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BDS Stage 1 > Blood > Flashcards

Blood Flashcards

1
Q

Blood makes up what compsotion of ECF ?

A

25%

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2
Q

What are are the 2 componenents of blood ?

A

cellular elements

plasma

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3
Q

What is the difference between ISF and plasma ?

A

plasma contains proteins

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4
Q

What does the plasma contain ?

A 
Gases 
trace elements
organic molecules 
ion 
water
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5
Q

What are the organic molecules that plasma can contain ?

A 
Amino acids 
glucose
proteins 
lipid 
nitrogenous waste
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6
Q

What are the 4 main plasma proteins ?

A

albumins
globulins
fibronogens
transferrin

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7
Q

Where are the plasma proteins produced ?

A

liver

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8
Q

What is albumin ?

A

the most abundant plasma protein
major contributors to colloid osmotic pressure
carriers of various substances

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9
Q

What are globulins ?

A

clotting factors
enzymes
antibodies
carriers

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10
Q

What are fibrinogens ?

A

form fibrin threads that are essential to blood clotting

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11
Q

What is transferrin ?

A

iron transport

globulins from the lymphoid tissue provide globulins

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12
Q

What are the cellular elements of plasma ?

A

erythrocytes
leukocytes
platelets

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13
Q

What do erythrocytes do ?

A

Transport oxygen from the lungs to the tissues

transport carbon dioxide from the tissues to the lungs

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14
Q

What do leukocytes do ?

A

involved in the immune reponse

work in tissues rather than the CS

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15
Q

What are thrombocytes ?

A

They are cell fragments that have split off a megakaryocyte

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16
Q

What are the types of leukocytes

A 
neutrophils 
eosinophils 
basophils 
monocytes 
lymphocytes
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17
Q

What is a haematocrit ?

A

ratio of red blood cells to plasma

expressed as a percentage

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18
Q

How is a haematocrit made ?

A

drawing a blood sample into a capillary tube
placing it into a centrifuge
red blood cells go to the bottom
thin buffy coat in the top - leukocytes

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19
Q

What is the PCV ?

A

total percentage of red blood cells in the total volume of the blood

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20
Q

What can a low PCV indicate ?

A

anaemia
over production of WBCs
blood loss

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21
Q

What can a high PCV indicate ?

A

dehydration

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22
Q

What are the 2 ways of carrying out blood doping ?

A

PCV transfusion where the plasma and buffy coat are removed and only the red blood cells are injected back in
Injections of erythropoietin - stimulate red blood cell synthesis

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23
Q

What can serum be used to test for ?

A

blood type

cholesterol type

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24
Q

How can we obtain a serum sample ?

A

removing the anti coagulant from the blood and the serum separates

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25
Q

What is serum ?

A

clear liquid that can be separated from clotted blood

it lacks cells and clotting factors that are in the plasma

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26
Q

What does the serum contain ?

A

antigens
antibodies
hormones
drugs

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27
Q

What are the properties of plasma ?

A

high specific heat capacity to move metabolised heat and maintain body temperature
over 90% water - transport molecules and materials

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28
Q

What is the most abundant cation in the plasma ?

A

sodium

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29
Q

What is the most abundant anion in the plasma ?

A

chloride

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30
Q

What is hyponatraemia ?

A

salt concentrations are diluted
osmolarity of plasma reduces
fluid will move across the blood brain barrier leading to swelling

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31
Q

What molecules are transported in the plasma ?

A

nutrients - glucose , aminoa acids , lipids and vitamins
waste products - creatinine , billirubin and urea
dissolved gases
Hormones - peptides and steroid hormones

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32
Q

Where is oncotic pressure higher ?

A

in the plasma than the ISF

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33
Q

What is oodema ?

A

obstruction/removal of lymph nodes
proteins move from plasma to ISF less colloid osmotic pressure and less opposition to hydrostatic pressure
excess fluid in the interstitial space.

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34
Q

What does an increase in capillary hydrostatic pressure do ?

A 
increase in venous pressure 
heart failure 
right ventricle fails 
build up of blood that is pushed back into the venous system 
swelling
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35
Q

What does a decrease in plasma protein concentration mean ?

A

due to liver failure
oncotic pressure not maintained
fluid not drawn back

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36
Q

What does an increase in interstitial proteins mean?

A

inflammation
histamine produced
leaky capillaries
proteins move out of plasma

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37
Q

What happens if arterial blood pressure falls ?

A

capillary hydrostatic pressure falls too
increase in fluid absorption
net absorption - maintain blood volume and therefore pressure

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38
Q

What is haemopoiesis ?

A

process by which blood cells and platelets are formed

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39
Q

What an pluripotent haematopoietic stem cells do ?

A

develop into any blood cell type

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40
Q

Where does haemopoiesis occur ?

A

initially in the yolk sac

as the embryo develops blood cell production spreads to liver , spleen and bone bone marrow

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41
Q

What are the remaining regions of active bone marrow as humans age ?

A

pelvis
spine
cranium
ribs

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42
Q

Why is active bone marrow red ?

A

contains haemoglobin

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43
Q

What colour is inactive bone marrow and why ?

A

yellow

adipocytes

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44
Q

What are the 2 lineages blood cells can be produced in ?

A

myeloid line

lymphoid line

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45
Q

What are the 2 classifications of leukocytes ?

A

phagocytes

granulocytes

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46
Q

What do monocytes become in tissues ?

A

macrophages

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47
Q

What can basophils become in tissues ?

A

mast cells

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48
Q

What are the phagocytes ?

