lunC1lCn Cl 88C

8ed blood cells known also as 88Cs have several lmporLanL roles Lo play ln our bodles 1he prlmary
funcLlon of red blood cells ls Lo carry oxygen from Lhe lungs Lo Lhe Llssues around your body As a
secondary funcLlon Lhey are also a key player ln geLLlng wasLe carbon dloxlde from your Llssues Lo your
lungs where lL can be breaLhed ouL When red blood cells sLop funcLlonlng properly you can resL
assured LhaL many Lhlngs are golng Lo go wrong ln your body
ln order Lo properly undersLand Lhe funcLlon of a red blood cll you have Lo undersLand someLhlng abouL
Lhe sLrucLure A Lyplcal 88C ls abouL 68 mlcromeLers ln dlameLer abouL Lhe same as Lhe wldLh of a
splder web sLrand An 88C ls blconcave ln shape 1hlnk of lL llke a mlnlaLure donuL only Lhe hole ln Lhe
cenLer doesnL poke all Lhe way Lhrough 1hls small shape and physlcal sLrucLure allows Lhe 88C Lo
squlsh ln Lo Lhe small caplllarles where your blood vessels are Lhe smallesL WlLhouL Lhls ablllLy Lo flex
Lhey would easlly geL sLuck and cause obsLrucLlons ln your clrculaLlon
1he oxygen carrled ln your red blood cells ls sLored ln a speclal proLeln known as hemoglobln 1here are
several dlfferenL Lypes of hemoglobln and Lhe exacL sLrucLure of Lhls lmporLanL proLeln ls qulLe
compllcaLed so Lhls explanaLlon wlll be someLhlng of a gross overslmpllflcaLlon A slngle hemoglobln
molecule ls made of four ldenLlcal subunlLs Lach subunlL has a heme componenL aglobln chaln and an
lron aLom bound Lo Lhe heme secLlon 8ed blood cells are compleLely lacklng ln mosL oLher common
cellular parLs such as a nucleus wlLh unA or mlLochondrla

Cxygen ls able Lo blnd Lo each of Lhe lron aLoms meanlng LhaL a slngle hemoglobln molecule ls able Lo
carry up Lo four oxygen molecules aL lLs maxlmum capaclLy lnLeresLlngly Lhe sLrucLure of hemoglobln
makes lL such LhaL Lhe more oxygen LhaL ls bound Lo one of Lhe subunlLs Lhe more oLher oxygen
molecules are aLLracLed Lo Lhe remalnlng lron aLoms Agaln Lhe deLalls of Lhls effecL lnvolve a loL of
complex chemlsLry buL Lhls effecL lL lmporLanL Lo Lhe proper funcLlonlng of a red blood cell ln oxygen
LransporL

1he ablllLy of oxygen Lo blnd Lo hemoglobln ls effecLed by many facLors 1he acldlLy of Lhe blood (pP) ls a
prlmary facLor as ls Lhe LemperaLure leLal blood has a dlfferenL ablllLy Lo blnd oxygen (lL holds on Lo
Lhe oxygen more LlghLly) CLher chemlcals such as hydrogen sulflde carbon monoxlde hydrogen sulflde
and 23blsphosphoglyceraLe (Lheres a mouLhfull eh?) also effecL Lhe ablllLy of hemoglobln Lo carry
oxygen

lacLors ln blndlng such as pP and LemperaLure are vlLal Lo hemoglobln funcLlon ?our red blood cells
need Lo grab on Lo oxygen ln Lhe lungs and leL go of lL ln Lhe Llssues SubLle changes ln Lhe pP and
LemperaLure of your blood (along wlLh some oLher effecLs) allow Lhe hemoglobln molecules Lo caLch and
release oxygen aL Lhe proper Llmes

