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Winter 2016 > B&L Unit 1 > Flashcards

B&L Unit 1 Flashcards

1
Q

What is the equation for hematocrit?

A

length of RBC layer/ (RBVs + buffy coat + plasma)

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2
Q

The biconcave disc shape of RBCs increases surface area to volume ratio by _________% compared to a sphere

A

40

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3
Q

RBCs are _________% wider than capillaries

A

25

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4
Q

Hematopoiesis is the formation of _________

A

Blood cellular components

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5
Q

Erythropoiesis is the formation of _________

A

RBCs

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6
Q

Hemolysis is _________

A

Rupturing of RBCs and release of their contents

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7
Q

Hemostasis is _________

A

Stopping of bleeding

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8
Q

1 _________ can make _________ platelets

A

Megakaryocyte 5000

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9
Q

Acute leukemia cells are _________ compared to chronic leukemia cells

A

Immature

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10
Q

_________ proteins on the cell surface are expressed by cells of the innate immune system to identify pathogen-associated molecular patterns

A

Pattern-recognition receptor (PRR)

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11
Q

Pattern-recognition receptor proteins on the cell surface are expressed by cells of the _________

A

Innate immune system

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12
Q

_________ are foreign molecular structures on pathogens (bacterial cell wall protein, bacterial dsRNA) that are recognized by PRRs in the innate immune system

A

Pathogen-associated molecular pattern (PAMP)

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13
Q

_________ of the innate immune system recognize _________ of pathogens

A

PRRs PAMPs

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14
Q

Toll-like receptors are a type of _________

A

Pattern-recognition receptor

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15
Q

A PAMP-stimulated cell releases _________ and _________

A

cytokines chemokines

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16
Q

Chemokines are _________ to phagocytotic WBCs

A

chemotactic

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17
Q

Cytokines are secreted by what type of cell?

A

Immune cells

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18
Q

Cytokines can be classified as _________, _________, or _________ (types of macromolecules)

A

Proteins Peptides Glycoproteins

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19
Q

Ig_________ is passed mother to fetus

A

G

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20
Q

IgG is a _________-mer

A

di

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21
Q

Ig_________ and _________ activate complement

A

G M

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22
Q

_________ is the first antibody to appear after exposure to a new antigen

A

IgM

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23
Q

Ig_________ is expressed on B cell membranes as their antigen receptor

A

D

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24
Q

Ig_________ is secretory

A

A

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25
Q

Ig_________ attaches to mast cells and makes them release prostaglandins, leukotrienes, cytokines, and release granules

A

E

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26
Q

Ig_________ is involved in parasite resistance

A

E

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27
Q

Type I immunopathology is also known as _________

A

Immediate hypersensitivity (like allergies)

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28
Q

Immediate hypersensitivity is also known as _________

A

Type I immunopathology

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29
Q

Type II immunopathology is also known as _________

A

Autoimmunity

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30
Q

Autoimmunity is also known as _________

A

Type II immunopathology

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31
Q

Type III immunopathology is when antibodies are made against _________

A

Soluble antigens

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32
Q

Type IV immunopathology is _________-mediated

A

T-cell

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33
Q

The Wright-GIemsa stain stains _________ components in cells

A

Acidic

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34
Q

Eosin stains _________ components a _________ color

A

Basic Orange-red (hemoglobin and some granules)

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35
Q

Methylene blue will stain _________ components a _________ color

A

Acidic Purple-blue (DNA, RNA, basophil granules, cytoplasm of mature lymphocytes and monocytes)

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36
Q

3 white blood cell blood measurements we care about

A

WBC count WBC differential Absolute count = total and differential

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37
Q

_________ is the most common WBC in children up to 8

A

Lymphocyte

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38
Q

_________ become macrophages once they enter tissues

A

Monocytes

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39
Q

_________ and _________ are the granulocytes involved in allergies

A

Eosinophils (mediate) Basophils (central role)

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40
Q

_________ are the granulocytes that deal with bacterial infections

A

Neutrophils

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41
Q

_________ are immature RBCs (before they lose RNA and ribosomes and stuff)

A

Reticulocytes

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42
Q

The range for the platelet count is _________

A

150,000 - 400,000/uL

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43
Q

What is the difference between plasma and serum?

A

Serum is the clear part of the blood after clotting. Plasma is unclotted.

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44
Q

In the fetal stage, blood cells are produced by the _________ and _________

A

Liver Spleen

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45
Q

Myeloid means _________

A

Bone marrow

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46
Q

The pluripotent cells of the bone marrow are _________ and the multipotent cells are the _________

A

CFU-LM (LM = lymphoid/myeloid) CFU-GEMM (GEMM = granulocyte/erythroid/monocyte/megakaryocyte)

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47
Q

_________% of nucleated cells in bone marrow are stem cells/progenitors and _________% of these are pluripotetent

A

1 1

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48
Q

7 hematopoietic growth factors (HGFs)

A

Erythropoietin (Epo) -> erythropoeisis

Thrombopoietin -> megakaryopoiesis

Interleukin-3 (IL3) -> eosiophils

Interleukin-5 (IL5) -> basophils

Granulocyte colony-stimulating factor (G-CSF)

Granulocyte-macrophage colony-stimulating factor (GM-CSF)

Macrophage colony-stimulating factor (M-CSF)

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49
Q

What type of macromolecule are hematopoeietic growth factors?

