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CABS2: Hematology > 1,000 ft view of hematology (incomplete) > Flashcards

1,000 ft view of hematology (incomplete) Flashcards

1
Q

what is blood considered

A

connective tissue but has a fluid matrix

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2
Q

what is the pH of the blood

A

7.35 to 7.45

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3
Q

what is the primary protein in the blood

A

albumin

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4
Q

what is albumin important for

A

primary protein that determines osmotic balance
needed for transport of hormones/fats/nutrients/meds, helps maintain intravascular volume

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5
Q

what determines your oncotic pressure

A

albumin

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6
Q

what is the buffy coat consided of

A

platelets
leukocytes (neutrophils, lymphocytes, monocytes, eosinophils and basophils)

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7
Q

what do RBC do

A

carries oxygen and CO2

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8
Q

what is determined by H+ concentration

A

the pH

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9
Q

what is the definition of pH

A

-log(H+)

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10
Q

what does pH =

A

HCO3-/pCO2

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11
Q

what is acidosis

A

Increased H+, lower pH

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12
Q

what is alkalosis

A

Decreased H+, Higher pH (more basic)

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13
Q

how much does plasma make up of whole blood

A

55% of blood volume

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14
Q

what is plasma made up of

A

primarily water
- caries nutrients, wastes, electrolytes, enzymes, hormones, gases
about 7% proteins
-albumin
-fibrinogen
-globulins (IgG, etc aka antibodies)

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15
Q

where is albumin made

A

in the liver

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16
Q

what nutrients are found within the blood

A

glucose, carbohydrates
amino acids
lipids
cholesterol
vitamins
rion

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17
Q

what waste is carried within the blood

A

urea
creatinine
uric acid
bilirubin

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18
Q

what are erythrocytes

A

AKA RBC
biconcave cells, no nucleus, no organelles
cannot perform intracellular functions such as making proteins
transports O2 and CO2

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19
Q

where are RBCs created and what is their lifespan

A

in the bone marrow
lifespan of about 120 days

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20
Q

how much of the RBC is hemoglobin

A

1/3
Heme (red) + globin proteins
O2 and CO2 binding protein

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21
Q

what does heme mean

A

red

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22
Q

what is oxyhemoglobin

A

bound hemoglobin

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23
Q

what is the function of porphorin proteins

A

bind the heme to the iron

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24
Q

where is iron stored

A

in ferritin

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25
Q

where is iron bound for transport

A

to transferrin

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26
Q

what is hepcidin

A

made in the liver to regulate iron levels through change in absorption
helps regulate feedback loop of iron absorption

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27
Q

what regulates Hepcidin expression

A

systemic iron levels, hypoxia, anemia, erythropoiesis , infection and inflammation

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28
Q

what is hemachromatosis

A

too much iron due to altered HFE gene (homeostatic iron regulator) regulation -> iron overload, tissue damage

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29
Q

What is a totipotential cell

A

total potential blood cell
stem cell capable of developing into all human tissue cells
found in bone marrow

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30
Q

what is erythropoiesis

A

stimulated by erythropoietin (EPO) - can be given exogenously

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31
Q

what produces and regulates erythopoiesis

A

kidneys based on O2 levels - hypoxia inducible factor

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32
Q

what does EPO stimulate

A

the myeloid stem cell to differentiate into RBC - EPO can be used to determine red marrow function

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33
Q

what part of the marrow is responsible for hematopoeisis

A

red marrow aka myeloid tissue

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34
Q

what factors do we need to make a RBC

A

hemoglobin
iron
folic acid
vitamin B12

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35
Q

what is B12

A

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

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36
Q

what is seen on a CBC with someone with a Vitamin B12 deficiency

A

megaloblastic anemia

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37
Q

what is Folate

A

absorbed in the duodenum
needed for DNA synthesis during erythropoiesis
helps with cellular maturation

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38
Q

what is seen on CBC with someone with a folate deficiency

A

megaloblastic anemia

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39
Q

what is the formation of a platelet

A

hematopoietic stem cell
megakaryoblast
megakaryocyte
platelet

40
Q

what is a platelet

A

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)

41
Q

what is the lifespan of a platelet

A

8-11 days then removed by macrophages within the spleen

42
Q

where are platelets produced

A

in bone marrow

43
Q

what is Von Willebrand Factor (VWF)

A

large circulating glycoprotein
secreted by endothelial cells and platelets
molecular glue

44
Q

what does VWF bind to

A

collagen, platelets and factor VIII

45
Q

what does VWF play a role in

A

adhesion
aggregation
carrier for factor VIII (increased half life)

46
Q

where are RBCs broken down

A

in the liver, spleen and bone after being engulfed by macrophages
hemoglobin is saved and reused

47
Q

what is porphyrin proteins broken into

A

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

48
Q

what is the largest lymphoid organ

A

spleen

49
Q

what does the spleen remove or sequester

A

RBCs

50
Q

what is the function of the spleen

A

filters antigen
helps to cleen the blood
removes aged erythrocytes
blood reservoir: can stretch, hold 300cc+

