5. Cardiovascular System Part 1 Flashcards

Question

Define erythropoiesis.

Answer 1

Production of red blood cells. The formation of red blood cells in the bone marrow.

Answer 2

a. Hypoxia - where oxygen is insufficient in the blood to maintain homeostasis in the body b. Erythropoietin - a hormone that stimulates red cell production c. Erythropoiesis – the production of red blood cells. Without the hormone, red blood cells will not be produced as fast or abundantly leading to a lack of oxygen (hypoxia). Hypoxia stimulates erythropoietin release from the kidneys which stimulates erythropoiesis in the bone marrow.

Answer 3

Hypoxia stimulates Erythropoietin (EPO) Things like high altitude, haemolysis (destruction of red blood cells), blood loss and pregnancy are cases

Answer 4

Inadequate Erythropoietin at birth. During the first few weeks of life the liver produces EPO and the liver is not as sensitive as the kidneys (which take over later) to hypoxia

Answer 5

The destruction of red blood cells to release Hb into plasma. The globin amino acids and iron are released and recycled.

Answer 6

It is carried out by specialised macrophages found in many tissues but especially the SPLEEN, bone marrow and liver

Answer 7

Macrophages* (phagocytic cells) found in many tissues but especially the spleen. Also bone marrow and liver. * Macrophages are large specialised white blood cells involved in the detection, phagocytosis and destruction of bacteria and other harmful organisms and the release of various components for reuse or release. In addition, they can also present antigens to T cells and initiate inflammation by releasing molecules (known as cytokines) that activate other cells.

Answer 8

A waste product . It is a yellow coloured pigment formed from the breakdown haem. It is formed mostly in the spleen, the graveyard for red blood cells, carried to the liver by the albumin protein where it is detoxified, and must be conjugated before it is excreted in the GIT mostly through faeces. It is also excreted in bile and urine via the gallbladder.

Answer 9

ABO and Rhesus

Answer 10

Foreign molecules that trigger an immune response are called antigens. Pathogens will be covered in antigens and these antigens have a shape that is exclusive to that pathogen. When the immune system detects an antigen white blood cells respond by producing antibodies – Y-shaped proteins made to the specific shape of the antigen detected. The antibodies lock onto the antigens and put up a flag that tells white blood cells to come over and destroy.

Answer 11

a. Universal donor O- Because the erythrocytes have **no A, B or rhesus antigens** there is nothing to react to and nothing for antibodies to attach to b. Universal recipient AB+ They have **all the antigens** and that means they do not produce antibodies and are happy to accept blood from anyone. They have A, B and rhesus antigens Our body produces antibodies against the antigens we don’t have. AB+ have therefore got all the antigens so no need to produce antibodies.

Answer 12

In the cell membrane

Answer 13

Rhesus positive have the rhesus antigen. 85% of people are rhesus + b. Rhesus negative do not have rhesus antigen. Rhesus is another antigen (in addition to A or B) on the surface of a blood cell

Answer 14

Inheritance of the rhesus factor is via a rhesus DOMINANT gene. Anti-rhesus antibodies are produced in rhesus NEGATIVE individuals only if they come in to contact with the rhesus ANTIGEN. They can come into contact in PREGNANCY or incompatible blood infusion.

Answer 15

In pregnancy the placenta separates the mother's blood from the foetal blood by a membrane. If the mum is RH negative and the baby RH positive the mother's blood could start looking at the baby's blood and thinking I haven't seen this before. The mother can start gradually creating antibodies against it. If this happens the first pregnancy is usually not affected because it takes time to develop the antibodies. Normally subsequent pregnancies are the issue, where the baby is RH positive, because now the antibodies are there and can pass through the placenta and start attacking the blood of the foetus. To combat these, we need to know mothers blood type and if RH- she will be given an injection of anti RH antibodies which binds to an inactivates foetal RH antigens.

Answer 16

Haemolytic disease of the newborn - causes anaemia (low number of red blood cells) and jaundice (an increased bilirubin level) during the first few days to weeks of your baby's life

Answer 17

White blood cells responsible for the immune system. Defend the body against - infection from pathogens including bacteria, virus and fungi - foreign particles

Answer 18

Neutrophils are the most abundant @ 60% and Basophils the least abundant at less than 1%. Monocytes (6%), Eosinophils (2-4%), Lymphocytes (30%).

