1,000 ft view of hematology (incomplete) Flashcards
what is blood considered
connective tissue but has a fluid matrix
what is the pH of the blood
7.35 to 7.45
what is the primary protein in the blood
albumin
what is albumin important for
primary protein that determines osmotic balance
needed for transport of hormones/fats/nutrients/meds, helps maintain intravascular volume
what determines your oncotic pressure
albumin
what is the buffy coat consided of
platelets
leukocytes (neutrophils, lymphocytes, monocytes, eosinophils and basophils)
what do RBC do
carries oxygen and CO2
what is determined by H+ concentration
the pH
what is the definition of pH
-log(H+)
what does pH =
HCO3-/pCO2
what is acidosis
Increased H+, lower pH
what is alkalosis
Decreased H+, Higher pH (more basic)
how much does plasma make up of whole blood
55% of blood volume
what is plasma made up of
primarily water
- caries nutrients, wastes, electrolytes, enzymes, hormones, gases
about 7% proteins
-albumin
-fibrinogen
-globulins (IgG, etc aka antibodies)
where is albumin made
in the liver
what nutrients are found within the blood
glucose, carbohydrates
amino acids
lipids
cholesterol
vitamins
rion
what waste is carried within the blood
urea
creatinine
uric acid
bilirubin
what are erythrocytes
AKA RBC
biconcave cells, no nucleus, no organelles
cannot perform intracellular functions such as making proteins
transports O2 and CO2
where are RBCs created and what is their lifespan
in the bone marrow
lifespan of about 120 days
how much of the RBC is hemoglobin
1/3
Heme (red) + globin proteins
O2 and CO2 binding protein
what does heme mean
red
what is oxyhemoglobin
bound hemoglobin
what is the function of porphorin proteins
bind the heme to the iron
where is iron stored
in ferritin
where is iron bound for transport
to transferrin
what is hepcidin
made in the liver to regulate iron levels through change in absorption
helps regulate feedback loop of iron absorption
what regulates Hepcidin expression
systemic iron levels, hypoxia, anemia, erythropoiesis , infection and inflammation
what is hemachromatosis
too much iron due to altered HFE gene (homeostatic iron regulator) regulation -> iron overload, tissue damage
What is a totipotential cell
total potential blood cell
stem cell capable of developing into all human tissue cells
found in bone marrow
what is erythropoiesis
stimulated by erythropoietin (EPO) - can be given exogenously
what produces and regulates erythopoiesis
kidneys based on O2 levels - hypoxia inducible factor
what does EPO stimulate
the myeloid stem cell to differentiate into RBC - EPO can be used to determine red marrow function
what part of the marrow is responsible for hematopoeisis
red marrow aka myeloid tissue
what factors do we need to make a RBC
hemoglobin
iron
folic acid
vitamin B12
what is B12
aka cobalamin
absorbed through the parietal cells in the stomach
needs intrinsic factor for absorption
assists with maturation process
assists with DNA synthesis
helps with folate synthesis
what is seen on a CBC with someone with a Vitamin B12 deficiency
megaloblastic anemia
what is Folate
absorbed in the duodenum
needed for DNA synthesis during erythropoiesis
helps with cellular maturation
what is seen on CBC with someone with a folate deficiency
megaloblastic anemia
what is the formation of a platelet
hematopoietic stem cell
megakaryoblast
megakaryocyte
platelet
what is a platelet
pieces off a fragmented megakaryocyte
contain cytoplasmic granules (release adhesive proteins, stimulate coagulation cascade, stimulate growth factors)
are able to adapt their shape and form pseudopodia (allow for better adhesion)
what is the lifespan of a platelet
8-11 days then removed by macrophages within the spleen
where are platelets produced
in bone marrow
what is Von Willebrand Factor (VWF)
large circulating glycoprotein
secreted by endothelial cells and platelets
molecular glue
what does VWF bind to
collagen, platelets and factor VIII
what does VWF play a role in
adhesion
aggregation
carrier for factor VIII (increased half life)
where are RBCs broken down
in the liver, spleen and bone after being engulfed by macrophages
hemoglobin is saved and reused
what is porphyrin proteins broken into
bilirubin
brought to the liver, excreted in the bile
can be release in the feces as urobilinogen
some released in urine during times of increased bile
what is the largest lymphoid organ
spleen
what does the spleen remove or sequester
RBCs
what is the function of the spleen
filters antigen
helps to cleen the blood
removes aged erythrocytes
blood reservoir: can stretch, hold 300cc+
what is hemostatic balance
procoagulants vs profibrinolyitic and anticoagulants
what is hemostasis maintained by
endothelium
coagulation proteins
platelets
what are the three steps to stop bleeding
