306 exam 3 Flashcards
Erythrocytes are ______ and shaped ______
Non-nucleated and shaped biconcave disk with flexible membrane
RBC’s are not released into the blood until they ______
mature
RBC’s lose their nucleus at (time)
maturation
RBC’s proliferate in the _______ with nucleus
bone marrow
mature RBC’s in the blood do not have a ______
nucleus
Polychromasia is
There are lots of immature RBC’s in the bloodstream when there should not be.
Polychromasia is a sign that ____
Mature RBC’s are being destroyed
The birth of RBC’s is called _____
Hematopoiesis
Iron stored in the liver is called __
Ferritin
Iron in the blood plasma is called _____
Transferrin
RBC’s live for _____
120 days
Hemoglobin is broken down into ____ and _____
heme and globin
heme is _____
the blood protein that binds to iron
globin is ____
the blood protein that binds oxygen
____ and _____ are recycled by the ____ when RBC’s die off
heme and globin are recycled by the spleen
When RBC’s are destroyed, _____ is recycled and _____ is wasted
heme is recycled and reused and globin is wasted
DMT-1 is
the major iron transporter enzyme
Transferrin is
enzyme responsible for iron metabolism
Hepcidin
Liver protein that allows iron to be released into the system
Four most severe signs of Anemia
- fainting
- chest pain
- angina
- myocardial infarction
What is hematocrit?
% of red blood cell mass in 100ml of plasma
MCV stands for ____
mean corpuscular volume
MCV (mean corpuscular volume) measures
average size of your red blood cells
Microcytic refers to ____
Low MCV
Normocytic refers to ____
regular MCV
Macrocytic refers to ____
high MCV
Four types of anemia’s with Microcytic RBC’s
Iron deficiency
Thalassemia
Chronic Anemia
Lead Poisoning
Five types of anemia’s with Normocytic RBC’s
acute bleeding
aplastic
hemolytic
low erythropoietin
malignancy
Two types of anemia’s with Macrocytic RBC’s
pernicious
low folate
3 main all causes of Anemia
- Loss
- Increased Destruction (Hemolysis)
- Deficiency in necessary components to form RBC’s
How long does it take for RBC’s to be replaced after acute severe blood loss?
3-4 weeks
Chronic unknown blood loss leads to _______ anemia
iron deficiency anemia
Chronic blood loss anemia is asymptomatic until hemoglobin levels reach _____
8g/dl or less
Dysfunction of bone marrow stem cells in aplastic anemia effects ______ cells
Both cells lines myeloid and lymphoid
Aplastic Anemia is
Decreased or impaired production from the bone marrow
Four causes of Aplastic Anemia
Chemotherapy and Radiation
Infections such as Mono or Hepatitis
Autoimmune such as SLE or RA
Leukemia’s
Acute chest syndrome is where _____
sickle cells occlude blood vessels in heart and lungs
Thalassemia is _____
Genetic defect resulting in the body not making enough hemoglobin.
Thalassemia is most common in people from ______ descent.
Mediterranean
Red blood cells in Thalassemia are ______ in MCV
Microcytic
Red blood cells in Thalassemia are _____ in color
Hypochromic (light color)
Red blood cells in Thalassemia ______ in size
varies in size
Most common anemia worldwide _____
Iron Deficiency Anemia
______ does not allow iron to be recycled
Chronic bleeding
Iron deficiency RBC’s are ____ in MCV
microcytic
Iron deficiency RBC’s are ______ in color
Hypochromic (light in color)
Observable signs of Iron deficiency anemia
cyanosis
brittle nails
pica
poor wound healing
headache
Pernicious Anemia is ____
Vitamin B12 deficiency
Two main functions of Vitamin B12
DNA synthesis
Nuclear Maturation
Intrinsic factor is ___
The enzyme in the stomach that absorbs Vitamin B12
Red blood cells produced by Pernicious (B12) anemia are _____
Large (macrocytic) and oval shaped
Signs/symtoms of pernicious anemia
bleeding gums
impaired sense of smell
parenthesis of extremities
unsteady gait
pernicious anemia is also called ____
megaloblastic anemia
polycythemia can be the result of increased erythrocyte production due to _______
hypoxia
relative polycythemia is due to ______
loss of plasma
absolute polycythemia is due to _____
increased number of red cells
2 Red blood cell changes in the Elderly
Hemoglobin levels decline with age
cannot replace hemoglobin as quickly in times of stress
official definition for hemostasis or coagulation
the arrest of bleeding or circulation of the blood
thrombocyte life span
5-10 days
old thrombocytes are removed via _____
macrophages in the spleen
thrombopoetin is secreted by the (3 organs)
liver, kidneys, spleen
platelets are made from _____
megakaryocytes
platelets are stored in the ______
spleen
prostacyclin is _____
an enzyme released by the endothelium that results in vasodilation just like nitric oxide
