BL 2 Flashcards by Nebuchadnezzer II

Define reticulocyte count + absolute reticulocyte count

Reticulocyte count: % of reticulocytes when 1000 RBCs are counted
- Absolute reticulocyte: %of reticulocyte x RBC count

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What anemias are going to be associated w/ decrease in exercise tolerance?

Any of them, but mainly Iron deficiency, Anemia due to renal dysfunction

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How is hepcidin regulated, and what does it do?

Hecidin is released from hepatic cells during high iron intake or infection/inflammation –> increased accumulation of ferritin –> lower plasma iron

(save it for a rainy day or keep away from bad guys)

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Where does absorption of Iron from diet take place? What form of Fe is it in?

duodenum

Ferric iron arrives at duodenum -> converted to Ferrous iron (via surface reductase) -> gets absorbed as Ferrous ion (via DMT1 transport) then

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Which anemia is associated with sore tongue?

B12 and folate deficiency

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Erythropoietin (EPO) made by what in response to what?

Made by kidney cells in response to hypoxia and promotes erythropoiesis

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Granulopoiesis makes what 3 types of granulocytes? Via what growth factor?

Neutrophils, Eosinophils, Basophils

via G-CSF or GM-CSF

*GM = Granulocyte-monocyte

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IL-5 Promotes production of which granulocytes?

eosinophils

*count fingers

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IL-3 Promotes production of which granulocytes?

basophils

*count fingers

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order of progression of the different precursor and mature cell types in erythroid maturation

HSC -> CFU-GEMM (pluripotent stem cell) -> BFU-E (progenitor) -> CFU- E (progenitor) -> Pronormoblast -> basophilic normoblast -> polychromatophilic normoblast -> orthochromatic normoblast -> reticulocyte -> erythrocyte

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order of progression of the different precursor and mature cell types in granulocytic maturation

HSC > CFU-GEMM > CFU-GM/G > myeloblast > promyelocyte > myelocyte > metamyelocyte > band > granulocyte (basophil, neutrophil, or eosinophil)

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order of progression of the different precursor and mature cell types in monocytic maturation

HSC > CFU-GEMM > CFU-GM/M > Monoblast > Promonocyte > Monocyte > Macrophage

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order of progression of the different precursor and mature cell types in megakaryocytic maturation.

HSC > CFU-GEMM > CFU-Meg > Megakaryoblast > Promegakaryocyte > megakaryocyte > platelet

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When looking at a bone marrow biopsy, what is the normal myeloid:erythroid ratio around?

2:1 - 4:1

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Does BM hyperplasia indicate increased destruction or decreased production?

increased destruction

Growth factors should signal marrow to make more of what is being destroyed

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What would CML and leukemoid rxns indicate in peripheral blood smears?

increased blood neutrophils indicating hyperplasia

Would MCV be high or low in B12/Folate deficiency anemias?

High

deficiency -> impaired DNA synth > cell cannot progress from G2 to M stage. So cell continues to grow w/o division

examples of PMN cells

Neutrophils, basophils, eosinophils

(granulocytes) - cell whos nucleus is lobulated due to granules

What is the opposite of an immunogen?

Toleragen

delivered antigen that does not = immune response AND furthermore prevents immune response to subsequnt exposure to immunogen.

How must the antigenic determinant of an antigen fit the lymphocyte receptor (at hypervariable region) to be activated? (3 things must happen)

Fit must be specific
Nearby receptors simultaneously bound by antigen
Other cell surface molecules costimulated

humoral vs cell mediated immunity

a. Humoral: this is the antibody mediated response,
i. Occurs extracellularly where all the bacteria etc. live.
ii. B lymphocytes are the main cells involved.
iii. B cells transform into plasma cells which secrete antibodies. Cytokines are also released.
iv. Can be transferred by serum.

b. Cell mediated immunity:
i. T lymphocytes become activated → activate macrophages, NK cells, and cytotoxic T lymphocytes.
ii. Cytokines are released when the T cells become activated. Not transferred by serum.

How can malignancies/sepsis result in anemia?

which cytokines are involved?

-Malignancy/sepsis > TNF > ↓ iron store availability > ↓ production of EPO > ↓ Erythropoiesis

–Malignancy/sepsis > INF-β ↓ erythropoiesis

How can chronic infection/inflammation result in anemia?

which cytokines are involved?

IL-1 ↓ iron mobilization -> ↓ production of EPO
IL-6 > high hepcidin
INF-γ -> ↓ erythropoiesis

How can renal insufficiency result in anemia?

↓ EPO made in juxtaglomerular region of kidneys -> ↓RBC production = anemia

Can you get vit B12 from plants? What about folate?

No - B12 (cobalamin) not from plants - meat, eggs, milk Yes - Folate can be from plants - meat, milk, bread, fruits, vegies, fish

Mechanism how B12 is absorbed for use

Food releases B12 in stomach acid → gastic parietal cells secret intrinsic factor IF and binds to B12 → B12 absorbed in terminal ileum → released from IF, binds to transcobalamin binding protein II (TcII) → B12 + TcII are transported to liver for storage or BM for use

Mechanism how folate is absorbed for use

Food w/ folate → absorbed in jejunum → altered (hydrolyzed, reduced, and methylated) → distributed to liver for storage (as methyltetrahydrofolate) + tissue for use → liver undergoes "turnover"

Would you have high or low retic count for B12 and folate deficiency? why?

Low due to impaired erythropoiesis

Would you have high or low retic count for hemolytic anemias?? why?

High Lytic -> so you must compensate. (nothing is stopping you)

Hereditary spherocytosis and thalassemias are considered hemolytic anemias, T or F?

True microcytic, hemolytic

Mneumonic to remember basic shape of hemoglobin O2 dissociation curve:

○ "30-60, 60-90, 40-75" partial pressure - % saturation At partial pressure of 30 mmHg, % saturation = ~60% At partial pressure of 60 mmHg, % saturation = ~90% At partial pressure of 40 mmHg, % saturation = ~75%

What is P50 indicating?

partial pressure of O2 at which O2 carrying protein (Hb) is 50% saturated

at high O2 [ ], does myoglobin have a high or low affinity for O2?

low affinity *notices a lot of O2, not worried about having some

at low O2 [ ], does myoglobin have a high or low affinity for O2?

High affinity * think of chart low affinity = left shift = higher affinity * senses O2 is low and starts getting greedy

At birth what is the % of HbF vs HbA?

65-95% HbF and 20% HbA

How does HbF bind O2 different than HbA?

Binds 2,3-BPG poorly ↑er Bohr effect → favor O2 transfer from maternal→ fetal circulation

Ferrous or Ferric iron in Hb binds to oxygen? What happens if it is ferric?

Ferrous Ferric iron → methemoglobin → decreased O2 binding

Describe humoral immunity: - occur intracellulary or extracellularly? - Which lymphocyte is mainly involved? - Are cytokines released? - Can it be transferred by serum?

Humoral: this is the antibody mediated response, i. Occurs extracellularly where all the bacteria etc. live. ii. B lymphocytes are the main cells involved. iii. B cells transform into plasma cells which secrete antibodies. Cytokines are also released. iv. Can be transferred by serum.

Describe Cell mediated immunity: - occur intracellulary or extracellularly? - Which lymphocyte is mainly involved? - Are cytokines released? - Can it be transferred by serum?

Cell mediated immunity: i. Intracellular ii. T lymphocytes become activated → activate macrophages, NK cells, and cytotoxic T lymphocytes. iii. Cytokines are released when the T cells become activated. iv. Not transferred by serum.