 What comes in nursing school explain in this video on erythropoiesis, which means the generation of the production of red blood cells? As always, I'm a big believer that if you know the physiology behind how something is supposed to function and then there's a breakdown somewhere in that process, you can easier memorize it and then also find out signs and symptoms that the patient might have. So let's look at this here for erythropoiesis. So when there's a decrease detected in oxygen in the tissues, red blood cell production gets stimulated. And then when that gets detected by the kidneys, then and the oil and water liver, they release this hormone called erythropoietin. And 90% come from the kidneys, 10% come from the liver. This erythropoietin then stimulates the bone marrow to produce red blood cells. Remember that the bone marrow has these undifferentiated stem cells that can develop into any cell that we need, whether it's a platelet, the white cell, a red cell. But the erythropoietin here tells it we need red cells. We need these erythrocytes. And so the bone marrow then produces the red blood cells, but what's required for that production are certain things, which is B12, folate, certain minerals such as copper and cobalt, and also iron. And as you can see here, I wrote iron deficiency anemia is the most common anemia that we find. And to really get a little bit more into the physiology here, I've drawn out a red blood cell, which is kind of this disc shape. And on this red blood cell, there's a small little molecule called the hemoglobin. And that contains two parts, which is the heme portion that contains the iron and then the globin, which is the protein that that heme is bound to. So heme and globin makes up hemoglobin. And knowing that heme contains iron, we know here that iron carries that oxygen on the hemoglobin. So without iron and without hemoglobin, we're not going to have any oxygen in the tissues. The iron that we get from our diet gets absorbed by the duodenum and the jejunum after small intestine. The excess gets stored in the liver as ferritin or hemocidrin, and it's just stored there until again, the oxygen in the tissue goes down and we need more red blood cells, then it is released into the bone marrow. And so then once we understand what it takes for erythrocytes to be generated, then we know that if there's a breakdown at certain points here, we're going to have anemia, which is a low red blood cell count. So when there's something going on with erythropoietin, when we can't produce enough of that, there is usually something going on with the kidneys or the liver. And this is called anemia of chronic disease. So think about anemias because of chronic kidney disease, CKD. So these are patients that are on dialysis, their kidneys are not working or only working to a very, very small portion. They cannot release that erythropoietin. So what they get is an injection of erythropoietin after the dialysis treatment to help with that red blood cell production. But those are chronic illnesses, therefore it's called anemia of chronic disease. Liver issues here, chronic ones could be hepatitis C or any type of cirrhosis, for example. Now when we have something wrong with the bone marrow where it just can't produce these red blood cells, that usually means that we have some sort of cancer of the bone marrow. And then this whole cascade here is broken down. Now the other thing that can happen, the hemoglobin itself can have some issues. And that is mostly because of genetic disorders. And the two here that pertain to the hemoglobin are thalassemia and sickle cell disease. Sickle cell disease, per se, there's not necessarily anything wrong with the hemoglobin itself, but the red blood cells themselves are sickle. So they have this kind of a half moon shape rather than this round shape. And then there's a whole lot of problems that kind of rise there. And then when we have any of these deficiencies, so deficiency in vitamin B12 or folate or iron, then we can have deficiencies there. So B12 deficiency is also called pernicious anemia, folate, folate deficiency anemia, and then iron deficiency anemia. So any of these vitamins or minerals, any deficiencies there can lead to anemia. And then we have the names again. And then think about, we talked about that iron is absorbed from the small intestine here. If we have some sort of malabsorption, this order, whether that is maybe a patient after some sort of GI surgery or maybe a gastric bypass, or maybe they have some sort of intestinal obstruction that requires the removal or cancer, then we can't absorb the iron. And then again, we're going to end up with iron deficiency anemia. So again, if you understand the cascade of events that it takes to produce the red blood cells, and then you know what area of this cascade things can break down, and then you can kind of come up with the signs and symptoms, or also already know, for example, the sickle cell, if it's this half moon shape, what kinds of signs and symptoms is it going to cause. And then another important thing here, so when we have anemia, anemia, meaning lack of red blood cells, we're going to have to draw certain labs. And those are clearly red blood cells, as well as hemoglobin and hematocrit. And looking over here, hemoglobin is attached to the red blood cells. So automatically when the red blood cells are low, hemoglobin and hematocrit are going to be low. And then we have these indices called red blood cell indices, MCV, MCH, MCHC and RDW that tell us about the size and the color of the red blood cells. And then we can find out which anemia these are the mineral and vitamin deficiency animes here that the patient is going to have. We can also look at reticular sites, which are immature red blood cells. So that usually means that there's something going on with the bone marrow. And then we can look at all these vitamins and minerals themselves. So iron ferritin that gets stored, the total iron binding capacity, transfer in B12, as well as folate. And I will have a separate video where I go into these different indices explaining what that means, if they're high, if they're low, what kind of anemia are we dealing with as well. I'm going to have all the videos about the different anemias that I wrote down here in purple for you. So please check those videos out if you're interested. And thanks for watching Nursing School Explains. See you soon.