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Haematology > Blood > Flashcards

Blood Flashcards

1
Q

What is blood?

A

A specialised fluid (Tissue) composed of a variety of cellular components suspended in a liquid known as plasma

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2
Q

How are blood components separated?

A

Centrifugation

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3
Q

What are the 3 layers of centrifuged blood?

A

Plasma - Top
Buffy coat
Erythrocyte layer - Bottom

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4
Q

What is contained in the buffy coat layer of centrifuged blood?

A

Platelets and leukocytes

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5
Q

What is the haematocrit?

A

The percentage of blood that is formed of erythrocytes

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6
Q

What is the average male haematocrit?

A

42

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7
Q

What is the average female haematocrit?

A

38

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8
Q

What is the lifespan of a red blood cell?

A

120 days

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9
Q

What is the lifespan of a neutrophil?

A

7-8 hours

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10
Q

What is the lifespan of a platelet?

A

7-10 days

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11
Q

What is haemopoiesis?

A

The formation of blood cells

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12
Q

What is the process of forming erythrocytes called?

A

Erythropoiesis

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13
Q

What is the process of forming platelets called?

A

Thrombopoiesis

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14
Q

What is the process of forming granulocytes called?

A

Myelopoiesis or granulopoiesis

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15
Q

What is the process of forming lymphocytes called?

A

Lymphopoiesis

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16
Q

What are blasts?

A

Nucleated blood cell precursor cells

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17
Q

What are megakaryocytes?

A

Multi-nucleated platelet precursor cells

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18
Q

What are reticulocytes?

A

Immediate red cell precursor cells

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19
Q

What are myelocytes?

A

Nucleated precursor cells between neutrophils and myeloblasts

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20
Q

What are some definitions of “myeloid”?

A

Bone marrow
Non-lymphoid lineage
Granulocytes and precursor pathways

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21
Q

What is meant by red marrow?

A

Haemopoietically active bone marrow

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22
Q

What is meant by yellow marrow?

A

Fatty, inactive bone marrow

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23
Q

How is yellow marrow effected by age?

A

Percentage of yellow marrow increases with age

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24
Q

What is the myeloid:erythroid ratio?

A

Relationship of neutrophils and precurosrs to proportion of nucleated red cell precursors (Range from 1.5:1 - 3.3:1) - This can change such as in reversal in haemolysis as a compensatory response

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25
Q

What is the first cell in the haemopoietic lineage?

A

Long term haematopoietic stem cells

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26
Q

What are the 2 main progenitor cells in haematopoiesis?

A

Myeloid progenitor cells
Lymphoid progenitor cells

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27
Q

What are the 3 cells arising from myeloid progenitor cells?

A

Megakaryocyte erythroid progenitors
Granulocyte-Monocyte progenitors
Pro-dendritic cells

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28
Q

What 2 cells are formed from megakaryocyte progenitors?

A

Megakaryocytes
Erythrocytes

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29
Q

What 2 cell types are formed from granulocyte-monocyte progenitors?

A

Granulocytes
Macrophages

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30
Q

What precursor cells are formed from the common leukocyte progenitor cells?

A
  • Pro-dendritic cells
  • Pro-T cells
  • Pro-NK cells
  • Pro-B cells
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31
Q

What are the 7 stages of erythropoiesis?

A
  • MEP
  • Pronormoblast
  • Early normoblast (Basophilic)
  • Intermediate normoblast (Polychromatophilic)
  • Late normoblast (Orthochromatic)
  • Reticulocyte (Anucleated)
  • Erythrocyte
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32
Q

What are the 5 main stages of neutrophil production?

A
  • Promyelocyte
  • Myelocyte
  • Metamyelocyte
  • Band cell
  • Neutrophil
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33
Q

Describe the process of thrombopoiesis?

A

When a megakaryocyte divides, the cytoplasm does not, so there are multiple nuclei in a single, very large cytoplasm, the edge of which buds off to form platelets that are released into the bloodstream

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34
Q

How do mature cells leave the bone marrow?

A
  • Formed blood cells can pass through fenestrations in endothelial cells to enter the circulation
  • Release of red cells is associated with sinusoidal dilatation and increased blood flow
  • Neutrophils acyively migrate towards the sinusoid
  • Megakaryocytes extend long branching processes called proplatelets into the sinusoidal blood vessels
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35
Q

What are the main developmental events in haemopoiesis?

A
  • Self-renewal - Form 1 new copy of itself
  • Proliferation - Increase in numbers
  • Differentiation - Commit to a lineage
  • Maturation - Acquire functional properties
  • Apoptosis - Cell death
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36
Q

Where do haematopoietic stem cells originate embryologically?

A

Mesoderm

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37
Q

During what week of development are circulating progenitor cells detectable?

A

Week 5

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38
Q

What is the first site of erythroid activity in development?

A

Yolk sac

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39
Q

In what week of development does erythroid activity in the yolk sac end?

A

Week 10

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40
Q

During what week of development does the liver become haematopoietically active?

A

Week 6

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41
Q

During what week of development does bone marrow become haematopoietically active?