A huge amounL of space ln a red blood cell ls Laken up by hemoglobln Well over 90 of Lhe conLenL of
an 88C LhaL ls noL waLer ls hemoglobln Lven Laklng waLer ln Lo accounL over a Lhlrd of Lhe mass of an
88C ls hemoglobln
1he second lmporLanL funcLlon [usL as lmporLanL as carrylng oxygen alLhough less commonly known ls
Lhe ablllLy of red blood cells Lo carry carbon dloxlde CC2 ls a wasLe producL of meLabollsm ln every cell
ln your body ?ou need some way of geLLlng rld of lL all Lhe Llme or you wlll dle raLher qulckly 8ed blood
cells serve as Lhe vehlcle Lo rld your body of Lhls wasLe
1he process by whlch your red blood cells LransporL carbon dloxlde ls dlfferenL Lhan oxygen LransporL
88Cs conLaln an enzyme called carbonlc anhydrase As Lhe CC2 enLers Lhe 88C Lhls enzyme wlLh Lhe
help of some waLer converLs lL lnLo anoLher chemlcal called blcarbonaLe 8lcarbonaLe ls used Lo conLrol
Lhe pP ln your blood and lL laLer excreLed elLher vla your lungs or your kldneys Some CC2 ls dlssolved ln
your blood dlrecLly and a small amounL ls acLually carrled on Lhe hemoglobln molecules buL Lhe vasL
ma[orlLy ls converLed Lo blcarbonaLe

8ecause red blood cells are so lmporLanL Lo your body when Lhey donL work properly lL ofLen leads Lo
dlsease AlLhough Lhere are llLerally dozens of dlseases relaLed Lo your blood lll menLlon a couple of Lhe
more common (or aL leasL lnLeresLlng) ones

Slckle cell dlsease ls a common dlsorder of Lhe red blood cells lL ls a geneLlc dlsease found mosLly ln
persons of Afrlcan descenL 1he dlsease lnvolves a slngle unA muLaLlon LhaL causes Lhe cell wall of Lhe
red blood cells Lo noL form properly 1he 88Cs become mlsshapen lnsLead of round and blconcave Lhey
become long and Lhln 8ecause of Lhls Lhe 88Cs do noL carry oxygen as efflclenLly and can become sLuck
ln small caplllarles causlng Lremendous paln lnLeresLlngly Lhe presence of Lhese mlsshapen red blood
cells ls noL enLlrely a bad Lhlng eople wlLh Lhls geneLlc defecL are more reslsLanL Lo malarlal lnfecLlons
whlch rely on normally shaped red blood cells Lo lnfecL a person

Carbon monoxlde polsonlng ls anoLher lnLeresLlng problem relaLed Lo red blood cells Carbon monoxlde
(CC) ls sLrucLurally very slmllar Lo oxygen whlch ls normally found as a palr of aLoms Pemoglobln
doesnL dlfferenLlaLe beLween CC and C2 very well ln facL carbon monoxlde ls hundreds of Llmes more
aLLracLed Lo hemoglobln Lhan oxygen 1hls ls a blg problem lf you lnhale Loo much CC 1he CC Lakes over
Lhe lron blndlng slLes on Lhe hemoglobln and doesnL allow space for oxygen Lo hlLch a rlde ln essence
you end up suffocaLlng because Lhe oxygen you breaLhe ln cannoL be LransporLed Lo Lhe Llssues ln your
body

WhlLe 8lood Cell luncLlon
WhlLe blood cells are Lhe lmmune sysLems way of guardlng Lhe body agalnsL any forelgn maLerlal
dlsease causlng and oLherwlse LhaL enLers Lhe body Any lncreases ln Lhe number of whlLe blood cells ln
Lhe blood lndlcaLe any number of dlsorders WhlLe blood cells are also known as leukocyLes 8lood
conLalns flve prlmary Lypes of whlLe blood cell each of whlch has Lhelr own unlque funcLlon

neuLrophlls are Lhe klnd LhaL paLrol Lhe bloodsLream and engulf any forelgn organlsms 1hese cells are
prlmarlly responslble for defendlng Lhe body agalnsL bacLerlal or fungal lnfecLlons 1he acLlvlLy of Lhese
cells and consequenL deaLh are whaL creaLes pus around wounds 1he cells use lysosomes Lo dlgesL
paLhogens however lysosomes cannoL be renewed and so Lhe cells dle qulckly afLer only lngesLed
several paLhogens 1hls Lype belongs Lo Lhe phagocyLe class of cells Cnce neuLrophlls reach Lhe area of
lnfecLlon Lhey respond Lo Lhe chemlcals LhaL are released by bacLerla and dead cells 1hey Lhen move
Loward Lhe hlghesL concenLraLlon of Lhem and begln Lo desLroy Lhe bacLerla wlLh powerful enzymes

MonocyLes whlch are also phagocyLes are responslble for paLrolllng Lhrough Lhe bodles dlfferenL
Llssues uesplLe havlng a slmllar role as neuLrophlls monocyLes are usually much longer llved 1hese
cells once Lhey have lefL Lhe blood sLream are responslble for removlng dead cell debrls ln addlLlon Lo
aLLacklng mlcroorganlsms MonocyLes are able Lo replace Lhelr lysomal conLenL and so Lhey have a much
longer llfe Lhan neuLrophlls