A

lymphocytes
monocytes
neutrophils

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49
Q

What are granulocytes ?

A

neutrophils
eosinophils
basophils
however they can have phagocytic properties

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50
Q

Where does an erythroblast loose its nucleus ?

A

bone marrow

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51
Q

What do reticulocytes loose ?

A

their mitochindria

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52
Q

How do megakaryocytes become platelets ?

A

the megakaryocytes loose their protrusions and become platelets

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53
Q

What are the proportions of blood cells made by bone marrow ?

A

25% red blood cells

75% white blood cells

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54
Q

Which cells have the shorter lifespan ?

A

white blood cells

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55
Q

What is the half life of neutrophils ?

A

6 hours

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56
Q

How long can a RBC survive in circulation ?

A

4 months

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57
Q

Which molecules can stimulate haematopoiesis ?

A 
cytokines 
colony stimulating factors 
interleukins 
erythropoietin 
thrombopoietin
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58
Q

What are cytokines ?

A

proteins that are released from a cell and stimulate growth and activity of another cell

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59
Q

What are colony stimulating factors ?

A

they are used in colony forming units

made by endothelial cells and WBCs

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60
Q

What is erythropoietin ?

A

a glycoprotein

controls red blood cell synthesis

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61
Q

What is thrombopoietin ?

A

produced in the liver cells

influences megakaryocytes

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62
Q

What are interleukins ?

A

secreted by WBCs
stimulate production of the same WBC in the immune response
mobilise haematopoietic stem cells

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63
Q

What does eryhtropoietin do ?

A

stimulates red blood cell production
released in times of hypoxia
increases RBCs and therefore haemoglobin allowing more o2 transport

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64
Q

What is released to produce EPO ?

A

HIF-1

a transcription factor

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65
Q

What is differentiation ?

A

the process by which a PHSC becomes increasingly committed to a particular cell type

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66
Q

Which molecules work during erythropoiesis ?

A

EPO IL-3

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67
Q

What is the process by which erythrocytes are formed ?

A

proerythroblast
erythroblast pinches off nucleus
reticuclocytes loose mitochondria (blood)
erythrocytes

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68
Q

What is the rate at which bone marrow generates new RBCs ?

A

2-3 million per second

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69
Q

How do red blood cells die ?

A

they live for 120 days
swell up
rigind and fragile

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70
Q

How are dead RBCs removed ?

A

tight network of vessels in spleen and liver

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71
Q

How is hypoxia detected ?

A

by the peritubular cells of the kidney

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72
Q

What do the peritubular cells do ?

A

release EPO

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73
Q

What does EPO do ?

A

increase stem cell turnover
maturation of RBC precursors
increase rate of RBC release

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74
Q

How long does it take for new RBCs to appear ?

A

1-3 days

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75
Q

What happens if there is excess HPO ?

A

immature red blood cells bind to the HPO

mop up the excess

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76
Q

What is thrombopoietin ?

A

a glycoprotein

regulates growth and maturation of megakaryocytes

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77
Q

Where is thrombopoietin produced ?

A

primarily in the lier and the kidney

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78
Q

How do platelets regulate the amount of TPO ?

A

platelets bind to TPO and destroy the excess TPo in negative feedback

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79
Q

What is leukopoiesis ?

A

stimulation and generation of leukocytes

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80
Q

What do CSFs do to leukocytes ?

A

they stimulate growth of leukocyte colonies

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81
Q

What makes CSFs ?

A

endothelial cells
bone marrow
fibroblasts
WBCs

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82
Q

What are inhibitory factors of leukopoiesis ?

A

hormones
antibiotics
alcohol

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83
Q

What are granulocytes ?

A

contain granules
neutrophils
basophils
eosinophils

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84
Q

Which cells are agranulocytes ?

A

monocytes

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85
Q

In a bacterial infection which cells will be abundant ?

A

WBCs

neutrophils and monocytes as they are phagocytic

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86
Q

In a viral infection which cells will be abundant ?

A

increased lymphocytes as they have memory cells

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87
Q

What is granulopoiesis ?

A

development of granulocytic white blood cells
neutrophils
eosinophils
basophils

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88
Q

What are the stages of granulopoiesis ?

A

myeloblasts
these enlarge and differentiate into
promyelocyte

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89
Q

What are neutrophils ?

A

most abundant leukocyte
granules contain lysozymal enzymes
multilobular nucleus

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90
Q

What are eosinophils ?

A

fight parasites and viruses in allergic reactions

they appear red

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91
Q

What do eosinophilic granules contain ?

A

Major basic protein

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92
Q

Are eosinophilic granules basic or acidic ?

A

basic - stain with Eosin which is acidic

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93
Q

What are basophils and what do they contain ?

A

histamine , heparin and peroxidases

used in allergic reactions

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94
Q

Are basophilic granules acidic or basic ?

A

they are acidic
they stain with haematoxylin dues which are basic
appears blue

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95
Q

What is major basic protein ?

A

predominant constituent of the crystalline core of eosinophilic granules
toxic in bacteria

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96
Q

What are macrophages ?

A

they are formed from monocytes
they are agranulocytes
they have a slightly indented nucleus

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97
Q

Which molecules are involved in monopoiesis ?

A

CSFs

interleukins

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98
Q

What are the steps in monopoiesis ?

A

monoblast
promonocyte (slightly indented nucleus)
mature monocytes
mature monocytes migrate from the bone marrow to the peripheral tissue and become macrophages

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99
Q

What do macrophages do ?