vasoconstriction
platelet plug
clotting cascade
what is the vascular endothelial lining
under normal circumstances, keeps platelets inactive, vessels dilated
covered in proteins that prevent unnecessary clotting: heparin and thrombomodulin
what does the vascular endothelial lining normally secrete
Nitric oxide (NO) - endothelium-derived vasorelaxant factor - vasodilator
Prostacyclin (PGI2) - vasodilator
what is dysrupted with a vascular endothelial lining injury
No NO
No PGI2
No heparin
what is released from ruptured endothelial cells causing contraction of the surrounding smooth muscles
endothilin - causing vasoconstriction
what is released/activated when there is damage to the cascular endothelial lining
VWF (Factor VIII)
causes actiation of platelets
platelets bind to VWF with glycoprotein1b
how is the platelet pug formed
they begin to adhere to the exposed VWF - bind via GP1b
they are activated so begin their pseudopodia shapes through platelet degranulation
what is TXA
clot forming medication
what granules are released during clot formation
CALCIUM: required for adhesion and intracellular signaling of the activated platelets
ADP: brings more platelets
Serotonin: increased vascular permeability
how fast does a platelet plug form
forms in about 3-5 minutes
what is factor 2
thrombin
what is factor 1
fibrinogen
what factors are within the common pathway
factors 5,2 and 1
what activates the intrinsic pathway
exposed endothelial collagen
what activated the extrinsic pathway
tissue factor that is released by the damaged cells
what factors are within the intrinsic pathway
Factors 12,11,9,8
what factors are within the extrinsic pathway
Factors 3 and 7
what factor is the common link between all pathways
factor 10
what created prothrombin activator
Xa reacts with factor V along with more calcium and platelet factor)
what forms the fibrin mesh
Factor III (fibrin stabilizer) will cross link with large proteins
what is vitamin K required for
liver activation of prothrombin, VII, IX, X
what is the effect of vitamin K deficiency
decrease clotting factors - increased bleeding tendency
what is the process of clot resorption
tissue plasminogen activator (t-PA) will stimulate plasminogen
plasminogen then converts to its active form -> plasmin
plasmin is an enzyme that will break down the formed clot (fibinolyssis)
where is tPA used
within the vascular system
what is PCC
prothrombin complex concentrates
Factors II, VII, IX, X
prot c&s, heparin
aPCC: II, VIIa, IX, X
what is FFP
fresh frozen plasma
all circulating plasma proteins
what are the significant bleeding labs
CBC
D-dimer
PT
PTT
INR
what does the CBC with diff include
RBC count
hemoglobin
hematocrit
RBC indices
WBC count and diff (neuro, lympho, mono, eosino, baso)
Blood smear
platelet count
mean platelet volume
what do low volume RBC count mean
active or recent bleeding
hemolysis
deficiency (iron or b12)
genetic issues (sickle cell)
drugs
bone marrow dysfunction
chronic illness
renal disease
overhydration
smoking
COPD
what do elevated RBC count mean
increased need for O2 carrying capacity (smoking, high altitudes)
polycythermia
dehydration
cirrhosis
what are Indices helpful for
give information about size, weight, hemoglobin concentration of the RBCs
assist with classifying anemia
what is the MCV
mean corpuscular volume
how much hemoglobin is within one RBC
what is RBC distribution width
indicates the variation in width of RBCs
what is hemoglobin (HGB)
the measure of concentration of Hgb in the blood which indicates oxygen carrying capacity
low levels indicate anemia
what is hematocrit (HCT)
indirect measurement of number of RBCs
measurement of the percentage of RBCs in the total blood volume
what do low HCT levels indicate
anemia
what do elevated HCT levels indicate
can be due to erythrocytosis
what can play a role in the HCT
hydration plays into percentage
what takes time to change during hemorrhage
Hgb and HCT values
what is the platelet count
assess the number of platelet (thrombocytes) which can indicate concerns for bleeding
maintain homeostasis of bleeding and will form clot
what is Prothrombin time (PT)
measures the extrinsic and common pathways of coagulation cascade
measured in seconds: HOW LONG DOES IT TAKE FOR CLOT TO FORM VIA THE EXTRINSIC AND COMMON PATHWAY WHEN EXPOSED TO TISSUE FACTOR(normally 11-13 seconds)
reported along with INR
what is INR
ration of prothrombin time measured and a control prothombin time
INR = (pt PT/Control PT)
used for monitoring warfain
what is the goal INR in patients on warfarin
2
what is a d-dimer
fibrin D-dimer
measurement of the breakdown(fibrinolysis) of the fibrin mesh
during fibrinolysis, the fibrin that is crosslinked by XIII forming mesh, is broken down by plasmin
what is a normal d-dimer level
<500mg/mL
*age adjusted
