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Phase 1 Cardio > 1 > Flashcards

1 Flashcards

1
Q

What is the life span of a red blood cell?

A

100-120 days

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2
Q

A RBC is approximately ……………. micro metres in diameter

A

6.2-8.2

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3
Q

Where are RBCs produced?

A

In the bone marrow.

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4
Q

What is polycythaemia?

A

When you have a high number of erythrocytes/high levels of Hb.

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5
Q

What is the condition called where you have a low number of erythrocytes and therefore a reduction of Haemoglobin?

A

Anaemia

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6
Q

What is the production of RBCs stimulated by?

A

Erythropoietin.

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7
Q

What is erythropoietin and where is it secreted from?

A

It is a glycoprotein cytokine mainly secreted by the kidney.

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8
Q

What is primary polycythaemia?

A

Where the bone marrow cells recklessly produce RBCs due to a change in their genetic code.

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9
Q

What is secondary polycythaemia?

A

Where an underlying condition causes increased production of erythropoietin which in turn increases RBC production.

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10
Q

Define corpuscula.

A

The problem is within the erythrocytes.

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11
Q

Define extra-corpuscular.

A

The problem is occurring outside the erythrocyte.

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12
Q

What is hypo-regenerative?

A

The bone marrow isn’t producing enough RBCs.

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13
Q

What is hyper-regenerative?

A

There is an increased destruction of RBCs.

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14
Q

What is the life span of a white blood cell?

A

most = hours/days

some eg. memory cells = years

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15
Q

The diameter of a white blood cell is ………… micro metres.

A

7-30.

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16
Q

Where do WBCs develop?

A

In the bone marrow/thymus depending on what type of WBC they go on to become.

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17
Q

What is the function of white blood cells?

A

Immunity.

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18
Q

Name the 2 types of immunity.

A

Specific (adaptive) and non-specific (innate).

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19
Q

Which WBCs are involved in the specific immune response?

A

Lymphocytes:
B cells
T cells
Natural Killer cells

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20
Q

Which WBCs are involved in the non-specific immune response?

A 
Neutrophils
Basophils
Eosinophils
Macrophages
Mast cells
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21
Q

What is granulocyte/stem cell production stimulated by?

A

G-CSF (Granulocyte-colony stimulating factor).

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22
Q

What is the condition where you have too many neutrophils?

A

Neutrophil leucocytosis

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23
Q

What is another name for white blood cells?

A

Leukocytes

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24
Q

What is the condition where you have too few neutrophils?

A

Neutropenia

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25
Q

What is Eosinophilia?

A

An increase in eosinophils in response to allergens, drugs, parasites, and some leukaemia.

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26
Q

What is Eosinopenia?

A

The number of eosinophil granulocytes is low- predictor of a bacterial infection; induced by stress, burns and acute infections.

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27
Q

Does Basopenia have much clinical significance?

A

No

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28
Q

Basophilia is usually ………….

A

malignant.

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29
Q

What is monocytosis?

A

An increase in the number of monocytes in the blood.

Occurs in association with infectious processes, or when the bone marrow is recovering from a toxic injury.

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30
Q

…………. is where there is a low number of monocytes in the blood.

A

Monocytopenia

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31
Q

Explain the humoral response.

A

B lymphocytes produce plasma cells. These produce immunoglobulins, which bind to intruders and destroy them.

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32
Q

Explain the cell mediated response.

A

An antigen is presented by the phagocyte. T lymphocytes recognise this and become active T cells/memory cells.

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33
Q

Name two treatments for white blood cell abnormalities.

A

1) Granulocyte transfusion

2) cellular therapy

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34
Q

When is granulocyte transfusion used?

A

Rarely, when there is an overwhelming sepsis.

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35
Q

Where are platelets produced?

A

In the bone marrow.

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36
Q

What are platelets produced by?

A

Megakaryocytes shedding particles (exocytosis).

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37
Q

What is thrombocytopenia?

A

A low platelet count.

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38
Q

What is thrombopoietin?

A

It is a glycoprotein hormone produced by the liver and kidney which regulates the production of platelets.

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39
Q

Thrombopoietin has TPO receptors on the short arm of the 3rd chromosome. TPO binds to these, activating pathways which stimulate megakaryocyte growth/platelet production. Using this info, what are used to increase platelet production?

A

Drugs called TPO receptor agonists are used to increase megakaryocyte production. These include eltrombopag and romiplostim.

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40
Q

Platelets have a diameter of …………

A

2-5 micrometres

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41
Q

What are the 3 stages of platelet activation?

A

1) Initiation
2) Propagation
3) Stabilisation

42
Q

Explain initiation of platelet activation.

A

There is injury to the endothelium.
Collagen and VWF adhere platelets.
The platelets change shape, tether, spread and adhere to each other.

