Blood Flashcards
1
Q
Three main functions of blood
A
Transport, acid base balance and protection
2
Q
What does blood transport
A
Nutrition, respiratory gases, excretion of wastes, hormone transport, temperature regulation
3
Q
What is the normal pH of blood and what happens when pH changes
A
7.30-7.45
Changes cause protein structure changes
4
Q
What part of the blood is used for protection
A
White blood cells and plasma proteins
5
Q
What is the composition of blood
A
55% plasma, 45% RBCs and <1% WBCs
6
Q
What kinds of fluids does blood contain
A
ECF (plasma) and ICF (fluid inside blood cells)
7
Q
Blood accounts for how much of body mass
A
Around 7% body mass (around 5L)
8
Q
What does normovolemia mean
A
Normal blood volume
9
Q
What does hypovolemia mean
A
Lower blood volume
10
Q
What does hypervolemia mean
A
Higher blood volume
11
Q
What is hematocrit (Ht), what is the formula
A
Percentage of blood volume occupied by RBCs
Height of RBC column / height of whole blood column *100
Normal value = 45%
12
Q
What is the composition of plasma
A
- > 90% water
- Ions: Na+ Cl- mostly (close to saline 0.9% NaCl)
- Nutrients, respiratory gases, wastes (glucose, amino acids, lipids, O2, CO2, urea, lactic acid)
- Proteins (albumins, globulins, fibrinogen)
13
Q
Different methods of separating plasma proteins
A
Differential precipitation by salts
Sedimentation in ultracentrifuge
Immunological characteristics
Electrophoretic mobility ***
14
Q
What is electrophoresis
A
Fractionation method based on movement of charged particles along a voltage gradient
15
Q
What is rate of migration in electrophoresis influenced by
A
The number and distribution of charged and by the molecular weight of each protein (each protein migrates at its own characteristic rate)
16
Q
Which direction do proteins move in in electrophoresis
A
Proteins migrate towards positive pole as proteins are negative
17
Q
Which proteins will move closest to the positive pole and which will move more to negative pole
A
Albumin, alpha 1 and 2, beta, fibrinogen, gamma (positive to negative)
18
Q
What does the size of band refer to in electrophoresis
A
How much of that particular protein is present
19
Q
Why do we use serums in electrophoresis instead of concentrate plasma
A
Much easier to work with, serum is plasma without the clotting factor
20
Q
What is the origin of albumin, fibrinogen, a1, a2, B globulins and gamma globulin plasma proteins
A
Albumin, fibrinogen, a1, a2, b globulins = liver
Gamma globulins = lymphoid tissue
21
Q
What happens to electrophoretic pattern in renal disease
A
Too much permeability, albumin flows out in urine (less albumin on strip)
22
Q
What is the electrophoretic pattern in bacterial infection
A
Lots of antibodies form meaning a peak in gamma globulins
23
Q
What is the major role of plasma proteins and how do they do it
A
Determining the distribution of fluid between the plasma and the ISF compartments by controlling transcapillary dynamics
24
Q
What must there be in order for there to be a net flow of water between ISF and Plasma and why
A
A difference in osmotic pressure because they otherwise have the same characteristics (same mOsm, % NaCl etc)
25
What kind of solutes contribute to the effective osmotic pressure of a solution and why
Non diffusible solutions because diffusible solutions do not contribute because they become equally distributed on both sides of the membrane
26
Can plasma proteins exert an osmotic effect?
Yes because they are non-diffusible
27
What is the effect of non-diffusible solute on osmotic pressure known as
Colloidal osmotic pressure (C.O.P.) of plasma
28
What happens if C.O.P increases in plasma
More water will flow into plasma
29
What happens if C.O.P. D ecreases in plasma
More water will flow into ISF
30
Across the capillary wall is there protein diffusion
No
31
Why do proteins make a major contribution to the C.O.P. Of a solution
There is no protein diffusion across the capillary wall
32
What are the two major forms of fluid transport across the capillary wall
Filtration and osmotic flow
33
What is bulk flow
Flow of molecules subjected to a pressure difference (ex: opening a tap)
34
What is the difference between diffusion and starling forces
D: exchange of nutrients, gases and wastes across the capillary wall
SF: determine the distribution of ECF volume between plasma and ISF
35
What does bulk flow depend on
Hydrostatic pressure difference
36
What is filtration
Bulk flow across a porous membrane which acts as a sieve withholding some particles
37
What are the key mechanisms for transport across capillaries
Filtration: fluid in blood vessel is under pressure, tends to push out fluid from inside the capillaries to ISF
Osmotic flow: plasma proteins tend to pull in to get fluid inside the capillaries
38
What occurs in the capillary bed
Exchanges between plasma and ISF
39
Where does net filtration occur in blood vessels
Arteries
40
Where does net absorption occur in blood vessels
Veins
41
How is net filtration or absorption calculated
Filtration - C.O.P.