8asophlls are responslble for releaslng chemlcals LhaL Lrlgger an lnflammaLory response 1hese cells
release Lhe chemlcal hlsLamlne whlch resulLs ln Lhe lnflammaLlon Loslnophlls are slmllarly responslble
for Lrlggerlng allerglc reacLlons 1hese cells also deal wlLh paraslLlc lnfecLlons Loslnophlls play a huge
parL ln allergles such as hay fever asLhma and hlves 1hls Lype of cell ls also parLly responslble for
anaphylacLlc shock 8asophlls are Lhe leasL common Lype of whlLe blood cell

1he lasL Lype of whlLe blood cell ls Lhe lymphocyLe whlch ls responslble for LargeLlng lnfecLlve organlsms
such as vlruses 1hls lasL Lype of cell ls also capable of locklng on Lo and desLroylng cancer cells 1hese
cells are more ofLen found ln Lhe lymphaLlc sysLem and lncrease greaLly ln number when Lhe body has a
vlral lnfecLlon LymphocyLes are Lhe mosL common whlLe blood cell ln chlldren and Lhe second mosL
common ln adulLs 1here are Lwo ma[or Lypes of lymphocyLes LhaL are found ln Lhe blood 1he Lwo Lypes
ar
e 8lymphocyLes and 1lymphocyLes each wlLh Lhelr own unlque funcLlons

Slgns SympLoms of Low Pemoglobln CounL
nemog|ob|n an lronrlch proLeln ln red blood cells LransporLs oxygen from Lhe lungs Lo cells LhroughouL
Lhe body All body cells need oxygen Lo funcLlon Accordlng Lo Mayo Cllnlc hemoglobln should be more
Lhan 133g per declllLer for men and 12g for women 1hough your docLor wlll verlfy your counL wlLh a
slmple blood LesL Lhere are several slgns and sympLoms of a low hemoglobln counL
Iat|gue and Weakness
aLlenLs mosL ofLen complaln of faLlgue and weakness wlLh a low hemoglobln counL accordlng Lo Lhe
naLlonal PearL Lung and 8lood lnsLlLuLe 8ecause Lhe cells do noL recelve enough oxygen muscles do
noL work efflclenLly causlng Lhem Lo ache when overused CfLen a person wlLh low hemoglobln wlll
complaln of achlng legs and Lhe lnablllLy Lo walk any slgnlflcanL dlsLance wlLhouL paln
neadache D|zz|ness and Ia|nt|ng
8ecause of Lhe lack of oxygen golng Lo Lhe braln people wlLh low hemoglobln ofLen complaln of
headaches ulzzlness may occur when rlslng from a chalr qulckly and Lhey may falnL lf sLandlng for long
perlods
Lack of Concentrat|on
Lack of concenLraLlon and forgeLfulness occur ln people when Lhere ls noL enough lron ln Lhelr blood
1hls ls a serlous lssue ln chlldren who may feel weak Llred and cranky Chlldren wlLh low hemoglobln
may do poorly ln school and develop behavloral problems
neart a|p|tat|ons and Chest a|n
Abnormal hearL rhyLhms may resulL from low hemoglobln levels 1he hearL musL pump harder Lo
compensaLe for Lhe lack of oxygen ln Lhe clrculaLlng blood 1hls lack of oxygen may also cause a
shorLness of breaLh
a|e Sk|n and Gums
A pale complexlon may slgnlfy lack of oxygen ln Lhe blood cells A low hemoglobln counL may be even
more noLlceable ln Lhe nall beds and gums boLh of whlch should be a healLhy plnk
|ca
lca ls Lhe cravlng Lo eaL lnedlble or unusual subsLances eople wlLh lron deflclency and low
hemoglobln may eaL dlrL or sLarch 1he naLlonal Anemla AcLlon Councll sLaLes LhaL Lhe deslre Lo chew on
lce ofLen slgnlfles anemla and advlses paLlenLs Lo have Lhelr hemoglobln checked Chewlng lce may be
one of Lhe less dangerous cravlngs
lnflamed or Sore 1ongue
An lnflamed Longue and cracks ln Lhe edges of Lhe mouLh may occur wlLh an lron deflclency 1hese are
noL serlous sympLoms buL may be very uncomforLable 8ecause of Lhe soreness Lhe paLlenL may noL eaL
properly maklng Lhe deflclency worse
PemaLocrlL