43
Q

Explain propagation of platelet activation.

A

Granular release.
Platelets are activated.
Platelet activation stimulated by fibrinogen, which binds to the receptor GPIIb-IIIa.

44
Q

Explain stabilisation of platelet activation.

A

Primary platelet thrombus.
Clot takes place on surface.
This is a thrombin/fibrin network.

45
Q

What are the 4 features of the structure of a platelet?

A

1) plasma membrane
2) cytoskeleton
3) dense tubular system
4) secretory granules

46
Q

Name the four secretory granules of platelets.

A

1) alpha granules (VWF, PF4, plasminogen)
2) dense granules (serotonine)
3) lysosome
4) peroxisome

lysosome and peroxisome clear debris

47
Q

How can thrombocytopenia be classified.

A

1) reduced production of platelets
2) increased destruction of platelets
3) altered redistribution of platelets
4) pseudo thrombocytopenia

48
Q

What is thrombocytopathy?

A

Any of several blood disorders characterized by dysfunctional platelets, which result in prolonged bleeding, defective clot formation, and a tendency to haemorrhage.

The platelet count is normal but there is a problem with their function.

49
Q

How can thrombocytopathy be classified?

A

It can be congenital or acquired.

50
Q

Bernard-Soulier syndrome is an example of ……………. and is ……………….

A

a congenital type of thrombocytopathy,

a rare AR bleeding disorder that is caused by a deficiency of the GpIIb receptor.

51
Q

What are some examples of causes of acquired thrombocytopathy?

A

Medication.

Underlying diseases such as renal failure, paraproteinemia, MPN, MDS and liver disease.

52
Q

Platelet and haemophilia ‘types’ are types of what?

A

Bleeding

53
Q

Give 5 reasons for platelet type bleeding.

A

1) Genetic disorder
2) Low platelet count
3) Medication
4) Liver disease
5) Renal failure

54
Q

Give 3 displays of platelet bleeding.

A

1) Skin/mucosal bleeding eg. gum/nose
2) Early post-procedural bleeding (mins)
3) petechial rash; non blanching

55
Q

Give 3 displays of haemophilia bleeding.

A

1) Muscle/joint bleeding
2) late post procedural bleeding (hours/days)
3) large suffusions/haematomas

56
Q

What are the 2 types of thrombocytosis?

A

1) Primary/clonal/essential

2) Secondary/reactive

57
Q

…………… thrombocytosis poses a much higher risk of clotting or bleeding than ………… thrombocytosis.

A

Primary

secondary/reactive

58
Q

What is a young RBC known as?

A

Reticulocyte

59
Q

What does a RBC consist of?

A

A membrane, enzymes of glycolysis and Haemoglobin

60
Q

Why do RBCs need a membrane?

A

To enclose Haemoglobin, otherwise haemoglobin would clog up the kidneys if allowed into the blood on its own.

61
Q

Where does Hb transfer oxygen to from lung?

A

Myoglobin in muscles.

62
Q

What is Hb formed from?

A

2 alpha and 2 beta chains.

4 haem groups.

63
Q

What is the normal level of Hb?

A

12.5 - 15.5 g/dl

64
Q

What is it called if you have a low Hb level?

A

Anaemia.

65
Q

What is it called if you have a high level of Hb?

A

Polycythaemia.

66
Q

What are symptoms of anaemia?

A 
Tiredness
lethargy
malaise (general feeling of discomfort/illness)
reduced exercise tolerance
shortness of breath 
angina
67
Q

If a patient presented with any of the following, along with tiredness, lethargy and malaise, what could you suspect?

Palor, pale mucus membranes, palmar creases, glossitis, angular stomatitis, kylonychia

A

Anaemia

68
Q

Iron deficiency anaemia:

A

Iron is needed for Hb production.
Lack of iron results in reduced proportion of small red cells.
In IDA there’s low Hb and MCV (mean cell volume) of < 80 fl

69
Q

Causes of anaemia may include:

A

Bleeding: occult GI (most common cause of IDA); menorrhagia (heavy periods)

Dietary: not getting enough iron in diet (worldwide most common cause of IDA)

70
Q

B12 and Folate deficiency anaemia:

A

V B12 and folate both needed for DNA synthesis .

With deficiency RBCs can’t be made in bone marrow -> less are released

Deficiency will affect all dividing cells but bone marrow is most active so is affected first.

71
Q

What is macrocytic anaemia?

A

When RBC size is larger than 100 fl.

Occurs due to VB12 or folate deficiency.

72
Q

Causes of B12 deficiency:

A

Intrinsic factor (produced by gastric parietal cells in stomach) needed for absorption of B12 in terminal ileum.

It binds to B12 and is then absorbed.