42
What moves by simple diffusion
Oxygen, carbon dioxide, nutrients, wastes
43
What are the main capillary exchanges
Simple diffusion and starling’s transcapillary dynamics (filtration and osmotic flow)
44
What do Starling’s Transcapillary dynamics do
Determine the distribution of ECF volume between Plasma and ISF (movement of water)
45
Difference between filtration and osmotic flow
Filtration pushes fluid out of capillaries osmotic flow pulls in fluid to capillaries
46
What happens to the proteins escaped through ISF
They are brought back by the lymphatic system
47
Which is more permeable capillaries or the lymphatic system
Lymphatic system
48
What percentage of fluid is not reabsorbed back into capillaries
10% into lymphatic vessels
49
What does the osmotic pressure of a solution depend on
The number of osmotically active particles / unit volume
50
What does the osmotic pressure of a solution not depend on
Size, configuration, charges
51
What does the protein fraction’s osmotic pressure directly relate to
The protein fraction’s concentration in the plasma
52
What is each protein fraction that exerts an osmotic pressure inversely related to
The molecular weight of that protein
53
What are the factors in transcapillary dynamics
1. Hydrostatic pressure
2. C.O.P.
3. Capillary permeability
4. Lymphatic drainage
54
What is edema
Accumulation of excess fluid in the interstitial spaces
55
What are conditions that lead to edema
1. Increased hydrostatic pressure (high BP)
2. Decreases plasma protein (C.O.P.)
3. Increased capillary permeability
4. Obstruction of lymphatic drainage
56
What does increased hydrostatic pressure mean for net filtration and net absorption
Net absorption is 0 or close to 0 filtration is higher than normal
57
What does decreased C.O.P. do to net filtration and absorption
Net filtration higher net absorption close to 0
58
What is an extreme example of edema due to decreased C.O.P.
Failure to synthesize plasma proteins
59
What are the effects of increased capillary permeability
Normally there is very little protein in ISF. If the capillary wall becomes more permeable, some plasma proteins escape into ISF where they can exert an onconic effect
60
What happens in reduced lymphatic drainage
Leftover proteins accumulate in ISF instead of being drained by lymphatic system
61
What are the roles of plasma proteins
1. Determining the distribution of fluid between the plasma and the ISF compartments by Starling Forces controlling transcapillary dynamics
2. Contribute to viscosity of plasma (which contributes to BP)
3. Contributes to buffering power of plasma (pH)
62
What are the proteins essential for clotting
Fibrinogen and globulins
63
What is the function of y-globulins
Immunoglobulins: provide specific resistance to infection
64
What proteins act as carriers for lipids, minerals and hormones
Albumin and some globulins
65
What is hematopoiesis
All blood cells are derived from a common, multi potential (pluripotential) hematopoietic stem cell (can give rise to multiple different blood cells)
66
What is erythropoiesis
Production of red blood cells
67
What is thrombopoiesis
Production of platelets
68
What is leukopoiesis
Production of white blood cells
69
What are cytokines
Substances which are released by one cell and affect the growth, development and activity of another call
70
What are Hematopoietic Growth factors (HGFs)
Cytokines that influence the proliferation and differentiation of blood cell precursors
71
What is the general pattern of hematopoiesis
Division and differentiation if an inducer and a stimulant
72
What are the sites of hematopoiesis (prenatal)
1. Yolk sack
2. Liver and spleen
3. Bone marrow
73
Where will hematopoiesis occur mainly after birth
Bone marrow (Distal long bones until 25)
74
What is the function of red blood cells
Facilitate transport of respiratory gases (mainly oxygen)
75
Why are RBCs shaped like a biconcave disk
Presence of spectrum, a fibrous protein forming a flexible network linked to cell membrane
76
What is the advantage of the shape of an RBC
Maximal surface area and minimal diffusion distance (increases efficiency of oxygen and carbon dioxide) *fick’s law
High degree of flexibility (Allows red blood cells to squeeze through narrow capillaries)
77
What makes up the CBC (complete blood count)
RBC, WBC, platelet count, hematocrit, Hb concentration
78
What is a cell called when it is normal sized
Normocytic cell
79
What is it called when a cell is smaller than normal
Microcytic
80
What would a cell that is larger than normal be called
Macrocyclic
81
What is a red blood cell that is deflated called
Sickle cell
82
What is a red blood cell called when it is over inflated
Spherocyte
83
What is the relationship between production and destruction of RBCs