PLMA1CC8l1
8efers Lo Lhe or raLlo of red blood cells ln plasma
When serum ls cenLrlfuged whlLe blood cells and plaLeleLs rlse Lo Lhe Lop (Lhls ls referred Lo as a 'buffy
coaL') 1he red blood cells are heavler and pack Lo Lhe boLLom Lhus Lhe reason for Lhe Lerm vC
meanlng packed cell volume
ls useful only lf Lhe hydraLlon of Lhe paLlenL ls normal
values are also lncreased aL hlgh alLlLudes
PemaLocrlL ls usually abouL Lhree Llmes hlgher Lhan Lhe hgb ln Lhe paLlenL wlLh boLh a normal red blood
cell counL and hgb
8eference values
Men 4232
Women 3748
regnancy uecreases especlally ln Lhe lasL LrlmesLer as serum volume lncreases
newborn up Lo 60
lncreased PemaLocrlL
Any decrease ln Lhe volume of plasma causes an lncrease ln hemaLocrlL even Lhough Lhe red blood cell
counL has noL lncreased An example ls Lhe paLlenL wlLh a burn here plasma or fluld may be losL from
Lhe vascular space maklng Lhe blood more concenLraLed Lhus hcL may be as hlgh as 6063
lf Lhe paLlenL's hydraLlon sLaLus ls normal an lncrease may lndlcaLe a Lrue lncrease ln red blood cells
(polycyLhemla)
osslble nurslng ulagnosls and lnLervenLlons

