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Cell Bio Exam 3 > 24 - Peripheral blood > Flashcards

24 - Peripheral blood Flashcards

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1
Q

How much blood is found in an average man?

A

For a 70 kg man, 5.5 L

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2
Q

What is the pH of blood?

A

Arterial blood: 7.40

Venous blood: 7.35

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3
Q

What are the functions of blood?

A
  1. Gas transport
  2. Other transport
  3. Hemostasis
  4. Immunity
  5. Regulation of temperature, pH and osmolality (concentration of fluids)
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4
Q

What is the shape of a RBC?

A

Biconcave disc

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5
Q

How do you separate blood into its constitutional elements?

A

Centrifuge (spinning)

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6
Q

What layers will blood separate into upon centrifugation? (3 layers)

A
  1. Erythrocytes (RBCs) - this is the heaviest layer, and therefore will be found at the bottom
  2. Leukocytes and platelets - this layer is a thin white coat, only about 1% of the total volume (“buffy coat”)
  3. Plasma - this is the lightest layer, and will therefore be found on the top, usually light yellow, but can change based on diet
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7
Q

What is a hematocrit level? What are the average levels for men, women and newborns?

A

Hematocrit

  • The percentage of blood that is RBCs

Average levels

  • Male = 45
  • Female = 40
  • Newborn = 55
  • By two months of age = 35
  • Adult values are reached by puberty
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8
Q

What is the difference between serum and plasma?

A

Not much…

  • When you use a centrifuge to separate the blood levels, the portion without RBCs or leukocytes is called the plasma
  • When you allow blood to clot, the fluid that remains is considered the serum
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9
Q

What accounts for the yellow color in plasma? Does this color ever change? Why?

A

Plasma

  • The yellow color during fasting is due to bilirubin
  • Following high fat intake, the plasma will appear white
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10
Q

What is the purpose of the drug ezetimibe? What effect does it have on the plasma?

A

Ezetimibe

  • A cholesterol lowering drug
  • Helps to inhibit cholesterol absorption in the small intestine
  • Without ezetimibe
    • Cholesterol will be present in the blood after fat intake
    • 0 hours = yellow
    • 2 hours = start to change to white
    • 6 hours = lipids are very visible in plasma (white
  • With ezetimibe
    • You will NOT see a color change in the plasma after fat intake
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11
Q

What proteins exist in the blood?

A
  1. Albumin
  2. Alpha-globulins and beta-globulins
  3. Gamma-globulins
  4. Clotting factors
  5. Complement proteins
  6. Lipoproteins
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12
Q

Albumin

A

Albumin

  • Colloid osmotic pressure
    • A form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel’s plasma that usually pulls water into the circulatory system
  • Most important protein of the blood
  • Largest molecular weight
  • Regulates the pulling of fluid out of the tissues and into the blood
  • Low albumin will therefore lead to edema and swelling
  • Because the liver produces albumin, liver failure can lead to low albumin levels and therefore edema and swelling
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13
Q

Alpha-globulins and beta-globulins

A

Alpha-globulins

  • Ceruloplasmin
  • AAT
  • Protein C

Beta-globulins

  • Transferrin (carries iron)
  • Angiostatin
  • Plasminogen (regulates clotting)
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14
Q

Gamma-globulins

A

Gamma-globulins

  • Synthesized by plasma cells
  • Form antibodies
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15
Q

Clotting factors

A

Clotting factors

  • Prothrombin
  • Fibrinogen
  • Acceplerator globulin (AKA factor VII)
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16
Q

Complement proteins

A

Complement proteins

  • Function in immunity
  • Function in inflammation
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17
Q

Lipoproteins

A

Lipoproteins

  • Transport cholesterol and triglycerides
  • Example: HDL and LDL
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18
Q

What are the formed elements of blood?

A

Cellular components and platelets (cellular fragments)

  • Erythrocytes
  • Leukocytes
  • Thrombocytes (platelets)
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19
Q

What are the two categories of leukocytes? Which types of cells do each of these categories contain?

A

Granulocytes (specific granules)

  • Neutrophils
  • Eosinophils
  • Basophils

Agranulocytes

  • Lymphocytes
  • Monocytes
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20
Q

Describe the size and shape of erythrocytes

A

Size

  • 4.2 to 6.1 million/mm3

Shape

  • Biconcave disk
  • This shape increases the surface area to volume ratio, thus facilitating gaseous exchange and increasing the carrying capacidy
  • Clearly seen in electron microscopes - there is a dark redish rim and a lighter colored center
  • The
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21
Q

Do erythrocytes contain normal organelles?