Rate of production = rate of destruction
84
What differs RBCs from normal cells
No sub cellular organelles
85
What is the composition of RBCs
Mostly water, then hemoglobin, then lipids, proteins and ions
86
What do RBCs have instead of mitochondria and was is their function
Glycolysis enzymes that generate energy anaerobically
87
What is responsible for the facilitation of CO2 transport in RBCs
Carbonic anhydrase
88
How many oxygen molecules can HB bind at most
4
89
What is HbO2
Hemoglobin combined with oxygen
90
What is deoxyHB
When oxygen is released from Hb
91
What is the structure of hemoglobin
4 protein chains, each chain has a heme region with an iron bound which is where O2 binds (2 alpha chains and 2 beta chains)
92
When does hemoglobin appear bight red
In lungs when Hb becomes saturated with O2
93
When does hemoglobin appear dark red
In tissues O2 dissociates from Hb
94
What is the function of hemoglobin
Transport O2 main source of high O2 solubility
Transport of CO2
Acts as a buffer
95
Why is Hb inside the RBC instead of dissolved in the plasma
1. Plasma viscosity would increase
2. Plasma C.O.P. Increases
3. plasma would be lost via the kidney
96
What are the factors that affect the ability of Hb to bind and release O2
1. Temp
2. Ionic composition
3. pH
4. pCO2 (amount of CO2 dissolved)
5. Intracellular enzyme concentration
97
What are the two stages of RBC production
1. Division and Differentiation (3-5 days)
2. Reticulocyte to RBC (24 hours)
98
What is the process of Red blood cell precursor proliferation (development)
1. Decrease in size
2. Loss of nucleus and organelles
3. Accumulation of Hb
99
What are Reticulocyte
Immature RBCs with ribosomes still left
100
What is the normal Reticulocyte count
Less than 1%
101
What is the Reticulocyte index
Reflects the amount of effective erythropoiesis in the bone marrow
102
What are the factors that determine the amount of RBCs
Oxygen requirements and availability
103
Are there more or less RBCs at a higher altitude
More
104
What is erythropoietin and where is it produced
A glycoprotein hormone/cytokine produced mainly by the kidney
105
What is the stimulus for the release of erythropoietin
Hypoxia (low oxygen)
106
What could cause hypoxia
1. Decreased RBC count
2. Decreased availability of O2 to blood
3. Increase tissue demand for O2
107
What is the function of the kidney in regulation of erythropoiesis
Senses hypoxia and increases the release of erythropoietin in plasma
108
What is the effect of increased erythropoietin in the plasma
Stimulates RBC production in bone marrow which increases RBC production
109
What is the effect on increased RBC production
Increased oxygen in plasma
110
What is the effect of increased oxygen in plasma
Kidney senses increased oxygen and decreases the release of erythropoietin
111
What kind of process is the regulation of erythropoiesis
Negative feedback process
112
What does the regulation of erythropoiesis maintain
Homeostasis
113
What is the process for erythropoietin action
A pluripotent stem cell becomes a committed stem cell (EPO stimulates proliferation)
(EPO accelerates maturation)
Committed stem cell becomes a reticulocyte which becomes a mature RBC
114
What is the effect of testosterone on erythropoietin
1. Increases release of erythropoietin
2. Increases sensitivity of RBC precursors to Erythropoietin
115
What is the effect of estrogen on erythropoietin
1. Decreases release of erythropoietin
2. Decreases sensitivity of RBC precursors to erythropoietin
116
Why do males have more RBCs than females
Because of the effects of testosterone on erythropoietin
117
What is the lifespan of RBCs
120 days
118
What prolongs the RBC lifespan
Nothing
119
How are old RBCs gotten rid of
They are recognized and removed from circulation by highly phagocytize cells (macrophages) (in the liver or spleen)
120
Why is the lifespan so short and final of RBCs
They have no sub cellular structures to replenish itself
121
What is another function of the macrophage aside from engulfing the old RBC
Recycles useful raw materials of RBC into cytoplasm
122
What are the components of RBCs that are recycled by macrophages
Globin, Iron and Hemoglobin
123
What does recycled globin produce
Amino acid pool
124
What does recycled hemoglobin produce
Heme which then produces bilirubin (yellow) which is excreted through the liver and intestinal tract
125
What does recycled iron produce
Transferrin which carries iron the ferritin storage i the liver, spleen and gut
126
What is the function of transferrin
Transport iron to ferritin and the once again from storage to bone marrow to be put back in an RBC
127
What causes jaundice
Excess of bilirubin in plasma
128
What causes excess billirubin in plasma
Excess hemolysis (breakdown of RBC) which produces excess Hb, heme and ultimately bilirubin