Answer 19

Know as Basophils (in the blood) and as mast cells (in the tissue). Think of them like the bomb squad dropping histamine and heparin. They are not abundant but they are mighty and they are key cells in creating inflammation. The modes of action are: i. NOT phagocytic - dont eat foreign cellls ii. The release of histamines, a chemical that dilates blood vessels and makes them permeable to allow other leukocytes entry. Think of it like the pressign the fire alarm and opening all the doors and windows to give firefighters easy access. iii. The release of Heparin which also assists with ease of access by thinning the blood (it is an anti-coagulant) so that it flows more easily bringing essential services in. They only reperesent 1% of white blood cells and that is a good thing because of its ability top create inflammation.You would find raised levels of Basophils in - inflammatory diseases - allergies - infections - Hypothyroidism - Luekaemia

Answer 20

Neutrophils pimary function is phagocytosis. They are first on the scene generalists. They are so diligent in their get trapped and dier in their own secretions. The modes of action are: i. Phagocytosis where they ingest and destroy microbes; ii. Production of reactive oxygen species (ROS) which break down foreign cells damaging their DNA so that they can no longer replicate; iii. and first on scene to the site of the infection in less than an hour. They are kamikaze’s that die on the process of their work, drowning in their own secretions which form pus. Neutrophils are the most abundant white blood cell at 60%. You would find raised levels of Neutrophils in - early infection - Leaukemia - Inflammatory disesases such as RA

Answer 21

Eosophinils primary function is the elimination opf parasites. It's mode of action is phagocytosis. It releases toxic proteins that exert anti-parasitic effects to break them down. They also are involved in hypersensitivity reactions such as allergies and migrate to allergic sites. Eosophinols make up 2-4% of white blood cells. You would find raised levels of in - parasitic infections - Atopic asthm - Alleries

Answer 22

There are three types of Lymphocytes - B Cells, T Cells and NK Cells. They are critical for **immunity against specific antigens** and the production of **immunological memory. ** They are like MI5. They are not interested in a petty burglary or mugging. They have specific interests in complicated areas and unless the problem falls into the category of, say, cybercrime or terrorism, they walk on by. B cells and T cells are specific. Macrophages stimulate them to work presenting them with a fragment of a foreign cell. - B Lymphocytes produce an immune response by producing an antibody - T-Lymphocytes kill specific invading pathogens. NK Cells kill invading cells. They are like little ninjas stabbing cells that they dont recognise, cells that are damaged or cells that have a fault. They go after anything so are non specific.

Answer 23

Know as Monocytes in blood and Macrophages in tissue. We are talking about tissue here. Macrophages primary functions are: - Phagocytosis - they are are the ultimate superstar phagocyte, carrying out the detection, phagocytosis and destruction of bacteria and other harmful organisms and the release of various components for reuse or release. - Antigen presentation: They present antigens to T cells and initiate inflammation by releasing molecules (known as cytokines) that activate other cells. The mode of action is therefopre also phagocytosis. They also secrete cytokines )eg: a protein called Interlukin 1) that promotea fever and activate t-Lymphocytes Basophils (in the blood) and as mast cells in the tissue. Think of them like the bomb squad dropping histamine and heparin. They are not abundant but they are mighty and they asre key cells in creating create inflammation. The modes of action are: i. NOT phagocytic - dont eat foreign cellls ii. The release of histamines, a chemical that dilates blood vessels and makes them permeable to allow other leukocytes entry. Think of it like the pressign the fire alarm and opening all the doors and windows to give firefighters easy access. iii. The release of Heparin which also assists with ease of access by thinning the blood (it is an anti-coagulant) so that it flows more easily bringing essential services in. They only reperesent 1% of white blood cells and that is a good thing because of its ability top create inflammation.You would find raised levels of Basophils in - inflammatory diseases - allergies - infections - Hypothyroidism - Luekaemia

Answer 24

Macrophages stimulate T-Lymphocytes and B-Lymphocytes to work by presenting them with a fragment of the foreign cell they are to target. B- Lymphocyes produce an immune response by producing antibodies (immunoglobons).

Answer 25

Macrophages stimulate T-Lymphocytes and B-Lymphocytes to work by presenting them with a fragment of the foreign cell they are to target. T-Lymphocytes kill invading pathogens and they also act as the coordinator of the lymphocytes.

