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V.M. is a -year-old African-American man who has sickle cell disease (SCD), sometimes called sickle cell anemia, marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions, and he started showing signs of chronic renal failure months ago. His regular medications are pentoxifylline (Trental), oxycodone-acetaminophen (Percocet), hydroxyurea (Droxia), and folic acid. In the hematology clinic this morning, V.M.'s hemoglobin measured . He received units packed RBCs over hours and then went home. He developed dyspnea and shortness of breath approximately to hours later, and his wife called . The emergency medical system crew initiated oxygen and transported V.M. to the emergency department (ED).
Identify two mechanisms that contribute to anemia in patients with SCD.