A

Glycoproteins

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50
Q

5 types of cells that produce hematopoeietic growth factors

A

Activated T and B-lymphocytes Macrophages Fibroblasts Endothelial cells

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51
Q

The last neutrophilic precursor with the ability to divide is the _________

A

Myelocyte

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52
Q

M:E ratio and normal stuff

A

Myeloid : erythroid ratio from bone marrow biopsy. Should be about 3:1.

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53
Q

What is allostery?

A

When one hemoglobin binds to oxygen, there is a change in configuration that increases binding affinity.

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54
Q

What is positive cooperativity?

A

Substrate binding increases binding affinity for addtional substrate

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55
Q

Hemoglobin is _________ in the taut state and _________ in the relaxed state

A

Deoxygenated Oxygenated

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56
Q

The Bohr effect is when a low pH _________ oxygen affinity for hemoglobin and a high pH _________ oxygen affinity and curve shifts to the _________

A

Decreases -> unloading b/c more CO2 Increases Right

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57
Q

Higher temperatures _________ oxygen affinity for hemoglobin and lower temperatures _________ oxygen affinity and the curve shifts to the _________

A

Decreases b/c exercise raises temps Increases Right

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58
Q

Hemoglobin is a _________-mer and myoglobin is a _________-mer

A

tetra mono

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59
Q

Alpha hemoglobin genes are on chromosome _________ and there are _________ copies from each parent. Beta hemoglobin genes are on chromosome _________ and there are _________ copies from each parent

A

16 2 11 1

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60
Q

The fetal hemaglobin tetramer is _________

A

a2y2

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61
Q

Hemaglobin F binds _________ poorly

A

2,3-BPG

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62
Q

The _________ effect is increased in fetal hemaglobin

A

Bohr

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63
Q

Methemoglobin forms when _________

A

iron is reduced from its 2+ state to its 3+ state, which doesn’t bind oxygen Curve shifts left

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64
Q

In methoglobinemia, the patient looks _________ , arterial O2 pressure is _________ , blood is _________ color, and _________ with O2 exposure

A

Cyanotic Normal Red/chocolate/brown/blue Doesn’t change

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65
Q

_________ can be givin via IV to reduce methemoglobin via the _________ pathway

A

Methylene blue NADPH-dependent

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66
Q

Deoxyhemoglobin absorbs at _________ nm and oxyhemoglobin absorbs at _________ mm

A

660 940

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67
Q

_________ form the buffy coat

A

Leukocytes

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68
Q

Dendritic cells connect the _________ and _________ immune responses

A

Innate Adaptive

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69
Q

The neutropil has _________ granules, the eosinophil has _________ granules, an the basophil has _________ granules (color)

A

colorless - neutral red - eosin blue - basic

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70
Q

The central lymphoid organs are the _________ and _________

A

Bone marrow Thymus

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71
Q

The peripheral lymphoid organs are the _________ , _________ , and _________

A

Lymph nodes Spleen Peyer’s patch

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72
Q

Lymphocytes interact with endothelial cells lining certain _________ in peripheral lymphoid tissues that are _________ (shape)

A

Postcapillary venules High and cuboidal

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73
Q

What is an immunogen?

A

An antigen in a form that can give rise to an immune response (can immunize)

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74
Q

What is a tolerogen?

A

An antigen delivered in a form/route that doesn’t result in an immune response and prevents an immune response

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75
Q

Normal reticuolocyte count range

A

0.4-1.7% of RBCs

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76
Q

Absolute reticulocyte count equation

A

% of reticulocytes * red cell count

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77
Q

REcognition/attachment Engulfment and Reticulocyte index equation

A

RI = reticulocyte count * (patient Hb/normal Hb) * stress factor Reticulocytes are pushed out of the one marrow before they are fully matured if the bone marrow is stressed

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78
Q

Anemia stress factors for the reticulocyte equation

A

1.5 - mild anemia 2.0 - moderate anemia 2.5 - severe anemia

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79
Q

Iron enters the duodenum through the transporter _________

A

DMT1

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80
Q

Low hepcidin means _________ iron absorption,

A

increased

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81
Q

3 nutritional deficiencies that can cause anemia

A

Iron Vitamin B12 Folate

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82
Q

Hormone deficiency that can cause anemia

A

Erythropoietin

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83
Q

2 types of anemia due to bone marrow damage

A

Aplastic anemia - blood cells aren’t being made Leukemia - crowding out of normal blood-making cells by cancer cells

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84
Q

Bite RBCs are a histological indicator of _________ deficiency

A

G6PD

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85
Q

Alpha thalassemia is a lack of _________ hemoglobin chains

A

alpha

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86
Q

Signs of hemolysis (4)

A

Increased bilirubin

Increased lactic dehydrogenase

Decreased haptoglobin

Hemosiderin in urine

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87
Q

The Leubering-Rapaport pathway in RBCs generates _________

A

2,3 DPG

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88
Q

2 types of anemia due to marrow damage

A

Aplastic anemia Leukemia

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89
Q

How does chronic inflammation cause anemia? (3)

A

Pro-inflammatory cytokines make cells resistant to erythropoietin Less erythropoietin production Iron is sequestered (since bacteria like to use it)

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90
Q

What does the spleen check for in RBCs?