A

Week 16

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42
Q

Where does haematopoeis occur in adults?

A

Axial skeleton, pelvis and proximal long bones

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43
Q

What parts of the body are haematopoietically active at birth?

A

All bones

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44
Q

What are some factors that regulate haematopoiesis?

A

Intrinsic cell properties (E.g. stem cells vs mature)
Signals from immediate surroundings
Specific anatomical area
Erythroid island ‘nurse’ macrophages

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45
Q

What factors regulate erythropoiesis?

A

EPO
Hb

46
Q

What factors regulate neutrophil formation?

A

G-CSF (Granulocyte-colony stimulating factor)

47
Q

What factors regulate development of platelets?

A

Thrombopoietin

48
Q

Where are bone marrow biopsies taken from in adults?

A

Posterior iliac crest of the pelvis

49
Q

Where are bone marrow biopsies taken from in children?

A

Posterior tibia

50
Q

What are some routine examinations performed on blood samples?

A

FBC
Cell indices
Morphology

51
Q

Name the cell

A

Neutrophil

52
Q

Name the cell

A

Monocyte

53
Q

Name the cell

A

Lymphocyte

54
Q

Name the cell

A

Eosinophil

55
Q

Name the formation

A

Platelet clump

56
Q

What is involved in immunophenotyping?

A
  • Identifies patterns of protein (Antigen) expression, unique to a cell lineage, using antibodies in combination specific to these antibodies
  • Lineage specific monoclonal antibodies are added which are marked by a fluorochrome
  • A laser and sensor are then used to detect colour of fluorochromes present (Flow-cytometry)
57
Q

How are bioassays performed?

A

Culture marrow in vitro/in vivo and show a colony of a particular cell type when incubated in different growth conditions

58
Q

What shape are erythrocytes?

A

Bi-concave discs

59
Q

How are erythrocytes adapted to their function?

A

Biconcave disc increases SA
Haemoglobin
Anucleated
Network of flexible cytoskeletal elements allowing them to squeeze through smaller vessels

60
Q

How does the spleen remove ageing red blood cells?

A

With age, their flexibility decreases, preventing them from moving through the small vessels within the spleen and liver, allowing aged cells to be removed as they become trapped

61
Q

Describe the structure of the RBC membrane

A
  • Not just a lipid bilayer, it is a complex structure containing many types of proteins
  • Protein spars (Spectrin proteins) run horizontally beneath the membrane to allow flexibility
  • Protein anchors (Ankyrin) bind these spars to the membrane
62
Q

What are risks of erythrocytes’ high haemoglobin levels?

A

High oncotic pressure, oxidation risk

63
Q

What are risks of erythrocytes having no nucleus?

A

Cant divide, cant replace damaged proteins

64
Q

What are risks of erythrocytes erythrocytes having no mitochondria?

A

Limited to glycolysis for energy generation

65
Q

Describe the structure of haemoglobin

A

4 globular proteins (2a 2ß chains)
Each contains a haem group, porphyrin ring and ferrous Fe2+ group

66
Q

What is ferrous iron?

A

Fe2+

67
Q

What is ferric iron?

A

Fe3+

68
Q

What causes EPO production?

A

Hypoxia, sensed by the kidneys

69
Q

What happens to all components of erythrocytes when they are broken down?

A
  • Globin chains are recycled as amino acids
  • Haem groups are broken down into iron and porphyrin
  • Porphyrin is broken down into bilirubin
  • Fe is then stored (Ferritin or hemosiderin) , added to proteins or released to transferrin (With aid of ceruloplasmin)
70
Q

What is glycoloysis in RBCs?

A

Embden-Meyerhof pathway:
- This is a form of ATP production in which glucose is converted to lactate
- NADH is formed from NAD+ in this process
- NADH acts as an electron donor to prevent oxidation of Fe2+ to Fe3+

71
Q

What is he name given to haemoglobin containing ferric (Fe3+) iron?

A

Methaemoglobin

72
Q

What are reactive oxygen species?

A
  • Reactive oxygen species such as superoxide and hydrogen peroxide are free radicals and have unpaired free electrons
  • This means they are capable of interacting with other molecules such as proteins and DNA, and damaging their structure
73
Q

Describe the formation of reactive oxygen species?

A
  • Oxygen (O2) →
  • Superoxide (O2 ^-) →
  • Hydrogen peroxide (H2O2) →
  • Water (H2O)
74
Q

How do erythrocytes protect against oxidative damage by reactive oxygen species?

A

They contain glutathione

75
Q

How does glutathione protect erythrocytes against reactive oxygen species?

A

Glutathione protects from hydrogen peroxide by reacting with it to form water and an oxidised glutathione product (GSSG)

76
Q

How is glutathione replenished in erythrocytes?

A
  • Glutathione is replenished by NADPH, which in turn is generated by the hexose monophosphate shunt (Glucose-6-Phosphate → 6-Phosphate-Gluconolactone) which skips a number of steps of glycolysis
  • The rate limiting enzyme of this is glucose-6-phosphate dehydrogenase (G6PD)
77
Q

Describe the uptake of CO2 in erythrocytes at the tissue?