Answer 26

The red bone marrow

Answer 27

Thrombopoietin – a hormone that is produced by the liver

Answer 28

8-13 days but 10 days on average

Answer 29

i. Vasoconstriction: Clotting begins when we expose/break the wall of the blood vessel. When this happens smooth muscle contracts resulting in VASOCONSTRICTION (narrowing of the blood vessels to slow blood flow). ii. Platelet plug formation: Collagen exposed outside the blood vessel >>> triggers platelets to release Thromboxane >>> causes vascular spasm >>> >>> attracting more Platelets >>> collagen and platelets chemically react to form a platelet plug . iii. Coagulation: This is the stage where the plug is reinforced. Enzyme thrombin >>> converts fibrinogen ( a clotting factor and one of the 3 plasma proteins, into the protein fibrin >>> Fibrin forms a mesh with its long sticky threads and erythrocytes get stuck in it and form clots. iv. Fibrinolysis: Break down the original clot. The enzyme plasmin dissolves the clot by digesting fibrin threads and inactivating fibrinogen and thrombin.

Answer 30

It is responsible for making 4 of the 13 clotting factors. It does not cause clotting itself.

Answer 31

K1 is found in dark green veggies and tomatoes. K2 is produced by intestinal bacteria and is also found in fermented foods. K2 is better absorbed and remains in the body longer. It is needed for clotting and also helps move calcium from the blood and sticking it into the bones.

Answer 32

a. Natural (body produces it) Heparin produced by mast cells and basophils b. Drug - Warfarin is a vitamin K blocker and hence by blocking vitamin K it blocks synthesis of 4 clotting factors. - Aspirin is an anti-coagulant that suppresses thromboxane c. Herb Ginkgo, garlic, ginger, turmeric d. Nutrient Vitamin E, Essential fatty acids (omega 3)

Answer 33

Anaemia refers to reduced Haemoglobin Concentration and therefore a reduced capacity to transport oxygen. It is an umbrella terms for lots of different diseases. A = Absence Aemia = Blood Symptoms refer to things a patient reports but may not be seen. They include:  Fatigue – tiredness that is not relieved by sleep  Shortness of breath on exertion  Palpitations – heart needs to best faster to get enough oxygen through  Irritability  Fainting

Answer 34

 Tachycardia  Thin, thready pulse  Pallor – pale skin and also pale conjunctiva which is the area under the lower eye that is normally red lid

Answer 35

Iron deficiency anaemia is the most common type of anaemia worldwide. It leads to a reduced concentration of Hb in red blood cells causing them to appear pale (less interaction of iron and oxygen) and small. Hence it is ‘HYPOCHROMIC MICROCYTIC ANAEMIA’ Hypo – less Chromic – colour Micro – small cytic – cell

Answer 36

Apart from deficient dietary intake, for example low intake of dark leafy veg, meat I. Malabsorption caused by things like low stomach acid, and coeliac disease because it strips the lining of the small intestine where we absorb nutrients II. Excessive blood loss – period, GIT bleed III. Excessive requirements for oxygen – pregnancy or rapid growth

Answer 37

I. General anaemia signs and symptoms such as fatigue, palpitations etc II. SPOON SHAPED NAILS III. ANGULAR STOMATIS (inflammation of the corner of mouth) IV. Glossitis - inflamed red tongue V. Brittle hair VI. Tachycardia

Answer 38

 Low Red Blood Cells  Hb  Low Ferritin which is the storage form of iron.

Answer 39

Mega – Large Blastic – Immature (think osteoblasts) So...it is characterised by large, immature and dysfunctional red blood cells. B9 and B12 are required for replication. When they are lacking DNA replication is slowed down. Red blood cells get bigger but they don’t get the appropriate signalling for normal maturation and division. MACROCYTIC CELLS. Because they are immature, they are likely to still have a nucleus and organelles leaving less surface area for gas exchange.

Answer 40

Need methylation to copy DNA. Folate is needed for methylation. B12 assists methylation too. Methylation is needed in every single cell in the body. The faster a cell is producing the more methylation and the more need for folate and B12. It is needed for DNA replication, detoxifying the liver, breaking down chemicals in the brain, breaking down hormones. Without healthy methylation we have all sorts of problems. For example, methylation of the DNA sequence of a gene may turn the gene off so it does not make a protein.

