5) Discuss why the mean corpuscular volume

5) Discuss why the mean corpuscular volume of the RBC helps determine the cause of the anemia. What are the terms microcytic, normocytic, and macrocytic referring to? (SLIDES 33-34) 6) Provide common examples of a: a) microcytic anemia b) macrocytic anemia c) normocytic anemia and the pathophysiology of them. (SLIDE 35), what is the term hypochromic RBCs referring to? 7) From the above case, what is Jane’s condition? Explain why her ferritin is reduced on the blood test. (SLIDE 47) 8) What potential treatment options are available for Jane’s iron deficiency anemia? What determines the most appropriate treatment? Scenario 2: An elderly man, Cyril, presents with generalized fatigue, muscle weakness, SOB, and “pins and needles” to his digits. His daughter states he has been forgetful over the past few months with a change in his behavior and poor balance. PMHx: – Gastrectomy for a bleeding ulcer many years ago – Parkinson’s disease – Excessive alcohol intake daily Meds: – Daily aspirin -Levodopa/Carbidopa Prior to his appointment, he is sent for routine blood work at the laboratory. CBC: Hg – 90 g/dL, Hct. – 30%, Plts – 100,000/ μL WBC – 6,000 /μL MCV – 105 fl Serum Vit B12- Low, RBC folate – Normal 1) With the above information, what is the likely cause of his anemia? Explain the pathophysiology of his anemia. (SLIDES 53-54) 2) Discuss the causes of megaloblastic anemia. (SLIDES 51-52) (large RBCs) 3) What is the process for normal Vit B12 absorption in the body, including Intrinsic factor? Discuss the potential causes of low Vit. B12. (SLIDE 57) 4) What are the symptoms of Vit B12 deficiency anemia? (SLIDE 57) 5) How can patients be treated for Vit B12 deficiency? When would Vit B12 injections be needed as opposed to oral supplementation? (SLIDE 57) 6) What foods contain Vitamin. B12? 7) Briefly discuss dietary sources of folic acid (vit B9) and possible reasons that can lead to folate deficiency. Why is dietary folate deficiency anemia common but dietary Vit.B12 deficiency anemia uncommon? Scenario 3: Adira, while building a deck, falls 15 feet onto her head and back. She sustains a large bleeding laceration to her left scalp and complains of feeling very dizzy and weak. Upon arrival at the ER, the bleeding from her scalp has soaked through 3 small towels. There is continued active bleeding from her left scalp, and significant swelling. She appears anxious and pale. Blood is taken for a CBC and a Type and crossmatch. VS: BP: 80/55, HR: 130, regular pulse, RR: 18, O2Sat: 99% MEDS: – Warfarin for a previous DVT – Sertraline for depression CBC: Hg – 90, Hct – 30%, Plts – 200,000/μL MCV – 85 fl, Blood Type: AB-negative, INR (international normalized ratio) – 3.5 1) What kind of anemia is Adira likely experiencing? (SLIDE 60) What is the immediate treatment? Explain why hemorrhaging can initially have a normal CBC (hemoglobin) test. What do you expect to happen to Adira’s reticulocyte count with the bleeding? 2) Discuss the body’s compensatory mechanisms for acute blood loss. What is the main goal of these mechanisms? (SLIDE 60) 3) Discuss the hemostatic mechanisms that will occur to try to stop the bleeding of any injured blood vessel. Review the role in plasmin in the hemostatic system. (SLIDES 71-77) 4) Briefly discuss the symptoms and signs of hemorrhagic shock. 5) Discuss the ABO blood types and the significance of the Rh factor on the RBCs. The ER team has decided that a blood transfusion needs to be given due to ongoing bleeding. What blood types can be given to Adira? Why should she receive Rh factor negative blood? (SLIDES 62-63) 6) What blood transfusion reactions need to be considered while a patient receives blood and what is done for the different reactions? (SLIDE 66) 7) Discuss the handling of blood. (SLIDE 67) 8) Briefly discuss the coagulation cascade. What is the primary objective of this system? (intrinsic VS. extrinsic; common pathway; fibrin clot). Select an inherited clotting factor deficiency to discuss. Why are there so many anticoagulants available to inhibit this system? (SLIDES 73-78) 9) How does warfarin and heparin impact the coagulation system? What can be done to reverse the effects of warfarin and of heparin? (SLIDES 77-79) 10) Discuss blood tests to monitor anticoagulants such as heparin and warfarin: PT/PTT, INR. What values are normal? What are acceptable values while using anticoagulants such as warfarin or heparin? What else can cause an elevated INR? PTT? or bleeding time? (SLIDES 79-80)

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