A

phagocytose pathogens and debris

they act as APCs to lymphocytes

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100
Q

How are lymphocytes made ?

A

along thelymphoid line

made from a common lymphoid precursor which can develop into a pro T cell or a pro B cell

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101
Q

How can lymphocytes be identified ?

A

large nuclei

they are agranulocytes

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102
Q

What are CD molecules ?

A

molecules on the surface that are used to differentiate and purify specific cells

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103
Q

How many CD molecules are there ?

A

300

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104
Q

What can antibodies do ?

A

can detect different molecules on WBCs and RBCs

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105
Q

What can uncommitted stem cells do ?

A

differentiate into a range of cells

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106
Q

What are sources of blood cells ?

A

bone marrow
peripheral blood (if cytokines are injected)
umbilical chord blood

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107
Q

Why might a bone marrow transplant be needed ?

A

if an individuals stem cells are effected

must be matched by HLA

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108
Q

What is non hodgkins lymphoma ?

A

cancers that develop in the lymphatic system

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109
Q

What is leukaemia ?

A

cancer of leukocytes and bone marrow

leukocytes replicate in an uncontrolled manner

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110
Q

What are the 2 types of leukaemias ?

A

acute and chronic

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111
Q

What is acute leukaemia ?

A

bone marrow releases masses of immature WBCs

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112
Q

What is chronic leukaemia ?

A

bone marrow releases relatively mature but ineffective WBCs

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113
Q

What can leukaemia affect ?

A

lymphoblastic (lymphoid line)

myelogenous (myeloid line)

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114
Q

What happens to the nucleus when erythroblasts pinch off it in erythropiesis ?

A

it is phagocytosed by phagocytes

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115
Q

What is the shape of erythrocytes ?

A

biconcave disc shape

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116
Q

What does the shape of the erythrocyte allow for ?

A

larger surface area
thin - rapid diffusion of oxygen
flexibility - squeeze through narrow capillaries

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117
Q

How do RBCs get their energy ?

A

ATP from glycolysis (they have no mitochondria)

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118
Q

What is the protein in a RBC ?

A

haemoglobin

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119
Q

What is a molecule of haemoglobin made from ?

A

2 molecules of alpha globin

2 molecules of beta globin

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120
Q

The 2 chains are different sizes , what does this allow for ?

A

they can fit together to make a tetramer

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121
Q

What does oxygen bind to in a haemoglobin molecule ?

A

one of the 4 globin chains

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122
Q

What ave rise to the alpha globin and beta globin families ?

A

a gene duplication

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123
Q

What does foetal Hb contain and why ?

A

gamma globin

higher affinity for oxygen

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124
Q

Why are the alpha and beta globin genes separated ?

A

Beta globin genes are in chromosome 11 chromosome breakage is believed to have separate the genes so that the alpha gene is on chromosome 16

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125
Q

How many haem groups are there per Hb molecule ?

A

4

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126
Q

What is a haem group made of ?

A

carbon-nitrogen-hydrogen porphyrin ring

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127
Q

What do the haem groups attach to in Hb ?

A

each haem group is tightly bound but non covalently bound to one of the 4 lobin chains

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128
Q

What happens to iron after it is ingested from the diet?

A

it binds to transferrin

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129
Q

What happens to excess iron ?

A

it is stored in the liver as ferritin

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130
Q

Where is haemoglobin made ?

A

in the bone marrow

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131
Q

How long does a RBC live for ?

A

120 days

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132
Q

How far does a RBC travel ?

A

1000 km

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133
Q

What happens to old RBCs ?

A

they are destroyed by the spleen and the Hb is converted to bilirubin

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134
Q

What happens to bilrubin ?

A

it is metabolised by the liver and excreted in bile
it is excreted by the kidney in urine
excreted in faeces

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135
Q

What is hyperbilirubinaemia ?

A

too much bilirubin in the blood
babies cannot break down the bilirubin so it builds up in tissues
presents as jaundice

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136
Q

What are the factors that determine Hb ability to carry oxygen ?

A

partial pressure of oxygen

number of free binding sites for oxygen in a RBC

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137
Q

Why is Hb nearly fully saturated in the lungs ?

A

there is a high enough partial pressure

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138
Q

What is the saturation in resting tissue and why ?

A

75 %
in resting tissue there is a high amount of c02 which means a lower Hb affinity for 02
the 02 is released

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139
Q

What happens during exercise ?

A

p02 falls
Hb will release 02
02 is used to generate ATP

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140
Q

What is the bohr effect ?

A

during anaerobic exercise there is a rise in lactic acid levels this reduces the affinity of Hb for O2 and 02 is released

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141
Q

What are the other molecules that Hb can bind to ?

A 
Carbon dioxide 
protons 
carbon monoxide 
nitric oxide 
glucose
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142
Q

Which gas out competes oxygen for binding sites on haemoglobin ?

A

carbon monoxide

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143
Q

What are haemoglobinopathies ?

A

qualitative
mutations in globin genes
globin chains are abnormal

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144
Q

What is an example of a haemoglobinopathy ?

A

sickle cell anaemia

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145
Q

What are thalassaemias ?

A

quantitative
reduced amount/abnromal globin chains
due to defects at the gene expression level

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146
Q

What causes sickle cell anaemia ?

A

a mutation in the gene coding for B globin of Hb

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147
Q

What is the sickle cell trait ?

A

heterozygotes
rarely have symptoms
confers a benefit in that they are resistant to malaria as the parasite cannot hold onto the actin in erythrocytes

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148
Q

What happens to those who are homozygotes ?