Answer 41

Apart from DEFICIENT DIETARY INTAKE of folate (B9) and/or B12 although unless vegan lack of B12 is rare.  LACK OF INTRINSIC FACTOR which is a molecule in the stomach that binds to ingested B12, carrying it through the gut and assisting with absorption in the blood. It is required for the absorption of B12 in the small intestine.  MALABSORPTION due to illness affecting absorption in the small intestine such as Crohn’s, low stomach acid, low pancreatic enzymes  DRUGS. Eg: methotrexate is a folate antagonist

Answer 42

No. The liver has abundant stores of B12. It takes takes 2-4 years for anaemia to develop. For Folate (B9) it is 4 months though

Answer 43

For both types, general anaemia signs and symptoms such as fatigue, palpitations etc. Magaloblastic anaemia also can present with o ENLARGED, RED, SHINY SORE TONGUE o NEUROLOGICAL SYMPTOMS such as tingling, numbness, weakness, loss of coordination, burning sensations, tinnitus, depression The difference in symptoms for megaloblatic aenemia primarily relate to lack of B12 and the impact this has on the nervous system. B12 is needed to coat nerve cells. The coating, called myelin, speeds up nerve transmission and fires up electrical impulses.

Answer 44

The signs and symptoms are the same except for the neurological symptoms because this is due to B12 deficiency not folate deficiency

Answer 45

(all-cell-lack) LACK OF ALL THREE BLOOD CELL TYPES. It is associates with Aplastic Anaemia which is a rare and potentially life threatening failure of haematopoiesis. A failure of the bone marrow to produce blood cells.

Answer 46

Aplastic anaemia affects all blood cells, not just red blood cells. It is the absence of production of all blood cells in the bone marrow, absence of haematopoiesis, as opposed to a malformed production of red blood cells in iron deficiency anaemia Iron deficiency anaemia is where an iron deficiency leads to a reduced concentration of Hb in red blood cells causing them to appear pale and small. Iron is part of Hb. If it is not there the cells will shrink

Answer 47

1. Congenital – Fanconi’s anaemia 2. IDIOPATHIC – unknown cause 3. Can be secondary to drugs – NSAIDS, chemicals, radiation, cancer, hepatitis, EBV

Answer 48

A - without plastic - formation a. ANAEMIA symptoms related to low red blood cells – pallor, headache, dyspnoea, palpitations etc b. MULTIPLE INFECTIONS due to low white blood cell count which can lead to sepsis c. EASY BLEEDING due to low platelet count which can lead to a haemorrhage

Answer 49

Haem – blood lytic – destruction Anaemia resulting from excessive breakdown of erythrocytes. When bone marrow production cannot compensate for the loss of red blood cells. In haemolytic anaemia the erythrocyte lifespan can be as low as five days compared to the usual 90 to 120. As a result bone marrow cannot keep up and cannot compensate for that loss.

Answer 50

Hemolytic anaemia is a blood disorder that typically happens when your red blood cells break down or die faster than your body can replace them with new blood cells o Genetic causes such as sickle cell and thalassaemia o Rhesus factor incompatibility, medications such as penicillin, autoimmune disorders, radiation. o Infections such as malaria and viral infections. The spleen will detect malformed red blood cells due to infection or virus and then destroy them permanently

Answer 51

Haemolytic anaemia is a form of anemia due the abnormal breakdown of red blood cells Same general signs of anaemia + o JAUNDICE due to excess bilirubin production o SPLENOMEGALY - The excess haemolysis in the spleen causes it to enlarge leading to abdominal distension and a feeling of fullness quickly whilst eating. o GALLSTONES - the increased destruction of red blood cells means that there are more erythrocytes to breakdown ... which produces more bilirubin ... which means there are more metabolites going into the gallbladder ...and more waste ...which can lead to blockages and ultimately gallstones o VASCULAR OCCLUSIONS ie: blockages in blood vessels

