Aula 3 - Blood Disorders Flashcards
1
Q
Complete the sentence:
Blood disorders are also called ____________ disorders.
A
Hematological
2
Q
Complete the sentence:
Blood is constituted by 55% of ________ and 45% of ________.
A
plasma, formed elements
3
Q
Question:
What is plasma made of?
A
Plasma is the liquid part of the blood and is mostly made out of water (90%) and also contains proteins, electrolytes, carbohydrates, minerals, metabolites, etc.
4
Q
Question:
What constitutes the formed elements present in the blood?
A
Mostly red blood cells (nearly 100%), but also white blood cells and platelets.
5
Q
Question:
What is the main function of red blood cells?
A
Transport oxygen.
6
Q
Question:
What is the main function of white blood cells?
A
Protect the organism against external elements.
7
Q
True or False:
White blood cells can protect the organism against external and internal elements.
A
True.
Especially in the case of autoimmune diseases.
8
Q
Question:
What is the main function of platelets?
A
Participate in the coagulation process.
9
Q
Complete the sentence:
Platelets are also called ________.
A
Thrombocytes
10
Q
Complete the sentence:
Red blood cells are also called ________.
A
Erythrocytes
11
Q
Complete the sentence:
White blood cells are also called ________.
A
Leukocytes
12
Q
Question:
Order the formed elements, from the highest volume to the lowest volume in blood.
A
Red blood cells > Platelets > White blood cells
13
Q
Question:
What are the 6 main functions of blood?
A
- Transport oxygen
- Transport nutrients
- Regulate body temperature
- Protect against foreign pathogens
- Participate in the coagulation process
- Regulate hydration
14
Q
Definition:
Hematopoiesis
A
Production of formed elements.
15
Q
Question:
Approximately, how many cells are produced daily?
A
Over 100 billion cells.
16
Q
Question:
Where does hematopoiesis occur?
A
Prenatal, first in the yolk sac, then the liver, then bone marrow.
Postnatal, mostly in bone marrow.
17
Q
True or False:
After birth, hematopoiesis occurs mainly in the bone marrow, specifically in the ribs.
A
False.
After birth, hematopoiesis occurs mainly in the bone marrow, mostly in the vertebral and pelvis.
18
Q
True or False:
All cells derive from a single hematopoietic stem cell.
A
True.
19
Q
Complete the sentence:
________ is a cytokine produced in the ________, which stimulates the production of erythrocytes.
A
Erythropoietin, kidneys (renal cortex)
20
Q
True or False:
Erythropoietin is a glicoprotein.
A
True.
21
Q
Complete the sentence:
________ is a cytokine produced in the ________ and the ________, which stimulates the production of thrombocytes.
A
Thrombopoietin, liver, kidneys
22
Q
Complete the sentence:
The differentiation of hematopoietic stem cells depends on certain elements such as ________ and ________.
A
cytokines, hormones
23
Q
Complete the sentence:
Erythrocytes are ________ (nucleate/anucleate), ________ (biconcave/biconvex) disk-shaped cells.
A
anucleate, biconcave
24
Q
True or False:
Hemoglobin is a dimer, i.e., formed by two protein subunits, alpha and beta.
A
False.
Hemoglobin is a tetramer, formed by 4 subunits: 2 alpha subunits and 2 beta subunits.
25
# **Complete the sentence:**
Each hemoglobin's subunit contains one ______ ______, where the oxygen will bind.
heme group
26
# **True or False:**
In hemoglobin, each heme group contains one iron atom.
**True.**
27
# **Question:**
What organ is responsible to remove erythrocytes from the circulation once they lose their function?
Spleen
28
# **True or False:**
Bilirubin is a byproduct of the breakdown of red blood cells.
**True.**
29
# **Definition:**
Hemolysis
Destruction of red blood cells.
30
# **True or False:**
Excessive hemolysis can cause jaundice.
**True.**
Hemolytic jaundice is a type of jaundice arising from excessive hemolysis (destruction of red blood cells), when the byproduct bilirubin is not excreted by the hepatic cells quickly enough, leading to its accumulation.