A

develop sickle cell anaemia
HbS polymerises at low P02 - long crystals of HbS
crystals are lress soluble and form intracellular precipitates - sickle cell shaped erythrocytes

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149
Q

What is the consequence of having sickle shaped RBCs?

A

fragile and more likely to tear

tangled and blocked in vessels

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150
Q

What is alpha thalassaemia ?

A

production of alpha globin is deficient
excess beta chain production
unsable tetramers

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151
Q

What is beta thalassaemia ?

A

excess alpha chains produced
bind to RBC membranes
damage
toxic aggregates

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152
Q

What is anaemia ?

A

condition that arises from insufficient erythrocytes or insufficient Hb content

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153
Q

What is the main consequence of having anaemia ?

A

there is a reduction in the ability of RBC to oxygenate tissues leading to tissue hypoxia

154
Q

What are the 3 absolute indices

A

MCV
MCH
MCHC

155
Q

What is the MCV ?

A

mean corpuscular volume
average RBC volume
measured in Fl

156
Q

What is MCH ?

A

mean corpuscular Hb content

average amount of Hb per RBC in pg

157
Q

What is MCHC ?

A

mean corpuscular haemoglobin concentration
g/L g/100 ml
average conc of Hb inside a RBC

158
Q

What are some features of anaemia ?

A

headaches
lethargy
shortness of breath
tachycardia

159
Q

How can we classify anaemia ?

A

based on RBC size and Hb content

mode of development

160
Q

If cells have a normal MCH and MCV they are ?

A

normocytic and normochromic

161
Q

If cells are normochromic and normocytic why might someone present signs of anaemia ?

A

acute blood loss
haemolysis
marrow disease

162
Q

if cells have a high MCV they are ?

A

macrocytic

163
Q

Why might someone have macrocytic cells

A

vitamin b12 deficiency

164
Q

If RBCs are small and pale they are ?

A

microcytic and hypochromic

165
Q

What are microcytic and hypochromic cells associated with ?

A

iron deficiency anaemia

166
Q

What are the signs of iron deficiency anaemia ?

A

hypochromic and microcytic RBCs

low MCV and ,MCH

167
Q

How can er classify anaemia based on mode of development ?

A

acute/chronic haemorrhage - iron deficiency anaemia
failure to produce RBC - due to deficiency in the haematinics , marrow disease or leukaemia
Excess destruction - haemolytic anaemia , sickle cell or thalassaemia

168
Q

What does leukaemia mean for the absolute indices ?

A

there is over production of WBC

leading to low PCV

169
Q

What is acute haemorrhage ?

A

less than litre of blood lost

170
Q

What can pumping with intravenous fluid cause ?

A

haemodilution
number of RBC decreases
normocytic and normochromic
blood contains reticulocytes - replace

171
Q

What is a chronic haemorrhage ?

A

occur over time
can be GI related
presents as Fe deficiency

172
Q

What are the haematinics ?

A

the vitamins and minerals needed for normal erythropoiesis
vitamin B12
folate
iron

173
Q

What is ferritin ?

A

excess iron is stored in the liver as ferritin

normal range - 15-400

174
Q

How much iron is in the body ?

A

3-5 g

175
Q

Where is iron in the body found ?

A

75% in Hb in erythrocytes
20% in ferritin in the liver
5% in myoglobin
0.1% transferrin

176
Q

What is myoglobin ?

A

a protein that contains a haem group

carries oxygen to the muscle

177
Q

What is transferrin ?

A

protein that binds to iron and transports it throughout the body to the bone marrow usually

178
Q

How is iron usually lost ?

A

sloughing of epithelial cells

179
Q

How much iron is required to meet the daily requirement ?

A

10-20 mg per day

180
Q

What percentage of iron consumed is absorbed ?

A

10%

181
Q

What are the 2 types of iron in the food ?

A

haem iron and non haem iron

182
Q

What is haem iron ?

A

found only in myoglobin in meat chicken and fish it is rapidly absorbed in the gut

183
Q

What is non haem iron ?

A

found in plants

not easily absorbed by the body

184
Q

What are the inhibitors if iron absorption ?

A

the bind to iron and prevent its absorption

eg, phytates , phosphates , tannins

185
Q

What are promoters of iron absorption ?

A

vitamin C and citric acid

186
Q

What are the 2 valency states of iron ?

A

Fe 2+ and Fe3+

187
Q

What is ferrous haem iron ?

A

Fe 2+

188
Q

What is non haem ferric iron ?

A

Fe3+

189
Q

Which form of iron is absorbed ?

A

ferrous

190
Q

How can Fe3+ be reduced ?

A

vitamin C and citric acid

191
Q

Why might someone have iron malabsorption ?

A

high phytate diet
low Vit.C
citric acid

192
Q

What is the avergae dietary intake of vitamin B12 ?

A

20 miligrams

193
Q

What is the minimum intake of vitamin B12 ?

A

1-2 miligrams per day

194
Q

What are sources of vitamin b12 ?

A

animal produce

marmite

195
Q

How long can vitamin B12 stores last ?

A

several years

196
Q

What is the average dietary intake of Folate ?

A

250 miligrams per day

197
Q

What is the minimum intake of Folate ?

A

150 miligrams per day

198
Q

What are sources of folate ?

A

liver and veg

199
Q

How long do folate stores last ?

A

few months

200
Q

What are folate and vit B12 needed for ?

A

DNA synthesis

201
Q

What happens when vit.B12 and folate are deficient ?