Answer 52

o SICKLE CELL IS AN INHERITED RECESSIVE CONDITION (substitution chromosome 11) that offers A PROTECTIVE EFFECT AGAINST MALARIA in endemic regions o When HbS (HbS is an abnormal form of hemoglobin associated with sickle cell anemia ) gives up oxygen to interstitial fluid it causes the ERYTHROCYTE TO SICKLE UP o It goes from nice round biconcave structure to long stretched structures the rupture easily. Sickle cells have a life span of 10 to 20 days so although erythropoiesis is stimulated, it cannot keep up with the rate of hemolysis. o The deformed cells form clusters that can very easily get stuck in blood vessels

Answer 53

o Usually begins age three to six months as foetal HB falls (HbF ) o General signs and symptoms of anaemia o SPLENOMEGALY and JAUNDICE - This is for the same reason as haemolytic anaemia. Excess work for the spleen as a result of the shorter life cycle of the red blood cells and excess waste of bilirubin leading to jaundice o Can also occlude vessels. Pain and swelling in hands/ feet, placental infarction (the interruption in blood flow between the placenta and the baby), strokes, renal colic

Answer 54

o Sickle cell anaemia is associated with an abnormal BETA globin chain in Hb which distorts the shape of the cell. Sickle cell anaemia is more of a QUALITY PROBLEM with the production of sickle shaped blood cells that are not in good condition and that therefore killed off by the spleen. o Thalassemia describes a defect in synthesis of either the ALPHA OR BETA Hb chains and therefore can affect in utero as well as after the Beta chain takes over from Gamma after birth. Thalassemia is more of a QUANTITY PROBLEM when not enough globins, globulin chains are being produced. Both are inherited diseases.

Answer 55

Before birth haemoglobin is made-up of 2 alpha and two gamma chains. After birth this changes to 2 alpha and two beta chains. The transition starts after birth but takes some time for the impact of a problem in a gamma chain to show up as a sign or symptom A-Thalassemia is when there is a defect in the alpha haemoglobin which therefore effects in utero and in adults. B-Thalassemia starts when HbA production begins and gamma chain ceases which is usually in the later part of the first year

Answer 56

Haemolytic disease of the newborn occurs when the mother produces anti-rhesus antibodies that cross the placenta. It occurs in circumstances where the mother is rhesus negative and the baby rhesus positive. The antibodies bind to the foetal rhesus antigens causing AGGLUTINATION (blood clotting) and HAEMOLYSIS. Sensitisation occurs with the first baby producing maternal antibodies against rhesus. This is most likely to happen at DELIVERY so the first born child is normally UNAFFECTED.

Answer 57

Polycythaemia (aka erythrocytosis) describes an excessive production of Eythrocyres resulting in increased blood viscosity, reduced blood flow and an increased risk of thrombosis. Normal levels of blood cells: plasma is 45:55. In women it is 42:58 and polycythaemia is diagnosed at > 56% blood cells In men it is 47: 53 and polycythaemia is diagnosed at > 60% blood cells

Answer 58

Polycythaemia, or erythrocytosis, means having a high concentration of red blood cells in your blood. o HIGH ALTITUDE because there is less oxygen. The kidneys detect this and release erythropoietin to make more erythrocytes. o UNKNOWN/GENETIC

Answer 59

A.k.a. erythrocytosis which is the overproduction of red blood cells o Mild cases there will be no symptoms. o ARTERIAL THROMBOSIS where you might have myocardial infarction [heart attack], pulmonary embolism or stroke. o VENOUS THROMBOSIS where you might see deep vein thrombosis (DVT) o Hypertension, red skin, headaches, dizziness, pruritus which is when you have red under the bottom eyelid, itchiness, particularly after bathing because warmed up skin has more blood vessels drawn to the area

Answer 60

Leuko - white penia – less/lacking = a marked reduction in the number of leukocytes Caused by: * viral infections such as glandular fever, hepatitis or HIV * Drug toxicity such as chemotherapy, and radiation * bone marrow disease * nutritional deficiencies such as folate and B12 due to their involvement in methylation

Answer 61

* SEVERE ILLNESS, nausea, fatigue, cough, shortness of breath,fever, malaise * SEVERE INFECTIONS and SEPSIS

Answer 62

White + increased cell numbers = a marked increase in the number of leukocytosis Leukocytosis is common is a normal response to infection inflammation

Answer 63

* Response to INFECTIONS * LEUKAEMIA (uncontrolled production of leukocytes in bone marrow due to cancer) * physical stress such as injury or surgery