adenosine diphosphatase (ADP) prevents _____
platelet aggregation
von willebrand factor is ____
glycoprotein in endothelium that promotes hemostasis specifically platelet adhesion
lactated ringer’s solution contains _____
calcium
never give lactated ringer’s solution with blood transfusions because ______
it contains calcium and calcium causes clotting cascade to happen
calcium is factor _______
IV
Vitamin K is the building block for making ______ and ______
clotting factors and Protein C&S
factor responsible for adhesion
von willebrand
Chronological order of coagulation steps
- vessel spasm
- platelet plug formation
- blood coagulation ending with fibrin
- clot retraction (pulls clot together tightly)
- clot dissolution
prostaglandin thromboxane A2 increases vasospasm by ______
vasoconstriction
Primary hemostasis is the act of ______
Forming the platelet plug
Two factors responsible for platelet activation
ADP - Fibrinogen
Thromboxane A2
ADP is a _____
Fibrinogen
Bilirubin is a breakdown product of
hemoglobin in which increased amounts can point to early erythrocyte destruction
_____ is needed to make hemoglobin
Iron
common finding of acquired autoimmune TTP _____
mucosal bleeding
TTP is
thrombotic thrombocytopenia purpura
the result (final step) of both the intrinsic and extrinsic coagulation pathways is ______
activation of factor X, leading to conversion of prothrombin II to thrombin IIa
______ does not blanch with pressure
petechiae
von willebrand factor is directly involved in _____ 3 things
primary hemostasis
platelet aggregation
platelet adhesion
two things needed for the bone marrow to synthesize RBC’s
erythropoietin and Iron
ADP causes the platelet membrane to become ______
rough and stick to bind together easier
calcium is released from ____ and serves as a _____ on the surface of the platelet where coagulation factors can bind.
released from the platelet, serves as a binding site for coagulation factors
thromboxone A2 is made from platelets through thromboxone A synthase, what is the action of thromboxone A2?
potent vasoconstriction
instrinsic pathway:
factors within the blood that activate platelets
extrinsic pathway:
factors in response to changes in blood vessels like injury or trauma
example of an extrinsic response
platelets are exposed to collagen and are activated
PTT measures the ______
Intrinsic pathway
PT measures the ______
extrinsic pathway
Warfarin measures the _____
extrinsic pathway
heparin measures the ____
Intrinsic pathway
merging of the two clotting pathways occurs at _____
Activation of factor X = Xa
what can be triggered directly by snake venom, amniotic fluid, embolism, and acute pancreatitis?
merging of the two clotting pathways (intrinsic and extrinsic)
three main coagulation inhibitors
adequate blood flow
antithrombin III
proteins C and S
Adequate blood flow functions to ____
clearance of coagulation factors by the liver
Antithrombin III functions to ______
inactivates thrombin and decreases the conversion of fibrinogen to fibrin
Proteins C and S function to ______
vitamin K dependent proteins. they inactivate co-factors Va and VIII.
Plasminogen is ______ in the blood and is activated by _____
inactive in the blood and is activated by tissue plasminogen activator (TPA)
Tissue plasminogen activator (TPA) converts ______ to _______ and then ______
tpa converts plasminogen to plasmin and they digests the fibrin strand
TPA is produced by (3 organs)
endothelium, liver, kidney
factors that are synthesized from vitamin K
II, VII, IX, X
antiplatelet medications work on ______
canceling out ADP thus stopping platelet aggregation
thrombocytopenia is any platelet count below _____
150,000
highest risk for bleeding when platelets are under _____
50,000
normal prothrombin time (PT)
11-12.5 seconds
normal INR time for DVT
2-3 for DVT
normal INR time for heart valve replacement
2.5-3.5
normal partial thromboplastin time (PTT)
30 - 40 seconds
normal D dimer
0.4mcg
virchow’s triad of thrombosis influencers
- injury to endothelium
- alterations in blood flow
- hypergoagulability
factor V leiden mutation leads to
prolonged and uncontrolled clotting increasing the risk of venous thrombosis
factor V leiden mutation is linked to
pregnancy having abruptio placenta and 3x increase in thromboembolic events
factor V leiden is an _______ disorder
inherited autosomal dominant
antiphospholipid syndrome
autoimmune disorder resulting recurrent in arterial and venous thrombosis
turbulence refers to
disruption of flow through the vessel: platelets contact endothelium
stasis refers to:
decrease in clearance of clotting factors by the liver and slowed inflow of clotting inhibitors.