31
# **Complete the sentence:**
White blood cells can be classified according to the presence or absence of cytoplasmic ________.
granules
32
# **Question:**
What are the two types of non-granulocytes?
Monocytes and lymphocytes.
33
# **Complete the sentence:**
White blood cells can be divided into non-granulocytes, such as ________ and ________, or granulocytes, such as ________, ________ and ________.
| Words: neutrophils, lymphocytes, basophils, eosinophils, monocytes
monocytes, lymphocytes
neutrophils, basophils, eosinophils
34
# **Question:**
What are the functions of monocytes?
They present 3 main functions in the immune system: phagocytosis, **antigen presentation**, and cytokine production. They also participate on **tissue repair**.
35
# **Complete the sentence:**
Monocytes can develop into ________ or ________ cells.
macrophages, dendritic
36
# **Question:**
What is the main function of lymphocytes?
Recognition, specially **self** (self-antigens present on the surface of leucocytes, such as lymphocytes) **vs. non-self** (antigen structures found on the surfaces of foreign bacteria, viruses, fungi, parasites, etc.) reply
37
# **Question:**
Which is the most common type of white blood cells?
Neutrophils
38
# **Question:**
What is the main function of neutrophils?
Kill bacteria through phagocytosis.
39
# **True or False:**
Neutrophils present a multi-lobed nuclei with large cytoplasmic granules containing highly active enzymes.
**False.**
Neutrophils present a multi-loaded nuclei with **very fine** cytoplasmic granules containing highly active enzymes.
40
# **True or False:**
Basophils normally present a uni-lobed nuclei.
**False.**
Basophils usually present a bi-lobed or tri-lobed nuclei.
41
# **Question:**
What is the main function of basophils?
Act in the case of allergies.
42
# **Complete the sentence:**
In the case of allergies, basophils secrete ________ (coagulants/anticoagulants) against hypersensitivity, such as heparin, and release histamine to ________ (contract/dilate) the blood vessels.
anticoagulants, dilate
43
# **Question:**
What is the role of the histamin and heparin released by basophils?
In case of allergies, basophils:
* release **histamin** to dilatate blood vessels and attract immune cells to the lesion.
* release **heparin** to promote the mobility of white blood cells.
44
# **True or False:**
Basophils and eosinophils are very similar.
**True.**
45
# **Question:**
What are the main functions of eosinophils?
Kill parasites, induce allergic reactions and release toxins to kill pathogens.
46
# **Question:**
What are megakarcyocytes?
Megakaryocyte is a large bone marrow cell with a lobated nucleus that produces blood platelets (thrombocytes).
47
# **Question:**
Besides being in the blood, in which organ are platelets mostly present?
Spleen
48
# **Distinguish:**
Homeostasis vs. Hemostasis
Hemostasis and homeostasis are two different things. Hemostasis is a biological mechanism to stop bleeding. Homeostasis is the maintenance of the body's state of balance.
49
# **Question:**
What type of cells do platelets adhere to?
Endothelial cells
50
# **Question:**
Why is it important for platelets to adhere to endothelial cells?
Endothelial cells are present in blood vessel walls, so it is important that platelets can adhere to these walls in case of rupture to help to stop the bleeding through coagulation.
51
# **True or False:**
The main function of platelets is homoestasis.
**False.**
The main function of platelets is **hemostasis**.
52
# **True or False:**
Platelet activation occurs upon exposure to
thrombin, adenosine diphosphate or collagen.
**True.**
53
# **Question:**
Describe the shape changes that platelets undergo once activated.
First **discoid**, then **spherical** with filopodial extensions, and finally **flat**.
54
# **Question:**
What are the 4 main intervenients in hemostasis?