A

Cytoskeleton abnormalities

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91
Q

The G6PD mutation causes problems in what RBC pathway?

A

The one that gets reduces oxygen radicals

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92
Q

7 components of the complete blood panel

A

Hemaglobin Hematocrit Red blood cell count Mean corpuscular volume White blood cell count Platelet count Mean platelet volume

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93
Q

How to calculate hematocrit by the RBC histogram

A

RBC volume (AUC) / total volume OR RBC count *MCV (mean corpuscular volume)

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94
Q

Axes of the RBC and platelet histogram

A

size vs. count

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95
Q

Reticulocytes are retained in the bone marrow for about _________ days

A

3

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96
Q

Reticulocytes circulate in peripheral blood for _________ days before they become mature RBCs

A

1

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97
Q

What is the difference between a manual differential and an automated differential? What does the manual one add?

A

Slide vs. flow Morphology

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98
Q

What does the neutrophil nucleus look like on a stained slide?

A

Clumped chromatin in 2-5 lobes

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99
Q

What does a lymphocyte nucleus look like on a stained slide?

A

Most of cell Round Dense chromatin

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100
Q

What does the monocyte nucleus look like on a stained slide?

A

Irregular, lobed

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101
Q

What does the monocyte cytoplasm look like on a stained slide?

A

Often has vacuoles

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102
Q

What does an eosinophil nucleus look like on a stained slide?

A

Bi-lobed

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103
Q

What does a basophil nucleus look like on a stained slide?

A

Obscured by coarse purple-black granules

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104
Q

_________ are found on the skin and are helical and make holes in undesireable bacteria

A

Cathelicidins

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105
Q

_________ is downstream in the TLR pathway and turns on pro-inflammatory genes

A

NF-KB

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106
Q

If the body can’t kill a pathogen, it _________

A

Walls it off

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107
Q

What 4 things happen in acute inflammation?

A

Vasodilation Leaky EC junctions Stretching of nerve fibers WBCs

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108
Q

What do dendritic cells do when they encounter a pathogen?

A

Eat it and present parts of it in the lymph node

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109
Q

Reticulocytes normally are _________ in response to anemia

A

Increased

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110
Q

What’s the difference between signs and symptoms?

A

Symptoms are subjective and what the patient tells you Signs are objectives and what you see in the patient

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111
Q

What is claudication?

A

Extremity pain due to lack of oxygen

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112
Q

What is dyspnea?

A

Difficulty breathing

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113
Q

What is dysuria?

A

Painful urination

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114
Q

Iron is more soluble at _________ pH

A

Low

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115
Q

_________ binds to iron in the stomach and brings it to the duodenum

A

Gastroferrin

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116
Q

The presence of protein and amino acids _________ iron absorption

A

Decreases

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117
Q

How does vitamin C affect iron absorption?

A

It keeps it in the right valence state for absorption

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118
Q

The presence of phytates and oxalates _________ iron absorption

A

Decreases

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119
Q

What are the storage proteins for iron?

A

Ferritin Hemosiderin

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120
Q

What does ferritin do?

A

Stores iron intracellularly

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121
Q

What is the transport protein for iron?

A

Transferrin

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122
Q

What does transferrin do?

A

Binds iron in the plasma

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123
Q

How does iron get into RBCs?

A

Transferrin enters through clathrin-coated pits

pH changes and iron affinity decreases

Iron goes out into the cell via the DMT transporter

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124
Q

Hepcidin increases accumulation of _________

A

Ferritin

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125
Q

What 3 things cause hepcidin levels to increase?

A

Inflammation

Infection

Iron overload

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126
Q

How do we measure ferritin levels?

A

The intracellular amount is proportional to the tiny amount in plasma

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127
Q

Increased iron absorption can be due to a mutant _________ gene

A

HFE

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128
Q

What happens in HLA-H mutation?

A

Increased iron absorption in the duodenal crypt

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129
Q

What is hemochromatosis?

A

Iron overload from excessive gut absorption. Genetic.

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130
Q

What is the treatment for hemochromatosis?

A

Bloodletting

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131
Q

What is hemosiderosis?

A

Iron overload from excessive accumulation of hemosiderin

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132
Q

What is the treatment for hemosiderosis?

A

Iron chelation

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133
Q

Hemoglobin levels are measured by _________

A

Spectometry

134
Q

RBC and platelet levels are measured by _________

A

Aperture impedance Or flow

135
Q

The largest blood cells are _________

A

Monocytes

136
Q

In aqueous solutions, iron forms _________

A

Insoluble hydroxides

137
Q

What 3 things does the innate immune system recognize?

A

PAMPS DAMPS Absence of certain normal cell surface molecules

138
Q

T cells secrete short-range mediators called _________

A

Lymphokines

139
Q

What do type 1 helper T cells, Th1 do?