Liver damage (no excretion of bilirubin)
Bile duct obstruction (gall stones) which prevents billirubin from exiting the liver and entering the intestinal tract
129
What is polycythemia
Production of RBCs is greater than destruction
130
What is anemia
Production of RBCs is less than destruction
131
How do we measure RBC dynamics
1. Number of RBCs
2. Amount of Hb
3. Hematocrit
132
What is hematocrit
The percentage of blood volume occupied by red blood cells
133
What are potential causes for a higher hematocrit
Polycythemia or dehydration
134
Hat are causes for a lower hematocrit
Anemia or fluid retention in the ISF compartment
135
What is the cause of relative polycythemia
Decreased plasma volume
136
What is the cause of absolute polycythemia
Physiological or pathological
137
What is physiological polycythemia
Secondary effect that occurs due to higher oxygen needs or lower oxygen availability
138
When can physiological polycythemia occur
At high altitude
Increased physical activity
Chronic lung disease
Heavy smoking
139
What is pathological polycythemia and why can it occur
A primary effect that can occur due to tumours of cells producing EPO or unregulated RBC production by bone marrow
140
Why is polycythemia a problem
1. Increases blood viscosity
2. Slow blood flow can lead to blood clots
141
What is anemia
A decrease in the oxygen-carrying capacity of blood
142
What are signs of anemia
Decreased RBC count and decreased Hb content
143
What are the different sizes of anemias
Microcytic, normocytic and macrocytic
(Normocytic is 90-94)
144
What are the different colours of anemias
Normochromic (33% Hb) and hypochromic
145
What are the possible causes of anemias
1. Diminished production of RBCs
2. Ineffective maturation
3. Increased RBC destruction/reduced RBC survival
146
What are the causes of diminished RBC production
1. Abnormality at site of production
2. Inadequate stimulus
3. Inadequate raw materials
147
What is the type of anemia with abnormality at the site of production called and what is its ethology and classification
Aplastic (hypoplastic) anemia
E: unknown, exposure to radiation, chemicals or drugs
C: normocytic or normochromic
148
What is the type of anemia with inadequate stimulus called and what is its ethology and classification
Stimulation failure anemia
E: renal disease (less EPO production)
C: Normocytic, normochromic
149
What is the type of anemia with inadequate raw materials called and what is its ethology and classification
Iron deficiency anemia (most common)
E: increased requirement for Fe or inadequate supply of fe
C: microcytic, hypochromic
150
How much iron is there in the body and where is it primarily located
4g (Hb and stored)
151
Which sex absorbs more iron from the gut
Females (who menstruate) because they lose more blood (twice as much)
152
What is the anemia related to ineffective maturation, what is its etiology and what is its classification
Maturation failure anemia
E: deficiencies of vitamin B12 and folic acid (required for DNA synthesis) an inadequate supply of Fr
C: maccrocytic and normochromic
153
Why could someone have a vitamin B12 deficiency
Failure of absorption
154
Why could someone have a deficiency in folic acid
Absence in diet or overcooking of veggies
155
How does the intrinsic factor work in vitamin B12 absorption
It binds to vitamin B12 and allows it to be carried to the small intestine for absorption rather than be digested in the stomach
156
What does intrinsic factor deficiency lead to
Pernicious anemia
157
What is an anemia of RBC survival disorders and what is its etiology
Hemolytic anemias (may be accompanied by jaundice)
E; congenital or acquired
Acquired by: abnormal RBC membrane structure, enzyme systems and Hb structure)
158
What are the two types of blood loss
External and internal (into tissues)
159
What is the stopping of bleeding called
Hemostasis
160
What is primary hemostasis
Begins within seconds on injury, lasts only minutes and includes vascular and platelet response
161
What is secondary hemostasis
Clot formation, only part that is visible and takes longer
162
What are the steps of hemostasis
1. Vascular injury (1)
2. Vasoconstriction (1)
3. Platelet plug formation (temporary) (1)
4. Blood clot formation (2)
163
How does the vascular response work in hemostasis
Smooth muscle cells in vessel wall respond to injury by contracting and opposed endothelial cells stick together
164
Does the vascular response (vasoconstriction) block blood flow entirely
No
165
What is the platelet response
A platelet plug (white thrombus) is formed that stops blood flow entirely
166
What is the platelet structure
Cell fragments, no nucleus, very small, many granules (factors for vasoconstriction, platelet aggregation, clotting, growth, etc)