A

No…

  • The typical complement of organelles is lacking
  • This is so that the erythrocytes are able to provide space for hemoglobin endogenous pigment
  • Although organelles are lacking, cytoskeletal components are present
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22
Q

Describe polycysthemia and anemia

A

Polycythemia

  • High RBC level, elevated above normal

Anemia

  • Low RBC level
  • Low hemoglobin can also be called anemia, even if RBC count is normal
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23
Q

What are the cytoskeleton and integral proteins of erythrocytes? What complexes do they form?

A

There are two major transmembrane proteins

  • Glycophorins: this family of proteins are unique to RBCs, the function is unknown
  • Band 3: an antiporter of Cl- and HCO3-

Two complexes form from the two transmembrane proteins, which incorporates additional proteins

  • Glycophorin complex:
    • Band 4.1 protein (anchor the cytoskeletal comonents, thus forming the complex)
    • Spectrin
    • Glycophorin
    • Actin
  • Band 3 complex:
    • Band 3
    • Band 4.2
    • Ankyrin
    • Spectrin

Note that Adducin is also present

  • A calmodulin-binding protein
  • Promotes actin-spectrin association
  • Actin molecules are held together
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24
Q

Hereditary spherocytosis

A

Hereditary spherocytosis

  • Disruption in the glycophorin complex and the band 3 complex leads to malformation of erythrocytes
  • Erythrocytes will become round
  • This can be caused by a mutation in anypart of the complex and will disrupt the structural integrity of the complex
    • Band 3, band 4,2, ankyrin and spectrin mutations will all lead to this
    • Results in the loss of the biconcave shape
  • Spherical RBCs are called spherocytes
    • These spherocytes will be recognized by macrophages as being foreign/defective and will therefore be destroyed and eliminated
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25
Q

Heriditary elliptocytosis

A

Elliptical shaped blood cells due to a mutation in…

  • Glycophorin protein
  • Band 4.1
  • Spectrin
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26
Q

What are blood group systems? Which grouping systems exist?

A

Blood group systems

  • These group systems are used to identify blood types based on the presence or absence of antigens on RBCs
  • Several grouping systems exist
    • ABO
    • Rh
    • Kell
    • Duffy
    • Lewis
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27
Q

Most important antigens to match in blood donors

A
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28
Q

Less important antigens to match in blood donation

A

Mnemonic: Kell kills, Duffy dies, Lewis lives

  • Kell
  • Duffy
    • This system of antigens is used by Plasmodium vivax (a parasite and a human pathogen - the most frequent cause of recurring malaria)
    • Malarial parasites can enter the RBCs
    • African American’s are resistant to malaria because they do NOT express Duffy genes
  • Lewis
    • Don’t have to worry about Lewis and incompatibility with antigens
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29
Q

Erythroblastosis fetalis

A

With the first pregnancy of an Rh negative mother with an Rh positive fetus…

  • Fetal and maternal blood is mixed
  • Rh positive blood enters the maternal circulatory system
  • Antibodies are produced against Rh+

In subsequent pregnancies…

  • Rh+ antibodies that the mother formed during delivery of the first Rh+ child can cross into fetal blood
  • These antibodies will attach to fetal blood cells and begin destroying them
  • This is known as erythroblastosis fetalis

Treatment

  • The mother will receive Rho-GAM just before birth and after birth of the first Rh+ baby
  • Rho-GAM contains antibodies against the Rh antigen
  • If the baby’s Rh+ erythrocytes enter the mother’s circulation they will be eliminated by the Rho-GAM before the mother develops antibodies
30
Q

Howell-Jolly bodies

A

Nuclear fragments that should not normally be present

  • Occasionally occlusions are visible in RBCs, which are small basophilic nuclear fragments in the cytoplasm of the RBC
  • The nuclear fragments are normally removed (pitted out) by macrophages in the spleen
  • Are present in patients with severe hemolytic anemia, dysfunctional spleens, or after splenectomy
31
Q

What is the effect of glucose-6-phosphate dehydrogenase deficiency on the blood?

A

Heinz bodies

  • A hein
32
Q

What are reticulocytes?