A

Recognize antigens, make lymphokines that attract macrophages

140
Q

What do Th17 helper T cells do?

A

Create focused inflammation

141
Q

What do type 2 helper T cells, Th2 do?

A

Stimulate macrophages to become alternatively activated Wall off pathogens

142
Q

What do follicular helper T cells, Tfh do?

A

Activate B cells

143
Q

What do Tregs do?

A

Make lymphokines to supress other T cells, keeping immune response in check

144
Q

What do cytotoxic/killer T cells do?

A

Destroy things with foreign or abnormal antigens on surface

145
Q

Myoglobin has a _________ partial pressure for oxygen than hemoglobin

A

Lower, so that it holds onto oxygen very tightly until oxygen concentration is very low

146
Q

2 components of the heme prosthetic group

A

Ptoporphyrin ring + bound iron

147
Q

Fetal hemoglobins have a _________ oxygen affinity than hemoglobin A

A

higher

148
Q

What are Heinz bodies?

A

Precipitated denatured hemoglobin

149
Q

_________ is found in people with high-affinity hemoglobin variants

A

Erythrocytosis (elevated RBC count)

150
Q

3 signs of methemoglobinemia

A

Cyanosis Arterial partial pressure of oxygen is normal Oxygen exposure does not change blood color

151
Q

What is the treatment for acquired methemoglobinemia?

A

Removal of inciting drug/chemical IV methylene blue to act as an electron receptor o reduce methemoblobin via the NADPH-dependent pathway

152
Q

What is the treatment for carbon monoxide poisoning?

A

100% oxygen and/or hyperbaric chamber

153
Q

_________ antibody is attached to mast cells

A

IgE

154
Q

IgE stimulates the mast cells to make _________, _________, _________, and release _________ when it encounters an antigen

A

Prostaglandins Leukotrienes Cytokines Granules

155
Q

In the embryonic stage, blood cells are produced by the _________

A

Yolk sac

156
Q

How does blood flow work in the bone marrow?

A

Arteries -> capillary-venous sinuses -> central vein -> systemic circulation

Only mature blood cells are allowed to get into the sinuses

157
Q

Does the reticulocyte have a nucleus?

A

No

158
Q

Cellularity estimate equation for % of bone marrow occupied by hematopoietic cells

A

100-age Very approximate

159
Q

Where in the lymph node to arterioles/veins enter/exit?

A

Hilum

160
Q

Where does lymph go one it reaches the lymph node?

A

Afferent lymph channel -> subscapular sinus -> efferent lymph channel

161
Q

In the lymph node, lymphocytes are arranged in _________

A

Follicles

162
Q

Areas of dividing cells in lymph node follicles are _________

A

Germinal centers

163
Q

2 tissue types in the spleen

A

Red pulp ~ lymph node medulla, filters White pulp

164
Q

Peyer patches contain _________ cells unique to it

A

mucosal M cells

165
Q

The part of the antigen that fits into the receptor is the _________

A

Antigenic determinant / epitope

166
Q

How are sideroblastic anemias formed?

A

They are congenital/aquired

167
Q

How does chronic infection/inflammation result in anemia?

A

IL1 reduces iron mobilizaiton, EPO production INF-y inhibits proliferation of erythroid precursors

168
Q

How does lead poisoning lead to anemia?

A

Inhibits synthesis of protoporphyrin and enzyme that ligates iron to porphyrin ring

169
Q

What types of anemia or normochromic and normocytic?

A

Thyroid Adrenal insufficiency Renal insufficiency Infection/inflammation/malignancy (sometimes microcytic or hypochromic though)

170
Q

How is vitamin B12 absorbed?

A

Released from food in acidic stomach IF binds B12 released in terminal ilium and bound to TcII (transcobalamin binding protein II) Liver

171
Q

B12 and folate are required for synthesis of _________

A

Methionine from homocysteine

172
Q

What enzyme reduces iron?

A

Cytochrome B reductase

173
Q

Which form of iron binds oxygen?

A

2+ (ferrous) 3+ (ferric) does not bind

174
Q

4 causes of hemoglobin-related cyanosis

A

Too much Deoxyhemoglobin Methemoglobin Sulphemoglobinemia Or acquired from drugs

175
Q

Is a blast forming unit committed to a lineage?

A

Yes

176
Q

Can myeloid and lymphoid stem cells self-renew?

A

No Multipotent hematopoietic stem cells can though!

177
Q

What does the pro-prefix in hematopoieisis mean?

A

The first committed cell in that lineage

178
Q

What are the 4 things erythropoietin does?

A

Activates stem cells Encourages mitosis and maturation Increases Hemoglobin B levels Reticiulocyte release

179
Q

What is a feature of immature blood progenitor cells?

A

They are large and their nuclei are round

180
Q

What are the 3 things thrombopoietin does?

A

Helps differentiate, mature, release platelets

181
Q

The 2 ways neutrophils kill things

A

Phagocytosis Degranulation

182
Q

Why do granulocytes have weird looking nuclei?