1. Platelets
2. Endothelial cells
3. Tissue factor-bearing cells
4. Coagulation factors
55
# **Complete the sentence:**
The intervenients of hemostasis (platelets, endothelial cells, tissue factor-bearing cells and coagulation factors) work to form a complex of cross-linked ________ and ________ to stop the bleeding.
fibrin, platelets
56
# **Complete the sentence:**
The coagulation system is well-regulated to ensure the balance between ________ factors and ________ factors.
prothrombotic (procoagulation), antithrombotic (anticoagulation)
57
# **Question:**
What suffix is added to the coagulation factors names when they're activated?
"-a"
## Footnote
E.g. Factor IIa is the activated form of Factor II.
58
# **True or False:**
The majority of coagulation factors are produced in the liver.
**True.**
59
# **Complete the sentence:**
The majority of coagulation factors are produced in the liver, yet there are exceptions such as **Factor XIII (fibrin-stabilizing factor)** which derives from ________ and **Factor VIII (antihemophilic factor)** which derives from ________.
platelets, endothelial cells
60
# **Question:**
What is the advantage of the production of coagulation factors by endothelial cells?
Endothelial cells are present in the skin and in the walls of blood vessels, which grants them **closer proximity** to possible rupture sites and ensures an **immediate and local response**.
61
# **Complete the sentence:**
Factors II, VII, IX and X depend on gammacarboxylase, a hepatic enzyme dependent
on vitamin ________.
K
62
# **True or False:**
Vitamin K helps to regulate blood coagulation by activating certain pro-coagulation factors (II, VII, IX, X).
**True.**
63
# **Question:**
What is the function of gammacarboxylase?
Converting factors II, VII, IX and X into their activated forms (i.e., IIa, VIIa, IXa and Xa).
64
# **Question:**
What does the medicine/drug Warfarin do?
Warfarin stops the recycling of vitamin K, inhibiting it's activity and, therefore, factors II, VII, IX and X don't get activated.
65
# **True or False:**
A single molecule of vitamin K can be reused many times.
**True.**
Vitamin K can be recycled.
66
# **Question:**
What are the 3 steps of hemostasis (coagulation process)?
1. **Primary Hemostasis**: vasoconstriction and platelet adhesion (creation of platelet plug).
2. **Secondary Hemostasis**: formation of fibrin, which creates a protein mesh to reinforce the plug.
3. **Fibrinolysis**: Breakdown of fibrin through plasmin (catalytic enzime), once the bleeding is controlled.
67
# **Complete the sentence:**
The secondary hemostasis involves the classical ________ ________.
coagulation cascade
68
# **Question:**
The coagulation cascade can be divided in two different ways. What are them?
The coagulation cascade can be divided into:
* Initiation, amplification and propagation
OR
* Extrinsic pathway, intrinsic pathway and common pathway
69
# **Complete the sentence:**
In the coagulation cascade, the extrinsic pathway is triggered by ________, while the intrinsic pathway is triggered by ________.
trauma to extravascular cells, internal damage to the vessel walls
70
# **Complete the sentence:**
In the common pathway of the coagulation cascade, prothrombin (factor II) is activated by converting into ________ (factor IIa), which activates fibrinogen (factor I) by converting it into ________ (factor Ia).
thrombin, fibrin
71
# **Question:**
What are the two main **coagulation analytical parameters**?
* **Prothrombin Time (PT)**: evaluates the extrinsic and common pathways of coagulation.
* **Activated Partial Thromboplastin Time (aPTT)**: evaluates the intrinsic and common pathways of coagulation.
72
# **Complete the sentence:**
To assess the effect of warfarin, we must use the ____________ (Prothrombin Time/Activated Partial Thromboplastin Time).
Prothrombin Time
73
# **Complete the sentence:**
There are two main coagulation analytical parameters: ________ is used to evaluate the intrinsic pathway, while ________ is used to evaluate the extrinsic pathway.
| Words: Prothrombin Time, Activated Partial Thromboplastin Time
Activated Partial Thromboplastin Time, Prothrombin Time
74
# **True or False:**
The coagulation pathways evaluated by the Activated Partial Thromboplastin Time and the Prothrombin Time are dependent on the tissue factor.