A

Reticulocytes

  • The immediate precursor to a mature erythrocyte
  • The cytoplasm of reticulocytes display specks of basophilia due to clusters of free polysomes which are synthesizing Hb
  • Last remnants of the free polyribosomes are visible in the end stages of synthesizing Hb
  • Once free polyribosomes are eliminated, the reticulocyte is considered to be a mature erythrocyte
  • Reticulocytes make up about 1% of the erythrocyte population, which is normal in peripheral blood
33
Q

What does a high level of reticulocytes indicate?

A

An increase in number = a demand for oxygen that is not fully met (e.g., hemorrhage, recent ascent to a higher altitude)

34
Q

Tibetans live at high altitude (Himalayan mountains). How is their hematocrit level compared to ours at sea level?

A

The same!

If we moved to high altitude, hypoxic inducible factors would ramp up our production of RBCs as an adaptive response

  • Tibetan’s hypoxic inducible factors are degraded so kidneys won’t respond – other mechanisms used for adaptation

Why? Long term increase of hematocrit results in the blood being too viscous and can impair oxygen delivery

35
Q

How big are leukocytes compared to erythrocytes?

A

Leukocytes are much smaller than erythrocytes

  • Leukocytes: 5,000-10,000 per mm3
36
Q

What are thre three types of granulocytes again?

A

Recall that granulocytes are one of the two types of leukocytes (the other is agranulocytes)

Granulocytes (specific granules, AKA secondary granules)

  1. Neutorphils
  2. Eosinophils
  3. Basophils

Note that you should be able to recognizes granulocytes at both the EM and LM levels

37
Q

What are neutrophils?

A

Professional phagocytic cells

  • At the LM level, neutrophils are much larger than RBCs (almost twice as large)
  • RBCs are nice “measuring sticks” in peripheral blood samples
  • At the EM level, neutrophils exhibit uniform density - they are relatively dark, but lobes are visible in the nucleus
    • With nuclear lobation, older cells will have more lobules
38
Q

Granules within neutrophils

A

Granules of neutrophils

  1. Azurophilic (primary) granules
    • Found in every type of white blood cells
    • Always represent lysosomes
  2. Specific (secondary) granules
    • Granules that contain enzymes that are antimicrobial in function
  3. Tertiary granules
    • Contain enzymes that allow neutropils to degrade the basal lamina
    • Aid in migration to site of inflammation
39
Q

Will neutraphils be elevated or low in bacterial infections?

A

Elevated!

40
Q

Band cell

A

AKA band neutrophil cell

  • Immediate precursor to neutrophil
  • Nucleus is forming band within the cell that will then form the lobated neutrophils
  • Can be measured in peripheral blood samples
  • A shift to the left indicates an increase in band cells
    • Number of band cells increase
    • Number of neutrophils increase
    • Indicates infection
41
Q

Neutrophilic changes in bacterial sepsis

A

Abnormal inclusions due to bacterial sepsis

  • Döhle body
  • Basophilic component within peripheral cytoplasm
  • Remnants of rER
  • Can be present in other types of bacterial infection
  • Often seen with a shift to the left
42
Q

Granules within eosinophils

A
  1. Azurophilic (primary) granules
    • Contain lysosomes
  2. Specific (secondary) granules
    • Will appear dark pink to red
    • The presence of reddish pink granulation identifies a cell as an eosinophil
43
Q
A
44
Q

What type of nucleus does an eosinophil have?

A

Typically a bilobed nucleus

45
Q

Granules within basophils

A
  1. Azurophilic (primary) granules
    • Contain lysosomes
  2. Specific (secondary) granules
    • Dark blue
    • Hard to distinguish because there is also a basophilic nucleus
    • These will contain histamine, heparin, chemotoxic factors
    • This will attract eosinophils and neutrophils to the site of injury
46
Q
A
47
Q

Will basophils be increased or decreased during an acute allergic reaction?

A

DECREASED - need to know this***

48
Q

How will basophils appear at the EM level?

A

At the EM level, the nucleus and specific (secondary) granules will be present)

  • The specific granules will be lighter in the center with a dark halo
49
Q

Basophils vs. mast cells

A

Basophils vs. mast cells

  • Very similar chemical components
  • They have a common precursor, but then they differentiate into different cell types
  • Occassionally people will call mast cells a basophil that enters the tissue, but this is NOT correct
50
Q

We just went through one of the two types of leukocytes (granulocytes - neutrophils, eosinophils, basophils), what is the other type of leukocyte?