A

ineffective DNA synthesis
delayed nuclear maturation
cytoplasmic maturation continues
cells have a large cytoplasm

202
Q

What are the features of v.12 and folate deficient cells ?

A

asynchronous cells
large cytoplasm
megaloblastic
neutrophils have more lobes

203
Q

What is the pathway of folate ?

A 
folate 
dihydrofolate 
tetrahydrofolate 
5,10 methylene 
5-methyl FH4
204
Q

What does methionine synthase do ?

A

it converts homocysteine into methionine

205
Q

What does M.S require ?

A

vit.B12

to allow folate to be recycled

206
Q

How is homocysteine converted to methionine ?

A

Homocysteine take carbon from 5-methyl FH4 to become methionine

207
Q

What does the 5-methyl FH4 become ?

A

tetrahydrofolate

208
Q

How is folate used in DNA synthesis ?

A

5,10 methylene FH4 donates carbon to dUMP
the 5,10 methylene FH4 becomes dihydrofolate
dUMP becomes dTMP which becomes DNA

209
Q

What happens if there is no vitamin B12 ?

A

MS would not be activated
no recycling of folate from 5 methyl FH4 to tetrahydrofolate
no 5,10 methylene to donate carbon to dUMP

210
Q

What is megaloblastic anaemia ?

A

deficiency in vit.B12 and folate
cells become megaloblastic
reduced survival time of cells
cant transport oxygen as well

211
Q

What are the 2 main problems associated with vitamin B12 deficiency ?

A

megaloblastic anaemia as no recycling of folate

B12 is a coenzyme for fatty acid breakdown - abnormal cell membranes - spinal chord degeneration - neurological symptoms

212
Q

What are the causes of vitamin B12 deficiency ?

A

dietary
GIT disease / surgery
pernicious anaemia
crohns disease

213
Q

Which cells produce IF ?

A

parietal cells that line the wall of the stomach

214
Q

What does IF do ?

A

binds to B12

helps b12 to travel through the tract

215
Q

Where does if bind in the ileum ?

A

IF binds to mucosal cells receptors

allows receptor mediated endocytosis into the blood

216
Q

What are the 2 binding sites on IF ?

A

one for b12

one for the receptor in ileum mucosal cells

217
Q

What is pernicious anaemia ?

A

autoimmune response to IF producing cells
eg. the parietal cells
destroys IF and b12 cant be absorbed

218
Q

What are the symptoms of pernicious anaemia ?

A

macrocytic cells
egg shaped
less biconcave
neutrophils are multilobular

219
Q

Why is serum B12 low in pernicious anaemia ?

A

v12 deficiency means that folate is trapped as 5-methyl FH4

this is extracellular

220
Q

What is the test for pernicious anaemia ?

A

schilling test

221
Q

What isthe first part of the schilling test ?

A 
a does of radioactively labelled B12 
2 hours later large does of IM B12 
this saturates b12 binding sites 
radio labelled b12 should pass in urine 
if less than 15% - malabsorption
222
Q

What is the second test

A

large dose of B12 and IF
large B12 im Injection
more than 15% absorption - pernicious anaemia
less than 15% - ileal disease

223
Q

Why can folate deficinect occur in a few months ?

A

small stones that can degrade over a few month

224
Q

What are the causes of folate deficiency ?

A

decreased intake
increased requirement
malabsorption in GI disease

225
Q

What can marrow disease cause ?

A

failure to produce RBCs

226
Q

What is aplastic anaemia ?

A

bone marrow not functioning
pancytopoenia
die to autoimmune disease or genetic fanconi anaemia

227
Q

What is spherocytosis ?

A

spectrin mutation abnormal RBC membrane

228
Q

What is haemostasis ?

A

the process by which bleeding stops to keep blood within the vessel

229
Q

What are the 3 mechanisms of haemostasis ?

A

vasoconstriction
formation of the platelet plug
blood coagulation to form the thrombus

230
Q

What is vasoconstriction ?

A

applying pressure to an artery or arteriole to limit blood flow and stop bleeding
pressure must be applied to reduce blood flow to allow the creation if the seal
smooth muscle responds to paracrines - constricts reducing blood flow

231
Q

How are thrombocytes formed ?

A

they are formed as the fragments off megakaryocytes

232
Q

What regukates the number of thrombocytes ?

A

thrombopoietin

regulates the number of thrombocytes by a negative feedback loop

233
Q

What destroys thrombocytes ?

A

spleen

234
Q

What is the average lifespan of a thrombocytes ?

A

8-12 days

235
Q

What do thrombocytes contain ?

A

basophilic intracellular granules

236
Q

What initiates platelet adhesion ?

A

exposure to collagen

237
Q

What is released on exposure to collagen and what does it do ?

A

vWF- released by the endothelium to make platelets sticky

238
Q

What allows platelets to bind to collagen ?

A

integrin

239
Q

How are platelets activated ?

A

when they bind to collagen

240
Q

What do activated platelets release ?

A

intracellular granules
serotonin
ADP
platelet activating factor

241
Q

What does serotonin do ?

A

aids in platelet aggregation

242
Q

What does ADP do ?

A

aids in platelet aggregation

243
Q

What does platelet activating factor do ?

A

activates more platelets

released by platelets , neutrophils , monocytes

244
Q

What does release of granules cause and why ?

A

thromboxane 2

this is released from the platelet membrane and increases aggregation and vasoconstriction

245
Q

How is the plug kept local ?

A

endothelium releases platelet activating factor to prevent the platelets binding to normal endothelium
also releases prostacyclin and nitric oxide

246
Q

What is coagulation ?

