lungs. The steep part is as a result of the release of the oxygen into the tissue. The S shape of the curve is as a result of the oxygen molecule effects in the hemoglobin conformation and its oxygen affinity. The distortion curve shifts to the rights when the affinity of hemoglobin for oxygen is reduced at any given oxygen partial pressure (partial pressure of oxygen PO2) in the blood (Collins, Rudenski, Gibson, Howard, & O’Driscoll, 2015, p. 12). Chronic hypoxia causes increased metabolism of the tissue. This cause the shift of the curve to the right. This is an indication that the partial pressure of oxygen is greater at any given levels of the hemoglobin saturation (Grossman et al., 2014, p. 2). These show a reduced affinity of hemoglobin for oxygen at any given partial pressure of oxygen in the blood.
Collins, J., Rudenski, A., Gibson, J., Howard, L., & O’Driscoll, R. (2015). Relating oxygen partial pressure, saturation, and content: the haemoglobin–oxygen dissociation curve. Breathe, 11(3), 194-201. doi:10.1183/20734735.001415
Ellis, S. S., & Pepple, D. J. (2015). Sildenafil Increases the p50 and Shifts the Oxygen–Hemoglobin Dissociation Curve to the Right. The Journal of Sexual Medicine, 12(12), 2229-2232. doi:10.1111/jsm.13038
Grossman, S., Porth, C. M., Conelius, J., Gerard, S. O., Moriber, N., O’Shea, E. R., & Wheeler, K. (2014). Porth’s pathophysiology: Concepts of altered health states (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Hsieh, Y., Chang, C., Kor, C., Yang, Y., Wen, Y., & Chiu, P. (2016). The Predictive Role of Red Cell Distribution Width in Mortality among Chronic Kidney Disease Patients. PLOS ONE, 11(12), e0162025. doi:10.1371/journal.pone.0162025
Panwar, B., & Gutiérrez, O. M. (2016). Disorders of Iron Metabolism and Anemia in Chronic Kidney Disease. Seminars in Nephrology, 36(4), 252-261. doi:10.1016/j.semnephrol.2016.05.002
Swain, K., & Palai, G. (2016). Estimation of human-hemoglobin using honeycomb structure: An application of photonic crystal. Optik – International Journal for Light and Electron Optics, 127(6), 3333-3336. doi:10.1016/j.ijleo.2015.12.081