A

Agranulocytes

  • These cells lack specific granules (which is why they are called agranulocytes), but they do actually contain other types of granules
51
Q

What are the two types of agranulocytes?

A

Agranulocytes

  1. Lymphocytes (1,500 - 2,500 per mm3)
  2. Monocytes (200-800 per mm3)
52
Q

Describe the size of lymphocytes

A

Come in three sizes

  • Most are small, about the size of a RBC
  • Medium and large cells can also be present
53
Q

Describe the nucleus of a lymphocyte

A

Nucleus of a lymphocyte

  • Large nucleus
  • Prominent
  • Occupies most of the cytoplasm
54
Q

What type of graules are present in lymphocytes?

A

We know there are no specific granules present, because it is an “agranulocyte”

  • Azurophilic (primary) granules are present
  • There are three types of azurophilic granules, but they cannot be recognized in a blood sample because they only express different antigens
    • B lymphocyte (humoral-mediated immunity)
    • T lmphocyte (cell-mediuated immunity)
    • Natural killer cell
55
Q

What type of cell do B lymphocytes differentiate into?

A

Plasma cells

56
Q

When will the level of lymphocytes become elevated?

A

VIRAL INFECTION

57
Q

We just went through the first type of agranulocyte (lymphocytes), what is the other type?

A

Monocyte

58
Q

Describe the size of a monocyte

A

Very large - one of the largest leukocytes

59
Q

Describe the appearance of a monocyte

A

Monocyte

  • Nucleus is prominent
    • Has a horseshoe or kidney shape
  • Cytoplasm
    • Large volume of cytoplasm
    • Will appear dark - blue/grey intense color
60
Q

What type of granules will be present in monocytes?

A

Azurophilic (primary) granules

61
Q

What do monocytes differentiate into?

A

Monocytes migrate into tissues where they differentiate into macrophages

62
Q

What are thrombocytes?

A

Platelets

  • Fractured megakaryocytes
  • Function in blood clotting and tissue repair
63
Q

What are the 4 zones of platelets?

A

Four zones (identifiable at the EM level)

  1. Peripheral - plasmalemma and glycocalyx
  2. Structural - microtubules and actin/myosin (contractile in nature)
  3. Membrane - open canalicular and dense tubular system
  4. Organelle - mitochondria, glycogen, peroxisomes, three types of granules
64
Q

What type of granules are present in platelets? In which zone are they located?

A

Organelle zone

  • Lambda granule - lysosomes
  • Alpha granule - pro-coagulation factor and platelet derived growth factor for tissue repair
  • Delta granule - contain calcium, ATP, ADP, serotonin, histamine and other mediators
65
Q

What are the symptoms of pernicious anemia? What causes it?

A

Pernicious anemia

  • Cause
    • Vitamin B12 deficiency
    • Either not being taken in by diet or not being properly absorbed by the gut
  • Symptoms
    • Low hematocrit and hemoglobin
    • Large RBCs (macrocytes) - RBCs are different sizes and shapes, not uniform
    • Swollen toungue (signature symptom)
    • Positive Rombert test - neurological finding
66
Q

Erythrocytes - elevated count? decreased count?

A

Elevated

  • Decreased oxygenation (high altitude, lung disease, heart disease)
  • Renal cell carcinoma

Decreased

  • Hemolytic anemia
  • Pernicious anemia
  • Disruption of myeloid tissue (cancer, radiation)
67
Q

Neutrophils - elevated count? decreased count?

A

Elevated

  • Acute bacterial infection (first line of defense)
  • Inflammatory process

Decreased

  • Many viral infections
  • Massive infection
68
Q

Eosinophils - elevated count?

A

Elevated

  • Allergic reations
  • Inflammatory bowel disease
  • Parasitic infestation
69
Q

Basophils - decreased count?

A

Decreased

  • Acute allergic reation
70
Q

Lymphocytes - elevated count?

A

Elevated

  • Viral infections
  • Lymphocytic leukemia is a common cause of significant elevation
71
Q

Monocytes - elevated count?

A

Elevated

  • Inflammation
72
Q

Platelets - elevated count? decreased count?

A

Elevated

  • Splenectomy

Decreased

  • Splenic sequestration (hypersplenism)

Cell Bio Exam 3 (8 decks)

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