6 P’s to evaluate arterial insufficiency
Pallor
Pulselessness
Paralysis of extremity
Paresthesia of affected extremity
Pain
Pressure
older adults have increases in ______ and reductions in ______
increased platelet aggregability and decreased fibrinolytic response
with anticoagulats: _____ is used acutely and ______ is used chronically for maintenance
heparin works faster and is used acutely, warfarin is used chronically for maintenance
if anticoagulants are contraindicated: ______ can be placed
a greenfield filter can be placed in the inferior vena cava
greenfield filter prevents ______
traveling emboli from reaching the lungs by trapping them in the vena cava
major side effect of thrombolytic therapy
hemorrhage
contraindications to fibrinolytic therapy
internal bleeding
thrombocytopenia
use of anticoagulants
intracranial surgery
CVA
recent seizure
recent MI
recent surgery or trauma
arterial puncture site
lumbar puncture
aneurysm
AV (arteriovenous) malformation
blood pressure above 185/110
Risks for increased bleeding
liver disease
thrombocytopenia
HIV and other viral infections
Hypersplenism
Clotting factor deficiencies
Hemophilia A is a ______ linked disorder
X-linked recessive disorder
in Hemophiliac patients, avoid _____
Aspirin, antiplatelets, and NSAIDS
cryoprecipitate (cryo) is
the portion of plasma that is rich in factor III
von willebrand disease is the most _________
most common hereditary bleeding disorder
von willebrand disease is ________ trait
autosomal dominant and occurs in both males and females
in von willebreand disease, factor ____ has _____
factor VIII has two separate proteins where von willebrand factor larger than factor VIII protein. Acts as a carrier
how to recognize von willebrand disease
spontaneous bleeding from mucous membranes and nosebleeds, excessive bleeding from wounds and heavy periods
drugs that increases platelet destruction
thiazide diuretics, heparin, alcohol
biggest risk for heparin induced thrombocytopenia
surgery
Idiopathic or immune thrombocytopenic purpura (ITP)
disorder of platelet consumption | IgG destroys platelets
How to see ITP
petechial rash and bruising 1-4 weeks after and infection was acquired
hemorrhagic bullae of gums, lips, and other mucous membranes
ITP can be the result of
viral infection
bullae are
large purulent blisters
mainline treatments for ITP
corticosteriods, splenectomy, iv immunoglobins
Thrombotic thombocytopenia purpura is (TTP)
platelet destruction not associated with or caused by the immune system
in thrombotic thrombocytopenia pupura (TTP)
platelets and fibrin strands build up in smaller vessels and damage platelets and RBC’s flowing by
TTP results in
thrombi formation, bleeding, and thrombocytopenia
cause of TTP
mutation in ADAM gene
DIC - disseminated intravascular coagulation is ________ a primary disease process
not a primary disease process
DIC results in
thrombosis and hemorrhage at the same time
both intrinsic and extrinsic pathways ultimately result in ___
thrombin generation
DIC is through the ______ pathway
intrinsic
_____ can trigger DIC
endothelial damage exposing the subendothelial collagen layer
in DIC, there is a widespread of _______ deposited into the micro circulation
Fibrin
in DIC, hemorrhaging occurs as a result of _____
depletion of clotting factors and platelets due to excessive clotting beforehand
platelet destruction NOT caused by immune system
TTP
platelet aggregation is induced by the release of ______
thromboxane A2
clot dissolution is regulated by ______ and ______ activators
thrombin and plasminogen activators
thalassemia is where
there is anemia and hypoxia resulting from the bone marrow not making enough hemoglobin
RBC’s come from
proerythroblasts
tissue factor is also known as _____ and is released upon ______
factor III and is released upon extrinsic tissue damage
______ stimulates platelet production
thrombopoetin
thrombopoetin is made by the ______
liver
polycythemia is recognized as _____
hematocrit above 50%
most common inherited bleeding disorder
Von Willebrand disease
parasthesia is _____
pins and needles tingling feeling