Answer 64

Leukaemia describes a group of bone marrow cancers, characterised by an abnormal overproduction of leukocytes. Note that it is a bone marrow cancer and not a blood cancer

Answer 65

The uncontrolled and abnormal overproduction of leukocytes results in - Suppressed erythrocyte production which leads to anaemia - Suppressed thrombocyte which leads to thrombocytopaenia

Answer 66

Acute leukaemia is more severe because of rapid onset, and a more aggressive course. We're dealing with immature (blasts) cells in the bone marrow that are aggressive and rapidly developing. Chronic leukaemia has a more insidious onset in that it comes on more slowly. More differentiated cells that are more mature and less aggressive.

Answer 67

o MALAISE, ANAEMIA [fatigue, pallor, etc], FREQUENT INFECTIONS, EASY BLEEDING/BRUISING o Fever, weight loss o In chronic leukaemia we see splenomegaly and lymph node enlargement

Answer 68

FULL BLOOD COUNT: anaemia, low thrombocyte, variable leukocyte count. BLOOD FILM [viewing sample of blood] BONE MARROW BIOPSY - this is the gold standard

Answer 69

Thrombocytopenia is a reduction in the thrombocyte count. Signs and symptoms are on a spectrum based upon the thrombocyte levels and how low they are * Easy and EXCESSIVE BLEEDING and bruising. Prolonged bleeding times * PETECHIAE (micro haemorrhages in the capillaries of the skin] * Haematuria, vomiting blood, bleeding gums. * Postpartum haemorrhage

Answer 70

EBV returning, hepatitis, HIV, MMR

Answer 71

Haemophilia is a deficiency of clotting factors. Haemophilia a: deficiency of clotting factor VIII (8), It is five times more common than haemophilia B haemophilia B: deficiency of clotting factor IX (9)

Answer 72

Genetic: X linked recessive disorder

Answer 73

In severe disease: EXCESSIVE AND EASY BLEEDING, gastrointestinal tract/mucosal haemorrhage, haematuria, haemarthrosis

Answer 74

Erythrocytosis is an over production of red blood cells. It could be a false reading due to dehydration where the loss of plasma volume makes it appear as if they’re moving blood cells It could be due to drugs like erythropoietin which is a hormone released by the kidneys in response to hypoxia of the blood. It could be due to altitude and this will be temporary

Answer 75

This is an under production of red blood cells. 2 common causes would be menstruation or internal bleeding such as a peptic ulcer or an inflammatory bowel disease such as Crohn’s

Answer 76

It isn’t overproduction of white blood cells. Causes could be: 1. Infection. Generally bacterial but it could be acute viral 2. Inflammation 3. Leukaemia which is overproduction of white blood cells but they are immature non-functional

Answer 77

Under production of white blood cells which in most cases will be due to a viral infection such as Epstein-Barr for Corona etc. Virus attack of the immune system in order to basically take it out!

Answer 78

The blood is made up of 55% plasma and 45% of red blood cells approximately. This leaves little space for platelets or white blood cells and this is because they are only released when needed. Platelets are released when there is a clotting need. Leukocytes will be low unless needed for trauma or infection.

Answer 79

Neutrophils pimary function is phagocytosis. They are first on the scene generalists. They are so diligent that they get trapped in their own secretions and die. The modes of action are: i. Phagocytosis where they ingest and destroy microbes; ii. Production of reactive oxygen species (ROS) which break down foreign cells damaging their DNA so that they can no longer replicate. They are first on scene to the site of the infection in less than an hour. They are kamikaze’s that die on the process of their work, drowning in their own secretions which form pus. Neutrophils are the most abundant white blood cell at 60%. You would find raised levels of Neutrophils in - early infection - Leaukemia - Inflammatory disesases such as RA

Answer 80

Iron for the production of haemoglobin because otherwise haemoglobin can’t find oxygen B9 for the development of maturing of Aretha sites B12 for cell division

Answer 81

If you are an A blood group your body is familiar with the A antigen and will welcome A. Your body will not want blood group B so the body creates antibodies against the B Antigen. If it is detected it is attacked.

Answer 82

1. Neutrophils 2. Monocytes (in blood) /macrophages in tissue 3. Eosinophils 4. Basophils 5. Lymphocytes - B lymphocytes, T lymphocytes and NK cells