A

They can fit through small spaces

183
Q

Eosinophils fight _________

A

Parasites

184
Q

What is in the cortex and paracortex of the lymph node?

A

Cortex - B cells Paracortex - T cells

185
Q

What is a lymph node germinal center? When does it occur?

A

A bunch of dividing cells that happens when an immune response occurs

186
Q

_________ and _________ are factors that reduce iron mobiliaation and erythropoietin production

A

TNF IL1

187
Q

_________ and _________ are factors that inhibit erythroid proliferation

A

INF-B (interferon beta) INF-Y (interferon gamma)

188
Q

Endocrine causes of anemia result in _________

A

Reduced reticulocyte count and index

189
Q

Under what anemic conditions do you transfuse?

A

Only when cardiovascular decompensation risk is present

190
Q

Where are iron, vitamin B12, and folate absorbed in the GI tract?

A

Iron - duodenum Folate - jejunum B12 - terminal ilium

191
Q

What helps us absorb vitamin B12?

A

Intrinsic factor

192
Q

What enzyme stores vitamin B12 in the plasma?

A

Transcobalmin II (TcII)

193
Q

5 major categories of vitamin B12 deficiency

A

Autoimmune disease Intrinsic factor deficiency Malabsorption Defective transport/storage Metabolic defect

194
Q

6 major categories of folate deficiency

A

Dietary insufficiency Malabsorption Drugs and toxins Inborn errors of folate metabolism Increased demands Increased loss/metabolism

195
Q

Sickle cell is a mutation in the _________ globin chain

A

Beta

196
Q

What is poikilocytosis?

A

Variation in shep of RBCs

197
Q

What is aplastic crisis in sickle cell disease?

A

When the bone marrow can’t rapidly produce RBCs (since in sickle cell it always has to) Characteristic finding is low reticulocyte count

198
Q

What happens to the spleen in sickle cell disease?

A

Lots of sickle RBCs become trapped in microcirculation Autoinfarction -> destruction by age 5 Lots of infections

199
Q

What happens to the lungs in sickle cell disease?

A

Increased vascular resistance -> pulmonary arterial hypertension

200
Q

How can you incrase expression of fetal hemoglobin?

A

Aministration of hydroxyurea Reduces anemia, pain crises, mortality Not sufficient evidence to show it helps the chronic complications

201
Q

When do you transfuse people with sickle cell disease?

A

Acute worsening or acute end-organ injury

202
Q

Domains of the light chain

A

1 variable, VL 1 constant, CL

203
Q

Domains of the heavy chain

A

1 variable, VH 3-4 constant, CH1, CH2, etc

204
Q

IgM forms a _________-mer

A

penta

205
Q

Chain structure of IgG

A

2 light, 2 gamma

206
Q

Chain structure of IgD

A

2 light, 2 delta Extra long hinge

207
Q

Chain structure of IgE

A

2 light, 2 epsilon Extra constant domain

208
Q

Chain structure of IgM

A

2 light, 2 mu w/ extra CHu4 domain Pentamer closed by J chain

209
Q

Chain structure of IgA

A

2 light, 2 alpha Joined by J chain Wrapped by secretory component

210
Q

When antibody types switch, the _________ chain changes, but the _________ does not

A

Heavy Light

211
Q

2 types of light chains

A

kappa lambda

212
Q

What is an antibody allotype?

A

Antibody chain alleles

213
Q

What is an antibody idiotype?

A

A persons unique set of complementarity determining region You consider other people’s idiotype antigenic

214
Q

What is a lattice/immune complex?

A

A complex of antigens and antibodies (since antibodies can bind multiple epitopes, we get a growing network)

215
Q

What is immune complex precipitation?

A

When the ratios of antigen to antibody are optimal, the complex get large and falls out of solution Agglutination is when this is cell-sized

216
Q

Why is IgM good at activating complement?

A

You need two adjacent Fcs to start the complement cascade and IgM has five adjacent

217
Q

The complement cascade activates _________

A

C3

218
Q

The classical complement pathway is activated by _________

A

IgG or IgM complexes with antigens

219
Q

Which antibody type is most resistant to enzymatic digestion?

A

IgA, with secretory component

220
Q

What is the main complement inhibitor?

A

C1 esterase inhibitor

221
Q

The alternative complement pathway is activated by _________

A

Bacterial cell wall components. It doesn’t need an antibody - handy!

222
Q

The lectin complement pathway is mediated by _________

A

Mannose-binding protein, a lectin

223
Q

What are lectins?

A

Proteins that bind carbohydrates

224
Q

4 actions of the complement pathway

A

Lysis Opsonization Chemotaxis Anaphylatoxis

225
Q

What levels of hemoglobin A are needed for disease?

A

1/2 levels - some symptoms 1/4 levels - disease 0 levels - incompatible with life

226
Q

Why is hydrops fetalis more common in asians than africans?

A

Asians are usualy have 0 alpha hemoglobins on a chromosome (–/aa) and Africans usually have 1 (-a/-a)

227
Q

What are RBCs like in thelassemia?

A

Low MCV and low hemoglobin concentration

228
Q

What do pyrogens do?