A

the conversion of the platelet plug into a more stable thrombus

247
Q

what is the overall reaction in coagulation ?

A

the conversion of soluble fibrinogen into insoluble fibrin

248
Q

What is vitamin K needed for and what does it do ?

A

it is needed for the activation of clotting factors and to allow calcium to bind to the clotting proteins

249
Q

What is the intrinsic pathway activated by ?

A

initiated by exposed collagen

this activates factor XII which is already in the blood

250
Q

What initiates the extrinsic pathway ?

A

initiated by damaged tissue exposing thromboplastin (factor III)
this activates factor VII
factor III must be released so this is extrinsic

251
Q

Describe the intrinsic pathway ?

A 
collagen exposure activates factor XII
XIIa activates XI
XIa activates IX
IXa activates X in the common pathway 
vWF activates VIII
252
Q

Describe the extrinsic pathway ?

A

Damages tissue exposes factor III
factor III activates VII
VIIa activates X in the common pathway

253
Q

Describe the common pothway ?

A

factor X is activated by the extrinsic and intrinsic pathways
Xa converts Prothrombin to thrombin via thromboplastin
Thrombin converts soluble fibrinogen into insoluble fibrin
Thrombin activates XIII which converts the insoluble fibrin into cross linked fibrin this is the clot

254
Q

What is required for coagualtion ?

A

vitamin K
calcium ions
phospholipids

255
Q

What does anticoagulation involve ?

A

stopping platelet adhesion
inhibiting the coagulation pathway
stopping fibrin production

256
Q

What releases anticoagulants ?

A

endothelial cells

257
Q

What are the anticoagulants ?

A

protein C
Heparin
Anti thrombin
thrombomodulin

258
Q

What do heparin, anti thrombin and thrombomodulin do?

A

block thrombin

factors IX XI XII and X

259
Q

What does protein C do ?

A

block V and VIII

260
Q

When the clot is no longer required what is it broken down by ?

A

plasmin - a fibrinolytic agent

261
Q

How is plasmin made ?

A

from plasminogen which is found in the clot

262
Q

What catalyses the reaction from plasminogen to plasmin ?

A

thrombin

tissue plasminogen activator

263
Q

Why is fibrinogen also broken down and why ?

A

to prevent it forming fibrin

264
Q

What are the blood indices ?

A

PCV
RBC count
Hb conc

265
Q

What is PCV/haematocrit ?

A

volume percentage of RBC s in blood

266
Q

How is PCV determined ?

A

centrifuging a blood sample into the buffy coat , plasma and packed red blood cells
the volume of red blood cells is divided by the total volume

267
Q

What is a normal PCV ?

A

35-54 %

268
Q

What is red blood cell count ?

A

the number of red blood cells a person has

269
Q

How is RBC count determined ?

A

placing cells in small squares
counting the number of cells
extrapolating this to find the number of blood cells
blood dilution factor

270
Q

What is the unit of RBC count ?

A

million per microlitre

271
Q

What is a normal red blood cell count ?

A
  1. 6-5.9 million per microlitre in males

4. 2-5.4 million per microlitre

272
Q

What is haemoglibin concentration ?

A

average concentration of Hb in a red blood cell

273
Q

How is Hb conc determined ?

A

Drabkins reaent added to blood sample
diluted
spectrometer used to measure the abosrption wavelength
compared to a graph

274
Q

What are the units of haemoglobin conc ?

A

g/L

275
Q

What is a normal Hb conc ?

A

13.5 to 17.5 g/L in males

276
Q

What are the absolute indices ?

A

measurement of the size and Hb content of RBCs they are used in the diagnosis of anaemia
MCH
MCV
MCHC

277
Q

What is MCH ?

A

mean corpuscular haemoglobin

average mass of Hb in a cell

278
Q

How is MCH determined ?

A

mass of Hb per L of blood / number of RBC per L of blood

279
Q

What are the units of MCH ?

A

pg

pico = 10 ^ -12`

280
Q

What is MCHC ?

A

mean corpuscular haemoglobin concentration

average conc of Hb per red blood cell

281
Q

How is MCHC determined ?

A

mass of Hb per 100 ml of blood / PCV in ml per 100 ml of blood

282
Q

What is a normal ,MCH ?

A

27-32 pg

283
Q

What are the units of MCHC ?

A

gg/L or g/100 ml

284
Q

What is the normal range for MCHC ?

A

30-35 g/100 ml

285
Q

What is MCV ?

A

mean corpuscular volume that a red blood occupies

286
Q

How is MCV determined ?

A

volume in litres occupied by a RBC in a L / number of RBC per L

287
Q

What is the unit of MCV ?

A

fl

femto = 10^-15

288
Q

What is the normal MCV ?

A

83-96 fl

289
Q

What are the absolute indices for iron deficienecy anaemia ?

A

MCV will be lower

MCH and MCHC also low

290
Q

What are the absolute indices for Vitamin B112 and folate deficnency ?

A

megaloblastic anaemia - MCV high

MCH high and MCHC high due to lower RBC count

291
Q

What are thromboembolic episodes ?

A

where the thrombus breaks loose and is carried in the blood stream to plug another vessel

292
Q

Why can clots from ?

A

scarring
foreign surfaces
slow blood

293
Q

What are pieces of the thrombus that break off called ?

A

emboli

294
Q

What is deep vein thrombosis ?