lluld volume deflclL r/L elevaLed hcL
ueLermlne lf Lhe lncreased hcL ls relaLed Lo a decreased plasma volume or a Lrue lncrease ln red blood
cells
lf Lhere ls a lack of volume an lncreased oral lnLake or parenLeral fluld replacemenL may be ordered
8lsk for ln[ury r/L posslble formaLlon of venous Lhrombl
lf Lhere ls an lncrease ln red blood cells an lncrease ln flulds may ald Lo decrease blood vlscoslLy (See
also 8ed 8lood Cell CounL)
Pere Lhe blood becomes more vlscous maklng Lhe paLlenL suscepLlble Lo formaLlon of venous Lhrombl
1herefore lL ls lmporLanL Lo malnLaln adequaLe hydraLlon
Lxample 2000 mL per day for an adulL
PCWLvL8 be sure Lo assess your paLlenLs overall sLaLus carefully paLlenLs wlLh hearL defecLs and
chronlc lung dlsease may be nearlng a sLaLe of congesLlve hearL fallure!
lL ls lmporLanL paLlenLs noL become dehydraLed Conslder Lhls when nC ls ordered for exLended
perlods of Llme
uecreased PemaLocrlL
May be due Lo
CverhydraLlon whlch lncreases Lhe plasma volume
Cr a Lrue decrease ln red blood cells (more common cause)
PcL ls lmporLanL ln assesslng Lhe magnlLude of blood loss
PcL drawn rlghL afLer a masslve blood loss wlll probably be normal Why? 8oLh plasma and 88Cs have
been losL ln equal proporLlon
A few hours afLer Lhe bleedlng eplsode Lhe plasma volume usually reLurns Lo normal due Lo a shlfL of
some lnLersLlLlal fluld lnLo Lhe plasma/vascular space (provlded Lhe paLlenL has adequaLe fluld balance)
1he hcL wlll be low because lL wlll Lake abouL eleven days for new maLure 88Cs Lo replace Lhe 88Cs
***Always lnLerpreL hcL ln relaLlon Lo Lhe Llme Lhe sample ls drawn and Lo Lhe probable hydraLlon sLaLus
of Lhe cllenL aL Lhe Llme
osslble nurslng ulagnosls and lnLervenLlons
8lsk for fluld volume excess
ls where low hcL reflecLs an lncreased plasma volume
Assess for slgns and sympLoms of excess fluld
uecrease fluld lnLake
SLrlcL l C
8lsk for acLlvlLy lnLolerance relaLed Lo loss of blood
Assess for paleness of Lhe skln and con[uncLlva
aLlenL's wlll ofLen have a normal 8 Powever lf Lhere's noL enough fluld Lo shlfL from exLravascular Lo
lnLravascular abd replace Lhe loss of blood Lhe 8 falls and slgns of shock may be noLed
lf Lhe loss lsn'L severe Lhe pulse may glve a clue Lo Lhe amounL of blood loss 1o assess Lhe pulse
perform Lhe 'LllL LesL' have Lhe paLlenL slL up and Lhe pulse wlll lncrease 1he pulse may lncrease even
more wlLh exerclse 1hese lncreases occur because Lhe C2 carrylng capaclLy of Lhe blood ls decreased
WlLh a hcL as low as 28 Lhe hearL raLe may lncrease even aL resL
Assess for slgns of conLlnued bleedlng
Assess for occulL (hldden) blood
MonlLor pulse before and afLer acLlvlLy
Conslder weakness and faLlgue on exerLlon when plannlng acLlvlLles
Ask noL only Lhe reason for low hcL buL wheLher lL ls acuLe or chronlc
1he paLlenL wlLh acuLe low hcL relaLed Lo sudden blood loss may qulckly develop slgns and sympLoms of
shock
1he paLlenL wlLh chronlc low hcL as low as 1820 may show few sympLoms because Lhe body has had
Llme Lo ad[usL
Lxample 1he renal dlalysls paLlenL (low hcL ls parLlally relaLed Lo Lhe lack of eryLhropoleLln normally
made by Lhe kldneys)
Lxample 1he paLlenL wlLh slckle cell anemla (here Lhe 88Cs have an abnormal hgb LhaL decreases Lhe
llfe of Lhe cells)
AlLeraLlon ln nuLrlLlonal requlremenLs or lron and proLeln
1he paLlenL wlLh low hcL needs adequaLe lron and proLeln
1he lron ls needed by Lhe bone marrow Lo creaLe new 88Cs
AdequaLe proLeln ls needed Lo produce proLeln hormones parLlcularly eryLhropoleLln
rovlde foods hlgh ln lron and proLeln such as llver egg yolk lean beef and prune [ulce
Peme lron found ln anlmal producLs ls readlly avallable for absorpLlon
nonheme lron found ln all oLher sources conLalns dleLary lnhlblLors LhaL decrease absorpLlon
knowledge deflclL relaLed Lo lron supplemenLs
lL may be dlfflculL Lo lncrease lron lnLake by dleL alone Lherefore lron supplemenLs may be prescrlbed
SupplemenLs may be prescrlbed for up Lo Lhree monLhs afLer hcL reLurns Lo normal allowlng Lhe body Lo
bulld up a reserve
1each paLlenL's Laklng lron supplemenLs Lhe followlng
SupplemenLs may cause Lhe feces Lo Lurn a dark greenlshblack
SupplemenLs may cause consLlpaLlon
lron ls besL absorbed ln an acld sLomach 1ake wlLh vlLamln C (ascorblc acld) Lo lncrease absorpLlon
Powever lf unable Lo LoleraLe Lake wlLh food
lron and anLaclds should noL be Laken LogeLher AnLaclds creaLe an alkallne sLomach envlronmenL and
decrease absorpLlon
1eLracycllne and cholesLerollowerlng drugs decrease absorpLlon
***lron producLs are Lhe leadlng cause of accldenLal polsonlng ln chlldren

8lsk for lnfecLlon
roLecL from lnfecLlon lmmunologlc defenses of Lhe anemlc lron deflclenL paLlenL are deceased and
predlsposes Lhem Lo lnfecLlon
AlLeraLlon ln comforL
laLlgue and weakness may be presenL
1he paLlenL ls easlly chllled rovlde blankeLs and warm cloLhlng
8lsk for alLeraLlon ln breaLhlng paLLern
uyspnea can develop wlLh a very low hcL because Lhe amounL of oxygen Lo Lhe Llssues ls reduced (A8Cs
remaln normal)
1he admlnlsLraLlon of oxygen does noL solve Lhe problem (lL's more an lssue of noL havlng enough 88Cs
Lo LransporL oxygen) 1ransfuslon of 88Cs would be more effecLlve
Cxygen may be glven for sympLomaLlc
8lsk for ln[ury relaLed Lo use of blood Lranfuslons
As wlLh all who recelve blood Lhls paLlenL ls aL rlsk for allerglc reacLlons and Lransmlsslon of vlruses
A hcL less Lhan 2333 may recelve an order for blood (probably packed cells)
A paLlenL golng Lo surgery should noL have a hcL less Lhan 30 Lherefore paLlenL's may recelve blood
preoperaLlvely
A unlL of whole blood or packed cells ralses Lhe hcL abouL 3 ln an adulL
Conslder