167
What is the lifespan of platelets
7-10 days
168
What is the hematopoiesis lineage
A pluripotent hematopoietic stem cell makes lymphoid and myeloid stem cells
Lymphoid makes lymphocyte and myeloid makes everything else including megakaryocyte which makes platelets
169
What is the process of platelet production
1. Pluripotent cell becomes
2. Myeloid cell
3. Thrombopoietin (mostly from liver ) is added to form
4. Megakaryocyte in bone marrow with granules which turn into
5. Platelets in the blood stream
170
What cells make up the vessel wall
Endothelial cells
171
What do endothelial cells contain that prevent things from sticking to the vessel wall
Prostacyclin and nitric oxide (vasodilators)
172
What is the role of collagen in endothelial cells
They are exposed when the vessel wall is damaged which allows for the platelets to stick (binds and activates platelets)
173
What are the steps of platelet plug formation
1. Adhesion
2. Activation and release of cytokines
3. Aggregation
4. Consolidation
174
What compounds are involved in the process of adhesion to aggregation
Von willerbrand factor, TXA2, ADP, serotonin and PF3
175
What is the role of thrombin in platelet plug formation
Important for production of blood clots
176
What do platelet factors do
They are released and attract more platelets
177
What do platelet factors promote
Coagulation scheme
178
What are platelet functions
1. Release vasoconstricting agents / cytokines
2. Form platelet plug (red thrombus)
3. Release clotting factors
4. Participate in clot retraction
5. Promote maintenance of endothelial integrity
179
What is petechia and what is it caused by
Small red dots caused by clearing into the skin due to capillaries and platelets not functioning properly
180
What does abnormal primary hemostasis response lead to
Prolonged bleeding
181
What can cause abnormal primary hemostasis response
1. Failure of blood vessel to constrict
2. Platelet deficiencies
Numerical or functional (congenital or acquired)
182
What is a thrombus
Blood clot
183
What cells are not required in blood clot formation
RBCs and WBCs
184
What is clotting initiated by and what does it result in
Injury to blood vessel wall
Sequential activation and interaction of a group of plasma proteins/clotting factors in the presence of Ca2+ and some phospholipid agents
185
Clot formation is a function of what part of the blood
Plasma
186
What takes longer the intrinsic pathway to extrinsic pathway of clot formation
Intrinsic
187
What is the intrinsic pathway
1. Damage to blood vessel
2. Releases interacting plasma factors plus Ca2+ and PF3 which contributes to the reaction of prothrombinase to
3. Convert prothrombin to thrombin which help with the reaction of
4. Fibrinogen to Fibrin which cross links to form a
5. Blood clot
188
What is the extrinsic pathway
1. Damage to tissue outside vessel
2. Releases interacting plasma factors plus Ca2+ and PF3 which contributes to the reaction of prothrombinase to
3. Convert prothrombin to thrombin which help with the reaction of
4. Fibrinogen to Fibrin which cross links to form a
5. Blood clot
189
Where are small amounts of thrombin generated rapidly and what can they trigger
Extrinsic pathway
Sufficient to trigger strong positive feedback effects to generate large quantities of thrombin in the intrinsic pathway
190
What are the factors in coagulation
Ca2+, phospholipids and protein plasma factors (limiting)
191
How is clotting kept in check
Inhibitors of platelet adhesion
Anticoagulants
192
What are anticoagulants and what do they do
Naturally occurring chemicals that block one or more of the reactions of the coagulation scheme
193
What are congenital clotting factors deficiencies
Single-factor hereditary deficiencies (hemophilia)
194
What are acquired clotting factor deficiencies
Multi-factor deficiencies (liver disease and vitamin k deficiency , vitamin k is a cofactors in synthesis of prothrombin)
195
What does clot retraction required
A contractile protein released by platelets (damaged endothelial cells are sticky, normal ones prevent stickiness)
196
What factors make up the plasminogen activator
Intrinsic Proactivators (endothelial cell factors) and extrinsic proactivators (tissue factors)
197
What is the path from plasminogen to fibrin fragments
Plasminogen
Plasminogen activator which helps make
Plasmin which helps make
Fibrin
Fibrin fragments
198
What does aspirin do
Inhibits platelet adhesion
199
What are the types of anticoagulant drugs and what do they do
Interfere with clot formation
Coumarin: blocks synthesis of functional prothrombin
Heparin: inhibits thrombin activation and action
200
What are the types of thrombocytes drugs and what do they do
Promote clot lysis
Tissue plasminogen activator
Streptokinase