If stomach is damaged -> less parietal cells -> less intrinsic factor -> less B12 absorbed -> anaemia

Autoimmune disease called Pernicious Anaemia causes production of antibodies against gastric P cells -> less intrinsic factor produced -> anaemia

73
Q

Why does Pernicious anaemia have a slow onset?

A

The liver has a store of B12 which can last 4 years.

74
Q

Causes of Folate deficiency:

A

Lack of fruit and veg in diet.

Malabsorption eg. due to celiac disease

Increased need eg. due to haemolysis/ anything that results in increased cell division.

75
Q

What is haemolysis?

A

When blood cells are destroyed before their 120 day lifespan.

76
Q

Examples of congenital haemolysis:

A

Membrane issues eg. Spherocytosis (blood cells are spherical and get stuck in vessels easily).
Enzyme issues eg. pyruvate kidney deficiency (less pyruvate produced -> less ATP -> build up of phosphoenolpyruvate -> G6PD deficiency)
Haemoglobin issues eg. sickle cell anaemia

77
Q

Examples of acquired haemolysis:

A

Autoimmune (immune system attacks own red blood cells)
Mechanical (fragmentation of RBCs by mechanical heart valve) OR intravascular thrombosis in DIC
Pregnancy- haemolytic disease of foetus and newborn

78
Q

What does a lack of number/function of Neutrophils lead to?

A

Recurrent bacterial infections

79
Q

What are WBCs produced from?

A

Immature precursor cells in bone marrow which are derived from stem cells.

80
Q

Which is the most numerous WBC?

A

Neutrophils

81
Q

What do neutrophils do?

A 
Phagocytose & kill bacteria
Release chemotaxins (signal more WBCs to come to site) and cytokines (important in inflammatory response)
82
Q

What do lymphocytes do?

A

Some generate antibodies against specific foreign antigens

Others are immunological memory

83
Q

…. …………………… are made in the bone marrow, stored in secondary lymphoid organs, differentiate into plasma cells and produce immunoglobulins when stimulated by exposure to foreign antigens.

A

B lymphocytes

84
Q

…. …………………….. are made in the bone marrow, mature in the thymus, some are helper cells (CD4- help B cells in antibody generation- responsible for cell mediated immunity), some are cytotoxic cells (CD8)

A

T lymphocytes

85
Q

Explain acute leukaemia:

A

Proliferation (rapid increase in number of) primitive precursor cells in bone marrow.

Proliferation without differentiation- replaces normal bone marrow cells resulting in anaemia, neutropenia (infections) and thrombocytopenia (excessive bleeding).

Presence of primitive white precursor cells in blood is a sign of acute leukaemia.

86
Q

Explain acute myeloblastic leukaemia:

A

malignant proliferation of precursor myeloblasts (unipotent stem cells) in bone marrow.

Primarily affects adults.

50% survive 5 years.

87
Q

Explain acute lymphocytic leukaemia:

A

malignant proliferation of the lymphoblast precursor cells in bone marrow.

Primary affects children.

80% cured.

88
Q

Explain high grade lymphoma:

A

lymphocytes in lymph nodes become malignant, very similar to leukaemia.

Classified as Hodgkin’s disease and Non-Hodgkin’s lymphoma.

Disease usually of lymph nodes that spreads to liver, spleen, bone marrow and blood.

89
Q

What is the lifespan of a platelet?

A

5-10 days.

90
Q

What is the normal number of platelets?

A

140-400 x10^9/l

91
Q

What is thrombocytosis?

A

A high number of platelets.

92
Q

What is the main risk of thrombocytopenia?

A

cerebral bleeding.

>80 = increased bleeding
>20 = spontaneous bleeding
93
Q

What can thrombocytosis lead to?

A

arterial and venous thrombosis -> increased risk of heart attack and stroke

94
Q

Where are coagulation proteins (enzymes) produced?

A

The liver

95
Q

What is the key coagulation protein/enzyme?

A

Thrombin

96
Q

What does thrombin do?

A

It creates a platelet plug.

97
Q

Which vitamin is essential for the correct synthesis of coagulation factors II, VII, XI & X?
(REMEMBER 1972)

A

Vitamin K

98
Q

What is the function of coagulation factors?

A

They circulate in the blood in their inactive form, and make blood clot. They convert soluble fibrinogen to insoluble fibrin polymer.

99
Q

Which is the most numerous plasma protein?

A

Albumin

100
Q

Where is albumin produced?

A

The liver

101
Q

What does albumin carry?

A

fatty acids, steroids and thyroid hormones.

102
Q

What are immunoglobulins?

A

antibodies produced by plasma cells.

eg. IgG, IgM, IgA, IgE

Phase 1 Cardio (3 decks)

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