A

blood clot usually develops inn a depp leg vein
causes pain and swelling
leads to pulmonary embolism - blood clot breaks off and blocks a vessel in the lung

295
Q

What is disseminated intravascular coagulopathy ?

A

tissue damage leads to factor III release from the extrinsic pathway
this uses up all the molecules in the coagulation pathway
fibrin degradation products are released - bleed to death

296
Q

How can artery blockage by a clot be removed in myocardial infarction ?

A

tissue plasminogen activator

297
Q

How does aspirin work ?

A

prevents platelet plug formation by inhibiting an enzyme in the synthesis of thromboxane A2

298
Q

How does warfarin work ?

A

blocks action of vitamin K - a cofactor needed in the activation of clotting factors

299
Q

When taking a haematocrit why is calcium removed ?

A

it is removed by the chelator to prevent coagulation

300
Q

What does ehlers danlos syndrome mean ?

A

collage disorder - platelet plug cant form as blood is not exposed to collagen

301
Q

What is purpura ?

A

red/purple spots on the skin
a bacteria releases a toxin that that activates clotting factor XII
this causes disseminated intravascular coagulopathy

302
Q

What is thrombocytopenia ?

A

low levels of thrombocytes
below 60 x 10^9 / dl
could be due to bone marrow suppression due to chemotherapy

303
Q

What is thrombocythemia ?

A

excess platelet production

304
Q

What is thrombopathy ?

A

platelets have defective thromboplastin (catalyses prothrombin to thrombin)

305
Q

What is haemophilia ?

A

blood clotting factor is absent or defective

there is a normal vascular and haemostatic response but no clotting

306
Q

What is haemophilia A ?

A

factor VIII deficiency
X-linked recessive
nornal bleeding time
affects intrinsic patway

307
Q

What is haemophilia B ?

A

factor IX deficiency

X-linked recessive

308
Q

What is haemophilia characterised by ?

A

spontaneous bleeding

309
Q

What is von willebrand disease ?

A 
most common inherited disorder 
vWF usually mediates factor
 VIII activation - therefore low levels of VIII 
and makes platelets sticky 
can lead to 
anaemia 
platelet count is normal
310
Q

What is bleeding time ?

A

the time taken for the formation of the platelet plug against a pressure of 40 mm Hg

311
Q

What is the normal bleeding time ?

A

3-8 mins

312
Q

What can bleeding time be used for ?

A

vWF deficiency

thrombocytopenia - needed in the plug

313
Q

Why is calcium removed ?

A

times are independent of calcium (needed in all 3 pathways)

314
Q

What is prothrombin time ?

A

time taken fro the formation of fibrin in a high concentration of thromboplastin on recalcification
effectiveness of extrinsic and common pathway

315
Q

What is normal prothrombin time ?

A

10-14 secs

316
Q

What is thrombin time ?

A

the conversion of fibrinogen to fibrin is catalysed by thrombin . thrombin is added directly to the sample bypassing the extrinsic and intrinsic pathways

317
Q

What is activated partial prothrombin time ?

A

intrinsic and common pathway effectiveness

issues with thrombin and fibrinogen

318
Q

What is normal APPT ?

A

38-45 secs

319
Q

What are the 2 types of immunity ?

A

innate and specific

320
Q

What are the chracteristics of innate immunity ?

A

operates early in the immune response
identical and present in individuals all the time
quality/quantity is constant after exposure
no immunological memory

321
Q

What are the characterisitics of specific acquired (adaptive) immunity ?

A

it is specific to non slef antiens
requires prior exposure
not immediate
immunoligcal memoey for the secondary immune rsponse

322
Q

What are the physical and chemical examples of innate immunity ?

A

keratinised epithelium
mucus
ciliated epithelium
extreme local pH

323
Q

How does mucus work ?

A

highly glycosylated protein
attracts water
stops particles spreading by sticking them together

324
Q

Which phagocytic cells are involved in innate immunity ?

A

neutrophils
eosinophils
monocytes

325
Q

What are the characteristics of neutrophils ?

A

multilobular nuclei
phagocytic
primary response
short lived and rapid turnover

326
Q

What are the characteristics of eosinophils ?

A

granulocyte
allergic responses
larger than erythrocytes

327
Q

What are the characteristics of monocytes ?

A

differentiate from macrophages in the tissues
signal innate and adaptive responses via cytokines n
scavenger cells for phagocytosis

328
Q

why mght opsinisation be required ?

A

not all foreign particles are recognised by the immune system some might need to be antibody coated
this makes the pathogen more attractive to phagocytes

329
Q

Where might opsinisation be important ?

A

in bacteria that have a capsule

330
Q

What is the complement system ?

A

proteins that interact in the blood

the proteins are inactivated and become activated by different pathways

331
Q

What can activated complement proteins do ?

A

carry out opsinisation - facilitating uptake and killing of pathogens
recruitment of inflammatory cells
perforation of the cell membrane can cause lysis

332
Q

What is adaptive immunity mediated by ?

A

lymphocytes

333
Q

What are the 2 types of adaptive immunity ?

A

humoral immunity - involves antibodies from a B cell lineage
Cellular immunity - activated T cells which can be cytotoxic or activate B cells

334
Q

What are dendritic cells ?

A

they can signal for other T cells

they are APCs

335
Q

What are mast cells ?

A

involved in alleries and the immune reponse as they release histmaine

336
Q

How do lymphocytes appear ?

A

large nucleus and small cytoplasm

larger than erythrocytes

337
Q

What are plasma cells ?

A

fully differentiated B cells
secrete antibodies
eccentric nucleus
extensive RER

338
Q

What is an antibody ?