A

Casue hypothalamus to produce prostaglandins that results in increased body temperature Exogenous pyrogens cause leukocytes to release endogenous pytogens

229
Q

What are 3 acute phase reaction proteins we should know about?

A

C-reactive protein

Serum amyloid D

Fibrinogen

230
Q

3 cell types that have histamine

A

Mast cells Basophils Platelets

231
Q

What does serotonin do to blood vessels?

A

Vasoconstriction to aid in clotting

232
Q

Which blood cell types have serotonin?

A

Platelets

233
Q

2 arachadonic acid pathways for inflammation

A

Cyclooxenase -> prostaglandins, thromboxanes Lipoxygenase -> leukotrienes, lipoxins

234
Q

Lipoxins antagonize ______

A

Leukotrienes

235
Q

What is a quantitative vs. qualitative hemoglobin disorder?

A

Quantitative is decrased/imbalanced production of normal globin chains Qualitative is production of abnormal globin chains

236
Q

4 downstream consequences of ineffective erythropoiesis in thalassemia

A

Anemia

Bone marrow expansion

Extramedullary hematopoiesis

Increased intestinal iron absorption

237
Q

4 ‘levels’ of alpha thalassemia

A

-1 = silent carrier -2 = Minor - trait state -3 = Intermedia - moderate anemia, needs transfusions sometimes -4 = Major - severe anemia, need transfusions like monthly. Hydrops fetalis.

238
Q

Thalassemia effects on mean corpuscular volume, hemoglobin concentration, red cell distribution width, RBC count, reticulocyte count

A

Decreases MCV

Decreases MCH, MCHC

Uniform RBCs (normal distribution width)

Increased RBC numbers

Increased reticulocyte numbers

239
Q

Peripheral blood smear in thalassemia (3 abnormal findings)

A

Hypochromia Target cells Microcytosis

240
Q

4 types of thalassemia syndromes

A

alpha-thalassemia

beta-thalaseemia

Sickle beta-thalassemia

Hb E syndromes

241
Q

What effect does iron deficiency have on red blood cell numbers, mean corpuscular volume, and red cell distribution width

A

Decreased

Increased

Increased

242
Q

With what other comorbidity is it difficult to diagnose beta-thalassemia

A

Iron deficiency. It makes the hemoglobin ratios look normal.

243
Q

Is RBC sicklin reversible?

A

Yes, at first

244
Q

What is acute chest syndrome in sickle cell disease?

A

A vicious cycle of hypoxia and sickling. Lungs can be fucked up and result in hypoxia due to infection, fat emolism, or pulmonary vasoocclusion

245
Q

What is sickle lung disease?

A

A common comlication of sickle cell anemia

Progressive obliteration of pulmonary vasculature due to chronic inflammation and destruction

Results in pulmonary hypertension, which results in R sided heart failure

246
Q

What is sickle solubility testing?

A

Detects hemoglobin precipitates by looking at cloudiness of a hemoglobin extract of blood

247
Q

What are the 3 antibody fragments?

A

Fc binds antibody receptors (Fab)2 is both Fab regions stuck together Fab binds antigens

248
Q

What is the secondary structure of the immunoglobulin fold?

A

Antiparallel beta sheet wiht disulfide bond holding it together

249
Q

What is antibody valence?

A

Number of antigens an antibody can bind

250
Q

____________ is the most common antibody in the blood

A

IgG

251
Q

The epitope is the part of the antigen that interacts with the ____________ region of the antibody and is a ____________ shape

A

Complementarity-determining Flat

252
Q

What is antibody cross-reactivity?

A

When antibodies bind to different antigens

253
Q

IgG plasma half-life is ____________

A

26 days

254
Q

Which antibody can pass to the fetus?

A

IgG

255
Q

How many J chains are there per antibody complex?

A

Just one

256
Q

How is the IgM pentamer held together

A

4 disulfide bonds, 1 J chain

257
Q

What is IgM’s single 2 weaknesses?

A

Will make blood too viscous Has a hard time getting out of the blood

258
Q

Classical pathway C steps

A

1 4 2 3 5 6 7 8 9

259
Q

How is C1q activated in complement?

A

It binds 2 adjacent Fc ends of bound antibodies

260
Q

What are the 4 consequences of complement?

A

Lysis

Opsoniation - eating of pathogen

Chemotaxis

Anaphylatoxis - release of histamine from mast cells

261
Q

What complement components make up the membrane attack complex?

A

6,7,8,9

262
Q

What happens if an immature B cell is exposed to an antigen it likes?

A

Receptor editing

If this fails, apoptosis triggered

This is because the antigens in the bone marrow are likely to be of self

263
Q

Can a newborn make IgG?

A

No! It starts at 3-6 months

264
Q

What cells express CD4 and what cells express CD8?