**False.**
* Prothrombin time (PT) evaluates extrinsic and common pathways, **depending on tissue
factor**
* Activated partial thromboplastin time (aPTT) evaluates intrinsic and common pathways, **independent of the tissue factor**.
75
# **True or False:**
Prothrombin time (PT), which evaluates extrinsic and common pathways, has normal values between 30 to 50 seconds.
**False.**
* Prothrombin time (PT) has normal values of **12-13 seconds**.
* Activated partial thromboplastin time (aPTT) has normal values of **30-50 seconds**.
76
# **Definition:**
Anemia
Anemia is an abnormally low hemoglobin (or low red blood cells) concentration.
77
# **Complete the sentence:**
A low concentration of red blood cells is called ________ and a high concentration of red blood cells is called ________.
anemia, polycythemia
78
# **Complete the sentence:**
A low concentration of hemoglobin is called ________ and a high concentration of hemoglobin is called ________.
anemia, erythrocytosis
79
# **Question:**
What are the possible causes of anemia?
* Hemorrhage
* Nutritional deficiencies
* Chronic diseases
(etc.)
80
# **Question:**
What are the possible causes of polycythemia?
* Dehydration
* Adaptation to high altitude
(etc.)
81
# **Question:**
Why does the adpation to high altitudes lead to polycythemia (increased concentration of erythrocytes)?
In high altitudes there is less oxygen, causing hypoxia. To compensate for the lack of oxygen, the body tries to produce more erythrocytes in an attempt to increase the oxygen transportation to tissues. Hypoxia induces the expression of erythropoietin, which increases red blood cell production.
82
# **Complete the sentence:**
Anemia might result from differences in erythrocytes, which may be related to ________, such as microcytic, normocytic and macrocytic anemias, or related to ________, such as poikiloicytosis and anisocytosis.
size, shape
83
# **Question:**
What are the 3 types of anemia related to the size of erythrocytes?
* Microcytic (lower mean corpuscular volume)
* Normocytic (normal mean corpuscular
volume)
* Macrocytic (larger mean corpuscular
volume)
84
# **Question:**
What are the 2 most common causes of macrocytic anemia?
* Abnormal nuclear maturation of young erythrocytes
* Presence of a higher fraction of young erythrocytes
85
# **Complete the sentence:**
Megaloblastic anemias are a type of ________ anemia.
Macrocytic
86
# **Question:**
What 2 conditions is megaloblastic anemia linked to?
* Vitamin deficiencies (Vitamin B12 or folic acid)
* Hepatic disorders.
87
# **Question:**
How is megaloblastic anemia associated with alcohol comsuption?
* **Direct toxic effect** over the bone marrow, leading to ineffective erythropoiesis;
* **Folate deficiency**, since alcohol interferes with the absorption, metabolism and storage of folate, a crucial element involved in DNA synthesis. Its deficit results in impaired cell division, resulting in larger erythrocytes;
* **Liver dysfunction**, since chronic alcohol consumption can affect the normal liver function, disrupting the storage and processing of vital nutrients such as vitamin B12 (whose deficit is one of the causes of megaloblastic anemia). Moreover, the ability of liver to produce erythropoietin can also be compromised.
88
# **Complete the sentence:**
Microcytic anemia is typically linked to due to abnormalities in ________ production.
hemoglobin
89
# **Complete the sentence:**
Iron deficient anemias and Thalassemia are two types of ________ anemias.
microcytic
90
# **Question:**
What is Thalassemia?
Group of inherited conditions that affect the subunits of hemoglobin. They can be divided into alpha thalassemia (affects the alpha subunits) and beta thalassemia (affects the beta subunits).
91
# **Question:**
What are the most common causes of normocytic anemia?
* Decreased number of red cell precursors
* Low levels of erythropoietin
* Chronic inflammation (affects the availability of iron)
92
# **Complete the sentence:**
In normocytic anemia, the reduced number of red blood cells is usually linked to low levels of ________ and/or ________, which impairs the production of these cells.
erythropoietin, iron
93
# **Complete the sentence:**
Sickle cell anemia is a type of ________ (microcytic/normocytic/macrocytic) anemia. However, it can also be a result of a ________ (beta/alpha) thalassemia, which is a type of ________ (microcytic/normocytic/macrocytic) anemia.