51
Q

what is hemostatic balance

A

procoagulants vs profibrinolyitic and anticoagulants

52
Q

what is hemostasis maintained by

A

endothelium
coagulation proteins
platelets

53
Q

what are the three steps to stop bleeding

A

vasoconstriction
platelet plug
clotting cascade

54
Q

what is the vascular endothelial lining

A

under normal circumstances, keeps platelets inactive, vessels dilated
covered in proteins that prevent unnecessary clotting: heparin and thrombomodulin

55
Q

what does the vascular endothelial lining normally secrete

A

Nitric oxide (NO) - endothelium-derived vasorelaxant factor - vasodilator
Prostacyclin (PGI2) - vasodilator

56
Q

what is dysrupted with a vascular endothelial lining injury

A

No NO
No PGI2
No heparin

57
Q

what is released from ruptured endothelial cells causing contraction of the surrounding smooth muscles

A

endothilin - causing vasoconstriction

58
Q

what is released/activated when there is damage to the cascular endothelial lining

A

VWF (Factor VIII)
causes actiation of platelets
platelets bind to VWF with glycoprotein1b

59
Q

how is the platelet pug formed

A

they begin to adhere to the exposed VWF - bind via GP1b
they are activated so begin their pseudopodia shapes through platelet degranulation

60
Q

what is TXA

A

clot forming medication

61
Q

what granules are released during clot formation

A

CALCIUM: required for adhesion and intracellular signaling of the activated platelets
ADP: brings more platelets
Serotonin: increased vascular permeability

62
Q

how fast does a platelet plug form

A

forms in about 3-5 minutes

63
Q

what is factor 2

A

thrombin

64
Q

what is factor 1

A

fibrinogen

65
Q

what factors are within the common pathway

A

factors 5,2 and 1

66
Q

what activates the intrinsic pathway

A

exposed endothelial collagen

67
Q

what activated the extrinsic pathway

A

tissue factor that is released by the damaged cells

68
Q

what factors are within the intrinsic pathway

A

Factors 12,11,9,8

69
Q

what factors are within the extrinsic pathway

A

Factors 3 and 7

70
Q

what factor is the common link between all pathways

A

factor 10

71
Q

what created prothrombin activator

A

Xa reacts with factor V along with more calcium and platelet factor)

72
Q

what forms the fibrin mesh

A

Factor III (fibrin stabilizer) will cross link with large proteins

73
Q

what is vitamin K required for

A

liver activation of prothrombin, VII, IX, X

74
Q

what is the effect of vitamin K deficiency

A

decrease clotting factors - increased bleeding tendency

75
Q

what is the process of clot resorption

A

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)

76
Q

where is tPA used

A

within the vascular system

77
Q

what is PCC

A

prothrombin complex concentrates
Factors II, VII, IX, X
prot c&s, heparin
aPCC: II, VIIa, IX, X

78
Q

what is FFP

A

fresh frozen plasma
all circulating plasma proteins

79
Q

what are the significant bleeding labs

A

CBC
D-dimer
PT
PTT
INR

80
Q

what does the CBC with diff include

A

RBC count
hemoglobin
hematocrit
RBC indices
WBC count and diff (neuro, lympho, mono, eosino, baso)
Blood smear
platelet count
mean platelet volume

81
Q

what do low volume RBC count mean

A

active or recent bleeding
hemolysis
deficiency (iron or b12)
genetic issues (sickle cell)
drugs
bone marrow dysfunction
chronic illness
renal disease
overhydration
smoking
COPD

82
Q

what do elevated RBC count mean

A

increased need for O2 carrying capacity (smoking, high altitudes)
polycythermia
dehydration
cirrhosis

83
Q

what are Indices helpful for

A

give information about size, weight, hemoglobin concentration of the RBCs
assist with classifying anemia

84
Q

what is the MCV

A

mean corpuscular volume
how much hemoglobin is within one RBC

85
Q

what is RBC distribution width

A

indicates the variation in width of RBCs

86
Q

what is hemoglobin (HGB)

A

the measure of concentration of Hgb in the blood which indicates oxygen carrying capacity
low levels indicate anemia

87
Q

what is hematocrit (HCT)

A

indirect measurement of number of RBCs
measurement of the percentage of RBCs in the total blood volume

88
Q

what do low HCT levels indicate

A

anemia

89
Q

what do elevated HCT levels indicate

A

can be due to erythrocytosis

90
Q

what can play a role in the HCT

A

hydration plays into percentage

91
Q

what takes time to change during hemorrhage

A

Hgb and HCT values

92
Q

what is the platelet count

A

assess the number of platelet (thrombocytes) which can indicate concerns for bleeding
maintain homeostasis of bleeding and will form clot

93
Q

what is Prothrombin time (PT)

A

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

94
Q

what is INR

A

ration of prothrombin time measured and a control prothombin time
INR = (pt PT/Control PT)
used for monitoring warfain

95
Q

what is the goal INR in patients on warfarin

A

2

96
Q

what is a d-dimer

A

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

97
Q

what is a normal d-dimer level

A

<500mg/mL
*age adjusted

CABS2: Hematology (4 decks)

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