A

Helper T - CD4 Killer T - CD8

265
Q

__________ secrete, IL__________ , which recruits neutrophils and monocytes

A

Th17 CD4+ T cells 17

266
Q

IL17 recruits __________ and __________

A

Neutrophils Monocytes

267
Q

__________ secrete, which __________ activates classical pathway macrophages

A

Th1 CD4+ T lymphocytes IFN-gamma

268
Q

__________ secrete __________, __________, and __________, which activates alternative pathway macrophages and eosinophils

A

Th2 CD4+ T lymphocytes IL4, IL5, IL13

269
Q

Mast cells express Ig__________

A

E

270
Q

2 phases of B cell activation

A
  1. Binding of antigen to B cell receptors (membrane-bound versions of the antibody it will eventually secrete)
  2. If the binding is strong enough, activation takes place
271
Q

What is the genetic process by which we get such large B cell diversity?

A

VJD recombination

272
Q

What is somatic hypermutation?

A

B cell clones are hypermutable so daughter cells make slightly different antibodies.

273
Q

What is affinity maturation?

A

Selection of best antigen-fitting B cell mutants after antigenic stimulation allows an incresae of affinity during an immune response

274
Q

What part of the antibody switches in class switching?

A

Heavy chain class (never light chain class)

275
Q

5 reasons B cells are so diverse

A
  1. 2-chain receptors - heavy and light
  2. Recombination of germ-line segments - V, D, and J combinations
  3. K or Gamme light changes
  4. N region diversity - random nucleotides are added or subtracted at VD and DJ hoins
  5. Somatic hypermutation
276
Q

What is hemolysis?

A

An abnormal decrease in red cell survival or increase in turnover

277
Q

What are two mechanisms for red cell destruction?

A

Intravascular - turnover within the vascular space

Extravascular - ingestion and clearance by macrophages

278
Q

What is a structural RBC cause of hemolysis?

A

Hereditary spherocytosis

279
Q

What are two enzyme disorders that causes hemolytic anemia?

A
  1. G6PD deficiency
  • > lack of oxidative protection
  • > oxidant stress
  • > early RBC death
  1. Pyruvake Kinase deficiency
  • > decreased ATP
  • > increased 2,3-DPG
280
Q

2 categories of autoimmune hemolytic anemia

A

Cold and warm

Refer to the temperature at which antibodies bind and activate complement

Cold -> intravascular hemolysis
Warm -> extravascular hemolysis

281
Q

Most red cell turnover occurs in the __________

A

Spleen

282
Q

What treatment is made for hereditary spherocytosis?

A

Splenectomy

283
Q

What type of inherited disorder is G6PD deficiency?

A

X-linked recessive

284
Q

Histological RBC changes in G6PD deficiency

A

Blister cells
Teardrop cells
Heinz bodies

285
Q
A
286
Q

What are the stages of B cell maturation and the antibody production?

A

Pro-B makes mu

Pre-B makes mu and L or K chain, producing cIgM

Immature B makes cIgM and sIgM. The self-reactive check occurs here

Mature B makes sIgM and sIgD

287
Q

When do babies make IgG? IgM?

A

IgG 3-6 months after birth

IgM 3 months after fertilization

288
Q

How are old people’s adaptive immune systems different than young people?

A

More memory cells

Fewer naive cells

So, less flexible and a larger stored library

289
Q

What does haptoglobin do?

A

Haptoglobin scavenges free hemoglobin in the blood

290
Q

How does paroxysmal nocturnal hematuria work?

A

An acquired defect in the myeloid stem cell gets rid of the anchoring protein GPI

Then, MIRL and DAF, which turn off complement are not expressed on the cell surface

In times of acidosis, ALL blood cells are in danger of dying from complement

291
Q

How do you test for paroxysmal nocturnal hematuria?

A

Sucrose test - activates complement

Acidify serum - activates complement

Flow to look for presence of DAF (CD55)

292
Q

What are the two types of immune hemolytic anemia? What characterizes each?

A

Warm
IgG-mediated
Extravascular hemolysis
Spleen eats

Cold
IgM-mediated
Intravascular hemolysis
Activates complement

293
Q

What test is used to diagnose warm autoimmune hemolytic anemia?

A

Coomb’s test, either direct or indirect

294
Q

What is the difference between the direct and indirect Coomb’s test?

A

Direct test confirms the presence of antibody-coated RBCs

The indirect test confirms the presence of anti-RBC antibodies in serum

295
Q

How does microangiopathic hemolytic anemia work?

A

RBCs are sheared as they pass through circulation

Causes:

Microthrombi
Prosthetic heart valces
Aortic stenosis

296
Q

4 causes of microcytic anemia

A

Iron deficiency

Chronic disease

Sideroblastic anemia

Thalassemia

297
Q

What are the causes of iron deficiency anemia in infants, children, adults, and old people?

A

Infants - breast feeding

Children - diet

Adults - peptic ulcer disease (M), menorrhagia or pregnancy (F)

Old people - colon polyps/carcinoma (developed world), hookworm (developing world)

298
Q

What are the 4 stages of iron deficiency anemia?

A
  1. Storage iron is depleted. Ferritin decreases, serum ferritin decreases, TIBC increases
  2. Serum iron is depleted. Serum iron decreases, % iron saturation decreases
  3. Normocytic anemia. RBC count decreased but they look normal
  4. Microcytic, hypochromic anemia
299
Q

What are the lab findings for iron deficiency anemia?