Normocytic, beta, microcytic
94
# **Complete the sentence:**
Autoimmune hemolytic anemias are a type of normocytic anemia in which ________ cause erythrocytes destruction.
antibodies
95
# **Question:**
In sickle cell anemia, what causes the sickle shape of the erythrocytes?
In sickle cell anemia, the erythrocytes have a sickle ("foice") shape, instead of a biconcave disk shape, due to a defective hemoglobin shape.
96
# **Question:**
What are the 2 main causes of erythrocytosis?
* Increased erythropoietin production.
* Polycythemia (it’s a syndrome that leads to increased erythrocytes mass and consequently low erythropoietin).
97
# **Definition:**
Erythrocytosis
Abnormally high hemoglobin concentration.
98
# **Distinguish:**
Anemia vs. Erythrocytosis
Anemia is an abnormally low hemoglobin concentration. Erythrocytosis is an abnormally high hemoglobin concentration.
99
# **True or False:**
Anemia can be caused by an abnormally low concentration of hemoglobin or red blood cells.
**True.**
100
# **Definition:**
Polycythemia
Syndrome that leads to increased erythrocytes mass (i.e., higher concentration of red blood cells) and consequently low erythropoietin.
101
# **Distinguish:**
Erythrocytosis vs. Polycythemia
* Erythrocytosis: abnormally high concentration of **hemoglobin**.
* Polycythemia: abnormally high concentration of **erythrocytes**.
They are often related.
102
# **Question:**
What causes low erythropoietin in polycythemia?
An increased production of erythrocytes leads to an increased use of erythropoietin, which ultimately decreases its levels.
103
# **Complete the sentence:**
An abnormally high concentration of white blood cells is called ________ and an abnormally low concentration of white blood cells is called ________.
leukocytosis, leucopenia
104
# **Complete the sentence:**
An abnormally high concentration of neutrophils is called ________ and an abnormally low concentration of neutrophils is called ________.
neutrophilia, neutropenia
105
# **Complete the sentence:**
An abnormally high concentration of lymphocytes is called ________ and an abnormally low concentration of lymphocytes is called ________.
lymphocytosis, lymphopenia
106
# **Question:**
What are the possible causes of leukopenia?
* Viral infections
* Autoimmune disorders
* Side effects of medications
* Bone marrow disorders
(etc.)
107
# **Question:**
What are the possible causes of leukocytosis?
* Inflammation
* Infection
* Stress response
* Trauma
* Leukemia
(etc.)
108
# **Question:**
What are the possible causes of neutrophilia?
* Increased bone marrow activity (bacterial infections, acute inflammation, leukemia, etc.)
* Release from marrow pool (stress, etc.)
* Demargination into blood (stress, bacterial infections, etc.)
109
# **Questions:**
What are the possible causes of neutropenia?
* Decreased bone marrow activity (drugs, anemia, etc.)
* Decreased neutrophil survival (viral infection, sepsis, autoimmune disease, etc.)
110
# **Complete the sentence:**
Lymphoma (cancer in lymphocytes) leads to ________ (lymphopenia/lymphocytosis).
Lymphocytosis
111
# **Complete the sentence:**
An abnormally high concentration of platelets (thrombocytes) is called ________ and an abnormally low concentration of platelets is called ________.
thrombocytosis, thrombopenia
112
# **Question:**
Why do malignancies lead to thrombocytosis?
1. One of the clinical manifestations of malignancies is bleeding, which leads to an increased production of platelets in order to allow the coagulation process.
2. Some malignancies may affect the bone marrow, which consequently affects the production of formed elements and may lead to an altered (in this case, increased) production of platelets.
113
# **Definition:**
Hemophilia
Rare genetic disorder in which coagulation is affected by a **deficiency of coagulation factors**, facilititating bleeding.
114
# **Complete the sentence:**
Hemophilia A is caused by a deficiency in coagulation Factor ____, while Hemophilia B is caused by a deficiency in coagulation Factor ____.