A

aqa secreted immunoglobulin that works in the mucosas , tissue and body fluids

339
Q

WHhat is the structure of antibody ?

A

2 light chains
2 heavy chains
2 antigen binding sites
receptor binding sites

340
Q

What are antibodies involved in ?

A

opsonisation
agglutination
neutralisation
activation of complement

341
Q

What does the activation of complement lead to ?

A

plasma proteins that are activated by pathogens leading to a cascade of different reactions

342
Q

What are monoclonal antibodies ?

A

they are clones of antibodies produced by the same B cell

highly specifc for an individual antigen

343
Q

How can monoclonal antibodies be used therapeutically ?

A

herceptin in the treatment of breast cancer - only used if the HER2 receptor is present
infliximab used in rheumatoid arthritis - works against a TNF

344
Q

What is a key step in adaptive immunity ?

A

presentation of an antigen to a T cell by an antigen presentingg cell

345
Q

What is MHC ?

A

major histocompatibility complex

set of cell surface proteins essential for recognition of the immune system - they are p;aced on APC

346
Q

What does an APC do ?

A

triggers T cells - activate cytotoxic T cells

activate B cells to produce antibodies

347
Q

Which cells acts as APCs ?

A

dendritic cells and macrophages

348
Q

What does it mean if MHC is highly polymorphic ?

A

more than 2 types
many different structures
specific combination is unique to the individual
MHC genes are analysed in tissue matching for transplantation

349
Q

What are memory cells ?

A

long lived cells that are capable of responding to an antigen on its re introduction after initial exposure

350
Q

What does immunological memory mean for the secondary response ?

A

in the secondary response antibody production is quicker and more substantial on the second exposure to the antigen

351
Q

How does gingivitis progress ?

A

inflammation attracts neutrophils which are in large reserves in the bone marrow
neutrophils engulf and kill bacteria
neutrophils try to access bacteria and this leads to destruction of collagen
when they die in large numbers they are degraded by macrophages - swelling

352
Q

What is the biochemical basis for the blood groups ?

A

a complex mixture of glycoproteins and glycolipids that are antigens in the surface of erythrocytes

353
Q

What are the classifications of blood groups ?

A

ABO system

Rhesus factor presence or absence

354
Q

What is the biochemical basis for the ABO systerm

A

ABO antigens are glycoproteins or glycolipids that consist of a ceremide (lipid) which has an oligosaccharide attached to it

355
Q

How are the A/B/O groups characterisd ?

A

different enzymes that alter the glycoprotien in a different way

356
Q

What are the enzymes responsible for modification ?

A

O - inactive glycosytransferase
A- A-Glycosytransferase
B- B- Glycosytransferase

357
Q

What do the enzymes modify ?

A

Glycoprotein H

358
Q

An individual develops blood group

antibodies to which antigens ?

A

the antigens it does not have present on its erythrocytes

359
Q

What do ABO genes exhibit ?

A

co dominance - some alleles are both expressed in the phenotype eg. AB or BO

360
Q

What is self tolerance ?

A

if antigens are already in the RBC surface - antibodies arent produced

361
Q

What does serum contain ?

A

the antibodies to the antigens of blood groups the person doesnt express

362
Q

Which antigens are present on someone of O blood type ?

A

none

363
Q

Which antigens are present on AB ?

A

A and B antigens

364
Q

When does agglutination occur ?

A

if the blood groups arent compatible

365
Q

Which group is the universal donor ?

A

O - no antigens

366
Q

Which group is the universal recipient ?

A

AB - no antibodies

367
Q

What does agglutination lead to ?

A

a haemolytic transfusion reaction
RBC agglutination
intravascular coagulation
RBC lysis - antibodies binfd to RBCs activating complement - leads to anaemia

368
Q

What is the recipient serum tested for ?

A

that there are no other antibodies against other antigens

369
Q

What percentage of caucasians have the D antigen and are Rhesus postive ?>

A

85%

370
Q

What happens in the first pregnancy of a rhesus positive baby and rhesus negative mother ?

A

the presence of the D antigen on foetal erythrocytes initiates the immune response from the mother
this is a primary response - minor destruction of foetal erythrocytes

371
Q

What happens in the second and subsequent pregnancies of a rhesus positive baby and rhesus negative mother ?

A

the mother will initiate the secondary immune response - memory B cells are abundant
major destruction of foetal erythrocytes - babies are anaemic

372
Q

What can be given to overcome haemolytic disease of the new born ?

A

mothers can be given transfusions of antibodies against the rhesus antigen - stops the rhesus antigen on foetal erythrocytes being recognised by the mother immune system

373
Q

What are the 3 modes of developing anaemia ?

A

failure to produce
excess destruction
acute/chronic haemorrhage

374
Q

What is haem iron ?

A

fe 2+

ferrous

375
Q

What are examples of innate immunity ?

A

Ciliated epithelium
Mucosa
keratinised epithelium
localised ph

376
Q

What are the roles of macrophages ?

A

scavenger cells

signal for innate and aquired immunity via cytokines

377
Q

What aer the actions that activated complement can carry out ?

A

opsinisation
perdoration of pathogen cell membranes
recruitement of inflammotry cells

378
Q

What are dendritic cells?

A

signal fro t cell s

APCs

379
Q

What are mast cells ?

A

in allergic reactions
produce histamine
inflammatory response

380
Q

What are the 4 roles of antiibodies ?

A

opsinisation
neutralisation
activaation of complement
agglutination

BDS Stage 1 (39 decks)

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