RBC morphology
Ferritin
TIBC
Serum iron
% iron saturation
Free erythrocyte protoporphyrin

A

Microcytic, hypochromic, increased RDW

Decreased ferritin

Increased TIBC

Decreased serum iron

Decreased % saturation

Increased free erythrocyte protoporphyrin

300
Q

What are the lab findings for anemia due to chronic disease?

RBC morphology
Ferritin
TIBC
Serum iron
% iron saturation
Free erythrocyte protoporphyrin

A

Microcytic, though in the early phase, is normocytic

Increased ferritin

Decreased TIBC

Decreased serum iron

Decreased % saturaiton

Increased free erythrocyte protoporphyrin

301
Q

What causes sideroblastic anemia?

A

Defective proroporphyrin synthesis -> low heme

From:

Genetic
Alcoholism
Lead poisoning
B6 deficiency

302
Q

What are the lab findings for sideroblastic anemia?

RBC morphology
Ferritin
TIBC
Serum iron
% iron saturation

A

Microcytosis

Increased ferritin

Decreased TICB

Increased serum iron

Increased % iron saturation

303
Q

What are the following hemoglobin’s chain composition?

HbA
HbA2
HbF
HbH
Hb Barts

A

alpha2, beta2

alpha2, delta2

alpha2, gamma2

beta4

gamma4

304
Q

Causes of macrocytic anemia

A

Folate deficiency

Vitamin B12 deficiency

305
Q

What causes megaloblastic anemia’s characteristic cells?

A

Can’t produce appropriate DNA precursors so rapidly dividing cells become large because they can’t divide

306
Q

How do folate, vitamin B12, and homocysteine do their thing?

A

Folate enters the body and is methylated

Vitamin B12 takes the methyl group so folate can do its DNA shit

Homocystiene takes the methyl group and becomes methionine

307
Q

What are the lab findings for folate deficienty?

RBC morphology
Neutrophil morphology
Serum folate
Serum homocysteine
Methylmalonic acid

A

Macrocytic RBCs

Hypersegmented neutrophils

Decreased serum folate

Increased serum homocysteine

Normal methylmalonic acid

308
Q

What is pernicious anemia?

A

B12 deficiency from

Intrinsic factor deficiency from

Autoimmune destruction of parietal cells

309
Q

What are the lab findings for vitamin B12 deficiency?

RBC morphology
Neutrophil morphology
Spinal cord morphology
Serum B12
Serum homosysteine
Serum methylmalonic acid

A

Macrocytic RBCs

Hypersegmented neutrophils

Subacute combined degeneration of spinal cord

Decreased serum B12

Increased serum homocysteine

Increased methylmalonic acid (destinguishes from folate deficiency)

310
Q

What are the lab findings for extravascular hemolysis?

Spleen
Bilirubin
Gallstones
Marrow

A

Splenomegaly

Jaundice from unconjugated bilirubin

Bilirubin gallstones

Marrow hyperplasia

311
Q

What are the lab findings for intravascular hemolysis?

Hemoglobin
Urine
Serum haptoglobin

A

Hemoglobinemia

Hemoglobinuria, hemosiderinuria (b/c builds up in renal tubular cells)

Decreased serum haptoglobin

312
Q

Where does clonal deletion of T and B cells occur?

A

Where they mature

T cells - thymus

B cells - bone marrow

313
Q

What does haptoglobin do?

A

Binds free hemoglobin

314
Q

What does hepcidin do?

A

Decrease gut iron absorption

Increase macrophage iron sequestration

315
Q

What is MCHC?

A

Mean corpuscular hemoglobin concentration

316
Q

How do you calculate mean corpuscular volume?

A

hematocrit / red blood cell count

317
Q

How do you calculate mean corpuscular hemoglobin concentraiton? (equation)

A

Hemoglobin levels / hematocrit

318
Q

At which step do all complement pathways merge?

A

C3 convertase cleaving and activating C3

319
Q

Which complement derivatives are chemotactic?

A

C3a

C5a (but pick this one if given the option of both)

320
Q

What makes up the membrane attack complex in complement?

A

C5b and C6-9

321
Q

Which 2 complement factors cause mast cell degranulation?

A

C3a

C5a

322
Q

Which complement component acts as an opsonin for phagocytosis?

A

C3b

323
Q

What is anaphylatoxis?

A

Part of complement

Release of histamine from mast cells

324
Q

IL-3 stimulates _________

IL-5 stimulates _________

A

Basophils

Eosinophils

325
Q

_________ stimulates basophils

_________ stimulates eosinophils

A

IL-3

IL-5

326
Q

What does lead poisoning inhibit?

A

Protoporphyrin formation

327
Q

Where is ferroportin located?

A

On the basal surface of intestinal cells. Iron goes out of these cells into the blood

328
Q

What is in the white pulp of the spleen?

A

Lymphocytes

329
Q

What cells are in the sheath that surrounds teh central arteriole of the spleen?

A

T cells

B cells are a little further out

330
Q

Sickle cells is a _______ to _______ substitution

A

Glutamine

Valine

331
Q

CD_______ marks immature T cells

A

1

Winter 2016 (8 decks)

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