A
  • CO2 is taken into the RBCs
  • This is reacted with H2O to form Bicarbonate (H2CO3)
  • This broken down into H+ and HCO3^-
  • H+ reacts with Hb- to form HHb
  • HCO3^- is exchanged with Cl- out of the cell
  • Water moves in with Cl- and so the cell swells
78
Q

Describe the release of CO2 from erythrocytes at the lungs

A
  • HCO3^- is moved into the cell as Cl- is moved out
  • Water moves out and the cell shrinks
  • H+ and HCO3^- react to form bicarbonate (H2CO3)
  • This is then broken down into CO2 and H2O
  • CO2 is then blown off at the lungs
79
Q

What shape does the oxygen dissociation curve form?

A

Sigmoid curve

80
Q

Why does the oxygen dissociation curve form a sigmoid curve?

A
  • When 1 O2 molecule binds to the 1st haem group, it changes the shape, making it easier for the next 2 to bind, the 4th is then harder again to bind
  • In high PO2 environments, haemoglobin will be highly saturated
  • In low PO2 environments, haemoglobin will be around 70% saturated, meaning oxygen is released to the tissues, but there are some reserved
  • Very small changes in PO2 at this point will result in a large change in haemoglobin saturation
81
Q

What factors can cause a Bohr shift to the left (Increased affinity for oxygen)?

A
  • If normal environment is lower PO2 (Foetal haemoglobin, high altitudes))
  • Low pH
  • High 2,3 BPG
  • High temperatures
82
Q

What factors can cause a Bohr shift to the right (Decreased affinity for oxygen)?

A
  • High pH
  • Low 2,3 BPG
  • Low temperature
83
Q

What are platelets?

A

Small cell fragments formed by megakaryocytes

84
Q

How are platelets adapted to their function?

A

Conspicuous granules - Contain coagulation factors

85
Q

Name the cell

A

Neutrophils

86
Q

What are the 2 main classes of leukocyte?

A

Granulocytes
Agranulocytes

87
Q

What are the 3 main types of granulocyte?

A

Neutrophils
Eosinophils
Basophils

88
Q

What are the 2 main types of agranulocyte?

A

Lymphocytes
Monocytes -> Macrophages

89
Q

What is the most common type of leukocyte?

A

Neutrophils

90
Q

What are the features of a neutrophil?

A

The granules they contain stain badly with both acidic and basic dyes, hence the name neutrophil

They have a prominent, multi-lobed nucleus

They can sometimes have a Barr body, an extra appendage of the multi-lobed nucleus, caused by the inactivated X chromosome in a female

91
Q

What are the functions of a neutrophil?

A
  • Phagocytosis
  • Granule release to break down tissue and attract other cells
  • Short lived cells not capable of further division
  • Numbers are increased with body stress
92
Q

What are some causes of neutrophilia?

A
  • Bacterial infection
  • Inflammation
  • Trauma or post-op
  • Corticosteroids (Moves white cells to vessel centre, so more taken in sample)
  • Myeloproliferative neoplasms
93
Q

What are the features of an eosinophil?

A

Eosinophils have a bilobed nucleus

Their granules contain high amounts of hydrolytic enzymes

Their cytoplasm has an affinity for the acidic stain Eosin, hence the name

94
Q

What are the functions of eosinophils?

A
  • Numbers are increased with parasitic infection
  • Involved in hypersensitivity (Allergic) reactions
  • Often elevated in patients with allergic conditions (e.g. asthma, atopic rhinitis)
  • True function may be less apparent (Involved in immune regulation)
95
Q

Name the cell

A

Eosinophil

96
Q

What is the rarest granulocyte?

A

Basophil

97
Q

What are the features of a basophil?

A

Their granules have a high affinity for basic dyes such as methylene blue

They have a bilobed nucleus but this is often obscured by the granules

The granules contain histamine, heparin and other inflammatory mediators

High affinity IgE receptors on their membrane are specific to certain allergens

98
Q

What are the functions of basophils?

A
  • Circulating version of a tissue mast cell
  • Role remains unclear
  • Mediates hypersensitivity reactions IgE-mediated histamine release
99
Q

Name the cell

A

Basophil

100
Q

What are the 3 classes of lymphocyte?

A

B cells
T cells
Natural killer cells

101
Q

Where are lymphocytes formed?

A

Bone marrow

102
Q

Where do T-cells mature?

A

Thymus

103
Q

Where do B-cells mature?

A

Bone marrow

104
Q

What are some causes of lymphocytosis?

A
  • Viral infection
  • Pertussis
  • CLL
105
Q

Name the cell

A

Lymphocyte

106
Q

What are monocytes?

A

Macrophage precursors

107
Q

What are the features of monocytes?

A

They are the largest lymphocytes

They have a non-lobulated horse shoe-shaped nucleus

108
Q

Name the cell

A

Monocyte

109
Q

What percentage of blood is plasma?

A

55%

110
Q

What does plasma contain?

A

Blood plasma contains around 90% water, proteins such as albumin, immunoglobulins and clotting factors, nutrients and salts

Haematology (32 decks)

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