VIII, IX
115
# **Question:**
What are the causes of **consuptive coagulopathy** or **Disseminated intravascular coagulation (DIC)** ?
* Overwhelming infections
* Massive hemorrhage
* Trauma
* Obstetric complications
* Severe burns
116
# **Question:**
What happens in **consuptive coagulopathy** or **Disseminated intravascular coagulation (DIC)**, that makes it very hard to treat?
1) Widespread activation of the clotting system ⭢ 2) Excessive formation of blood microclots:
* Blockage in small vessels and organ dysfunction
* ⬇ **coagulation factors and platelets** ⭢ Bleeding tendencies ⭢ 1)
## Footnote
(It is a non-ending cycle)
117
# **Question:**
What are the 2 main **possible causes** of iron deficiency anemia?
* Deficient intake of iron (or malabsorption of iron)
* Blood loss
118
# **Question:**
What are the general **clinical manifestations** of iron deficiency anemia?
* Tiredness
* Weakness
* Shortness of breath
* Pale skin and mucosa
* Tachycardia
* Fragile skin appendages (brekage in nails and hair)
119
# **Question:**
Why is **pale skin** a clinical manifestation of iron deficiency anemia?
Pale skin is caused by the decreased number of **red** blood cells in the blood.
120
# **Question:**
Can iron deficiency anemia have **gastrointestinal clinical manifestations**?
Yes.
* Glossitis (swollen and inflamed tongue)
* Achlorhydria (absence of stomach acid)
* Hematochezia (red, fresh blood in feces)
* Melena (black, old blood in feces)
121
# **Question:**
What is **Pica**?
Pica is a rare clinical manifestation of iron deficiency anemia, where people crave non-alimentary products such as clay or dirt.
122
# **Question:**
Where is iron primarily absorbed in the body?
Duodenum
123
# **Complete the sentence:**
In an anemic scenario, the body will attempt to ________ (increase/decrease) the iron uptake.
increase
124
# **Question:**
Why does the body increase the iron uptake in an **hypoxia** scenario?
Hypoxia corresponds to the lack of oxygen. Tissues and organs require oxygen (and nutrients) to survive, so the body will attempt to increase the supply of oxygen to the tissues by increasing the number of oxygen transporters, aka red blood cells. Red blood cells contain iron, so an increase in the production of red blood cells requires an increase in iron levels, which is achieved by an increased iron uptake.
125
# **Complete the sentence:**
Lower levels of iron will ________ (increase/decrease) the levels of hepcidin.
Decrease
126
# **Question:**
What is the role of hepcidin in the recycling of iron?
Hepcidin controls the passage from iron accumulation places to plasma (blood). Therefore, hepcidin plays a crucial role in processes that allow the body to store iron, relocate it and reuse it.
127
# **Definition:**
Ferroportin
Ferroportin is a transmembrane protein that transports iron from the inside of a cell to the outside of the cell - it is an iron exporter.
128
# **Definition:**
Hepcidin
Hormone/protein that regulates iron uptake, namely
129
# **Complete the sentence:**
Hepcidin binds to ________, leading to its lysossomal degradation.
Ferroportin
130
# **Complete the sentence:**
High levels of hepcidin makes it ________ (easier/harder) for ferroportin to transport iron to your bloodstream, ________ (enabling/preventing) iron absorption.
harder, preventing
131
# **True or False:**
Ferroportin is responsible for storing the iron, transports it from the bloodstream to the liver.
**False.**
Ferroportin transports iron from the duodenum into the bloodstream, allowing it to be reused instead of stored.
132
# **Truth or false:**
Hepcidin binds to ferroportin to allow the release of iron into the bloodstream.
**False.**
Hepcidin binds to ferroportin to stop it from releasing the iron into the bloodstream. In other words, hepcidin binds to ferroportin to store the iron in the liver.
133
# **Complete the sentence:**
In case of iron deficiency anemia, the levels of hepcidin are ________ (high/low).
low
